Connections continue to strengthen throughout regional centres of Papua New Guinea with increasing opportunities for orthopaedic surgical training becoming available. The long term benefits for local communities in having more experienced and specialised surgeons are significant, and Outreach continues to work with these regional facilities to support them as best possible during these times.

As a consequence of the modular style of specialist training, there is periodically a requirement for local trainees to undertake instructional workshops off-site. In smaller centres with limited local surgeons, there is a potential reduction of local surgical services for the duration of their absences. 

Valuable open communication with Dr Stephen James in his role as Head of Surgery continues to provide a mechanism of success for this program. Frank discussions have been held regarding the future visits and the capacity the ANGAU Hospital has to meet the community demands and needs as a surgical hospital, and while consideration will be given in future for Outreach to provide surgeon coverage during periods of leave, at this point in time, it will continue with the two visits annually. Anaesthetic inclusion has been invited to contribute to the development of local anaesthetic providers, promoting a multidisciplinary approach.

Implant availability continues to place limitations on surgical management of orthopaedic trauma. A dominating proportion of patient admissions result from domestic violence involving bush knives. The injuries sustained include open fractures, nerve and tendon injuries, and significant soft tissue wounds, each with a high risk of wound infection and sepsis. The resources required to treat these patients are actively draining the capacity to care for other surgical patients and shifting local capacity to manage safe surgery.

The teams travelling to Lae and Kokopo during 2018/2019 both relied on Orthopaedic Outreach instrumentation and equipment including donated sutures and implants from Johnson & Johnson Medical, which is conveniently freighted for us by DHL Express.