With six teams visiting various sites within Fiji, Orthopaedic Outreach invests significant resources annually into the provision of an orthopaedic surgical service as well as education and training opportunities for training surgeons, perioperative nursing & allied health staff. These teams are primarily focused on assessment and management of orthopaedic trauma and infection, as these areas represent the overwhelming majority of patient presentations throughout Fiji.

Fiji is identified as the surgical training capital of the Pacific, with the Fiji National University (FNU) School of Medicine coordinating the Masters of Surgery program. With the only other established Medical School across the Pacific, being in Papua New Guinea, geography and accessibility dictates where pacific trainees attend. The opportunity provided here is a collection of the future surgeons from around the pacific all training in one site. Orthopaedic Outreach specifically target this group annually, working in liaison with key figures within the FNU to deliver a trauma management workshop. This is structured around adult learning principles of problem-based learning, exploring clinical case studies and practical application of trauma management.

Summary of recent visits

Labasa

Dr Andreas Loefler made two visits to Labasa, Fiji. He was accompanied by Ms Michelle Glynn (DePuy Synthes) in November 2013, and by Ms Angela Grein (Prince of Wales Private Hospital) in May 2014.

Some positive changes were noted during these visits including: a greater awareness of hand hygiene, with gloves and handwash now available in the wards; additional equipment including a CT scanner and an increase in the number of available computers. Unfortunately, poorly prioritised health spending and staff cuts have negatively impacted on staff morale. However, residents and interns still showed a great interest in lectures provided by the Outreach team, which focussed on reinforcing basic principles.

Lautoka

Dr Tanya Burgess accompanied Dr Stuart Myers in June 2014 to Lautoka Hospital, Fiji. The overall impression was that Lautoka Hospital is quite a well-run and effective facility and registrars have excellent textbook knowledge, they have limited opportunity to progress due to a lack of adequately trained staff to guide and supervise and guide them.

Suva

Dr Doron Sher has maintained a regular presence in Suva’s Colonial War Memorial Hospital, having been a regular visitor for Orthopaedic Outreach for many years. Doron has managed to work closely with local surgeons in Suva to build their capacity to assess and treat the increasing number of shoulder and knee injuries, many of which are sports related.

Drs Michael McAuliffe & Peter Brazel continued to make valuable contributions to the support of local Fijian medical staff, visiting both Lautoka and Suva. As has been evident from previous visits to Fiji the predominance of orthopaedic problems centre around trauma particularly those related to road and industrial accidents, complications related to sepsis both primary and hospital acquired and the enormous burden of diabetes and its systemic problems.

Apart from resource limitations, surgery at times remains a cultural challenge in Fiji, with strong influence from village communities for traditional ‘massage’ therapies. These result in mixed outcomes, and combined with late presenting trauma contribute to areas requiring immediate attention.

Education: Suva

Four specialist perioperative nurses supported by Orthopaedic Outreach worked with local Fijian operating theatre nurses providing an educational program based on best clinical practice principles. Topics have a patient safety focus including aseptic technique, management of orthopaedic trauma, airway management and electrosurgery safety.

Following on from the perioperative nurse training, a separate training program on Fracture Management designed for medical staff in the surgical training program. The young surgeons experienced two days of problem-based learning led by Drs Matthew Wilkinson & Ashish Gupta with associated support from Dotdash Australia, providing the opportunity to practice skills in a simulated setting on sawbones.