For our surgeons,  Dr Geoffrey Rosenberg and Dr Mark Ridhalgh, this was the sixth and seventh visit respectively. For anaesthetist, Dr Rod Green, this was his fifth visit. It is also important to note the legacy of the late Dr Ian Stratton who pioneered corrective surgery for children with club feet in Tonga remains in the Tongan Club Foot program. This highly successful program is currently led by Dr Andrew Leicester visiting annually to Nuku’alofa.

For this visit, we were accompanied by an orthopaedic registrar, a theatre sister and we were joined by Graham Hextell, Orthopaedic Outreach Operational Manager, and a team of four nurses from St Vincent’s Hospital, who had been delivering a 4 day short course on ‘Care of the Orthopaedic Patient’ to the nursing and allied health staff.

Because of our continuing visits, we feel that all members of the team have developed a strong rapport with the Tongan medical staff. At all levels, this consists of trust and mutual respect, as well as genuine friendship. Over the years we have seen the orthopaedic development of Dr Kolini Vaea as well as Dr Saia Piukala as competent orthopaedic surgeons. In fact, there is frequent email communication with Kolini to discuss potential cases, particularly their surgical management.

Recently, the hospital received an image intensifier as well as a traction table and this has made an enormous financial as well as logistical difference to Tonga. The skill and ability to treat common injuries such as fractured necks of femur as well as slipped capital femoral epiphyses in children are now available. Previously, these conditions were either treated non-operatively or involved expensive transfers to New Zealand.

Extensive building works have taken place as well and there is now a new outpatients department with excellent facilities. Infrastructure continues to improve in Tonga at a rapid pace. They are in the process of receiving a shipment of new hospital beds as well as new sterilising equipment. A permanent biomedical technician now resides there and his guidance and expertise in maintenance is extremely valued and worthwhile.

The constant in all developing countries is either the late or indeed non-presentation of simple orthopaedic fractures and dislocations. Over the years of our visits, our impression is that the incidence of the above is slowly diminishing. We believe the population is slowly being educated that early presentation to the hospital with relatively uncomplicated injuries is definitely far more desirable than late presentation. Towards the end of this visit we discussed this with the local doctors and they indeed agreed and felt that overall the trend was much improved with more appropriate early presentations. Similarly, it is often difficult to ensure ongoing follow-up. Over the years of our visits, our impression is that the incidence of the above is slowly diminishing. We believe the population is slowly gaining confidence in their own local health system with patients more aware of the importance of follow-up assessments. Towards the end of this visit we discussed this with local doctors and they agreed and felt that overall the trend was much improved with more appropriate early presentations.

To summarise, therefore, we continue to see constant improvement in the ability to treat orthopaedic conditions, both emergency and elective, in Tonga. This is primarily due to the enthusiasm and willingness of all the medical, nursing and allied health staff with whom we work.