Fiji Training Program - Labasa
DR. ANDREAS LOEFLER

Labasa is the main town on Vanua Levu, Fiji’s second biggest island. The town is an administrative and trading center and has a population of 25 000 people. The main industry is sugar, with cane fields surrounding the town and the sugar mill dominating its activity. Sugar cane is still harvested by hand. The town's population is mainly Indian but in the rural areas there is a majority of Fijians. This difference is seen throughout Fiji and ownership of land continues to be the major political issue in the country.

Labasa Base Hospital serves the Northern Health Sector or approximately 200 000 people. The hospital has about 120 beds and is presently being expanded by another 40 beds. There are two operating theaters and one additional procedure room with anaesthetic equipment. The hospital is staffed by Fijian doctors who are on rotation and by doctors on contracts from India, the Philippines and other developing countries.

The theaters are equipped with basic orthopaedic instruments, a traction table, an image intensifier and a reasonable selection of sutures and drugs. The orthopaedic equipment is mainly donated and there are gaps in selection of implants and tools. Joint replacement is not available in the public system in Fiji. The hospital has a lab and x-ray facilities, but there is no CT-scan and no nuclear medicine. Patients can be sent to the capital city, Suva, for CT-scans, second opinions and specialized procedures such as spinal surgery.

The theater staff in Labasa have a basic understanding of orthopaedic tools and procedures. Minor trauma including some internal fixation is cared for by general surgeons. Major trauma including fractures of the pelvis and the femur are usually airlifted to Lautoka on the main island where there is an orthopaedic surgeon.

The orthopaedic workload includes much trauma which presents late, acute and chronic infection, post-traumatic arthritis and many patients with diabetic ulcers of the feet. There is presently no prosthetic service for amputees.

The recent visits of Orthopaedic Outreach included nursing staff and a surgeon. The nurses have been teaching both on the wards and in the theater. The surgeon conducted clinics and performed what ever surgery deemed feasible in terms of the equipment and the aftercare. Cases included sequestrectomy for chronic osteomyelitis, fusion of the hip, delayed fixation of fracture dislocations, excision of osteochondromas and fixation of non unions.

The aim of the past and of future visits is to teach the resident medical and nursing staff basic principles of orthopaedics. As some internal fixation of fractures is being performed the staff need to learn more about the use of appropriate equipment and surgery. To a lesser extent, Orthopaedic Outreach is able to support the hospital with some equipment which has been donated by hospitals in Australia. The visits also seem to give the local medical staff some moral support as they work with limited facilities and funds.

PROJECTS

Bali Training
Program

Cook Islands

East Timor Project

West Timor Report

Fiji - Labasa

Fiji - Lautoka

Fiji - Suva

Fiji - Suva and Lautoka

Kiribati

Papua New Guinea

Samoa

Solomon Islands

Tongan Footclub Program - 2007

Tuvalu

Vanuatu