Interplast Solomon Islands
Saturday 5 April – Thursday 17 April 2008
Report by Rotary Observer Walter van Schie
Honiara: 7 April - 11 April 2008
Gizo: 13 April – 16 April 2008
Team Members
Peter Hayward Surgeon Sydney
Darrell Nam Surgeon Melbourne
David Kinchington Anaesthetist Sydney
Rachael Kearns Nurse Sydney
Robyn Lind Nurse Launceston
Walter van Schie Rotary Observer Hobart
Sarah Rhodes Photographer Sydney (?)
Walter van Schie in theatre in the Solomons
Travel Arrangements
Customs outbound and inbound posed no problems.
The team members from Tasmania flew to Melbourne on the 4th of April and stayed at the Ciloms Airport Lodge to facilitate an early start next morning. At 4.50am Terese Karaan met Darrell Nam, Robyn Lind and Wal van Schie with $120,000 worth of surgical equipment. All baggage, personal and surgical was ticketed direct to Honiara which worked very well. Discussions with airport baggage staff inferred a discounted excess baggage fee would be payable but no excess baggage fee was paid to any airline either outward bound nor inward bound (saving Interplast about $6000). Team members Peter Hayward, David Kinchington and Rachael Kearns from Sydney joined the Melbourne and Tasmanian team members in Brisbane. Sarah joined the team in Honaria on the 8th of April and left on the 12th.
Length of stay
I received advice from Marion Wright that my tenure was restricted to activities in Honiara, that I would fly in on the 5th of April with the team and leave on the 10th. I was pleased that Kevin Shadbolt and Ian Shuey recognized the shortcomings of such a brief stay and took action to have this remedied. I was able to stay with the team for the duration. This proved to be extremely beneficial. I would otherwise not have been able to appreciate contrasts between Honiara and Gizo in terms of culture and environment and importantly; observe and take note of those issues in Gizo relating to human resources, communication, support, equipment, supplies and maintenance and appreciate how the team members were able to counter all these challenges.
Accommodation
Accommodation in Honiara was at the King Solomon Hotel. Accommodation was satisfactory with airconditioning and fans in all rooms. Sometimes there was no hot water in the showers but this was of no great consequence given the warm climate. Service included laundry which sometimes resulted in clothes being returned to the wrong person. Staff members were helpful. Food was good but often very slow in arriving. Accommodation was booked to 17 April instead of to 12 April and no accommodation had been booked at Gizo. The team was able to rectify this quite easily.
Accommodation in Gizo was at the Gizo Hotel. Great welcome with cold drinks. Rooms were satisfactory though hot water in some showers was lacking again. Mosquitoes were omni-present in ground floor units. Food was excellent.
Hospitals
Honiara Hospital was clean and well maintained. The team was met by Gabriel, the surgical practioner. Some 95 people were queued with about 41 with cleft lip/palates hoping to be attended to by the surgeons. Helpful local staff and clinic resulted in prioritizing these persons. On arrival the team was advised only one theatre was available.
Gizo Hospital and its organization was not up to the standard of Honiara Hospital. On arrival at Gizo Hospital only a handful of patients were waiting in clinic for the Interplast team. Gizo staff were not prepared for the team’s arrival. The administrative staff at Honiara had not advised the team’s arrival date to staff at Gizo.
Some equipment in the operating theatre was dysfunctional resulting in frustrating delays for the surgeons.
Gizo Hospital has just one theatre which limited the number of operations that could be undertaken. The theatre seemed stunningly clean but sadly this was due to the little use that was made of it on a day to day basis.
The head doctor made himself known to the team along with the hospital dentist. They both then left the island on the same day.
Recommendations
- Interplast Australia advises both hospitals of arrival dates rather than relying on one to advise the other.
- Interplast contacts the local media in advance so all islanders are aware of the team’s pending visit.
- Local doctor (particularly if head doctor) ensures hospital is set up correctly, to ensure all equipment is operating as it should and is encouraged, in advance, to stay for at least one day after the team’s arrival to provide support for the team.
Operating
In Honaria a number of local nurses were provided to assist, including the provision of scrub nurses. Mary Sirici was a very proficient scrub nurse and Ian Leito proved to be an excellent theatre assistant for Peter Hayward and David Kinchington. At first it seemed that there would be just one theatre made available for the week but persistence by our team doctors and with the support of the local anaesthetist resulted in full use of two theatres for the duration. The support from local staff and the available resources together with the surgical equipment that came with the team resulted in a good environment to allow the surgeons to undertake a steady stream of operations.
In Gizo, the team arrived at theatre at 8.00am on the Monday but were unable to commence operating ‘til 11.15am having to repair the leaking vaporizer. This machine was mandatory for effective anaesthetics but had last been serviced in October 2000. There was very little oxygen available (maybe due to leakage?) and bottles of oxygen had to be procured from the Gizo Dive Shop.
As mentioned above, Gizo Hospital has just one theatre which limited the number of operations that could be undertaken. Nevertheless, while one surgeon used the theatre, the other made full use of the ante-theatre/recovery to undertake minor operations using local anaesthetic.
Performance of the team
The performance of each team member was exemplary. All team members were dedicated to attaining the best possible outcome and worked tirelessly to that end. The doctors, in clinic, showed great empathy to incoming patients where they were forced to make very difficult decisions in some circumstances in relation to non-priority cases.
In surgery, not only did each team member demonstrate great knowledge and expertise, as well as wonderful teamwork, they gave me an enormous amount of feedback and education on the range of procedures. (I feel almost qualified to perform some operations myself!) The team engaged well with the locals showing an insight and empathy into their culture and their modus operandi. In some instances they were required to demonstrate great patience and did so without any events affecting their performance. I felt both humbled and privileged to have been so welcomed as part of the team.
Contact with Rotary
I attended meetings with both the Rotary clubs on the Solomon’s; one at Honiara that attracted around 30 members and another at Gizo which attracted just five. Don’t be mislead though. The output and proactive nature of Gizo Rotary was reflected in the number of programs they were undertaking – from construction of an ablution block for a school to the renovation of another school, the replacement of drinking water facilities in areas affected by last years tsunami and the list goes on. It was my pleasure to become acquainted with both clubs and their presidents. I came back with an assignment from incoming D9600 District Governor Wayne Morris (Rotary Club of Honiara). He asked if I could set in progress a program to have basic equipment such as pencils, pens, and books that were discarded by schools here in Australia, to be sent to the Solomons for the use of children in these financially challenged schools.
Finance
Interplast organized the itinerary and paid for all flights and associated expenses. Members of the team paid for accommodation, meals etc as well as excess baggage (which was waived). These expenses to be reimbursed after the trip on presentation of receipts (and a copy of credit card statements showing monetary exchange rates).
As a member of the Moonah Rotary club, and a member of the Interplast program for my club, I am conscious of the value of each dollar raised for Interplast. I am also naturally frugal (blame my Dutch heritage). I was pleased to note then that spending by team members was constrained to accommodation and the responsible purchase of consumables (meals etc).
High Commission
The team was looking forward to having dinner with the High Commissioner of Solomon Islands at his residence in Honaria. This was set for the evening of Wednesday 16 April. Unfortunately, the flight designated to return the team to Honiara from Gizo was postponed from 4.20pm on the 16th to 7.00am on the 17th and the opportunity was taken from us.
Need for future visits
I was sent as an observer for Rotary. Now I have returned to Tasmania I see my role is to undertake powerpoint presentations to all the clubs in our district, to enlighten them with a view to creating a larger financial base to ensure this program is not just continued, but that more teams can be sent and a greater number of these disadvantaged people may be operated on. In other words, I see an ongoing need for Interplast teams to continue to visit these disadvantaged communities.
The team performed some sixty operations in the short time they were there. Sixty examples of a great gift to these communities. There is not room on these pages to describe each of these sixty operations but I can describe two:
Anu before
Anu after
Anu was an 11 year old girl walking down the street in 2003 when she was struck by a passing car that resulted in her skull being smashed. Her eye socket, five years later was still half way down her cheek. The muscles controlling her eyelid were severed. Even though there was little wrong with the eyeball itself, Anu had no vision from her left eye.
This was a major disfigurement with both physical implications and social repercussions for this young girl. I watched the surgeons reconstruct her face restoring the eye socket to its proper position and then reattach the muscles to her eyelid. A small miracle.
Sammy, a 20 year old forestry worker, fell and inadvertently grabbed the blade of his machete severing three main tendons. Thankfully, the nerves in Sammy’s hands were not severed and the surgeon was able to reattach all tendons using local anaesthetic, sew his hand back up and put a cast on his arm that Sammy will have to wear for four weeks. If he exercises his hand properly over the next twelve months, Sammy will restore normal use to his hand. Sammy was fortunate he cut his hand the week before the team arrived and not the week after.
And finally,
I would like to express my gratitude to the Interplast Committee for selecting me and offering this wonderful opportunity. I would like to thank Marion Wright and Terese Karaan for their role in coordinating everthing for those two important weeks. I would like to express my appreciation to all the medical members of the team for making me feel so welcome as part of the team and for the wonderful education I was given over two short weeks. I’m grateful of course to Kevin Shadbolt and Ian Shuey for their support and their input in ensuring I stayed for the duration of the visit. And of course, a big thank you to President Frank Hill and the members of Moonah Rotary club for having faith in me and supporting me in my quest to be the Rotary Observer in this instance.
Walter van Schie
Rotary Observer and Past President
Moonah Rotary
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