In April this year I was lucky enough to be involved with the Myers Hand Team Orthopaedic Outreach Program at Lautoka Hospital Fiji. Dr Myers and his wife Emilie have been involved with Orthopaedic Outreach and many trips to Fiji since 2005, and have the mammoth logistics of organising supplies, equipment, staff, and patient records down to a fine art. Being the first trip I was involved in, it was difficult to appreciate what to expect – although I knew it was going to be busy and rewarding.
Lautoka is on the west of the island of Vitu Levu and is 24km north of Nadi. Lautoka Hospital services the western half of the Fijian population.
One of the main goals of the trip is to educate and provide support for the local staff with regard to management of orthopaedic hand injuries. This has been the goal since the first trip over ten years ago by Dr Myers and Emilie, and as local staff knowledge, equipment and skills improve, there has been a corresponding improvement in outcomes for patients. The number of revision surgery needed has decreased over this time also.
There were 14 members of the team this year, which included Dr Myers (Hand Surgeon), an Orthopaedic Surgeon, an Orthopaedic Registrar, two anaesthetists, a theatre nurse, an ultrasonographer, hand therapists and orthopaedic physiotherapists, two occupation therapy students and a medical student.
On first arriving at Lautoka Hospital, I was overwhelmed by the traffic jam leaving the hospital, thinking this was more like Sydney rather than what I expected in Fiji. When I asked the taxi driver about it, he commented that there was a big clinic on today and patients were being dropped off early to be seen. At that point, with our clinic due to start later in the morning, I knew that it was going to be a busy week.
The cases that we encountered were as interesting as they were challenging. Being part of the team that provided necessary surgical interventions, post-op care and plan for ongoing therapy for these patients was rewarding. We saw many cases requiring tendon repairs, some cases requiring tendon transfers, and there were many delayed presentations following trauma which required all the skills of the team. Having the opportunity to watch interesting procedures, fabricate post-op casts and splints in theatre was fantastic.
There were many learning opportunities for local staff and the team over the week and I personally learnt a lot from the experience. The grand round provided a clinical backdrop for discussion of pros and cons of different types of management for a variety of orthopaedic cases.
Education of the local staff in the Physiotherapy Department was a combination of formal presentations, practical sessions and informal discussions. I personally had the opportunity of a more formal presentation to the Physiotherapy Department on Flexor Tendon Repair Rehabilitation as well as on Assessment of the Wrist.
We had the opportunity to discuss some of the issues associated with poor outcomes following flexor tendon repairs. We were able to discuss our current understanding of pain, and some persuasive techniques to get patients on-side. I was able to see first hand the reluctance of patients to start their post-operative therapy, and the challenges faced by the local therapists. We discussed some strategies that proved helpful for patients seen throughout the week.
Overall, it was a great week, with long days, opportunities to see unusual cases, and problem solve with a fun, friendly and fantastic team.
I can’t wait to get back to follow up with the patients seen on this trip.
Vinaka, Adrian Jollow
