Monthly Archives

October 2016

By Sepehr Lajevardi

By | Quiet Anaesthetic Achievers | No Comments

Being National Anaesthesia Day, I thought it would be fitting to recognise the incredible contribution made to the Solomon Islands over the years by our volunteering anaesthetists who have been teaching the local doctors safe anaesthetic technique.

The generosity of my anaesthetic colleagues in volunteering their services in the developing world amazes me. The number of times I’ve seen anaesthetists agree to give up their income for a week or more, and venture on a journey self-paid to assist on a surgical mission to a remote part of the Solomon Islands is inspiring. Yet not much is said about these quiet achievers the other side of the “blood-brain-barrier”, with oftentimes the surgical heroics taking the lime-light and crowding out our humbler anaesthetic counterparts.

The anaesthetist is a unique professional possessing many qualities, some more subtly recognised than others. During my training, it has been interesting to see the personality types that various medical professions attract with some very stereotypical observations. As the saying goes “opposites attract”, and this is particularly true for surgeons and anaesthetists. Although things are slowly improving, surgeons have for many years had the reputation as being somewhat authoritarian, and a little gruff or prickly on the exterior, with a no-nonsense approach. Decisiveness and efficiency were viewed as favourable attributes of the surgeon. Anaesthetists, on the other hand, almost as a result of survival and self-selection, are often more considered, pragmatic, adaptable, patient, and gentler sorts, who quietly keep things moving and are often not in the limelight, and frequently get little attention or credit for their contribution. But ask any patient who is more important or what scares them most before an operation, and it’s always the possibility of not waking up from their anaesthetic. The anaesthetist holds their life literally in their hands, and in this regard the  anaesthetist is viewed as very important with the surgeon viewed more or less as the technician.

How important the anaesthetist is to the team was made all the more real during my last surgical visit to Gizo, in the far Western Province of the Solomon Islands, when our anaesthetist did not turn up due to an unexpected death in his family. This missing ingredient to the team represented a major “spanner in the works” to our surgical mission. Working without a anaesthetist is a bit like trying to tie your shoe laces with one hand! And for a few days we were limited to basic surgery only suitable under local anaesthetic infiltration. Needless to say when our anaesthetist turned up three days later we were very grateful and respectful, with no complaints whatsoever!

The developing world also poses unique challenges to the anaesthetist, requiring nimble adaptation and clever resourcing. This is not quite the case for the surgeon where a “knife is a knife”. In the developing world, there are far fewer investigations and drugs available with monitoring and post-operative support far less than that which is standard in Australia & New Zealand.

Performing surgery under regional anaesthesia has a particular application in the developing world, with most ANZCA anaesthetists now trained in the skilful use of epidurals, spinals and regional blocks. This avoids the need for general anaesthesia, and is a safer option in the remote setting where failure to wake promptly from an anaesthetic could be a major concern.

Over the years the contribution that volunteering ANZCA-trained anaesthetists have made in teaching safe anaesthetics to local doctors in the Solomon Islands has been steadily increasing. And it is to this talented and adaptable group of specialists that we are extremely grateful, as at the end of the day they make us surgeons look good.

Dr Sepehr Lajevardi is an advanced plastics surgical trainee at Royal Perth Hospital and elected Treasurer of DAISI. Dr Lejevardi first volunteered at Gizo hospital in December 2015, and has a particular interest in plastic reconstructive surgery. He is always looking for volunteer anaesthetists to accompany him on surgical trips! 

by Gareth Iremonger

By | New Gowns & Scrubs for National Referral Hospital | No Comments

Due to lack of theatre gowns and surgical scrubs National Referral Hospital (NRH) operating theatres in the capital Honiara almost came to a complete stand-still last month, with only life or limb-threatening surgery being performed.
Thanks to Alvin Zheng from (Cabrini Linen, Melbourne), and logistics provided by Barry Barford (Berrima District Rotary), a 20 foot shipping container with 10 pallets of surgical scrubs and 250 new theatre gowns has been successfully packed and sent to Honiara (see photo below).

scrubs-for-solomonsIn addition to over 8 pallets of surgical scrubs, the container also included linen, overalls, warming jackets, and theatre dresses.   It is hoped that this large volume of scrubs and linen will be circulated to each of the hospitals in the Solomon Islands.

Dr Rooney Jagilly is the medical superintendent at National Referral Hospital (NRH), Honiara (above photo second from left) who made the urgent request to DAISI earlier this month for gowns & scrubs, who believes that “surgery will now be allowed to resume at full pace”. “Previously people would bring their own scrubs to hospital which was not ideal because the OR did not have enough. Now we have enough for all so that all the scrubs are managed by the hospital”.
The cost for freighting the container was paid by DAISI and made possible due to a number of generous donations to DAISI.

Make a tax-deductible Donation to DAISI today and Save a Life!

by David Knox

By | Gynae Visit To Gizo | No Comments

Left to Right: Dr Pat Chan, Lalita Fuo, Dr David Knox & Registrar Dr Briley Pinau

It was a somewhat inauspicious start. The FlySolomons plane bringing us from Honiara to Gizo was named Megapode, after an endemic bird that is largely flightless. However the flight was flawless as was the water taxi trip from the airstrip to the town across the beautiful but shallow coral lagoon.
This was our second visit to Gizo so we knew what to expect……the heat and humidity, the idyllic tropical scenery, the friendly people, the bustle of the local market and the red betel nut spit stains on the road. The hospital though is excellent, having been built by the Japanese after the old one was washed away in a tsunami 9 years ago. Importantly the operating theatres are air conditioned.
Women with gynae problems had been notified of our visit and over two hundred had travelled to Gizo from all over the Western Province for consultation and screening for possible surgery. The first day was largely spent reviewing over a hundred of these and selecting the most urgent for surgery. These were mainly large pelvic masses (ovarian tumours and fibroids) requiring Laparotomy and Hysterectomy. Many were severely anaemic as a result of years of heavy bleeding but only one required blood transfusion. As there is no blood bank, a compatible relative was asked to donate.

Left to Right: Dr Pat Chan, Dr David Knox, Dr Leo Lacy & Dr Briley Pinau

We only had 3.5 days operating but did 22 operations, 11 of these were major laparotomies, including 8 total abdominal
hysterectomies. The remainder were mainly cone biopsies for cervical premalignancy. We were ably assisted by 3 local hospital doctors and by Dr Briley Pinau an O&G trainee in Honiara. Dr Leo’s expertise in regional anaesthesia was very valuable and even cases requiring a large midline incision were able to be done safely and effectively under a spinal/epidural block.
Thankfully, as on our previous visit in April 2015, there were no significant postoperative complications and the local doctors have reported that all our patients are recovering well.
Sadly, cervical cancer is a common problem and we had to turn away 4 or 5 young women with advanced, inoperable cancer. There is a huge need for national HPV vaccination and cervical screening programs.
There is also an urgent need at Gizo hospital for an operational CO2 insufflator and CO2 gas bottles to allow laparoscopic procedures as well as a better range of surgical sutures ( in particular 1 Vicryl)
We have been invited to return next year, ideally every 6 months as there are no local gynaecologists visiting the area. It would also be ideal if a local O&G trainee was able to attend as a regular part of their training.



by Dr James Fink

By | Bond Medical Student Rotations to Kirakira Hospital | No Comments

My association with the Solomon Islands begin in 2012 after I took an initial “fact finding” mission to Honiara – asking questions and meeting various people involved with SI Health.  By the end of that visit, I had the idea to create student rotations in a provincial hospital.  The Permanent Secretary of Health at that time, Dr Lester Ross, suggested Kirakira as a site for this because this was a hospital and community that often did not get much attention by medical outreach work.  I presented this idea to the Deans of Medicine at Bond University and they courageously agreed, understanding that when organising a program such as this that we should not let “the perfect” get in the way of “the good”.In January 2013 Bond had their first group of students attend a 4 week rotation at Kirakira Hospital.  These students have been accompanied by mostly clinical staff from the Gold Coast Hospitals who stay for the first one to two weeks of the rotation.  This clinical supervisor serves as both a guide for orientation, as well as a clinical and educational resource for the Kirakira Hospital staff.

james-fink-3When the Australian based clinical staff departs, the student’s supervision is taken on by the local clinical staff.  Because these are final year medical students, we believe their knowledge and experience aids the workforce of the Kirakira hospital.  Feedback has been very positive.

Over 30 medical students per year have attended these rotations to Kirakira since 2013 allowing a presence in the community for most months of the year.  Bond University has also had students from their physiotherapy program, nutrition program and programs associated with the Faculty of Society and Design visit Kirakira.  Numerous health professionals from a variety of disciplines (including medical specialties) have attended as supervisors.  As of September 2016, well over 200 people have visited Kirakira in association with this program.   Relationships with the hospital and community are strong.  The Bond University – Kirakira partnership represents an example of University engagement in Global Health which can serve as a win-win for both parties involved.

Recognising that the health of Makiran’s involves much more than hospital care, and that some of the local wants/needs lie outside a University’s scope, I have established the Strong Island Foundation.  This charitable organisation builds on existing relationships in Kirakira and focuses efforts on health, education and development.     Strong Island Foundation established a nursing exchange and assisted with the local doctors continuing professional development in 2015.  You can see the website for more details (please note, we’re a work in progress):

I am very pleased to be contributing to and hearing about work associated with DAISI.  Global Health efforts often suffer from territorialism, poor communication and duplication.  Strong Island Foundation and the association with DAISI provide an excellent opportunity for collaboration that will allow greater capacity to promote awareness, to treat, educate and train all with the intention of assisting the Solomon Islands Health System.













Dr James Fink (centre) from Bond University with  two of the Kirakira hospital midwives – Smyrna ( left)  and Betty (right).