Monthly Archives

August 2018

By Dr Daniel Kozman

By | DAISI's inaugural visit to Kiribati | No Comments

On the 16th July Dr Harry Lam and his children (Chiara and Lucas) and myself flew to Tawara, the largest island of the Pacific Island nation of Kiribati (pronounced Kiribas). This picture perfect nation sits on the equator and is made up of many small islands. The majority of the 110 000 population live on the main island of Tawara.

The first thing we noticed upon arriving (apart from the mud crabs walking around the arrival terminal) was how many people travel to Kirabati on business.  After collecting our luggage and proceeding through customs, we were pleased to find the hotel shuttle waiting for us (because there are no taxis in Kirabati). After a quick stop to buy SIM cards and recharge cards we headed off to the hospital.

We were warmly greeted by the Permanent Secretary Mrs Kaaro Neeti and the Acting Director of the Hospital Dr Kabari (also the head surgeon).  We underwent a tour of the hospital and were struck by the contrast between how basic the hospital was but how well stocked it was with equipment. Courtesy of the Taiwan Government, the is a 64 slice CT scanner, a state of the art Rehab centre as well as other equipment. However, there is a shortage of several medicines, adequate beds and ward space. None the less, the Doctors and Nurses do a wonderful job in caring for the patients and their families with the limited equipment.

On our four operating days we were welcomed by the nursing staff led by Sister Deny.  Dr Lam showed of some Ultrasound techniques for regional nerve blocks for the several patients undergoing surgery for diabetic foot sepsis. Dr Hilda and Dr Tekeua (registrar and head anaesthetist) were very receptive to these techniques.

There are 2 operating theatres, one clean and one for ‘dirty’   cases. Dr Migel (a surgeon from Cuba) was very welcoming to us and together we treated patients with Diabetic foot sepsis, often performing amputations from forefoot to below knee amputations and draining sepsis. We also operated on infant hernias, hemorrhoids, rectovaginal fistulae from birth injuries and several perianal fistula performing several LIFT procedures. We also performed endoscopy on a young lady with suspected gastric cancer. We performed transanal excision of a large polyp in a 2 year old child.

Dr Lam carried out Echo work shops for the local physicians and this was very useful. The hospital owns a very high quality Echo machine and so workshops on its use are very helpful.

The challenges we faced were firstly patients being reluctant to present for modern medical treatment, opting for traditional medicine till the pathology was quiet advanced. Secondly, we found that there was little preparation for this visit. We were glad to make close and valued friendships with the doctors and nurses and admin staff. We had very productive discussions about future visits including trying to source equipment needed especially laparoscopic equipment with the aim of running laparoscopic workshops in the future.

At the end of our trip we were blessed with new friendships, and look forward to further developing our working relationships in the future. We are extraordinarily grateful for the warm hospitality we were shown by all the nurses and doctors. We were treated to Cuban and Kiribati hospitality and look forward to returning to this island paradise soon.

Author: Dr Danny Kozman is a DAISI member and colorectal surgeon with a particularly interest in teaching laparoscopic surgery.  Dr Kozman has done a number of volunteer trips to the Solomon Islands, with this being his first trip to volunteer in Kiribati.

By Dr Harry Lam

By | Regional Anaesthesia in Kiribati | No Comments

My visit to the republic of Kiribati (pronounce Ki-ri-bas) was a delightful follow-up to my initial involvement with DAISI one year ago to the Solomon Islands.

The republic of Kiribati (population ~120,000) is between Fiji and Hawaii of USA. Basic development indicators for health, education and life expectancy in Kiribati are among the poorest in the Pacific region. Their medical graduates are from Cuba, Fiji or Papua New Guinea.

After an exciting and nervous initial contact with the Director of Hospital services on the first day, it was apparent my visit became a regional anaesthesia workshop for the local anaesthetists and a cardiac ultrasound workshop for the local physicians.

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Dr Harry Lam performs transthoracic ECHO looking for valvular disease. 

Although I had brought a portable echo/ultrasound machine, their hospital was blessed with a nerve block machine donated by another Australian organisation and their echo machine from the Taiwanese team who regularly visits.

Regional anaesthesia workshop – Sonoanatomy of the upper and lower limb (peripheral nerves and plexuses) was demonstrated to the attendees. Needle techniques were practised and learnt by local staff quickly in order to provide complete Anaesthesia for numerous diabetic-related Debridements and multi-level amputations.

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Dr Harry Lam with patient who had lower limb surgery under regional anaesthesia.

Cardiac ultrasound workshop – the combination of rheumatic heart disease and high rates of infectious diseases gave us plenty of opportunity to demonstrate How to perform a comprehensive echocardiogram to assess and grade valvular pathologies and to look for echo signs of infective endocarditis to the local physicians. They do have the ability to then refer these patients out of Kiribati for definitive treatment in India, Fiji or Taiwan.

After more than 10 years of overseas aid work, it still never ceases to amaze me that there are lot more facets of medicine to offer to different parts of underdeveloped countries. We aim to continue this relationship with Kiribati in 12 months time for more transfer of skills including the aim of introducing laparoscopic surgery.

Author: Dr Harry Lam is a DAISI member and cardiac anaesthetist, with a particular interest in the use of ultrasound for cardiac assessment and as an aid for performing regional anaesthesia. Dr Harry Lam has extensive experience working in developing world hospitals, with a number of Nepal and South- Pacific missions to Solomon Islands and Vanuatu.