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daisi inaugural charity ball

by Nili Hali

By | DAISI Inaugural Charity Ball raises money for Kilu 'ufi Hospital | No Comments

The inaugural DAISI Charity Ball was a great success, with 190 guests attending raising more than $25,000 in money towards an ambulance and medical and surgical supplies to be shipped to Kilu’ufi hospital in the Malaita Province of the Solomon Islands.  This equipment is aimed a supporting future DAISI visits to teach laparoscopic surgery at Kilu’ufi hospital with the hospital Medical Director Dr Henry Kako, and the onsite surgeon Dr Micky Olangi and anaesthetist Dr David Danitofea all very keen on the prospects of laparoscopic surgery being available to the poorest province in the Solomon Islands.

The DAISI Charity Ball kicked off with welcome drinks and music by Dr Narko Tutuo (an anaesthetist who himself worked for many years in Malaita Province).  MC’s for the night we Nili Hali and Dr Sepehr Lajevardi.  We were most fortunate to have the attendance of Honorable Permanent Secretary for the Ministry For Health in the Solomon Islands, Dr Tenneth Dalipanda, and Director of Medical Services for National Referral Hospital (NRH) in Honiara, Dr Rooney Jagilly both attending the evening and giving insightful speeches about the challenges facing health care delivery in the Solomon Islands.  Other Speeches include those by DAISI’s outgoing Chair Dr Tim Nicholson, DAISI founder and Secretary Dr Gary McKay, gynaecologist a/Prof Norman Blumenthal and hepatobiliary surgeon Prof Charbel Sandroussi.  The evening was a wonderful melting pot including a number of members of charities providing exceptional volunteer services in the Solomon Islands including the Program Manager Helen Carter from the John James Foundation, Mr Ian Hoskings, founder of The Solomon Foundation, and Dr Tony Clark from the Australia & New Zealand Gastro-Intestinal Training Association (ANZGITA).

The three course meal was followed by a raffle that included a holiday to Thailand, with $10,000 raised from this alone. Music by the Pacific Island band Manutabu was an instant success with many dancing the night away.  The evening concluded with the announcement of the newly elective DAISI officer bearers, Dr Sepehr Lajevardi (Chait), Dr Daniel Jozman (Vice Chaur), Dr Gary McKay (Secretary) and Dr Eric Yip (Treasuer), and a special thanks to outgoing Chair Dr Tim Nicholson.

Finally, the success of this evening would not have been possible without our wonderful sponsors, including Olympus, who have provided three laparoscopic stacks and associated equipment over the past two years.  Without these, DAISI’s success in teaching laparoscopic surgery in the Solomon Islands would have not been possible. Other sponsors include Westmead Private Hospital, Horten Medical, Doctor’s Health Fund, St Leonard’s KwikKopy, the Solomon Foundation and the John James Foundation.

For a full listing of photos from the night please visit “daisi charity ball photos

Dr Sepehr Lajevardi and Nili Hali

DAISI Charity ball MCs Dr Sepehr Lajevardi (newly elected Chair), and Nili Hali.

 

welcome speech by tim nicholson

Outgoing Chair Dr Tim Nicholson, giving welcome speech.

 

Honorable Permanent Secretary for Health for Solomon Islands Dr Tenneth Dalipanda

Honorable Permanent Secretary for Health for Solomon Islands Dr Tenneth Dalipanda

ian hosking founder the Solomon Foundation

The Solomon Foundation founder Ian Hosking, with DAISI member Dr Aruna Shivam.

 

Dr Gary McKay - Founder DAISI giving speech

DAISI Founder Dr Gary McKay giving speech on “Lessons Learnt” during DAISI’s previous two years.

 

Dr Rooney Jagilly

Dr Rooney Jagilly, Director of Medical Services, National Referral Hospital (NRH), Honiara giving speech.

 

Manutabu band and dancers

Dancing the night away to music by the Pacific Island Manutabu band.

sir trevor garland

Sir Trevor Garland,  Consul General for the Australian High Commission in the Solomon Islands since 1994 & coordinator of the Solomon Islands St Vincent’s tertiary patients referral program, discussing challenges faced by NGOs at the 2017 DAISI charity ball.

 

Narko Tutuo playing welcome music

Welcome music by Dr Narko Tutuo.

 

Ryde doctors

Dr Sunny Misir, James Nugent, and Dr Logan Kanagaratnam from Ryde Hospital, attending the DAISI Charity Ball.

 

Prof Norman Blumenthal

DAISI member a/Prof Norman Blumenthal, Gynaecologist from Notra Dame discussing medical issues faced by women and children in the Solomon Islands.

 

Manutabu band

The Pacific Islands Manutabu band entertaining

Prof Charbel Sandrousi

DAISI member Prof Charbel Sandroussi giving speech on laparoscopic surgery project in the Solomon Islands.

westmead private hospital staff

Westmead Private Hospital staff attending the 2017 DAISI Charity Ball.

 

Mark Muhlmann and Norman Blumenthal

DAISI members Dr Mark Muhlmann, Dr Gary McKay & a/Prof Norman Blumenthal.

Dr Erik Fuentes

Jovana Kuljaca and Breast surgeon Dr Erik Fuentes.

Dr Pavi Pasupathy and Julie Crawford

ENT Surgeon Dr Julie Crawford, and anaesthetist Dr Pavi Pusapathy.

medical students Graeme Wertheimer and Ariah Steel

Notra Dame medical students Graeme Wertheimer and Ariah Steel.

Dr Scott Siotta

by Dr Sepehr Lajevardi – Treasurer DAISI

By | A stitch in time saves nine. | No Comments

National Referral Hospital Surgical Outreach Team (NRHSOT) surgeon Dr Scott Siota doing key hole surgery through small incisions with DAISI volunteer surgeon Prof Charbel Sandroussi. 

We’ve all heard it said that prevention is better than cure.  When it comes to good health, there is no substitute for a healthy diet and lifestyle.  Many diseases and cancers can be prevented by simple measures such as increasing dietary nutrition, avoiding obesity regular exercise and refraining from certain known carcinogens found in cigarettes, alcohol and beetle nut.   Sometimes, despite this, disease or cancer still occurs.  This is when early detection and treatment is vitally important. The fifty plus age group represent a population most at risk for cardiac and diabetic disease and many cancers. Cancers, if diagnosed early, can be removed far more easily and successfully that if diagnosed late and hence the phrase “a stitch in time saves nine”.   Self-performed breast examination once a month can easily pick up a new small breast lump that can be removed surgically before it spreads.  Bowel cancer may present in its early stages with streaks of blood within the stool, or even a change in bowel habit and sudden constipation.  Colonoscopy is a quick, non invasive procedure that can diagnose bowel cancer early allowing surgical treatment alone to cure this disease.  This is available at both National Referral Hospital (NRH) and Gizo hospital. Thyroid cancer and head and neck cancer, particularly oral and lip cancer, is common in the Solomon Islands, and is first noticed by a small ulcer or lump that doesn’t heal or disappear over time.

Over the past 100 years, medical aid in the Solomon Islands has largely been reactionary, treating disease once it occurs.  It is only in the last 20 years that significant strategies in preventative medicine have been made.  Infectious diseases such as malaria, dengue fever and tuberculosis are less common than twenty years ago, but still remain a challenge, with significant medical funding currently tackling these in a preventative manner.  Medical service delivery has also, for most of the past century, been mismatched with a focus on tertiary hospital care rather than preventative medicine or early detection of disease. More than 80% of doctors are in the capital Honiara and only 20% of doctors are in rural provincial hospitals, where the need is the greatest, with these hospitals covering over 85% of the population.

The ministry of health’s ambitious policy of universal health coverage known as the Role Delineation Policy (RDP) will bring better health coverage to the majority of the population who are deprived of care that is available only in urban centres. The RDP defines what level of facility, human resources and services will be provided at different levels of care, from community health centres to rural health centres, to area health centres to provincial hospitals. The policy proposes that larger area health centres will have a resident medical doctor and dentist with imaging, laboratory and procedural facilities. The idea once fully implemented in a few years will revolutionise health care service provision to the rural population, and will see a reduction in the late presentation of disease being referred to Honiara.

Currently, specialist surgeons and gynaecologists from Honiara’s National Referral Hospital Surgical Outreach Team (NRHSOT) are visiting provincial health centres to provide screening and surgery to these remote centres. This not only provides service delivery where it is most required, but represents major cost savings in avoiding unnecessary transfer of patients to Honiara for their surgery or treatment.   Over the past year, over 400 operations have been performed by NRHSOT visits to remote provincial hospitals including Gizo, Kilu ‘ufi, Kirakira and Munda.  These teams are led by senior specialist surgeons from Honiara, and often supported by volunteer specialists from abroad, providing highly sophisticated specialist surgery.  In the last year, Gizo hospital and National Referral Hospital (NRH) have been offering key hole (laparoscopic) surgery, and endoscopy (gastroscopy and colonoscopy) for early disease and cancer.  These minimally invasive procedures can avoid the need for a large operation or incision. However getting the message to the community is often the hardest challenge to the success of these fly-in fly-out missions, with screening of suitable patients for surgery usually conducted the first day of a one week visit.  With greater awareness by the community of when these visits are scheduled to happen, it is hoped that all in the community can benefit from these NRHSOT visits.

Screening for surgical cases (thyroid, breast lumps, hernia, colorectal conditions, early symptoms of bowel cancer such as blood mixed in stool) will occur at Gizo hospital from 10am – 2pm on Monday 25th September, and Tuesday 27th February. Screening will occur at from 10am-2pm on Thursday 8th November at Kirakira hospital. Surgery and screening colonoscopy and gastroscopy will then be conducted that same visit with visits usually one week in duration.

 

Dr Sepehr Lajevardi is Treasuer of DAISI, and is a plastic surgery registrar who has participated in a number of visits to Gizo hospital over the past three years.

daisi ball

DAISI charity ball, Fri 3 Nov 2017 6:30-11pm Novotel, Manly

By | DAISI Charity Ball 3 Nov 2017 | No Comments

DAISI Annual charity ball will be held at the Grand Ballroom, Novotel 55 N Steyne, Manly, with cocktails served 6:30-7pm, and 3 course meal in the Grand Ballroom from 7-11pm.

Tickets are $175 per person, with tables seating 8-10 people per table.

Please RSVP by 30th Oct 2017 to: staff@daisi.com.au.

All money raised will go towards sending an ambulance and shipping container of surgical & medical supplies to Kilu ‘ufi Hospital, Malaita Province.

DAISI is a registered with the ATO as a tax deductible & DRG charity (ID: 51 769 931 239)

registrars using applied laparoscopic simulator

by Dr Sepehr Lajevardi – Treasurer DAISI

By | Laparoscopic surgery takes off in Solomon Islands | No Comments

Image: Surgical Registrar Dr Clay Siosi and other surgical registrars practicing laparoscopic surgery on the Applied® simulator at National Referral Hospital (NRH) Laparoscopic Workshop in Honiara, January 2017.

 

National Referral Hospital (NRH), the main referral hospital for the Solomon Islands, located in the country’s capital city Honiara, performed its first laparoscopic (key-hole) surgery in January 2017.

Although more than fifty years since laparoscopic surgery first began worldwide, surgeons in the Solomon Islands have made up for lost time, rapidly acquiring these skills thanks to a team of volunteer surgeons and anaesthetists under the umbrella charity “DAISI” (Doctors Assisting In Solomon Islands), with a second and third DAISI laparoscopic workshop at NRH conducted in April and June 2017. These three workshops involved 25 volunteer specialist surgeons and anaesthetist’s from Australia 4 registrars and 6 nurses.

Dr Scott Siota, a general surgeon from NRH, and his team of registrars are now doing diagnostic laparoscopic and laparoscopic appendicectomy independently.

“We are so excited to be able to offer something to our people that for many years just was not available due

to lack of resources” said local Honiara surgeon Dr Scott Siota.

The acquisition of laparoscopic equipment was due to the generosity of a number of hospitals, MedEarth and Olympus, and was shipped over to the Solomon Islands thanks to the support of Rotary and DAISI.

NRH is the only tertiary hospital in the country, located in the capital city Honiara.  It receives transfers and admissions from almost one thousand islands across the nine provinces that make up the Solomon Islands.  With no CT scanner in the country, diagnostic laparoscopy, now available at NRH, makes sorting out the “undifferentiated abdominal pain” much easier, allowing quicker diagnosis and treatment, and discharge from what is already an overly burdened hospital.

In the West, laparoscopic surgery typically involves the use of disposable single-use equipment.  This reliance on disposables is however problematic for the Solomon Islands, being expensive, and ugly with these disposables often ending up as land-fill.  Therefore the introduction of new technology and procedures needs to be culturally appropriate, and one of the main objectives of DAISI, is to promote sustainability and provide re-usable instruments to avoid a reliance on disposables.

Laparoscopic surgery has a difficult learning curve.  A systematic approach is required for teaching safe laparoscopic surgical skills, with ongoing teaching sessions scheduled to occur on a regular basis, and organised totally by volunteers.  Teaching also needs to include dedicated nursing staff, to ensure the necessary equipment is sterilised and cared for and stored appropriately.

Dr Douglas Pikacha doing key hole surgery

Image: DAISI volunteer and colorectal surgeon Dr Gary McKay & Honiara surgeon Dr Douglas Pikacha perform the first laparoscopic cholecystectomy at National Referral Hospital (NRH) in January 2017.

Fortunately, due to the incredible generosity of so many individuals and organisations, DAISI has been able to send three shipping containers in the past two years with much needed medical equipment.

Prof Charbel SandroussiImage: DAISI volunteer hepatobiliary surgeon a/Prof Charbel Sandroussi & local surgeon Dr Scott Siota doing laparoscopic cholecystectomy at National Referral Hospital (NRH) in April 2017.

This year alone over 83 specialists have volunteered in the Solomon Islands with DAISI.  “It never ceases to amaze me how much generosity there is amongst my surgical and anaesthetic colleagues.  The trick is tapping into and directing this generosity” says Dr Gary McKay, founder of DAISI.

With only five local surgeons serving the entire population of 580,000 in the Solomon Islands, the surgical caseload is often overwhelming.  This represents a one hundred fold difference to Australia.  The per capita income is also one hundredth that of Australia.

Dr Anubhav Mittal Hepatobiliary Surgeonimage: DAISI volunteer and hepatobiliary surgeon Dr Anubhav Mittal & colorectal surgeon Dr Daniel Kozman performing laparoscopic cholecystectomy while anaesthetist Dr Adam Hill watches on during most recent visit to Solomon Islands in June 2017. 

The Solomon Islands is currently facing a turning point in its history, with the recent departure of the Regional Assistance Mission to the Solomon Islands (RAMSI). Solomon Island’s strive for self-determination must include a commitment to improving the medical workforce in the Solomon Islands. Overseas training of surgeons and anaesthetists is expensive and fraught with failure.  Unfortunately the “brain drain” often results in overseas trained doctors never returning to the Solomon Islands. With a huge number of recent medical graduates just returning to The Solomon Islands from medical training in Cuba, the need is now greater than ever to provide post-graduate specialist training within the Solomon Islands.  DAISI is very excited to be involved in this process.

Article by Dr Sepehr Lajevardi who is currently a plastics registrar and Treasurer of DAISI.

GIZO teamdeparting sydney airport

By Gary McKay

By | Laparoscopic (Key-Hole) surgery arrives at Gizo in time for Easter | No Comments

Pictured above are DAISI volunteers travelling to Gizo hospital to participate in the laparoscopic surgical visit to Gizo hospital.

Easter is a time for remembrance and healing, which is the theme for a team of specialist surgeons providing a 1 week volunteer surgical mission to Gizo hospital the first week after Easter. Screening of patients will occur on Tuesday 18th April 2017.

Dr Douglass Pikacha (senior general surgeon pictured below) and Dr Benjamin Koete (senior gynaecologist) both from National referral hospital, will visit Gizo hospital with a team of specialist surgeons and gynaecologists providing surgery to the people of the Western Province the first week after Easter long weekend.

douglas pikacha

Dr Douglas Pikacha (pictured above) performed the first key hole removal of gallbladder at National referral hospital and will lead the surgical visit to Gizo hospital.

“The key to happiness is giving”, and this team of specialist surgeons will be participating in the spirit of Easter by providing latest state of the art key-hole (laparoscopic) surgery for common surgical and gynaecological conditions.Gizo hospital was the first in the country to provide key-hole surgery, with the donation of laparoscopic equipment by Olympus, with the first laparoscopic removal of gallbladder in the Solomon Islands performed by visiting surgeon Dr Neil Meulman in April 2012. Since this time numerous key-hole operations have been performed at Gizo hospital. Recently Olympus donated further laparoscopic equipment to National Referral Hospital, Honiara with laparoscopic removal of gallbladder and appendix and diagnostic laparoscopy in Honiara since February this year. Key-hole surgery provides many benefits for abdominal surgery avoiding a large incision. Through a number of small less than 1cm incisions, key-hole instruments and cameras are inserted allowing the surgeon to operate without their hands actually entering the abdomen. Safety is paramount, and key-hole surgery has been shown in research to provide many benefits over open surgery. Key-hole surgery avoids the need for a large abdominal incision, and results in less pain, shorter length of hospital stay, and fewer post-operative complications. It also allows for much sooner return to work and usual activities. Tuesday the 18th April, patients will be allowed to present for screening, and if suitable provided surgery at Gizo hospital during this first week following Easter. Conditions that most benefit, are pain due to gallbladder stones and inflamed appendix confirmed on ultrasound. Gynaecological conditions that most benefit from key-hole surgery include tubal ligation for sterilisation, removal of ovarian cysts, and removal of uterus for conditions (fibroids and cancer) that cause bleeding and anaemia. Traditional open surgery will also be provided including surgery for hernias, and colorectal conditions.m

Author: Dr Gary McKay is a DAISI member and secretary of DAISI and has accompanied a number of surgical volunteer visits to the Solomon Islands. 

 

Dr Karishma Buhariwalla

by Karishma Buhariwalla

By | My Experience in Gizo as a Volunteer Medical Student | No Comments

As a final year medical student at UNSW, I chose Gizo Hospital for one my recent elective placements which I’ve just returned from, as I wanted an experience that was different and separate to the medicine I was used to in Australia, and a lifestyle that was unlike what I have been exposed to. Gizo delivered on both counts. My placement was for one month, in December mostly in the ED and I lived at Rekona Lodge.  I was fortunate to share this experience with a fellow medical student Shelly Wen.

December is one of the hottest months of the year although being virtually on the equator the difference in temperature throughout the year is only one or two degrees. Living in Gizo means tolerating the heat and the humidity, the constant battle with mosquitoes.  Fortunately Gizo is surrounded by crystal clear waters, with a dip in the water, or scuba diving session a pleasant break from the incessant heat.  For a developing world the cost of processed foods is surprisingly high as it is all imported, so I had to experiment with shopping at the local market where there is a plentiful supply of cheap fruits and vegetables and local produce, many of which are local varieties that I had not seen before.

Students who choose to come to Gizo Hospital will enjoy many unique aspects to their placement, such as working independently and gaining hands-on experience in a variety of challenging situations. There are many moments that stand out for me, such as assisting with O&G surgery including an elective list of open tubal ligations, where general anaesthesia isn’t available and local anaesthesia with ketamine is the only relief the women get. The O&G registrar “Dr Jenny” manages to do through a open 3cm incision what is normally only achievable in Australia with laparoscopic surgery. I marvelled at how stoic and resilient the women were and frankly shocked at how they could sit up and walk off the operating table right after the procedure. This quality was reflected in the people of the Solomon Islands; most patients bore their pain quietly and without fuss and it was sometimes hard to gauge just how bad the situation was.  It made me feel “soft” by comparison.

The geographical distribution of the Islands also means that patients present much later with late-stage complications of common conditions that I don’t see much of in Australia eg: gangrenous diabetic foot ulcers deep and large abscesses, women of 42-44 weeks gestation, and deformed limbs due to badly healed fractured bones that were not seen in the hospital in a timely manner.

I was also surprised by the incredibly young population of Gizo and the Solomon Islands in general, with most women giving birth at a very young age and having anywhere between 3-8 children.   Suffice to say, any students choosing to do their placement in the maternity ward will definitely stay busy.  The lack of visible older people in the Solomon Islands is also a stark reminder of this country’s low life expectancy.

An experience I will never forget is taking the hospital boat for a day trip to the village of Leona on Vella La Vella island, an hour away by boat from Gizo. I was “lucky” to sit at the stern of the boat with uninterrupted views of the scenery. After this one hour trip my kidneys felt like they were in my throat with each bump of every wave felt through the frame of this thin fibreglass “pencil” boat.  I later learned if you sit at the back of the boat the ride is much smoother!  After this we spent the day in the tiny local clinic, in a hot room with a tin roof, inserting the Jadelle contraceptive implant in women, some as young as 14 and 15. The implant consists of two rods and lasts for 5 years. The consultation involved a counselling session with the local nurse who provided a thorough explanation and then the patient was brought to our room where we inserted the implant. I found this to be an important health strategy for Gizo as it was a useful step in controlling birth rates and provided women with a feasible and acceptable option of contraception due to its long-term yet reversible nature. A more permanent option implemented at Gizo hospital, is advising those women who have just delivered their 4th baby to undergo tubal ligation. Since the procedure is not done laparoscopically, the only way to do it is straight after birth whilst the uterus is still large and easily palpable. Otherwise women have to essentially wait till the next time they deliver.

Due to the limited resources in Gizo, many tests were not available and diagnosis was mostly clinical. As a student I found this a useful experience to practice and refine my OSCE skills. However, it sometimes also left me feeling unsatisfied and uncertain as to whether we had made the right call or done all we could.

My time in Gizo was fun, challenging, eye-opening, with invaluable experiences and any student who chooses to come here can expect the same!

Karishma Buhariwalla is a 6th year final medical student from the University of New South Wales, who spent December 2016 volunteering in the Solomon Islands with fellow medical student Shelly Wen.

recovery

by Dr Sepehr Lajevardi

By | Gizo Hospital Opens Early For Surgery In 2017 | No Comments

(Above Left): Clayton Dalano – Operating Theatres Nurse Manager at Gizo Hospital responsible for coordinating patient flow during the surgical visit in January 2017

Gizo hospital in the Western Province of Solomon Islands will be open for urgent surgery from Monday 16th January until Friday 27th January 2017 to try to help deal with the extra burden placed on surgeons in the Solomon Islands with the recent unexpected leave of two surgeons.

A team of 8 surgeons and four anaesthetists from Australia and one Solomon Islands surgical trainee Dr Michael Buin will screen patients and operate from Monday 16th until Friday 27th January 2017.
Volunteering surgeons include those with expertise in general, plastics, burns, colorectal, breast, thyroid and ENT surgery. Suitable cases include burns & tendon injury, hernias, lumps, tumours, bowel cancer, thyroid goitre, head and neck or parotid tumours, anal conditions (haemorrhoids, fissure etc) gallbladder and throat conditions. Gastroscopy and colonoscopy is also available to anyone with GI bleeding or anaemia. Laparoscopic key-hole surgery is also being introduced to aid the diagnosis of vague abdominal complaints and allow for the removal of gallbladder to be performed through small incisions allowing quicker recovery.
The service is free of charge and is a combined initiative of the Solomon Islands Ministry for Health and the not-for-profit organisation “Doctors Assisting In Solomon Islands” (DAISI).  Dr Rooney Jagilly (Medical Superintendent at National Referral Hospital) and Ministry for Health Under Secretary Dr Greg Jilini have both been pivotal in planning and organising these visits. This represents one of thirteen such visits by DAISI volunteers scheduled for next year involving over 50 volunteer doctors.

everyone-getting-involved

A particular emphasis during these surgical visits is the training of surgical trainees from the Solomon Islands such as Dr Michael Buin (pictured in above photo fourth from the left)

If you are someone with a surgical condition needing surgery, we suggest you present for assessment to Gizo hospital at 8am on Monday 16th January 2017. We recommend you present fasted so that if necessary immediate surgery can be offered. Screening will also continue to occur week days each morning from 8am until 9am between 16th-27th January 2017.

Author: Dr Sepehr Lajevardi is a plastics surgical registrar from Royal Perth Hospital and elected Treasurer of DAISI. Dr Sepehr will be volunteering his services during January 2017 along with 8 other specialist surgeons.

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By Lowie Institute

By | Lowie institute reports benefits of including the Pacific Islands to Australia's Labour Market | No Comments

KEY FINDINGS OF LOWIE REPORT
Recognising the importance of the Pacific, Prime Minister Turnbull has called for a ‘step-change’ in Australia’s engagement with the region.
The profound development benefits that can be delivered to our nearest neighbours through greater access to Australia’s labour market is an element missing from the current migration debate.
Allowing just 1 per cent of the Pacific’s population, an average intake of under 3000 people, to work permanently in Australia would deliver more benefits to the Pacific peoples by 2040 than Australia’s current aid Program.

EXECUTIVE SUMMARY
A stable and prosperous Pacific Islands region is essential for Australia’s security and foreign policy. Australia is investing significant amounts of aid in the development of the region with very mixed results. The economic, demographic, governance, and climatic challenges the Pacific faces will make sustained development of the region even more difficult in the years to come. It is for this reason that Prime Minister Turnbull has committed Australia to a ‘step-change’ in Australia’s engagement with the Pacific built on fresh ideas.

One idea that would produce a ‘step-change’ would be to make it easier for citizens of the Pacific Islands region to work in Australia. This would allow citizens of the region to earn an income far above their potential at home, and considerably improve their living standards.

This Analysis assesses the impact of two models of such a proposal: one capped and one uncapped. It finds that allowing just 1 per cent of the Pacific’s relatively small population to work in Australia would bring more benefits to the people of the Pacific than what Australia currently gives in aid. Measures would need to be taken to manage risks and costs to Australia; however, these risks should be weighed against the significant benefits it would bring to Pacific Islanders.

INTRODUCTION
Addressing the 47th Pacific Islands Forum Leaders’ Meeting in Pohnpei in September 2016, Prime Minister Malcolm Turnbull acknowledged:

“My Government recognises that Australia’s interests in the region and the complexity of the challenges we face demands more engagement at every level, more integrated policy and fresh ideas. We are committed to a step-change in our engagement.”[1]

A step-change in our engagement is indeed necessary, because the development prospects of many of Australia’s neighbouring Pacific Island economies are bleak.[2] Disadvantaged by remoteness from major markets, small market size, weak governance, and rapidly growing populations, it is difficult for Pacific economies to follow conventional pathways for economic growth. There is certainly no track record of success. The average annual income of people in these economies in 2015 was around $3900 (purchasing power parity (PPP) adjusted in current international dollars), just 8 per cent of the Australian average.[3]

Australia has a strong interest in seeing a stable, prosperous, and developed Pacific. The region is part of Australia’s near neighbourhood. Former Australian Prime Minister John Howard memorably referred to the Pacific as “our patch”.[4] Australia and New Zealand are the first countries that Pacific Island states look to for assistance after natural disasters or conflict. A stable Pacific is critical to Australia’s security. It is also an area where Australia has significant economic interests, including close to US$1.5 billion in trade per annum and US$15 billion worth of investments.[5]

The importance of the Pacific Islands region to Australia is further reflected in the amount of aid that Australia has invested in the region. In real terms it has given over US$40 billion since 1960. This is almost two-thirds of total Australian aid over that period.[6] The results of this assistance have been mixed at best. While aid has improved welfare and governance throughout the Pacific, as a whole the human development indicators of the region remain poor.[7] There are limits to what foreign aid alone can achieve. It is too finite, its delivery too fragmented, and it is too limited in its ability to change domestic incentives in developing countries to have a deep impact. Aid helps, but in the Pacific it has rarely been transformative.

Meanwhile, the challenges facing the Pacific Islands region are growing. Globalisation has not overcome the problems of remoteness and size as was hoped. Progress on governance remains stalled in many countries. Natural disasters and climate change will be major obstacles to future development. Compounding this, the region’s population, already facing a significant youth bulge, is expected to grow by a further 49 per cent in the next quarter of a century. By contrast, Australia’s population will grow by 29 per cent.[8] Any incremental improvement in development indicators across the Pacific region in coming years is likely to be overwhelmed by these challenges.

At best, current approaches to development in the Pacific will see the region continue to muddle through; at worst, the region’s development levels will decline to a point where some states in the region will become unstable and, in some cases, unviable. It is time, therefore, to debate fresh ideas that will translate Prime Minister Turnbull’s call for step-change into action.

One idea that has already been floated in a variety of forms would be for Australia to allow a significant number of Pacific Islanders to work in Australia. This would enable citizens from Pacific Island countries to earn an income far above their potential at home and considerably improve their living standards. It would also open opportunities to the Pacific Island community that are far beyond what would otherwise be within reach. Indeed, in a recent radio interview Prime Minister Turnbull acknowledged the connection between providing greater access to the Australian labour market and improving development prospects in the Pacific.[9]

The Prime Minister’s comment was delivered in the context of what has become an increasingly polarised debate about both skilled and unskilled labour migration to Australia, and, in particular, the impact of this on Australian workers. What has largely been missing from that debate, however, has been consideration of the development benefits that could be delivered to Australia’s nearest neighbours by increasing their access to Australia’s labour market.

The aim of this Analysis is to calculate those benefits. It does so by considering two models for increasing Pacific access to Australia’s labour market: one that would allow for relatively unrestricted access (hereafter the ‘uncapped model’); and a second model that would provide for more restricted access (hereafter the ‘capped model’), whereby a lottery quota system would be used to control the flow of Pacific Islanders who could come to Australia per year.

The uncapped model illustrates the full transformational impact such a proposal could have on the region. Based on very conservative assumptions, the uncapped model could increase the income of some Pacific Island countries by around 300–400 per cent over the next 25 years. To be clear, that is the increase in income for the entire population of those countries, not just the income of those who have migrated. While the less ambitious capped model would obviously have a less transformational impact on the people of the Pacific Islands region, it would still deliver benefits far greater than Australia’s existing aid program.

Our estimates reflect a view of development as something that affects people rather than place — if a policy lifts many Pacific Islanders out of poverty, it matters little where it happens. We are conscious that this focus is a different way of thinking about development, but conventional thinking is clearly not working in the Pacific.

There are, of course, risks and costs associated with either model and this Analysis explores some of these, as well as ideas that might help to mitigate them.

DEVELOPMENT CHALLENGES FACING THE PACIFIC
In 2006 a seminal report published by the Australian Agency for International Development (AusAID) highlighted the poor development performance of Pacific Island countries. The region, the report noted, suffered from high unemployment, social and political instability, and serious crime. Some countries also faced daunting health and environmental challenges. Without an upturn in economic growth, the future for these countries was bleak.[10]

A decade on, that statement remains true. Aid and remittances have played an important role in avoiding a failed Pacific region. However, at best, the Pacific continues to muddle through, unable to achieve a stable economic or human development growth path. The twin tyrannies of small size and extreme isolation have made it all but impossible for regional states to follow a conventional growth path, and have left the Pacific as the most aid-dependent region in the world.

Aid as a percentage of gross national income, 2011–2013 average

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Figure 1: Top 20 aid-dependent countries in the world

Note: Palau and Vanuatu are ranked 21 and 22

Source: World Bank Databank

Scholarship on global growth and development over the past two decades has shown that institutions are critical to development.[11] However, institutional quality in the Pacific is low and shows few signs of improvement.[12] There are worrying trends in some countries towards further consolidation of power for the elites.[13]

Furthermore, the pressures on the Pacific are only likely to get worse. The Pacific is one of the world’s most natural disaster prone regions, contributing average annualised losses of 6.6 per cent of the GDP for Vanuatu and 4.4 per cent of the GDP for Tonga alone.[14] Climate change will exacerbate these vulnerabilities, increasing the intensity of natural disasters and threatening the entire existence of atoll states, such as Kiribati and Tuvalu.

Demographic challenges add to these problems. The median age in Melanesia is 22, while in Polynesia and Micronesia it is 26. Australia’s median age is almost double that at 37.5.[15] This dramatic youth bulge shows no prospect of slowing down, with the population of the region forecast to grow by 49 per cent over the next 25 years, again double the forecast for Australia.[16]

These trends will severely test the resilience of Pacific Island states and prevent them from prospering.

Read the full Lowie Institute Report

 

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by Danny Kozman

By | Laparoscopic Surgery in the Solomon Islands | No Comments

Thanks to the help of a handful of volunteers, DAISI was able to load and send today a shipping container full of much needed medical and surgical supplies to the Solomon Islands.  Most importantly laparoscopic equipment donated by Olympus, Hurstville Private and Westmead Private Hospital.  This will arrive in time for the next planned surgical visit in January/February next year, where the emphasis will be on teaching safe laparoscopic procedures.

In Australia, the first laparoscopic surgery began in the mid 1980s, however until now, the only laparoscopic equipment in the Solomon Islands consisted of a single laparoscopic stack at Gizo hospital donated to the hospital in April 2013 by visiting surgeons Dr Neil Meulman and Dr Fred Boseto from Bathurst hospital.  This was utilised very well for over 3 years, but unfortunately was unable to be used on the most recent visit after the old Gizo hospital burnt down (which housed the pharmacy supplies), due to lack of carbon dioxide.  On the most recent gynaecological visit to Gizo, laparoscopic surgery could not be performed because the CO2 insufflator was not working.

But thanks to the generosity of Olympus, and Hurstville private hospital, three laparoscopic stacks containing insuflator, fibroptic cabling luminator, and monitor, as well as laparoscopic cameras  are now on their way to the Solomon Islands in time for a planned laparoscopic workshop in January/February next year.   Westmead private hospital have also donated laparoscopic trochars (both disposable and re-usable), and laparosopic graspers, staplers and accessories.

This will now allow for minimally invasive surgery to be performed for diagnostic laparoscopy, and removal of gallbladder avoiding the need for an open laparotomy incision.

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By David Maze

By | Violent Quake Rocks Solomon Islands | No Comments

A 7.8 magnitude earthquake struck 70 kilometres off shore in the Solomon Islands overnight. The earthquake’s epicentre was 48 kilometres deep and nearest to the Makira-Ulawa Province, in the country’s southeast. The quake was initially recorded as magnitude 8.0 by the United States Geological Survey but was downgraded to a 7.8 on the Richter Scale.
At least 9 aftershocks of magnitude ranging 5.1 to 6.5 were recorded to rock Kirakira, capital of the province, at approximately 20-minute intervals following the primary event. The province, which is home to over 40,000 people, recorded damage to homes, businesses and infrastructure all across the island. No casualties have been confirmed. Honiara, the country’s capital just 200 km away experience total blackout of electricity and phone reception. Although tsunami sirens sounded through the night, there was no major damage and panic did not overtake the city. Aid efforts are suffering the result of damage to telecommunications.

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Solomon Islands sits on the so-called Ring of Fire or Circum-Pacific Belt, a a basin of 40,000 km over which 90% of the world’s earthquakes occur and 75% of the world’s volcanoes lie. The frequent earthquakes often trigger tsunami warnings as the destructive events force waves to propagate across the pacific ocean striking neighbours such as Australia, New Zealand, Vanuatu, Fiji and even reaching as far as Japan, USA and Canada. Fortunately, this earthquake’s tsunami warnings were called off approximately 15-hours after the event.
Although not expected to be a serious setback to the country’s primary economic driver, agriculture, there are possible implications for supportive sectors such as tourism and energy production. Any major damage to infrastructure slows or halts production in these sectors.
DAISI has already packed a shipping container today to help with health services in the Solomon Islands following this disaster. It also hopes to help build lasting infrastructure and to fortify against future disasters in this susceptible region of the world. It will continue to provide medical and further aid as part of its ongoing mission to empower and collaborate.

Dr David Maze is a Juniour Medical Officer from the Central Coast Local Health District (Gosford) with an interest in General Physician training. Dr Maze first volunteered in the Solomon Islands for 6 weeks in Nov-Dec 2015 working mainly in the Emergency Department. Dr Maze plans to return to volunteer in the Solomon Islands in 2017 .