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by Gary McKay

By | ZOOM sessions begin in response to no end in sight for cOVID travel bans. | No Comments

With no end in sight for the COVID travel bans, DAISI Chair Matt Rickard suggested at the last DAISI board meeting that we organise some ZOOM sessions aimed at supporting our South-Pacific colleagues.

The idea was to provide expert advice where requested & required, and educational support to the trainess in surgery, gynaecology and anesthetics. These three specialties were chosen, as to date this is where DAISI has mostly focused its attention.

Eighteen ZOOM webinars are now scheduled to occur this year in specialty areas of anaesthetics, gynaecology and general surgery.

The first successful general surgery ZOOM session on the topic “hernias” took place on 23rd March 2021, with only a few hitches, mostly technical from my end, with surgical registrars and participants from PNG, Vanuatu, Kiribati and the Solomon Islands. A mixture of trainees and consultants turned up, with a number of current clinical cases presented, leading to interesting discussion and debate. This opportunity for cross-pollination of ideas was what we intended, and overall I was very happy that we had achieved this goal. The knowledge transfer was defininitely not unidirectional, with all of us on the Australian panel blown away by the wit & resourcefulness of our South Pacific colleagues. Some novel techniques for repairing hernias, when mesh is simply not available, where presented by Dr Elvis Japhlet from Sopas in the remote PNG highlands, and Mike Buin from Western Province of Solomon Islands.

The first gynaecological ZOOM session is scheduled for 20th April 2021 being jointly organised by Dr Leeanne Panisi (director of obstetrics and gynaecological services in the Solomon Islands) and the first anaesthetic ZOOM session is scheduled for 25th April 2021, and is being coordinated by anaesthetist Dr Jessica Lim from Sydney in consultation with the head of National Referral Hospital (NRH) department of anaesthetics Dr Kaeni Agiomea.


In coming up with the idea, it was felt that the ZOOM sessions should be an opportunity for DAISI to show support to specialists and their trainees.  Vitally important is the need for these sessions to represent a supportive environment for dynamic case discussion and that they not be didactic “sermons” or lectures or drab PowerPoint presentations: a multitude of which can be found on youtube!  It was also agreed that these ZOOM sessions should include a specialist panel representing the field being discussed (e.g. surgery, anaesthetics and gynaecology) from both the South Pacific and Australia and New Zealand, with equal representation. It was important that we avoid any actual or perceived paternalistic neocolonialistic approach and, to put it crudely, that we not be guilty of “teaching grandmother how to suck eggs”. If the first session is any indication, this was achieved with the Australian panelists probably learning more from this session than their South Pacific colleagues!
 
The first session on 24th March involved specialists Drs Basil Leodoro (Vanuatu), Elvis Japhlet and Kennedy James (PNG), Mike Buin (Solomon Islands), Gary McKay & Prof Christophe Berney (from Australia).

Day light savings created confusion with the start time with apologies from late attendees Dr Ako Millan, Sameul Kejuel and Kabiri Tun (Tungaru, Kiribati) Dr Debra Smith (Brisbane), and Dr Isaiah Borchem, Rodger Ikasa, Ian Umo and Dominic Inaido (Alotau, PNG) pictured above.

Now that day light savings are over, the start time will be less confusing, and clear instructions will be given of exact start times with Australian Eastern Standard Time (AEST) being one hour behind Solomon Islands & Vanuatu, and two hours behind Kiribati.


Surgical sessions will continue monthly the last Tuesday of each month 5-6pm (AEST). Gynaecology sessions will be the second last Tuesday of the month 5-6pm (AEST) every 3 months and anaesthetic ZOOM sessions will occur on every three months on either a Sunday or Tuesday (still undecided) and more frequently if sufficient interest warrants it.  

The original idea of having break out sessions at the end of the ZOOM sessions to allow one-on-one discussion and mentorship was good in theory, but in practice not possible due to limited ZOOM access in some cases with multiple trainees logging on together. This is something we can rethink or tweak as we become more familiar with the sessions, and as I, a self-confessed Luddite, grapple with the technical aspects of ZOOM!

Finally, in the spirit of inclusivity, if you or anyone you know would like to be on the invite list and is not already, please contact me, preferably on WhatsApp. +61 411 248 910 or email me gary@daisi.com.au

by Barry Barford

By | Avoiding the pitfalls of shipping | No Comments

When shipping medical equipment overseas it’s easy to overlook and get caught out by obstructive regulations. In previous articles we’ve discussed some of the problems that can arise when a shipment arrives at its destination. In this article we’ll look at some issues that can prevent the shipment even leaving Australia or failing to arrive, if not dealt with properly.

Packing without pests

Donated medical equipment shipped in a container is usually packed into the container as is, without any additional protection. However, more fragile items may need to be securely packed, particularly if they are to be shipped as less-than-container-load (LCL) cargo. If the equipment is to be packed into a wooden box or crate, it’s important to use the right timber. All wooden packing material, including pallets, used for export must meet the requirements of the International Standards for Phytosanitary Measures (ISPM). In the case of timber used for international shipping purposes the standard is ISPM15. It applies to all wood more than 6mm thick and requires it to be treated against pests, meet bark tolerance requirements and be appropriately marked as shown at image 1.

All professional packers for export will know about this requirement, but anyone less may not. If unsuitable timber is used and it is not detected before leaving Australia, the cases may be destroyed on arrival overseas or be refused entry. At very least they will be sent for treatment, risking damage to the contents. In summary, always specify ISPM15 timber when packing for export. For more information go to https://www.agriculture.gov.au/export/from-australia/wood-packaging/faq-ispm15#what-is-ispm-15               

Insurance – who needs it?

Most donated, used equipment is shipped uninsured because shippers don’t want to pay premiums for goods of little or no commercial value. Insurance for second-hand goods is difficult to get anyway, and if it is obtained it tends to negate the low-value declaration made on shipping documents to help the receiver avoid customs duty and taxes. However, if new or high-value used goods are being shipped it could be an expensive mistake not to insure them. Enquire about premiums with your freight forwarder to make an informed decision and then specify “insurance required” on your shipping instructions if appropriate.

 Container safety versus culpability

There is a horrifying Youtube that can be found on the internet where a container is being lifted by a crane and about to be swung onto the ship, when the floor of the container suddenly bursts open and a load of concrete slabs crashes onto the wharf below. Had anyone been standing underneath they would have been killed instantly. That container somehow slipped through the safety checks and you wouldn’t want to be the person responsible for it. If you’re going to buy your own used container you must make sure that it meets the standard for export. This is governed by the International Convention for Safe Containers. Not any old container will do as those sold for storage, for example, may not be structurally sound for shipping purposes. So when buying a used container specify that it will be used for export shipping purposes and ensure that it has a valid CSC plate and certificate. The plate looks something like image 2 and is usually attached to the left door.

Agonising over air freight

DAISI doesn’t normally use air freight but those who do will know that since 1 March 2019 all air freight exported from Australia must be x-ray screened before it can be loaded onto the aircraft. This procedure, known as piece level screening, was introduced in response to heightened security concerns. Freight is classified as either homogenous – where all the items in a carton are exactly the same and uniform in every respect when viewed on an x-ray monitor – or non-homogenous where cartons contain mixed goods of varying shapes and sizes. If you do use air freight on occasion and are shipping non-homogenous goods, make sure the cartons are supplied loose and not on pallets. The reason for this is that if the security staff are not certain of what they are seeing on the x-ray monitor, they will open the carton for a manual inspection. If the cartons are plastic-wrapped onto a pallet they can’t do this and the whole consignment will be returned to you for resubmission at your expense.

Batteries not included?

Medical devices are replete with lithium batteries – lithium ion and lithium metal – which are among the most contentious items in the shipping world. On the face of it they are categorised as Class 9 dangerous goods and have been implicated in a number of aircraft and cargo ship fires. However, there are many, many exceptions to the rule which are beyond the scope of this article to describe in detail, but suffice it to say that the final classification of lithium batteries will depend on a number of considerations including the following:

  • Are the batteries installed in the equipment?
  • If not, are they packed separately with the equipment?
  • Are they lithium ion (generally rechargeable) or lithium metal (generally not rechargeable)?
  • How many batteries are there in total?
  • What is the rating of the batteries in watt hours?

As a very rough rule of thumb, if the batteries are either installed in the device or packed separately with it, are limited in number and have a rating of less than 100 watt hours, they will be an exception to the dangerous goods regulations. However, there is a lot more to it than that so get advice from your freight forwarder as declarations and hazard labels may be required. Note that different rules apply to different transport modes – IATA for air freight and IMDG for sea freight. A good way to make a self-determination is to get hold of a material safety data sheet (MSDS) from the battery supplier and check the Transport section. In the example at image 3 it indicates that the batteries in question will be an exception to the dangerous goods rule so long as certain packing instructions are complied with.

Shipping can be a headache, but it will be a lot easier armed with an awareness of the obstacles and how to overcome them.     

Barry Barford is an Associate Member of DAISI and a former Shipping & Logistics Officer.   

By Mavis Nishimura Podokolo

By | Zooms session begin in response to COVID isolation | No Comments

GIZO hospital in Western Province this week received medical gifts worth AUD10,000, it is reported.

According to Dr Mike Buin, surgeon at the Gizo Hospital, the medical gifts received ranges from crutches, operating theatre equipment, gowns, kids’ toys, books and medical trolleys.

“The Gizo hospital team have received medical gifts worth AUD10,000. 

“Gifts range from crutches, operating theatre equipment, gowns, kids’ toys, books and medical trolleys. A big thank you to our friends and volunteers from Australia, Dr Tutuo and your team for the gifts to Gizo Hospital. 

“We hope to get over this pandemic soon so that you can come and visit us again,” said Buin.

He said Dr Narko usually volunteers to Gizo hospital as part of Doctors Assisting in Solomon Islands or DAISI, now known as Doctors Assisting in the South Pacific Islands. 

“You can check out their website.”

Buin adds that usually DAISI has about two to four tours to Gizo Hospital per year where specialist surgeons come and operate.

“However, due to the covid-19 situation, all surgical tours in 2020 were cancelled. And, 2021 tours are also uncertain and likely to be no DAISI tours for this year as well,” said Buin.

By Ian Hosking Richards

By | COVID ward opens in Honiara | No Comments

The recently opened 56-bed field hospital in Honiara, which has been totally funded by Solomon Islands Government through The Ministry of Health & Medical Services (MH&MS), is now ready to take patients.  The Order of St John has been working closely with MH&MS on the project.  They have provided 8 stations which will monitor the more serious patients and will provide additional St John Ambulance Service nurses to cover staff shortages when necessary.  St John Ambulance Service will also provide all covid-19 patient transport, as mandated by the current state of emergency provisions.

The country is lucky to be able to call on locals who have experience in handling infectious disease outbreaks.  The Chief Advisor to the Ministry of Health & Government was formerly the World Health Organisation (WHO) representative in Africa for Ebola, and the Head of St John, Mr Doug Kelson, set up two field hospitals in PNG to handle the cholera outbreak about 12 years ago.

In his weekly address, Prime Minister Manasseh Sogavare spoke at length about the new facility.  He outlined the role of the hospital in caring for asymptomatic patients as well as those with mild to moderate signs of the virus.  He added that any patients showing severe signs of covid-19 would be treated at the National Referral Hospital’s isolation units.  Mr Sogavare explained that the project was entirely funded by the government due to the urgency of the situation, and that the process of applying for donor funding would have taken too long.

Prime Minister Manasseh Sogavare spoke at length about the new facility.  He outlined the role of the hospital in caring for asymptomatic patients with COVID-19

So far Solomon Islands has been largely successful in keeping the virus out of the country.  For months it had no cases at all.  The first case was reported at the beginning of October shortly after international students were repatriated from The Philippines. 400 students had been stranded there after the country went into lockdown.  Despite having tested negative 3 times before being repatriated, the student tested positive after arrival in Solomon Islands.  The current tally is 17 cases, with 5 having made a full recovery.  Whilst there has yet to be any cases of community transmission, it is a widely held belief that this is only a matter of time, and that within the next 8-10 weeks we will see cases of community transmission. 

The Prime Minister acknowledged this in his speech, remarking ‘This is the first of its kind in Solomon Islands, an important achievement in our ongoing fight against the deadly virus.  The completion of the field hospital will further enhance our preparations for various possible scenarios, including community transmission if it may arise’

Ian Hosking-Richards is the current Sponsorship Officer for DAISI, and also, in his own right, the Founder of The Solomon Foundation, and the current Solomon Island’s Honorary Consul (Elect) for NSW. Ian has been actively involved on many fronts improving the delivery of medical services to the Solomon Islands. Ian has been actively involved with DAISI in the establishment of a cardiac assessment and rehab service at Gizo Hospital and National Referral Hospital and in providing surgical services to Solomon Islands requiring treatment in Australia. Both DAISI and The Solomon Foundation enjoy all the benefits of this working partnership.

By Robert Iroga

By | Solomon Islands records its first COVID-19 Case | No Comments

Solomon Islands has recorded its first confirmed COVID-19 case today, in its capital Honiara. The single confirmed case is being quarantined at National Referral Hospital (NRH) in its isolation ward.


Minister for Health Dr Culwick Togamana has disclosed that precautionary measures have also been undertaken with the patient (COVID-19 patient) at NRH Isolation ward that included doctor – patient communication via mobile phone and staff of isolation ward 1 and 2 restricted from crossing over.

Speaking to the nation today to detail what his ministry is doing after the country has recorded its first COVID-19 case, with the patient now in the NRH Isolation Ward, Togamana said it has also been agreed that family and relatives are to bring clothing for the patient with all dirty clothes to be kept in bag for wash after discharge. “Additionally any food from relatives for the patient must be pre-packed or canned food and dropped off at NHEOC for health workers to deliver,” he said in his address on radio.

Togamana further stress that all the staff who are involved in operations undergo daily risk assessment and adequate Infection Prevention and Control procedures have been put in place and they pose no risk to the community or family members.

“On the safety of front line staffs, all staffs at the NRH care areas are not allowed for cross overs to other care areas, and each workflow is now implementing a unidirectional work-flow. Accommodation for front line staffs on 2 weeks deployment is been progressed, where duty staffs will follow a strict pre-deployment deployment and post deployment instruction,” he said.

Robert Iroga is a reporter for the Solomon Business Magazine

By Nili Hali

By | Expired & Deregistered Medical Products Will Not Be Included In DAISI Donations | No Comments

As part of its clinical governance process, Doctors Assisting In-South Pacific Islands (DAISI)’s Founder and Secretary Dr Gary McKay announced the decision as an organisation to cease shipping to the South Pacific donated medical supplies and equipment that are recently expired or deregistered with the TGA. This brings DAISI in line with current World Health Organisation (WHO), and Australian Council For International Development (ACFID) guidelines.

Initially, seeing the poor state of supplies in the South Pacific provincial countries we were volunteering in, with many products many years expired, it seemed reasonable to accept and donate recently expired medical goods and equipment. This was on the basis that the actual life of drugs is usually a year or two longer than the stated expiry date.

But DAISI has today changed this policy in order to be compliant with the World Health Organisation (WHO) guidelines, realising that there are some risks associated with donating and using expired goods. DAISI also felt, that although these WHO guidelines, are not regulations or mandatory, that DAISI should adhere to them, as they represent a consensus opinion after WHO consultation with many Charities doing developing world medicine through your the world.

DAISI’s adopting of the WHO Guidelines will mean that a lot of potentially usable medications and equipment will simply become landfill. But on the other hand, the potential harm associated with using a drug that is non effective due to its expiry, will be avoided.

This policy change has also been an opportunity for DAISI to take pause and consider its other donation policies, to ensure that DAISI is responsible in every possible way when it comes to donations. There is a false perception that “beggers cant be choosers” or that “something is better than nothing”, and this is wrong with this mentality paving the way for sloppy processes and governance. We must always ask ourselves, would it be safe or reasonable to use it in Australia or to give it to a family member. If the answer is no, then the answer should still be “no” when it comes to the South Pacific.

DAISI’s responsible donations policies now mandate that recipients are involved in the donation process, and that only equipment which is expressly asked for is donated. Just because we think it is valuable does not mean it is actually of any value to the recipient. One example of this is the recent well intentioned donation of a large number of influenza vaccines intended for Papua New Guinea, not realising that the influenza virus is a winter virus that really has very little activity in the warmer tropics.

Donated equipment must also be in full working order and tested before sending, and ideally serviced with a reasonable expected durability and functionality for a least a few years use. In the best case scenario, equipment will be donated with a service agreement, which has occurred recently with the donation by Olympus of a laparoscopic stack to Gizo hospital used for performing key hole surgery.

By Barry Barford

By | Use own containers or LCL to beat the bond | No Comments

Swire Shipping, which practically has the monopoly on cargo shipping services to Papua New Guinea and the Solomon Islands, has announced it will, with immediate effect, impose a security deposit (bond) on all of its carrier-owned containers released to aid shippers. This is in response to a growing number of containers detained or abandoned by consignees who, to make things worse, often fail to pay detention charges as well.

It doesn’t matter if shippers such as DAISI are innocent bystanders, all aid shippers are caught in this blanket impost on the use of carrier-owned containers. Bonds are typically US$3,000 for a 20-foot container and US$5,500 for a 40-footer, and while they are fully refundable if the container is returned in good condition within the free period (14 days in the Solomon Islands), they represent a substantial additional outlay.

But there is a way around them. Consider purchasing your own shipper-owned container. A used container in good condition can be purchased for around $3,000 and once you’ve packed it with your equipment and shipped it to its destination, it simply remains with the consignee. You pay no bond, you don’t have to return the container to anyone and the freight rate is considerably less than you would pay for a carrier-owned container. Note, though, that containers for export shipping must have a valid CSC plate and certificate in accordance with the International Convention for Safe Containers.

In fact the consignee may choose to sell or use the empty containers, which have a significant inherent value.  These containers are often used for storage or, in remote parts of the South Pacific where construction resources are scarce, incorporated as components into construction projects as shown below.

331DEDC7-3368-4736-BF52-A204A41568AFTwo left-behind medical aid shipping containers in remote outpost being used as a foundation for building a family home.

An even better policy is to ship only what is really needed and use a less-than-container-load (LCL) service rather than pack, say, a laparoscopy stack into a container and then hunt around for other stuff to fill the container with. Goods such as this should be professionally packed, as in the photo below, designed for loading and unloading by forklift and suitable for shipment by sea or air.

23D21191-56F7-4284-B1DA-294DD22C276F

COVID-19 response: Four Maquet Servo 1 ventilators professionally packed for LCL shipment to East Timor. (Photo courtesy Pentagon Freight Services, Darwin.)

Barry Barford is DAISI’s Shipping & Logistics Officer and a shipper’s representative for a number of medical training organisations.

By Elvis Japhlet

By | Third DAISI container arrives Sopas | No Comments

Dr Elvis Japhlet takes selfie of the third DAISI shipping container this year to arrive at Sopas Hospital. 

 

On behalf of Sopas Hospital Staff, the Sakarawan community and EPHA, I would like to thank DAISI once again for the arrival of another container full of medical equipments and supplies today. Particularly the organisation and logistics required for such a feat by DAISI PNG Program Officer Mark Taffa, with money contributed by Owen Miller Foundation and Horten Medical.

 

We truly thank you from the bottom of our hearts, and look forward to putting this equipment to good use with future DAISI surgical trips once COVID-19 travel restrictions are lifted.

Dr Elvis Japhlet is the head surgeon at Sopas District Hospital in the remote highlands of PNG, and has been working together with DAISI to improve the delivery of surgical services to Enga Province. 

 

By Barry Barford

By | Aid shipments affected by COVID-19 | No Comments

Photo courtesy Freightwaves.

It’s sometimes hard to comprehend the speed at which COVID-19 has spread within Australia and around the world – it’s just four weeks since the virus spread was declared a pandemic. During that time two container loads of medical equipment and supplies shipped for DAISI to Sopas District Hospital have arrived in Papua New Guinea, but what options for shipping remain over the coming weeks?

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The extent to which freight movements have been affected depends on the mode of transport. Air freight, most of which is carried on passenger aircraft, is severely restricted owing to the suspension of most international flights by Qantas, Virgin and the airlines of neighbouring countries. Pacific Air Express continues to operate a dedicated freighter service from Brisbane to the Solomon Islands, Papua New Guinea and Vanuatu. Express delivery companies such as TNT, DHL and Toll are offering restricted services subject to availability of flights.

Sea freight remains largely unaffected, although schedules have had to be adjusted to allow for the 14-day transit time between ports required by many countries. However, this situation may change as Pacific Island nations take action to protect their vulnerable communities. Already the Solomon Islands have imposed a 14-day quarantine period (before ships can enter port) on arrivals from any international port, unlike most other island nations which specify particular ports. Less-than-container-load (LCL) services are still operated by Kalgin Global Logistics and Vanguard Logistics from Sydney,Melbourne and Brisbane, but these too rely on the regular schedules of carriers like Swire Shipping.

Among the countries assisted by DAISI, only Papua New Guinea and Fiji have so far reported cases of COVID-19. As at midday on Thursday PNG had two cases and Fiji 15, with neither country reporting any deaths. However, it should be noted that elsewhere in the Pacific numbers are rising. French Polynesia, which in the last week of March had reported 18 cases, now has 51. And New Caledonia which at the same time had seven cases now has 18.

Resumption of normal freight services is unlikely to come soon and it could get worse before it gets better, but a gradual easing of restrictions could occur depending on the success or otherwise of each country’s efforts to contain the spread of the virus. By any measure the situation locally is nowhere near as dire as in Europe and the US, and for that we can be thankful.

Author: Barry Barford is DAISI’s Shipping & Logistics Officer and a member of the UK-based Humanitarian Logistics Association.

By Dr Elvis Japhlet

By | Second and third container arrive at Sopas | No Comments

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Sopas Hospital staff in front of the second shipping container delivered this year.

On behalf of Sopas District Hospital staff, community and Enga Provincial Health Authority (EPHA), I would like to thank Doctors Assisting In South-Pacific Islands (DAISI) and its executive for the first and second containers of medical equipments/supplies received this year with value more than one million kina.

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Our extreme gratitude is extended to Horten Medical/various hospitals in Australia/individuals/organisations/companies that have assisted and/or donated these medical equipments/supplies, and the Owen Miller Foundation largely responsible for paying for freight charges.

These donations will truly go a long way in saving the lives of many people in the highlands of PNG particularly Enga Province.

This is indeed a huge blessing.

Special thanks to so many individuals in particular Dr Gary McKay, Roshini McKay, Mark Taffa, Matt Rickard, Christophe Berney, Carina Chow, Adelene Ong, Jessica Lim, and all DAISI team members (cannot mention all their names as too many) who have visited Sopas District Hospital and all who have contributed in one way or the other towards these supplies.
God Bless you all!

 

Dr Elvis Japhlet is the head surgeon at Sopas District Hospital in the remote highlands of PNG, and has been working together with DAISI to improve the delivery of surgical services to Enga Province.