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Post COVID resumption of DAISI trips

Apr 03
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by Dr Gary McKay

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It is with a great sense of relief and excitement that DAISI has finally been able to resume volunteer training missions to the South Pacific after exiting from what has been an almost three year COVID hibernation.

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As an organisation DAISI felt it necessary to resume trips first in the Solomon Islands where it has the longest track record, and the most established partners.

The first trip was in December last year by the Solomon Island’s Programme Officer and colorectal surgeon Professor Peter Hewett. It was intended as an administrative fact finding mission with the aim to discuss strategy, strengthen alliances, and establish a programme of training visits for 2023.

Prof. Peter Hewett during fact finding mission to National Referral Hospital (NRH), Honiara December 2022.

However this trip also rapidly turned into a colorectal surgical clinical visit due to a backlog of cancers.

Surgeons Dr Scott Siotta and Prof. Peter Hewett performing colorectal surgery at National Referral Hospital (NRH) December 2022.
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In addition to these clinical responsibilities Prof. Hewett along with surgeons Dr Scott Siota and Dr Rooney Jagilly concluded a successful meeting with Under Secretary Dr Greg Jagilly and Permanent Secretary Ms Pauline McNeil discussing the role of DAISI visits within the recently published strategic plan.
By the end of this trip, a full curriculum with monthly DAISI volunteer training missions for 2023 was decided and agreed upon. DAISI was keen for the training visits in 2023 to meet all key objectives, and to ensure appropriate monitoring of this. Top of the list was the training of our local partners in all areas of subspecialty surgery with monthly visits by DAISI sub-specialty teams, complementing wherever possible the visits also planned by other visiting NGOs, including our partner and sister organisations Australian & New Zealand Gastroenterology International Training Association (ANZGITA), the John James Foundation, The Solomon Foundation, Strong Island Foundation, and the Royal Australian College of Surgeons (RACS) Pacific Islands Program as well as a growing number of trips planned by the new emerging player in the region, China.

In February colorectal surgeons Professor Matt Rickard and Dr Robert Winn conducted a colorectal training trip to National Referral Hospital (NRH) and Gizo hospital. Structured lectures on bowel obstruction, left hemicolectomy surgical technique and CT interpretation were given on the request of NRH surgeons due to the growing need in these areas. These lectures were well received and attended by all the local surgeons and surgical trainees with Promotion of this event through social media, Whatsapp and email endured high attendance rates.

Prof. Matt Rickard gives lecture on bowel obstruction at National Referral Hospital (NRH)..

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Formal teaching will from now on be much more emphasised on all training trips.

In March this year Gynaecologist Dr Alan Tong and Anaesthetist Dr Leo Lacy conducted the first gynae trip to Gizo provincial hospital since COVID. This ten membered DAISI team included four gynaecologists and, although a little overpowered for the number of cases prepared, was overall a very successful mission. Despite laparoscopic surgery training being an intended major emphasis of this trip, this was hampered due to the need to bypass NRH where the majority of trainees are located as theatre renovations were underway. However the one gynae trainee in attendance was exposed to both simulator and real live laparopscopic training.

Dr Alan Tong teaches gynae trainee Dr Angeline Nagu basic principles of laparoscopic surgery at Gizo hospital in March 2023.

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The ten memberer gynae team with local staff at Gizo Hospital March 2023. Left to right:  RN Chris, RN clayrick, Dr Pinar Cingiloglu, Dr Sui, RN Thadeus, Dr Dhivya Thangavel, RN Rilence, Dr Alfram, RN Finlyn, RN Larisa, RN Patricia Boso, RN Ulla Maekinen, Dr Jose Perreira, Dr Nargis Noori, Dr Leo Lacy, Dr Angeline Naqu, Dr Mandy Wang, Dr Alan Tong, Dr Martin Plymouth, Dr Luting Liu, & RN Clayton Deylano.

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It was felt during debrief that in order for DAISI to meet its teaching objectives, future gynae visits should include National Referral Hospital (NRH) in the capital Honiara, where most of the specialists and trainees are located.

Later this month urologist, and previous Chair of DAISI Dr Tim Nicholson will conduct a urology visit to Gizo Hospital with local surgeon and urology trainee Dr Augustine Melly. This trip will also include an anaesthetist Dr Ian Carter and DAISI funded urology CNC Yolanda Zhao.
This urology trip poses unique challenges both in terms of the equipment and the large volume of irrigation fluid required for cystoscopy and transurethral prodtate surgery. Training of a local surgeon in urology is essential after loss of the inly urologist from the public sector in the Solomon Islands ten years ago.

This will be followed a vascular & Diabetic foot trip in May, the second of its kind led by vascular surgeon Prof. This is in response to the huge burden placed by diabetic foot disease placed on the limited number of hospital inpatient surgical beds at National Referral Hospital (NRH). This trip will focus mainly on the teaching of outpateint management of diabetic foot ulcers.

A Head and Neck trip by Dr Eva Wong & Dr Linda Fenton is also planned for June, a second gynae trip in July and a hepatobiliary trip by upper GI surgeon Prof Sandroussi in September 2023.

DAISI, being non government funded, requires its members to volunteer their services and pay their own way. The challenge, as always on these trips, is to provide the highest possible standard of care and training, whilst dealing with limited resources. This requires our volunteers to be skilled, resourceful, and wise in their decision making. DAISI is incredibly grateful and blessed to have so many volunteers with all these attributes.

With this year’s program fully booked, DAISI is now recruiting suitably qualified specialist volunteers for 2024.

Author Dr Gary McKay is a general & colorectal surgeon from Sydney.  He is the founder of DAISI and the current elected Secretary.

Jan 14
5

By Mavis Nishimura Podokolo

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

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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.

Dec 22
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By Dr Matthew Malone

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If the news reported that crocodile or shark attacks were to blame for 20 people losing their legs in 1 month alone, there would likely be a call to arms. This problem is actually occurring as we speak, except crocodiles or sharks are not to blame… Its Diabetes.

I was recently invited by DAISI to visit the Solomon Islands on a fact-finding trip to look into and report on the extent of diabetes related foot disease. I have worked across the UK, Middle East and Australia and further consulted across the globe in the area of diabetes foot disease. I have been exposed to varying levels of healthcare and worked in areas with different populations and incidences of diabetes foot disease. However, the extent of this problem in the Solomon Islands is disturbing. Diabetic Foot Disease, including foot ulcers are amongst the most common complications of uncontrolled diabetes. People with diabetes are more susceptible to developing foot ulcers that are slower to heal and more prone to infection. Currently in many Pacific countries, untreated, infected diabetic foot ulcers are leading to multiple amputations and sometimes death. The true extent of foot disease in the pacific islands is largely estimated, because there is no accurate record keeping.

I visited the National Referral Hospital in Honiara and had the opportunity to spend the day with a wonderful general surgeon Dr Rooney Jagilly. Dr Jagilly heads up the general surgery ward, a ward consisting on 50 beds. Alarmingly, such is the extent of the diabetes foot disease that 50% (25 beds) of the ward were solely dedicated to people with diabetes foot disease. Many patients had extensive leg amputations or surgery to remove large sections of the foot, secondary to infection and sepsis. The surgeons, the nurses and all ward staff work effortlessly, but are faced with significant challenges that include a never-ending tide of new people needing beds for diabetic foot disease, the lack of basic health infrastructure and support, and a lack of some basic woundcare necessities. In addition, the problem of managing diabetic foot disease in the out-patient setting paints a similar picture. I also spent the day working in the diabetes-wound clinic. The clinic treats between 30-50 patients with diabetic foot ulcers per day, with minimal resources. In the face of such adversity, I was overwhelmed by the nurses and doctors, that despite the inherent lack of equipment or support, strove to provide the best care they could for each patient, with so little.

What was glaringly obvious to me was that this is a massive problem in need of support. I am not the only person to recognise that diabetes and its complications are a scourge on the pacific islands. In 2015 the International Diabetes Federation reported the astonishing statistic that Pacific island countries or territories accounted for eight of the top ten in the world for diabetes prevalence. About 40% of the Pacific island region’s population of 9.7 million has been diagnosed with a noncommunicable disease, notably cardiovascular disease, diabetes and hypertension. These diseases account for three quarters of all deaths across the Pacific archipelago and 40–60% of total health-care expenditure.

The table below shows the change in diabetes prevalence for selected low- and middle-income countries of interest to Australia, with Australia included as a comparator.

 

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Fig 1. Diabetes prevalence rates in Australia versus South-Pacific Nations.

With a doubling of diabetes in the South Pacific in the last quarter of a century it can only be viewed as an epidemic worthy of serious concern and consideration.

With this in mind DAISI has thought it necessary to begin to address the burden of illness particularly as it relates to inpatient admissions to National Referral Hospital, the major referral hospital in Solomon Island’s Capital Honiara.

Dr Matthew Malone is the current Head of Department for the High-Risk Foot Service at Liverpool Hospital in Sydney and a Senior Research Fellow with the Liverpool Diabetes Collaborative Research Unit at the Ingham Institute of Applied Medical Research Sydney. In December 2019 Dr Malone travelled to National Referral Hospital (NRH), Honiara, Solomon Islands to organise and conduct a two day diabetic foot clinic, as part of a pilot program intended to improved the management of the diabetic foot, and reduce admission and amputation rates.

 

Feb 21
5

by Gareth Iremonger

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This year, DAISI® was proud to welcome Petra Breiting to the group. Hailing from Switzerland Petra has more than 30 years experience as an OR Scrub Nurse and Trainer. In early 2000 Petra volunteered her time and experience training local theatre staff at the National Referral Hospital (NRH). Over the years she has worked tirelessly to source medical equipment for the Solomon Islands.

On her recent visit to Gizo Hospital she was shocked to find a lack of clean drinking water for patients and their families. Gizo hospital has running water but it is pumped from an underground aquifer. The pumped water is brackish and only able to be used for grey water systems. Drinking water must be bought or sourced from the island of Kolambangara, which is almost 20km away. Resupply trips occur weekly but it’s a costly exercise and does not meet the demands of a growing number of patients and families.

Clean water is vital to the health of all communities and essential to recovery. Petra in collaboration with others has kindly donated funds for the new water treatment unit at Gizo Hospital. The water treatment unit is manufactured by the Swiss company Trunz which manufactures and distributes solar and wind powered water purification and desalination systems as well as energy supply systems for remote locations.

The system will be installed in April and will supply up to 600 liters of clean potable water per hour. Storage tanks will also be installed to provide a back up supply. Long term there will be efforts to capture rainwater from the roof of the hospital.

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Water purification and water tanks similar to those planned for Gizo hospital in April 2016.

With easier access to water, and continued efforts to improve sanitation practices we are improving the health of the western province.

Please consider donating to DAISI®. Every dollar counts and we are very grateful for your support. Petra is just one of the many inspiring people our group supports. By donating to DAISI®, you are saving and improving lives every day.

Gareth Iremonger is an aerospace physiologist, flight lieutenant in the Royal New Zealand Air Force, and was a final year intern in Auckland when he volunteered at Gizo hospital emergency department for 3 months in 2015.  He is committed to ongoing humanitarian work with a particularly interest in medicine in the Pacific islands, and is the Vice-Chairman of DAISI.