Regional Anaesthesia in Kiribati

By Dr Harry Lam

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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.