This DAISI combined surgical and nursing two day forum was led by colorectal surgeon Prof Peter Hewett and stomal therapist Amanda Summers, both from Adelaide. It emphasised various aspects of colorectal and stomal surgery and wound nursing care.
Prof Hewet and Amanda Summers first visited National Referral Hospital (NRH) . The aim of this trip to NRH was to build on skills already acquired from the four previous visits in 2016, 2017 and 2018 including one by Prof Peter Hewett’s in 2018.
The visit began with a Friday morning lecture by Prof Peter Hewett on anorectal conditions to all of the medical staff, with a number of textbooks on anorectal disease left with the departmental head for the surgical registrars to use as part of their training.
There were to be two rectal cancer cases but sadly (but not unexpectedly) one of the patients a 40 year old female decided against the procedure. This provided extra time for teaching in the morning, so Prof Hewett went through a DVD by Prof Bill Heald and Brendan Moran on operative aspects of open ultra low anterior resection which was viewed together before the second planned rectal cancer case. The case was a 64 year old male with locally advanced rectal cancer. Prof Hewett assisted the head surgeon Dr Rooney Jagilly for most of the case but anteriorly it had invaded seminal vesicles so he finished the dissection.
Saturday morning stomal therapist Amanda Summers gave a talk on stomas and management of stomal complications to the surgical doctors. Prof Peter Hewett helped out with a couple of cases: an endometrioma with 4 litres of old blood causing bilateral ureteric compression and an advanced lymphoma of jejunum needing a gastroenterostomy. This allowed for numerous discussions about surgical techniques with registrars.
Amanda Summers is now the second stomal therapist to visit the Solomon Islands as part of a DAISI visit. Amanda provides a description of her visit below:
Working at the National Referral Hospital in Honiara was an incredible experience and I feel truly grateful to have gone over there to share my knowledge and clinical skills with the beautiful Nurses and Medical staff. On the first morning Mary and I had a tour of the Hospital by Maria one of the Head Nurses. It was extremely interesting to see the difference of healthcare in the Solomon Islands compared to at home. I presented to the Nurses a talk on what a stoma is, the different stomas, general management, different appliances, troubleshooting and complications with stomas. I believe this was a wonderful session and that the Nurses were very engaged and asked lots of questions. On the practical side we had the opportunity to attend a pre op and I was able to explain the importance of pre op education and correct site marking. There was also a fistula patient at the hospital that I was able to attend to and with the Nurses present I applied a stoma bag and explained that bags can be used for stomas, fistulas and wounds.
On the second day I presented the same Stomal talk to the Medical team along side Prof Hewett which was also well received. With a little bit more of a focus on how to attend a correct site marking pre op with is the Medical teams role in Honiara as there is no Stomal Therapy Nurse. I also attended some wound reviews with the Medical and Nurse team this was very interesting and together we worked out the best regime that could work with limited supplies.
With the Stomal products that had been previously sent over and the ones I brought over Mary and I set up a little stoma supplies cupboard on the ward for them and I’ll continue to send products to them. Especially now that I have a better understanding of what they require. Along with providing assistance via email.
My time at Gizo Hospital was also truly amazing the Nursing and Medical teams were so welcoming and it was such a pleasure to work with them. Along with the rest of the DAISI team. During my time at Gizo Hospital I attended Stomal education to a small number of staff and some medical students currently on placement there. I worked on the Male and Female wards attending to wound dressings. This was well received especially on the female ward, the staff were very interested in what I had to say and were there watching me attend the dressings to learn from me. I also went to the postnatal Ward. Reviewing C-section wounds, also discussing hernia prevention and pelvic floor exercises for the women and also had time to have cuddles newborns. My highlight of my Gizo was following a Stomal patient’s complete journey from outpatients diagnosis (1st diagnosed last year) and discussion of theatre to pre op siting, watching the whole operation and then attending his post op education on day 1. We also made a little area in the theatre store room for Stomal supplies to be placed and advised each area. This should help them out when/if they have other Stomal patients and also have access to them if they wanted to use the products for wound management too.
Given the opportunity to return the Solomon Islands I believe it would be extremely beneficial to have 2-3 Nurses that have a particular interest in stoma and wounds that I could work solely with and then these Nurses can be identified as stoma and wound resource people for their Hospitals. I would also do more of a focus on wounds then I did this trip and would very much like to observe more of the wounds in the hospital and the outpatient department. Overall the time I spent in the Solomon Islands has been a fabulous learning experience for me and I would love to return one day.
2 minor (Laparoscopic)
3 major (Laparoscopic)
14 minors (open)
5 majors (open)
24 Total Cases