David Graham
In 2018, 2019, 2022 and 2023 Dr David Graham led a team of surgeons and hand therapists to Kathmandu, Nepal. These trips were in conjunction with Orthopaedic outreach and AUSNEP charity. In the process of making ongoing and sustainable relationships with local surgeons and therapists, the team initially visited the Tribhuvan University (TU) Teaching Hospital and
Sushma Koirala Memorial Hospital. The 2023 trip was transitioned to the National Trauma Centre, Kathmandu, Nepal at the invitation of Dr Shilu Shrestha.
Dr Shilu Shrestha is the only fellowship trained hand and microsurgeon in Nepal and is a pioneer female surgeon. Dr Shilu is dedicating her career to advance the practice of hand and microsurgery throughout Nepal. This visit included provision of donated equipment, technical oversight during hand surgeries and treatment as well as facilitation and support of a scientific meeting.
Patients were pre-identified by Dr Shrestha and her registrars and brought into a joint clinic with our two hand surgeons and therapists. This allowed for collaborative discussion and guidance through management for the 34 patients reviewed. There was a significant trend of complex trauma from machinery and road accidents, with a delayed presentation to tertiary centres. Many open fractures had been managed with suturing and casting only. Management in the tertiary centres was primarily with K wire fixation for all hand and elbow fractures.
A full day workshop led by local hand therapist Sanju and supported by Australian hand therapists Paul Foster and Clancy Tisdell was well received by the local physiotherapists. This followed on from previous workshops led by Marin Suzuki, Natalia Alfaro, Jade Wong and Stacey Fritsch. Lectures included non-operative management for hand conditions and post-surgery rehab considerations. The afternoon included practical classes on casting and thermoplastic splinting. Sanju has formed an online network with the attendees and the hand therapists, who will all continue to provide advice once the physiotherapists return to their local centres.
The trip culminated in a CME symposium on hand surgery. This comprised of a full day of lectures from the hand surgeons and hand therapists. Nepalese orthopaedic surgeons and registrars had travelled from a range of hospitals in Kathmandu and other cities to attend. The CME participants commended the day and requested for this to become an annual event. Feedback also included wanting a practical workshop, more case presentations and collaborative discussions for next year. Other AHSS surgeons who have generously donated their time and expertise to Nepal include Dr Brahman Sivakumar and Dr Trevor Gervais.
The Nepalese surgical team, including the local surgeons and nurses, who all worked together. Local surgeon Dr Shilu Shrestha and Australian team including David Graham, Brahman Sivakumar, Sarah Brereton (Registrar), Graham Hextell (Orthopaedic Outreach).
In traditional Nepalese dress, the visiting team are acknowledged for their support to the local community. Image from aus-nep.com. David Graham, Brahman Sivakumar, Sarah Brereton, Paul Foster (AHTA), Clancy Kemety (AHTA), Lisa Kiddle (AUSNEP), Helen (Maggie) McGuire (AUSNEP), Hayley McGuire (AUSNEP), Vin Mantala (AUSNEP).
