David Graham
In 2023 Dr David Graham led a team to the Solomon Islands. The team included AHSS members Dr Anna Watson and Dr Brahman Sivakumar and AHTA hand therapist Stacey Fritsch.
The outreach itself was based at the National Referral Hospital [NRH] in central Honiara. NRH is a 300-bed hospital and is the only facility in the Solomon Islands offering Orthopaedic treatments. Over the last decade and a half, orthopaedic training has been facilitated through the auspices of the Pacific Islands Orthopaedic Association [established by Queenslander Dr Des Soares], with regular teaching trips by several faculty based in Australia and New Zealand.
A separate hand surgery component has been established by Swiss surgeons [Drs Hermann Oberli, Konrad Mende and Alexandre Kaempfen, who have set up the HandsOn training programme, with twice-monthly zoom meetings, teaching modules and outreach trips once to twice per year. The HandsOn programme proved the perfect blueprint to insert the Australian outreach trip, and with collaboration with this team and their programs, it has allowed for allocation of specific teaching topics to ensure continuity and completeness.
This trip involved busy preoperative clinics in the fracture clinic of the NRH. Most patients triaged presented with the sequelae of missed or mismanaged trauma or following burns contractures. There were also several patients with congenital hand pathology, as well as compressive neuropathies. Once all the patients were assessed, the team sat down with the local registrars to plan the operating week.
The local registrars consisted of Drs Clay Siosi, Agnes Auto, and Oralae Pitakia The operative cases were allocated to maximise teaching opportunities and hands on experience for the local staff.
Two operating theatres were made available for the visiting team throughout the week, and were stocked with non-locking fixation equipment, an older intraoperative fluoroscopy unit, a basic microscope, and Esmarch bandage for exsanguination. Various equipment requirements were highlighted for procurement in future trips, including locking plates and cannulated screw technology, fine k-wires and a pneumatic torniquet. An ultrasound machine may also be of benefit, as anaesthetic blocks are currently rarely performed and unguided when they are. Ultrasound guided will likely increase theatre efficiency and through-put if popularized.
The team commenced operating on Monday afternoon and continued until Friday. Notable cases included a first stage Maquelet for an infected non-union of a proximal ulna, a four-finger first stage flexor tenolysis and insertion of spacer, tendon transfers for PIN palsy following a shark bite, and multiple burn contracture releases. Patients were reviewed at the following morning ward round and then discharged. Select patients underwent a wound review on Saturday morning, with Stacey and local physiotherapists fashioning thermoplastic splints and commencing rehabilitation.
Education was a key focus of this trip, and in addition to hands on education, formal lectures were organised, and attended by all the registrars, consultants and several auxiliary staff. Topics covered included the basics of fracture fixation for distal radius, metacarpal and phalangeal fractures, and the principles of soft tissue reconstruction around the hand. Cases were also analysed, with the opportunity for informal questions and discussion. As Clay was coming up to his fellowship exam [to be held in Suva, Fiji], he was critiqued on his history-taking, physical examination and management plans. Stacey also liaised with the local physiotherapists and identified a young up-and-coming clinician to take on the role of NRH hand therapist in the future. The AHSS has funded two pneumatic tourniquets for the NRH and loupes for the local surgeons/registrars, both of which were gratefully received. Orthopaedic Outreach and AHSS also generously facilitated Clay and Agnes to attend the AHSS annual scientific meeting in Sydney 2023.
David Graham, Anna Watson, Clay Siosi-Lewi, Brahman Sivakumar in the operating theatres of National Referral Hospital, Honiara.
Clay Siosi-Lewi, Anna Watson, Brahman Sivakumar, David Graham, Stacey Fritsch (AHTA) with local nurses and therapists.
