The goals of getting early surgery for neck of femur fractures (NOFs) were stressed and the need for other teams involvement, like our anaesthetists and physicians colleagues. A literature bank was created to contribute articles that will help other teams understand approach to NOFs management. Other conditions of the hip including paediatric conditions were covered and infections of the hip.

A variety of surgical approaches to the hip and acetabulum were covered. Practical stations held mostly in the afternoon and includes clinical stations of history taking and physical hip examination, cannulated hip screw, Dynamic Hip Screws(DHS) fixation, concepts/principles of Hip replacement. (see attached timetable). The module ended on Friday 14^th and students and teachers leaving the next days.

We would like to thank the funders of the modules, South Pacific Projects, AO Alliance, Orthopacifix, Various individual students sponsor Like WHO and Australias DFAT, the lecturers that came to teach out of their own costs.

We acknowledge Dr Patrick Houasia Head of department and the local Orthopaedic team, the National Referral Hospital and Ministry of Health Solomon Islands for hosting the modules and allowing us access to facilities and patients. We Thank The NRH kitchen for providing us meals and for Pacific Casino Hotel, Millys and Rekona lodge for accommodating our students and Lecturers. We Thank Des Soares for organizing the modules, preparing equipment, the logistics to get all of us to Honiara and ensuring the modules go as planned.

Tagio Tumas

Stephen Kodovaru

Topics covered over the week include basics of History Taking and Spine physical exams trauma cervical spine and lower spines, infections, degenerative conditions and paediatric spine conditions and their management (detail timetable attached). The practical stations include history taking scenario (Dr and Patient), students partner to carry out spine examination, dura repair exercise on water filled ballons, setting up skull traction, laminectomy and pedicle screws and posterior lumbar fusion on sawbones.

We were able to see a good number of patients with spine trauma admitted in the ward that provided an opportunity for demonstrating clinical signs. The spine module ended on Friday 8 March with an assessment exam. Because of the cyclone in Queensland, Drs Ben and Alpesh had to leave early on Thursday via Fiji and we adjusted our sessions to accommodate the change. Dr Mich and Cheung were able to continue to the end.

Graduation video.mp4

Dr Shaun Mauiliu (2019) and Dr Areta Samuelu (2022) are previous graduates of the PIOA program and now serve on the faculty of Miedicine at the National University of Samoa teaching orthopaedics. They are also emplyed as orthopaedic surgeons at TTM Hospital Apia.

You can view the entire graduation ceremony here https://www.facebook.com/watch/live/?mibextid=wwXIfr&ref=watch_permalink&v=1026564382724927&rdid=BsSPOmzhWrlzxvRp

Here Dr. Tommy Walters from Lae in Papua New Guinea (PNG) writes “Hi Des . I used my loupes today for a Radial nerve exploration and repair (Male 50, bush knife wound left distal humerus/elbow). It was really helpful. Thank you for my loupes. Tommy.”

Sadly, PNG is rife with violence and bush knife injuries are common. Tommy’s new skills will be very useful for the people of Lae.

Middle image : Blue – proximal end. Green distal end just approx. 0.5-1mm from where it divides into Superficial and deep branches.

Right image – Repaired Radial Nerve

2017 Hip Course.(From L to R) Dr Vaughan Poutawera (NZ), Dr Silent Tovasia (First Solomon Island orthopaedic surgeon), Dr Hermann Oberli (pioneer of orthopaedic surgery in Solomon Islands (Swiss)), Dr Andy Vane (NZ).

We will have 14 students from 7 countries (Papua New Guinea (5), Solomon Islands(2), Timor Leste (1), Fiji (2), Palau (1), Vanuatu(1) and Samoa(2). Lecturers from Solomon Islands, Australia, New Zealand and the United States (Hawaii) will assist with teaching.

PIOA graduates and trainees were invited to participate in the International Society of Limb Salvage (ISOLS) 24 meeting in Brisbane.

PIOA is very grateful to Peter Steadman and Prof. David Wood for organising a special workshop to develop tumour services for the Pacific.

PIOA graduates Areta Samuelu (Samoa), James Tewa’ani (Solomon Islands, Juvencio Dias (Timor Leste) and trainees Viola Kokiva (PNG) Tommy Walters (PNG) and Pauliasi Bauleka (Fiji) and prospective trainee Jenny Tovu (PNG) with Eka Wiratnaya (faculty from Bali).

The PIOA exit exams follows the approximate format of the AOA / RACS exams. There are 2 written papers with 10 short answer (1 page) questions each. There are 2 Operative surgery computer vivas (with 5 cases in each) and 1 Imaging and Investigation computer viva (with 5 cases). There are 2 clinical vivas (with upto 5 patients in each). In all, there are 45 clinical scenarios assessed and the exam is mapped to ensure a wide coverage of the curriculum.

The written exams and computer cases for Operative surgery and Imaging and Investigation were prepared by Dr Richard Lander with assistance from Dr John North. Unfortunately both Dr Lander and Dr North became unwell shortly before the exams and were unable to be there as examiners. Dr. Lander did provide advice to the examiners at the final examiners meeting. PIOA is grateful for the dedicated servcie over many years by Dr Lander and Dr North.

The examiners were Dr Andreas Loefler from Australia, Dr David Bartle from New Zealand and Dr Shaun Mauiliu from Samoa who have all been examiners for PIOA previously.

There were 4 candidates and 3 were successful.

PIOA congratulates the following successful candidates

Dr Anthony Nasai, first PIOA graduate from PNG (with Haynes Rasin from Bougainville, PNG)

Dr Juvencio Dias, first PIOA graduate from Timor Leste

Dr Reshwin Rajan, Solomon Islands / Fiji (with fellow Solomon Islands trainees Oralae Pitakia, Jeffrey Yiapi and Agnes Auto)

Module 2 was held at the Tupua Tamasese Meaole (TTM) Hospital in Apia, Samoa from 16^th to 27 September 2024. There were 12 trainees who attended the module. They are Dr. Robert Fa’ataga and Dr. Michael Leota from Apia in Samoa, Dr. Agnes Auto, Dr. Oralae Pitakia and Dr. Jeffrey Yiapi from Solomon Islands, Dr. Paul Lomavatu and Dr Manoa Valeniyasana from Fiji, Dr. Tzun Rafael from Palau, Dr. Julio Martins from Timor Leste and Dr. Thomas Kiele, Dr Haynes Rasin and Dr Tommy Walters from PNG.

The lectures were delivered by Dr. Shaun Mauiliu and Dr Areta Samuelu from Samoa, Dr. Roy Craig and Dr David Lees from New Zealand, Dr Graham Gumley, Dr Jenny Green, Dr Sarah Coll and Dr. Des Soares from Australia. Prof. Nik Friederich from Basle in Switzerland taught Research methods each morning via Zoom.

In this module, the students were taught a systematic approach to diagnosis and management of orthopaedic Upper limb conditions. This included clinical history taking and a thorough clinical examination, investigation and a structured, systematic approach to orthopaedic decision making. There was also an emphasis on a systematic approach to the management of upper limb conditions including the management of closed and open fractures and hand trauma. In addition, there were focussed lectures and practicals on the management of trauma affecting the long bones of the limbs, tendon repair and microsurgery techniques for nerve and vessel repair.

 Lectures were supplemented with practical demonstrations. Each morning. we commenced with a ward round seeing two patients and getting the students to present the history and clinical signs of the patients. Their management was then discussed and suggestions for improvement were made. This was a useful exercise as we were able to improve clinical skills. It was also helpful to try and elucidate clinical reasoning and decision making and help with developing these skills. The students enjoyed having expert advice on the diagnosis and management of Shoulder and elbow conditions such as rotator cuff disease and frozen shoulder.

The students were assessed with practical tasks (history taking, focussed clinical examinations and a practical task (tendon repair on pork trotter, microsurgical nerve repair on Chicken Maryland (sciatic nerve) model as well as a written examination on the final day of the modules.

The Research methods module was taught by Prof Nik Friederich by Zoom from Basle in Switzerland. Each day we began with a lecture and practical exercise aimed at understanding basic Research methodology including basic statistics and working throgh critical analysis of the surgical literature.

The exit exam was also held in the second week. There were 3 successful candidates Amthony Nasai (PNG), Juvencio Dias (Timor Leset) and Reshwin Rajan (Fiji / Solomon Islands).

Our thanks to the staff and patients of the TMM Hospital, Apia, and Lynn’s Getaway accommodation. Our special thanks to Bek’s restaurant who provided nutritious food for the duration of the course and made us feel at home.

Finally, this module would not have been possible without the generous financial support from the Pacific Community (SPC), Wyss Medical Foundation, AO Alliance Foundation, Australian High Commission, Palau and South Pacific Projects.

We will have 12 students from 6 countries (Papua New Guinea (3), Solomon Islands(3), Timor Leste (1), Fiji (2), Palau (1) and Samoa(2).

Papua New Guinea Fiji Solomon Islands

Samoa Palau Timor Leste

Lecturers from Samoa, Swizterland, Australia and New Zealand will facilitate the module.

In addition, 4 PIOA students will sit for their exit exams in the week 23-27 September 2024. This includes studenst from Papua New Guinea(2), Fiji (1), Timor Leste (1).

Check the website for a report on the module in early October.

The main purpose was to do and teach basic spine surgery (discectomy and all types of decompressions, no instrumented surgery). I brought a spinal bed (Wilson frame ) with me and some basic decompression instruments.

We did 13 spinal decompressions, had 2 dural tears (sutured during the surgery) , but no other complications. During my stay I also did many other surgical procedures such as infection surgery, revision surgery, severe trauma (dislocated spine) and corrective surgery. There was great support from the team, nursing staff and an enormous gratitude from the patients.

I was impressed by the great hands of the surgeons and the failure of surgery or bad outcomes were almost entirely attributable to lack of proper instruments and implants. I believe Samoa has a great future for orthopaedic surgery, but will need ongoing support.

I encourage other surgeons to spend time in Samoa, supporting the team with mentoring and upskilling. Especially subspecialty surgeons/teams are useful, since they already have a good solid basic skill set.  

Besides work, I had the pleasure to enjoy Samoa at its best ; food, beer, golf, walks, snorkeling, wedding, BBQ, quiz night, a visit to Savaii, dinners and parties. 

I can only recommend it. Everyone benefits from this experience, myself and the people of Samoa. What more can one ask for.

Koen De Ridder,

(Paediatric and Spinal orthopaedic surgeon – usually based in Wellington, New Zealand)