Dr Stuart Myers

Lautoka Hospital, Fiji

Orthopaedic Outreach Hand Surgery team Report: 2005- ongoing

 Fiji has a total population of 849,000 spread over more than 300 islands.
Life expectancy at birth is 66 for females and 73 for males, and the infant mortality rate is 15 per 1000 live births.
However, significant improvements in health indicators have taken place over the past 10 years.
Total health expenditure per capita is US$165. The demand for Hand Surgery  services in Fiji remains high.
Hand injuries are very common. 

Dr Stuart Myers (Orthopaedic Hand Surgeon) and Emilie Myers (Hand Physiotherapist) have spent the last decade working as volunteers
with Orthopaedic Outreach in Fiji.  They have taken bi-annual trips to Lautoka Hospital.  This has involved 16 trips to date, with a large team.

The team of Australian volunteers includes:
Hand Surgeon,
Orthopaedic fellow,
Medical & Physiotherapy students.
Radiographers & Ultrasonographers.
To date more than 100 Australians have been able to participate.


Lautoka is in Western Fiji.  Travel is from Sydney to Nadi with Fiji Airways.  Lautoka is a  ½ hour taxi ride west.
Lautoka is known as the “Sugar city” for its Sugar industry. The population is 60,000.  
The hospital services the western half of the Fijian population.  
The eastern half of Fiji is primarily serviced by Suva Colonial War Memorial Hospital (CWMH),
and Labasa Hospital the North Island.
Lautoka Hospital Facitities:
Lautoka hospital has 375 beds and in 2014-5, is being refurbished.  
There is an ICU, 2 full operating theatres, and 1 minor ops theatre.  
The Physiotherapy department has 10 full time staff, a well equipped gym and hydrotherapy pool (usually empty of water).  
There are no other Allied Health services.  There is a disabled school adjacent to the hospital.

Medicine, Nursing and Allied Health are taught at the University of the South Pacific (USP) based in Suva, and now with a campus in Lautoka.
The workload consists of a variety of adult and paediatric Orthopaedic trauma and elective conditions.  
There are many relating to motor vehicle and  workplace  accidents and mal-united paediatric fractures.  
These are all complicated by the significant Diabetic problem which faces the whole Fijian  population.
Skeletal traction is the mainstay treatment for many fractures which would receive internal fixation in Australia.  
Large Orthopaedic outpatient clinics are held twice a week (>100 per clinic).  
There are daily ward rounds of >60 adult and paediatric Orthopaedic patients.

The treatment options for fractures are limited by the miss match of Orthopaedic stock in the plates and screws kits.
There are few drills and a very limited supply of surgical disposables.  
The post injury/ operative fracture management is impaired by poor quality Plaster of Paris which does not easily set.  
There is also an underutilisation of the well trained Physiotherapy Staff.

The Diabetic problem relates to poor wound healing and a large volume of lower limb amputations.  
There are only a few wheelchairs and no formal prosthetic service.

Impact of Orthopaedic Outreach:
On our first visit, the problem of infection was pressing.  
At that time, the trauma and diabetic cases were in the same ward.  
Subsequently the wards were separated, making a big difference to cross infection rates.
Our team did a full audit of patient notes with the aim to identify key problems.  
The findings were that there are significant delays to treatment and infection.  
More repeat surgery is done in the attempt to salvage cases.  
Emilie did work-site assessments to investigate the local work safety in the Sugar and Wood-chip mill.  
While there are some work safety measures in place, they are not enforced.
Teaching, practical workshops and case reviews occur on every visit to Lautoka.  
Extra Surgery and Physiotherapy workshops have been run in Suva at the University and Hospital over the years as well.
The team takes hundreds of kilos of donations each visit, which are then all donated to the hospital.  
Fiji Airways kindly provides us with free airfreight on our flights to take the gear with us.  
We have been able to provide the hospital with a crutches lending pool.  
The 300 pairs of crutches are loaned out and returned.  
Previously cases requiring crutches had to get into the town, (often non-weight-bearing) to buy a local heavy wooden crutches.  
We have given the operating theatres a printer so cases can be typed and copies printed off for files.
All cases are documented and photographed digitally.
The files are submitted to the hospital for review, as well as to Orthopaedic Outreach and AusAid.
Key Achievements Since 2005, We have undertaken 16 visits to Fiji.
Close to 320 operations have been performed and almost 2000 consultations provided.
Training programmes directed at registrars, medical students, physiotherapists and nurses have also been a feature.  

Dengue Fever, Sugary tea!!.

Meeting fellow Fijian colleagues, and their extended families.  
We have staff gatherings each trip and we have developed good friendships with many of the hospital staff.  
We appreciate the large caseload the local staff face daily and admire them for their constant work.  
We have a system of emailing and discussing cases together, as well as a Facebook page: “Hand Physiotherapy Forum Australia & Fiji”.

Local Needs:
We take enough of our supplies to cover cases seen in the week.  And we  supplement the local surgical resources and orthopaedic disposables.
They need good quality Plaster of Paris and thermoplastic splinting material.
Teaching and continuing education support through online access to journals, and lectures would be very helpful.  
Emilie has compiled a teaching manual “Hand Physiotherapy Fiji” for all central and regional Physiotherapy staff.  
It contains practical hand protocols and patient hand-outs.  Stuart’s website holds a library of lectures online which are Fiji specific.

Donations can be made directly to Orthopaedic Outreach and are tax deductible.
Emilie ran a series of lectures for Physiotherapists in Sydney, and the money raised was donated to Orthoapedic Outreach.
In 2006 Stuart organised for Qantas to provide 25 networked computers for the hospital.
We have left many hand surgery kits, and purchased some chairs for hip fractures among other things.
Ausmedic annually provides us with sheets of thermoplastic.  
We are able to make the hand splints for our patients, and leave the rest which enables the local Physiotherapy department to make splints all year.
Other projects:
School Book donation Project Henry and Anna Myers
Henry and Anna have gathered books from their Sydney primary school and donated them to the Lautoka Hospital Paediatric ward
and to Lautoka Primary school.  This is an ongoing project.  The aim is to create and supply a large mobile library for the children to read.

The plan for the next decade is to continue to compliment the Pacific region training programme with appropriate teaching for Orthopaedic,
Nursing and Physiotherapy.  Regular bi-annual visits by the Hand team will then be able to supplement the local Orthopaedic, Surgical
and Rehabilitation interventions. We endeavour to support ongoing teaching to all staff, and offering treatment and follow up to local patients.
We hope cement local partnerships with various organisations eg Fiji Airways, to ensure a smooth transport process for all of our donations.
Our team will continue to provide case support throughout the year and to communicate with other visiting teams and local staff.

Cane train

  DOnations  Operating theater  Children donating boks  crutches  Aluminium crutches