To introduce another orthopaedic surgeon to the visits to Cancar

INTRODUCTION

The orthopaedic programme at St. Damian has been the culmination of the rehabilitation of leprosy patients in the 1970s/1980s which later included the physically disabled and deformed patients. Dr John Hargrave MBE, AO provided some surgical treatment since 1993 which instigated the visits which are now undertaken by the orthopaedic surgical teams.

The regular visits from the Plastic/Reconstructive and Orthopaedic surgical teams since 2002 have seen the development of St Rafael and St Damian Hospitals into better functioning establishment. A new operating theatre complex has been added to St Rafael, St Damian has built a new accommodation block for visiting teams which include clinical assessment rooms, a room where local anaesthetic procedures are performed plus wards where patients are prepared for surgery and accommodated immediately after surgery.

 
Despite the rain season, patients from all over Flores arrived presented for assessment and treatment, some patients were still unable to make it due to bad roads.

Team Personnel:
Personnel included in this team were:
Dr. Tim Keenan    Orthopaedic Surgeon/Team Leader
Dr. John Kagi   Orthopaedic Surgeon
Dr. Colin whitewood   Orthopaedic Surgeon
Dr. Jerome Wisniewski Anaesthetist
Dr. Ross Boulter Anaesthetist
Mrs. Victoria Gibson Theatre Nurse
Mrs. Helen Wood Recovery Nurse
Ms Ruth Boveington    Coordinator

Indonesian counterparts:
Dr Hendrikus Harianto Leprosy surgeon / counterpart surgeon
Dr Michael Resident GP – St RafaelDr Irwin Resident GP – St Rafael
Operating theatre nurses – RS St Rafael
Ibu Ernavati
Ibu Viktoria Ibu Sabina Pak Kanis Pak Donny
Location  St Damian and St Rafael Hospitals, Cancar, Ruteng, Kab Manggarai, Flores NTT

The organisation and management of the consultation and assessment clinics and post operative care was overseen by Sr Elsa SSpS and the staff at St Damian. In the operating theatre complex, the theatre nurses Ibu Viktoria, Ibu Sabina, Ibu Ernavati, Pak Donny and Pak Kanis worked tirelessly under the guidance of Sr Reginardis SSpS.

Overview

The team met at Bali on the morning before travelling to Labuan Bajo. The assistance of Pak Hendrik (travel agent at Bali) at the domestic check in counter was invaluable enabling the team’s baggage being loaded without excess baggage charge. The return tickets were reconfirmed at check in before departure. On arrival at Labuan Bajo, the tickets were again reconfirmed as from experience, it is difficult to assume that the reconfirmation at Bali airport would guarantee availability of seats on the return flight.

The team was provided lunch at Labuan Bajo where half a dozen patients were consulted before travelling to Cancar. The road trip was good although parts of the roads were being eroded due to the rain season which was just ending and considerable roadwork was being undertaken to enable the road to be passable.

Patient consultation commenced soon after arrival and continued for 3 hours. Given that it was
late and for fear of rain, only patients from Cancar (resident patients and patients being accommodated at St Damian) were consulted and assessed that evening with the bulk of patients from outside Cancar to be seen on the following day (Sunday).

On the Sunday, after patient consultation the team visited the operating theatre to set up for the week. It was noted then that apart from the anaesthetists who had brought required medical supplies and consumables, no one else on the team had brought any consumables and had to depend completely on the supplies in storage, left by the previous (Plastic) team. There was a limited amount of such items as crepe bandages, nylon sutures, larger size sterile gloves etc. One of the nurses had to borrow a box of larger size gloves from his clinic as the gloves at the hospital were not big enough to fit our surgeons’ hands.

By the end of the week, a total of 100 patients were seen, most of which were children with club feet. A total of 42 surgical procedures were performed, 8 of which were local anaesthetic procedures performed by Dr Harianto. Many more patients from East Flores were expected but due to the wet season, parts of the roads in the area were impassable, therefore they were unable to arrive for assessment. Most of the patients that arrived were from Bajawa, they were with club feet deformity.

The inclusion of the third orthopaedic surgeon (Dr. Colin Whitewood) who is also a qualified physiotherapist proved very productive. Dr Whitewood was enthusiastic and keen to teach the
physiotherapy staff at St Damian follow up physiotherapy techniques for post operative patients. He has expressed interest in being involved in future visits. Dr Harianto left the general surgical team at Soe to join the orthopaedic team at Cancar. He had been assisting and guiding the general surgical team at Halilulik and Naob before travelling to Cancar to join the orthopaedic team. Later in the week, he had to return to Kupang to again accompany the general surgical team to meet with the Director of Health at Kupang to express gratitude to the department for the assistance provided with the clearance of general surgical team’s medical supplies through Customs at Kupang airport.

Strengths

Continued support from the Office of the Bupati of Manggarai, SSpS sisters – Cancar, and the Office of the Consulate of the Republic of Indonesia in Darwin

The last orthopaedic team visit undertaken in October 2006, therefore this visit was most welcomed by orthopaedic patients who have waited since the last visit.

The inclusion of Dr. Whitewood who is an expert physiotherapist as well as an orthopaedic surgeon was invaluable.

Continued active interaction with the untiring operating theatre and ward nursing staff

Opportunity to work with available local doctors

Domestic flight bookings were problem free
 
Weaknesses

Timing of the visit was at the end of the rain season therefore many patients were unable to arrive due to bad roads

Lack of consultation with new team members on preparation of consumables for the visit which resulted in inadequate supplies being available.


 
Summary of Clinical Activities – April 12 – 19, 2008

Total number of clinical assessments:  100
Total number of surgical procedures:     42
General anaesthetic procedures            34
Local anaesthetic procedures:              08

Summary of Team Activities – April 11 – 21, 2008

April 11, 2008 Team members arrive in Denpasar Picked up and paid for domestic tickets      April 12, 2008  Team departs Denpasar for Labuan Bajo. Lunch, onward travel to Cancar Met   by SSpS sisters, staff and patients at St Damian. Short break then start patient consultation.
April 13, 2008 Patient consultation / prepare operating theatres
April 14, 2008 Surgical procedures / patient consultation / ward round
April 15, 2008 Ward round / surgical procedures / patient consultation / ward round
April 16, 2008 Ward round / surgical procedures / patient consultation / ward round
April 17, 2008 Ward round / surgical procedures / patient consultation / ward round
April 18, 2008 Ward round / surgical procedures / patient consultation / ward round        Farewell by patients and staff of St Damian
April 19, 2008 Team departs for Labuan Bajo with Sr Elsa SSpS
Team departs for Denpasar.
Most team members depart for Australia
April 20, 2008 Remaining team member departs for Australia