O S S A A

 

OVERSEAS SPECIALIST SURGICAL ASSOCIATION OF AUSTRALIA

 

TEAM VISIT

 Cancar, Flores

 

                  April 18 – 25, 2009.

 

                       

 

TEAM LEADER’S REPORT

 

 

 

DR MARK MOORE AM

MB, ChB, FRACS

PLASTIC AND CRANIOFACIAL SURGEON

 

Implementation of Dr John Hargrave’s mission in East Timor and Eastern Indonesia; providing a specialist surgical service to the disadvantaged where the service is not available or affordable 

 


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AIMS AND GOALS

 

 

1.                  The provision of an ongoing, regular, high quality Plastic and Reconstructive Surgical Service to those patients with physical disability and deformity, both congenital and acquired in the region of Nusa Tengarra Timur (NTT), Indonesia where this service is not available or affordable.

 

 

2.                  To continue to work with our counterpart local medical and nursing staff in the hospitals of NTT where we visit to teach and transfer those skills necessary to appropriately manage patients with physical disability and deformity, with particular focus on cleft lip and palate and burn and burn contracture management.

 

 


 

INTRODUCTION

 

Since 2002 the OSSAA Plastic & Reconstructive  Surgical teams have been the only reconstructive surgical service provided on a regular basis to the patients of NTT.

These teams and their predecessors have focussed their attention at the St Damian/St Rafael Hospital complex in Cancar, Flores and in more recent times expanded to Halilulik, West Timor, as well as an anticipated visit to Lela, Flores later in 2009.

 

This visit in April 2009 is the first OSSAA visit to Cancar in this calendar year and was developed as a single surgeon visit following a request from our local counterpart staff.   Some refurbishment of the theatre environment was being undertaken with a new anaesthetic machine being commissioned so that only one operating theatre was available.

 

The team was met and accompanied by Dr Harianto, our counterpart doctor and leprosy specialist who, having recovered from his own recent illness, was able to contribute fully to the team’s consultative and surgical service provision.

 

As with most previous visits, patients presented to our team from widely throughout the length of Flores, as well as a number of patients from the nearby island of Sumba and some also from West Timor.


 

TEAM MEMBERS:

 

 

      Dr Mark Moore, AM                                Plastic Surgeon/Team Leader

      Dr Harianto Hendrikus                             Leprosy Specialist / Counterpart Surgeon

      Dr Tony Pearce                                         Anaesthetist

      Mr Darren Bradbrook                               Anaesthetic and recovery nurse

      Ms Ruth Boveington                                Coordinator / Interpreter

 

      Counterparts:

 

      St Damian                                                St Rafael                               

     

      Sr Virgula SSpS                                        Sr Reginardis SSpS

      Sr Elsa SSpS                                             Dr Michael.                

      Sr Maria SSpS                                           Dr Tommy                              

      Pak Ferdi Jaleng                                        Ibu Ernavati   

      Pak Ferdi Jelalu                                         Ibu Sabina

      Pak Nasrin                                                

      Ibu Meri Moe                            

      Ibu Tanti                                                  

      Pak Nasrin                                                

      Pak Pontianus Kon Tamat

                                                                                               

                                                                                

                                                                                            

 

    

LOCATION

 

      St Damian and St Rafael Hospitals, Cancar, Kab. Manggarai, Flores, NTT

                                                        

The visit on this occasion was coordinated and overseen by the SSpS sisters of St Damian and St Rafael Hospitals, with the appropriate notification to the patients of the region of the team’s visit being fully undertaken by local staff following communication with the OSSAA team coordinator.

 

Following the initial consultation clinic the operating schedules for the week’s work was communicated by the team to the local nursing and medical staff, allowing appropriate planning and scheduling of theatre times.

                                                        


 

OVERVIEW

 

This OSSAA Plastic and Reconstructive Surgical visit to Cancar was the first in the calendar year 2009. The team continues with a programme of twice yearly plastic surgical visits, this having been augmented in recent times by both orthopaedic and ENT surgical services.

 

Where initial planning of this visit had included an orthopaedic team in concert with the plastic surgical team, due to the unavailability of an operating theatre it was agree to defer the orthopaedic surgical visit until later in the year.

 

With the regular nature of team visits to this complex the local staff are well attuned to the requirements for planning these volunteer surgical missions and this visit proceeded in a largely uneventful fashion as has become standard in recent times.

 

The local counterpart medical staff working with the team on this occasion included Dr Harianto Hendrikus, our long term, highly regarded colleague who once again joined the team from Jakarta and contributed significantly both from the view point of a consultative service, as well as undertaking a large number of minor surgical procedures.  The team were also able to work with Dr Michael, a resident local medical practitioner who has now been present in Cancar for more than one year and has worked with the team on at least two previous occasions.

 

The travel arrangements for the team to arrive in Cancar proceeded in a fashion that has become standard over recent visits.  This involved transfer from Bali to Labuanbajo, via Indonesia Air Transport, this having been organised by Mr Hendrik Tawur.  Having arrived safely in Labuanbajo the team was met by staff from St Damian, whereupon we were transferred to the SSpS shop in the township.  A small number of patients were seen there prior to our road transfer to Cancar.

 

Having arrived at St Damian late on Saturday afternoon, the team commenced an assessment clinic so that by day’s end 32 patients had undergone assessment.

 

On Sunday morning the assessment clinic continued with members of the plastic surgical team seeing more major cases.  Dr Harianto undertook review of the large number of patients with more minor skin lesions and lipomas.  At the completion of both these clinics more than 100 patients were seen and theatre lists constructed for the following five days.  Later on Sunday afternoon the team proceeded to the operating theatre complex to prepare the theatre and anaesthetic equipment for the week’s operating.

 

Once again the largest clinical workload for the team were those patients with cleft lip and palate deformities.  It was pleasing to see that a large number of patients returned for cleft palate repair, having had their cleft lips repaired on preceding visits.  These included a number from the eastern end of Flores who had travelled considerable distances to bring their children back for the second step in the programme of cleft repair.  This enabled the team to review the results of its preceding cleft lip surgery and it is now becoming possible to undertake both lip and palate surgery at an age appropriate time.  There are however still a number of older children and adults who continue to present unrepaired, usually having been denied access to a full and proper programme of education because of their unrepaired facial deformity.

 

The other area requiring ongoing clinical input is in the field of burn contracture management.  A number of long term patients with severe, extensive burn contractures were reassessed and proceeded to surgery.  With the available splinting and physiotherapy services in Cancar it is pleasing to see that these patients are achieving dramatic improvement in function and cosmesis. Included in this group was a patient with severe burn contracture of the anterior neck which was released during the November 2008 visit and resurfaced using a split skin graft.  This has healed extremely satisfactorily and has been splinted well by the local staff.  She has maintained virtual full release of her neck and on this occasion the team was able to proceed to skin grafting of her periorbital soft tissues to allow her to close her eyes.  This surgery was undertaken successfully on this visit, such that by week’s end the grafts were left open.

 

The other patient of note from the November visit was the young lady with extensive burn scarring on the right neck and anterior chest who presented with a squamous cell carcinoma in the area of burn scar.  This area was excised and skin grafted in November 2008, and by the time of this visit she had already demonstrated signs of local recurrent tumour.  Further wider excision was undertaken with further split skin grafting and tissue brought to Australia for assessment.  This was again confirmed to be a squamous cell carcinoma.  Ideally this young lady would be further assessed and the possibility of radiotherapy offered to her given the high potential for further local recurrence. She will continue to be seen by the team on future visits.

 

Whilst the main surgical procedures were being undertaken in the operating theatre complex, Dr Harianto was able to proceed with 24 local anaesthetic surgical excisions, these being undertaken in the St Damian Hospital Outpatient area.

 

During the week the team was also assisted by Dr Michael, the local medical practitioner and on occasions Dr Tommy the local dental practitioner also assisted the team.  Dr Michael continues in Cancar for the next few months, although he has plans to return to Jakarta for specialist training later in 2009.  Dr Irwin who previously assisted the team in Cancar has more recently left and gone elsewhere in Manggarai.

 

At week’s end the team undertook a full ward round, passing on instructions to Sr Elsa, Dr Michael and the nursing and physiotherapy staff so that appropriate management of patients can be undertaken following the team’s departure.

 

Early on Saturday morning the team departed to Labuanbajo before catching the connecting flight back to Bali.  The team transited in Bali before returning to Australia.

 

During the visit the team held further discussions with Dr Harianto regarding the establishment of our counterpart NGO in Indonesia.  At this time a preliminary agreement has been signed with the PRR sisters to act as our local NGO office.  Appropriate documentation of this will be put together by Dr Harianto for presentation to the Indonesian Department of Foreign Affairs later in the year.

 

 

 
 

SUMMARY OF THE VISIT

 

 

STRENGTHS:

 

  • Regard and support  for the OSSAA teams from the Regional and Provincial Governments and Departments of Health of NTT.

 

  • Progressing of the NGO agreement with the PRR sisters to satisfy the requirements of the Indonesian Government.

 

  • The ongoing high quality operating theatre environment and ward staff and physiotherapists at Cancar permitting the treatment of increasingly complicated reconstructive surgical patients.

 

  • Indonesian Consul in Darwin for ongoing support and provision of appropriate visas.

 

 

  • Excellent assistance provided by Mr Hendrik Tawur in arranging domestic travel within Indonesia.

 

 

WEAKNESSES:

 

  • The absence of  Indonesian plastic surgical trainees from the visit.

 

 

 
SUMMARY OF TEAM ACTIVITIES

 

 

April 17, 2009.                        Team members assemble in Denpasar

 

April 18, 2009.                        Team departs Denpasar on Indonesian Air Transport.

Arrive Labuanbajo where met by Cancar staff with initial consultations in Labuanbajo and then onward road travel to Cancar.

Patient consultations commence in Cancar

 

April 19, 2009.                        Outpatient consultations

                                                Preparation of operating theatre

 

April 20, 2009.                        Operations, consultations, ward round.

Dr Harianto arrives

 

April 21, 2009.                        Operations, consultations, ward round

 

April 22, 2009.                        Operations, consultations, ward round

 

April 23, 2009.                        Operations, consultations, ward round

 

April 24, 2009.                        Operations, consultations, ward round

 

April 25, 2009.                        Team departs Cancar for Labuanbajo and onward transfer to Bali and thence to Darwin

 

 
SUMMARY OF CLINICAL ACTIVITIES

 

April 18 – 25, 2009. 

 

 

 

Total Patient Consultation:                                      102

 

Total Surgical Procedures:                                       72

 

            GA procedures                                       48

            LA procedures                                        24

 

            Cleft lip                                                21

            Cleft palate                                          14

    Canthopexy                                           01

    Burn Contracture                                    07

     Other                                                   05

 

 


ACKNOWLEDGEMENTS

 

 

  • The sisters and staff in Cancar for their dedication to their communities and the commitment to their patients and the local community.

 

  • The consistently high quality support of the operating theatre and ward staff at St Damian Hospital.

 

  • The respective Bupati in Manggarai, the NTT Health Ministry and the Office of the Consulate of the Republic of Indonesia in Darwin for their continuing support of our work, documentation and provision of visas.

 

  • Pak Hendrik Tawur for organising the internal air travel in Indonesia.

 

  • The various public and private health care institutions in Adelaide who support the ongoing work of OSSAA in this region

 

 

 

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To see a pdf (676kb)of the Photos, please click HERE   

 

 

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