PISA MEETING, 2014
The 2014 PISA meeting was held at the Holiday Inn, Suva in Fiji 18 – 21 August. The title of the meeting was Pacific Surgical Training: Outcomes and Future Directions…Building Bridges. Key themes discussed were:
Disaster Management in the Pacific
Surgeons in Public Health
Trauma in the Pacific
Improving Oncology Outcomes in the Pacific
Visiting Surgical Teams
Development of Specialist Surgical Services in the Pacific
Development of Surgical Trainees
The following presentations have been made available for review:
2009 Tsunami Disaster Response in Samoa – Dr Emosi Petueli
Solomon Isl. Disaster Response Management – Dr Aaron Oritaimae
POMR Tonga – Dr Saia Piukala
CWM Hospital Peri-Operative Mortality – Dr Josese Turagava
Management of Severe Burns – Dr Semesa Matanaicake Jnr
Management of Mangled Limbs – Dr Alex Manumua
Traffic Related Injury in the Pacific – Dr Iris Wainiqolo
Trauma in the Pacific – Dr J Herman
Tuvalu Case Discussion – Dr Maliesi Latasi
The 2014 PISA meeting was sponsored by NZAID, DFAT, Pasifika Medical Association, the Royal Australasian College of Surgeons, Braun, Device Technologies and SAPL.
PISA MEETING, 2010
The 2010 PISA meeting, in association with the Vanuatu Medical and Dental Association, was held in Port Vila, Vanuatu from the 9 – 13 August 2010 at the Tourism, Hospitality and Leisure Centre.
The conference titled, “Health Leadership: strategic responsiveness,” addressed the four key themes:
- Child health
- Burn management
- Surgeons and public health
- Disaster management.
The tenth PISA meeting has been sponsored by NZAID, AusAID, Pasifika Medical Association and the Royal Australasian College of Surgeons.
PISA MEETING, 2009
In July 2009 the eighth meeting of PISA was held in Suva, Fiji with sponsorship from NZAID and assistance from the Royal Australasian College of Surgeons in New Zealand. Representatives from Cook Islands, Federated States of Micronesia, Kiribati, Marshall Islands, PNG, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu were present as well as a number of surgeons from New Zealand and Australia.
The Meeting Covenerwas Dr Ifereimi Waqainabete. Dr Waqa is a General Surgeon, Clinical Director of CWM Hospital and a lecturer at the Fiji School of Medicine. He is known to a number of New Zealand Surgeons as he has spent some time working in both Christchurch and Palmerston North Hospitals. The surgical traineeds based in Fiji were his very able assistants and took responsibility for running the audiovisial, organising a number of social events, undertaking general administrative tasks and, on top of all that, presenting papers.
Workforce issues continue to be major importance throughout the Pacific. There is no doubt that the Fiji School of Medicine’s post graduate programmes for the Diploma and the Master of Surgery are adding to the local workforce but this is a slow process. “Workforce Development” was again one of the topics for this meeting, alongside “Acute Surgical Care” and “Oncology – the Pacific Way.” The majority of papers and case presentations were given by the Pacific surgeons and the surgical trainees.
PISA MEETING, 2008
In July 2008, the seventh PISA meeting was in Suva, Fiji. The main objectives of the meeting were to:
- Provide an appropriate continuing medical education programme for Pacific Islands’ surgeons with attention primarily on surgical oncology and acute surgical care (including trauma).
- Provide a practical experiential learning opportunity
- Discuss and plan for the training and continuing development of the surgical workforce required for the delivery of surgery throughout the Pacific Island countries
- Provide information the Pacific surgeons on the NZAid funded Medical Treatment Scheme and the AusAID funded Pacific Islands’ Project
- Enable surgeons from Pacific Island nations to develop/further develop communication and support networks with colleagues from other PICs
Workforce Development was the focus of the first formal day of the Meeting. Overall, numbers continue to be an issue, as is retention. Isolation, workload and remuneration continue to be problems, although some of the issues are slowly being addressed in some of the countries. As the previous meeting in 2006, it was recognised that resolving workforce issues is complex and requires long term strategies. The Pacific medical schools and PIC governments have key roles to play and appropriate, short term clinical attachments in New Zealand and Australia are required to suppor the local developments.
Cancer treatment was a key clinical focus for this meeting, oncology – the pacific way. Accessing clinicians for timely diagnosis and then accessing appropriate treatment modalities are both ongoing problems in many parts of the Pacific. Breast, head and neck, colorectal, prostate and paediatric cancers all received specific attention. Prioritising patients to identify who are most likely to benefit most from treatment is a key issue in an environment of restricted, costly resources. The aspect of cancer treatment was discussed and extended beyond treatment in-country to include access to overseas treatment.
The meeting included a hands-on workshop on internal fixations of fractures using saw bones. The larger Pacific Island countries have orthopaedic surgeons, but not in sufficient numbers to provide care in all regions/islands. In many Pacific Island countries the general surgeon has to be able to treat all types of trauma injuries, including fractures.
While trauma is not the only aspect of acute surgical care, it continues to be a major component of this throughout the Pacific. What is available to a trauma victim in Port Moresby is very different to the resources that a sole medical practitioner on an outer island in Vanuatu can access for a patient with the same injuries. Presentations on trauma cases from the Cook Islands, PNG and Fiji provided a basis for discussions; and suggestions on diagnosis and treatment options were tailored to fit the resources available to different participants.
The meeting’s primary objectives of providing an appropriate CME programme and discussion of developments for the surgical workforce were met through relevant case and clinical presentations, clinical demonstrations and structured presentations and discussions on workforce. Participants report that these meetings continue to be a valuable source of information and provide the only opportunity for face-to-face discussions of common issues with their surgical peers from a ride range of Pacific Island Countries.
PISA MEETING, 2006
On the 7th March 2006, the sixth PISA meeting was officially opened at CWM Hospital in Suva, Fiji by the New Zealand High Commissioner to Fiji, Michael Green. From this official beginning, the meeting proceeded through three and a half days of presentations and hands-on practical demonstrations to its informal beach picnic closure four days later.
The New Zealand Agency for International Development (NZAID) and its parent body, New Zealand’s Ministry of Foreign Affairs and Trade have sponsored the last five of these biennial meetings. New Zealand surgeons, and more latterly a number of Australian surgeons, have given of their time to participate in these meetings, and administrative assistance has been provided by the New Zealand Office of this College. On this occasion an oncologist from Palmerston North and an O&G specialist from Auckland also attended and participated in relevant sessions.
At least one surgeon was present from the Cook Islands, Federated States of Micronesia, Marshall Islands, Papua New Guinea, Samoa, Solomon Islands, Tonga and Vanuatu. There was a high attendance by Fiji surgeons and by the surgical trainees from the postgraduate Fiji School of Medicine programmes. The Meeting was preceded by a Registrars’ Training Day and these registrars, particularly those in the Masters programme, contributed significantly to the Meeting. The FSM Masters programme now has its first female trainee who presented a paper that explored issues surrounding her multiple roles of surgical trainee, wife and mother within a Pacific culture.
The Pacific Islands surgeons contributed papers and cases for discussion or participated in panel discussions. One paper by Mr Ifereimi Waqainabete presented his research into the neuropsychological effects of kava.
His research subjects were all medical students in Fiji. After persuading us all that kava did indeed have neuropsychological impacts, Waqa and his family then hosted a Pacific night which included a kava ceremony. Some of those present were obviously keen to test the validity of the research for themselves.
The programme included sessions on urogynaecology, breast disease and malignancies, trauma, disaster management, thoracic problems and, of course, the ubiquitous diabetic foot. Maintaining an appropriately trained surgical workforce is even more problematic throughout the Pacific Island nations than it is in New Zealand and Australia.
Workforce issues merited a focused session of their own, but also arose within discussions on other issues.
One afternoon was focused on a series of lectures and a hands-on workshop of the “Ponseti Technique” of clubfoot casting. This was run by Dr Haemish Crawford from the Starship Children’s Hospital in Auckland and included two other visiting speakers. The first was Dr Shafique Pirani from the University of British Columbia who explained how he had initiated this technique in Uganda where the incidence of clubfeet seems almost as high as in the South Pacific. Mr Martin Egbert, a businessman from Las Vegas and parent of a child treated by this technique in the USA, gave an insight into the extensive parent network that exists worldwide for this condition. He explained how the Ponseti Technique has become the standard of care for clubfoot babies in the United States.
Following the lectures and videos a number of young children were presented for evaluation. Some of these children were casted and the technique explained again. This gave some delegates the opportunity to get their “hands wet” as well. This session concluded with the formation of a Pacific Island Ponseti Interest Group that agreed to explore the possibility of setting up a programme in each of the Pacific Islands present, similar to that working so successfully in Uganda.
The Fiji meeting provided the opportunity for PISA’s General Meeting at which Professor Eddie McCaig (Fiji) was re-elected President, Dr John Hedson (Federated States of Micronesia) Vice President and Dr Teariki Noovao (Cook Islands) Treasurer. Mr Ifereimi Waqainabete (Fiji) is the newly-elected Secretary and has been replaced as Trainee’s Representative by Dr Saia Piukala (a Masters student from Tonga). PISA was also able to collect the required signatures for it to proceed with its application for incorporation in the Cook Islands.
As in other years, those present from Australia and New Zealand were impressed with the day-to-day expertise and dedication of the Pacific surgeons, all of whom are working in conditions and with a range of equipment and diagnostic tools below (and in some countries considerably below) those available to our own surgeons.
PISA MEETING, 2003
The fifth PISA Meeting was held from the 15 to 18 July 2003 on Rarotonga in the Cook Islands. The meeting aimed to offer continuing medical education on appropriate themes to surgeons and surgical trainees from Pacific Island nations. This was to be achieved through case discussions, hands-on operative experience and structured presentations. There were also opportunities to discuss inter-country issues of general interest.
On this occasion, the PISA meeting coincided with the Annual Cook Islands Health Conference. This enabled those present for the Surgeons Meeting to participate in relevant sections of the Health Conference and vice versa. The day before the official opening of the Surgeons Meeting, a number of the Pacific island surgeons conducted a trauma workshop for Cook Islands police, firemen, ambulance drivers and tour operators.
The continuing medical education components of the meeting included:
- Presentations by the Pacific surgeons and surgical trainees of difficult and/or interesting clinical cases for discussion
- Presentations by surgical trainees on their research
- Observation of laparoscopic surgery and paediatric surgery by video link from the operating theatre to the hospital’s seminar room
- Hands-on training experience in laparoscopic surgery for some participants
The meeting also provided the Pacific Island participants with the opportunity to network with their peers from similar environments and to discuss more generic issues related to medical/surgical care in the Pacific such as workforce and training issues. A specific session dedicated to diabetes as well as trauma were also included in the program.
The main operative teaching component of the Meeting was conducted by John Dunn, a General Surgeon from Auckland, with assistance in theatre from Jane Walker, a theatre nurse from Auckland Endoscopy. Kiki Maoate conducted a paediatric surgery operative session and Tony Hardy assisted in orthopaedic cases in the Outpatient Clinic.
A major development during this meeting was the appropal of a constitution for PISA and the election of their Interim Executive Committee.
Participants of the 2003 PISA meeting expressed satisfaction with both the content of and the outcomes of the meeting. In particular, the formalisation of PISA enables Pacific surgeons to have a collective voice on issues of surgical interest within the Pacific.