This report describes my medical service with PIMA at London Hospital on Christmas Island, Line and Phoenix Group, Republic of Kiribati, central Pacific Ocean, May 17-24, 2011.
I was extremely well received the entire time by Doctors John Tekanene and Teraira Bangao, and the friendly hospital staff. Every effort was made to assist me in my work as consulting Orthopedic Surgeon.
My work began with an inventory of operating room equipment. I found a large quantity of donated used Synthes high-technology instrumentation, consisting of three separate small fragment sets, the basic large fragment fracture instruments, and tools for the Dynamic Hip Screw, all including plenty of bone screws but no fracture repair plates. This equipment is of little use in the present island environment. At the same time, there is a severe inventory shortage of basic supplies such as Steinman pins (there is one bent one), Kirshner wires (none), traction bows, pulleys, rope, and the like. Plaster of Paris inventory is limited to a few rolls, and there is some older fiberglass casting material starting to harden in the packages. Webril and stockinette are needed, four and six inch sizes. There are only a few well-used metal splints. I have suggested an equipment swap with other Kiribati hospitals, Synthes stuff for casting materials, splints of all sizes, etc.
I saw a dozen or more patients each day for Orthopedic consultation, some selected by MD referral, and many self-referred, especially after I was announced on the local radio. My time was best utilized by MD referrals, and the injured from the international fishing fleet. I felt particularly useful to a 20 year old Vietnamese fisherman with a displaced both bones forearm fracture, and we were able to send him home nicely reduced and casted, together with his x-rays and a letter of instruction. I believe the hospital will bill the boat owner for my services. One nice feature of this practice was that our international patients were billeted with me at Captain Cook Hotel, so I lived among them: Ngoc in his new cast, the Spaniards with supposed appendicitis eating with gusto in the old British officer’s mess, and our psychiatric patient Elvis from the Philippines, already much improved. Elvis had been behaving strangely on the tuna longline boat, sleepless, wandering about babbling in his language, fighting, but he straightened out nicely with medication from Dr. John and tourist accomodations on the beach. Also I was able to advise several patients about their arthritic joints and malunited fractures, and speak to parents about their crippled children, including cases of old polio and severe clubfoot. I saw spine deformities from old tuberculosis, and one active case. I made one recommendation for possible elective reconstructive surgery off-island, a 29 year old tattoo artist with a 90 degrees malrotation of his proximal femur and end-stage hip avascular necrosis following a childhood electrical injury.
On Sunday we went around the island by truck to the small clinic at Poland, where I saw 27 patients (about ten per cent of the village population), and everybody said I was the first Orthopedist ever to visit there. We tried to bring several to London the next day for x-rays, but there was not transportation. Perhaps next time. The Poland clinic has some basic sanitation needs such as screens to keep out flies, and handwashing facilities.
I worked closely with Ordman the xray technician, and was able to share some tips about positioning of patients. The scope of her work has been limited by the lack of different x-ray film sizes and the dimensions of her drying rack, so that her day grinds to a halt when the rack is full.
I did no surgery on the island, and would not attempt clean orthopedic cases there under the present circumstances. Emergency surgery such as drainage of infection and debridement of open fractures is feasable, they have the knives and Dr. Bangao who is a very capable anesthesiologist. It would be good to get a donation of some bone plates for emergencies, new or used.
The biggest impact I forsee would be to somehow improve the almost non-existant fracture referral on the island. Island culture seems to be that extremity injuries are treated by the traditional massage practitioner, and the doctors are not seeing many, so are not getting the experience. My first priority for the hospital is for basic sanitation such as hand washing, and elimination of flies indoors using fly traps and screens.
I had a very fine experience at London Hospital and I look forward to more.
by Kent Saltonstall MD, Associate Clinical Professor of Orthopedic Surgery Emeritus, University of Washington Medical School, Seattle, Washington, USA.