Surgeons Bring Help to Island Nation

Our Surgeons in Kiribati: Trauma surgeons Dr. Jennifer Smith (at left) and Dr. Lydia Lam work to remove a large growth in the neck of a young island woman on Christmas Island while PIMA volunteer anesthesiologist Dr. Shalini Sharma peers over the curtain. Local physician Dr. Harry Tong looks on.

Our Surgeons in Kiribati: Trauma surgeons Dr. Jennifer Smith (at left) and Dr. Lydia Lam work to remove a large growth in the neck of a young island woman on Christmas Island while PIMA volunteer anesthesiologist Dr. Shalini Sharma peers over the curtain. Local physician Dr. Harry Tong looks on.

Often, when we help others, we too are helped in the process.

That’s what happened when we took three very talented young medical professionals from the University of Southern California Keck School of Medicine and L.A. County/USC Hospital to Christmas Island in Kiribati last month to perform some much needed surgeries, do some teaching and recommend upgrades to the operating environment there.

7-2012-17-2012-2PIMA volunteer trauma surgeons Dr. Lydia Lam and Dr. Jennifer Smith, together with anesthesiologist Dr. Shalini Sharma, worked hard to deal with all the surgeries that came their way during the one-week stay, and said they came away feeling great.

“The trip for me was invigorating and reaffirms my decision to be in medicine,” Dr. Lam said. “After a week of pure medical practice and seeing resolution of the patient’s medical problems was rewarding and refreshes the drive to better my own practice, “ she said.

Among the surgeries they performed were a recto-vaginal fistula repair, ovarian cyst removal, thyroid cyst excision, inguinal hernia repair on a six-year-old boy, hydrocele excision and more.

Dr. Lam’s report on our trip is published below, to be followed in the future by Dr. Jennifer Smith and Dr. Shalini’s reports.

7-2012-9Carlton Smith, president

Pacific Islands Medical Aid, Inc.

Christmas Island, Jun 5-12, 2012

By Dr. Lydia Lam, MD

The trip began for me when I first learned that Pacific Island Medical Aid was looking for surgeons to send to Christmas Island. This was an exciting opportunity that I looked forward to from the moment the trip was confirmed. For the few months prior to our departure, the situation unfolded itself as a small island needing desperate medical aid. There were few pictures shared with us from prior physicians who had gone and the working conditions were daunting. As we neared our departure date, the cases from Christmas Island were being lined up for us and it was a potpourri of cases.

We departed LAX on June 4, 2012 and landed in Honolulu in the evening. There we met Carlton Smith, who was our tour guide and host for the week in Christmas Island. It was clear that he had our well being in mind and would make sure our stay and work on the island would be successful. Our flight the next morning was about 3 hours long and we were all very excited to see this tropical paradise. As we were landing, we caught glimpse of a beautiful island with lagoons in the middle of it and clear blue waters everywhere.

7-2012-4After landing, we were treated to wonderful VIP welcome and coincided with the departure of the Minister of Health. It was enlightening to hear his plans for the island and the impending new building for the hospital.

Our work began by meeting Dr. Tereira, the physician in charge and an anesthesiologist, and Dr. Harry, the surgeon. We followed by meeting the remainder of the OR staff and many of the RNs who worked in the ward. We saw many clinic patients including chronic sore throats, headaches, several trauma patients and people with lumps and bumps. During the week, we performed cases to include repair of a rectovaginal fistula, removal of a large ovarian cyst, right thyroid removal, an inguinal hernia repair, assisted in a couple of caesarean sections and removal of a hydrocele. In addition, we were able to perform several procedures in clinic to include the debridement of a diabetic ulcer, drainage of a large back abscess, and removal of a neck lipoma.

7-2012-5However, it was not the cases that made our trip memorable, but rather the people and the need for this medical assistance. The rectovaginal fistula patient is a young woman in her early 20s who has had 2 beautiful children. However, after the delivery of her first child 4 years ago, developed the rectovaginal fistula. This is a result of a traumatic childbirth leaving damaged tissue behind. Her fistula resulted in drainage of stool that was uncontrolled. In an environment without good sanitary conditions, it was very difficult for her to be clean and take care of her children. The strength of the people and the need for specialized medical care is evident when this young woman and her family stayed in an outdoor “tent” for 3 months awaiting our arrival hoping we would be able to repair the fistula.

Similarly, the young boy and his family travelled from the other side of the island, about 30 miles away, and stayed to see us. Unfortunately, we were unable to help his young brother with the undescended testicle but we were able to repair his inguinal hernia. A typical problem in these third world countries is the lack of access to medical care. The inguinal hernia repair took just under 1 hour to repair but without it, the hernia could continue to enlarge and become a disability physically to a young male, especially when physical labor is the majority of their workforce.

7-2012-12The conditions that we saw in photos prior to our arrival were accurate. The operating room was not well equipped. The surgical instruments, though adequate, were not many. There are a few trays assembled ahead of time for sterilization but more than 2 cases of the same type would require cleaning and re-sterilizing of instruments. Medical waste is an issue on a small island so disposable equipment, though more sanitary, would be difficult. PIMA currently is working on the helping with their medical waste disposal. Most importantly, a new anesthesia machine and patient monitor will be necessary for more complicated cases. Despite the limited supplies, the hospital staff has made it work. They are hardworking, and a well-trained group for the environment. The professionalism seen in them was equal to any hospital found in the United States.

The hospitality of the hospital staff was never ending. Although we were there for a week of work, we had an equal amount of time eating, learning about the islands and the hospital staff and enjoying their company. They treated us with respect, always had delicious food for us and accommodated our every need. Their appreciation was felt at every dinner they had for us and the picnic that was arranged. At the end of the week, we realized we had made friends for life.

7-2012-107-2012-11Personally, the trip for me was invigorating and reaffirms my decision to be in medicine. Working in a competitive environment with the many political and non-medical stressors can make one lose sight of the point of medicine. After a week of pure medical practice and seeing resolution of the patient’s medical problems was rewarding and refreshes the drive to continue to better my own practice. More importantly, the gratitude and relief seen in the patient’s faces allows me to know that I have had the privilege to make at least these people’s lives better. I am hoping that the opportunity will arise again for me to journey to this part of the world and continue to contribute to the care of these warm and grateful islanders. In the meantime, I will be assisting PIMA in any way possible to provide well rounded care of the people on Christmas Island.