Report to Pacific Islands Medical Aid by Dr. Kent Saltonstall M.D.

This report describes my second and third medical assignments at London Hospital, Christmas Island, Republic of Kiribati, in the central Pacific Ocean.  As before I was very well received by Dr. Teraira Bangao, the anesthesiologist and hospital director, and Dr. Harry Tong, the full-time general surgeon.  These very experienced colleagues provide all the primary care on the island.  They have a good understanding of the people’s medical needs in relation to the resources available.

During my first assignment a year ago I was able to see dozens of patients for Orthopedic consultation, many with problems due to complications of diabetes.  Then in December 2011 I learned more about the very sick ones.  With Dr. Teraira’s skillful anesthesia assistance I operated on little Tavita, age six, for septic arthritis of the hip.  When I saw him again in May 2012 he was running about the place quite happy, and apparently cured of his infection.  In the interim, Dr. Harry had operated on a similar case, an older child who is cured also.  In December 2011 we evacuated to Fiji our boy Ruteti, paralyzed by some spinal illness that was never clearly diagnosed  at Fiji, nevertheless he was greatly improved on treatment for tuberculosis by the time I saw him again in May 2012.  Ruteti can now transfer and walk with support, and he is regaining bladder control.  I was a multidisciplinary team of one for this boy, providing hands-on physical therapy, bladder management, and corrective splinting.  Ruteti was my major effort on this third visit.  Our wonderful operating room nurse Kuuta will coordinate his care going forward, including advice to the family and reintegration into school and the traditional island society.  We think Ruteti is the only young paraplegic on the island.

My other project on this third visit was the beginning of a fracture treatment program, with generous material support from PIMA.  Enthusiastic staff will carry this forward in my absence, although at present hampered by lack of x-rays due to a chemical film development problem.

Other surgical projects for the island include upgrade of the operating room, in cooperation with a PIMA General Surgery and Anesthesia team.  A Gynecologic surgeon , Dr. Baranika Toromon, has been assigned by the Kiribati Ministry of Health to give the doctors much needed assistance in her specialty.  The government’s policy of rotating doctors among the Kiribati islands appears to be the best way of providing medical flexibility for a growing population.

Toward the end of my week at the hospital I learned from Dr. Teraira that I am the only Orthopedic Surgeon in the nation of Kiribati.

Respectfully Submitted,

Kent Saltonstall MD, Associate Clinical Professor of Orthopedic Surgery Emeritus, University of Washington Medical School, Seattle, Washington, USA.

Safer Surgeries Now Possible With New Anesthesia System

 

Amazing Team: With PIMA's new anesthetic machine and monitor in place at Ronton Hospital on Christmas Island, our joint Kiribati-USA surgery team was able to perform successful surgery on this little boy last month. With the boy's thankful parents looking on are (from left) Kiribati nurse Tekan, surgeons Drs. Jennifer Smith and Lydia Lam of University of Southern California/L.A. County Hospital, Kiribati anesthesiologist Dr. Teraira Bangoa, our anesthesia team, Drs. Shalini Sharma of Southern California and Kirsten Randall of Anchorage, Alaska, and Kiribati anesthesia nurse Tokoriri behind.

Amazing Team: With PIMA’s new anesthetic machine and monitor in place at Ronton Hospital on Christmas Island, our joint Kiribati-USA surgery team was able to perform successful surgery on this little boy last month. With the boy’s thankful parents looking on are (from left) Kiribati nurse Tekan, surgeons Drs. Jennifer Smith and Lydia Lam of University of Southern California/L.A. County Hospital, Kiribati anesthesiologist Dr. Teraira Bangoa, our anesthesia team, Drs. Shalini Sharma of Southern California and Kirsten Randall of Anchorage, Alaska, and Kiribati anesthesia nurse Tokoriri behind.

Danger lurked in the small operating room on Christmas Island in Kiribati every time a surgery required general anesthesia. For years and years, an old, unreliable and unsafe 1950s Japanese anesthesia machine was all that was available at the little Ronton Hospital on the island.

Pressure valves and regulators didn’t work, and there was no monitor. Few elective surgeries were done and emergency surgeries were tricky.

To move forward with surgery training and safer surgeries in general, it was obvious to our Pacific Islands Medical Aid volunteer anesthesiologists that a priority had to be to provide a good, safe, easy to use and reliable system.

Anesthesiologists Dr. Shalini Sharma of Southern California and Dr. Kirsten Randall of Anchorage, Alaska, worked together to choose a good machine and monitor, have them shipped, then two months ago personally installed the system and trained the local medical staff on the island.

Thanks to them and the many who donated the money to make it happen, we at PIMA are now able to take great medical specialists to the island for safe surgeries and local training. Here is Dr. Sharma’s story:
By Dr. Shalini S. Sharma, M.D., M.P.H.

After months of preparation, we were finally at LAX. In two hours we were heading out on our week-long adventure to install a state of the art anesthesia machine and monitoring system in a remote area of the world.

This was my second trip to the island, and I was looking forward to tackling all the goals we hoped to accomplish, but I was a bit nervous. Questions kept running through my head… ‘what if that part came loose?, or ‘what if a valve malfunctioned ?’

I kept going through all the possibilities for several weeks prior to the trip, making sure I didn’t miss any small piece of this enormous project. But it was no use, there was nothing I could do now. As I took my seat on the plane, I looked over and met a comforting smile from my two friends and trusted surgical colleagues, Dr. Lydia Lam and Dr. Jennifer Smith.

I spent hours researching, coordinating and collaborating with my close friend and esteemed colleague Dr. Kirsten Randall. We focused on the specifics of the machine, the parts necessary to install the unit and the potential challenges we would face on the island.

Once we chose the machine, it was shipped to my hospital… all 350 pounds.

After some considerable obstacles, I was able to assemble the unit, confirm that every element of the device worked smoothly, then disassembled it packed it up again. All this work paid off when we discovered a malfunctioning oxygen sensor that needed to be replaced before shipping to the island… had we skipped this process, we would have not been able to use the machine for upcoming surgeries.

Once on the island, we were met with familiar, smiling faces, laughter and warm embraces. The staff, nurses, doctors and their families were there to greet us, adorn us with beautiful extremely fragrant, hand-made floral crowns and welcome us to the island with wonderful food and cold drinks. Nurse Kuta even prepared fresh coconut water for us to drink.

Our visit was even more unique as we accompanied and watched three Kiribati children reunite with their families after having cleft palate repair (all organized by PIMA and Mending Kids International). During that moment, I forgot about the project at hand and enjoyed visiting with the local people again. I have traveled a great deal, but have never felt such warmth, kindness and genuine hospitality.

Now, only if the anesthesia machine was ready for use…I couldn’t rest until we assembled and tested the machine and monitor. The next morning, after a wonderful dinner hosted by PIMA, we got to work.

We arrived at the hospital to find an enthusiastic staff prepared to help unpack and assemble the machine. In a few minutes, we had power drills and enough manpower to unpack all 350 pounds and transport the machine to the operating theater.

One by one, we began connecting the pipes, hoses and cables. Next came the monitor system. We began attaching each element and deciphering the manual, page by page.

After a few issues with the power source, we were surprised that we had assembled the entire machine and monitoring system in less than four hours! It was such a wonderful feeling that all of our work paid off in these last few hours, and we were successful.

The following day, we began with our surgical cases, working alongside Dr. Teraira and his assistant Nurse Tokoriri. We were able to work together to discuss the machine, the ventilator, the monitoring system and how to apply this unique machine (Draeger Fabius Tiro) for adult and pediatric cases.

Newly donated anesthesia machine, monitor and supplies are put in place at the little hospital on Christmas Island by PIMA volunteer anesthesiologists Dr. Kirsten Randall (second from left) and Dr. Shalini Sharma (to her left).  At right is Kiribati anesthesiologist Dr. Teraira Bangao. At left is local anesthesia nurse Tokoriri.

Newly donated anesthesia machine, monitor and supplies are put in place at the little hospital on Christmas Island by PIMA volunteer anesthesiologists Dr. Kirsten Randall (second from left) and Dr. Shalini Sharma (to her left). At right is Kiribati anesthesiologist Dr. Teraira Bangao. At left is local anesthesia nurse Tokoriri.

They listened intently and asked purposeful questions… we were excited. The island could now handle more advanced cases and the anesthesia team was able to care for more complex issues.

As the week progressed, we were able to perform several surgeries, including a pediatric case under general anesthesia. After installing the new machine and bringing several boxes of supplies (donated through Dr. Randall by Providence Hospital in Anchorage, Alaska) we were equipped to perform anything from neonatal to geriatric type cases. It was such an amazing progression from our previous trip where I felt the island was not fully prepared to handle surgeries for pediatric patients.

As our week ended, we were treated to wonderful food and festivities by the hospital staff and their families. They handcrafted beautiful gifts for us to take home and prepared dances in our honor. At the end of the night, as we concluded our celebration, many shared their heartfelt gratitude for all that Pacfic Islands Medical Aid, its founder Carlton Smith and the doctors have done for the island and the local people.

It was a very sincere and touching moment, and as I left the next morning, I thought to myself that these wonderful people will likely never know how much they have done to change me as a physician. Being so content with the things that we have and finding joy in the friendships we built during our trip will stay with me forever.