Lumps, Bumps, Serious Conditions Dealt With

In January 2014, on a bone-fishing trip to Christmas Island, I met Carlton Smith, founder and president of Pacific Islands Medical Aid, Inc. (PIMA). He was headed to the island medical center with a group of pediatric surgeons to work in the hospital for a week.

I took a day off and spent it with them as they worked and quickly became an admirer of PIMA and Carlton. I had worked as a surgical volunteer more than 20 times in Central America and immediately recognized the authenticity and value of PIMA. It was only four months later that I was back with Carlton at the invitation of PIMA and the Kiribati government with my anesthesiologist colleague and friend, Dr. John Rosoff, MD.

My first impression of Carlton and his program proved to be correct. He has dedicated ten years of his life and resources to making medical care available to the people of this remote and underserved atoll.

The trust and goodwill he has nurtured from the humblest household to the doctors and nurses all the way to top officials in Tarawa (the capital of the country 2,000 miles away) is remarkable.

This has allowed him to bring medical and surgical teams of various specialties, including women’s health, pediatrics and diabetes… to develop a World Health Organization-backed cervical cancer detection and treatment program, to provide cataract surgeries to several hundred patients and to refer literally dozens of patients to the United States for cardiac valvular surgery, scoliosis surgery, cleft lip and palate surgery, and complex cranio-maxillary surgery.

Our week began with a busy triage day. The cases ranged from lumps and bumps to serious, life-threatening conditions. On four operating days, we did 3-4 operations a day, some serious and complicated.

We removed a seriously damaged gallbladder, drained a deep soft tissue abscess in the leg, did an amputation for a diabetic woman with a necrotizing infection of her leg, and removed a smoldering appendix among many other less complex operations. And we participated in the care of a variety of non-surgical patients.

Dr. John Rosoff was a tireless and obviously popular teacher, establishing rapport and respect with the medical officer in charge on the island, anesthesiologist Dr. Teraira Bangao, and his two newly trained nurse anesthetists. He was able to teach them spinal anesthesia techniques, the use of laryngo-mask airway anesthesia and how to use their new, modern anesthesia machine donated by PIMA.

John remarked that he had actually not done a single anesthesia case, but rather coached and encouraged the local staff as they strengthened old skills and picked up new ones.

Aside from Dr. Teraira, the only other physician on the island ( and for that matter in the three Line Islands in the area) is obstetrician/gynecologist Dr. Baranika Toromon… one of the finest colleagues I have ever had the privilege of working with. ‘Amazing’ doesn’t even begin to describe the breath of her clinical skills, her judgment, her technical ability or the compassion and dedication she showers on her patients and her co-workers. She sleeps in the hospital (on a gurney) every other night of her life to cover medical and surgical emergencies and takes calls from her home every night for obstetrics.

Thinking about the privilege of working with her still brings tears to my eyes and motivates me to arrange to help her again as soon as possible.

In conclusion, I can offer the following thoughts:

  1. Carlton Smith and his organization, Pacific Islands Medical Aid, are beyond reproach from all I saw and from the actions of testimonies of the people he had tirelessly worked with for several years.
  2. Christmas Island (Kiritimati) is remote and the medical necessity there is huge, given the resources available to assist the people.
  3. The hospital has been greatly assisted on dozens of fronts by PIMA’s efforts.
  4. Drs. Teraira and Baranika are hard-working, good-hearted, skillful and knowledgeable colleagues and partners.
  5. They have a genuine need for general surgical help offered in a spirit of respect and humility.

By Dr. Larry Falk, MD