Adventures in the South Pacific
Our “Adventures in the South Pacific” originated with surfing on Tavarua Island, Fiji, starting in 1985. During the initial annual visits we would care for the Fijian workers on the island, then during later visits go to their villages on the “mainland” as they call their largest island, Viti Levu. Then we began bringing Fijian adults and children to San Diego for medical care. The care included congenital cataract removal, cleft lip and palate repair, and chronic cardiac problems among others. As more people in need appeared I decided to ask the Ministry of Health if we could bring a surgical team to Fiji to care for the cleft lips and palates, burn scar revision and grafting, and (limited) congenital deformity patients coming to us during our visits. The Ministry staff were most gracious and helpful.
We organized our first Scripps Health surgery team in 2001 with the help of International Relief Teams of San Diego. We went to a 40-bed subdivisional hospital in a smaller village on the main island. We performed 40 surgeries there in five working days. We returned in 2003 to Lambasa Hospital (a 125-bed hospital) on Vanua Levu, the second (but much less populated) large island. In 2006 the team went to Lakemba hospital and in 2007 to Vanuambalavu Hospital at the request of the Ministry.
These two islands are in the southern and northern ends of the easternmost isolated Fijian islands. In order to have our equipment and supplies there, we had to ship everything three months before our arrival. The Ministry then shipped the materials to each of the islands on the once-a-month supply boat to arrive before the team did. The team took the overnight flight from LAX to Nadi, Fiji, transferred by van to the capital of Suva and, the following day, took the once-a-week flight (if the weather is good) in a 16-passenger DeHaviland Otter type plane (Chinese made!), which lands on a grass landing strip in the jungle if there is not too much water on the runway.
The hospital on each island was a 12-bed hospital. We used one of the four-bed wards as our operating theatre, as they are called there. My anesthesia machine consisted of small oxygen bottles, a hand help breathing bag, a sevoflurane vaporizer, a monitor with EKG, blood pressure, and oximetry. We used dental type sterilizers between cases and a small bovie unit. The 240-volt hospital generator was run during the day for us. Air conditioning consisted of a breeze blowing in off the bay (at about 88 or 90 degrees!). We performed 45 surgeries in Lakemba and 60 in Vanuambalavu. There were no hotels or restaurants on these islands, so we were strictly on the local diet of fish, crab, chicken, goat, taro, cassava, sweet potato, local vegetables, seaweed, and occasional pudding for dessert. We were the first team to ever visit these areas and were able to help many people.
At the time we started the surgery team visits, the American owners of a resort on one of the outer islands asked through International Relief Teams for a cataract surgery team to come to their island to care for the many cataract patients there who could not get to the main island for care. In 2001 and 2002, we took a cataract team to Lalati Resort on Benqa Island and performed cataract surgeries in the utility room of the resort. Thirty surgeries were performed in 2001 and 25 in 2002. Some patients had not been able to see for 12 years. Needless to say, they were thrilled beyond words.
As a result of the interaction with the owners of this resort and several of their guests who wished to provide further help to Fiji, we set up the Loloma Foundation (www.lolomafoundation.org ), a 501 (c) 3 U.S. nonprofit corporation. It is dedicated to providing medical and educational support to Pacific Island countries. Since organization of the foundation, we yearly ship one to three shipping containers of supplies to the hospitals, clinics, and schools we have determined to have the greatest need. Through the foundation we were able to ship all our materials for the surgical team visits. The foundation has shipped from US$250,000 to US$1,000,000 worth of supplies each year. Through the foundation, clinical medical teams, primarily from Scripps Clinic, have visited most of the more populated Fijian islands.
Under the auspices of the owner of Lalati (and a board member of Loloma), who travels extensively through the Pacific Islands, Loloma Foundation organized a trip to Vanuatu in February 2005. After extensive preparations through the Ministry of Health, the group flew to Vanuatu and then boated for 12 hours to Tana, one of the southernmost islands in the group and very remote. We ran medical clinics at their 40-bed hospital in the small town of Lenakel and outer villages on the island. The ENT, radiology, and infectious disease specialists in the group also made rounds for a day at the central hospital in Port Vila, the capital of Vanuatu.
The foundation organized a team visit to the Solomon Islands in May 2008. The team of 14 medical practitioners and seven assistants spent three days in Honiara, Guadalcanal, running medical clinics. The team then went by chartered boat for 10 days to the outer Solomon Islands providing medical care for the local population. It was very interesting visiting and working in all the World War II battle zones. Many clinic facilities were left over from the war. After the war ended, everyone left, no one has returned, and the country is off the edge of the world for development. It is subsistence living with rampant malaria, chronic ear and skin infections, perforated eardrums, rheumatic fever, and cardiac valvular problems, several cases of post malarial meningitis hemiplegia in teenagers, even a few cases of yaws. Included in our team were two internal medicine residents from the Scripps Clinic training program. Needless to say, it was the experience of a lifetime for them (and for us). The team was 4,500 patients in two weeks! We are planning a return to the Solomons in September of this year with a clinical and a surgical team. By the time of publication, the January 2009 team will have run medical clinics and provided cataract surgery to inhabitants of the outer northwestern islands in Fiji.
The third leg of the programs in the Pacific is an academic program. The Fiji School of Medicine (FSM) has been in existence for over 100 years. They grant an MB/BS British-type degree through the University of the South Pacific with six years of schooling after secondary school. They train the doctors for most of the Pacific Island nations except for French Polynesia and Papua New Guinea, which has its own medical school. At the start of the surgical programs, I learned that the Australians, through their AUSAID program, had set up a postgraduate training program at FSM for surgery, internal medicine, pediatrics, OB/GYN, and anesthesia. Their support was ending in 2001, so I met with the head of internal medicine at FSM and offered to search for volunteers at Scripps Health to spend two weeks at a time teaching at FSM in the specialty training programs.
The beginnings of the program involved the (continuing) help of Dr. Philip Higginbottom, infectious disease, Scripps Clinic, and Dr. David Roseman, gastroenterology, Scripps Memorial Hospital. The volunteers were so well received that in 2003 a formal memorandum of understanding was signed between FSM and Scripps Health whereby Scripps would provide volunteer specialists to be visiting teaching faculty at FSM and FSM would provide temporary Fijian medical licenses, work permits, liability coverage, and housing. Since then the program has been expanded to include nurses, physical therapists, ultrasonographers, biomedical engineers, and IT technicians. The program is supported by a very generous yearly grant from one of Dr Higginbottom’s patients that allows us to cover the cost of airfare for the visiting staff. It has been a very rewarding experience for each of the people who have travelled to Fiji and viewed as a tremendous asset by the staff at FSM.
As one may surmise the experience providing both clinical and academic help has been extremely rewarding. There are many poignant tales and many funny remembrances. Perhaps the most memorable is as our boat was readying to leave one of the isolated islands in Vanuatu, an older man came hobbling with a large walking stick out of the jungle to the shoreline. He waved as though in distress that he had missed the clinic. One of the doctors volunteered to go back to shore in the zodiac to help the poor soul we had missed. They conversed and gestured, the man lowered his head and returned to his path through the jungle. As our partner returned of course the question, “What happened”? He wanted to know if we had any Viagra! How word travels. Pfizer should be proud of their advertising program.