Registrar Report- Teri Maheno

Working in the Pacific Islands is something I’ve been interested in since I started as a junior orthopaedic registrar with the Orthopacifix SMO’s in Tauranga now some 6 years ago. Needless to say when the opportunity presented itself to head to Samoa with Vaughan I jumped at it- tropical island in the middle of Wellington autumn? Yes please! The additional pleasure of working with two of my favourite registrars (now consultants) Areta Samuelu and Shaun Mauiliu again was just an added bonus.

I arrived in on what was sold to me as a ‘cold’ Samoan night- it was 26 degrees at 10pm! As I quickly came to learn the temperature remained sensationally hot.

Vaughan and I pitched up to TTM hospital on Monday morning to one of the most chaotic clinics I’ve ever seen. There were dozens of people lined up in the corridor, hallway, outside rooms, stacked inside small treatment rooms but despite that everyone seemed in good spirits. I don’t exactly know what I was expecting from a clinic in the islands but I saw more of the spectrum of orthobullets in that one clinic than I have in any New Zealand outpatient clinic. Congenital tibial pseudoarthrosis, chronic paediatric whole bone osteomyelitis, neurofibromatosis, cervical myelopathy, a plethora of ACL deficient knees, SUFEs, scaphoid non-unions, fracture dislocations of native hips (that were 4 months old and still out)- you name it, it was there.  One of the things that stood out to me was how incredibly stoic these people were, many having tried to ‘walk off’ serious injuries that would put most of us in hospital on a PCA.

Theatre was another story- the II for the operating theatre had been broken for the last 3 weeks, when I asked when they thought they might get a new one the response sat vaguely at ‘hopefully in the next 3 months’. Instead I learnt to use what was hilariously coined my ‘eye eye’s’. Both bone forearms, ankles for syndesmotic fixation, humeral non-union ORIFs etc were all done just by good exposure, an idea about fracture pattern from an x-ray on someone’s phone and a little bit of good luck. Funnily enough some of the x-rays from that time look better than what I usually achieve with a II machine and specialist plates- probably something to be said about doing the basics well rather than relying on fancy implants and on table imaging. Implants are limited and you pick your plates out of a box in the back room pre operatively before the scrub nurse flashes it in the autoclave for you. Screw options are limited and its fairly normal to cut the screw to length rather than find one in the right size. Despite all this some awesome orthopaedic fixation gets done there, largely all closed, and without any fanfare. Much like the patients, the surgical and theatre staff in TTM just get on with things with what they have. It’s pretty impressive.

Of course we managed to find some time for extra-circulars- some awesome snorkelling at Palolo Deep, a road trip round the island to Tusua trench and a vomit inducing walk up Mt Vaea before flying home. Samoa is a real treat both to visit and spend some time working.

I am grateful to the Orthopacifix Charitable Trust for the work they do in the Pacific Islands and to Stryker for their scholarship funding to assist with the costs of the visit. The biggest thanks to Shaun and Areta for having me, and to Vaughan for asking me to tag on. It might have been my first time to Samoa but I’m planning on it not being my last!