Delivering Cardiac Surgery in the South Pacific
David Baines
The Children's Hospital at Westmead, Westmead NSW
In the mid 1980's a program was developed to form a self-contained team able to provide open heart surgery in the islands of the South Pacific. The first trip was in 1986 to Tonga and subsequent trips were made to Vanuatu and Fiji. The surgery predominantly involved valve repair or replacement for rheumatic heart disease in adults.
In 1991 a team went to Vanuatu to undertake not only adult valve surgery, but for the first time, surgery for congenital heart disease in children. The following year the paediatric component was extended to Fiji and subsequently to Papua New Guinea. More recently, several trips under the auspices of the College of Surgeons have been made to East Timor to undertake closed heart surgery in children, with a view to expanding to open heart surgery for children and adults in 2006.
This Open Heart program was conceived and is still co-ordinated by the Sydney Adventist Hospital (SAH), with a major contribution from the Adventist Development and Relief Agency (ADRA). Volunteers generally fund their own airfares (and sometimes accommodation, to varying degrees), with the rest of the costs coming from Ausaid, sometimes the government of the country involved and donations from various organisations, especially medical equipment companies, and of course ADRA.
Commonly, two weeks of surgery is undertaken with a week of adults and a week of children. A cardiologist precedes the main team by a few days to vet the patients and draft an operating schedule. The team is essentially self-sufficient with all the staff required to undertake this sort of work - ICU staff, both nursing and medical, nursing staff for "step-down" ward, physiotherapists, biomed technicians and of course theatre staff, including perfusionists. Nearly all the drugs, disposables and technical equipment required are taken with the team, usually air-freighted, often at a reduced rate by the national airline of the country concerned.
Co-ordination of the whole process is undertaken by a small, but extremely dedicated group from the SAH, and there are individuals and community groups in each country who contribute in various ways. Local paediatricians, cardiologists and other staff are vitally important in making sure that appropriate patients are present and optimised.
The emphasis of the project is to get the most "bang for the bucks", so a "fast-track" approach to surgery/anaesthesia/ICU is mandatory and will be discussed. Interestingly, cultural differences in the expectations of pain management are readily recognised, with often minimal post-operative analgesia being required. Despite undertaking many seriously ill patients, the results have been very gratifying, with mortality comparable to major centres.
Advantages for local hospital staff include both formal and informal teaching sessions throughout the stay, and in New Guinea the medical staff are encouraged to perform the closed cases themselves, with supervision readily available. A major disadvantage is the disruption to elective surgery in the host hospital during the teams stay, and also the drain on some resources, especially laboratory supplies.
It has been a great experience and an honour to be involved in these projects and I am always impressed with the professionalism and dedication of all team members.
Time of Presentation
Saturday 7 May 2005 - 1030-1200
