The team consisted of 3 doctors, Dr Dinesh Lal (Consultant Gastroenterologist/Hepatologist & Consultant Physician), Dr Mahendra Naidoo (Senior Registrar Advanced trainee, Research Fellow Medicine), Dr Ajay Kumar (Stroke Physician/Geriatrician), 5 Senior/Specialist nurses in Gastroenterology, ICU, Endocrine/Diabetes, Stroke, Surgery, these included, Georgina Voschezang, Jannette Hennings, Varanesese Dawai, Navleen Prasad, Ateca Rokoqica, Senior Neuro Physiotherapist - Ruth Madigan, Senior Neuro Occupational therapist - Yvonne Harris, Senior Speech Pathologist, Kelly Davis plus we were very blessed by our administrative / technical / logistical support without whom missions to the North would be extremely challenging, these were our trustees, Mr Shailendra Sharma (Engineer, logistical/technical support), Mr Rajesh Chaudary (Charted Accountant –Administrative lead plus logistics/networking).
A. Mission Proper
B. The mission was very enlightening and fruitful for us. It was a tremendous success, a first of this calibre and expertise to the North I believe, both from the local and our perspective and in regards to our aims.
C. A brief synopsis is outlined below:
1. Teaching
2. Daily lecture series on Cardiovascular/Neurological real time patients, in Fiji Context (Resource limited setting) by Dr Mahendra Naidoo and Dr Ajay Kumar.
3. Daily ward round teaching, patient and disease based, Dr Mahendra Naidoo and Dr Ajay Kumar.
4. MDT (multidisciplinary –predominantly acute strokes, plus acute coronary syndromes) lecture series 2, attended by doctors, nurses allied staff plus assistants, Labasa and Savusavu
5. Capacity building/training
6. Practical training sessions in Gastroenterology, specifically scoping techniques by Dr Dinesh Lal - audience predominantly doctors and nurses. Manual handling, transfer techniques, complication prevention, plus swallowing assessments in acute stroke by Physiotherapist, Occupational therapist and Speech therapist, Stroke nurse - audience predominantly nurses, physiotherapists some aspects attended by doctors.
7. Service delivery
8. Specialist Outpatient Medical Clinics (~130 patients seen both sites of varying complexity, Dr Mahendra Naidoo, Dr Ajay Kumar).
9. Gastroscopies / Colonoscopies (Total 41 patients).
10. Mini workshops conducted by MDT on assessment and management of acute stroke patients
11. Diabetic and wound care management by Endocrine /Diabetic nurse Varanisese / Ateca, audience nurses.
12. Respirator management/CPR by ICU nurse, Jannette Hennings, audience ICU nurses.
13. Clinic at Older Peoples home Labasa with equipment donation (Dr Ajay Kumar, Stroke Nurse Navleen Prasad).
14. Home visit/assessment - Stroke patient (Team: Shalen, Rajesh, Mahendra & Ajay).
15. Administrative/Logistical networking
16. Multiple Conjoint meetings daily with MOH reps, NSSC Mr Isoa Bakani, Senior Hospital Clinicians, Senior Hospital Administrative staff, Board members, Business leaders and NGO reps lead by Rajesh Chaudary and supported by Shailendra Sharma .
17. Liaising and personal communication with Clinical Dean, Dr Eddie McCaig of FNU.
18. Complementation/supplementation of services.
19. Medication, an adequate supply for at least short term of antihypertensive, Diabetic, Cardiac, Gastrointestinal plus other medication was donated. We also helped source some surgical supplies plus rehab equipment, these included: Walking Frames, Wheel Chairs (at least half specialised), Shower/toilet commodes, Crutches, AFO's, Transfer sheets, other personal "nursing kit ".
D. Mission Highlights
E. Our Visiting team have the highest regards for our local counterparts, Administrative, Allied staff, nurses, and the doctors plus Support from MOH and local councils, Rotary club plus Sarava boys and our many supporters in the North. The local logistics and support was superb and without a glitch. The comrade we shared in terms of conjoint teaching learning paradigm was excellent. Both parties are now enriched in terms of current trends in management of acute Cardiovascular conditions in Developed countries and as to what is practical and deliverable in Fiji setting. Furthermore we have made plans to make this an annual mission to help upskill each other and both parties firmly believe that we conjointly made a positive difference to patient management and staff moral.
F. Recommendations
We the Visiting medical team plus FOFH collectively believe that:
1) These missions are essential for capacity building.
2) Furthermore it is an excellent opportunity where there is exchange of expertise and we can help each other practise contemporary practical medicine in resource limited setting.
3) For foreseeable future and longevity of these types of missions the strong affiliation already forged amongst, MOH, FNU, local stake holders and visiting teams need to continue to make these missions a reality, easier deliverable and tailor made to the local needs at a minimal cost.
E. Acknowledgments
o To all our Donors, here in NZ and Locally in Fiji to make this mission possible.
o To our local counterparts, Hospital staff, MOH for their support.
o My personal thanks to my team of volunteers and their families for releasing them.
Dr Ajay Kumar
Mission Team Leader