Theatre team with Nams and Shodhan from Pharma Tech sitting at the rear

This visit proved to be worthwhile and productive particularly from a surgical point of view, as there were four children with significant slipped upper femoral head epiphysis of the hip joints causing pain and disability which all required surgery. The children underwent surgical stabilization of their hip joints during this visit with good outcomes post operatively. On previous visits I would probably fix one or at most two such cases.

Clinically the highlight was to assess a case that presented with a weak drop foot which was diagnosed using the CAT scan as a severe cervical (Neck) canal stenosis (narrowing) which was a surgically correctible problem in his neck, avoiding an impending quadriplegia. A referral was made to a Neurosurgeon at Apollo hospital in India and accepted for semi-urgent surgery.

I arrived on a delayed flight from Auckland on Monday afternoon 20 November and commenced the Outpatient clinic at 2.45 pm finishing early evening. I would not have seen so many patients if it had not been for the assistance of the local surgical team. They helped with translating and transcribing. This has been a practice I have followed with previous visits, as there are no dictation facilities available. More patients were reviewed in the mornings at the Theatre Suite on successive days between operative cases.

Surgery began on Tuesday morning 21 November and went through to early Saturday afternoon. The trauma table that had been sent over in 2021 from New Zealand proved its value by being used multiple times during this visit. In fact, the four paediatric cases with slipped femoral head epiphysis would not have been undertaken if it was not for the trauma table being available. As well, many of these surgical procedures would not have been possible without the equipment that had been purchased from India through Quantum Surgicals. For example, the fixation of the four children’s hips was only possible because we had specific cannulated hip screws of varying sizes to use. There were the inevitable fracture non unions that required fixation and again without the surgery these patients would have remained severely disabled. 

With the use of surgical fixation the replacement of the equipment used continues, to prevent unavailability from occurring, which is not an uncommon scenario to occur because of costs. The funding of purchasing the equipment will remain with the Whanganui North Rotary club who have been committed to the Orthopaedic Surgical services upgrade project since 2022 and will be till 2024.

Nams and Shodhan with Ana Akauola, Medical Superintendent Vaiola Hospital

In addition to the clinical work, I had several meetings which included meeting up with the visiting Pharma Tech team of Drs Shodhan and Nams Mangalore. They were visiting from India to undertake a feasibility study to upgrade two operating theatres at Vaiola hospital. Their company has had extensive experience in upgrading operating theatres back in India, in fact they have been involved with 80 theatre upgrades. They were able to undertake a thorough assessment of the operating theatres at Vaiola hospital during their week stay. The plan is for the upgrade materials to be prefabricated in India and shipped over by a container earlier next year. A team of ten or twelve personnel will follow to undertake the upgrade over a period of two months, hopefully in March and April next year.

The hope is that Pharma Tech will be able to submit a contract fee for the upgrade in December 2023 and that a contract can be signed soon after so the work can commence.

A zoom meeting was held on Friday afternoon involving Drs Ana Akauola, Superintendent of Vaiola hospital; Bill Tangi, Head Surgeon Vaiola hospital, Shodhan and Nams Mangalore, myself with Mr Tony Hodge and Andrew Daddy, representing the Whanganui North Rotary club. The meeting was held to discuss the overall operating theatre upgrade and logistics of the project. A presentation was given of the proposed theatre upgrade by Nams followed by a Q and A session. Whanganui North Rotary club who are currently fundraising money in New Zealand and Australia and are the International club will officially lead the project, which Dr Ana Akalofa and Tangi are happy for them to do both financially and logistically.

I had a meeting with Mr Semisi Fukofuka, from the New Zealand High Commission, late Thursday afternoon discussing the Operating theatre upgrade. He had been briefed previously and was aware of the state of the operating theatre at Vaiola hospital. Following our meeting the hope is to arrange dialogue with the New Zealand MFAT team responsible for Tonga.

I was also able to meet up with the local Rotary club in Nulu’Alofa on Saturday morning to introduce Drs Shodhan and Nams Mangalore. The club will have a pivotal role in assisting with Customs when the container arrives and supporting the team when they commence the operating theatre upgrade in March and April 2024. The members were keen to be involved as well as publicizing the project to the local community.

And finally, during this visit we had the opportunity to have with us two junior orthopaedic surgical doctors from New Zealand, Dr Charlotte Tuimana and Letania Mikaeke who both have very strong Tongan connections. They are very keen to keep up ties so that in the future following further training may become involved with supporting the Orthopaedic Surgical service in Tonga.

With respect to sustainability of the service the good news is that Dr Tevita Tuungafasi will be coming to New Zealand next year, commencing January 2024 as a General Surgical Registrar initially working at Waikato hospital and then the following year at Whanganui hospital to focus on upskilling himself in Orthopaedic trauma surgery.

All in all, this was a fruitful visit. The local surgical team have been a pleasure to work with and are always very welcoming. I was certainly encouraged with the commitment of all parties involved with the theatre upgrade project to make it a success for the people of Tonga. Finally, I am thankful for the NZTS through PMA and Whanganui North Rotary club for supporting my work in Tonga.

My next visit will not be planned for till the Theatre upgrade dates have been finalized for early next year. My hope will be for three visits next year complimenting the Australian team visit mid-2024. 

John van Dalen

Orthopaedic Surgeon

December 2023