In April 2018 John van Dalen, Orthopaedic Surgeon from Whanganui, New Zealand began visits to Vaiola hospital, Nuku’Alofa with support from the New Zealand Ministry of Foreign Affairs and Trade (MFAT). The focus of these visits, of up to ten days, was to assist and teach the resident surgical team management of complex fractures. These visits complimented the Australian Orthopaedic surgical team visit in mid-year.

It became evident during the visits that new equipment was required to upgrade the service. It was during the Covid 19 lockdown period, that funds were raised through Rotary and MFAT, headed by the Whanganui North Rotary club in New Zealand, to purchase equipment from India. In addition, a trauma surgical operating table donated by Whanganui hospital was shipped over to Tonga.

During Covid 19 lockdown in Tonga there were no surgical visits possible so zoom clinical meetings were undertaken to discuss management of fractures.

In August 2022 John re-commenced visits to Tonga and on the first visit was able to use the newly purchased equipment. The trauma surgical table was used on the visit in December 2022, which allowed fixation of a fracture neck of femur and a slipped upper femoral epiphysis in an adolescent girl. Also, a closed rodding of a tibial shaft fracture was performed, procedures which had not been performed previously in Tonga. With subsequent visits in March and June 2023 further use of the newly acquired equipment and the surgical trauma table were undertaken.

With the increased use of fixation for fracture management intra operative infection was a concern as the current operating theatre air filtering system at Vaiola hospital was not full proof. A new project www.tonganhosptialprojects.com was then instigated early in 2023 to upgrade two operating theatres at Vaiola hospital, Nuku’Alofa. A zoom meeting with an Indian contractor was arranged in June 2023 and an agreement undertaken to proceed with a feasibility study, which should be realised later in 2023.

The Whanganui North Rotary Club agreed to spear head the fund-raising drive to raise US$250,000 for this project. The hope is that the operating theatre upgrade may occur in 2025.

In addition to this project, with support from PMA, operating nurses attended a fracture nurses’ course in June 2023 in Auckland to upskill themselves.

The plan is to continue Orthopaedic Surgical outreach with regular visits supported by PMA and for Dr Tevita Tu’ungafasi to come to New Zealand to upskill himself in complex fracture management in 2025-26. Following the completion of the operating theatres upgrade there is hope of offering

arthroplasty surgery for the Tongan people and the wider South Pacific community. The upgrade will also benefit other visiting surgical teams.

John van Dalen

FRACS

Whanganui Hospital, Whanganui, New Zealand