Report on Module 2, Kundiawa, PNG Highlands

New graduates L to R Mark Rokobuli, James Tewa’ani, Shaun Mauiliu, Alex Munamua

Module 2 was held at the Sir Joseph Nombri Memorial Kundiawa General Hospital in Kundiawa, Simbu Province in the Papua New Guinea Highlands(PNG) from July 29th to August 16th, 2019. There were 15 trainees in the Knee module and 13 trainees attended the Foot & Ankle module. They are Dr. Alex Munamua, Dr. Reshwin Rajan and Dr. Clay Siosi from Solomon Islands, Dr. Pita Sovanivalu from Fiji, Dr. Johnny Hedson from Pohnpei, Federated States of Micronesia, Dr. Naseri Aiotato from American Samoa, Dr. Juvencio Dias from Timor Leste and Dr. Haynes Rasin from Buka (autonomous region of Bougainville), Dr. Viola Kokiva, from Kavieng, Dr. Raymond Saulep and Dr. Bohu Urakoko from Kundiawa, Dr. Felix Diaku and Dr Kevin Lapu from Rabaul, Dr. Stevens James from Lae and Dr. Anthony Nasai from Wabag (all from PNG).

The lectures were delivered by Dr. Nik Friederich from Switzerland, Dr. James Aoina, Dr. Hamish Leslie, Dr. Soots Leilua and Dr. Tim Chuang from New Zealand, Dr, Dr Daryl Teague. Kaushik Hazratwalla and Dr. Des Soares from Australia.

Back L to R: Areta Samuelu, Shaun Mauiliu, Des Soares, Mark Rokobuli, James tewa’ani, Alex Munamua. Front row: L to R Andreas Loefler, Peter Cundy, Richard Lander, Sud Rao

In addition, the second ever exit examination was held with the following PIOA trainees presenting – Shaun Mauiliu, Areta Samuelu (both from Samoa), Mark Rokobuli(Fiji) , Alex Munamua and James Tewa’ani (both from Solomon Islands). They were examined by Dr. Richard Lander and Dr. Sud Rao from New Zealand and Dr. Peter Cundy and Dr. Andreas Loefler from Australia.

Nik teaching knee arthroscopy on a knee model Viola Kokiva,, Raymond Saulep and Pita in background watching
Nik and Des demonstrating TKR technique on sawbones

In the Knee module students were taught a systematic approach to history taking, clinical examination and investigation with a focus on common knee conditions. The practical sessions were aimed at common knee management options including external fixation and internal fixation for supracondylar and tibial plateau fractures. Small group workshops on knee arthroscopy using a model, ACL reconstruction and high tibial osteotomy using sawbones were completed by all students. The surgical technique for knee arthroplasty using sawbones and discussion of the removal of infected implants was also covered.

Tim Chuang, Pita Sovanivalu, Viola Kokiva and Johnny Hedson

In the foot and ankle module, the students were taught a systematic approach to diagnosis and management of  lower limb  conditions. This included clinical history taking and a thorough clinical examination with emphasis on a systematic approach to the management of conditions affecting the foot and ankle. This included the management of soft tissues and closed and open fractures. In addition, there were focussed lectures and practicals on the management of foot trauma with the small group workshops on ankle fractures and forefoot and hindfoot injuries.

Overall the 3-week module was intense, and it was obvious the students were stimulated to learn. The students are now already reading ahead to prepare for the next module on Introductory topics, Spine and Research to be held in Apia, Samoa commencing on 23 March 2020.

Morning tea

Our thanks to the staff and patients of the Kundiawa General Hospital, Simbu for the use of the Conference room and for allowing us to conduct the course there. Our special thanks to the CEO and Director of Medical Services of  Kundiawa Hospital who made us welcome and provided transport to and from Mt Hagen and many other forms of assistance.

Bohu Urakoko, Naseri Aiotato, Raymond Saulep
Daryl Teague and Nik Friederich

Thank you to Kongo coffee who generously provided coffee for morning tea each day as well as a gift pack of coffee for all students and lecturers. Thank you also to the 3 women’s church groups who provided nutritious food for the duration of the course and made us feel at home.

Back L to R Des Soares, Anthony Nasai, Naseri Aiotato, Reshwin Rajan, Felix Diaku, Haynes Rasin, Johnny Hedson, Steven James, Juvencio Dias, Viola Kokiva, Pita Sovanivalu, Raymond Saulep Front L to R Shaun Mauiliu, Areta Samuelu, Mark Rokobuli, Daryl Teague, Nik Friederich, Kosh Hazratwalla, James Tewa’ani, Alex Munamua, Kevin Lapu and Clay Siosi. (Bohu Urakoko not in picture)

Finally, this module would not have been possible without the generous financial support from Wyss Medical Foundation, AO Alliance Foundation and South Pacific Projects.

Congratulations Dr. Clay Siosi

Congratulations! Dr. Clay Siosi, a PIOA trainee from Solomon Islands has been selected by the American Association for Hand Surgery (AAHS) /HSE International Reverse Surgery Fellowship review taskforce as the 2020 recipient! The International Reverse Surgery Fellowship was created by the AAHS to sponsor an international hand surgeon’s visits with AAHS member surgeons at their institutions. The goal is to provide expert, hands-on experience so that Clay can return home to improve local care and educate others.

PIOA exit exam 2019

Back row : Candidates (L to R) Areta Samuelu (Samoa), Shaun Mauiliu (Samoa), Des Soares (Director of Training), Mark Rokobuli (Fiji) James Tewa’ani (Solomon Islands) Alex Munamua (Solomon Isldands,
Examiners (front row L to R) Andreas Loefler and Peter Cundy (Australia) Richard Lander and Sud Rao (New Zealand)

We are pleased to report that 4 out of our 5 final year candidates successfully completed the final exit examination. This was run by independent examiners from Australia and New Zealand. We are grateful to Dr Richard Lander (Chief Examiner) and Dr Sud Rao from New Zealand and Dr Peter Cundy and Dr Andreas Loefler from Australia. The exam followed a similar format to the FRACS examination with 2 written papers, 2 clinical vivas and 3 computer based vivas. Candidates were tested on 45 different scenarios. We are proud of the teamwork and cameraderie shown by our final year candidates as they supported their colleague who was unsuccessful.

Next modules – Knee, Foot & Ankle, Kundiawa, PNG

The next modules commence on Monday 28 July in Kundiawa, PNG highlands. We are grateful to the Sir Joseph Nombri Memorial Hospital which will host us for the next 3 weeks. The topics to be covered include Knee , Foot & Ankle. We will have 16 trainees do the modules. In addition we will do our second ever exit exam. We have 5 candidates presenting for their final exam. They are Shaun Mauili and Areta Samuelu from Samoa, Mark Rokobuli from Fiji , Alex Munamua and James Tewa’ani from Solomon Islands.

First ever TENS nail performed in Samoa

Dr Shaun Mauiliu, PIOA final year trainee performed the first ever TENS nail in Samoa. Shaun learned the technique in 2018 at the PIOA Paediatric module. He has recently received a new NET brand TENS set supplied by Narang Medical Ltd. from India which provides cost effective implants for less developed countries.

The fracture was redcued closed and the surgery took 30 minutes. Well done Shaun and team. Very proud of you.

PIOA represented at Asia Pacific Orthopaedic Association (APOA Sports meeting 2019) conference in Kuala Lumpur

From L to R Dr. Jashint Maharaj and Dr. Reshwin Rajan (Solomon Islands)

PIOA first year trainee, Dr. Reshwin Rajan, from Solomon Islands presented a poster at the Asia Pacific Orthopaedic Association (APOA) Sports meeting 2019 conference in Kuala Lumur. He is the first trainee to represent PIOA at APOA. His paper was on the “Epidemiology of Soccer related fractures in Solomon Islands“. Pictured with him is Dr. Jashint Maharaj, an associate member of PIOA, previously of Fiji but now living in Brisbane, who also presented at the same conference.

Graduation ceremony for Dr. Stephen Kodovaru – Master of Surgery (Orthopaedics) at National University of Samoa (Apia)

Today marks the culmination of a 7 plus year journey for Dr. Stephen Kodovaru from Solomon Islands. Stephen received a Master of Surgery in Orthopaedics from the National University of Samoa in Apia. He is the first graduate of the Pacific Islands Orthopaedic Association training program. He is also the current President of PIOA.

You can read more at
https://www.samoaobserver.ws/category/samoa/39922

Report on Module 1, 2019 – Introductory module / Upper limb module

New trainees from L to R: Viola Kokiva (Kavieng, PNG), Bohu Urakoko (Kundiawa, PNG), Haynes Rasin (Buka, AR Bougainville, PNG), Reshwin Rajan (Honiara, Solomon Islands) and Juvencio Dias (Dili, Timor Leste)

Module 1 was held at the Modilon Hospital and the Madang Lodge Conference room in Madang, Papua New Guinea(PNG) from February 4th to February 22nd, 2019. There were 14 trainees in the Introductory module and 17 trainees attended the Upper limb module. They are Dr. Shaun Mauiliu  from Apia in Samoa, Dr. Alex Munamua, Dr. Reshwin Rajan and Dr. Clay Siosi from Solomon Islands, Dr. Pita Sovanivalu from Fiji, Dr. Johnny Hedson from Pohnpei, Federated States of Micronesia, Dr. Naseri Aiotato from American Samoa, Dr. Juvencio Dias our first trainee from Timor Leste and Dr. Haynes Rasin from Buka (autonomous region of Bougainville), Dr. Jimmy Yakea from Popondetta, Dr. Viola Kokiva, our first female trainee, from Kavieng, Dr. Raymond Saulep and Dr. Bohu Urakoko from Kundiawa, Dr. Felix Diaku and Dr Kevin Lapu from Rabaul, Dr. Stevens James from Lae and Dr. Anthony Nasai from Wabag (all from PNG). The lectures were delivered by Dr. Bruno Fries from Switzerland, Dr. David Bartle, Dr. Vaughan Poutawera and Dr Roy Craig from New Zealand, Dr. Stephen Kodovaru from Solomon Islands, Dr Sara Coll, Dr. Ian Incoll, Dr Paul Hitchen, Dr. Stephen Quain, Dr. Matthew Sharland, Dr. John Stephen, Dr. Graham Gumley, Dr. Keat Choong (Infectious diseases) and Dr. Des Soares from Australia.

In the Introductory module students were taught a systematic approach to history taking, clinical examination and investigation with a focus on trauma and common orthopaedic conditions. In the first week the practical sessions were aimed at common trauma management options including external fixation and basic internal fixation.

In the upper limb module, the students were taught a systematic approach to diagnosis and management of Upper limb conditions. This included clinical history taking and a thorough clinical examination with emphasis on a systematic approach to the management of conditions affecting the shoulder, arm, elbow, forearm, wrist and hand. This included the management of the soft tissues and the management of closed and open fractures. In addition, there were focussed lectures and practicals on the management of hand trauma with the first ever microsurgery course over 4 days.

Lectures were supplemented with practical demonstrations. Each morning we commenced with a ward round seeing two or three patients and getting the students to present the history and clinical signs of the patients. Their management was then discussed and suggestions for improvement were made. This was a useful exercise as we were able to improve clinical skills. It was also helpful to try and elucidate clinical reasoning and decision making and help with developing these skills. The students enjoyed having expert advice on the management of elective conditions and trauma affecting the upper limb PNG has a large volume of severe trauma due to bush knife (machete) and gunshot wounds.

The highlight of the course was the 4 day microsurgery workshop each afternoon. Our students went from complete novices to being able to do a nerve repair using a “chicken Maryland” model in 15 minutes. The chicken sciatic nerve is the same diameter as a human digital nerve in a finger. PIOA is very grateful to Dr. Graham Gumley for leading this part of the course. The students were assessed with a written examination on the final day of the course.

Overall the 3-week module was intense, and it was obvious the students were stimulated to learn. The students are now already reading ahead to prepare for the next module on Knee and Foot and ankle to be held in Kundiawa, PNG, commencing on 29 July 2018.

Our thanks to the staff and patients of the Modilon Hospital, Madang and the Madang Lodge Hotel for the use of the Conference room and for allowing us to conduct the course there. Our special thanks to the staff of Madang Lodge Hotel who provided nutritious food for the duration of the course and made us feel at home. Finally, this module would not have been possible without the generous financial support from Wyss Medical Foundation, AO Alliance Foundation and South Pacific Projects.


Staff and students at the end of week 1
Front row L to R: Keat Choong (AUS),Bruno Fries (Switzerland), Vaughan Poutawera (NZ), John Stephen(AUS), Stephen Kdovaru (SI – President PIOA) David Bartle (NZ), Ian Incoll (AUS)
Staff and students at the end of week 2
Front row L to R: Bruno Fries (Switzerland), Susan Hitchen, Paul Hitchen, Sarah Coll , Stephen Quain, Matthew Sharland, Des Soares (all Australia)
Staff and students at end of week 3
Front row L to R: Bruno Fries (SUI), Des Soares (AUS), Roy Craig (NZ), Graham Gumley (AUS), Shaun Mauiliu (Samoa – Director of Training designate)

PIOA welcomes Dr. Juvencio Dias our first trainee from Timor Leste

From L to R Dr. Juvencio Dias (Timor Leste) and Dr. Shaun Mauiliu (Samoa) learning microsurgery skills while practicing on a rubber glove.

PIOA is pleased to welcome Dr. Juvencio Dias from Timor Leste. He is our first trainee from Timor and is based in Dili. Juvencio is fluent in 6 languages (English, Spanish, Portuguese, Bahasa, Tetun and his local language. He is a quiet but very hardworking student.

PIOA will faciliate supervision visits by Dr. Matthew Sharland who is based close by in Darwin.

PIOA welcomes Dr. Haynes Rasin our first trainee from Bougainville

From L to R – Dr. Anthony Nasai(Wabag), Dr. Haynes Rasin (Buka, Bougainville) and Dr. Des Soares

PIOA is pleased to welcome Dr. Haynes Rasin our first trainee from the autonomous region of Bougainville in PNG. Haynes is an experienced general surgeon who has worked in Bougainville for many years. Patients with trauma make up a large part of his surgical workload. He was very pleased to be able to take a supply of implants back with him after the course.

PIOA facilitates the provision of high quality, low cost implants from India and China and encourages hospitals to purchase these implants in order to develop local systems that are self reliant rather than relying on constant donors.

PIOA will facilitate a supervisory visit to Haynes after the August module. Dr. Nik Friederich from Switzerland will visit Haynes and help advise him on how he can further develop the orthopaedic service in Buka.