Building safe surgical teams in Samoa

PIOA ran a safe surgical teams workshop in TTM Hospital on Saturday 25 March 2023

The workshop focussed on Situation analysis, Decision making, Communication and Teamwork. Here are some comments from those who attended.

RN Faatalaleleigafou Maliko / Junior theater Nurse.

  • For me as a new grad it was great opportunity to learn about communication, interacting between colleagues/ different methods of signing in & learning how the other pacific island countries how they are doing it, and this was an eye opener for me. After the course and in the last couple of weeks this has given us the confidence to speak up about factors that affect patient safety within the theater. Understanding the process of communication and knowing what to do during an emergency and how to deal with patient safety.

RN Heaven Isaia / Senior Theater Nurse.

  • All my years of working as a theater nurse, SST has given as a sense of understanding and knowledge, and the process of communication. After the course I have noticed a big improvement in knowledge and knowing the communication chain if there is an emergency and more transparency in our roles and how we communicated with each other.
  • After the SST I have noticed a healthier and a more respectful workplace then before we did the course.
  • It is a very good way that SST has uplifted the professionalism within our operating theater.

RN Filipi Keresoma/ Senior Theater Nurse.

  • SST is a useful training it helps in terms of planning and prioritization of the day during the day.
  • With our limited resources that we have, this course has given us more knowledge and skills in dealing with difficult cases and learning to work as a team for patient safety.
  • This course has also highlighted us to communicate better, and work as a team and the bottom line is the safety of the patient.

Dr Cecilia Vaai Bartley / Anesthetic Registrar -final year trainee.

  • For the SST, I found it really good, it was helpful to talk about non-technical skills as this directly affects technical skills very much.

It was  good also that it involved everyone like the scrub nurse & surgeons, and this helps us deal with issues that affect patient safety and how we can all work as a team

Some reflections on the Paediatric orthopaedic module

Dr. Haynes Rasin, Buka, Bougainville

The week was very informative for me. I appreciated a lot of new knowledge gained in this section.

An example, that there is a condition called Blount’s disease which is similar to rickets. However, have certain features that a characteristic of each and thus differentiates from the 2.  In Rickets, there is diffuse bowing, but in Blount’s disease there proximal tibial deformity with medial beaking.  Also cupping, fraying and metaphyseal splaying are present in Rickets but absent in Blount’s disease.

 I also appreciate the knowledge to guide growth in children. The techniques involved which I think that if I can assist to do at least 2, I can confidently do them in our setting provided our theatre meets the requirements, eg. need for II. As the simple, basic plate and 2 screws for use can be readily ordered for such. The other new thing I learnt here was the presence of the bars that affect the bone growth and lengthening. Now I know how to identify the bars, also know the pathology they will cause. Perhaps, in the past I did see some of them but just passed them since I did not know what they signify.

I would have thought that perhaps, having the pediatric module for 7 days then having the exam on the following Monday morning would have given ample time for me to grasp the ideas and principles well before the exam.

I really appreciated the club feet talk. I used to have trouble understand the Pirani score and the serial casting methods that go with it. I now have better understanding at least to do the casting in the order required.  

The correct method of application of a hip spica on a traction bed.  Having the right equipment makes it easier to do the procedure.

So now the challenge is for me to submit proposals for 2 traction beds for our hospital, 1 for children and 1 for adults.

I sincerely thank the visiting lecturers for their time, effort and commitment to impart on us the paediatric orthopaedic knowledge.

Perhaps, an overseas attachment would reinforce further this knowledge as I would have the opportunity to observe, assist in such procedures and gain confidence in doing them.

Thank you

Haynes Rasin

PIOA students celebrate the graduation of Areta Samuelu and Pita Sovanivalu

From L to R Tommy Walters(PNG), Shaun Mauiliu(Samoa), Clay Siosi(Solomons), Des Soares(Australia), Jacky Pahun(PNG), Areta Samuelu(Samoa), Reshwin Rajan(Solomons/Fiji),Kevin Lapu(PNG) Anthony Nasai(PNG), Pita Sovanivalu(Fiji), Haynes Rasin(PNG), Pauliasi Bauleka(Fiji), Juvensio Dias(Timor), Nathan Saxby(elective medical student), Agnes Auto(Solomons), Julio Martins(Timor), Viola Kokiva(PNG)

The National University of Samoa graduation ceremony was held on 31 March 2023 in Apia. Two PIOA graduates Dr Areta Samuelu from Samoa nd Dr Pita Sovaonivalu from Fiji were awarded the Master of Surgery (Orthopaedics). It was a privilege for students attending the PIOA module in Samoa to be able to join in and observe the graduation ceremony. Dr Shaun Mauiliu, PIOA President and Dr Des Soares, Deputy Director of Training were also able to participate in the academic procession. PIOA is very grateful to Dr Rossana Pifeleti, Dean of the NUS School of Medicine for including us in the ceremony.

Reflections on the Paediatric module by Dr Viola Kokiva

I am writing to express my utmost gratitude for the PIOA Paediatric Orthopaedics Module that I was a privileged to attend from the 13th to 18th of March 2023 in Apia, Samoa.

Dr Viola Koiva (right) with fellow PIOA trainees Dr Jacky Pahun (left) and Dr Agnes Auto (middle) enjoying a break in the course.

There were quite a number of new concepts taught that opened my eyes to how I should manage paediatric bone cases and I am greatly impressed and challenged to think beyond what I am used to seeing and practising in my country Papua New Guinea.

I am so pleased to learn that there is something we can offer to most of our patients whom we think nothing else can be done for. The most impressing concepts for me were:

– the cerebral palsy Gross Motor Function Classification System (GFMCS) that we can use to assess how as Orthopaedic surgeons, we can assist these children have a better quality of life when they grow up and become adults. It was interesting to see that they too can continue to be part of the productive work-force even if they’re GFMCS III. We surgeons play a role in helping the physicians manage cerebral palsy cases.

– the Osteomyelitis management emphasis on early diagnosis and drainage to save bone and reduce the unwise use of multiple antibiotics for long term therapy in osteomyelitis. This is so useful as I see a lot of these cases in my out-patient clinics and managing them is not always straight-forward.

– the calculation of LLD and the orthopaedic management options available for the children with LLD, how we can help save their limbs and prevent other skeletal deformities. This will lead to a better quality of life in the future and give them hope to find work and contribute to the country’s economic growth.

– the guided growth-plate arrest concept is also very useful and doable now that we have II in Port Moresby for those children with deformities from Blount Disease or Rickets condition.

– DDH screening is important early on and follow-up very useful so we can intervene early as surgeons and prevent major complications for the affected child’s development.

I look forward to more zoom classes and modules with PIOA that will help me expand my knowledge and skills in Orthopaedics so I can do better for my people around Papua New Guinea and the Pacific.

Editors note: PIOA is grateful to the Pacific Community and AO Alliance Foundation for their generous funding for this program.


The PIOA AGM 2023 was held online on Sunday 26 February 2023 commencing at 4pm AEST(Brisbane time).

Here are the papers from the meeting;


Draft Minutes of the AGM (to be ratified at next AGM in Feb 2024)

President’s report

Director of Training report

PIOA Trainee report – Raymond Saulep

Treasurer report – the Treasurer presented the Summary accounts and the Financial statement for PIOA Queensland Inc listed below.

Summary accounts (for all bank acounts)

Financial statements for PIOA Queensland Inc

Detailed Income and expenses for PIOA Queensland Inc.

PIOA module Apia, Samoa – 13 March to 1 April 2023

The next PIOA module will be held at the Tupua Tamasese Meaole (TTM) Hospital in Apia, Samoa from 13 March to 1 April 2023. The topics covered will include Paediatric orthopaedics (13-18 March), Tumour (20-24 March), and Infection, Inflammation and Professional topics (25 March to 1 April).

We will have students from Timor Leste, Papua New Guinea, Solomon Islands, Fiji, Cook Islands, Samoa and American Samoa at the module. The module is sponsored by AO Alliance Foundation and the Pacific Community (SPC).

We will also celebrate the graduation ceremony from the National University of Samoa of our recent graduates Dr Areta Samuelu and Dr Pita Sovanivalu.

Pita Sovanivalu – new graduate

In his own words:

I’m currently working as acting Chief Medical officer in orthopaedics at Labasa Hospital (only divisional hospital in northern fiji serving a population of 150000).

Thanks to PIOA for what it has done for me in regards to :

Improve my theoretical orthopedic knowledge.

Taught me the importance of taking a proper history and examination.

Improve my surgical skills .

Continuous CME every Sunday.

Arranging individual mentoring with senior orthopaedic doctors from Australia/ NZ.

Provide a platform for discussion of cases and treatment plan.

Arranging for visitation of orthopedic team to our respective hospital to come and help in attending complex cases.

I hope and pray that PIOA will continue to do orthopaedic training in the Pacific.

Some comments from our students

Juvencio Dias (Timor Leste)

Juvencio Dias

During 2 weeks Module in Suva I have learnt a lot about Hip and Spine. The Module is very practical and made it easy to understand how to performed surgery from different surgical approaches to Hip and Spine.

I also was able to see different cases in the ward, and was guided by Senior Orthopaedic consultants and best lecturers from Australia and New Zealand. I’m Very Happy to attend this Module in Suva and my Gratitude  to PIOA and to CMWH (staff and Patients) as well.


Agnes Auto (Solomon Islands)

Agnes Auto

This learning experience has added value to my contribution in reducing Disability Advanced Life Years (DALY) in the Solomon Islands.

I feel more confident with the knowledge and skills learned, and am challenging myself to put these into practice the once I return home, to work with my Senior Colleagues .

I am thankful for the opportunity to grow with PIOA and grateful to the SPC for their support and enabling me to attend.

Tagio Tumas


Clay Siosi (Solomon Islands)

Clay Siosi Lewi

Spine – the learning I acquired through this training has broadened my understanding and management of spine pathologies or problems I see in my home country. It provide focused approach in identifying and managing my patients.

Hip – wealth of knowledge from the members of faculty. I learned about hip and pelvic trauma management. Their experience and expertise knowledge has opened up another level of understanding…

Best regards 


Deacon Teapa (Cook Islands)

I would to say thank you to PIOA and SPC for giving this valuable opportunity for being part of this organization. Coming back from nearly 12 years of academic hiatus I find the last 2 weeks on the PIOA modules has been fulfilling and enriching to my personal professional development. The course has provided me an opportunity to reinforce my knowledge and past experience, learn new things and especially

operative skills sets from some of the best orthopaedic surgeons in Australasia. I look forward towards the next modules in the coming months and years.

ATAWAI WOLO (Thank you very much)

PIOA meeting with Fiji National University 20 September 2022

In other developments for PIOA, we had a long-awaited meeting with FNU and major stakeholders in the Surgical & Orthopaedic department to address the urgent need to develop orthopedic care in Fiji. This meeting also helped address a lot of issues regarding training and it was a milestone for both PIOA and FNU. The future looks bright and looking forward to building quality orthopedic care in the Pacific, so watch this space.

Figure: sitting L- R Dr Josese Turagava (consultant Pediatric Surgeon CWM hospital) , Dr William May (acting Vice Chancellor/ Dean College of Medicine Nursing & Health Science for FNU), Dr Abhay Choudhari (Assistant Professor Surgery FNU), Dr Emosi Taloga (Orthopeadic Consultant CWM Hospital), Dr Basharat Munshi (FNU), Dr Timoci Qereqeretabua (Consultant Surgeon CWM Hospital, Dr Mai Ling (FNU) Dr Des Soares, Dr Pauliasi (Orthopeadic Consultant CWM hospital) , Standing: Dr L-R : Dr Semisi (CWM Hospital) , Dr Ilaitia Delasau (Consultant Surgeon CWM Hospital) / Photographer Dr Tu’uau Shaun Mauiliu