PIOA AGM 2021 – Trainee report

Musculo-­‐skeletal  pathology  has  always  been  both  a  diagnostic  and  management dilemma  in  almost  all  of  the  Pacific  Island  Countries.  The lack  of  general  knowledge  and  skills  necessary  for  basic  proper  diagnosis  and  subsequent  employment  of  complementing  management  principles  has  always  been  a  challenge  for  most  of  the  islanders’  medical  practitioners.  

Whether  it  is  on  a  remote  atoll  or  the  hinterlands  of our  bigger  islands,  the  wide  expanse  of  the  Pacific  Ocean and  the rugged  terrains,  has  always  posed  great  difficulty  for  our  population  to  access  basic  orthopedic  services,  which  apparently  for  most  of  our  islands,  appear  to  be  a  service  enjoyed  by  the  few  who  are  living  in  and  close  to  the  capital  towns  or  cities.    
The  introduction  of  Pacific  Islands  Orthopedic  Association  (PIOA)  training  has  certainly  been  a  blessing  for  us  since  its  birth.  It  has  served  as  the  conduit  for  delivery  of  quality  knowledge and  skills  necessary  to  equip  one  to  deal  with  our  common, and  also  not  so  common; musculoskeletal  problems.
We  take  our  hats  off  to  our  faculty and  their  families,  from far  and  near;  who  have  given us  their undivided  attention  and time in  this  journey  in  building  our  island  capacity.  Knowing  well  that  the  islands  will  present  to  them  its  many  challenges,  they  have  continued  on  in  this  journey.  Building  from  strength  to  strength.  

For  sure,  the  vision  held  at  some  time  in  the  past  by  a  few, is  now  taking its  form  and  is  now embraced  by  many.  Though  it  might  seem  a  slow  walk  for  some,  but  for  those  of  us  impacted  by  the  very  training  and  are  seeing  results,  it  is  progress.  It  is  such  that  gives  us  the  hope  of  a  better  tomorrow  for  our  people  in  the  islands of  the  Pacific.

2020  Academic  Year.
New  Trainees.
A  warm  welcome  to  our  new  fellow  trainees  for  2020.    The  trainees  were:
1) Kini  Serevi  – Fiji,
2) Upa  Kaupa  – Papua  New  Guinea,  and;
3) Agnes  Auto  – Solomon  Island
Finalist  2019.
Congratulations  to  our  finalist  trainees  of  2019.  Namely,  
1) Shaun  Mauiliu  – Samoa,
2) James  Tewa’ai  – Solomon  Island,
3) Mark  Rokobul  – Fiji,  and;
4) Alex  Munamu  – Solomon  Island.
Continuing  Trainees.
Congratulations  on  your  perseverance  through  2020  despite  the  many  challenges  through  out  the  2020  academic  year.
In  light  of  the  COVID  19  pandemic,  it  has  been  a  challenging  year  in  delivering  modules  for  the  trainees.  Travel  restrictions  with  closed  borders  have  made  it  impossible  for  travel in  general for  the  modules.  
However,  the  COVID  19  pandemic  experience  has  also  brought  forward  brilliant  thoughts  for  the  way  forward  for  living  in  general  and  of  course delivering  of  our  modules.  The  Zoom  Platform  was our  greatest  friend  and  aid.  
2020  Zoom  conferences:  The  Challenges,  Solutions  and   recommendations.
It  was  surely  great  that  the  sessions  were  delivered  using  the  Zoom  platform.  The  sessions were  delivered  as  per  the  schedule.  However,  trainees  were  not  able  to  attend  in  person  at  times  for  the  following  reasons:
1) Trainees  were  on  call during  Zoom  session  times.  It  was  in  itself  a  challenge  as  call  schedules  were  made  to  factor  in  trainees  as  all  were  on  the  ground  and  had  to  continue  to  take  calls.  Surely,  the  sessions  were  recorded  and  shared  but  would  be  better  to  sit  in  a  live  session  for  many  reasons. Hopefully,  2021  will  be  better.
2) Internet  signals. At  times  Internet  connectivity  is  a  problem  across  the  islands.  I  
find  personally  that  you  can  have  multiple  ISP  connections.  For  example,  I  use  both  Digicel  and  Telikom  cell  phone  companies here  in  PNG.  So  I can  swing  between  the  companies  whenever  signal  drops  in  one.  We  cannot depend  on  just  one.  Have  a  back  up  option.
3) Practical  Sessions. Obviously,  we  did  not  have  the  practical  sessions.  Probably,  we  
can  have  video  recordings  of  the  practicum and  shared  with  the  trainees.  We  can  have  the  actually  hands  on  when  we  have  the  opportunity.  
All  in  all,  2020  was  a  successful  year  despite  the  limitations  that  we  had.  Though  COVID  19  closed  off  our  borders,  it  never  closed  off  the  opportunity  for  continued  learning.  The  Zoom  Conferencing  platform  paved  the  way  for  our  new  normal  in  learning. Thank  you  from  all  the  trainees  to  our  faculty  members  of  PIOA  for  your  
undivided  support  through  2020.
May  2021  be  better  as  we  continue  to  grow  in strength.
To  God  be  the  Glory!
Raymond  Saulep
PIOA  Trainee, Kundiawa
Student  Representative,  2020.

PIOA AGM 2021 – Presidents’ report

Bula, Talofa, kia ora, Mauri, G’day

Greetings to you all from Honiara

I’d like to welcome you all to this PIOA AGM virtual meeting hosted from Brisbane, Australia.

The past year 2020 has been a very challenging year for everyone and unprecedented in many respects. Covid 19 has restricted world travel that impacts many programs including our associations 2020 programs. As we meet we are not sure when most of this restrictions will be lifted. In general our part of the world has been spared the health impacts of Covid 19 seen in other parts of the world but certainly in other aspects like economy, our island nations have not been spared, impacting on our health systems.

Challenges offer opportunities for innovation and am proud to say PIOA as an association has continued to maintain weekly presentations over the platform zoom to offer its trainees continuous learning this past year. We were able to deliver  topics on trauma and orthopaedic conditions that I believe assisted us in our delivery of services in our respective hospitals.

We are not able to conduct many of our programs including exams and delivery of twice a year face to face modules this past year but were able to accept new trainees and i’d like to welcome our new trainees to this meeting. We have new intakes from PNG, Fiji, Solomon Islands and East Timor.

PIOA was formally registered with the Australian Charities and No for profits commission on the 27th of March 2020.

I would like to acknowledge the many partners who supported our association, AOA and Orthopaedic outreach, NZOA and Orthopacifix Charitable Trust, Surgeons from NZ, Australia and Switzerland providing time for delivery of lectures, Hospitals in NZ for hosting our trainees attachment, the Samoa National University for accrediting our program and AO alliance, South Pacific Projects, Peace Nexus Foundation and others for funding.

I would like to acknowledge des and shaun for organising and facilitating our training programs and ensuring the association maintains its registration requirements, but moreover continuing to advocate and seek new partners in our association programs.

I believe todays meet will be fruitful and look forward to our discussions

 Thank you

Dr. Stephen Kodvaru

President PIOA


The PIOA AGM was held on 21 February 2021 at 4pm AEST using ZOOM. It was attended by members from Australia, New Zealand, Switzerland, Timor Leste, Papua New Guinea, Solomon Islands, Fiji, and Samoa.

PIOA 2020 modules cancelled due to COVID-19

On 6 March 2020, the PIOA training committee decided to cancel the Apia module scheduled to commence on 23 March. Since we made the decision the Australian government placed a ban on overseas travel for all residents. This ban was then extended by many other countries. We have now also cancelled the second module planned for this year. We hope to recommence training modules again in 2021.

However, we have not wasted any time. We rapidly pivoted to holding a weekly seminar using Zoom. This has been well attended by our students from 7 different Pacific Island Countries. We have been privileged to have lecturers from Australia, New Zealand and Switzerland.

Our students have embraced the future with enthusiasm and commitment. PIOA has offered access to the tutorials to people who are not on the PIOA program, as a way of giving back. We look forward to returning to more hands on and face to face learning in 2021.

Next module – Apia Samoa

The next module in the PIOA program will be held at TTM Hospital in Apia, Samoa. We will welcome 3 new trainees (one from Fiji and 2 from PNG). This module will cover Introductory topics, Research, Spine and Hand and will run from 23 March to 10 April 2020.

A highlight during the module (and the reason for the module being delayed from February to April) is the graduation ceremony at the National University of Samoa for 4 of our PIOA graduates who successfully completed their exit examination in August 2019.

PIOA represented at the NZOA ASM

Dr. Reshwin Rajan from Solomon Islands presented a paper at the New Zealand Orthopaedic Association. Here is his report:

Stephen Kodvaru, Andy Vane and Reshwin Rajan

NZOA Pacific Ambassador Program was initiated by NZOA and Orthopacifix Charitable trust in 2018. Dr Raymond Saulep(PNG), was the first candidate. This year I was fortunate enough to be selected as the second Pacific Ambassador to NZOA. This program involved a week of observership at Tauranga Hospital and attending the NZOA ASM. This year the NZOA ASM was held at Dunedin, NZ, from 29th September to 2nd October.

On the final day of the conference, I also presented my paper on “Epidemiology of Soccer Related Fractures in Solomon Islands”. It was well received by the audience and I received a lot of positive remarks. It was indeed an honor representing PIOA at the NZOA 69th ASM. In summary, it was a great learning experience for me. During my six days attachment at Tauranga Hospital, I was involved in a total of 12 surgeries (mostly trauma and a few elective cases).

Vaughan Poutawera, Reshwin Rajan and Areta Samuelu

I would like to thank Orthopacifix Charitable Trust for meeting my travel expenses, not forgetting Mr Vane and Poutawera(VP) for accommodating me at Tauranga. Lastly but not the least, it was a great joy meeting my Brother Dr Areta and PIOA President Dr Stephen Kodovaru. Thanks again for making my stay in NZ a memorable experience.

AOA ASM 2019 Canberra

Des Soares, Areta Samuelu and Raymond Saulep at the Outreach session

The Australian Orthopaedic Association Annual Scientific Meeting was held in Canberra this year. Dr. Areta Samuelu (Apia, Samoa) and Dr. Raymond Saulep (Kundiawa, PNG) represented PIOA. Raymond also attended the Australian Orthopaedic Registrars Association conference and presented on Spine TB. Areta presented at the Outreach section. It was good to also meet up with Dr. Eka Wiratnaya one of our PIOA orthopaedic friends from Bali, Indonesia.

Areta Samuelu, Raymond Saulep, Eka Wiratnaya and Des Soares at the President’s Reception

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.