PIOA exit exam 19-23 September 2022, Suva, Fiji

The highlight of the module was the exit examination which was made up of 7 sections. There were 2 written papers, 2 clinical vivas where candidates had to examine patients and formulate a diagnosis and management plan.  There were 3 computer vivas (2 in operative surgery and 1 on investigation and diagnostic imaging).

Dr Richard Lander from Palmerston North New Zealand was the chief Examiner, and Dr John North from Brisbane Australia was his assistant. Two of our graduates Dr Stephen Kodovaru from Solomon Islands & Dr Tu’uau Shaun Mauiliu from Samoa, were invited as co-examiners during the weeklong examination process as part of succession planning for PIOA.

Dr Areta Samuelu & Dr Pita Sovanivalu successfully completed the final exam and will be eligible to graduate with a Master of Surgery (Orthopedics) from the National University of Samoa in Apia in April 2023.

Dr Areta Samuelu with new examiners and President Stephen Kodovaru and Director of Training Tua’au Shaun Mauiliu
Dr Pita Sovanivau with new examiners and President Stephen Kodovaru and Director of Training Tu’uau Shaun Mauiliu
Stephen, Pita, Richard Lander, John North Areta and Shaun

PIOA Hip module 17-24 September 2022, Suva, Fiji

The lectures for the hip modules were delivered by Dr Vaughan Poutawera & Dr Andrew Vane from Tauranga New Zealand, Dr Kaushik Hazratwalla from Townsville & Dr Des Soares from Brisbane Australia.

In this module, the students were taught a systematic approach to diagnosis and management of traumatic and degenerative conditions affecting the hip. This included clinical history taking and a thorough clinical examination with emphasis on a systematic approach to the management of osteomyelitis, septic arthritis and degenerative conditions such as osteoarthritis. In addition, there were focussed lectures and practicals on the management of trauma affecting the pelvis, acetabulum and femur.

Learning to ex-fix a pelvis

During the afternoon practical sessions, each student was given opportunity to deal with different conditions affecting the hip from the femur, hip joint and acetabulum. This was a very useful exercise to help them recognise and learn the up-to-date management of hip condition. One of the popular sessions was teaching cementing techniques to the trainees and this gave them options in dealing with difficult and complex cases.

Acetabular preparation for cementing
Ex-fix a femur

In the mornings ward rounds were continued as usual, making the students more confident in their orthopaedic history taking and examination. The module was also concluded with an end of block written examination.

Hip module group
The Tauranga team – Vaughan, Reshwin, Shaun and Deacon

PIOA Spine module (12-16 September 2022) – Suva, Fiji

The lectures for the Spine modules were delivered by Dr David Bartle from Tauranga New Zealand, Dr Ian Cheung & Dr Des Soares from Brisbane & Dr Michelle Atkinson from Sydney, Australia, and Dr James Tewa’ani from Solomon Islands.

In the Spine module students were taught a systematic approach to history taking, clinical examination and investigation with a focus on common spine orthopedic conditions. The practical sessions were aimed at common spine management options including cervical & lumbar spondylosis and stabilisation and internal fixation of spine trauma. Small group workshops focused on using Gardner Wells tongs/ halo traction using a model.

Condom model for practicing dura repair

A novel condom model was used to practice dural repair. Sawbones were used to demonstarte pedicle scre placement and laminectomy / spinal decompression. Other practical sessions looked at rehabilitation for spinal patients and other malignancies that affect the spine.

Each morning we commenced with a ward round seeing two 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 spine.

At the end of the module the students’ knowledge was tested with a written paper examination.

Dinner at end of Spine module

Congratulations to our new graduates

At the PIOA module held in Suva, Fiji, we celebrate the success of two of our trainees in their exit exam. We welcome Areta Samuelu (Apia, Samoa) and Pita Sovanivalu (Labasa, Fiji) as Fellows of PIOA. The examiners were Dr Richard Lander (New Zealand/Aotearoa), Dr John North (Australia), Dr Shaun Mauiliu (Samoa) and Dr Stephen Kodovaru (Solomon Islands).

From L to R Stephen Kodvaru, Pita Sovanilvalu, Richard Lander, John North, Areta Samuelu, Shaun Mauiliu

PIOA to restart modules – Suva, Fiji

After almost 3 years due to the COVID pandemic PIOA will hold the Spine and Hip module in Suva Fiji in co-operation wth the Fiji Ministry of Health and Medical Services and CWM Hospital, Suva. We are grateful to the Pacific Eye Institute which is kindly hosting us at their conference room. The module will be held between 12 – 24 September 2022.

We look forward to seeing trainees from Timor Leste, Papua New Guinea, Fiji, Solomon Islands, Samoa, Kiribati and Cook Islands.

PIOA assists Kundiawa Hospital with C arm digital xray

One of the common problems throughout developing world hospitals is the failure of II (C arm) machines. These are technologically sophisticated and used in the Operating theatre to do on table xray imaging of fractures in multiple planes. The devices fail in 3 main areas (bulb failure, motherboard or other electronic failure or damage to cable from rodents in base. Because the machine is large and heavy it is not possible to send it back for maintenance. Service personnel are also very expensive and hard to come by. The cost of the device is around US $80-100,000. PIOA worked in partnership with Australian Doctors for Africa to develop a low-cost C arm (it has been named C-Bones). We had assistance from Mick Caratti, a highly skilled engineer who did the detailed engineering design. Manufacture of the C arm was done by Alloytech in Bayswater, WA. The C arm device is purely mechanical and robust. The XR generator is a battery-operated unit that can provide 300 exposures per charge. It has been designed for veterinary use (portable) and is fully certified. The digital receiver is also wireless and communicated with a laptop via a router. It takes single shot static x rays which appear on the laptop within 2 seconds of image being taken. It is not a continuous image intensifier. The first prototype was installed in Kundiawa in PNG in June. A second is now installed in Hargeisa Hospital in Somaliland. This device can be delivered for USD $35000 (one third of the cost of a regular II). Installation is straightforward and detailed instructions are provided. Please contact PIO Pty Ltd (email des.soares@drdes.com.au) if you want more information about the C Bones.
X ray generator – can adjust kV and mAs
C Bones install at Kundiawa
C Bones install at Hargeisa Hospital, Somaliland

Reflections from Shaun Mauiliu, Director of Training

Talofa and good evening to all the faculty and students of PIOA

First I would like to thank Dr Des and Prof Nik and all our research committee for your hard work and teaching in the last couple of years.

I just want to share with everyone especially our trainees in the various pacific islands my own experiences.

Above is an article that just been published I know it’s not a much , but I thought it would worth to celebrate.

But first I thought it would best to start from my own experience going through the PIOA training program.

First of all I started like all of you guys, I was scared and had no idea about orthopedics even worse I had no idea about how to look after an orthopedic patient. But through the guidance and education that I have learnt from PIOA, this has given me the platform and courage to do the impossible. I was just like you, I was alone, working 100 hours a week, slaving like a dog to maintain a service, and at the same time neglecting my health and especially my family and the people that matter the most.

Yes we all have excuses and reasons not to do assignments and not to fill your logbooks , or that you are overwhelmed with patients, but i can bear testament to all the teaching and mentoring from PIOA, that you can make a positive change to the lives of our patients if you WORK HARD , HONEST, RESILIENT, HONEST & TAKE RESPONSIBILITY

During my years of training I worked alone and had a lot struggles and at times being treated like a nobody. But I stuck to my training in PIOA and to god be the glory for he has guided me to were I am now

My challenge to all the trainees please don’t not take advantage of the opportunity you have, take it and use it wisely please. Look after yourself and family first before your look after your patients.

The article I shared above is not much but testament to my mentors and especially to our PIOA faculty

We should all learn to celebrate our achievements when we can and we should all work together as a team

Once again a massive congratulations to Viola for passing your exams looking forward and to working with you in the future. You are a true testament of resilience.

Once again thank you Des and Prof Nik and our entire faculty for your ever ending support and mentoring

Just wanted to share with everyone in this forum even if you are alone in an island you can still do research and give the same level of care for your patients as you do in first world countries

Hope that this pandemic ends soon so we can all meet up and have a proper module😂😂😂

Kind regards


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.