PIOA Introductory and Trauma modules held in Suva, Fiji

The PIOA Introductory and Trauma modules were held at the Colonial War Memorial (CWM) Hospital in Suva, Fiji from March 4th to 16th, 2024.

Week 1 Back row from L to R, Faculty in bold,  Penijamini Naiceru (Fiji) Tzun Rafael (Palau,) James Tewa’ani (Solomon Islands, Pita Sovanivalu (Fiji), Tommy Walters (PNG), Juvencio Dias (Timor Leste), Shaun Mauiliu (Samoa), Manoa Valeniyasana (Fiji),Robert Fa’ataga (Samoa), Jeffrey Yiapi (Solomon Islands), Paul Lomavatu (Fiji). Front row from L to R Jacky Pahun (PNG), Pauliasi Bauleka (Fiji), Oralae Pitakia (Solomon Islands), Viola Kokiva (PNG)

In this module, the students were taught a systematic approach to diagnosis and management of orthopaedic conditions and trauma. This included clinical history taking and a thorough clinical examination, investigation and a structured, systematic approach to orthopaedic decision making. There was also an emphasis on a systematic approach to the management of trauma including 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 trauma affecting the long bones of the limbs.

Lectures were supplemented with practical demonstrations. 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 diagnosis and management of trauma –which is common condition throughout the Pacific and are often poorly managed. The students were assessed with practical tasks (history taking, focussed clinical examinations and a practical external fixation task as well as a written examination on the final day of the modules.

Week 2 Back row from L to R, , Penijamini Naiceru (Fiji), Tommy Walters (PNG), Haynes Rasin (PNG), Juvencio Dias (Timor Leste), Viola Kokiva (PNG), Jacky Pahun (PNG),Tzun Rafael (Palau,) Jeffrey Yiapi (Solomon Islands) Paul Lomavatu (Fiji), Manoa Valeniyasana (Fiji), Robert Fa’ataga (Samoa), Front row Faculty in bold from L to R  Pita Sovanivalu (Fiji), Mark Rokobuli (Fiji), Des Soares (Australia), Areta Samuelu (Samoa), Clay Sios i (Solomon Islands.

Welcome to new trainees in 2024

PIOA welcomes the following new trainees in 2024.

Jeffrey Yiapi – Solomon Island

Oralae Pitakia – Solomon Islands

Riobert Fa’ataga – Samoa

Tzun Rafael – Palau

Manoa Valeniyasana – Fiji

Paul Lomavatu – Fiji

Penijamini Naiceru – Fiji

Congratulations to our new graduates

The exit exams were held at CWM Hospital in Suva, Fiji (25-29 September 2023). They consisted of 2 written papers of 2 hours duration each, 3 computer stations and 2 clinical vivas. Congratulations to our successful graduates Dr Clay Siosi Lewi from Solomon Islands and Dr Aitaoto Naseri Aitaoto from American Samoa. Thanks to our examiners Dr Richard Lander (NZ) and Dr John North (Australia) and examiner in training Dr David Bartle. Dr James Tewa’ani and Dr Areta Samuelu were exam observers.

Richard Lander with Naseri Aitaoto
Richard Lander with Clay Siosi
L to R John North, Richard Lander and David Bartle

the Next generation (Solomon Islands)

Great to see Dr Agnes Auto, PIOA registrar in Honiara, training the next generation. Learning to use the goniometers gifted by PIOA. Accurate measuring and recording are the basis of good orthopaedic decision making.

Left to Right: Oralae, Steven (Black Shirt), Agnes and Jeffrey (Seated) at Fracture Clinic, National referral Hospital, Honiara, Solomon Islands


PIOA graduate Dr Areta Samuelu was delighted to welcome PIOA lecturers Dr. Tim Gregg from Wellington, NZ and Dr Jason Donovan from Waikato, NZ on a surgical visit. Tim and Jason are experienced paediatric orthoapedic surgeons. The purpose of the visit was to help and train Areta in the management of congenital pseudoarthosis of the tibia, a rare but debilitating condition affecting the lower limb. You can read about the visit in detail below.

Some pictures from the visit.

Pre-op xray showing pseudoarthosis(false joint) at mid tibia
Post op XR after correction

Congenital Pseudoarthrosis of the Tibial- Extremely rare- 1:140,000-190,000- Anterolateral Bowing and Congenital Pseudoarthrosis of the Tibia are congenitalconditions, most commonly associated with Neurofibromatosis Type 1, that present with abowing deformity of the tibial.- Diagnosis is confirmed with radiographs of the tibia.- Treatment is nonoperative with bracing for patients who are weightbearing withoutpseudoarthrosis or fracture. Surgical correction is indicated in the presence ofpseudoarthrosis or fracture.- Risk Factors- Up to 55% associated with Neurofibromatosis Type 115% associated with Fibrous Dysplasia

In planning for both these cases, it took a year for it to fruition. Both cases turned up to our clinic in 2021 and then the whole of 2022- 2023 took time for us to plan around covid and especially counselling for the parents in both these cases as both cases will need follow up till these kids reach skeletal maturity as both cases are very rare and only a few people can do this operation.With the use of our network in both NZ and Australia, we reach out for help, and we develop a discussion and options for both patients, In March 2023, they visited Samoa as course convenors for the PIOA Paediatric Module. This great opportunity was considered also to discuss and ask for their advice on the complex paediatric cases we had on island.Dr.Tim Gregg and Dr.Jason Donovan are both renowned consultant orthopedic surgeons working in Wellington and Waikato NZ respectively. They specialize in Pediatric orthopedics and are facilitators / Mentors for the PIOA (Pacific Island Orthopedic Association) program in the Pacific and are integral part of the training program for NZ trained orthopedic surgeons.Following this meeting, both surgeons then made their own arrangements by volunteering freely and own funding through the PIOA collaboration to aid and management of our complex cases.As part of our planning phase, we had the privilege of having one of the reps from NZ to assist us with the equipment’s from Paragon Medical.

Pre op xrays of child 2
Front view
Side view
Post op xrays
Resting after surgery

Both Tim and Jason Volunteered their precious time and expertise in coming to Samoa to perform surgeries for both these rare cases for free. Both Surgeons paid for their airfares and accommodation to travel for that week in Samoa.With all the cost involved for both these cases each case cost about 50,000-70,000NZD for each patient if they were to be transfer to NZ for this treatment and even more for other special services involved.This not only benefited our government but also building capacity for our local staff in knowledge and to operate on these rare cases. This was the biggest success of the visit for both families and also our health department especially moving forward to the future of developing specialized services on island.

The team

First and foremost, we would like to thank team from New Zealand for the sacrifice they made while on holiday to operate on these surgeries. It goes without saying that their willingness and commitment to help us cater to the people of our country is remarkable and incomparable. They also managed to provide their own equipment that were used on their cases which was a huge help for us during our busy schedules in the theatre. The surgeries that were carried out are usually done overseas but having them performed on island made a huge impact on the lives of our patients and the services that we provide locally.To our local staff, thank you for showing up and being able to show enthusiasm to learn and grow in this profession. It is a milestone to witness and observe high skilled surgeons in action and I hope that we have each learnt a lot from this rewarding experience.Thank you also to Dr Faamuamua Arasi and Dr Cecelia B Vaai for working side by side with us in the past few weeks. Malo lava le tautua.And lastly, we’d like to acknowledge the Ministry of Health and Director General for the support and making sure that this visit took place so that we’re able to further our knowledge in a field that’s forever evolving every day in terms of surgical techniques and case management.

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