O S S A A

 

OVERSEAS SPECIALIST SURGICAL ASSOCIATION OF AUSTRALIA

 

 

 

TEAM VISIT

 

Halilulik, West Timor

December 6 - 14, 2008.

 

 

 

TEAM LEADER’S REPORT

 

 

 

DR MARK MOORE AM

MB, ChB, FRACS

PLASTIC AND CRANIOFACIAL SURGEON

 

Implementation of Dr John Hargrave’s mission in East Timor and Eastern Indonesia; providing a specialist surgical service to the disadvantaged where the service is not available or affordable

 

 


 

 

AIMS AND GOALS

 

 

1.                  To expand and  maintain a regular Plastic & Reconstructive Surgical Service to those patients with physical disability in the West Timor region of Nusa Tenggara Timur (NTT), Indonesia

 

 

2.                  To work with the local counterpart medical and nursing staff at the Rumah Sakit Katolik Marianum to maximise the teaching and skills transfer of the management of patients with physical disability and deformity.

 

 

 

 


 

INTRODUCTION

 

Beginning in 2007 OSSAA has sought to expand the Plastic and Reconstructive Surgical service provided in the West Timor part of Nusa Tenggara Timur.  Prior to this time many patients throughout West Timor were transported to the St Damian complex at Cancar, Flores for treatment.  The difficulties of maintaining this patient transfer, from both a logistic and financial viewpoint, saw OSSAA explore the potential available in Halilulik with the same order of nuns that provide the service in Cancar.

 

This visit represents with 3rd plastic surgical visit undertaken, with the two previous visits having focussed largely on the provision of surgical management of cleft lip and palate patients.

 

The team was aware on the previous visit that a new operating theatre complex was almost completed in Halilulik and it was hoped that on this occasion this facility would be available for use, allowing the expansion of the service available.


 

TEAM MEMBERS:

 

 

Dr Mark Moor                               Plastic Surgeon/Team Leader

Dr Phil Blum                                             Anaesthetist

Ms Penny Craig                                        Theatre Nurse

Ms Ruth Boveington                         Coordinator / Interpreter

 

 

      Counterparts:   RSK Marianum

 

      Sr Helma SSpS                                         Director RSK Marianum

 Sr Theodorine SSpS                                  Theatre Nurse

 Br Rufinus                                                 Theatre Nurse

 Nn Grace

Nn Adel

     

                                                                                

     

 

LOCATION

 

     

      Rumah Sakit Katolik Marianum, Halilulik, Kab Belu, West Timor, NTT

     

The visit to Halilulik was on this occasion coordinated by the SSpS sisters who routinely run the facility.  Assistance was given by Andy and Rachel Passey, VSO volunteers from England and was useful in various communication issues in advance of the visit.  Their assistance in relaying information to local sisters ensured the provision of the appropriate documentation for the team’s entry into Indonesia.  On this occasion the team was not assisted by Dr Harianto who is still recovering from illness.

                                                        


 

OVERVIEW

 

Access to West Timor at this time is only available via Bali.  The team on this occasion utilised Air North flights out of Darwin, spending one night in Bali before transferring to Kupang on the Saturday.  The domestic transfers were arranged as in the past by Mr Hendrik Tawur, who has dramatically eased many of the initial concerns regarding airline transport to the various areas in NTT.

 

After arriving in Kupang, the team was met by the SSpS sisters based in Kupang as well as Sr Theodorine who had travelled down from Halilulik to oversee the team’s transfer.  In addition the team had the opportunity to speak to Mr Joseph Curtin from Oxfam UK, who has been instrumental in sending a patient from West Timor to Cancar for ongoing treatment.  Photos of the patient were provided to Mr Curtin so that these could be passed onto the patient’s family in West Timor.

 

The team then proceeded to Merdeke Clinic in Kupang where a consultative session was held on late Saturday afternoon, seeing approximately 20 patients.  Several of these patients were follow ups from a previous visit, as well as a number of new cleft patients who were arranged to be transferred to Halilulik for surgery on Tuesday.  In addition 2 patients with Apert Syndrome and an adult patient with noma were also assessed and details obtained as these patients have surgical conditions which require treatment in a  more sophisticated facility than is available in NTT.  This may occur in Indonesia or Australia.

 

On Sunday morning the team then undertook the 6 hour drive to Halilulik in 2 vehicles where the team was met by Sr Helma and other members of the community of the RSK Marianum.

 

A consultation clinic was held soon after arrival.  The turnout for this clinic was slightly disappointing with the numbers down compared with the previous visit.  There may have been several factors in this, including the manner in which the notice advertising the team’s arrival was circulated.  This was a combined notice detailing a visiting Indonesian Ophthalmology team two weeks before our visiting plastics team and it may have resulted in some confusion with patients regarding the timing of our visit.  The other issue related to the timing of this visit being in the wet season where travel conditions are less ideal and thus there are greater difficulties for patients travelling from more remote regions.

 

Nevertheless, enough patients were seen in both Kupang and Halilulik itself to generate surgical lists for the following 5 days.  There was on average approximately 7 surgical procedures undertaken daily with the team finishing generally by late afternoon.  These was a bonus in this in that the Indonesian ophthalmological team had two weeks before operated to very late hours, thus tiring out the local nursing staff.

 

The new operating theatre complex had recently been commissioned, including a new Pelon anaesthetic machine.  The theatre was set up on the Sunday afternoon following the consulting clinic, allowing surgery to commence on Monday morning.  Unfortunately there was no bottled oxygen available on site, although new supplies were obtained by the middle of the day on Monday.  Fortunately Dr Blum in the anaesthetic equipment brought with him, included an Oxford miniature vapouriser which in concert with an oxygen concentrator present in the theatre complex allowed surgery to start early on Monday without any delays.  Two small children with cleft lips were repaired using this form of anaesthetic delivery, following which the oxygen arrived and the new anaesthetic machine was available for use.

 

During the week some 34 procedures were undertaken, including 29 cleft procedures on 28 patients.  One patient who had undergone previous surgery by an Indonesian surgical team required both a major revision of his lip repair, a well as a re-repair of his soft palatal cleft.

 

A number of patients who underwent cleft lip repair in July were returned on this occasion to have their palate repaired.  A number of these were at a relatively young age allowing for the completion of their lip and palates within a timeframe that would be acceptable in most countries.  As has been seen in the past, the quality of the cleft lip scars in these children is consistently of a high standard without the degree of hypertrophic scarring that one often sees in patients in Australia.

 

On this visit the team opted to undertake a small number of burn procedures, despite the absence of a dedicated physiotherapy or splinting service on site.

 

One young teenage boy was already an inpatient in hospital with burns to his anterior neck, chest and hands.  This burn was recent and a number of scars were significantly hypertrophic and an area over the anterior neck and upper chest remained unhealed.

 

It was decided to skin graft the unhealed area leaving the established contractures for treatment on a subsequent visit.

 

This was undertaken uneventfully and at week’s end the team were able to perform the first dressing change under Ketamine anaesthesia with virtual 100% graft take and advice was given to the local nurses regarding the subsequent dressings and a programme of physiotherapy.

 

Two other cases with established contractures across the elbow and the knee were released and grafted, again with advice being provided regarding their post operative management.

 

The post operative care was undertaken in a satisfactory fashion within the wards of the RSK Marianum with all cleft patients being discharged on the 2nd post operative day.  There were no anaesthetic or post operative issues noted in any case prior to their discharge from hospital.

 

At week’s end the team confirmed its return in April 2009, again utilising a single surgeon team.

 

The team’s anaesthetist, Dr Blum returned to Kupang for onward transfer to Bali and home to Darwin.  The other three members of the team were then transferred to the border with Timor Leste where they were met by Dr Eric Vreede, the RACS coordinator of the ATLASS programme, to undertake a scoping mission of the hospitals in Maliana and Suai.


 

SUMMARY OF THE VISIT

 

 

STRENGTHS:

 

  • The development of regular cleft lip and palate surgical service to West Timor allowing infant and children with cleft lip and palate to receive early treatment.

 

  • The commencement of a small burn and burn contracture surgical service in Halilulik

 

  • The opening and use of a new, clean and well designed operating theatre complex in RSK Marianum

 

  • The continued support from the local and provincial governments for the OSSAA team work in Halilulik.

 

  • The continued ongoing support of the Indonesian Consul in Darwin for the provision of appropriate visas and documentation to allow easy travel within Indonesia.

 

WEAKNESSES:

 

  • The slightly lower number of cases than usual, perhaps due to local communication difficulties and the wet season.

 
SUMMARY OF TEAM ACTIVITIES

 

 

 

December 5, 2008.                  Team members depart Darwin for Denpasar

 

December 6, 2008.                  Team departs Denpasar on Merpati Airlines to arrive in Kupang.

Consultation clinic at Merdeke Clinic with SSpS sisters

 

December 7, 2008.                  Transfer to RSK Marianum in Halilulik

                                                Consultation clinic

                                                Preparation of operating theatre

 

December 8, 2008.                  Operations, consultations, ward round

 

December 9, 2008.                  Operations, consultations, ward round

 

December 10, 2008.                Operations, consultations, ward round

 

December 11, 2008.                Operations, consultations, ward round

 

December 12, 2008.                Operations, consultations, ward round

                                               

December 13, 2008.                Free day

 

December 14, 2008.                Dr Blum departs Halilulik for Kupang and on transfer to Denpasar and Darwin

                                                Remaining members of team transfer to border to Timor Leste for scoping mission in Timor Leste

 

 


 
SUMMARY OF CLINICAL ACTIVITIES

 

December 6 - 14, 2008.

 

 

               TOTAL CONSULTATIONS:                          59

 

 

               TOTAL SURGICAL PROCEDURES:                35

 

                     CLEFT LIP                                         19

                    

                     CLEFT PALATE                                   10

                    

                     BURN                                               04

                    

                     OTHER                                             02

                                                                                


 

ACKNOWLEDGEMENTS

 

 

  • The sisters and staff in Halilulik, as well as Andy and Rachel Passey for their organization and successful implementation of the team’s visit

 

  • The consistent quality of support within the operating theatre complex, on this occasion by Sr. Theodorine and Br. Rufinus.

 

  • The Bupati of Belu, the NTT Health Ministry and the Office of the Consulate of the Republic of Indonesia in Darwin for their continuing support of our work, documentation and provision of visas

 

  • Pak Hendrik Tawur  of BCB Travel of Bali for organising and facilitating the internal air travel in Indonesia.

 

  • The various public and private hospitals in Adelaide and Darwin, as well as the anaesthetic and suture companies who have assisted OSSAA in this visit.

 

 

 

 To view a PDF (1.7mb) of photos of this Visit please click HERE

                       

 

 

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