My Work With Interplast as a Plastic Surgeon

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Not many jobs give you the opportunity to travel overseas and work in a completely different setting, whilst changing the lives of the local population for the better. Surgeons, nurses, anaesthetists and allied health professionals are able to travel on volunteer programs to various parts of the world in order to share their knowledge and skills and often, provide life saving surgery.

Interplast is a non government organisation that has been facilitating volunteer surgical and allied health programs to Asia and the Pacific for over 40 years. The main focus is to provide plastic and reconstructive services to these developing nations, as well as training local health workers. In September 2017, I went to the beautiful islands of Samoa with Interplast. For the past 7 years “Team Samoa” has comprised myself, team leader and Sydney Plastic Surgeon Dr Ben Norris; the unflappable anaesthetist Dr Allan Goodey; and theatre nurse to the stars, MJ Laing. This year we were joined by anaesthetic nurse Caz McLaughlin on her second trip to Samoa and hand therapist Kylie Harrison on her first.

Any Interplast program is organised almost a year in advance by the head office. This requires a comprehensive needs assessments, fundraising (many thanks to the ever generous Rotary), organising the team, sourcing and ordering equipment’ and then navigating the potential minefield of customs, logistics, travel, accommodation etc etc etc. In short, there is a tonne of organisation that goes into these trips and thankfully we health care professionals don’t have to do any of it!

The trip begins in Melbourne, where supplies are loaded. We bring everything we need with us – all the sutures, dressings, surgical instruments, anaesthetics and pain-killers – Interplast aims to be self sufficient and not drain the resources of the local hospital we are visiting. Sometimes trips span two weeks and sometimes, like this year, it is a one week program. The trip is preceded by advertising campaigns on radio, and posters around the local hospital. The local surgeons also collect lists of patients they would like us to consult on. This year, our liaison registrar Dr Petu Emose, did an amazing job and sent us a detailed list of patients who’d be seeing – including photos – a few weeks in advance. This really helped us prepare for what cases we’d be treating. We were even able to arrange for some patients to be fasting so we could operate on them the first day.

Our week started with an outpatient clinic at the Tupua Tamasese Meaole (TTM) Hospital. TTM is located in Apia, the capital of Samoa and our accommodation is a comfortable hotel five minutes away by taxi. The TTM was rebuilt by the Chinese government a few years ago. It is sparkling clean, air conditioned and a huge improvement on the old hospital.

We see a wide variety of cases in the clinic, from babies with cleft lips to elderly patients with large tumours and everything in between. Our main caseload are cleft lip and palates, correction of burns contractures in children and various types of cancer. There are always patients on the ward for us to treat – this year, there was a 6 year old boy who had suffered extensive burns to both lower legs 6 months ago when his lava lava caught fire (a lava lava is a Samoan sarong). This little boy had undergone numerous procedures to remove the burnt skin and apply skin grafts to reconstruct the areas, but the wounds had become infected and he was left with large raw areas. We operated on him twice during the week – once to clean all the wounds up and then again the following day to harvest skin grafts from his back to completely cover all his remaining wounds (I have since heard from Dr Petu that all his grafts took and he has been discharged from hospital). His beautiful mother had been living at the hospital with her son for the whole 6 months, so you can imagine the disruption this prolonged admission caused to the family.

During and after the clinic, we prioritised all the cases we had to do. We try to do the young children and larger cases early in the week so that we have a few days to monitor their recovery before we left. The less urgent cases we scheduled for later in the week, in case more urgent cases came up in the meantime. There are some patients who we simply couldn’t help, and we had to break the bad news that we wouldn’t be operating. This is a heart-breaking part of the program – many patients and their families had traveled from remote villages or surrounding islands, hoping that our team would be able to fix whatever the cancer or condition was. There was one older man who had an extensive cancer on his scalp which was not treatable. Even if he had been in Australia, we still wouldn’t have operated on him. Breaking that news is hard. There is no palliative care in Samoa, so he will be cared for by his family and other people in his village.

We started operating on the Monday afternoon. I was in one theatre with Dr Allan Goodey, our anaesthetist from New Zealand. Allan is amazing. He has been travelling to Samoa for many years longer than I have. He even went over at short notice when the tsunami hit the southeast coast of the Samoa in 2009. Allan was ably assisted by Caz McLaughlin. In addition to being our anaesthetic nurse, Caz also controlled all the theatre scheduling and documentation for the program. MJ Laing is a Team Samoa veteran and one of the most experienced plastic surgery scrub nurses in Sydney. MJ made sure all the instruments and equipment we needed were sterilised and ready.

Dr Ben Norris is the country coordinator for the Interplast program to Samoa. While I was doing the cleft lips and palates in one theatre, Ben was in the other theatre, with a local anaesthetist, doing an unbelievable variety of cases. Whenever I would pop my head in, Ben would have just finished something amazing like a radial forearm flap for an upper arm tumour, or a mastectomy and axillary clearance for breast cancer, or a parotidectomy. Probably the most memorable case for Ben and I was three years ago. A young man was referred to us by the local surgeons with elephantiasis causing massive swelling of his scrotum. This was affecting his ability to walk and was extremely uncomfortable. In a marathon procedure, we removed over 20kg of scrotum and refashioned the skin around his penis and testicles. We have seen him every year since and he is extremely happy with the result.

Interplast programs are a win for everyone. We provide surgical care to communities who otherwise would have to go without. We provide training for the local nursing, medical and allied health staff to improve the standard of care in these developing nations even after we leave. On an individual level, it is very satisfying to be able to put the skills and knowledge that we have spent years accumulating to good use. Often we are dealing with complex conditions that we might not have seen before without the assistance of medical imaging or the ideal surgical instruments. This stretches you as a doctor makes you appreciate your training.

I always look forward to the Samoa program every year. It is a chance to catch up with old patients and old friends. The Samoan people are so patient and relaxed. All the patients in hospital are surrounded by the love of their families, who travel long distances and at great expense to care for their relative recovering from surgery. Every time I go, the Samoan patients and their carers teach me the importance of family in one’s life. Although going overseas with Interplast takes you away from your family and friends for a short period of time, it makes you love and appreciate them more when you return.

The work done on Interplast programs can be life changing both for the individual patients and their wider communities. Interplast is currently supporting program in 17 countries in the Asia Pacific region. Please support the great work of Interplast by making a donation through their website https://www.interplast.org.au/