Australian Sai Medical Services Unit - Voluntary Medical Camp in rural Fiji (Viti Levu)

A Collaborative Service Activity Of the Sai Medical Unit Of Australia & Sathya Sai Service Organisation Of Fiji

This was the third year of free medical services which were provided over the period Monday 17th August to Friday 21st August 2009 in the rural areas of Viti Levu by volunteers from Australia and Fiji as a service project of the Sri Sathya Sai Service Organisation. The team members comprised of 6 General Physicians, 3 dentists, 1 dental prosthetist 2 O&G specialist, 1 paediatrician, 2 ophthalmologist, 1 optometrist, 3 pharmacists, 4 nurses and 8 volunteers 1 IT volunteer. Some members of the local heath authority team also extended their help. Assistance was provided by a large number of the local Sai members, school members, and members of the Red Cross. About 60 First year and Second year medical students from, UPSM along with two tutors, joined and remained with the team for 5 days. They were of great assistance in scribing, as translators and general help. In return they learned clinical and communication skills. This was a great community effort.

Once again a Combined Medical Conference of the Sai Medical Unit Australia, Sri Sathya Sai Organisation of PNG, Sathya Sai Service Organisations of Fiji, Umanand Prasad School of Medicine and Fiji College of General Practitioners was organised at the University of Fiji Campus, Saweni, Lautoka on Sunday 16th August to kick off this service project. This was a great success.

Combined Medical Conference, Lautoka

Guests at the Combined Medical Conference, Lautoka

• 17th August 09 Tagitagi Sangam School, Tavua
• 18th August 09 Ratu Filamone Memorial School, Sorokoba - Ba
• 19th August 09 Loma Indian School, Sigatoka
• 20th August 09 Lomary Catholic School, Deuba
• 21st August 09 Andrew's Primary School, Nadi

Children wait to welcome the Medical Team to a Camp

Welcome ceremony for medical team at Camp

Each camp site was set up with various stations: Registration, Triage, Nurses station, General Clinic (including a paediatrician), Dental clinic, Eye clinic, Women's health clinic, and pharmacy.

Medical Services offered during the camps same as each year included a full patient consultation, basic physical examination. Diagnostic facilities such as screening for diabetes with finger prick tests for most patients over 40 years, blood pressure and ECG tests in appropriate patients were done at the Nurses station. Free medications were dispensed through our pharmacy which had a comprehensive range of drugs.

Full patient consultations at Camp

Ladies awaiting consultations at Camp

Dental department services included extractions, fillings, palliative, preventive advice, repairs, additions to existing dentures and provision of partial dentures. Appropriate referrals were made for further care.

Dental treatment at Camp

Dental treatment at the Medical Camp

Eye services provided a comprehensive check up and giving out of free prescription glasses and eye drops. Appropriate referrals were made for further care.

Eye services at the Medical Camp

Women's health clinic provided a full gynaecological assessment and Pap smear check ups for eligible patients for screening. Patients requiring further follow up and management were referred via referral letters to the relevant departments in the base hospitals. Abnormal pap smears were followed by communication with local area health services.

Women's health services at the Medical Camp

Statistics

Doctor's consultation at the Medical Camp

Many patients had multiple consultations that included medical, dental, eye and gynaecological assessments. Some of the problems encountered at the camps were same as at each year in the past as follows:

General Medical clinic:

Majority of attendees presented at the general clinic.

Common Conditions presented and treated:

• Diabetes, obesity, Diabetic neuropathy, Goitre
• Hypertension, IHD, CVA
• Musculoskeletal pain, Back, neck and legs. Knee pain, OA knees
• Tinea, tinea versicolor
• Impetigo, Abscess, Acne, Eczema, infected eczema, Scabies, infected scabies
• GORD, gastritis, peptic ulcer
• Anxiety, depression, headaches
• Asthma, bronchitis, COPD
• Rhinosinusitis, otitis media, otitis externa
• Anaemia

Patients waiting for consultation at the Medical Camp

Uncommon Conditions presented and treated:

• Hypothyroidism, hyperthyroidism
• Rheumatoid Arthritis, frozen shoulder, rotator cuff tendonitis, gout, Osteomyelitis, carpal tunnel syndrome
• Constipation, hernia
• UTI, Kidney stones, BPH
• Ear wax, Perforated ear drum
• Breast Cancer

Dental prosthetist making a denture

Diabetes, hypertension and ischaemic heart disease no doubt contributes to the greatest morbidity of the Fiji population not only in terms of shortening the life span significantly but also adding to the health burden in terms of requiring secondary level care. Although patients seem to have a pretty good follow up of these diseases via the local health centres and hospitals, control of the hypertension and diabetes seemed to be quite poor as reflected in the routine check ups. Compliance, lack of proper understanding of the disease and running out of medications seem to be important reasons behind the poor control of these conditions. Patient education may help with this.

Pharmacists at work during the Medical Camp

Chronic pain was the most common problem encountered at the consultations. Significant numbers of these patients had pain in multiple areas suggesting fibro myalgia type of symptoms. Some of the other reasons for musculoskeletal pains included, poorly treated (or untreated) old injuries, occupation related, such as heavy physical labour in cane cutting areas, poor postures, degenerative diseases and rheumatoid arthritis. While many cases of chest pain were musculoskeletal in nature, in the presence of risk factors, ischaemic heart disease was difficult to exclude without further assessments.

Lady patient gives symptoms during clinic at the Medical Camp. Three medical students take notes.

Dental clinic:

It is also important to stress that a tremendous amount of support was equally provided by the general volunteers that travelled with the medical team and the year 1 and year 2 medical students of the Umanand Prasad School of Medicine (UPSM). The students are a credit to the institution as a whole.

In addition the team would also like to thank Dentsply, GC Australia, Henry Schein Halas, Colgate (Aus) and other individuals for their support of these camps. No clinical treatment would be possible without the appropriate equipment, materials and supplies. Once again these companies have graciously donated supplies that were able to be used throughout the course of this camp.

The team made certain that all consumables, materials and instruments were provided and that local resources were not affected at all. Local help was sought in providing portable equipment including a compressor, portable dental chairs and dental units with suction.

Dental surgery uses suction.

Eye clinic:

• Screened for Refractive error- Children & Adult- Myopia, Hypermetropia, presbyopia Dispensed spectacles for above
• Dispensed sunglasses for patients with Pterygium
• Screening for Diabetic retinopathy for those with diabetes & high blood sugar
• Advice & education on Blepharitis, Cataract, Pterygium, Macular degeneration, glaucoma
• Treatment & Prevention of diabetic retinopathy

Crowds waiting at a clinic.

Women's Health:

Most women came for a check up but key symptomatology included: abnormal bleeding, abdominal pain, pelvic mass, urinary dysfunction, vulval pruritus, and infertility.

KP's lab will process the slides free of charge.

Pharmacy:

Pharmacy services were provided, and there were additional staff on hand to assist at this camp. More time was able to be taken to give patients full pharmaceutical advice than has been the case in previous years.

Patients were counselled on disease state, management and correct use of their prescribed medicines.

Pharmacist prepares medicines for dispensing at a clinic

A total of 4000 scripts were dispensed during the clinics.

Nurses Station

Four nurses managed the workload carried out at the nursing station at each venue. The stations were set up in such a way that patients had easy access from triage and medical officers' rooms. Like the previous camps, the following activities were carried out by the team:

• Blood pressure checks
• ECG
• Blood sugar level monitoring
• Urinalysis
• Wound management
• Patient education

For most patients' blood pressure and sugar levels were checked as part of the initial patient assessment process. Some patients were sent to the nursing station for ECG and blood pressure checks to confirm the medical diagnosis. It was noted that some of the patients had very high blood pressure and blood sugar readings despite taking their prescribed medications.

The Nurses Station at a clinic

This year we were lucky to have an ECG on a software - it was very easy and quick to complete the procedure and print results using the computer. A few patients presented with chest pain - they were managed appropriately, one patient was transferred to the nearest hospital for further treatment and management.

ECG monitoring at a clinic

Wound dressings were also attended to at this station. The types of wound included: diabetic ulcers, open infected wounds, boils and others. Despite the set up in school classrooms all dressings and other procedures were conducted by adhering to strict infection control at all times. Clinical waste were collected and disposed appropriately at the end of each day.

Disposal of clinical waste

Patient education was an on-going aspect as the patients were attended to at this station.

It was great to have the university students assisting us with the procedures carried out at the station. They indicated that their placement and experience was very beneficial towards gaining new knowledge and skills. Overall the care and education was provided to the patients and their family in a safe, professional and ethical manner to achieve identified health outcomes.

Registration and Data entry:

The data entry team had lot of data entry work through the camp, starting with registrations and then diagnosis later. We used Microsoft Excel for data entry. Since we did not have a network setup, we used our stand alone computers and shared the data amongst each other at regular intervals.

Team and the students

The Medical Team at a clinic location

Combined Medical Conference of the Sai Medical Unit of Australia, University of Fiji the Sathya Sai Service Organisations of Fiji and the Fiji College of General Practitioner.

This was held again at UOF campus, and it was well organised by the university staff. There were approximately 200 participants. Opening was done by Minister for Health Dr Neil Sharma who addressed the participants. He participated in the conference interactive session of, "Risk management in Clinical Practice'. Dr Isimeli Tukana did a presentation on Heath priorities in Fiji. Dr Mary Schramm discussed registration of medical and dental practitioners to the Fiji Medical Council. Medical diagnostic and management topics were presented by various other speakers on Red eye, Allergies during childhood, Bereavement and Disaster Situation, Non communicable disease burden in Fiji - by students of UPSM and Holistic care in General practice. Afternoon session was dedicated to Small group sessions on clinically interesting topics. General consensus was the conference was well organized, conducted, attended and should be a worthwhile annual event.

The Sai MediCare: Physicians, Dental Surgeons, Pharmicists, Nurses, Medical Students, Team Leaders, Coordinators and Volunteers

Conclusion

All the members of the team who served through the Sri Sathya Sai Service Organisation thoroughly enjoyed the opportunity provided with the support of Ministry of Health, in enabling us to carry out the voluntary Sai MediCare services in Viti Levu, Fiji. This team served the patients in rural areas with a variety of problems and managed to complement the good work already done by Ministry of Health professionals. We look forward to continuing work of similar nature working hand in hand with our local counterparts in providing on-going voluntary services to the needy.

Having made collaboration with UOF and their medical faculty we hope we can contribute towards facilitating educational work in years to come. We thank the Ministry of Health and the entire local respective, government officials, who have enabled us to carry out the above voluntary project successfully.

With the support of individuals, NGOs and Government Departments this ongoing project can provide help to the economically challenged and provide that with Love.

Sai MediCare: Medical care with Love

We gratefully acknowledge all the assistance given to our team by:

• Sathya Sai Service Organisation of Fiji and all their members
• Ministry of Health Fiji, Government Supplies
• Pharmaceutical Suppliers Chandulal's Pharmacy Ltd
• Customs Officials
• School staff, communities in the area of school where the camps were held and Red Cross
• Automart Laoutoka - Loan of a van for transport of equipment over the seven days.
• Air Pacific for allowance for extra baggage.
• Medical and Dental suppliers: Dr Stoloff of independent Diagnostics, Dr Criniti, Abbot Diabetic care, Henry Schein Halas, GC Dentply (Australia) P/L, Colgate Oral care, Heraeus Kulzer Australia P/L, GC Australasia Dental P/L.
• Dr K P Singh of Medlab for processing and reporting on all the pap smears free of charge.
• All the team leaders of each station of the camp to manage their teams and all the volunteers for working with lots of love tirelessly before, at the camp and afterwards.

Medical Camp Photo Album

A photo album with snaps from the Medical Camps at various locations along with photos of the Conference is available for viewing. You may view the 2009 Fiji Medical Camp Photo Album