Report on the Annual Free Medical Services in rural Fiji
Island of Viti Levu ~ 15th August to 22nd August 2010

A Collaborative Service Activity of The Sai Medical Unit Australia
and Sathya Sai Service Organisation of Fiji

Love in Thought Word and Deed
"Care and Share"

The 2010 visit to Fiji by the Sai Medical Unit was the 4th occasion upon which free Medical Camps were provided in Fiji. The team comprised of 38 members from Australia and 5 Sai devotees from Fiji. 40 medical students from Uma Prasad School of Medicine (University of Fiji), 2 tutors and 2 staff joined the team in batches. At each camp site some 8 to 10 devotees joined to participate in service and facilitate arrangements and catering for meals. The school staff and the communities in the area of the camp assisted in planning advertising, accommodating, warm welcoming and catering.

Medical Symposium held on the first day

Again a Free Medical conference was organised on 15th August 2010 at the University of Fiji auditorium. Dr Rajanishwar Gyneshwar assisted in planning and facilitating the conference with support from University of Fiji Staff and members of Fiji College of GP. The Conference Opening was given by the Minister of Health, Dr Neil Sharma. The Conference Closing ceremony was done by Adi Salaseini Kavunono Iloilovatu, First Lady of Fiji, and wife of the President of Fiji. Topics presented were of great value to all. Total attendance at the Conference was approximately 200.

First Lady of Fiji came to close the Medical Symposium

This was followed by 5 days of rural service: 16th August to 20th August

1. Bulabula Indian school ~ Ba
2. Nanuku Sangam School ~ Rakiraki
3. Muaniweni Primary School ~ Naitasari
4. Vashista Muni Primary School ~ Nauva
5. Tuva Indian School ~ Sigatoka

A warm welcome for the Medical Camp Volunteers

The total number of patients who registered for medical dental treatment and Healthare education over the five days numbered 2350.

Medical, Dental and Healthcare Services given:

Patient Education: Sessions were held near registration area for patient education in women's health, Men's health, Diabetes, Healthy eating, Dental health, Stress and anxiety management, Lifestyle changes, and proper use of medication.

Nurse's station: BP check up, dressing, blood test for sugar, ECG, Patient education on various topics.

General Medical clinic: attended to large spectrum of presentations, Diabetes, hypertension, IHD, musculoskeletal pains, thyroid diseases, skin diseases, gastrointestinal diseases and neurological diseases. Patient education material was given where needed.

Eye clinic: check up, prescription glasses, drops, referrals and education.

Examination and testing of vision correction at the Eye Clinic

Women's clinic: check up, pap smears, treatment and education.

Dental Clinic: check up, extractions, fillings, education, dental prosthesis and repairs to dentures.

Pharmacy: dispensing prescribed medication free with proper advice on use.

Fellowship with local Sai devotees in the evening with Satsang and meals was well appreciated by all.

Bus used to transport volunteers to and from Camp locations

Team members:

Registration at the Medical Camp

Gynaecology Team Report

Team members - the team comprised of specialist gynaecologists in practice in Sydney. They were joined by 3 Sydney midwives. The team worked well together, learnt a lot about each other and from each other and gained great insight about Sai human values and spiritual development. They were privileged to have a number of students from the University of Fiji attached to them each day. The total number of pap smears taken numbered 377. Pap smear slides will be processed in a pathology laboratory in Sydney.

Womens Clinic

The team ensured that the women were provided with privacy for their examinations. This was made possible by the team being allocated as private a location as possible. Within this location curtains and barriers were used to further ensure the maintenance of modesty at all times.

The gynaecological health of the women was generally good. Three women were referred for further management for pelvic tumours. Several women had asymptomatic cervical polyps, there were four cases of infertility, several cases of urinary incontinence and some women with menopause related symptoms.

Observations taken:

1. The students were a great asset and had the benefit of exposure to clinical gynaecology and also the Sai human and health values.

2. The involvement of the non devotee team members was excellent in demonstrating the catholicity of Sai values in healthcare. The opportunity to 'walk the talk' in role modelling these values is a great blessing for our own sadhana.

3. Women valued the opportunity to seek specialist opinion for their problems. We were able to reassure many and others we referred for further management.

4. Cervical cancer rates in Fiji are some 10 times greater than in Australia and NZ and the case fatality rates are very high. Diagnosis to death intervals in Fiji are as low as 3 years. Fiji does not have a universal pap smear screening capacity. We are complementing the Ministry's efforts in reducing cervical cancer rates by our medical camp efforts. The pap smears are processed in Australia thus not putting any pressure on the Fiji health resources.

In the previous 3 years we have found pre cancerous lesions which have been referred for treatment and also assisted in managing cancer. These referrals have challenged the limited gynaecological resources in Fiji. In future we plan to provide visual inspection of the cervix using acetic acid (VIA) and treating aceto white lesions with cryocautery at the camps. This is an evidence based intervention shown to reduce cervical cancer rates in low resource settings.

Future initiatives: Equipment for polypectomy, IUCD insertion and colposcopy and cryocautery would be useful adjuncts. We plan also to provide women with preventative health information regarding common female gynaecological concerns. This will fit in with this year's initiatives with regard to health education.

Nursing team report

The nursing team compromised of four nursing staff: 2 midwives and 2 registered nurses. The 2 midwives worked in the women's health clinic where they conducted well women checks. The number of women seen at women's health clinic was higher than the previous years.

Medical attention at the Nurses Station

A physical assessment including head to toe assessment was carried out for every woman who presented at the clinic. Breast examination and abdominal palpation for any abnormality was also carried out for these women. As part of an education service, the women were educated on how to conduct breast examinations themselves. There were some women who were detected of some abnormalities following abdominal palpation and they were referred to the gynaecologist team for further investigations. Two pregnancies were picked up during these assessments and both the women were referred to the gynaecologist team for appropriate follow up and management.

Approximately 90 to 95 Pap smear checkups were attended to for eligible patients each day over the 5 day period at this clinic. It was their first time to work in the camp; however, both the midwives enjoyed their experience and managed their workload very well. Most patients thanked the midwives for their service and also stated that they benefitted highly by attending the clinic.

The two registered nurses worked at the nursing station and carried out the following procedures:

• Blood pressure checks
• Blood sugar checks
• Urinalysis
• ECG
• Wound dressings
• Medication administration including nebulised medication for asthma patients
• Physical assessments

Almost all the patients were seen at this station prior to General Practitioners' consultation. There were a large number of patients with high blood pressure and blood sugar readings. Some of these patients were known hypertensive and diabetic patients while the others were not diagnosed previously. An ongoing education was provided by the nurses on individual basis based on the patients' education needs. Some of the areas of education needs were identified as follows:

• control of diabetes including diet, medication therapy, exercise and life style
• medication therapy in management of hypertension
• foot care in diabetic patients
• identifying signs and symptoms of hypoglycaemia and hyperglycaemia
• wound care
• general health hygiene

Overall the workload was managed well, the patients seemed happy, they appreciated the service provided and thanked the nursing staff.

The undergraduate medical students were also allocated to work with the nursing team which was a tremendous help. They expressed that their experience as a great learning opportunity. As usual the nursing team had a wonderful and rewarding experience during this camp.

Pharmacy Report

The pharmacy was staffed by three Pharmacists, General Volunters and students from UPSM. The pharmacy functioned well and efficiently throughout the 5 days of the Camp. A total of 2561 prescriptions were dispensed over the 5 days.

The Pharmacy at work

Pharmacy supplies were adequate to fill all but four prescriptions. Although adequate supplies were ordered from government stores and pharmaceutical wholesalers in time, some items on our formulary were not available for reasons unknown. This issue was addressed by filling those affected scripts with alternatives approved by the prescriber.

The availability of UPSM students and a Fijian Pharmacist helped considerably. This meant that patients did not have to wait long for scripts to be filled and there was always a pharmacist available for counselling. A member of the Pharmacy Team gave talks on various health related matters in the Patient Education part of the camp. These were well received.

A dedicated van was made available to transport pharmacy stock and equipment between camps. This helped immensely in setting up and packing up, as we did not have to sort through a lot of boxes to find our stock and equipment. There was enough time on the last day for an inventory of stock and equipment to be made. All remaining stock was either returned for credit or has been stored for use next year.

Dental Clinic Report

The Dental team comprised four dentists from Australia, one from Fiji and one Dental Prosthetist from Australia.

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, year 2 and year 3 medical students of the Umanand Prasad School of Medicine (UPSM). The students are a credit to the institution.

Dentist and Patient smiling

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 could 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 greatly. Local help was sought in providing portable equipment including a compressor, portable dental chairs and dental units with suction.

Considerable support and assistance was given by the Ministry of Health, Fiji, the Oral/Public Health team Lautoka/Yasawa, Dr Bindiya of the Fiji School of Medicine, and the Senior Dental Officer, RakiRaki Dental Clinic.

Dental records were recorded in triplicate, a middle copy for the patient, the bottom copy for Fiji Sai Organisation and the top copy for our own records. The records also allowed us to keep track of DMFT (decayed, missing, filled teeth) the treatment provided and to write a referral to local dental clinics.

Due to the bulky nature and difficulty of transporting dental equipment several vehicles were assigned to transport dental equipment. These vehicles were loaded and unloaded at the end and start of each day respectively as per the need of the following day. This was a great advantage and helped to save time, and was less labour intensive.

The general setup at each location followed a similar outline and utilised the previoius camp protocols as it allowed workflow to progress quite well. Each room (dependent on size) was divided into registration/triage, restoration chairs, extraction chairs and sterilization.

This year we were able to provide all treatment on portable dental chairs. There were 3 chairs utilized at all camps. 2 chairs were predominantly used for restorative treatment with one chair being used solely for extractions. Depending on the requirements the restorative chairs were also used for extractions. Triage while predominantly carried out at the registration desk was also performed on the portable chairs if they were unused.

Autoclaving was used generally for all instruments, cold sterilisation used for non-autoclavable items and certain non-invasive instruments. Care was taken to control cross-infection. Under the given environmental situations, we managed to achieve a good level of infection control. Yellow plastic bags were used to collect clinical waste and sharps were collected in a designated sharps container. Clinical waste was disposed by the local clinics and hospitals as per their normal procedures. While there was provision to carry unsterile instruments, at almost all of the camps this year we were able to complete autoclaving prior to leaving each campsite. This allowed for instruments to be readily available for the next camp.

Health Education and Awareness Program

A Health Education and Awareness Program was prepared using the following broad classifications:

• Women's Health Issues
• Men's Health Issues
• Severity of Headache (Migraines, Tumour)
• Diabetes
• Healthy Eating and Obesity
• Hypertension
• Mental Health
• Stress Management
• Preventive Medicine
• Health and Hygiene
• Smoking/Kava
• Medication Misuse
• Dental Hygiene
• Eye Care

Each session was to have a DVD/video component (approximately 15 minutes), followed by an interactive session (approx 30 mins) with an assigned subject expert in the area. A roster was developed based on the available subject experts for the different topics - however, a lot of flexibility was exercised in order to meet the unique patient/client needs and the available facilities/resources at the different localities.

Patient Education in progress

It was discovered that the maximum target audience was around 9.00am to 12.00pm, and it was decided to cover the entire range of the important topics, around this time, even if they were brief. Attention span was another crucial factor that needed to be considered.

The audience comprised of the registered patients who were waiting to be called in. Expecting people to stay back for information sessions after their visit to the doctors was not feasible!!

With a large turnover of patients, it was very quickly realised that the medical professionals could not be spared for the delivery of all the information sessions. Hence, most of the training was facilitated by the Education Unit, with the assistance provided by the University of Fiji staff and students.

In all localities, men's and women's health issues were targeted at segregated audiences. Professor Fred Merchant was an invaluable facilitator in the delivery of the sessions on men's health issues.

Dr Nadana Chandran (Neurosurgeon) delivered sessions on the severity of headaches to large, interested audiences. Some oral hygiene sessions were delivered by Dentists whilst a session on medication misuse was delivered by a Pharmacist.

Other presentations were given on womens' issues and other common topics e.g. Healthy eating, diabetes, hypertension, importance of exercise, or any other topic, for which the subject experts were not available due to their workload. Preparation of fact sheets under the guidance of the medical professionals will allow the educators could facilitate sessions and spare the medical experts to attend to the clinical needs.

Sessions were given in the three main languages: English, Fijian and Hindi (Fiji-Hindi dialect). We encouraged group questions and also attended to individual queries. Special thanks are in order for the medical students who provided the Fijian interpretation.

Some of the common one-to-one topics of discussion were related to:

• stress management;
• women's health issues;
• men's health issues;
• healthy eating to reduce weight, and/or take care of their diabetes and/or hypertension;
• Use of common herbal medication (eg. "achi" or the noni-drink)

Involvement of University of Fiji and UPSM students:

The statistics and the impressions provided by many of the participants give tangible evidence of the great work done and the results. What words cannot describe clearly is the mood prevalent at the conference and the various camps, the immeasurable gains made by the participants, patients and the members of the team.

Daily Briefing for Medical Students at the camps

One of the highlights of the Conference was the well researched presentation by the medical students.

The Sai Medical Units acknowledges the cooperation and contribution by the Medical School. It was nice to see the mentors and the students turn out in full force. Their contribution is a testimony to their dedication, enthusiasm and energy. The sacrifice made by the students by living under difficult conditions and participating with a smile always providing much needed physical help is to be commended. We could not have achieved so much without their assistance with triage, screening eye patients, assisting the doctors and not to mention the physical labour. The students would have realised that there is more to medicine than acquiring knowledge and skills. Their mentors are to be commended for the leadership and guidance provided.

Location Statistics

Daily Breakdown

Conclusion

Each year improvements are made in the communication with all the parties involved in the camp. Proper communication and involvement with full dedication has helped us to improve our delivery of the service with love. Our theme this year was "Care and Share" which was exemplified by involvement by all the members of, the Sai medical unit Australia, the Sai Service Organisation of Fiji, staff of the University of Fiji, Students of the Uma Prasad School of Medicine, the Fiji College of General Practitioners, the Fiji Ministry of Health, the various Schools where the camps were held, the communities around the schools and a number of private businesses.

Acknowledgements:

Projects such as this could not be successful without support and generosity of all those involved, be they suppliers of medicines, medical and dental equipment, transport specialists, airlines, and other collaborators and the generosity received from a number of industries and businesses. We acknowledge all the organisations and individuals who assisted us in our task:

Saying "Thank you!" to a Headmaster at one of the Schools used for the Camps

• Team members from Australia and Fiji for the voluntary participation and providing their skills and time.
• Members of Sai Service Organisation of Fiji for all the guidance, support, meals and fellowship.
• Dr Neil Sharma Minister of health and the members of the Fiji Ministry of Health for officiating the conference, all the assistance in planning, registration of our members, pharmacy supplies, dental mobile equipments, and custom clearance.
• Adi Salaseini Kavunono Iloilovatu, First Lady of Fiji, for gracing the closing ceremony.
• University of Fiji staff and UPSM students for all the assistance with the conference and the camps.
• Members of Fiji College of General Practitioners for participation at the conference.
• Air Pacific for accommodating our needs for the bookings, fares and excess baggage.
• Various business establishments for their support in kinds to make our stay comfortable. Ajay FMF Lautoka, Punjas Lautoka, Tappoos, K B L Lautoka, FPS Vinita Ram, P Meghji and Co. Ishvarbhai, C K Narsy Laundry.
• Jilyan Wong and Fiji Water for supplies of clean water and soft drinks.
• Chandulal Pharmacy for supply of pharmaceutical supplies.
• Automart Lautoka for loan of vehicle for planning and carting equipments and supplies.
• Hotel Managers and staff at all the hotel for making our stay after busy day comfortable. Water Front hotel Lautoka, Rakiraki Hotel, The Pearl, and Sofitel.
• Special appreciation of Mr YP Reddy for his generosity.
• All the School staff and communities around the schools for accommodating and making the camp event a celebration in the area.
• Bulabula Indian School, Ba
• Nanuku Sangam School, Rakiraki
• Muaniweni Primary School, Naitasari
• Vashista Muni Primary School, Nauva
• Tuva Indian School, Sigatoka

View the Photo Album of this Camp