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Report for Swiss Fellowship Training Trip 2010

The AO Swiss fellowship Award attachment was a great privilege for me especially being the second Solomon Islands Orthopaedics Registrar to be able to go to Europe and learn from some of the best surgeons in the world. This trip wouldn't have been possible without the help of certain individuals and institutions concerned.

Acknowledgements

Hermann and Elisabeth Oberli
Dr Hermann and Elisabeth Oberli

Firstly I would like to thank the almighty lord especially for keeping my family safe back at home my beautiful and loving wife, Stella and my 3 adorable children, Tutina, Bradley and Chorote. Without their understanding and support also I do not think this overseas attachment would have been bearable.

I would also like to thank Dr Hermann Oberli greatly from the bottom of my heart for his help in continuously not only helping but being a person who we always know and trust to be around for us. We are indebted deeply to you and your loving wife Elisabeth.

I would also like to thank Andreas, the consul for Switzerland in Sydney for facilitating my visa and Mr Willy Fuchs and the Stanley Thomas Johnson Foundation and AO Foundation and the Lions Club for providing me with the financial needs for the whole program. Your generosity will not go unnoticed and will be remembered by us in the Solomon Islands.

To the Hospital Directors of Uri Hospital and FMI Hospital, Mr. Baer and Mr. Heinz, my greatest respect and appreciation for your understanding and help which enabled me to work in comfort and feeling always home even though being far. In St Gallen to Professor Kuster for financing my stay there, I thank you most greatly. My personal thanks goes also to Dr Gabor Puskas also for looking after me during my stay in Geneva Spital. Tagio tumas bro.

To Dr Joller in Uri Hospital, Dr Spycher in Interlaken along with Dr Kulling in St Gallen, you all showed me what it takes not only to be a surgeon but a person in the eyes of patients and also the staff. I have learnt a lot from you all and wish you both and your families well. I always felt being part of a family around your teams and even knowing your families. I hope to see any of you in the Solomons and ensure you that you will always have a home here.

Lastly but not the least I would like to thank my Head of Department, Dr Patrick Houasia and the Orthopaedic Team in the Solomon Islands for their patience during my absence in taking the extra load I left on their shoulders. I hope my trip has taught me and shown me new ways in which we can move our department to greater heights within our limits and improve patient care for our people.

To those who helped me but were not mentioned I thank you all from the bottom of my heart and hope our paths may cross somewhere some time.

Tagio Tumas and God Bless us all,

Dr Alex Bradley Munamua
Swiss Fellow 2010
Solomon Islands Orthopaedic Registrar in training

Preface

This report is a brief content of all the things that I did during my six months stay in the various hospitals in Switzerland.

I stayed in a total of 3 hospitals namely Uri Kanton Spital, Interlaken Kanton Spital, St Gallen Kanton Spital and at Geneva Kanton Spital for a shorter attachment. Within all three attachments I got to attend Grand rounds, CME sessions, and Consultant clinics and also observe and assist in surgery. Apart from the attachments I managed to attend the Swiss Surgery Congress and also the Swiss Orthopaedic Congress respectively.

Surgical team Spital Interlaken
Surgical team Spital Interlaken

The whole 6 months was filled with plenty of learning experiences any fellow would like to have and I had done with warm welcoming hearts from everyone I had contact with. This attachment has enriched me and taught me so much within such a short time.

Administration and Personal

From arriving from the Solomons, I had accommodation where ever I was put which I for one am so grateful to all those involved. Traveling from each destination has always been easy after 2 months of practice and getting lost at the train station. Other things like eating and personal needs was never a problem especially communication back home when one had email and Skype. Loneliness and being home sick was but a part of my lesser problems.


Clinical experience

knee arthroscopy equipment
Training knee arthroscopy while in St Gallen Spital

All 4 hospitals had so much to learn and I got the upper hand by having to work with chief consultants and consultants; something not every registrar gets to have. Clinical cases ranging from trauma to complicated revision surgery, one really got to see that despite the complexity of the case, basic principles still applied. One of the aims that I had when going to Switzerland was to be open minded and try and learn every thing no matter if the application was not appropriate to my setting in the Solomon Islands. A good experience was in St Gallen where I was attached also to the plaster men and also did a few steroid infiltrations especially in the spine and shoulder. This was so practical for someone who does a lot of conservative and non surgical treatments. I tried as much as possible to apply all the principles of fracture management after only attending the course a year ago which too helped in my learning. Coming to Switzerland gave me the best opportunity to experience the completeness of how to management cases correctly with the right implants and equipment.

Working in a setting with limited resources is very humbling knowing that it cannot be done but rather it helps an aspiring surgeon to think ahead and plan what future he can mould knowing his limitations but not to accept anything but the best he can offer for his patients.

Using your instruments was but one of the many things overemphasized in most teaching hospitals and I felt lucky to be one of the registrars being taught such important teaching first hand with the many registrars there.

Surgical skills

plaster team St Gallen
Plaster team, St Gallen

Working with some of the best surgeons in Europe gave me an opportunity to learn surgical approaches in specific cases especially in shoulder and knee surgery which was one of my specific areas which I wanted to learn whilst being in Switzerland. Knee arthroscopy (diagnostic and ACL reconstruction), open rotator cuff repairs were among the more frequent cases I made sure to scrub in and I did get to be in most. Attending a pelvic surgical course in Geneva and also the two congresses also gave me an opportunity to see other specific cases.

Even though I only assisted and observed I have to say that I am now more comfortable in assisting and willing to do my first case when ever I have the opportunity to do one. My confidence has grown since I did this fellowship attachment.

Specific surgical skills I learnt from assisting in surgery

  1. Fracture management both in surgery pre-op, intra-op, post-op
    1. Tibial plateau
    2. Femoral fractures
    3. Ankle fractures
    4. Colles fractures
    5. Distal Clavicle
    6. Spinal injuries
    7. Pelvic ring injuries
  2. Sporting injuries
    1. ACL reconstructions; different grafts and post op rehabilitation
    2. Rotator cuff tears; open cuff repairs, ultrasonography
  3. Foot problems
    1. Hallux Valgus
    2. Plantar fasciitis
    3. Tenosynovitis problems
  4. Hand
    1. Carpal tunnel syndrome
    2. DeQuervain's tenosynovitis
    3. Trigger finger
    4. Dupuytren's contracture
  5. Hip
    1. Total hip replacements
    2. Surgical approaches to the hip
      1. Watson Jones
  6. Spine
    1. Internal fixation
    2. Nerve root denervation with infiltration

Clinical significance to the Solomon Islands

Well I guess I have already mentioned most of the important points about this fellowship which I am honored and thankful to all those who made it possible. I hope the relationships forged from my predecessors and I will continue to remain strong so that together we will make a change for the patients in the Solomons in the field of orthopedics. Orthopedics is a young department in the Solomon Islands but already has stamped its mark by its commitment and dedication in working hard and its plan to expand its ties everywhere to anybody who is willing to share the same dream. I for one would like to conclude that despite sharing the problem with culture difference and language difficulties during the fellowship, most of my goals were achieved and proved the satisfaction expected. Thank you one and all for the time and commitment you all contributed. May God bless you all.

TAGIO TUMAS.

© October 2010, Dr Alex Bradley Munamua

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