Pacific Islands Orthopaedic Association
Report for MODULE 1, Honiara, 11.-23. February 2013
What have I learnt?
- How to take a full history of the patient and the
importance of history taking.
- Proper documentation of the Range of motion of the
- Proficient examination of the Shoulder, knee, ankle,
elbow and the wrist
- Learn how to perform the neurological examination of
the Upper and lower limbs.
- The importance of ethics in the practice of clinical
medicine. Patient-Doctor relationship
- Importance of the crisp algorithm in the care of the
critically ill patients.
- The importance of the urine output in the critically
ill. It should be more than 30ml/hr in an average 70kg
person. Thus, the important 5 rules of the kidney: Kidney
perfusion is dependent on the cardiac output and blood
pressure, low urine output does not mean furesimide
deficiency, Anuria is almost due to obstruction, when there
is oliguria a fluid bolus challenge is important, kidneys
need good perfusion.
- How to fix the patella fracture, the olecranon process
with a Tension band wire. Principles behind it being
- How to fix the long bones fractures with a lag screw.
The principles and the technique being learnt.
- How to communicate with a sick patient or the relatives
using "IS BAR"
How will the knowledge influence our daily work.
- Simply knowing the Ccrisp algorithm will certainly make
a lot of changes to our very sick patients, both preop and
post op patients. ABCDE, a simple but very important tool
in resuscitation, and the rest of the algorithm
- Again history taking is very important. With a good
history, a good idea of the diagnosis is already
established before doing the examination and it also
directs one to the necessary examination.
- Urinary output is a very important facet to monitor in
the critically ill or post-operative patients. Fluid
challenge being very important. Thus all sick patients or
those after big major operation to go on urinary output
- Communication is very important tool in the medical
practice, especially with patients, relative and a
colleague. The importance of it cannot be over emphasized.
A good communication with everyone involved in the care of
the patient avoids any errors in patient care.
- I have taken to fully examine the complete neurological
examination of a patient. I don't think I would have done
these 3 months back.
- It makes me think more widely and strategically when
confronting a critically ill patient. Having a system
leaves us with a very small margin for critical error.
- It certainly has changed my approach in the fracture
clinic. I am now very thorough when examining a patient and
I am seeing a patient more completely and not just a "sore
- I have a plan for my patient in the ward. I guess I am
more organised in ensuring all the necessary things are
done, and at the same time having more time to listen to
- I am much better with interpretation of blood results
than I used to.
- I have a system of interpreting x-rays. I still need
What do I do now, what do I want to learn next.
- First and for most is to ensure that all knowledge
learnt to be put into practice in everyday life. And to
have a log book to remind me of the cases I have
- I want to attend more hand workshops to ensure I
develop my special interest.
- I want to attend the advanced AO work shop. that will
certainly advance my knowledge and skills of internal
- To learn more about the physiology of the kidneys.
- To attend further Crrisp courses or the EMST.
- To develop further my judgemental skill in looking
after the critically ill.
- To learn more about respiratory medicine and its
relevance in the critically ill.
- To be attached at another centre for trauma care.
- To be proficient and to know how to interpret the
- To fine tune my surgical skills further with a very
good knowledge of anatomy
Dr. George Kabwere, Registrar, Orthopaedic Department
National Referral Hospital, Honiara, Solomon Islands
© April 2013, Dr George Kabwere