Blanche Wilkie reports on the recent Interplast Australia mission to Vanuatu.

When most people think of Vanuatu, a tranquil island paradise usually comes to mind. However, Geelong plastic surgeon Dr Ian Holten, and his team of six Australians who visited Vanuatu as part of an Interplast mission during May 2006, experienced a very different side to the island.

‘Half a mile down the road from a lush five-star resort you see shanty towns with no running water and electricity - the basic things we take for granted,'' Dr Holten says. ‘Malaria and tuberculosis are endemic. Children are dying unnecessarily.'

This is the 10th year that Interplast Australia has sent a team of plastic surgeons to Vanuatu. Word of their mission spreads quickly among the community via newspaper and radio advertisements and there are hundreds of people waiting to be seen by the visiting surgeons when they arrive. This year the team, (plastic surgeons Dr Naveena Somia, Dr Craig Rubenstein and Dr Ian Holten, anaesthetist Dr Rob Grace, and surgical nurses Jenny Eltringham and Krissy Durbridge) consulted 70 patients and performed 60 operations over the 13 days.

Congenital conditions are prevalent in Vanuatu.Cleft or facial deformities typically result in discrimination or worse - children with facial deformities have even been abandoned at birth as a result. Burn scars and keloid scars are also typical cases in need of plastic surgery.

A mobile plastic surgery unit was transported from Australia by the Interplast team, consisting of 12 cases weighing a total of 300kg. The cases largely contained sutures, scalpels, instruments and bandages. The team divided their time between the capital, Vila, and the island of Santo, which they flew to on a light aircraft. They typically worked from 8am until 10pm in poorly resourced hospitals.

‘At one hospital the defibrillator didn't work and we couldn't perform blood tests. Air conditioners were on the blink and there were power failures and dripping taps,' says Dr Holten.

The first patient treated at Vila Hospital was two-year-old Flora (pictured). Flora was born with a cleft lip and had subsequently been abandoned by her mother.

‘There are still widely-held beliefs informed by witchcraft, and facial deformities such as this are regarded as a type of pay-back for past misdeeds in the family. As a result, there is a lot of social stigma associated - the child will never be baptised or integrated into the community. They may even be kept indoors for most of their childhood,' says Dr Holten.

‘We try to operate on these children before they are three- or four-years-old and have developed an understanding of the negative reaction to their appearance. With a 15-year-old, for example, we can improve the physical aspect but the psychological scars are ingrained. Flora is lucky because we were able to treat her at such an early age, and she now has a chance of living a normal life.'

Twenty-one-year-old Leitana suffered burns to 15 percent of her body - to her hands, arm and legs -after she rolled into a fire during an epileptic fit. When the Interplast team arrived she had already been at Vila Hospital for three weeks and maggots were crawling out of the dead skin tissue. Inadequate nutrition had exacerbated her condition.

The team performed a seven-hour operation, rebuilding her hands and grafting skin. Members of the Interplast team also bought tins of Sustagen for Leitana to aid in her recovery. 'Leitana was very grateful - if they'd had to cut her hands off to save her life she would have been totally reliant on having people feed her and attend to her personal hygiene needs,' says Dr Holten.One of the cases at Lugan Ville Hospital in Santo involved rebuilding the nerves in the wrist of a teenager, John, using nerves from his leg. Two months prior to the operation, John had injured his hand with broken glass. 'We were essentially rewiring using stitches that are finer than hair over a distance of 5cm. John's hand was remobilised as a result of this procedure,' explains Dr Holten.

Dr Holten describes the experience as being both humbling and rewarding:

‘I feel humbled because these people have so little and yet are so happy, have good family values, and are grateful for any assistance they can get. If someone can't use their hands because they have been burnt and can't work, it is difficult to live because there is no dole or social security in Vanuatu. All the plastic and reconstructive work we perform is making a huge difference in people's lives.'

Introducing local doctors and nurses to aspects of plastic surgery and imparting skills for training purposes is also an important part of the Interplast Australia mission. Unlike Australia, nurses in Vanuatu are responsible for injecting anaesthesia in certain circumstances, such as epidurals during childbirth. During the Interplast visit, nurses were trained in the principles of anaesthesia, and the quality and safety of a range of procedures were improved.

Interplast Australia is a non-profit organisation that provides voluntary medical teams to undertake programs of plastic and reconstructive surgery in developing countries, and was founded in 1983 by the Royal Australasian College of Surgeons and Rotary International District 9800.

For more information or to make a donation visit www.interplast.com.au or contact:
Interplast Australia
C/- The Royal Australasian College of Surgeons
Spring Street
Melbourne VIC 3000
Ph + 61 03 9249 1231
Fax + 61 03 9249 1235
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ACSM #33