Making a difference: Waikato surgeon takes skills to Samoa

At Waikato Hospital, Dr Stephen Adams performs routine operations several times a week.

In Samoa, he found children who had waited years for surgery.

Adams, head of paediatric surgery at Waikato Hospital, travelled to Apia in June this year with a six-person Royal Australasian College of Surgeons (RACS) team.

Over five days, they assessed more than 50 children and performed 26 operations.

Some were procedures familiar to Adams in Hamilton. In Samoa, they carried a different weight.

The team treated children with conditions including Hirschsprung disease (where nerve cells are missing in a baby’s large intestine), anorectal malformations, hernias, undescended testicles and tumours.

Adams had wanted to become involved in Pacific outreach surgery for several years.

A colleague was unable to attend the trip, and Adams led the team. It comprised two surgeons, two anaesthetists and two nurses.

The mission is part of an annual RACS programme providing specialist surgical support across the Pacific.

The work starts well before the visiting surgeons arrive, with Samoan clinicians identifying and preparing patients throughout the year.

“They’re a really good medical team,” Adams said. “It’s just that they have no available resource to achieve it.”

The team began work on the Monday with a clinic of more than 50 children before moving into theatre that afternoon.

They operated until about 8pm and ran two operating theatres each day for the rest of the week.

For Adams, the differences from Waikato were quickly apparent.

A steam steriliser could take four or five hours to process instruments, and the hospital had limited supplies of some medicines.

The team also had to decide which operations would use the specialist paediatric instruments they had brought.

Adams decided against several operations because the equipment or circumstances were not suitable.

“We did have an ethical obligation to provide correct care, not just make do,” he said.

For Adams, one of the most striking aspects of the trip was how familiar many of the surgical problems were.

The team saw conditions he treated routinely in Hamilton, including hernias and undescended testicles, alongside more complex bowel and anorectal conditions.

The difference was how long some children had lived with them.

One patient had been dealing with the same problem for four or five years.

In another case, Adams removed a kidney that had been infected for a long time.

“It’s unusual for that to happen in our setting,” he said.

Several children were severely anaemic and needed blood transfusions.

Adams said some families struggled to afford necessities, including infant formula.

One young boy with an anorectal malformation underwent surgery to correct the condition.

“He was just smiling, happy and lovely,” Adams said.

“He was just delightful to look after.”

Not every case had a surgical solution.

Adams also reviewed children with serious illnesses that could not be corrected surgically. In some cases, the team could assess the child and reassure families that the local care was appropriate.

“Heartbreakingly, in a couple of cases, there really wasn’t anything more that could be offered.”

Local doctors and trainees worked alongside the surgeons, while the visiting nurses provided formal and informal education.

“It’s not really about us kind of parachuting in and doing stuff,” Adams said.

“It’s about supporting and developing and growing teams as well.”

The relationship continues from New Zealand.

Adams remains in contact with Samoan clinicians.

He hopes some of the trainees he worked with will come to New Zealand for further training.

Adams said greater funding could allow the team to spend two weeks operating rather than one, giving them more time to treat patients and train clinicians.

“The funding is probably the biggest barrier to care,” he said.

“Surgery is one of the most impactful things you can spend one dollar on.”

Australia’s Department of Foreign Affairs and Trade was the major funder of the latest mission.

Adams said the most important outcome was not the number of operations completed.

“Probably the real outcome is that we’re increasing our ability to work with these guys and to develop them and improve them.”

Tom Eley is a multimedia journalist at the Waikato Herald. Before he joined the Hamilton-based team, he worked for the Weekend Sun and Sunlive. He previously worked as a journalist at Black Press Media in Canada and won a fellowship with the Vancouver Sun.