Fiji Training Program
ANZGITA is the supporting partner in the World Gastroenterology Organisation's (WGO) Training Centre located in the Colonial War Memorial Hospital's (CWMH) Endoscopy Unit which operates in association with Fiji National University's (FNU) College of Medicine, Nursing & Health Sciences (CMNHS). The centre was established in 2008 when the first annual training program was conducted by ANZGITA. The centre trains physicians, surgeons and nurses from across the Pacific Island countries and territories during annual training programs. Attendees, in turn, have established services at their home hospitals. At CWMH, doctors diagnosed and treated over 1,000 patients in 2018/19 and ANZGITA, through the support of industry and other donors, provides donations of equipment and accessories to assist.
The lead Director of the Training Centre is Assoc Professor Jioji Malani, supported by Dr Mai Ling Perman with ANZGITA co-directors Prof Finlay Macrae and Assoc Prof Chris Hair, our Pacific Programs Leader in support. Read about Chris's passion for his work.
The lead Director of the Training Centre is Assoc Professor Jioji Malani, supported by Dr Mai Ling Perman with ANZGITA co-directors Prof Finlay Macrae and Assoc Prof Chris Hair, our Pacific Programs Leader in support. Read about Chris's passion for his work.
Fiji Update
The COVID situation in Fiji (pop. 900,000) remains critical. Please keep our friends in mind. There have been 30,000 cases during the outbreak and 239 deaths. The seven-day average for daily cases is 1039. However, 70% of the eligible population have received the first vaccine dose (14% fully). No one fully vaccinated has died. The Australian & New Zealand governments are providing vaccines and other aid.
Assistant Prof Mai Ling Perman has been appointed Acting Head of the School of Medical Sciences in the College of Medicine, Nursing & Health Sciences at Fiji National University. She is also President of the Internal Medicine Organisation of the Pacific. Dr Vikash Sharma replaces her as Acting Head of Department for Mental Health, Childcare and Adult Medicine and Dr Aminiasi Rokocakau replaces Vikash as Acting Head of the Internal Medicine Unit. Congratulations to the three musketeers (Mai Ling's label!) with whom we have a close working relationship.
World Gastroenterology Organisation (WGO) Research Projects
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We are currently working with the WGO on three CWMH Fiji research projects which it is funding: 1) the implementation of an endoscopy reporting system to gather research and operational data (see below), 2) helicobacter pylori antibiotic resistance testing and 3) ATP monitoring of endoscope cleaning & disinfection. Read more about the projects here.
The WGO sees the Endoscopy Reporting Project as having the ability to assist in enhancement of patient safety and quality of care, improvement of personal and institutional audit and strengthening of training and accreditation of new gastroenterologists and research programs. The hope is that it will form a template for similar implementations in other WGO training centres especially in low resource countries. |
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Provation has generously supplied their software product licences at no cost to the project. ANZGITA volunteers, who have considerable product experience from Queensland Health installations, have assembled and configured the system which has now been shipped to CWMH. Due to COVID, their further assistance with commissioning and the user training will need to be done remotely during December.
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Developing a Public ERCP Service in Fiji
Assoc Prof Chris Hair, Pacific Programs Leader, with Mr Frank Bainimarama, Fiji Prime Minister, at the 2017 program
Over 2019 and 2020 ANZGITA will further develop the training of Dr Aminiasi Rokocakau of Fiji in ERCP procedures following his fellowship at Royal Melbourne Hospital (RMH) in 2018 where his training was initiated. This will be a purely voluntary exercise accomplished due to the dedication of a team of trainers supported by generous industry partners.
The training will be done at Dr Rokocakau’s workplace – the Colonial War Memorial Hospital (CWMH) in Suva. Teams formed from experienced ERCPists (currently including 6 from Australia and New Zealand) and nurses will volunteer their time to provide the training. One of the teams will visit Dr Rokocakau monthly for a 3-day period leading him in the further development of his skills. A nurse experienced in supporting ERCP procedures will go on most visits to assist and provide skills training to CWMH nurses.
The Fiji Ministry of Health and CWMH administration and medical management have endorsed the program and are working with Dr Rokocakau to ready the necessary facilities and support services at CWMH. The Australian Government through its PIP program, which is administered by RACS, will cover the expenses incurred by the volunteer clinicians who are providing their services pro bono. ANZGITA has used donated funds to purchase two latest-release Fujifilm duodenoscopes from CR Kennedy at a discounted price negotiated on our behalf with Fujifilm.
Equipment reprocessing, accessories and other needs are being supported by Montserrat Day Hospitals, Cantel Australia, Whiteley Corporation and CK Surgitech who have all donated equipment, materials or services towards the program. We are currently in discussions with other major suppliers for further donations-in-kind.
The training will be done at Dr Rokocakau’s workplace – the Colonial War Memorial Hospital (CWMH) in Suva. Teams formed from experienced ERCPists (currently including 6 from Australia and New Zealand) and nurses will volunteer their time to provide the training. One of the teams will visit Dr Rokocakau monthly for a 3-day period leading him in the further development of his skills. A nurse experienced in supporting ERCP procedures will go on most visits to assist and provide skills training to CWMH nurses.
The Fiji Ministry of Health and CWMH administration and medical management have endorsed the program and are working with Dr Rokocakau to ready the necessary facilities and support services at CWMH. The Australian Government through its PIP program, which is administered by RACS, will cover the expenses incurred by the volunteer clinicians who are providing their services pro bono. ANZGITA has used donated funds to purchase two latest-release Fujifilm duodenoscopes from CR Kennedy at a discounted price negotiated on our behalf with Fujifilm.
Equipment reprocessing, accessories and other needs are being supported by Montserrat Day Hospitals, Cantel Australia, Whiteley Corporation and CK Surgitech who have all donated equipment, materials or services towards the program. We are currently in discussions with other major suppliers for further donations-in-kind.
Annual Training Programs
Dr. Peter Katelaris (left) engaged in training at WGO Training Centre at CWMH/FNU
A 4 week period of concentrated training is held annually at the Training Centre as part of the gastroenterology module of FNU's School of Medicine, Nursing and Health Sciences postgraduate Diploma and Masters curriculum. Physicians, surgeons and nurses from Pacific Island countries who are not enrolled in these courses also attend.
Since 2008, trainees have come from Fiji, Kiribati, Samoa, Cook Islands, Federated States of Micronesia, Solomons Islands, Tonga and other Pacific Island countries and territories.
The Fijian endoscopists and senior nurses who have participated in the program for several years have gained a level of skill which enables them to train colleagues during the annual program and throughout the year. This improvement and growth demonstrates the programs are meeting their goal of transferring skills and knowledge and building self-sustaining services development.
The program has an emphasis on ‘Endoscopy Training in Totality’. The delivery of the training, with all its component parts (including administration, access to equipment, maintenance, service organization, cleaning, GI Nursing, endoscopy training and now Train the Trainer training) is far more valuable than simply transferring endoscopy skills.
Medical training, predominantly in gastroenterology, is delivered through lectures and tutorials and through involvement in clinical practice such as ward rounds. Structured assessments of competency are completed, with physician trainees being assessed as they enter the program and as they leave - with a measurement of the competencies achieved in the month so documented.
Gastroenterology nursing is predominantly in the safe delivery of endoscopy by the introduction of the standards and competency benchmarks of the Gastroenterology College of Nursing of Australia (GENCA). Read nurse Allana Parkes' presentation to fellow nurses on her experience of the 2017 program. The GENCA website features reports by nurses on the 2014 program.
Since 2008, trainees have come from Fiji, Kiribati, Samoa, Cook Islands, Federated States of Micronesia, Solomons Islands, Tonga and other Pacific Island countries and territories.
The Fijian endoscopists and senior nurses who have participated in the program for several years have gained a level of skill which enables them to train colleagues during the annual program and throughout the year. This improvement and growth demonstrates the programs are meeting their goal of transferring skills and knowledge and building self-sustaining services development.
The program has an emphasis on ‘Endoscopy Training in Totality’. The delivery of the training, with all its component parts (including administration, access to equipment, maintenance, service organization, cleaning, GI Nursing, endoscopy training and now Train the Trainer training) is far more valuable than simply transferring endoscopy skills.
Medical training, predominantly in gastroenterology, is delivered through lectures and tutorials and through involvement in clinical practice such as ward rounds. Structured assessments of competency are completed, with physician trainees being assessed as they enter the program and as they leave - with a measurement of the competencies achieved in the month so documented.
Gastroenterology nursing is predominantly in the safe delivery of endoscopy by the introduction of the standards and competency benchmarks of the Gastroenterology College of Nursing of Australia (GENCA). Read nurse Allana Parkes' presentation to fellow nurses on her experience of the 2017 program. The GENCA website features reports by nurses on the 2014 program.
2019 Program
ANZGITA team members with Assoc Prof. Malani at Colonial War Memorial Hospital
Nine ANZGITA doctors and nurses conducted the 12th annual training program in 2019 which followed the established structure and with content updated to cover the latest advances in gastroenterology of relevance the the Pacific region. Physician trainees came from Fiji, Tonga and Timor-Leste. Nurses came from Fiji, Nauru and Tonga.
During 2018/19, with the support of industry partners, the Fiji Government and its logistics partner, Gibson Freight, we sourced over $180,000 of consumables for the Ministry of Health. This included six Fujifilm endoscopes, a back-up automatic endoscope reprocessing (cleaning & disinfection) machine, disinfection chemicals and endoscopy consumables (including for ERCP - see above).
Following the program, work commenced with the WGO, to implement a new procedure documentation software system donated by a major supplier at the training centre.
During 2018/19, with the support of industry partners, the Fiji Government and its logistics partner, Gibson Freight, we sourced over $180,000 of consumables for the Ministry of Health. This included six Fujifilm endoscopes, a back-up automatic endoscope reprocessing (cleaning & disinfection) machine, disinfection chemicals and endoscopy consumables (including for ERCP - see above).
Following the program, work commenced with the WGO, to implement a new procedure documentation software system donated by a major supplier at the training centre.
Fiji Training Program 5 July 2019
The annual four-week Fiji training program, held in partnership with Fiji National University and Colonial War Memorial Hospital, Suva started on 5 July. It ran for four weeks and 5 doctors and 5 nurses attended for periods of up to two weeks as trainers.
Dr Mai Ling Perman led preparations on behalf of Fiji National University and Colonial War Memorial Hospital (CWMH) and was a trainer, along with Country Program Leader Dr Chris Hair. We have received generous donations of accessories for the program from Boston Scientific and Cook Medical as well as excellent prices for new equipment from Fujifilm / CR Kennedy.
Dr Mai Ling Perman led preparations on behalf of Fiji National University and Colonial War Memorial Hospital (CWMH) and was a trainer, along with Country Program Leader Dr Chris Hair. We have received generous donations of accessories for the program from Boston Scientific and Cook Medical as well as excellent prices for new equipment from Fujifilm / CR Kennedy.
Dr Mai Ling Perman, Fiji
In the early years of the Fiji training programs, Dr Mai Ling Perman had a strong interest in endoscopy and with the ANZGITA team's support and that of FNU Assoc Prof Jioji Malnai she quickly developed competencies and continued to develop her skills over the following years. In 2013 Mai Ling came to Australia for intensive training. Subsequently, she undertook more observational training in Japan, and attended a WGO train-the-trainer course in London in 2015. Mai Ling is now a teacher at the FNU Medical School and does frequent outreach training across the Pacific. This has taken her to Vanuatu, Palau, Kiribati, Tonga, Marshall Islands and probably other visits we are not aware of. Mai Ling is on the left in the photo celebrating her birthday while in Marshall Islands supporting colleagues.
Amongst her achievements in addition to the many patients she has treated in Suva, is the formation of a competency assessment form for endoscopy trainees that we also use in other pacific programs, and over-seeing the ongoing gastroenterology curriculum and program in Suva. According to Chris Hair, who leads all our activities in the Pacific, "Mai Ling has probably done more for pacific endoscopy than anyone, and arguably had the most influence through her training, teaching and clinical work."
Amongst her achievements in addition to the many patients she has treated in Suva, is the formation of a competency assessment form for endoscopy trainees that we also use in other pacific programs, and over-seeing the ongoing gastroenterology curriculum and program in Suva. According to Chris Hair, who leads all our activities in the Pacific, "Mai Ling has probably done more for pacific endoscopy than anyone, and arguably had the most influence through her training, teaching and clinical work."
Previous Programs
There were two short reports by doctors on their involvement in the 2015 program that provide an interesting insight. The newsletter of the New Zealand Society of Gastroenterology (NZSG) has a note (page 3) by Martin Schlup on his two week involvement in the program. The RACP News has a note (article extracted) by Greg Lockrey. (Thanks to RACP and NZSG for permission to republish.)
