Orthopaedic Humanitarian Mission to Jayapura
Papua April 2015

Malaysia:

  • Prof Sharaf Ibrahim
  • Dr Ikraam Ibrahim
  • Nurse Masniza Mustaffa
  • Dr Shalimar Abdullah
  • Dr Suryasmi Duski

Indonesia:

  • Dr Karya Triko Biakto

Host Team:

  • Dr Johannes Daniel Asamsium
    (Head of Orthopaedics)
  • Dr Robert Tirtowijoyo
  • Dr Heriyanto Manihuruk
  • Dr Only One Taylor
  • Dr Berlianto Djahjadi

Advisors:

  • Dr Dohar AL Tobing
  • Dr Lutfi Gatam

9th April (Thursday)

1200 Arrival at Jayapura airport. We were picked up by Dr Heri and brought to lunch at Youngwe Restaurant on the banks of the Sentani Lake. Lunch was the delicious lake fish “mujair” (black tilapia) which we were to have many times throughout our stay. We proceeded immediately to the RSUD Dok II Jayapura as there were patients awaiting our arrival.

1500 Greeted by Dr Only One who gave a brief history of the hospital. It was built during the 1940s with long rows of blocks and an elevated ramp. A new block was being built. We went to the Discussion room where there were seats for about 50 people. We were joined by Dr Johannes as Head of Orthopaedics, Dr Robert, Dr Berlianto, Dr Triko (speaker from Makassar) together with many nurses, young doctors and medical students from Cenderawasih University.

Case 1 – A 6-year old child with right hip pain due to chronic septic arthritis of the hip.

Case 2 – A 9-year old native Papuan adopted girl with an unclear medical history and difficulty in communication. She had a fall at 6 years of age from her tree house and apparently had pain and deformity in the hips and knees. She had a severe limp bilaterally with obvious limb length discrepancy. Radiographs showed an absent left femoral head. This could be a complication of a previous fracture neck of femur resulting in avascular necrosis and resorption of the femoral head.

Case 3 – A 30 year old male with pain in the right hip for 2 years. Radiographs shows coxa magna of  the right hip.  Possibly untreated Perthes disease.

Case 4 – A 29 year old native policeman sustained a laceration wound at the anteromedial aspect of the right arm two years ago presented with complete claw hand. Previous surgery was done by a general surgeon. Planned for Zancolli’s lasso procedure.

Case 5 – A 35 year old native Papuan with an arrow wound at his right neck. He has a incomplete supraclavicular upper trunk right BPI. He was unable to abduct his right shoulder nor flex his elbow.

Case 6 – A 35 year-old Makassar male with a malunited distal end radius fracture.  Planned for open wedge osteotomy and plating .

After lively discussion including questioning the young doctors, the case discussions ended at 1800 hours. We checked-into the comfortable and lovely Swiss-bel hotel. The hotel is situated by the Pacific ocean with a clear view of Papua New Guinea. We were impressed with how crystal-clear the waters with coloured fishes and even blue starfishes just at the door step – it just shows how pristine Papua is.

Dinner was at Cirita Restaurant – just a 5 minute walk from the hotel. The restaurant  is a rustic wooden house on stilts facing the Pacific. We chose our 5 different types of fish from an icebox, grilled and ate in combination with delicious sauces whilst enjoying the Pacific breeze.

10th April (Friday)

After a restful night we were at RSUD by 8.00 am. We awaited our team of doctors from Malaysia (Dr Ikraam, Dr Suryasmi and Nurse Masniza) and immediately began operating.

Operative Case Procedure Surgeons
Chronic septic arthritis with adduction-flexion contracture of the right hip Adductor and iliopsoas releases followed by debridement and lavage Prof Sharaf, Dr Mervin, Dr Ikraam
Traumatic complete claw hand Zancollli’s FDS lasso procedure for index to small finger Dr Shalimar, Dr Only One, Dr Suryasmi
Spinal metastasis Decompression and stabilisation Dr Triko, Dr Mervin
Malunited left distal end radius Opening wedge osteotomy and buttress plating Dr Shalimar, Dr Only One, Dr Suryasmi

 

At 2pm – we were all in the Ballroom of Swiss-Belhotel Jayapura for the lecture sessions. Earlier there was the opening ceremony and lectures by Dr Robert (Musculoskeletal trauma) and Dr Herlambang (Osteoporosis). The hall was packed with both doctors and paramedics.  There were about 250 participants. There was a palpable positive vibe.

The afternoon session began with Dr Suryasmi’s talk (Fractures and Wounds) followed by Dr Shalimar (Upper Limb Injuries), Dr Ikraam (Lower Limb Injuries), Prof Sharaf (Clubfoot) and Nurse Masniza (Management of wound dressings). Although our presentations were in English we all spoke in Bahasa – aided by our audience for technical translations!

At 5pm, we started two simultaneous workshop. Prof Sharaf was on-stage with the Ponseti clubfoot casting workshop. There was only 1 model of clubfoot which he demonstrated on followed by medical officers trying out. Nurse Masniza took another corner and began demonstrating aseptic wound technique.  Everyone had so many questions and were very enthusiastic to practice that we ended at 6.30pm !!

Dinner was at a posh restaurant (B-one) with in-house singers and karaoke. The speciality was fried fermented chicken which although it had a somewhat weird taste was delicious. We also tried and loved the “terung belanda” juice.

11th April (Saturday)

The second day of the symposium began with Prof Sharaf’s talk on Neglected Paediatric Conditions and Dr Triko’s two talks (Spinal Injuries and Spine TB).  After coffee break, there was casting workshop by Dr Robert, Only One and Berlianto whilst Dr Suryasmi and Nurse Masniza continued with a short demonstration on vacuum dressing. Closing ceremony was by Dr Dohar Tobing who gave a short summary on how the whole idea began. We exchanged gifts with all the speakers. Once again, there was such a positive vibe and jovial mood.

We returned to RSUD for post-operative ward rounds and had a chance to see the clean and airy wards.

We all left for lunch at Sentani Lake – a one hour drive but thanks to Dr Heri, he had arranged for a police outrider to escort us and we arrived earlier. We ate at Youngwe Restaurant which had a scenic view of the lake with a cool breeze. Dr Johannes demonstrated to us how to eat “papeda” the Papuan staple dish of sago starch – a jelly-like material which the locals eat instead of rice. The black tilapia smothered in chilli paste was once again so tasty and delicious. Of course we also had other seafood dishes.

We had a further 1 hour bumpy drive to Harlen beach in a convoy of about 6 cars – the water was so blue, peaceful and inviting – and took a 15 minute boat ride to an island. There, we proceeded to snorkel and admire the beautiful underwater corals and fish. Our hosts were gracious enough to provide us with complete snorkels, fins and lifejackets. We lost track of time until it was sunset. A few of us went exploring to the nearby local village and hiked up a small hill.

It was nightfall as we travelled back to Sentani town. The stars were so bright and a light rain fell as we drove back in the lush Papuan jungle complete with insect sounds. We stopped by a restaurant for dinner – black tilapia were kept in an aquarium – these were freshly grilled outside. This was my 3rd time eating the fish but i still enjoyed it very much, leaving nothing but bones. We were all so tired as we arrived to the hotel.

12th April (Sunday)

Prof Sharaf and Triko left early at 5.30 am whilst the rest of us left at 8.30am. Dr Only One met us at the airport and had checked us in. We took more group photos for the last time and left with a heavy heart. The hosts had been attentive and wonderful. We had had an enjoyable time and would love to return.

Fig 1. Prof Sharaf assessing a patient during the pre-operative discussion
Fig 2. Radiograph of the child with right hip septic arthritis for adductor and iliopsoas releases
Fig 3. Dr Shalimar, Dr Only One and Dr Suryasmi performing an opening wedge osteotomy on a distal end radius
Fig 4. Programme schedule excerpt
Fig 5. Dr Ikraam giving a lecture whilst Dr Heri moderates the session
Fig 6. Participants trying their hands at clubfoot casting whilst Prof Sharaf watches and Dr Robert was the co-ordinator
Fig 7. Nurse Masniza demonstrating aseptic wound dressing
Fig 8. Group photo of speakers and committee (left to right: Dr Only One, Berlianto, Johannes, Masniza, Suryasmi, Sharaf, Dohar, Shalimar, Triko, Donald, Heriyanto, Ikraam, Robert)
Fig 9. Packed hall listening intently to the lectures
Fig 10. Post-operative ward round
Fig 11. Recreational moment as we leave for snorkelling