Christmas Island: Flies, Elvis, and the Culture of Massage Practitioners

My Week as an Orthopedics Consultant in the Central Pacific

Editor’s Note: Dr. Saltonstall is associate clinical professor of orthopedic surgery emeritus at the University of Washington School of Medicine in Seattle. He traveled to Christmas Island in May 2011 as an orthopedic surgery consultant at London Hospital, sponsored by Pacific Islands Medical Aid, a charitable organization. He submitted to the charity this report about his week on Christmas Island. Kent is not convinced the internet is here to stay, nonetheless classmates can reach him at kentsaltonstall@gmail.com.

By Kent Saltonstall’68
May 28, 2011

This report describes my medical service with Pacific Islands Medical Aid at London Hospital on Christmas Island, Line and Phoenix Group, Republic of Kiribati, central Pacific Ocean, May 17-24, 2011.
Kent Saltonstall
I was extremely well received the entire time by Drs. John Tekanene and Teraira Bangao, and the friendly hospital staff. Every effort was made to assist me in my work as consulting Orthopedic Surgeon.

My work began with an inventory of operating room equipment. I found a large quantity of donated Synthes high-technology instrumentation, consisting of three separate small fragment sets, the basic large fragment instruments, and tools for the Dynamic Hip Screw, including plenty of screws but no plates. This equipment is of little use in the present island environment. At the same time there is a severe inventory shortage of basic supplies such as Steinman pins (there is one bent one), Kirshner wires (none), traction bows, pulleys, rope and the like. Plaster of paris inventory is limited to a few rolls, and there is some older fiberglass cast material starting to harden in the packages. Webril and stockinet are needed, 4 and 6 inch. There are only a few well-used metal splints. I have suggested an equipment swap with Tarawa, Synthes stuff for plaster, splints of all sizes, etc.

I saw a dozen or more patients each day for Orthopedic consultation, some selected by MD referral, and many self-referred, especially after I was announced on the local radio. My time was best utilized by MD referrals and the injured from the international fishing fleet. I felt particularly useful to a 20-year-old Vietnamese fisherman with a forearm fracture (both bones displaced), and we were able to send him home nicely reduced and casted, together with his X-rays and a letter of instruction. I believe the hospital will bill the boat owner for my services. One nice feature of this practice was that our international patients were billeted with me at Captain Cook Hotel, so I lived among them: Ngoc in his new cast, Spaniards with supposed appendicitis eating with gusto in the old officers’ mess, and our psychiatric patient Elvis from the Philippines, already much improved. Elvis had been behaving strangely on the longline boat, sleepless, wandering about babbling in his language, fighting, but he straightened out nicely with medication from Dr. John and tourist accommodations on the beach. Also I was able to advise several patients about their arthritic joints and malunited fractures, and speak to parents about their crippled children, including cases of old polio and severe clubfoot. I saw spine deformities from old tuberculosis, and one active case. I made one recommendation for possible elective reconstructive hip surgery off-island, a 29-year-old tattoo artist with a 90 degree malrotation of his proximal femur and end-stage hip avascular necrosis following a childhood electrical injury.

On Sunday we went around the island by truck to the small clinic at Poland, where I saw 27 patients (about 10 percent of the village population), and tried to bring several to London the next day for X-rays, without success. Perhaps next time. The Poland clinic has some basic sanitation needs such as screens to keep out the flies and handwashing facilities.

I worked closely with Ordman the X-ray technician, and was able to share some tips about positioning of patients. The scope of her work has been limited by the lack of different X-ray film sizes and the size of her drying rack, so her day grinds to a halt when the rack is full.

I did no surgery on the island, and would not attempt clean orthopedic cases there. Emergency surgery such as drainage of infection and debridement of open fractures is feasible, they have the knives and the anesthesiologist. It would be good to get a donation of some bone plates for emergencies, new or used.

The biggest impact I foresee would be to somehow improve the almost non-existent fracture referral on the island. Island culture seems to be that extremity injuries are treated by the traditional massage practitioner; the doctors are not seeing many so they are not getting the experience. My first priority for the hospital is for basic sanitation such as hand washing, and elimination of flies indoors using fly traps and screens.

I had a very fine experience at London Hospital and I look forward to more.

More information about Pacific Islands Medical Aid is available at the organization's website, www.pacificislandsaid.org.