Inside the Operating Theatre

It’s the end of the fourth day of operating in Tonga and time to reflect on some of my experiences. This is my second trip with Open Heart International and my first to Tonga. I’ve volunteered for this trip as a surgical assistant working with Dr Ian Nicholson performing adult and paediatric cardiac surgery.

As with my first trip, it’s been an enjoyable, rewarding and fulfilling trip. In terms of the workload, we’ve been operating for three and a half days now and have completed 14 cases. The first few patients have been discharged, just 3 days after their operation! We’ve repaired holes in hearts, replaced and repaired heart valves, resected obstructions in the heart and tied off abnormal connections in the arteries coming from the heart.

For the technically minded, we’ve operated on conditions such as atrial and ventricular septal defects, rheumatic aortic and mitral heart valve disease, ventricular outflow tract obstructions and patent ductus arteriosus. Congenital and rheumatic heart disease remains a major public health problem in this country and I’m told that OHI is the only organisation that provides heart surgery for the community here.

As you can see, it’s been an impressive workload in just under four days in one operating room, something that would be rarely seen back at home in Australia. Equally impressive has been the logistics of setting up a temporary adult and paediatric cardiac surgical service that includes the pre-operative assessment and workup, a cardiac operating theatre, a heart-lung perfusion service, a cardiac intensive care unit and a post-operative ward. Three and a half tonnes of equipment has been freighted over for this trip and included consumables, ventilators, heart lung bypass machine, ECHO ultrasound machine, prosthetic heart valves, etc.

It’s been a rare experience to work with such a diverse group of people from all over Australia from a range of professions committed to help as many Tongans as possible in the short time we are here. Despite working in an unfamiliar environment and at times with unfamiliar equipment, and often with people they’ve just met, the team here have managed to pull it all together and get the job done with efficiency, hard work and good humour.

It’s been a pleasure to work with such a group of motivated, committed people. I’ve also had the opportunity to operate on some of the smallest patients in my career (under the watchful eyes of Dr Nicholson) and see pathology I’d rarely see at home in Australia, so it’s been a professionally satisfying trip also. It’s after midnight here, and time to try and get some sleep now. Another full day of operating later today and includes double valve surgery, a redo sternotomy and a >130 kg/>6ft patient. The Tongans are not exactly small!