A young patient has their cleft lip and palate examined by Dr Marucci while mum holds them in her arms.

What does it really take to provide plastic and reconstructive surgery in places without the resources to meet demand?

Building on the momentum of Interplast’s previous visit to Samoa in March 2023, the team returned to Tupa Tamasese Meaole (TTM) Hospital in October to continue to deliver life-changing care and training to local personnel. Providing quality care is by no means a one-person job. Specialist plastic surgeons, Dr Benjamin Norris and Dr Damian Marucci, were joined by anaesthetists, Dr Alan Goodey and Dr Indu Kapoor, nurses, Mary-Jane Laing and Norma Schwalger, and physiotherapist, Katherine Anjou.

After arriving in Samoa, the Interplast team was met by Ministry of Health and Samoan surgeon, Dr Mayday Fanueli. Immediately, the work began. Mary-Jane and Norma took the lead in unpacking equipment, and worked alongside the TTM Hospital’s Central Sterile Supply Department team to sterilize everything ready for the next day.

Interplast team worked with local personnel to meet with patients, provide consultations and examine patients together. The clinic was full of patients both new and those retuning for follow up from the previous trip in March. It was a very busy day!

A child opens their mouth so Dr Marucci can examine their cleft palate. Their mother gently holds their head still, while Dr Fanueli smiles gives encouragement.

Dr Marucci and Dr Fanueli consult with a young paitent with a cleft lip and palate.

Working side by side gives staff an opportunity to share skills and knowledge, and bounce ideas off of each other. Patients also receive information on their condition and care in their first language, so they can best understand and feel empowered in their own treatment.

Once patients have been assessed, it is necessary to prioritise those who stand to gain the most through immediate surgical intervention. Unfortunately, not all patients seen at the clinic that day will be operated on during this trip. Some may need longer, more complex procedures or the facilities may not be appropriate for their postoperative care. All of these barriers are noted by Interplast, so we can address them in future programs, and the patients’ details are taken by the hospital, so they can receive treatment in the future.

The team then prepare for surgery and huddle for proper introductions. Breaking down power imbalances helps create an environment where people can have equitable input, feel comfortable raising concerns, and work with mutual respect. Then, for each patient, The World Health Organisation’s Surgical Safety Checklist is completed before any procedure begins.

A team of four people in surgical scrubs stand around an anesthetised patient. One person reads from a multi-page document.

The surgical team review the WHO Surgical Safety Checklist before starting the patient’s procedure.

Over the next three days, everybody worked together to ensure patients received the excellent care they needed. At the same time, Interplast staff were able to provide additional training and mentoring to local counterparts. Dr Marucci supported Dr Fanueli to refine her suturing skills, which are essential in the successful repair of cleft lip and palates. Metres away, in the second theatre, Dr Norris guided Dr Faasao Junior Posini to complete a range of skin grafts and flaps to cover damage left by tumours and amputations.

Natasha Mamea, Senior Nurse Specialist at TTM Hospital knows the significance of training in this area. “We have allocated our team to learn from Interplast because these types of surgeries, including cleft palates, [cleft] lips and contractures are only done when Interplast teams come once a year. So, it’s a privilege for us…”

A team of people in personal protective equipment perform surgery on an unseen patient.

Dr Marucci and Dr Fanueli lead the team in a cleft lip and palate repair.

Meanwhile, Katherine worked closely with Samoan physiotherapist, Kerupi Ioane, fitting and fabricating splints to support the rehabilitation and healing of patients post-surgery. By moulding the splint during surgery, it can be fitted immediately and encourage the best possible healing outcomes.

Kathrine and Merupi fit a split to a patient’s forearm and hand.

Kathrine and Kerupi working together to mould a split for a paitent.

Dr Goodey was also able to give a lecture on safe fasting before anaesthesia to 50 Samoan clinicians. Patients that have not fasted appropriately may not be safely operated on, which can impact their wait time, staff workload and facility availability.

Dr Goodey stand in from of a presentation while people sitting in chairs listen.

Dr Goodey presenting to the staff of TTM Hospital.

By the end of the week, the team had achieved a fantastic result. In just five days, they completed:

  • 46 consultations
  • 29 surgeries
  • 11 allied health treatments.

Procedures included repairing cleft lips and palates, burns reconstruction, and surgery for congenital and acquired anomalies. Over half of all surgical patients, including the energetic Siniva, were between 0-5 years old.

After signing out and packing up, volunteers were invited by the Australian High Commission’s Health Programs Team to celebrate 40 years of partnerships between the people of Samoa and Interplast. They were joined by members of the Samoan Ministry of Health, the World Health Organisation and the clinicians from the TTM Hospital to reflect on the partnership.

Some members of this team have been visiting Samoa since 2008, helping to forge the longstanding commitment of Interplast to strengthen the capacity of their Samoan counterparts and provide greater access to safe surgery. The evening was a very meaningful opportunity to connect with those long-term friends and colleagues.

A group of people pose and smile for a photo.

Attendees of the event celebrating the 40 year partnership of Samoa and Interplast.

Interplast is delighted to have been invited back to Samoa year after year, since 1983. We are grateful to our past and present surgical, allied health, clinical leadership and civil society partners in Samoa who share our vision for equitable health services. We cherish the trust the Samoan community bestows upon us and will continue to uphold our connections to peers, families and communities in Samoa for the next 40 years to come.

The TTM Surgical Department and the Interplast volunteers hosted Claire McGeechan, the Australian Deputy High Commissioner, at the TTM Hospital for a morning visit.

“It’s great to see the Samoa-Australia partnership in action in the health space. Continuing relationships such as these strengthen health outcomes for Samoans and help to build the capability of both Samoan and Australian medical professionals.”

After farewells, our volunteer team returned to Australia and helped staff in the office properly record, debrief and evaluate the successes and barriers of the trip.