ISSUE NO: 12. Sr Margaret Maloney

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1 ISSUE NO: 12 Seven visits have been undertaken so far this year, three to Cancar, three to Timor (Nusa Tenggara Timur) and one to Timor Leste (East Timor), involving 28 personnel. A further three visits are anticipated to be undertaken before the end of the year. A total of 1011 patients were clinically assessed and 486 surgical procedures performed, 88 of which were for cleft lip and palate deformities. A technique of anaesthesia for clefts, modified by Dr Tony Pearce and now used by all anaesthetists on recent visits, speeds up the turnover of patients between cases, is safe, and allows more procedures to be performed. There were no patients from Timor sent to Cancar for treatment, the patients from Timor were delighted that the teams are now expanding to Timor so that they would not have to endure travelling by boat then a 12 hour long bus ride to Cancar. Sr Margaret Maloney OAM, was also awarded an Order of the Australia Medal at the Queen s Birthday this year, For services to the international humanitarian aid through the provision of volunteer nursing services in developing countries. Sr. Margaret has been involved with OSSAAA since 2001 and also travels with other surgical teams to Fiji, Sri Lanka, Pakistan and was a team member of the South Australian Medical Relief team to Banda Aceh following the tsunami in CANCAR, FLORES, NTT Congratulations to the following team members. Outpatients clinic Dr Robert Sillar Sr. Margaret Maloney Dr Robert Sillar OAM, one of our general surgeons who was awarded an Order of the Australian Medal at the Australia Day honours 2008 For services to medicine particularly as a practitioner and educator in the field of surgical oncology and melanoma, as a general surgeon and through the provision of humanitarian aid overseas. 3 surgical visits have been undertaken to Cancar so far this year. The Orthopaedic surgical team consisting of 8 personnel visited in April. The Plastic surgical team (4 personnel) visited from late May to early June and the ENT (Ear Nose & Throat) surgical team visited following the Plastics team s departure. Counterpart, Dr. Harianto joined both orthopaedic and plastics teams. No Indonesian surgeons joined the teams at Cancar so far. Dr Michael (RMO St Rafael) and GP Dr Erwin (Cancar resident, possible long term counterpart) appreciated the team visits as they learned new skills and gained additional knowledge and experience from the teams.

2 Dr Spain examines patients before surgery - Cancar Orthopaedic surgical team Cancar May 2008 A young patient with Anthrogyphosis syndrome. Many more patients turned up at the Plastics team visit. As in previous visits, most of the patients were for cleft lip and palate repairs and burn contractures. A number of the post operative cleft lip patients who have had cleft lip repairs by Australian and Indonesian surgeons with inferior results, came from Sumba and Maumere to have their cleft lips surgery revised by our plastic surgeon, some arrived to have their palates repaired. Before surgery, X-Ray showing bone deformity A further visit from the Plastic team is expected before the end of the year. The ENT team undertook their second visit since requested by the community in the region. Unlike the orthopaedic and plastic teams who were looked after at St Damian, the ENT team was cared for at St Rafael in the VIP wards of the hospital. Most of the patients who arrived for assessment had thyroids, head and neck cancers and tonsillitis. Drs Michael and Irwin assisted Dr Krishnan throughout the week. The general surgeon at Ruteng and his anaesthetic technician, Pak Mus also went to Cancar for a couple of days to observe and learn about tonsillectomy procedures. Dr Michael performed a few tonsillectomies with Pak Mus, under the supervision of Dr Krishnan. Post bilateral medial hamstring release & extension supracondylar osteotomies Valgus ankle X-Ray of bone deformity Post-op bilateral club feet ENT patients - Cancar Patients from all over Flores and Sumba turned up for assessment when the teams arrived. The Orthopaedic team visit took place towards the end of the wet season so that many patients from the coast could not make it to Cancar due to bad roads.

3 the duration of the visit. Both general surgical teams had had the misfortune of medical supplies being off loaded or stolen from flights. Qantas staff at the check-in counter at the Sydney airport refused to check in medical supplies belonging to the earlier team although the team had agreed to pay excess baggage for the boxes. Instead the medical supplies sent to Darwin by Air Express and by the time the supplies arrived at Darwin, the team had left for Kupang. Then AirNorth would not send on the boxes unaccompanied, the team leader had to pay for someone from Darwin to Kupang (return) to accompany the supplies, one week after the team had arrived at Kupang. ENT Team members with Drs Michael and Irwin & OT nurses Summary of clinical activities Orthopaedic surgical team (May 10-21, 2008) Total patient consultation: 100 Total surgical procedures: 42 Plastic surgical team ( May 30- June 07, 2008) Total patient consultation: 154 Total surgical procedures: 96 Cleft lip and Palate: 31 Other: 65 Ear Nose & Throat (ENT) surgical team (June 07-14, 2008) Total patient consultation: 207 Total surgical procedures: 58 Head & neck cancer: 20 Tonsils: 17 Other: 21 TIMOR (WEST TIMOR), Nusa Tenggara Timur The latter general surgical team visiting Soe had setbacks with flights from Brisbane and were delayed for 24hrs thereby missing their connecting flight to Kupang therefore needed to travel via Surabya to arrive at Soe two days later than scheduled. In the process, they lost one box of anaesthetic supplies. Unfortunately, airline delays are beyond our control, although they disrupt pre organised schedules, which is a disadvantage to team members, patients and hospitals alike. Despite the late arrival medical of consumables, the first team still managed to perform some local anaesthetic procedures at Halilulik and Naob. There were very few disposables at the Soe hospital when the team arrived therefore limiting the teams capacity to perform surgery. Following the arrival of the consumables, the team was able to perform a variety of procedures e.g. thyroidectomise, head & neck tumours, bony tumours, bladder stones, trauma cases plus other urgent cases brought in by local interns or residents. Due to flight delay from Brisbane, and losing their anaesthetic consumables case, and arriving much later than anticipated, the latter team visiting Soe felt less enthusiastic when they finally arrived. Even so, they worked hard at the remainder of the week and performed really well. They also saw a large number patients and performed a variety of cases such as; thydoids, hernias, lipomas, burn contracture releases, chronic osteomyelitis, etc. Team members with local staff under a welcoming banner April 2008 Soe Two general surgical team visits have been undertaken to Soe. The team that visited earlier also briefly visited the Marianum Catholic Hospital in Halilulik and the Leprosy Rehabilitation Centre, Naob. The latter general surgical team remained at Soe for Summary of clinical activities General surgical teams: April 05-19, 2008 Total patient consultation: 222 Total surgical procedures: 109 June 08-22, 2008 Total patient consultation: 166 Total surgical procedures: 77 The third visit was by the plastic surgical team which travelled to Timor from Ruteng having completed a week at Cancar. The team was met by the SSpS

4 sisters at the airport and taken to Puskesmas Merdeka for patient consultation. Most of the patients that turned up were post operative patients who went to Cancar for cleft lip repair and required their cleft palates repaired. These patients weree sent to Halilulik for surgery. area. During the 3 ½ days there, the team operated on 35 cleft patients. A child with bilateral cleft lip and palate Children from Kupang who went to Cancar for bilateral cleft lip repair and had cleft palate repair at Halilulik, June Before and immediately after surgery One of the nuns outside Atambua had a list of 67 cleft patients for our team. Unfortunately there was no time to operate on all patients. The nuns are praying for another visit later this year. Halilulik & Naob Summary of clinical activities Plastic surgical team Halilulik & Naob (June 07 14, 2008) Total patient consultation: 96 Total surgical procedures: 75 Cleft lip and palate repair: 40 Other (including burns): 32 New operating theatre complex Halilulik (Naob s new OT is exactly the same model). The 5 hour long drive to Halilulik was very uncomfortable, the team arrived later in the evening, consulted with patients who had been anxiously waiting all day. The team operated at Halilulik for three and half days then travelled to Naob for one day s operations. The nurses (Nuns) at Halilulik do not have a lof of experience in the operating theatre, except for one who had OT nurse training in Europe. She scrubbed for every surgical procedure, alternating with our own theatre nurse. There is a substantial number of clefts in the area, it has been 10years since any regular cleft service from Japan and Singapore had been to the Team with hospital staff RS Katolik, Halilulik

5 The Plastic surgical team visit to Halilulik and Naob signifies the expansion of the cleft service to Timor. Many of the patients have been to Cancar for cleft lip repair and required palate repairs. Some just arrived for post operative review. The hospital ital at Halilulik (& Naob) is building a new operating theatre complex, it is hoped that this will be ready for use at the next visit. The operating theatre complex in Naob is expected to be mainly utilised by orthopaedic and plastic teams. TIMOR LESTE Team members with OT staff Baucau Leprosy Rehabilitation Centre Naob The most ost recent visit to Timor Leste exceeded 400 cleft lip and palate repairs since June Several long longterm follow-up up patients were reviewed with excellent outcomes. The team assessed patients at Baucau and Lospalos and performed surgical procedures at a Baucau hospital with a small but very supportive staff. It was apparent that the high cost of fuel prevented patients from areas outside Baucau to turn up. The patients who were scheduled from Lospalos were transported to Baucau and returned, by the hospital ho vehicle. Team members with PRR Nuns, Naob 4 yr burn patient Naob Cleft ft patient, previous surgery by Indonesian doctors,complete doctors, re- do Halilulik, June 2008 At this visit, long term contacts were also rere established e.g Sr. Ercia (now Mother Superior), Mr Bernardo of the Lospalos clinic, Sra Robela at Com). These contacts have requested that messages be sent to them one month prior to the team visits so that they can inform villagers who have no means of knowing about the team visits. Mr Bernardo stressed that he was only aware of the team visit the week before the team arrived. Whilst in Timor Leste an American Mercy ship arrived in the country with Australian surgeons from Operation Smile, who were on their first surgical mission to perform cleft patients in the country. It is discouraging that the people involved in this mission did not make any effort to share information on their int intended visit to Timor Leste, our surgical teams have undertaken 23 clinical visits since the country s independence and have performed more than 400 cleft procedures, procedures It was also sad to note that a number of cleft patients who have had cleft lip repairs by other surgical teams with very unsatisfactory outcomes continue to turn up for complete re do. Feedback on unqualified cleft surgeons practising on patients in Timor Leste has been relayed to try and prevent this process.

6 The last 3 plastic team visits ts saw 5 adult cleft patients who were not or minimally repaired. These patients have had no schooling as a result of the deformity and often remain unemployed and bullied bullied. Cleft patients: Twins brothers Halilulik young woman. She had further release to her neck contracture and is waiting for her palate repair at the next visit. An article on Yanti has been published in the RACS Surgical News magazine, May Oxfam representative met the team at Kupang airport for a briefing on Yanti s current condition. condition The patients brought to Adelaide by the Lions Clubs of Brighton and Edwardstown for surgery in 2006, Dorfianus and Delviana (Maria) are getting on with their lives. Dorfi is now married and lives in Ruteng. Delvi still lives with the ALMA sisters at Bajawa and goes to school. Before surgery After surgery Patrisiana, a long term burn patient from Atambua also had further contracture release to her face. The other patient, Cundawan, brought to Adelaide for surgery by ROMAC has had a recurrence of mengocele, she requires further correction surgery. Cleft patients, (brothers) Baucau post- operative patient by Indonesian doctors who arrived for complete re-do re Summary of Clinical activities: July 05-10, 10, 2008 Total patient consultation: 66 Total surgical procedures 29 Cleft lip and palate: 17 Others (incl burns): 12 Travel difficulties The inconvenience experienced by the general surgical teams travelling to Timor regarding excess baggage need to be reassessed. Accompanying consumables and equipment need to be kept to a minimum, airline staff are not always helpful. AirNorth has been supportive, other airlines do not always recognise humanitarian services provided to the disadvantaged. Yanti Patrisiana Delviana Other News Dr John Hargrave MBE, AO went to Darwin in May this year for the unveiling of the Memorial of the Leprosarium at East Arm. He also went out to re re-visit remote Aboriginal communities where he was involved in the treatment of leprosy. His visit to Darwin gave the first opportunity to meet with Dr Mark Moore AM, since handing over leadership of the organisation orga in The plastic surgical team also had their consumables case loaded onto a separate flight from Melbourne and arrived at Denpasar 24 hours after the team. team The travel agent at Bali was notified and after presenting the documentation from the Indonesian Consulate in Darwin, the case was released and sent on to Cancar at no cost. The travel agency at Bali is familiar with the humanitarian service we provide to the disadvantaged communities so that we are no longer charged with excess baggage costs.. Patient Follow up Yanti, a bilateral cleft lip and palate patient who also suffered from burn contracture and was sent from Atambua to Cancar though Oxfam, has turned out to be a confident and sensitive Darwin May 2008 Dr Moore gave a presentation to an audience from Volunteering for international internati Development from

7 Australia (AVI) through Patrick Markwick-Smith who was involved with ASEA Rehab in Darwin and has expressed continued support for OSSAA. Fundraising & Donations. On June 8th Connie Granozio commitee member held the premiere of the hit movie Sex and the City. 400 mostly ladies (except for 3 nervous men) attended. It was a great day, Cup cakes and pink champagne were served up all in keeping with the movie theme. The movie was great fun and was highly publicised so selling of the tickets was really easy. $4500 was raised on the day 13th A Film Evening held at the Chelsea Theatre on July, was also an outstanding success. More than 570 members and guests attended to enjoy Mama Mia, recommended by Mr. Bob Parr, program manager for Wallis theatres. Everyone who went to see the film left in high spirits. A profit of $ , which included donations to the value of $ , was raised Sincere thanks to sponsors for the film evening go to; the Yalumba Wine Company, The Romeo Family, (North Adelaide Foodland) and Bakery on O Connell, we also thank the donors of the Raffle prizes, Mr & Mrs Ken Loveday, Dr Tony Pearce, Retravision, Wallis Theatres and Mr Trevor Terrell from the Federal Printing House. The Fundraising committee is organising a mid-year lunch on Sunday September 14, 2008 at the Glenelg Golf Club with Dr Craig Jurisevic as guest speaker. Dr Jurisevic is a member of the 10/27 Royal South Australian Regiment and has served in Israel, Northern Albania/Kosovo, Afghanistan and Timor Leste. He will give a talk on War Zone Surgery, Improvise and Survive. For tickets and bookings, please contact Doug Omond on tel / or dougaljd@optusnet.com.au. Amy Storen, mother of Angus with the bilateral cleft lip deformity arranged donations to OSSAA in lieu of gifts for Angus s christening. She also encouraged other parents with cleft children to support OSSAA. Dr Moore has repaired Angus s lip. The Rotary Club of Adelaide has donated $3, towards including a speech pathologist on a future team visit, to assist mothers and cleft children with feeding and speech training. Many patients who have had cleft palate repairs still struggle to correct their speech. It is anticipated that a speech pathologist will be included with the plastic team on a regular basis. Acknowledgements: Reports on team visits are available on our website: Special gratitude to the following for their support: Amanda & Laurie Kennedy (LSJS Jubilee Charity Foundarion) for their donation and commitment into 2008 Alison Kelty / Xanadu for her tireless support and promotion of OSSAA Calvary, Burnside, St Andrews and Royal Adelaide Hospitals for their assistance with consumables DSU staff at Royal Adelaide Hospital for sterilising instruments Tyco Healthcare - Emily Miller & Eleni Argyriou, for anaesthetic equipment, staplers, clip appliers, Laryngoscopes loan set Johnson&Johnson David Carney, for sutures, Megan Winter for marking pens Ansell Medical Mark Clear for sterile gloves Mark Ritchie and Deshan Solomon - Abbott for anaesthetic agents Mr AP Haddad for pharmaceuticals AIR NORTH & GARUDA for assistance with Excess baggage Adelaide Pathology Partners for ongoing pathology support RACS for International Projects team for their wide ranging assistance Consulate of Republic of Indonesia Darwin for their ongoing support to our teams Trevor White - suction drains Jim Kiley - Atlas Healthcare - Syringes and Needles. Membership Memberships remain at $25.00 a year for ordinary membership and $100 for corporate membership. Remember, the organisation depends on your support to improve the lives of those who are much more disadvantaged. The Committee of Management would like to thank all members and individuals for the help and support throughout this year and previous years. We trust that you will continue to help and support those who do not have the chance to helping themselves. Further information can be obtained by visiting our website: or write to us at: PO Box 138, UNLEY, SA 5061 or to: Ruth Boveington, PO Box 795, Darwin, NT ruthbov@oz .com.au