2025 so far: Vinaka and tangkyu tumas for all your work
We live in unprecedented times. Paediatric healthcare
providers face daunting challenges in our warming,
artificially intelligent world. TPA aims to play our steady
part in a community of people intent on doing the best job
possible of looking after the kids who will grow up on this
rapidly changing planet.
Each week our many meetings generate whole newsletters
worth of rich content and there is not room to do justice to
all of the pearls and achievements, or to thank everybody
we would like to by name! Some highlights are included
below. Meanwhile, our project to commence newborn
screening for congenital hypothyroidism in Honiara has
almost finalised its Australia-based ethics approval and an
enthusiastic group of doctors and nurses have met for the
first time as a Medical Education discussion group which
promises to be another great way for our community to
upskill and connect.
Vinaka and tankgyu tumas to our colleagues in Lautoka,
Suva and Port Vila who met with us during our recent trip to
Fiji and Vanuatu in March. Our group of volunteers thank
you for the time spent providing invaluable feedback to TPA
to help us drive our agenda and best meet needs.
Above: Dr Kathryn Currow with Dr Thyna Orelly, Head of Paediatrics and Dr Jimmie Obed, Medical Superintendent of `Vila Central Hospital, Vanuatu.
So many overseas colleagues prioritise TPA meetings in
jam-packed days and we are committed to ensuring that
the sessions are as high yield and accessible as they
possibly can be. To this end, thank you to everybody who
has so far spent some time with Dr Lauren Chong and Dr
Claire Ferguson answering our focus group questions. Our
favourite question that we asked was: if you were in charge
of on-boarding a potential TPA sub-specialist volunteer,
what would you want them to know about your culture or
workplace? Many answers focussed on how it is so
important to understand that many hospitals are managing
patients from very large catchment areas across
challenging geographies and that the supply of diagnostic
tests and equipment can be so very fluid and
unpredictable.
We also came away with a big list of topics and areas we
hope to cover (or expand on) this year:
▪ Medical and nursing sessions on aspects of
intensive care, including both neonatal and
paediatric.
▪ Infection prevention and control
▪ ENT
▪ Radiology
▪ Updates on core, common, critical topics such as
neonatal sepsis, paediatric septic shock and
asthma
We are on the way to addressing these topics already.
Requests for topics are always welcome and greatly
appreciated at any time and once suggested, are often
echoed by other colleagues
Above: Thank you to the Colonial War Memorial
Hospital Paediatric team in Suva for insightful
meetings.
With a changing climate, the traditional ‘dengue season’ is
increasingly being replaced by multiple spikes at
unpredictable times of the year. At Lautoka Hospital (as
simultaneous thunder and lightening sounded above us)
we heard how cases of severe dengue at this unusual time
of year have exacerbated bed pressures, with paediatric
patients spilling over into the adult wards. At Colonel War
Memorial Hospital in Suva, we discussed how shortages of
essential supplies (such as normal saline) make individual
case management that much more challenging.
Every year, the Lancet releases a countdown tracking
global progress in key indicators around climate change in
health. One of these indicators is the proportion of national
leaders who explicitly discuss the intersection of climate
change and health – of the 68 leaders who did this in 2023,
39 (57%) of them were from Small Island Developing
States. Fiji’s own Prime Minister his Excellency Sitiveni
Ligamamada Rabuka said, “for small island developing
states, the triple burden of non-communicable diseases,
mental health and the climate emergency are straining the
health infrastructure and resources”.(1)
Of course, many aspects of dengue management are
beyond TPA’s mandate – things like vector control and
population awareness campaigns. But one important thing
our Australian community can consider is our own political
engagement around climate change as advocates for the
health of children.
Below: Dr Claire Ferguson, Dr Lauren Chong, Lautoka
Hospital PICU NUM Mr Seruvatu Kacanivesikula, Dr
Kathryn Currow
Below: Lautoka Hospital Children’s Ward Nursing Unit Manager Ms Laniana Sorovakatini who was kind enough to indulge us when we insisted she pose with this trophy for most outstanding ward 2024
Below: the hard-working paediatric nursing staff of Central Vila Hospital, Vanuatu (first photo) and Colonial War Memorial Hospital, Suva Fiji (second photo). We look forward to seeing you on Zoom again soon
Every year, 1.2 million children contract tuberculosis
globally. Estimating the global burden of TB in children is
challenging due to the lack of a standard case definition,
the fact that it is often paucibacillary (less bacteria causing
disease), extra-pulmonary (affecting organ systems other
than the lungs), young children cannot produce sputum on
demand, and the “available” diagnostics are not highly
sensitive, or always available.
We have had some very interesting discussions about
different presentations of tuberculosis and diagnostic
challenges in children in the Pacific where both the
Tuberculin Skin Test and Quantiferon or IGRA testing may
not be consistently available. Of particular note, we
discussed a child in Fiji who had several recurrent
presentations with a pleural effusion evading diagnosis –
testing negative for TB on pleural fluid culture, negative
Gene XPERTs, a negative AFB on gastric lavage and nothing
on lymph node biopsy before the astute pathologist took
the latest pleural fluid sample and spin it down for
cytology, managing to find the acid-fast bacilli (TB) at last!
Just the latest inspiring episode of creative problem-
solving TPA has the privilege to witness. Thank you to
respiratory physician Dr Dustin Mills for his guidance as we
discussed the above and some of the principles of
managing post-infectious (including post TB)
bronchiectasis. Given the enduring burden of TB and its
challenges, a huge thank you too to infectious diseases
physician Prof Clare Nourse for a comprehensive update
on tuberculosis which was clearly very valued.
Cảm ơn, សូមអរគុណ, thank you to all Australian colleagues
who share their time and expertise. Bula and welcome
again to any new presenters who are joining us in 2025.
Your contributions are deeply appreciated as with every
Zoom hour we spend together, we expand and solidify all of
our knowledge.
Below: Our final photo is of TPA volunteers with the allied
health professionals of the Frank Hilton Organisation
providing a unique and vital service to children in Suva with
developmental disability. Our allied health volunteers look
forward to meeting with you again soon.
Australian volunteers continue to benefit from exposure to pathology rarely seen in Australia and to the challenges of problem-solving and adapting their clinical reasoning to resource-limited settings. Do you know a subspecialist, senior nurse or allied health professional who would like to join our community?
The new TPA Medical Education group had its inaugural meeting this March led by Dr Tom Volkman from Perth, an experienced medical educator and paediatrician. This introductory session was attended by enthusiastic
paediatric doctors and nurses from 7 different countries keen to learn and share together.
References Van Daalen, Kim R., et al. “The 2024 Europe report of the Lancet Countdown on health and climate
change: unprecedented warming demands unprecedented action.”
The Lancet Public Health 9.7 (2024): e495-e522
