ISPO Australia member Andrew Jolly (AJ) is currently on assignment as an Australian Volunteer for International Development (AVID) in Kiribati. AJ is supporting the prosthetics & orthotics (P&O) team at the Tungaru Rehabilitation Service (TRS), and commenced his 6-month assignment in September 2016. The following report provides an update from AJ of progress so far.

Background

Kiribati (pronounced Kiribass) is a nation of 33 low lying coral atolls, spread out over 3.5 million square km’s of ocean, straddling the equator in the central Pacific. The people of Kiribati face significant challenges to health, including overpopulation and resultant limited access to clean water and sanitation. As a result, Kiribati has significantly poor health outcomes when compared to other small island nations, and faces the double burden of high communicable and non-communicable diseases.

ISPO Australia is a long-term supporter of the TRS in Kiribati, which is a one-of-a-kind service for the Pacific region. Based in the nation’s capital, Tarawa, TRS is the national provider of rehabilitation and P&O services, and delivers services across the acute, outpatient and community streams. Rehabilitation services ceased temporarily following a fire that destroyed the original facility in late 2012. In August of 2015, a new centre had been completed, fitted out, and TRS services resumed.

Progress summary

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Prosthetic technician Tebakaro, with thermoforming equipment in new facility

I am pleased to report that after 12 months of service provision, the P&O department set up 12 months earlier remains very well resourced, and is sufficiently equipped to house a growing P&O team well into the future. The new facility has the capacity to fabricate high-quality prosthetic and orthotic devices using low-cost, thermoplastic techniques. Approximately 50 prosthetic limbs had been delivered to clients since September 2015. Prosthetic technician Tebakaro, working largely independently for that period, faced an enormous backlog of clients whom had previously not received prosthetic limbs due to the interruption of services throughout 2013 and 2014. In the remaining months of this year, the P&O department has grown, both in it’s team and it’s scope of service delivery.

 

Major achievements

Akoaki Eritane

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Akoaki (center) welcomed by fellow TRS team members Taukoriri, Mwakei and Atateka

In October 2017, TRS warmly welcomed Akoaki Eritane to the team following her graduation from the Cambodian School of Prosthetics & Orthotics (CSPO). Akoaki is the first fully-qualified, ISPO Category II prosthetist/orthotist in Kiribati (and in the central Pacific region!) Akoaki graduated alongside fellow Pacific Islander Posenai Patu, who joins a fantastic team at the Mobility Device Service in Samoa.

Akoaki has a briliant start to her work with TRS, working across a broad scope of P&O service provision. Since Akoaki’s arrival, the P&O department has begun providing custom orthoses, which were not previously available through the service. Akoaki has a fantastic nature with clients, and has exceptional competency in both clinical and technical aspects of her P&O work. We have worked together to contextualise her training to the Pacific environment, focussing on management of clients with disabilities as a result of NCDs and chronic health problems.

 

ICRC training course, Samoa

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Tebakaro and Akoaki joined the MDS team in Samoa for training in use of ICRC technology

 

ISPO Australia has recently supported Akoaki to join Tebakaro to attend an ICRC training course in Samoa, delivered by Motivation Australia. The course has helped to consolidate Akoaki and Tebakaro’s existing capacity to produce limbs using ICRC technology, which will allow the service to operate at lowest cost possible forthcoming.

 

 

Outreach clinics

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TRS outreach team arriving at Marakei airport

In November 2016, I was fortunate to join a small team from TRS to deliver a weeklong outer island outreach clinic to the island of Marakei. A total of 30 assessments were conducted, and 19 wheelchairs delivered to clients facing significant barriers to accessing TRS services in Tarawa. TRS management has recently secured funding from the Australian government to deliver 8 outer island visits per year, which has reduced the gap between each island visit from 8 years to 4. This means a significant improvement for Kiribati’s most vulnerable clients requiring rehabilitation services. Looking to the future, TRS has a great opportunity to grow the knowledge and understanding of outer island health workers in community-based rehabilitation techniques as they continue outer island engagement.

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TRS outreach team working with community based health workers to assess a client for a wheelchair

 

Resource management

The P&O team has worked hard to establish pathways for procurement of materials required for ongoing operation. We have recently begun development of a standard operating procedure manual (SOP) to consolidate work processes and service system, as a strategy to minimise the amount of external support required for ongoing operation of the service.

Looking forward

I look forward to providing members with further updates as ISPO Australia continues it’s support to TRS into 2017. Major activities for next year will include improving amputee pathways, and building skills for amputation prevention activities. ISPO Outreach will deliver an instructional course for the management of high-risk foot.

The TRS has a fantastic opportunity to be leader for rehabilitation and P&O services in the Pacific, and may provide a template for future service development elsewhere in the region.

On behalf of the TRS and the ISPO Australia team, thank you for your interest in the TRS project. If you would like to know more about ISPO Australia’s work in the Pacific, please contact ISPO Outreach Co-chairs Louise Puli and Phoebe Thomson via outreach@ispo.org.au

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