The 34th Pacific Society of Anaesthetists Annual Refresher Course

Dr Chris King, NZSA GHC Trainee Representative & Trainee Grant Recipient.

Nadi, Fiji. 18-22 August 2025

‘Care for your staff and they will care for your patients.’

This was one of the key messages permeating the presentations at the Pacific Society of Anaesthetists (PSA) Refresher Course, which I had the pleasure of attending as the trainee representative on the NZSA Global Health Committee (GHC).

The history of this conference spans 36 years, with the first conference being held in 1989, missing only two years – for COVID-19, and the 2006 Fijian coup d’état. The NZSA GHC has been involved in supplementing workforce relief to enable anaesthetists from various countries to attend the conference, and has provided an advocacy role for health system improvement, hosting and education roles through the Pacific trainee exchange to Hawke’s Bay, Christchurch and Waikato hospitals.

Sustainability & Anaesthesia in the Pacific was the theme of this year’s conference. Keynote speaker, Professor Eugenie Kayak, made it clear that the sustainability of anaesthesia services need not come at the expense of quality patient care. It was inspiring to be reminded that small but consistent changes are all that’s needed to step towards sustainable practice and to hear of the large strides that have been taken within Australasia towards improving sustainability. She spoke about her role on the Chief Medical Officer Advisory Group for Australia’s National Health and Climate Strategy and their goal to reach net-zero carbon emissions in healthcare by 2040.

Look no further than the Pacific Islands for examples of the imminent threats to the environment. Tuvalu’s country update illustrated the existential crisis climate change and rising sea levels pose to the Pacific islands. As a low-lying atoll island nation with a population of 10,500, an airport runway which spans the length of the country, and a highest peak of 4.6m above sea level.

The Island updates from the various represented countries have been a highlight of conferences gone by. This year, Dr Mario Soares, an anaesthetist from Timor-Leste, was presented with the NZSA award for the best island update by NZSA Global Health Committee Chair, Dr Caroline Zhou. It was humbling to learn about Dr Soares’ proficiency in six languages in his job, and hearing about the spinal he performed on his wife as the only available anaesthetist during the birth of their second child. To paint a picture of the staffing shortages in Timor-Leste, Baucau Hospital in the county’s east serves a population of over 283,000 people, with one operating theatre and one anaesthetist. The latest target by the World Federation of Societies of Anesthesiologists (WFSA) is five anaesthetists per 100,000 population. In Timor-Leste, its one anaesthetist covering the expected workload of almost fifteen.

In the island update from Vanuatu, Dr Robinson Toukone demonstrated how connected the islands were in their response to the 7.4 magnitude earthquake centred just off the coast of the island Efate in Vanuatu, two weeks before Christmas in 2024. Dr Robinson was grateful for the coordination and support provided by Dr Lamour Hansell and his team with The Pacific Community (formerly South Pacific Commission), and identified the need for a crisis response guideline for Vanuatu.

During the ICU day, we were joined by the Suva ICU nurses who were present for Dr Elizabeth Bennett’s reflections on her 22 year career in intensive care in the Pacific Islands. Dr Bennett discussed her recent success in receiving the Australian and New Zealand College of Intensive Care (CICM) Medal for 2024, recognising her establishment of a training programme for intensive care medicine in the Pacific. Dr Bennett shared some of the improvements to intensive care services in her time. Including how intensive care for leptospirosis had a mortality of 100% at the start of her career, and today has an ICU survival reaching 90% in her unit.

A multiple island research project by final year trainees audited the WHO Bellwether procedures to identify delays in the chain of survival for emergency laparotomy, caesarian section and open fractures. Interestingly, the Kingdom of Tonga was an outlier in the time delay to definitive surgery for emergency laparotomy, with a delay to surgery of 14 hours, compared to six in Fiji and Samoa. The reason for the delay was unclear and not investigated, although there are a few factors of note. Of 63 patients audited, only three were taken to Viola Hospital via ambulance alone from the main island. Others from the other two main island groups were taken via a combination of boat, fixed-wing flight and ambulance. There are no street numbers, so the ambulance is directed via references to landmarks on the street and local knowledge. 50% of patients audited reached the hospital within two hours of the call to emergency services.

I was fortunate to meet such a connected group of anaesthetists, intensivists and trainees among those attending the conference, and reflect on the NZSA’s involvement in playing a critical role towards training and facilitating the annual forum.

Photos

Top: Dr Chris King and Keynote speaker Professor Eugenie Kayak after her inspiring presentation on Sustainability in Anaesthesia from the Australian Context.

Second: NZSA Global Health Committee Chair, Dr Caroline Zhou presents the NZSA award for Best Island Update to Dr Mario Soares gtom Timor-Leste. As a gesture of support for training from the NZSA, the latest edition of the Oxford Handbook of Anaesthesia is also gifted to the Fijian National University trainees.