On the basis of the initially disappointing news that we were unfunded, we went about trying to raise money for the project, and the main funding came from the Humanitarian Services Committee of the Australian Orthopaedic Association who donated $10,000 with any extra funding coming through Orthopaedic Outreach. In addition I contributed personal funds to the project to cover various costs such as the Registrar accommodation / food etc.

We found ourselves in familiar territory this time with only a few variations on the theme. This previous experience served us well and we found that many issues and concepts were easier to negotiate, given our previous trips.

This team was much smaller than the previous trip with only an Orthopaedic team on the ground, the General Surgical team having lost funding as well. In addition a Physiotherapist did not accompany us although this would have been a great advantage on this particular trip, as there was a very impressive young physiotherapist, Peter, in Atambua, who was extremely keen to learn.

On the basis of all of this and also due to the fact that the Medical Director, Dr John, was new, we did not get the opportunity to run the PTC [Primary Trauma Care] lectures this time. We would definitely like to take that opportunity up, on one of the next trips, but with all the change and slight uncertainty, we could not set that up.

All the teaching was based on “Teaching on the Run”, in that staff came to the clinic, ward rounds and theatre, and during that time we tried to impart packages of information to them that could be useful. We tried to keep it as simple as possible.

We noted that there had been some incremental improvements in RSUD Atambua since our last visit particularly in the anaesthetic team who were impressive, and the nursing staff who are unending in their goodwill and desire to learn.

The major issue in Atambua in respect to Orthopaedic surgery, is, that there is no one readily identifiable on the ground, who has a real interest in learning Orthopaedics. There are rotating doctors through the area, but the real change will come with some permanency and some interest. It is hard to quite understand this when one is working there, but the future of the project lies in the handover of skills, not on a service position by us. I have discussed this with various parties, and insight was provided by Mr Peter Riddell, Plastic Surgeon, in Adelaide who has been visiting the region for years and who currently has a very impressive setup in Kefa. He did go to Atambua, but had the same experience as myself and has ultimately found a few people on the ground on Kefa who are keen to learn and who are performing various surgeries now from his tuition. He has invited me to join this team there while providing ongoing care in Atambua, and I am keen to do that.

Clearly the viability of these trips relies on two parties working together. Atambua suffers from its remoteness and lack of continuity. We need to assess in the next 2-3 years whether it will be a viable option. It is definitely preferable to Soe we feel, but we should involve ourselves in Kefa and see what they have done there, and see if there are concepts that we can transfer to Atambua.

My feeling is, that over time we can make change there, but it is a major undertaking and will need a lot more input than one surgeon and one team can either afford or give their time to. On the basis of that, I plan to try and enlist some help up there to work this out.

Our next visit may be September 2008 if we have funding, or next May 2009.

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