A new general anaesthesia platform paves the way for the first Paediatric Eye Surgical Week in Fiji

Earlier this month, an Outreach Team from the Pacific Eye Institute (PEI) in Suva, Fiji ran the first outreach for children, known as Paediatric Eye Surgical Week. Between the 12th – 16th September, 16 children underwent sight restoring eye surgery, some on both eyes.

This outreach was able to go ahead thanks to the establishment of a new general anaesthesia platform at the Colonial War Memorial Hospital (CWMH) eye department, where PEI is based. The PEI team worked in close collaboration with CWMH’s Eye Clinic, Paediatric and Neonatal Intensive Care Units (PICU), Anaesthetic team, Post Anaesthetic Recovery Unit (PARU) and Emergency Unit to make this happen. The new general anaesthesia platform is a huge achievement for eye care services in Fiji, as it means they are now able to treat more children and adults who require general anaesthesia for eye surgery.

The PEI team had been trying to establish a children-focused outreach before the COVID-19 pandemic however, restrictions over the last two years had prevented them from moving forward. They had also been reached out to by a mother of twin girls who needed eye surgery and wanted help getting her daughters to Australia for treatment. This request, along with the growing backlog of patients caused by COVID-19, encouraged the team to reach out to hospitals in the other divisions of Fiji to see how many more children were waiting for eye surgery. Using the data collected from the divisional heads, they began to plan Paediatric Week.

35 children were identified as needing surgery, some using new telemedicine platforms. Telemedicine is the practice of delivering remote health care over phone, video, or computer messaging. These services allowed teams across Fiji to work together, share information, and ensure these children got the care they needed. The pre-surgical process is more involved when dealing with children due to their still developing eyes and more complex surgical and anaesthesia requirements, so this preplanning stage was vital. Dr Elenoa Matoto, who headed the project, played a huge part in this, along with the doctors from PICU and PARU.

Another success of the outreach was the use of the new PHACO machine, which was installed at PEI in June this year. This specialised equipment meant the main eye surgeon, Dr Subash Bhatta, could perform less invasive surgery. The nurses and matrons also did a wonderful job providing care to the children before and after surgery, and to the parents. As well as being more complex, surgery on children can be very frightening for the patient and their families, so this extra attention from everyone involved helps to ensure the best outcome possible. This outreach in particular highlighted the importance of teamwork and the role that each individual and organisation played in its success.

Two of the children who received eye surgery that week were brothers Aariv*, 9 and Kiaan*, 12. The brothers underwent cataract surgery together after struggling with eyesight problems for years. The older brother spoke to the team about how he always thought places he visited were dirty and at home he was always making his mum to sweep his room. Kiaan now understands that it was his eye condition that made the world seem cloudy, but since his successful surgery, everything seems clean again.

While 25 children were planned for surgery, based on those who could have the pre-work completed in time and with minimal disruption for the family, only 16 went ahead because of complications with the cases. However, this is still a huge success, especially for the children that would have otherwise had to travel overseas for treatment. Operating on children has extra risks and requires more attention before, during, and after the procedure, but the extra work is worth it for their futures.

*While this is their story, the names of the brothers featured have been changed to protect their identity.