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Biomedical subjects

D A Watters

Publications and source records attributed to D A Watters.

At least 19 recordsLinked to original sources
PubMed2001

Surgical capability and surgical pathology in Papua New Guinea in the year 2000.

BACKGROUND: Papua New Guinea (PNG) is a country of 4.5 million people with an annual health budget of only 96 million Kina (1K = US$0.35). There are 19 hospitals in the country and national surgeons are now staffing most of these hospitals. This review aims to describe the surgical pathology in the year 2000 and the capability of PNG surgeons to manage it. METHODS: A review of publications, reports and surgical audit data on surgery in PNG was conducted. Surgical audit has been computerized for over 5 years. The review also draws on personal experience and data from MMed theses submitted to the University of Papua New Guinea. RESULTS: Surgical pathology Surgical practice in PNG remains very general. Late presentation and advanced disease are common. Trauma, infection, malignancy and congenital anomalies dominate the surgical scene. The pattern of disease is different from what is found in the West. Western diseases are emerging with the incidence of appendicectomy rising from 5/100,000 to 75/100,000 in the past 30 years. The incidence of diabetes and gallstones has also risen. Osteoporosis, Colles' and neck of femur fractures are rare. Surgical capability The standard of surgical care is acceptable with a low wound infection rate for clean and clean-contaminated abdominal surgery of 0.9% and an anastomotic leak rate of 1.6%. Transurethral prostatectomy is also being performed to a satisfactory standard for head injuries admitted with a Glasgow Coma Score of 6-8 and a good outcome is achieved in over 70% of cases. Hospital mortality for surgical admissions is 3.7%. Subspecialties in orthopaedics, urology and head and neck surgery have been established. Neurosurgery, paediatric and cardiac surgery are being developed. Priorities for the next decade Papua New Guinea needs to continue to develop surgical subspecialties, particularly paediatric and neurosurgery, while maintaining a broad competence in general surgery. Services for burns, spinal injuries, rehabilitation and oncology need to be improved. Surgeons need to be more involved in rural health and teaching basic skills to primary health-care workers. Acquisition, maintenance and repair of surgical equipment needs to be improved so that PNG's well-trained surgeons can have the right tools for their trade. CONCLUSIONS: Papua New Guinea offers a wide range of surgical pathology. The standard of surgery in PNG is reasonable but there are many areas that need development during the period of the next national health plan, 2001-2010. Australasian surgery has many opportunities to assist surgeons in PNG to achieve their objectives.

Diabetes Mellitus↗
PubMed2001

Rising incidence of breast cancer in Papua New Guinea.

BACKGROUND: Three previous reports have shown the incidence of breast cancer in Papua New Guinea (PNG) to have risen in the 30 years between 1958 and 1987. In the present report the incidence and pathology of breast cancer in the decade 1989-1998 are described. METHODS: This was a retrospective review of all histopathology specimens in PNG from 1989 to 1998. During this period the female population grew from 1 640 000 to more than 2 000 000. RESULTS: There were 790 cases of breast cancer. The age of the patient was not known in 221 cases (26%). The age-standardized incidence was 6.9 per 100 000. The incidence of breast cancer has been steadily rising in the 40 years since cancers were recorded in PNG. The incidence has risen in all four regions, most notably in the islands. The peak incidence was in the 45-54-year-old age group (18.4/100 000); 83.9% of women with breast cancer were aged 54 or less. Fifteen per cent were under 35 years old and 55.7% were under 45. The incidence fell in the elderly. The tumours tended to be advanced. The actual size was recorded in only 163 cases (20.7%) but there were only three T1 tumours in this group. Clinical signs of advanced breast cancer were recorded in 206 cases: ulceration of skin (91 cases), peau d' orange (69 cases), nipple retraction (43 cases) and lymphoedema of the upper extremity (three cases). Axillary nodes were positive in 185 of 247 patients (75%) in whom they were sampled. CONCLUSIONS: The incidence of breast cancer in PNG women has steadily risen over the past 40 years and the highest age-specific incidence occurs in the 35-54 age group. Tumours present late at an advanced stage. Clinical information on pathology request forms is poor and a prospective clinical audit is needed. Strategies need to be developed to detect breast cancer earlier in this population of women.

Adolescent↗
PubMed2000

Progress of surgical training in Papua New Guinea to the end of the 20th century.

BACKGROUND: Health care in Papua New Guinea (PNG) throughout the 20th century has been characterized by a significant shortage of medical practitioners and surgical expertise. A number of initiatives within the country and from outside have sought to address these deficiencies of numbers and quality. The present paper seeks to review the development of surgery and surgical training in PNG. METHODS: Review of the surgical literature, reports and records in the Division of Surgery at the University of Papua New Guinea (UPNG), and personal observations are used to look critically at the content and productivity of the various training initiatives. RESULTS: For the first half of the century, PNG relied on national medical assistants who were trained, supervised and directed by expatriate doctors. Medical training of PNG doctors began in 1951 and by 1999 more than 600 doctors had graduated. Expatriate specialist surgeons arrived in 1950 and were the only surgeons until the postgraduate Master of Medicine (surgical) programme produced its first graduates in 1978. This programme has now produced 37 surgeons who are reasonably well distributed throughout the country. Higher surgical diplomas were introduced in 1994 for more specialized training of some of the general surgeons. These training developments have been supported by AusAid as well as by Australian surgeons. CONCLUSIONS: Surgical expertise has progressively improved throughout the 20th century with the most major advances being achieved in the last decade. Training programmes have provided an expanding core of expertise of considerable quality, but the numbers of doctors and surgeons remain well below requirements.

Curriculum↗
PubMed1997

Surgery for tuberculosis before and after human immunodeficiency virus infection: a tropical perspective.

AIM: To review from a tropical perspective the presentation and management of tuberculosis and how it is affected by coexistent human immunodeficiency virus (HIV) infection. METHODS: A 20-year literature review using Medline (National Library of Medicine, Washington, DC, USA) searches of the terms tuberculosis, HIV and acquired immune deficiency syndrome (AIDS) by site, body system and geographical region was undertaken. RESULTS: The dual epidemic of HIV and tuberculosis now afflicts well over 4 million people. In subSaharan Africa 20-50 per cent of patients with pulmonary tuberculosis and 60-90 per cent of those with extrapulmonary tuberculosis are HIV positive. Tuberculosis presents both with generalized systemic symptoms, and with symptoms and signs according to the site of involvement. Specific sites reviewed include lymph nodes, abdomen, bones and joints, pleural and pericardial spaces, and genitourinary system. CONCLUSION: All surgeons need to be aware of the manifestations of tuberculosis at different sites and the effects of HIV infection. HIV-positive patients are more likely to present with systemic illness and multiple sites of involvement, and to respond poorly to major surgery. Surgical management is generally limited to making a diagnosis or treating life-threatening complications.

AIDS-Related Opportunistic Infections↗
PubMed1996

Trauma admissions in the southern highlands of Papua New Guinea.

BACKGROUND: Trauma is a common cause of surgical admission in Papua New Guinea (PNG) but to date there has been no study of the whole trauma burden in provincial hospitals. METHODS: A 1-year retrospective study was made of all surgical admissions to the provincial hospital at Mendi. RESULTS: Trauma was the third commonest reason for hospital admission and accounted for 43% of all surgical cases. The common causes of injury were tribal fights (24%), domestic violence (14.3%), assault (16.7%), road accidents (14%) and domestic accidents (25.1%), which comprised falls, penetrating wounds and bites. Males accounted for two-thirds of cases, and 19% were children below the age of 16. Only eight of 454 patients died (1.8%), because most trauma deaths occur before the patient reaches hospital. There were only 37 multiple injuries and only five patients had an injury severity score of greater than 16. The average inpatient stay for trauma admissions was 10.6 days. CONCLUSIONS: The cost of trauma in Mendi is difficult to calculate, but is enormous. In addition to 11% of the recurrent hospital expenditure (over US$1.1 million, excluding pharmaceuticals), the community costs include loss of earnings and productivity, as well as permanent disability. The social disruption caused by tribal fights results in cessation of the local economy, burning of aid posts, schools and homes and destruction of gardens for subsistence farming. Those who reach hospital alive tend to have single injuries and survive.

Adolescent↗
PubMed1996

The future of surgery in Papua New Guinea and the South Pacific.

Surgery in the South Pacific is different in many respects from surgery in Australia and New Zealand. It is primarily the surgery of trauma, infection, advanced malignancy, hollow-tube obstruction and congenital abnormalities. Specific tropical infections such as tuberculosis, typhoid, pigbel and amoebiasis occur regularly but constitute only a small proportion of all cases. The patients tend to be young, rural and poor, and often present late because access to surgical services is limited. The treatment patients receive is also compromised by a lack of resources--the result of underfunding and inefficient administration. Standards for appropriate surgical practice should be determined in-country and based at least on surgical audit and clinical studies. Even though Western diseases are emerging in the tropics, the best management may sometimes be different. Training of national surgeons is a priority if a sustainable surgical service is to be established. Such training is more effectively carried out in the home country, or at least in one with similar pathology and problems, rather than overseas. Project aid should support these schemes and encourage regional co-operation through the Fiji and Papua New Guinea medical schools. There remains an important role for visiting surgical specialists, but they need to ensure that they transfer skills and encourage the professional development of promising local doctors rather than simply focusing on treating patients.

Adolescent↗
PubMed1996

Neurosurgery in Papua New Guinea.

BACKGROUND: An audit of neurosurgery in Papua New Guinea (PNG) based on the experience of a visiting neurosurgeon is presented. The objectives of the study were to determine the type and frequency of neurosurgical conditions in PNG, whether major neurosurgery can be performed successfully in PNG, and to develop a strategy for the development of neurosurgical services in PNG. METHODS: The audit was carried out over two periods of 2 weeks duration in 1992 and 1993 in Port Moresby and Goroka. Instrumentation and equipment were limited and no additional equipment was used. Myelography and angiography were available in Port Moresby. RESULTS: There were 82 patients in total, 55 (67.1%) were consultations, 23 (28%) had elective surgery, four (4.8%) had emergency surgery and 16 (19.5%) await surgery. Cases were subdivided into nine major groupings: neurotrauma 18 (seven severe); spine 18; congenital 13; hydrancephaly four; scalp, skull and orbit six; vascular three; peripheral nerve three; and neurology five. Seventy-two (87.8%) patients required CT/MRI which were unavailable. Four ventriculograms were performed in lieu of CT/MRI. Fifteen (18.3%) cases could not be treated in PNG. CONCLUSIONS: Neurosurgical problems in PNG can often be adequately managed with limited resources. Complex procedures were performed with gratifying results and acceptable morbidity. There is sufficient pathology in a country of four million people to justify training a small number of neurosurgeons by the end of the decade. CT scanning will be a necessary adjunct.

Adult↗
PubMed1996

Head injuries in Papua New Guinea.

Head injuries are the commonest cause of death in the surgical wards in Port Moresby and the commonest cause of death in road accidents. Three prospective and retrospective studies performed over the last decade aimed to determine the pathology and outcome in 274 head injuries admitted to Goroka in 1988-1991 (4 years) and Port Moresby in 1984-1985 and 1992-1993 (total 2.5 years). Head injuries were managed by general surgeons without CT scanning or intracranial pressure monitoring. There were 196 adults and 78 (28%) children; 195 were male and 79 female. Assaults (32%), motor vehicle accidents (49%) and falls (17%) were the commonest modes of injury. The case fatality rate was 21% (57 of 274 cases). Six of the deaths were avoidable. The fatality rates for admission Glasgow Coma Scores of 3-5, 6-8 and over 9 were 81%, 21% and 3% respectively. Two patients died of infection complicating open depressed fractures. The case fatality rate for extradural haematoma was 20% and subdural haematoma 67%. Nine patients died of associated abdominal injuries. Most of the deaths were unavoidable because of the severity of primary brain injury. The speed of diagnosis and quality of care could have been improved but the most important area is management of the airway. General surgeons properly trained in trauma care (which includes emergency airway management) are well able to cope with the majority of head-injured patients in Papua New Guinea.

Adolescent↗
PubMed1996

Trauma in Papua New Guinea: what do we know and where do we go?

Trauma is a major health problem in Papua New Guinea. Injuries are the commonest cause of death in the productive age group of 15-44 years. Trauma is the leading cause of surgical death in Port Moresby General Hospital. The common causes of injury are road traffic accidents, domestic violence, criminal assault, tribal fights, accidents at home and at work, burns and falls. This review summarizes what has been published on the different causes of trauma in Papua New Guinea. Though much has been written little has been done to implement the recommendations made. Papua New Guinea needs a spinal unit and it needs burns units in its major hospitals. There should be better facilities for rehabilitation. Little has been done to curb tribal fighting and domestic violence. Road traffic fatalities have at least remained static in the last decade and wearing seat belts is now compulsory, but the law must be enforced. Driving after drinking alcohol must be stopped and protective roll bars or cages must be fitted to all open-back utility vehicles which carry passengers. Progress requires vision and commitment by surgeons, leaders in public health, hospital administrators and politicians.

Abdominal Injuries↗
PubMed1995

Hydrometrocolpos and segmental colonic dilatation in a girl with megacystis-microcolon-intestinal hypoperistalsis syndrome.

OBJECTIVE: To report a case of a newborn female infant noted to have features of the megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) with the additional features of hydrometrocolpos and segmental colonic dilatation and review the literature. METHODOLOGY: The details of the case were collated and compared with the previous published experience with this condition. RESULTS: Thus far there have been 58 previous cases of MMIHS described, only four of which have had colonic dilatation. A number of concurrent anomalies have been described, but not the hydrometrocolpos or dysmorphic features seen in this patient. CONCLUSION: This case appears to be MMIHS with additional features not previously recorded.

Abnormalities, Multiple↗
PubMed1995

Surgical management of elephantiasis of male genitalia.

OBJECTIVE: To assess the outcome of the surgical management of severe elephantiasis of male external genitalia. PATIENTS AND METHODS: Twelve patients with gross oedema of their penis and scrotum were managed by excision of the lymphoedematous skin and subcutaneous tissue and a split-skin graft. RESULTS: The cosmetic and functional results were satisfactory in all cases. There was no recurrence and all patients were able to resume sexual activity. CONCLUSION: Surgical excision of affected tissue and split-skin graft is an effective management for severe lymphoedema of the scrotum and penis.

Adult↗