ANZGITA trainers and trainees in Timor-Leste

The joy of a cultural and travel experience, the opportunity to help and “give back”, and yes, the CPD credit points, are all reasons for volunteering to deliver in-country endoscopy training in resource-limited Indo-Pacific countries.

The Australian & New Zealand Gastroenterology International Training Association (ANZGITA) program for 2023 includes trips to the Solomon Islands, Timor-Leste, Fiji, Samoa and Tonga.

ANZGITA Programs Coordinator Dr Robyn Nagel has travelled to both Fiji and Timor-Leste in the past and is booked to visit the Solomon Islands in March this year.

She told the limbic that she is looking forward to her next trip to a different country.

Dr Nagel, a gastroenterologist in a solo practice in Toowoomba, Queensland, says the relationship between ANZGITA trainers and participants in host countries is definitely two-way.

“I think this is a nice grounding exercise to remind people of the reason they did medicine in the first place. So you go over with that feeling that you want to help, but I have to say… it’s very much a bilateral relationship. They are always incredibly generous and very much wanting to share cultural knowledge.”

She said ANZGITA doctors and nurses were most likely to volunteer as trainers early in their careers “when they’re very passionate” or later when they’re semi-retired and “have a sense of trying to give back”.

Dr Robyn Nagel with trainees in Fiji

“In the middle, it’s hard. If you’ve got a family, it’s incredibly difficult to take the time off …there are people who do that, and they’re just very committed individuals.”

Dr Nagel works in her practice three and a half days a week and when she’s away her patients have back-up from other gastroenterologists and a private casualty in the regional city.

“I have people who pick up the slack so that’s easy from that point of view.”

However when she traveled for ANZGITA 13 years ago and her children were teenagers she admits it was logistically more difficult.

“So you’re trying to sort out your practice before you go and then you’re away from your family and it’s really time that you could be having a holiday. You think, should I be doing this to the detriment of my family?”

ANZGITA evolved out of the Gastroenterology Fiji Training Team (GeFiTT) which initially delivered specialised teaching services for South Pacific Islands at the World Gastroenterology Organization (WGO) Training Centre in Suva from 2008.

Professor Finlay Macrae, head of colorectal medicine and genetics at the Royal Melbourne Hospital, was the founding chair when ANZGITA incorporated in 2014 and remains chair of its Boards of Directors.

Brisbane gastroenterologist and ANZGITA trainer Dr Mark Norrie said the program will be part of Professor Macrae’s legacy and will hopefully continue to grow and facilitate more endoscopy services throughout the Asia-Pacific region.

“We are very grateful that we seem to have a large number of doctors and nurses from both Australia and New Zealand who are willing to volunteer their time because we don’t get paid to go over there and do this teaching.”

Dr Norrie has volunteered regularly since 2010 including in Fiji, twice to Myanmar and six times to the Solomon Islands.

“It’s very rewarding I think – that process of passing on education and teaching skills so that the medical practitioners in those particular countries can carry on and do the work when we’re not there. So basically, it’s capacity building.”

“The Hippocratic Oath does say that we’re sort of obligated to pass on our skills so it’s both a professional and a personal obligation, I think.”

Dr Robyn Nagel with trainees in Fiji

Both Dr Nagel and Dr Norrie said the scope of work was different to what they see in Australia.

“There’s a very different disease demographic, so we go over prepared to do colonoscopies and take off lots of polyps. But their major problems are what we faced when I started in endoscopy and I’m in my 30th year of gastroenterology now. So when we started we were doing more gastroscopies… and treating huge bleeding ulcers from Helicobacter,” Dr Nagel said.

“Patients will get a couple of weeks therapy with a drug that we don’t know is effective [due to antibacterial resistance] … but then they’ll go out and potentially get reinfected because it is so prevalent.”

She said it seemed like about 20% of patients in Timor Leste had ascites – about half from advanced malignancy and the other half from chronic hepatitis B infection.

“And that’s not something we’re really addressing as we don’t get involved in primary care or vaccination, or so far.”

Dr Norrie said the precipitant for providing a training service in the Solomon Islands was a senior surgeon whose wife died of bowel cancer.

“And I guess had they had an endoscopy service there that might have been diagnosed earlier and then she would have had curative surgery, but that wasn’t available at the time,” he said.

“Nowadays, if they have problems that come through the door like bleeding ulcers or varices related to liver disease…they’re able to make that sort of diagnostic evaluation that was not there previously.”

“There’s a lot of disease like oesophageal cancer in particular, which is a big problem in the Solomon Islands that they can now diagnose which they couldn’t before and although often they can’t necessarily cure it, they can at least provide facilities to give the patients comfort, for example putting stents in so that patients can swallow.”

Dr Mark Norrie with ANZGITA colleagues and trainees in the Solomon Islands

Dr Norrie said he had an enduring respect and admiration for the local doctors who had to deal with the same complex problems that Australian doctors did but with much fewer resources.

“We have accessible diagnostics like CT scans and MRI scans and pathology. That’s something that they don’t have. They have to deal with a whole range of different complicated problems without the sort of backup and support of other colleagues and investigative facilities that we have in Australia.”

He said the need was enormous. For example, he was once delivering training at Honiara National Hospital when a tropical cyclone flooded the hospital.

“That demonstrated very clearly how their health services become stretched very quickly,” he said.

“You certainly can’t solve all the problems. I guess you support and help the clinicians on the ground where you can and your small contribution can make a difference to some people anyway.”

Read more about ANZGITA’s 2023 program here, volunteer here or show your support here.