A surgical future in Vanuatu

Dr Trevor Cullwick discusses the challenges and future directions of surgery in Vanuatu.

Dr Trevor Cullwick is the senior general surgeon at Vila Central Hospital, the main referral hospital in Vanuatu.

Born and raised in Vanuatu, he completed the majority of his surgical training at Fiji National University and took to the surgical aspect right from his undergraduate degree. “I thoroughly enjoyed the structure and the thought process that went into it, and the challenge,” Dr Cullwick said. “I realised that in a rural setting I wanted the surgical skill set or at least to be able to help people. So that drove my passion further,” he continued.

A desire for further training and experience brought Dr Cullwick to Australia and Aotearoa New Zealand. He undertook an attachment for two years in Christchurch in Orthopaedics and has just returned from his Rowan Nicks Scholarship at Melbourne’s Northern Hospital, under the supervision of Ms Wanda Stelmach. This occurred during the COVID-19 pandemic, which meant Dr Cullwick was juggling his surgery and COVID-19 restrictions at the same time.

The COVID-19 pandemic has created difficulties in Vanuatu as well. Although there have been no community outbreaks, Vanuatu has been unable to host visiting medical teams. These visiting teams usually advise and discuss patients with surgeons in Vanuatu, and they bring in much needed medical supplies. Another issue is that Dr Cullwick and his colleagues are unable to refer difficult cases to be seen in Australia and Aotearoa New Zealand. “This has impacted our services greatly,” he said, “because we’ve cut down on electives, we’re only doing emergencies and electives in some situations. That has affected us.”

Other than COVID-19, Dr Cullwick sees the main challenges in Vanuatu falling under the category of human resources. “We don’t have enough surgeons to actually carry out the surgery. There are currently four of us serving a population of 300,000,” he said. This is also an issue for anaesthetists and other support staff. Dr Cullwick thinks it’s important to consider building service capacity in a broader team sense. Another challenge is the financial support necessary to develop services and standards of healthcare. Dr Cullwick sees this as a long-term issue that needs commitment, a rigorous process and vision from the Ministry of Health.

Vila Central Hospital is the main referral hospital in Vanuatu and provides health services to over 78,000 people. It is the only hospital able to perform a high standard of surgery. Dr Cullwick worries that 60 per cent of the population don’t have access to simple surgeries, such as hernia repair or lipoma, so they have to fly to Vila Central Hospital, which is costly. Dr Cullwick would like to see funds and staff made available to provide outreach and surgical services in remote communities.

Dr Cullwick spoke highly of the Foundation for Surgery and the College. He expressed appreciation for the College’s programs, such as the Pacific Island program, that provide training, and for the College’s facilitation of examinations. He also appreciates the worth of scholarship and fellowship programs funded by the Foundation. He personally found it valuable to be able to “go and see what it’s like in these developed centres, where we can say, ‘Look, we’re not far off, and here are little tweaks we can do to bring about changes’.”

Dr Cullwick is clear that his future lies in surgery in Vanuatu. “I love what I do. I love general surgery. I love how I can help people and at the same time be able to teach and be an example for the young guys that are coming up,” he said. Developing the next generation of surgeons is key for him. “With the facilitation of RACS we can get our young surgeons attached to existing teams to groom them, to learn the process, to inspire their passion. These are the surgeons who will eventually be taking over from us.”

Dr Cullwick is focused on the service he can provide to his patients. “When you get into surgery you can work anywhere but it’s about your capacity and where you want to see surgical services. For me, that is Vanuatu.”

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Thanks to you, many more children, families and communities have access to quality surgical care when they need it most. With your help we are building the surgical capacity of our nearest neighbours and support the work of our Pacific and Timorese colleagues, like Dr Cullwick.

The Foundation for Surgery has been instrumental in supporting surgical needs in remote and disadvantaged communities in the Asia-Pacific region.

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