fcgp annual conference magazine 2017

Annual Conference 30th June - 2nd July 2017 Shangri-La’s Fijian Resort & Spa, Yanuca, Fiji Islands

Fiji College of General Practitioners 1

Annual Conference Magazine 2017

Chairperson: Dr. Bijend Ram

Dr.Devika Kumar

Chairperson:

Chairperson: Dr. Vinod Singh

Chairperson: Dr. Shanita Sen

Chairperson: Dr. Ram Raju

Chairperson: Dr. John Fatiaki 2 Fiji College of General Practitioners Annual Conference Magazine 2017

Dr. Kanna Goundar Dr. B. P. Ram

Conference Organizing Committee 2017

Conference Director’s Message

F/L-R: Mrs. Morine Patel, Ms. Joycelyn Sahai, Mrs. R. K. Ram, Mrs. Shakuntla Raju, Mrs. Suman Lal B/L-R: Dr. Dhirendra Lal, Dr. Bijend P Ram, Dr. Ram Raju, Dr. Iane Penjueli It gives me great pleasure to join you all for the Fiji College of General Practitioners Annual Conference-2017 being “The College Silver Jubilee Celebration”.

The Conference management team include Dr.Ram Raju, Dr Iane Penjueli, Dr Bijend Ram and Dr. Kanna Gounder and of course group of volunteers, Suman Lal, Joycelyn Sahai and Morine Patel and Janice Brown. This hardworking team has been meeting regularly over the past 10 months organizing this historical event at the world famous 5-star Shangri-La's Fijian Resort and Spa, at The Yanuca Island, Fiji.

On behalf of organizing committee and The College Executives, a warm welcome to all participants, families, friends and sponsors. A special welcome to our foreign delegates and volunteering speakers. Thank you for participating in this conference and sharing your expertise. Not forgetting the family members supporting here today.

Our theme “The General Practice, Public Systems, Specialists and Medical care in 2025” . This is seen from different perspective in our developing country. The transformation of the System, the Practice and Fijian culture is a gradual process which requires continuous commitment. Conferences of this caliber is the best contributor to bring about the required change in shaping the future of our people.

To this end, I hope the management of our healthcare institutions will empower and support The Fiji College of General Practitioners endeavor to achieve this.

The college handles large number of patients and now transformed to provide specialist consultation, diagnostics and surgical procedures.

This annual event brings us all together, now reaching 25 years of continuous encouragement, support and dedication by our members. The interest generated from overseas guest speakers was overwhelming with quite a few being our former citizens. They have come back to join fellow colleagues to share their knowledge and experiences in their areas of work. I believe it is also a time for reunion for many of them and I hope this does materialize as well.

I wish to thank all the speakers sincerely as the hallmark of all conferences is the level and depth of scientific papers. There’s something of interest for everyone as we have tried to accommodate all of the speakers who had shown keen interest covering all relevant medical issues at no cost to the College.

Special welcome to Emeritus Professor John Murtagh, AM, the world’s leading and outstanding General Practitioner and Family Physician who kindly accepted our invitation as one of the of Chief Guest Speakers along with Professor Leon Piterman, AM, of Monash University. Both John and Leon were here 25 yrs ago in our inaugural conference (and several times since) and we are blessed to have these two stalwarts with us again and in future. They have been a pillar of strength along with Monash who have been closely associated with our College by supporting medical students as well.

Come , enjoy and experience the moments we are offering blended with variety of activities, fun, friendship and surprises.

Please allow me to conclude, do visit our Website www.fcgp 2017.com for updates. Do contact us for any other assistance.

Be a winner, take back memories and the freshness of our Silver Jubilee Celebration at The Shangri-La’s Fijian Resort and Spa, Yanuca, Fiji Islands.

Dr. Dhirendra Lal | Conference Director

GUEST SPEAKERS Hon. Rosy Sofia Akbar Minister for Health and Medical Services

Hon. Rosy Sofia Akbar is a Fijian politician and Member of the Parliament of Fiji. She is the current Minister for Health & Medical Services. She is originally from Ba and before entering politics she was Vice-Principal of A.D. Patel College.

The Ministry of Health is responsible for the following: Medical services including drug and other supplies, associated with patient care in urgan hospitals and health centres, Subdivisional hospitals, Rural Medical and Nursing Stations; Research confined to virus control, vector control, filariasis control and surveillance of AIDS; Public Health targeted at Maternal/Child Health, Communicable Disease Prevention, Family Planning, Pollution Control and Rural Health Sefices; Health Education and Training through FSM and FSN; Operation of three Nursing Homes (Old People’s Home) at Suva, Lautoka and Labasa.

HE. Mr. Vishvas Sapkal

High Commissioner of India to the Republic of Fiji

HE. Mr. Vishvas Sapkal joined the Indian Foreign Service (IFS) in 1998. He holds the degree of Engineering in Electronics from Walchand College of Engineering, Shivaji University, Kolhapur, Maharashtra.

During his diplomatic career, he has served in Indian Missions in Moscow, Yerevan and Chicago in various capacities. He was Consul General of India to St. Petersburg, Russia. He also served in Multilateral Economic Relations Division, Northern Division, Finance Division and India Africa Forum Summit Secretariat of the Ministry of External Affairs in New Delhi. Prior to this assignment, he was Deputy Chief of Mission at Embassy of India in Cairo.

Before entering into the IFS, he served in Indian Information Service (IIS) of Government of India as well as Engineer in Maharashtra Electronics Corporation Ltd. (MELTRON) and Lecturer of Electronics Engineering in PVPIT Budhgaon, Sangli, Maharashtra and Walchand College of Engineering, Sangli, Maharashtra. He is conversant in Marathi, Hindi, English and Russian languages.

Mr. Sapkal is married to Dr. Anita Sapkal. They have two sons.

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MESSAGE FROM THE MINISTER FOR HEALTH AND MEDICAL SERVICES Greetings.

Hon. Rosy Akbar I am indeed honoured and pleased to be able to contribute towards this message.

The Fiji College of General Practitioners (FCGP) and the Fiji Medical Association (FMA) are commended for its unprecedented commitment for the advancement of health care systems in Fiji. This first ever combined conference will bring revolution and thrive on strengthened partnership between the two most powerful institutions in their endeavours to foster health development by recognizing and empowering the general practitioners and medical professionals.

Strengthened collaboration between FCGP and FMA will unleash new opportunities to boost the competency development of the medical professionals that will greatly complement the vision championed by the Ministry of Health and Medical Services which is developing our country as the “Healthy Population”.

I am truly pleased with the rejuvenated commitment to collaborate the strategic plans to advance the health care system in Fiji. This expanded networking will generate productivity and motivate the medical professionals to effectively and collaboratively deliver the role that they have been entrusted with. Being a health professional, one must persevere to broaden their knowledge on health care services through information sharing and networking, as such a seminar of this nature provides a good platform to achieve that.

The emergence of escalating rates of the Non-Communicable Diseases, poses new challenges for the general practitioners and overall health system. Thus technological advancements influences the way medical practitioners need to approach issues like Non-Communicable Diseases (NCD).

New ways of conceptualising diseases, new technologies, increasing specialisation, changing roles and practice, and an increasing focus on prevention and management have unfolded new challenges and demand for the role of medical professionals. As a way forward, strategic and innovative plans need to be looked into to efficiently accommodate for the crucial roles that the practitioners have in positively changing the lives of the patients, their families and carers, and for the future provision of health care. This is indeed an immediate and pressing concern, given that the social and economic burden of chronic diseases continues to increase.

As such, the theme selected by the Association for its 25th Silver Jubilee Annual Conference, ““The GP, Public System, Specialists and Medical Care in 2025” provides an opportunity to nurture unity, sincerity and together lead the way to create better health services for all. I would like to take this opportunity to pay tribute to all the doctors and medical professionals for their hardwork and commitment to this noble profession. I convey my best wishes to the Fiji College of General Practitioners and Fiji Medical Association as it leads the way forward in promoting the development of medical profession to its highest standards for the benefit of our nation.

Indeed the networking platform provided through the FCGP is a gateway to broaden the knowledge and expertise needed to take the medical profession to a much higher level. To keep pace with the rapidly changing demands of health care, the GP’s must persevere to enhance their skills through training and education opportunities, it’s inspiring to witness the GP’s who continue to shine in their efforts to reach for greater heights their career. As the Ministry of Health and Medical Services, we stand ready to support you all the way in this endeavour.

On that note, I wish to convey my heartiest congratulations to all the members of Fiji College of General Practitioners and Fiji Medical Association for their great achievement and service to the nation. My sincere wishes for the success of FCGP 25th Annual Conference and I must say I am tremendously pleased with the partnership between FCGP and FMA. Indeed a proud achievement for our medical professionals and our nation and hoping this partnership will continue to nurture through many more years of success and prosperity.

With Best Wishes always.

Hon. Rosy Akbar | Minister for Health and Medical Services

Dr. John Fatiaki

President’s Message

It gives me great pleasure to extend to all participants, speakers and sponsors a very warm Fiji welcome to the Annual 2017 FCGP conference at the Fijian Resort and Spa on Yanuca Island on our beautiful Coral Coast.

Our Western faculty has put together a comprehensive scientific programme with the theme “The GP, Public System, Specialist and Medical Care in 2025” that will find wide appeal amongst participants and will have something for all. This has been complemented by a social program each day that will allow us to enjoy the facilities and activities of the Fijian Resort and its sister town of Sigatoka.

The FCGP aims to improve people’s lives, by promoting high standards of healthcare in family medicine, and by hosting this forum for sharing new concepts. In its twenty fifth year, the FCGP Conference has expanded its scope to cover many relevant topics such as: chronic disease management, Breast cancer, Antimicrobial Resistance in Fiji, Infectious Disease trends by 2025, GP Skills in MSD’s, Urological emergencies, Helpful tips for the GP, and much more.

The committee has selected these topics to promote personal and continuing care for the individual, family and the community. We believe these topics need more attention from family medicine practitioners, and for that we have invited world-renowned speakers and experts to share their expertise and best practices.

We are honored to have our Minister for Health, Hon. Rosy Akbar, as the chief guest at our dinner on Saturday evening, and Professors Leon Piterman and John Murtagh as keynote speakers at the formal convocation dinner on Friday evening and as presenters in our scientific sessions.

Our hope is that this conference will not only provide a forum for continuing medical education and professional development, but will also allow us to rekindle old friendships and make new ones. In this regard, we look forward to your active participation in the scientific programme and invite you to take time to enjoy both the conference and the delights of The Fijian Resort and Spa Fiji.

Dr John C Fatiaki FFCGP | President - FCGP Fiji College of General Practitioners 5 Annual Conference Magazine 2017

I would like to send my greetings and best wishes to all those involved in the 2017 Fiji College of GPs’ annual conference. You all deserve special congratulations as it is your ‘Silver Jubilee’! Many countries are only just starting out in family medicine, and we are all impressed and delighted by your mature success as an organisation.

The conference looks very exciting, and I hope you will all learn much. I am sorry I cannot attend, but will be meeting in my own region at the same time with many European GPs. I hope we shall look across the world and feel a sense of shared achievement and pleasure at our efforts to serve patients .

On behalf of the WONCA Executive, I wish you a very successful event.

Professor Amanda Howe President, WONCA Muju Cola Vina'a It is a great pleasure to share a few thoughts and I welcome you to my mothers province.

The FCGP since its inception as the GP branch of FMA to its legislated existence in the 2010 Medical & Dental Practitioners Act has grown from strength to strength.

The FCGP forward thinking in collegiality, professionalism and networks is something that the Fiji Medical Association is able to learn from and follow.

Our beginnings were together and the Goverment has indicated that we work more collaboratively as a voice for all Doctors in Fiji.

FMA currently has 330 members mostly Doctors in the civil service. The significant salary increases last year given by the Fiji First Goverment has enabled our civil service colleagues to live more comfortably and maybe remove the stigma of being the "poorer cousin".

This combined conference will allow us to work together, listen together, plan together and decide our destiny together.

On a personal note I am proud to acknowledge that the highest award of the FMA; the Life Membership, is currently held by 7 esteemed living Doctors and 3 of them ( Dr Ram Raju, Dr John Fatiaki and Dr Wahid Khan) are senior FCGP members.

God Bless this combined conference. God Bless FCGP. Ifereimi Waqainabete | Associate Professor General Surgery President FMA Psalms 23:1 - The Lord is my Shepherd, I shall not want.

FCGP 2017 Annual Conference On behalf of the Royal Australian College of General Practitioners, I would like to extend my heartfelt congratulations to all members of your college for celebrating 25 years of the Fiji College of General Practitioners Annual Conference. I wish you all the best for this special occasion.

The FCGP Annual Conference has transformed into a truly memorable event for doctors in our region. I’m sure the 2017 conference will once again provide an excellent opportunity for doctors from across the Pacific to come together in a beautiful location to hear from an array of celebrated speakers.

It is wonderful news you have extended an invitation to Professor John Murtagh to attend as keynote speaker. Professor Murtagh is an esteemed doctor, in Australia and throughout the world, and I am proud of his strong connect to the RACGP. FCGP 2017 attendees are privileged they’ll have the chance to hear from Professor Murtagh and your long list of other renowned speakers.

I look forward to hearing news from the FCGP 2017 Annual Conference and working with you in the future, to further strengthen general practice in our region and improve the health of our communities.

Dr. Bastian Seidel President

Distributor in Fiji by: 6 Fiji College of General Practitioners Annual Conference Magazine 2017

RNZCGP message for Fiji College of General Practitioners Conference delegates, 2017 Ni sa bula vinaka and Kia ora, I bring greetings from the President, Board and Executive, and your colleagues who are members of the RNZCGP. Unfortunately, Dr Malloy is unable to attend the conference in person.

As a Board member of the RNZCGP, and Chair of its Pacific Chapter, I am happy to represent the RNZCGP at the Fiji GP conference this year. I look forward to lively discussions with colleagues from Fiji and abroad, and am particularly interested in hearing your thoughts and ideas on how the RNZCGP can work with the Fiji College of GPs to support your continuing professional development.

The RNZCGP wishes the Fiji College of GPs a very successful and enjoyable conference.

Vinaka vakalevu and Matewa Dr. Apisalome (Api) Talemaitoga Board Member RNZCGP

STEVRO LIMITED Phone: 332 1466 Fax: 332 3254

Key Note Speaker Leon is Professor of General Practice at Monash University and immediate past Pro Vice-Chancellor of Monash’s Berwick and Peninsula campuses, the former Head of the School of Primary Health Care which he founded and former Senior Deputy Dean of the Faculty of Medicine, Nursing and Health Sciences. He is also a past member of the Board of Examiners of the Australian Medical Council, the FRACGP, and sits on various university, professional and government expert committees. He is a Board Adviser to the Royal District Nursing Service, Board member of Berwick Health Care and the Insight Centre for the Blind and Vision Impaired and maintains part time clinical practice in Moorabbin.

Prof. Leon Piterman MBBS, MD, MMed, MEdSt, FRCP(Edin), FRACGP

Leon has extensive expertise in medical education, medical research and clinical audit. He has published widely on clinical and educational issues related to general practice with particular interest in mental health and chronic disease. He was awarded the F.H. Faulding Prize for Research in General Practice in 1987, the Silver Jubilee Teaching Prize in 1992 and the Hong Kong College of General Practitioners Award for best research project in 1994. He has over 160 publications in refereed journals and co-authored the text “General Practice Psychiatry” which has been translated into Italian and Chinese.

He is responsible for establishing and conducting Monash’s most successful Diploma/Masters in Family Medicine which, conducted by distance and on campus learning over a 20 year period has produced over 1400 graduates in Australia and overseas. Graduates reside in Hong Kong, Malaysia, Singapore, Thailand, Japan, China, Philippines, Fiji, UAE, UK and Canada.

He has delivered numerous short courses to GPs and GP trainees In Australia and overseas.

In June 2006, he was made a Member of the Order of Australia (AM) for service to family medicine through distance education for doctors in remote areas, to research and student training, and to international education. In 2016 he was awarded the David DeKretser Medal for distinguished service to Monash’s Faculty of Medicine Nursing and Health Sciences.

ABSTRACT 1: Chronic Disease Management and IT Solutions.

Non communicable disease(NCD), including chronic and at times complex disease has overtaken communicable or infectious disease as the number one cause of illness, disability and death globally. Whilst this has been the case for decades in developed countries, non communicable disease is also emerging as the major health problem in developing countries. There are a number of reasons for this change in disease trends. They include better control of infectious disease through sanitation, vaccination and judicious use of antibiotics ( notwithstanding the emergence of antibiotic resistance), population aging, urbanisation, sedentary lifestyle, obesity, cigarette smoking, alcohol Although the threat of epidemics/pandemics remains real ,and we have lived through some of these in the past 20 years, such as SARS, H1N1 Swine flu, Ebola virus, the World Health Organisation (WHO) has over this period of time directed much of its attention to recommending the prevention and management of non communicable disease. Of course Fiji still has a burden of infectious disease which cannot be ignored and is likely to be exacerbated by the effects of climate change on its islands.

In its 2014 Global Status Report on non communicable diseases the WHO reporting on 2012 data indicated that 56 million deaths occurred that year of which 68% were due to non communicable causes. In Australia chronic disease accounts for 90% of all deaths and in In Fiji that figure is 80% in China the figure is 79%. Globally and in both Australia and Fiji the four commonest forms of NCD are cardiovascular disease, cancer, chronic lung disease (mostly smoking related), and type 2 diabetes (often obesity related).

These death rates have led to a series of recommendations and targets for action emerging from a meeting of countries Health Ministers in July 2014 at the United Nations General Assembly.

Around 40% of deaths from NCD occur in people aged less than 70 and a large proportion of these are preventable. The WHO has set a target of 25% reduction of premature death from NCD by 2025 with each country developing policies and practices to achieve this target. The economic cost of failure to achieve this reduction in low and middle income countries by 2025 is estimated at US$7 trillion. The following 9 global targets have been ambitiously set:(ref ) 1.A 25% relative reduction in overall mortality from c a rd i o vascular disease, cancer, diabetes and chronic respiratory disease.

2. At least 10% relative reduction in the harmful use of alcohol as appropriate within national contexts.

3. A 10% relative reduction in the prevalence of insufficient physical activity.

4. A 30% relative reduction in the mean population intake of salt/sodium.

5. A 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years.

6. A 25% relative reduction in the prevalence of raised blood pressure, or contain the prevalence of raised blood pressure according to national circumstances.

7. Halt the rise in diabetes and obesity.

8. At least 50% of eligible people receive drug therapy and counselling ( including glycaemic control) to prevent heart attacks and strokes.

9. An 80% availability of the affordable basic technologies and essential medicines, including generics, required ton treat major non communicable diseases in both public and private facilities.

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Achieving many of these targets will require a concerted effort on our public and private health systems.

Whilst population based health promotion strategies including social marketing are essential to achieve these ambitious goals they cannot be achieved without and effective and efficient primary care health delivery system. In most countries this means well trained, well resourced ,well motivated, and well rewarded general practitioners working in concert with public health campaigns and with secondary and tertiary specialist providers. Integration of the various health sectors using information technology is essential and patients should have access to their health records at all times on smart phones or similar devices.

This lecture uses a case study to illustrate the problems facing GPs in managing a patient with chronic disease, an IT solution through the development of web based care plans by CDM Net enabling connectivity across the care team and addition of a patient held ‘App” called “ Meditracker” giving the patient ownership and portability of their medical health record.

ABSTRACT 2: GP 2025 Australian Perspective

ABSTRACT 3: Difficult to treat Depression Depression is rapidly emerging as the second commonest cause of disability world wide(WHO). With a life time prevalence of 17% for Major Depressive Disorder and a 12 month prevalence of 4%, and rising suicide rates, including youth suicide, the condition poses major challenges for governments, public health officials, and particularly for general practice where most cases of depression are seen and potentially treated. GPs may experience difficulties in diagnosis as well as difficulties in treatment.

Depression may be masked and present as somatic symptoms, predominant anxiety or co –morbidly with physical illness especially in the elderly as well as those with chronic disease and patients with other mental health problems such as schizophrenia, personality disorders and drug and alcohol dependency. It is important to differentiate bipolar depression from unipolar depression as the treatment for the former may be different and the risk of suicide is much greater in bipolar depression.

Treatment difficulties arise for a variety of reasons including stigma associated with the condition, reluctance of patients to accept the diagnosis, inadequate specialist resources including expertise in psychological therapies such as CBT, inadequate treatment for inadequate duration, side effects of medication including sexual dysfunction with SSRIs and SNRIs and in cases of treatment of major depression not responding to drugs fear of use of ECT. New modalities including Transcranial Magnetic Stimulation will hopefully overcome this.

Prof. Leon Piterman

There are three certainties in life. Death , taxes and change.

Predicting the future of general practice is fraught, however what is certain is that it will change in the next decade and even more so in the decades to follow. I am not qualified to predict the future of general practice in Fiji, but I am sure it will be shaped by climate change, globalisation and chronic disease with outbreaks of communicable disease.

In Australia, the forces for change include population growth, ethnic and cultural diversity, aging and chronic disease, social inequality, rising mental health problems, drug addiction, domestic violence, consumerism and Dr Google. These problems are occurring at a time when the GP workforce is changing. Increased feminization, full time to part time, personal clinic ownership to corporate ownership, procedural deskilling, loss of self esteem, professional burnout, poor retirement planning. The government as the dominant 3rd party payer through Medicare is able to blame GPs through their gatekeeper role, for the escalating cost of health care. In fact the government faces serious budgetary concerns in the coming decades as people living longer expecting high quality care including replacement of failing parts. It is likely that the current 9% of GDP spent on health could rise to 18% in the next decade as the baby boomers are in their 70s and 80s with 25% of the population aged over 65 and no longer working to contribute to the tax base. GPs may be perceived as overtrained and too expensive and replaced by nurse practitioners, fee for service will no longer be viable and health insurance through rising costs will be the domain of the rich.

Developments in technology will broaden the scope of practice with genetic testing routinely applied to preventive care, pharmacogenetics to drug prescribing, targeted therapies for cancer treatment, subcutaneous chips for monitoring blood chemistry and cardiac and neurological dysfunction as well housing personal health records. Are we ready to face the new world? How well are our medical schools and institutions resourced to graduate the GP of the future? Currently our medical schools are producing excessive numbers of graduates many of whom face unemployment. Will Australia become an exporter of health care to the region? The crystal ball provides exciting challenges.

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MBBS, MD, MMed, MEdSt, FRCP(Edin), FRACGP

Dr. Philip Lim

Musculoskeletal Medicine, Northside Physical Medicine Suite 105, 2 Atchison Street, St Leonards NSW, Australia Philip is a medical practitioner with special interest in musculoskeletal medicine and is in private practice on the North Shore of Sydney, in sunny Australia.

Philip grew up in Malaysia and was educated in the UK. He graduated from the University of London (MB.BS.) in 1985. He moved to Australia in 1987 and attained a Masters of Medicine in Physical (musculoskeletal) Medicine from the University of Sydney in 2002. With over 30 years experience in medicine, his interest is in Manual Therapies along with Regenerative Orthopaedic Medicine using Platelet Rich Plasma injections to both ligaments and joints under ultrasound guidance.

He is a Foundation Fellow of the Hong Kong Institute of Musculoskeletal Medicine, past Fellowship Examiner for the Hong Kong Institute of Musculoskeletal Medicine and Member of the Australian Association of Musculoskeletal Medicine and the American Association of Orthopaedic Medicine. He is the first Australian to attain accreditation in Prolotherapy from the American Association of Orthopaedic Medicine.

Philip has conducted workshops for GPs in Sydney in orthopaedic examination and treatment in manual therapies and regenerative injections. He has also presented in Venice at the Biobridge conference on his approach to regenerative injections as well as in Hong Kong.

He has been in private practice in Sydney for over 13 years and look after patients with chronic pain and degenerative musculoskeletal ailments. His treatment modalities are well documented in his website:

www.northsidephysicalmedicine.com.au TOPIC: GP skills in MusculoSkeletal Medicine Prolotherapy and Pain Management (Offering a Complete Healing Approach).

Diagnostic Quiz Prof. John Murtagh A challenging quiz has been developed to test the clinical skills of the participants. Approximately 20 case histories encompassing clinical scenarios will cover important common problems as well as a selection of uncommon but important cases which are real brain teasers.

Prof. John Murtagh John Murtagh is Emeritus Professor of General Practice, School of Primary Health Care, Monash University; Professorial Fellow in the Department of General Practice, University of Melbourne and Visiting Professor, University of Peking, Beijing. He is the author of several publications including Murtagh’s General Practice, General Practice Companion Handbook, Patient Education, Practice Tips, Cautionary Tales, Murtagh’s Diagnostic Strategies, Murtagh’s Flash Cards (App), Back pain and spinal manipulation (co-author).

In 1995 he was awarded the Member of the Order of Australia for services to medical education, research and publishing. He continues to give keynote lectures, author books and consult private patients.

In addition there will be matching items linking famous people to their cause of death. Example: A 16 yr female students dies without a diagnosis for her chronic fatigue and anorexia (present for 6 months). Symptoms; severe fatigue, somnolence, weight loss, vomiting (X 5 per week), syncope especially with venesection. Examination by 3 doctors found ‘nor remarkable’ although her father thought that she had slightly change colour. First line investigations normal.

Helpful tips for the GP (Prof John Murtagh) - Many ‘tricks of the trade’ will be outlined in a demonstration presentation included are treating supraventricular tachycardia with a slick valsalva manoeuvre using an empty 20ml syringe: clearing Eustachian tube blockage : foreign body in a child’s nose: mosquito bites: hiccups: emergency splint for babies and toddlers & many others.

Current Surgical Management of Breast Cancer in Australia

Dr. Kampta Prasad Samalia

F.R.A.C.S. – Urologist Surgeon Consultant Urologist Dunedin Hospital, Visiting Consultant Urologist Mercy Hospital, Clinical Leader Dunedin Hospital 2000 – 2013 (Urology Department), Senior Clinical Lecturer University of Otago (Urology).

ABSTRACT:

To help GP’s recognise common urgent conditions and treat it Most can be managed and followed by GPs Some need referral to hospital for further treatment.

Dr. Joon Kim MBBS FRACS General & Breast Surgeon

The Surgical Management of Breast Cancer in Australia has evolved and been refined in the last 15 to 20 years based on evidence based medicine. My talk will aim to inform delegates on the current surgical management of breast cancer in Australia. It will focus on the techniques, the benefits as well as the challenges of the current surgical management recommendations.

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ABSTRACT: Coronary Artery Disease Pattern In Fiji And Diagnostic Aspects Angiographic Prevalence of Obstructive Coronary Artery Disease in Fiji

Dr. Bharatvansh (Bharat) Bali Specialist Physician/Cardiologist Lautoka Hospital, Fiji

Dr Bharat is one of the emerging young leaders in cardiology in Fiji. Having finished his Masters in Internal Medicine, he was very keen on furthering his cardiology knowledge first as a specialty interest in CWM Hospital in Suva and later a one year General and Invasive Cardiology Fellowship in Auckland, New Zealand where he trained in angiography, angioplasty and pacemaker implantation.

Following his fellowship, Dy Bali returned to a Specialist position in Fiji where he provides Medical and Cardiology Services in Lautoka Hospital.

Dr Bali’s Masters was centered on prevalence of cardiac disease in Fiji and access to care. He remains very conscious of the limited resources in his country but the abundance of good will, enthusiasm and willingness to improve observed in many of his generation.

Dr. Ali Khan MBBS, FRACP, FCSANZ Interventional Cardiologist, Auckland, New Zealand Dr Ali Khan is a Senior General and Interventional Cardiologist working at North Shore Hospital, Auckland, New Zealand. Ali did his post-graduate training in Cardiology in Auckland before undertaking Interventional Cardiology Fellowship training in the esteemed William Beaumont Hospital in Royal Oak, Michigan.

Dr Khan has interests in both Invasive and Non-invasive Cardiology, Catheter based Cardiac and Endovascular interventions, CT coronary angiography, General and Preventative Cardiology, Cardiomyopathies, Cardiac Rhythm disorders, and Metabolic disorders associated with cardiovascular disease. He has a prticular interest in complext coronary interventions including chronic total occlusions and debulking procedures.

Introduction: The angiographic prevalence of Obstructive Coronary Artery Disease (OCAD) in Fiji is not known. The angiographic prevalence of OCAD at CWM Hospital Cardiac Catheterization Laboratory would reflect on the burden of disease on the health sector, assess the diagnostic yield of referral strategy and effectiveness of non-invasive testing. The study also aims to determine the predictors of obstructive coronary artery disease. Furthermore, the proportion of Single vessel (SVD), Double Vessel(DVD) and Triple Vessel (TVD)Coronary Artery Disease can be obtained.

Method: A descriptive, unicenter, retrospective record review of patients undergoing invasive coronary angiogram from June 2009 to May 2014 at CWM Hospital Cardiac Catheterization Laboratory. Out of 708 patients, 463 cases were analyzed.

Results: The angiographic prevalence of OCAD at the CWM Hospital Cardiac Catheterization Lab is 82.5% from June 2009 to May 2014. Out of the OCAD cases, the proportion of SVD is 23%, DVD 22% and TVD 55%. The angiographic prevalence of significant Left main coronary Artery Disease is 11%.

The clinical predictors for OCAD are Diabetes Mellitus Type 2 OR=2.18, (95 % CI 1.31-3.62) ,p=0.003, Hypertension OR= 1.791 (95 % CI 1.09-2.9) p=0.026, Current Smoking OR 3.85 (95 % CI 1.96-7.52)p<0.005, Dyslipidemia OR =2.71 (95 % CI 1.64- 4.47) p<0.005, Family History of CAD, OR=2.01 (95 % CI 1.23-3.26) p=0.006 and the presence of definite angina on history OR 4.78 (95 % CI 2.52-9.04) p<0.001. The non-invasive predictors of OCAD are a positive EST with OR=3.31 (95% CI 1.16-9.40), p=0.04 and presence of Regional Wall Motion Abnormality( RWMA) on Echocardiogram, OR=3.96, (95% CI 2.02- 7.74), p<0.001. The risk of complication from invasive coronary angiogram is 0.86% per procedure.

Discussion: The angiographic prevalence of OCAD at the CWM Hospital Cardiac Catheterization Lab is significantly high with a high proportion of TVD and high prevalence of Left Main CAD. Fiji needs a local Percutaneous Coronary Intervention (PCI) service and plan for establishment of cardiothoracic services in future to provide Coronary Artery Bypass Grafting( CABG).

Dr. Seif El-Jack MBBS, FRCP (UK), FRACP, FCSANZ, FACC, FSCAI Interventional Cardiologist, Auckland, New Zealand

Dr. Parma Nand MBBS, FRACS (Gen Surg), FRACS (Cardiothoracic) Cardiothoracic Surgeon Auckland, New Zealand

Seif El-Jack is a general and interventional cardiologist based at Auckland’s North Shore where he is the Lead Interventional Cardiologist and the Director of the Interventional Research Programme at the CardioVascular Unit, Waitemata DHB. Starting in the UK, Seif finished his general cardiology training at Greenlane and Auckland City Hospitals where he also completed an Interventional Cardiology Fellowship. Seif undertook a further interventional cardiovascular fellowship at William Beaumont Hospital, Michigan, USA. He has subspecialty interest in ischaemic heart disease treatment and prevention, coronary and non-coronary interventions and device-based interventional treatment for hypertension. Seif has maintained a keen interest in academic cardiology and leads a busy Interventional Cardiology Research Programme at North Shore Hospital which actively participates in international and local research with several relevant publications in interventional cardiology in peer reviewed journals.

Cardiothoracic SurgeonMr Parma Nand, is a senior cardiothoracic surgeon in Auckland City Hospital New Zealand. He has extensive qualifications and working experience in Fiji, the UK, Canada, Australia and New Zealand.

He has been coming annually to Fiji since 2010 as part of the Australia-NZ ‘visiting-team’ doing angiography and angioplasty at CWM Hospital. He is preapring for another visiit in September 2017.

Parma Nand specialises in Coronary Artery Bypass Graft (CABG) surgery, valvular repair, aortic surgery and transplant surgery.

Fiji-born Mr Nand maintains a very close relationship with Fiji Islands: he is one of the founding members of the charitable Friend of Fiji Heart Foundation and has lead the annual surgical mission since 2006 with major contributions towards the health and well-being of numerous Fijians. Parma and FOFHF continue their dedicated work with the next visit planned for September 2017.

Fiji College of General Practitioners 11 Annual Conference Magazine 2017

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ABSTRACT 2: Village based Rehabilitation programs following injury or disability.

Keywords: Rehabilitation, Community, Village Health Nurse

Rehabilitation programs help people with a disability to achieve an optimal level of performance and improve their quality of life [1] while preventing complications from medical conditions. Rehabilitation focuses on the attainment of functional goals that are important to the individual’s physical, mental, spiritual, sexual and social health [2]. There are limited rehabilitation opportunities for a Fijian person living with a disability because of a lack of rehabilitation services, financial barriers, or reduced awareness of a person’s rehabilitation potential.

Mr. Shane McSweeney

Occupational Therapist President of Coral Coast Rehabilitation

ABSTRACT 1: Supporting Diabetic patients in the community with appropriate Rehabilitation services.

Keywords: Diabetes, Rehabilitation, Village Health Nurse

Fiji, like many Pacific Island nations has a significantly high incidence of diabetes, both controlled and non-controlled. ‘Coral Coast Rehabilitation’ (CCR) in conjunction with the village health nurses and communities of Korolevu-i-wai have been developing programs for diabetics to increase health awareness, improve monitoring and provide rehabilitation programs to support patients with diabetic foot complications and lower limb amputations. CCR annually brings a team of Rehabilitation health professionals to Fiji to conduct rehabilitation clinics and provide diabetic foot focussed therapy including foot care education, exercise programs and gait education.

Programs are focussed on empowering the village nurse with education and knowledge on how to assess and monitor the health of people with diabetes, when and why to refer such people to the local GP, and how to complete recommended therapy programs developed by our team. To support this initiative CCR has invested significantly in the region equipping each village health nurse with a blood sugar level (BSL) machine, yearly supply of BSL strips, education on how to use these tools and interpret results.

Such programs have proven to be a huge success as village nurses are now able to check weekly BSL readings of their patients, increase nurse contact time within their community and develop a greater involvement in improving the health of the community. The diabetes management initiative has closely included the Korolevu Health Clinic staff to whom the village nurse passes on the statistics for patients BSL readings. This process improves the understanding of a patient’s condition and the management required to improve their health status.

Diabetic foot care and management of complications are a major concern given most patients do not receive or access any comprehensive rehabilitation services in the region. Along with the support of the village health nurse, Health Clinic, and family, therapy programs are developed to support a person living with an intact diabetic foot (with the goal to develop a healthy foot), and to provide appropriate pre amputation therapy advice and post-operative therapy programs.

Although the community are aware of diabetes, the psycho-social elements and long term impacts of uncontrolled diabetes are still greatly under-valued and largely ignored. Our team is focussed on empowering the community with accurate and meaningful education about diabetes and preventative care to avoid complication such as foot ulcers and amputation.

CCR are focussed on reducing the stigma of diabetes by empowering the village nurses to take an active position in their communities with the appropriate equipment, education, and skills to help support the diabetic patients and local Health Clinic staff.

This presentation will focus on this successful Village based Diabetes initiative and how this can be replicated in other regions of Fiji.

‘Coral Coast Rehabilitation’ (CCR) was developed after hearing stories of people’s suffering while living with injuries or disabilities in Fiji, when these people could potentially be helped by rehabilitation interventions.

CCR was formed in 2014 to develop rehabilitation services in the Korolevu-i-wai community. Consultation included assessing the needs and wants of the village health nurses, local Medical Clinic, along with consultation with the Chief, Elders, and other stakeholders. Each year a team of Rehabilitation Health professionals run clinics in the village, including in people’s homes, to assess and provide treatment options and therapy plans. A collaborative relationship between CCR staff, the village nurse, family and GP ensures ongoing support is provided for the person to continue their rehabilitation program with the family or village nurse when the CCR team returns to Australia. Subsequently CCR focus on a ‘Village Up’ model.

A key focus of CCR is transference of knowledge to village nurses by providing education in the principles of rehabilitation (e.g., patient assessment, identifying treatment goals and planning therapy programs) and training in specific skills for health promotion (e.g., blood sugar and blood pressure monitoring, providing advice regarding diabetic foot care and healthy diet). The aim is to empower and up skill the village health nurse by building community awareness of their role and increasing their confidence in providing health care. CCR has a focus to provide a culturally acceptable rehabilitation service that collaborates with local health services, while making therapy non-intimidating and fun.

CCR’s village health model, program structure, achievements and future plans will be presented.

1. Medicine, A.F.o.R. [cited 2017 11 January]; Available from: https://www.racp.edu.au/about/racps-structure/austrasian -facuty-of-rehabilitation-medicine.

2. Stiens, S., B. O’Young, and M. Young, Person-centred rehabilitation: interdisciplinary intervention to enhance patient enablement, in Physical Medicine and Rehabilitation Secrets, B. O’Young, M. Young, and S. Stiens, Editors. 2002, Hanley and Belfus: USA. p. 4-9.

Dr. Oripa Bune Graduated with MBBS-2011, PGDCH-2016.

Served in Serua/Namosi Subdivision as Medical Officer for Korovisilou Health Centre in 2013.

Joined the Paediatrics Department at Lautoka Hospital in 2014-2015, and CWM-2016.

Currently on Oncology Rotation.

ABSTRACT: Overview of Childhood Cancers & Services in Fiji (Statistics 2013-1st Qtr 2017).

There has been documented evidence of late presentations of childhood cancers. Hence the need for Awareness on Early Recognition of Signs of possible Cancers, & Posters.

Fiji College of General Practitioners 13 Annual Conference Magazine 2017

14 Fiji College of General Practitioners Annual Conference Magazine 2017

Dr. Alice Bourke

MBBS, FRACP Geriatrician Royal Adelaide Hospital South Australia

ABSTRACT: Medications in the elderly

A.Prof. Jagdish Maharaj

Senior Consultant in Rehabilitation Medicine, Lourdes Hospital & Community Health Service, Australia; & Clinical Associate Professor, Sydney Medical School, University of Sydney.

In Fiji life expectancy is 67 years for males and 73 years for females and approximately 6% of the population is over 65 years of age. In developing countries, the proportion of elderly using at least one medication daily can be up to 90% and the elderly population is the group most likely to have medications prescribed. Common chronic conditions such as ischaemic heart disease and diabetes are amongst the most common causes of premature mortality and morbidity. As the population ages appropriate medication prescribing and use are increasingly important. Pharmacodynamics and pharmacokinetics change as we age and therefore medication prescribing is more complex.

The evidence in clinical trials to guide therapy is lacking for older people and those with multiple comorbidities. Polypharmacy which is prescribing > 5 medications is an increasing problem. Several criteria can help us identify potentially inappropriate medications for older people and guide prescribing and deprescribing.

ABSTRACT: Rehab in 2025

The discipline of Physical and Rehabilitation Medicine (Rehab) has really only developed its niche since early in the last century. The ongoing epidemiological, demographic and psycho-socio-economic transitions in global populations, along with the emergence of chronic disabling conditions causing years of healthy life lost to disability (YLD) has seen the demand for physical rehabilitation grow exponentially.

The World Health Organization framework for the practice of Physical and Rehabilitation Medicine was first established in 1980 as the International Classification of Impairment, Disability and Handicap (ICIDH). This further evolved into International Classification of Functioning, Disability and Health (ICF) in 2001 with strong emphasis on client-focused interdisciplinary coordinated care both in institutions and within community settings.

Rehabilitative services, physical therapies and interventions can be provided in different settings under the recognized best practice guidelines and principles for optimal client outcomes. Institutional-based rehabilitation, rehabilitation in the community and Community-Based Rehabilitation form very important aspects of effective individual focused rehabilitation service provision models.

While pioneering the specialty for spinal cord injured WWII returned servicemen and women at the Stoke Mandeville Hospital, Dr Ludwig Guttmann introduced sports as a mode of rehabilitation.

This presentation will discuss current evolving practice trends and therapeutic modalities in Physical and Rehabilitation Medicine with some specific examples including the use of stem cell technology, biorobotics and brain-computer interfaces for neuroprosthetic devices. Escalating global projections of disabling conditions with corresponding increase in the burden of YLD indicate that there is and will continue to be a growing need for Physical and Rehabilitation Medicine that is limited by our innovations, imagination and the integration of technology into best practice. Rehab in 2025 will be a shared vision.

Dr. C. K. Reddy

DSM Fiji 1979, FRACS, General & Laparoscopic Surgeon - Hamilton Braemar Private Hospital - Clinical Committee Member Southern Cross Hospital - Hamilton. Anglesea Private Hospital Senior EMST instructor â&#x20AC;&#x201C; RACS

ABSTRACT: The General Practitioner, Surgical Team and Medical Errors

Preoperative planning and execution is critical to obtain best surgical outcome. Obesity, uncontrolled Diabetes Mellitus and smoking increases the morbidity and mortality in surgical patients.

Reducing the pre-op risk factors improves the surgical outcome. The role of the General Practitioner is crucial in correcting some of the risk factors.

Medical errors (adverse events) are common and caused by medical management rather than the underlying condition of the patient. Medical errors are the third leading cause of death. Why does it happen? How should we respond? How can we prevent them?

Naming, blaming and shaming have no remedial value. It is simply not acceptable for patients to be harmed by a health care system that is there to offer healing and comfort.

Recent studies have shown that poor teamwork and communication in operating theatres have a negative impact on performance and patient safety. In 2008, World Health Organization introduced the safety checklist as a tool for clinicians to improve safety in operating theatres and to reduce unnecessary deaths and complications.

Communication breakdown is reported as the root cause in more than 50% of operative and postoperative events. The checklist has reduced the overall complication and death rate. Checklists need limited financial resources to be introduced into hospital systems.

Newer technology introduces new and unique potential complications. It is no longer acceptable to train on patients to upskill surgical techniques. Simulation and training courses have been introduced to minimise complications.

ABSTRACT: Lifestyle Influences on Fertility The desire to have a family is, for most of us, a strong one, and not being able to fulfill that basic need is enormously traumatic. The impact of infertility can be devastating not only for the couples but also for the future planning of nations.

Dr. Sunil Pillay

Whilst researchers are making great progress in the ever changing landscape of fertility medicine, couples health and their behavioral patterns are also of paramount importance. This session will be anevidence based discussion on how our lifestyle influences our fertility and the simple measures that could profoundly improve both our natural fertility and outcomes of success with advanced fertility interventions.

Fiji College of General Practitioners 15 Annual Conference Magazine 2017

16 Fiji College of General Practitioners Annual Conference Magazine 2017

ABSTRACT: Cerebrovascular Disease Spectrum Stroke remains the forefront runner as the cause of death word wide . It is the most devastating acquired adult neurological disease. For every stroke there are at least 5 other significant ones affected.

The talk will try and encompass its current status in terms of diagnosis, realistic investigations and management options in private and hospital setting and future trends /options available .

Dr. Krishant Sarat Naidu MBBS, PGDipSPMED, FACSEP

Dr. Ajay Kumar

ABSTRACT: Sudden Cardiac Death and Cardiac Screening in Athletes

Focus will be on TIA/minor strokes, stroke subtypes and prognostication .Treatment options current and future. Post stroke issues â&#x20AC;&#x201C; the unmet need.

Crystal gazing into 2025 and beyond.

Aim - To review the current evidence and best practice guidelines regarding sudden cardiac death and cardiovascular screening in athletes.

Method - Medline Literature search - Review of current cardiovascular screening guidelines

ABSTRACT:

Results

- Sudden cardiac death in athletes is an uncommon but devastating condition.

- The incidence varies among population groups based on ethnicity.

- Cardiomyopathy and congenital anomalies are the most common cause, followed by arrhythmias and infectious.

- Males are 9x more commonly affected.

- 75% of patients will have structural abnormalities at post mortem.

- Strenuous exercise increases the risk of death in predisposed individuals 2.5x - Exercise produces normal functional and structural cardiac adaptations that need to be distinguished from pathology that increases risk.

- 75% of athletic patients are asymptomatic prior to a sudden cardiac event.

- Cardiac screening and subsequent exclusion of at risk athletes from high level exercise has been shown to decrease the incidence of sudden cardiac death.

- A pragmatic approach to screening is advised, with a clinical history, examination and electrocardiogram.

Dr. Gyaneshwar Rao Specialist Physician, C W M Hospital, Suva

Rationale Usage of Anti-Epileptic Drugs

Seizure disorders are a common occurrence encountered by most medical personal in different areas of medicine. They can be provoked or unprovoked.

Epilepsy is generally an unprovoked seizure disorder occurring more than once. Many other conditions may mimic epilepsy and hence a firm diagnosis needs to be established before any anti-epileptic drugs are instituted. While some newer anti epileptics drugs are available now the traditional drugs have their importance in the treatment of epilepsy in Fiji. The choice of drugs depends on the type of epilepsy diagnosed. My talk will focus on the rationale use of anti-epileptic drugs in the management of seizure disorders.

Fiji College of General Practitioners 17 Annual Conference Magazine 2017

Mahanarayan oil Cedrus Deodara Oil

Vatanashak oil

Cinnamomum camphora Eucalyptus Oil

Wintergreen Oil

Tarpene oil

Headache Vigna mungo oil

Stiff Neck Shoulder Pain Lumbago Sciatica Knee Pain Mascular Sprain and Inflammation

18 Fiji College of General Practitioners Annual Conference Magazine 2017

Ankle Pain

Dr. Vimal Chand

Dr. Vinod Singh

BMLSc, MB chB, Otago, (N.Z), FRACGP, Cert MLT, (FSM), Fiji. Member Obesity Interest Group, NSW. FRACGP - GP Astley Medical Centre, St Mary’s.

DSM ( Fiji ) FRACP. Distinguished Clinical Teacher and Senior Lecturer, Medicine, University of Auckland.

Senior Consultant Physician Acute Stroke and Internal Medicine, WDHB, Auckland, NZ.

ABSTRACT: Obesity: The Tsunami

ABSTRACT: Management of Hype- Acute Stroke

Obesity is a complex, multifactorial chronic disease with genetic, environmental, physiological and behavioural determinants that requires long term care.

The biggest advance in the treatment of hyper-acute stroke has been made from increasing physician awareness and the much improved patient awareness of stroke.

According to the World Health Organisation, nine of the top ten most obese countries or territories in the world, are from the Pacific Islands.

FAST ( Face Arm Speech and Time ) campaign launched in NZ in July last year has contributed to a % increase in the rate of Thrombolysis at our hospital (a population of 500,000 patients and largest DHB in NZ ).I will discuss how this has been achieved and how it has changed the outcome of many stroke patients.

Obesity is associated with a broad range of complications including cardiovascular disease, diabetes, sudden death, sleep apnoea, osteoarthritis, and several cancers.

The paper will highlight prevalence and cost to communities and patient centred approach to the management of obesity.

Discussion will focus on lifestyle change, diet, exercise, motivational interviewing, pharmacotherapy and surgery in management of obesity.

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In hospital management of hyper acute stroke has evolved rapidly with Thrombolysis, Clot retrieval, and hem- crainectomy for malignant stroke being the rule rather than exception for the appropriate patients. Super early plain CT scan with adjunct CT angiography and CT perfusion scans of brain have revolutionized the treatment of hyper acute stroke . I will show some case examples to high light this.

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© 2017 Hologic, Inc. ALL RIGHTS RESERVED. Cynosure and Pellevé are registered trademarks of Hologic, Inc. Emerge and Love Looking Good are trademarks of Hologic, Inc. Fiji College of General Practitioners 19 Annual Conference Magazine 2017

Dr. R Ponnu S Goundar

MBBS DCP FRCPA DAvMed FFCGP MACLM

Dr. Mary Schramm

ABSTRACT: Paraquat Poisoning In Fiji

ABSTRACT: The Dangers of Reinventing the Wheel

Paraquat poisoning is common in Fiji. This is mostly seen in younger age group. The reason for suicide by paraquat ingestion is disappointment in their life. Paraquat affects multiple organs, chiefly the lungs. The is mostly from pulmonary function failure.

Paraquat is a strong weed-killer, and is available freely in the shops in Fiji. There are no restrictions.

Biological science has progressed by leaps and bounds in my lifetime, and with it, our capacity to understand and modify the processes of health and disease.

Suicide – Paraquat

Paraquat was first synthesized in 1862 but it’s herbicidal property was recognised in 1955.Paraquat was manufactured and sold by Imperial Chemical Industries in 1962. It is most commonly used herbicide.

In Fiji, next to suicide by hanging, paraquat is used for suicide much more commonly. This is evident from the figures supplied by the Commissioner of Fiji Police Force. Paraquat is easily available to anyone from the outlets. There are no restrictions for sale of paraquat in Fiji. In United State of America one has to have a licence to procure paraquat.

Paraquat is a multi-organ toxic substance. It primarily affects the lungs and death is due to pulmonary failure. Besides the lung, paraquat toxicity affects the liver, kidneys, brain and gastro-intestinal tract.

Though the number from suicide by paraquat is less compared to suicide by hanging, but the process of death is incomprehensible. Death is really a torture and sometime prolonged due to severity of the lesions produced by paraquat. Whereas in hanging death is instant more or less.

With tuberculosis potentially conquered, vaccinations against and growing number of the pathogens of contagious diseases, and biochemistry becoming a clinical tool in real time, and the absence of a World War for 70 years now, life should have been good. n our Pacific island nations we usually have to wait for access to “the latest”. But this same time time lapse, allows us to choose the innovations which have sustained their early promise, and spend our dollars on second and third generation, lower cost, low-maintenance, high-tech equipment.

We are members of a profession that has through many bonded itself into to the Hippocratic ethics of service to our common humanity; of loyalty to our patient and our communities.

There are forces that have the power to erode and damage our humanitarian service, and many of them come disguised as “progress” Our defence is to carry a healthy scepticism with us, while we give of our best within the limitations of the knowledge available, and the working hypotheses of our time.

It is time we all have to stand together and approach the authorities collectively to look into paraquat sale and suicide by paraquat.

SIGATOKA Ph/Fax: 650 0223 Mobile: 893 3151

Dr. Reeta Lochan

BSc.; DSM (Fiji) ; Post-Grad Dip in Rehab.

Diploma in Industrial Health (Otago University) FRNZCGP. General Practitioner, Hamilton, NZ. Medical Appeal Board Member & Designated Doctor-Work and Income New Zealand.

Vocational Medical Service Provider, ACC.

Dr. Ravi Naidu

MBBS, PGDip Internal Medicine Masters in Internal Medicine Medical Consultant CWM Hospital

ABSTRACT:

Ms. Rashika Goundar

Bachelor of Pharmacy, Fiji National University, Fiji Islands Master of Clinical Pharmacy, Curtin University, Australia

Antimicrobial resistance in Fiji: here, now and in the future

Antimicrobial resistance (AMR) has been recognised as one of the greatest threats to global health, food security and development today.

While AMR is a natural phenomenon, the process is being accelerated by the overuse and misuse of antimicrobials in humans, animals and agriculture. By the year 2050, it is estimated that 10 million people will die per year due to AMR and up to 3.8% of the global economy will be lost if no action is taken. Improved diagnostic testing and some new antimicrobials are expected to reach the market by 2025 but are not in any way a substitute for judicious antimicrobial use. The United Nations and other international organisations acknowledge the magnitude of this problem and have committed to urgent collaborative multi-sectoral action to tackle AMR. Fiji has been a leader in the Pacific region, with the endorsement and ongoing implementation of the Fiji National AMR Action and Operational Plans. The private sector plays a critical role in the fight against AMR as the majority of antimicrobials are prescribed in this setting. A recent local study demonstrates an increasing number of fluoroquinolone prescriptions from general practitioners being dispensed by private pharmacies in Fiji and further surveillance and investigation of local susceptibility patterns and indication for broad spectrum Gram-negative cover is warranted.

ABSTRACT:

Stress, Stress related illnesses and Management - GPâ&#x20AC;&#x2122;s Perspective.

The WHO Global Burden of Disease Survey estimates that mental disease, including stress related disorders will be the second leading cause of disabilities by the year 2020. WHO Data reports Ischaemic heart disease and stroke have been leading causes of death globally for past 15 years. Diabetes related deaths were up 2.8 % in 2015.

Although the final outcome of these chronic diseases depends on obvious medical, pathological and physiological factors of the condition, the role of stress caused from personal, emotional, behavioural , psychosocial, and environmental factors should not be ignored. Humans are provided with efficient physiological pathways to cope with stressors. A large body of evidence suggests that prolonged activation of physiological stress responses is harmful to humans. Stress makes us more vulnerable to disease and has the potential to make a condition worse eventually leading to death .

Dysfunction and disease of digestive, cardiovascular, reproductive, urinary systems; addictive disorders, depression and anxiety disorders, weakened immune systems, headaches and sleep disorders are most common presenting stress related disorders seen in clinical practice .

The evidence that stress can cause cancer is weak (breast, bowel, lung or prostate â&#x20AC;&#x201C; meta analysis 2013). There are links for developing certain behaviours due to stress that increase cancer risk It has been demonstrated that individuals with stress and stress related disorders experience impaired physical and mental functioning, more days off work and are high users of social services and health care services.

It is reported that only 3% of the patients get advice on stress management.

Early recognition and discussing/providing appropriate stress management strategies is essential for prevention of disabilities , improving outcomes and quality of life for our patients.

Fiji College of General Practitioners 21 Annual Conference Magazine 2017

Dr. B. P. Ram

DSM (Fiji), DTPH (Aust), HPM (Harvard), FRSTMH (London), Fellow of the FCGP Dr. B. P. Ram, Head of Community Medicine [UMANAND PRASAD SCHOOL OF MEDICINE & HEALTH SCIENCES – UNIVERSITY OF FIJI]. He has led evaluations of National health and WHO related country level initiatives and Continues to provide Consultation to State and International Public health Agencies, Aid Donors and Professional bodies. He is a Research analyst on Infectious diseases trends, status and building an outstanding information resource to medical education.

ABSTRACT: Infectious Disease trends 2025 - Challenges for Fiji Surveillance GP Net in Mortality, Morbidity, Risk Patterns and Case Burden Reductions.

Infectious Disease trends into 2025 will bring many more issues beyond the realms of the medical profession. The less known hidden genetic changes from infections occurring in the communities in the form of “Gender change” taking place is a reality. You can do something now to guard your wellbeing, past your life and that of your progeny. Anti-septic, sterile and pure living only will save life on earth.

Antibiotic resistance keeps growing and the world is running out of treatment options while the new drugs being needed would not be developed in time mostly for gram negatives as pharmaceuticals had concentrated on against gram positive bacterium. WHO has drawn up a list of highest priority needs for new antibiotics; examples of these and newer bugs would be discussed. Locally in Fiji a National status Report needs to be complied and focus on Health Safety Advisories extension Services and GP Networks.

Ashnit Kumar

MBBS Student - UPSM

He has led teams in Public health tours, Preventive health Screening, Monthly Public health Forums, directing Student initiatives and is the Chairperson of the UPSMHS “Community Care and Public health Preparedness Team [CCPHPT]” being instrumental in Continuing to make presentations at FCGP Western Journal Clubs while pursuing his community outreach works since 2016 - both local and internationally Monash University Students projects with UniFiji - UPSMHS. [MBBS 4 and Sponsored by Dr. Muang Mon].

ABSTRACT: Shangri La Recommendations on Health Interventions outcome for ACATA - Shangri La Hotel Staff; (a three year follow of Staff and families - a Corporate Health Initiative).

This presentation highlights a Programme addressing the Wellbeing issues of the Workers and Concerns for the Future of the Resort Staff /Employees, Families and the Coral Coast Community. The Shangri La Management drafted and implemented the programme through ACATA Trust -Health & Wellness Policy frame and rolling out the first holistic corporate health program amongst top corporates in Fiji, working towards steering the population away from NCDs. To achieve this innovative public health interventions objective the Management undertook to implement the staff health – welfare long-term training programme through the full assistance and with full involvement of all hotel employees to: a). Develop Staff capacity for self – determination regarding health, fitness and proper nutritional service and practices. b). Deploy System to monitor staff improvements such as changes in work attendance, performance, coping, member usefulness to family-children / the aged and community. c). Assist staff at disadvantage by isolation, identification of high-risk health conditions and special attention to workers’ existing disease and those progressing towards bad health status.

The findings of this Corporate health programme are discussed at length.

22 Fiji College of General Practitioners Annual Conference Magazine 2017

Dr. Shunil Sharma

MBBS, FRACP. Consultant Rheumatologist

ABSTRACT: Rheumatoid arthritis - Diagnosis and Management Rheumatoid arthritis is a chronic inflammatory autoimmune disease which affects up to 1% of the population. Whilst it primarily involves the joints in a bilateral symmetrical manner, there are several atypical presentations as well and ultimately significant systemic disease with end-organ involvement. It commonly presents with painful swollen and warm joints which progressively become worse.

Whilst the cause of this disease is unknown, it is felt that there is a combination of genetic factors with environmental triggers which is start it off.

Research into of the causation has led to significant advances in the treatment in the last decade. There is a small window of opportunity from the start of the symptoms to the diagnosis (6 to 12 months) before you start getting erosive changes and damage. It is imperative to make the diagnosis early and treat aggressively before the erosive changes evolve.

The goals of treatment are to reduce the pain and inflammation, improve the physical outcome and quality of life. In this presentation, I hope to introduce a paradigm of diagnosis, treatment and long-term management.

Miss. Joshila Lal

B.Pharm(Aust) MAIRD(Fiji) PGDTT(Fiji) DipSc -Herbal Med (Aust) MPS Vice President | Fiji Pharmaceutical Society Joshila Lal has been a lecturer in Pharmacy Practice at the College of Medicine Nursing and Health Sciences since 2009. She obtained her Bachelor of Pharmacy from Monash University and has worked in all areas of the pharmaceutical sector which includes retail, hospital and pharmaceutical industry.

Her interest in complementary and alternative medicine led her to pursue studies in herbal medicine and subsequently obtained a diploma in herbal medicine from Melbourne, Australia. Since then she has also completed her Masters and now pursuing her Masters in Tertiary Education.

She is the Deputy Head of School – Health Science, Fiji National University and is a board member of the Pharmacy Professions Board. She is also the board chair of a local NGO – Medical Services in the Pacific and board chair of the Fiji Pharmacy Standards Committee.

ABSTRACT: A Move towards Safer Prescriptions A prescription is a legal document written by an authorized person, usually a doctor which in turn authorizes the patient to be issued one or more medicines by a pharmacist. Most countries have their own prescription requirements and guidelines needed to make a prescription valid and which describes who is authorized to write a prescription. In Fiji, Essential Medicines Formulary (2006) which was previously known as Fiji Essential Drug list (EDL) outlines all the vital requirements of a valid prescription. The importance of a prescription is that it is a legal document and thus it has to be complete and legible to ensure that intended treatment is dispensed and chances of medication errors are minimized.

There are many reasons why medication errors occur. Illegible and incomplete prescriptions certainly contribute to increasing the risk of medication errors and causing harm to patients’. Many studies show alarming statistics of poor handwriting resulting in medication errors which usually prove to be dire for the patient and costly to the healthcare system. The good news is that these medication errors are preventable with the use of electronic prescription systems.

Hand-written prescriptions are still the preferred flavor in Fiji despite the many benefits provided by electronic prescription systems. Pharmacists have embraced this technology to assist with running their practices but it has been slow to catch on with the medical practitioners. Pharmacists in Fiji are dealing with a dangerous situation where illegible prescriptions vastly outweigh the legible ones and the solution for this would be to adopt systems which prevent such problems.

The world is progressing and we must embrace technology to move away from dangerous hand-written prescriptions and treat this very crucial, life-saving legal document with the utmost care. It is time the prescribers in Fiji embrace change and work smarter. After all, it is only lives that are at stake.

VanMed Labs is a private medical Laboratory. We provide pathological tests.

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- 9 branches in Fiji with 2 testing sites - 1 testing lab in Port Vila and 1 bleeding centre in Santo, Vanuatu - 1 testing Lab in Honiara, Solomon Islands

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Various tests done in-house include, ZIKA, ALLERGY RAST, LUPUS â&#x20AC;&#x201C; Antinuclear Antibody (ANA) Double Stranded DNA (dsDNA), Cancer markers, Lifestyle blood testing, Microbiology culture and sensitivity reports and many more. Enquire with your GP. Or call in directly.

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Samabula Lab closes at 9pm on weekdays. All labs open at 7.30am.

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Fiji College of General Practitioners 23 Annual Conference Magazine 2017

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Address Phone Email 24 Fiji College of General Practitioners Annual Conference Magazine 2017

107 Foster Road, Walu Bay, Suva 331 0022 hello@psh.com.fj

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