July 29, 2018
By Suzanne Semanson
It has been only two days since we left Pitcairn and already we are within hours of our next port, Mangareva. As Captain mentioned during our last muster, that’s hardly enough time to digest our time in Pitcairn. What I did not expect upon arriving at Pitcairn was that I would put my physical therapy skills to use there.
Pitcairners are a robust bunch, accustomed to highly demanding physical work, be it launching and manning their longboats and managing its cargo in high seas to any number of other physically demanding tasks that are required from a community of 50 individuals living on a high remote island in the middle of the South Pacific. With the remoteness of their island, injuries are often shaken off and pushed to the side because there’s work to be done after all.
Within the first couple of days, one of my shipmates brought his host to see if I would look at his shoulder. It was a Friday night; we were at Andrew’s place and a dance party was about to get started. Yet, one look at the owner of the painful shoulder told me otherwise. This interaction led me to make a visit to the island’s Health Clinic the next morning, in search of supplies. I met the island doctor, a modest, soft-spoken Romanian man who immigrated to Australia as a young boy who now specializes in Emergency Medicine with ample experience in remote, rural areas – the perfect area of expertise for his position. One of the things I learned from him is the high injury rate on the island due to the islanders’ physically demanding lives and jobs – I was also surprised to discover the high surgery rate among the Pitcairners as a result of years of strenuous work. The doctor explained to me that he is able to proficiently manage the acute situations locally or send people to Tahiti or New Zealand for surgeries (a seemingly common and costly endeavour). However, there are no allied health services on the island to help the biggest cohort of individuals who are managing injuries. These injuries may be for them to modify how they accomplish their daily tasks, but not serious enough for a surgery. That is true until they live long enough with an injury stubborn to heal, that may turn into a recurrent chemic condition that progresses to the point that surgery becomes the next step.
It didn’t take long for word to spread that there was a physiotherapist on the island. The doctor graciously turned their 2-bed hospital ward into an additional treatment room so that we could both treat our own caseloads. By the following day, I was holding office hours in the morning. The doctor and I had plenty of opportunities to consult with each other on various patient cases. What a fantastic experience it was to be part of a collaborative team of patient, MD + PT.
A few days later, the doctor approached me to express how clear it is to him that the island has a real need for physiotherapy services. This is true not only to more comprehensively manage musculoskeletal injuries and therefore improve the islanders’ chances to heal more effectively from these injuries, but perhaps I wonder if it could have an impact in their orthopedic surgery rate.
Surgery for an islander is an incredibly costly affair for the individual, the community, and their government. Getting the individual off the island typically means waiting up to 3 months for one of their 4 annual cargo ships and several thousands of dollars to get them either to Tahiti or New Zealand. They may be taking this trip alone or a family member may accompany them which doubles the financial cost as well as the human cost for the island to now be missing 2 individuals from their families and workforce. These surgical medivac trips often last several months for the healing to occur and to coordinate with the cargo ship schedule for them to return.
Back to my first patient with the painful shoulder. Long story short, he was supposed to leave the island on the August ship to have a 2nd surgery to deal with his shoulder pain. However, after receiving some physiotherapy (and anti-inflammatories), he said he’s going to hold off on surgery. Will this work longterm? No clue. But this at least gives him a fighting chance to rehabilitate his shoulder with PT intervention coordinated with pain management. Surgery is always meant to be the last resort for people. However, in the case of the people of Pitcairn Island, it becomes the 2nd step when RICE (Rest, Ice, Compression, Elevation and anti-inflammatories) and pain meds do not provide lasting relief. As part of the medical community, we can do better by them than that.
I am encouraged that the islanders and their doctor sees the value of having PT on the island. I am also hopeful that the doctor’s advocacy for the people of Pitcairn Island to the British government to offer PT services on the island will become a reality. In the not so distant future.
