RACS-ANZCA Annual Scientific Congress 2014

Rodney Mitchell of Adelaide chaired the inaugural Indigenous Health session at the RACS-ANZCA Annual Scientific Congress in Singapore on 9 May 2014. The following abstracts link to the presentations:

Indigenous Health Programs in North Dakota

Prof Robert Sticca

Cross-cultural delivery of anaesthesia

Dr Andrew Fenton

Indigenous Australian culture is one of the oldest living cultures in the world. It is also incredibly diverse; until relatively recently around 500 languages were spoken. Around 30% of the population of the Northern Territory are indigenous, of which close to 60% live in Very Remote Areas. At the largest hospital in the Top End, Royal Darwin Hospital, around 55% of inpatients are indigenous, 70% of whom do not speak English as a first language at home. Differences between the culture of Indigenous Australians and that of ‘Western Medicine’ contribute to the formidable barriers to accessing health care and achieving a more equitable health status. Communication with indigenous patients is complicated not just by the many different languages and dialects used across Australia, but also by nuances in non-verbal communication and even a fundamentally different understanding of health and disease. Although these challenges are not unique to Anaesthetists, they are often compounded by the time constraints that we work under, the complexity of the information we are trying to convey and the abstract nature of the risks we discuss.

Pancreatitis in indigenous patients

Dr Abraham Jacob, Dr Ollapallil Jacob, Dr Penny Stewart

Background

Many of the patients that were once doomed to die in the early stages of fulminating severe acute pancreatitis (SAP) now survive due to advances in intensive care. Those who do not promptly respond to intensive care management with persistent multi-organ dysfunction still have a high mortality. There is a role for early surgical intervention in two subsets of critically ill patients. The first, with Acute Compartment Syndrome (ACS) of the abdomen with persisting organ dysfunction and the second being overt infection of the pancreas with the presence of gas in the retroperitoneum, which may occur as early as the first week, contrary to the widely believed opinion that infection in a pancreatic necrosum is a late event.

Methods

The current study is an eight-year (2005-2012) study. The data was collected prospectively by the Surgical Department in Alice Springs Hospital. Intensive care data was also sourced from ANZICS CORE (Australia and New Zealand Intensive Care Society and Centre for Outcome and Resource Evaluation) for ICU mortality comparison between intensive care units of Australia and New Zealand and Alice Springs.

Results

There were 1163 episodes of acute pancreatitis with an annual incidence of 275 per 100,000. Of importance 114 had SAP of which 42 developed pancreatic necrosis. 11 patients required surgical intervention.

Conclusions

Early decompressive laparotomy with VAC (Vacuum assisted closure) laparostomy is essential for the survival of these select patients. We attribute the improved outcome in this cohort due to early surgical intervention.