Putiputi Charitable Trust
Pacific Urogynae Treatment Inititative
Rarotonga 
Aitutaki Hospital 
Rarotonga Hospital at night 
Recovery room 
View from a hill on Aitutaki 
Dr’s Basilli and Wallace operating together with Joyce Sakei as scrub nurse 
Mairi operating 
Surgical ward – Rarotonga 
Cook Island Hospitality 
Flying into Aitutaki 
Perineal tear workshop 
Rarotonga from the air 
Mangaia 
Looking from Rarotonga Hospital 
Clinic on Atiu
Introduction
The Putiputi Trust was established primarily to help women in the Pacific suffering from urinary incontinence and pelvic organ prolapse. It now also encompasses managing a broader spectrum of Gynaecological problems on some of the more remote Cook Islands and has made a major contribution to improving the standard of Anaesthesia and Intensive Care in The Cook Islands.
Incontinence and pelvic organ prolapse is neither life threatening nor painful and therefore often trivialised. The Putiputi Trust was established to help fund Urogynaecology services in the Pacific. Urogynaecology is a sub speciality of Gynaecology and covers services that provide assessment, investigations and treatment for women with urinary incontinence, vaginal prolapse, recurrent urinary tract infections, bladder pain and pelvic floor injury after childbirth, including faecal incontinence. There is very little access to any medical specialist services for women in the Pacific, even more so for issues not involved with managing fertility or childbirth.
Patients with urinary incontinence suffer greatly from embarrassment, are often unable to exercise, socialise and in some cases even stop working, effectively becoming hermits in their own homes. Patients who must get up many times at night to empty their bladder not only feel tired and emotionally frustrated from lack of sleep, there are major health implications associated with persistent broken sleep. Nocturia (rising at night to pass urine) is a major risk factor for hip fractures and head injuries in elderly people. Obesity and Diabetes are major problems in the Pacific. Poor sleep is a trigger for sugar cravings and a tired, sleep deprived person is less likely to exercise, this in patients already reluctant to play sport because of the embarrassment and discomfort of incontinence. Therefore, we feel that focussing on Urogynaecological problems is justified.
For over 10 years Dr Mairi Wallace and her team have been providing Urogynaecology clinics and surgery for women in the Cook Islands. Mairi has also provided mentoring for Urogynaecologists providing similar services in other island nations and is actively involved with the Pacific Society for Reproductive Health (PSRH), providing teaching to doctors and nurses.
Dr Wallace first became involved with helping women in The Cook Islands in 2009. The Cook Islands Ministry of health has an established and well organised programme of Health Specialist Visits (HSV). Doctors from various medical specialties, including general medicine, paediatrics, orthopaedics and ophthalmology, amongst others, visit the islands annually to provide specialist care. Each visit usually lasts a week. Ever since 2011 the programme has included Urogynaecology. Initially this was also for a week. Dr Wallace and either a nurse or a physiotherapist would arrive on a Thursday evening, do a clinic on Friday and then operate Monday to Thursday the following week. In 2018 an anaesthetist joined the team. The Urogynaecology annual HSV is unique in that it is the only HSV that includes a multidisciplinary team – Urogynaecology Nurse, Pelvic Health Physiotherapist, Urogynaecologist and Anaesthetist. We are also the only team to routinely visit outer islands. The visit lasts two weeks with clinics in Rarotonga, Aitutaki and at least one other outer island. Patients needing surgery or further investigation are flown to Rarotonga.
Looking Ahead
Until now we have had no actual money to spend. With the formation of the Trust, we are able to accept monetary donations. The plan would be to not only spend this on new instruments but hopefully over time enable us to mentor others and sponsor them to come with us – whether nurses, physiotherapists or surgeons. If this help could extend to similar missions in other pacific nations, so much the better. We have also only ever asked medical supply companies for donations of instruments or consumables. Each HSV costs the Cook Island Government not only in accommodating the team but also airfares and hire cars. If we could get these expenses covered and arrange direct flights from one island to another, it would make our mission so much more sustainable.
Chairman’s Message
Returning as I have to the Cooks, continually for over a decade, has meant that I get to see and follow up on previous patients. My surgical cases are added to my database and in this way I have been able to keep track of complications and success rates. I’m pleased to say that our Cook Island patients do as well as my patients in New Zealand. Shelley Solomon, and now Tina Kusser, are particularly good at taking down patient contact details and keeping in touch. Dr Kevin Basilli, the local Gynaecologist and Mrs Tohoa Cummings, nurse lead usually based in Aitutaki, let me know if there are any problems and don’t hesitate to email me for advice. Michael Kalkoff has worked tirelessly outside of the scope of Urogynaecology to improve anaesthetic services and provide ongoing support.
The work we do is rewarding and has lead to the development of collegial relationships and friendships. We hope over time to be able to support others to provide similar services in other Pacific nations.
Chairman
Puitputi Trust
Putiputi Charitable Trust 