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And keeping in the same mold. Uh We've asked Graham forward, who's the CEO of Australian doctors for Africa, who has been involved in projects supporting the Sub Saharan Africa to talk about how we've managed to, he's managed to sustain a project and the input into many countries continually with great success and give us an insight into that. So is grams, talk up and running and he's hopefully going to join us live as well for question and answers. Thank you. Good evening, good afternoon and good morning. Wherever you may be, my name is Doctor Graham Forward. I'm the CEO and founder of Australian Doctors for Africa. And I'm talking to you from Perth in Western Australia. This is an organization that we found it in 2005 and it's designed to provide a link between Australian philanthropy, both donors but also doctors and nurses and surgeons and African medical need. The idea is to link my country which is on the right. There are eucalyptus trees with African countries and this is a shot of Ethiopia with eucalyptus trees in the background at the moment, Australian doctors for Africa active in Madagascar, Ethiopia and Somalia land, especially also in the cameras, which is an Island Republic between Madagascar and Mozambique in the in the Mozambique Channel in Mauritius. And we're just dipping our toe in the water in South Sudan. In the past, we visited Eritrea, but it's not a suitable location for our volunteers at the moment. And we're thinking about starting a project in Zimbabwe in the near future. The mainstay in the flagship for Australian Doctors for Africa activities is orthopedic surgery. Along the way, we have also added gastroenterology, urology, pediatrics, obscene Gainey, especially club foot surgery and screening and treating and ear, nose and throat surgery. But it's, it's orthopedics with its motor vehicle trauma, industrial accidents and conflict and war, which provides the mainstay and the backbone of everything that Australian doctors for Africa does. This is a, a simple staircase that's guided our work over the years, we've started off with service provision, which means showing up with your toolbox and consulting and operating over time. It becomes obvious that the gold rests in training and teaching local doctors and nurses and surgeons. And from there, we can progress to some infrastructure development and advanced development, which I'll explain to you basically means public health initiatives. So service provision, this is actually in Madagascar and an orthopedic clinic involves showing up with a small team. Our volunteers go away for a fortnight at a time. It seems that people that can escape from their practices and their families for two weeks without being missed. Two greatly, we see hundreds of patient's, we carry out lots of operations and then we leave and there's no doubt that providing a service like this is a wonderful thing to do for those two or 300 patient's who have consultations and for the 40 or 50 patient's who have orthopedic operations over time. However, the gold becomes apparent with those doctors who hang around these clinics by visiting the same hospital over and over again. It pretty soon becomes clear which young doctors are interested and enthusiastic, which consultants are engaged, who is able to be taught and who wants to learn. The advantage here is that if you can teach and train a, a local surgeon, then the services being provided for 52 weeks of the year rather than for just the two weeks that we're there. We have a number of training initiatives especially in orthopedics and are great partners. A oh Alliance have helped us develop a pre basic course in orthopedic surgery. Let me explain that to you. Uh This is Michael Ren. He's an at West Australian orthopedic surgeon. And our idea behind the pre basic courses was that junior residents and registrars who first start might not have much experience with drills with screwdrivers and with the use of hammers in Ethiopia and in Madagascar, it's not common for households to have workshops, to have power drills and to have the things which we might take for granted. So the pre basic courses designed to teach junior doctors the basics of how to use a power sore. Uh, well, a power drill more than a power sore. A power drill, how to tap out a screw, how to apply a plate and screws with appropriate reduction of the fracture. And this has been a wonderful initiative. We've, we've talked many, many junior doctors in Ethiopia who have now progressed to become senior orthopedic surgeons. And as thanks to Michael Ren uh Manoa alliance that we've been able to develop this. Uh This is in fact a famous picture now with highly Gebreselassie, the Sydney Olympian gold medalist uh teaching residents in the I O and Australian doctors for Africa pre basic course in Addis about two years ago. He's been three or four years and uh he's becoming quite proficient as an orthopedic surgeon. Once you have orthopedic surgeons who are trained and skilled, it's only sensible to provide them with the wherewithal so that they can utilize those skills. Uh This we call infrastructure development as the next step up the development staircase. So this is in Somaliland where we took really a enormous demolished building and renovated. It were able to produce that outcome as a result of relatively small investment, relatively local equipment was provided and we donated some equipment via container from Australia. The Leicester Group have done a similar sort of thing in Gonda in Ethiopia. This is a industrial military auto club which is still in its container and it's been fitted onto the side of the operating room in Gonda in Ethiopia and it provides a full sterilization. They didn't have to build a new building. They just put a concrete plinth, then cut the container and left the auto club inside it. A very creatives development providing excellent sterilization for relatively low cost. This also is pretty easy to convince Australian donors or all the fittings in here came from Australia. Uh the air conditioner we bought locally and all the rest is just a renovation of an existing building, an existing facility, advanced development initiatives. This is where we have the opportunity as time builds up to make interventions which are really preventative or really developmental. So in Madagascar, we have a very large club foot screening program. We have an education and an outreach program in a region that supplies that services five million people. Uh I regard this as an example of advanced development because detecting a child with a club foot early means that treatment becomes relatively simple and the outcomes are good in a completely different area. Uh wherever there's orthopedics and traumatology, there's a requirement for image intensification or see arms. Uh A top quality G E or Philip Cr is approximately 100 and $20,000 which is beyond the budget for of Australian doctors for Africa. So in association with West Australian companies and with doctor does sores who's a Queensland orthopedic surgeon. We developed an extremely robust cr this is a digital transmitter that comes from South Korea and this is being trialed at the moment in Port Moresby in New Guinea and uh in Hargeisa in Somaliland, this comes in at about a quarter or 1/5 of the price of an off the shelf. Uh major manufacturer. Uh The results are excellent and we're working more towards developing this so we can roll it out. But that's an example of what I would call advanced development. So just to refresh your memory, uh this is how Australian doctors for Africa functions in every location. We start off just showing up with our toolbox and seeing if we can give people a hand. It pretty soon morphs into training and teaching as you work out who the intelligent, enthusiastic and devoted surgeons and nurses and doctors are. And once you have that, that cadre inside you in a country, then you can proceed to offer them the things that they need with infrastructure development. Apart from the buildings which I showed you, we frequently would import uh plates and screws which we purchase from India and a very reasonable price. So the things that we have learned, well, some of them are self uh apparent, but the first principle which I think we have always adhered to is that were there just to give a hand. Uh This is not our problem. And we're not there to take over or impose our beliefs or our thoughts. We're just there to give local people a hand to develop their orthopedic and trauma taal Aji services. So this is fairly typical of the sort of reception which we have. This is uh an actual container being unloaded in Hargeisa in Somaliland. Uh Some of these are hospital people and some of these uh local Somali Landers who have been recruited to help unload the container. It's this sort of goodwill and spirit which we try and engender uh idea being is we're there to give them a hand and they can do most of it themselves. This is the other end of the equation. Graham Wilson's one of our volunteers in Perth and he's just finished loading with some volunteers from the rotary club in Perth. This 40 ft container. Well, I can tell you a 40 ft container takes a lot of donated medical equipment, beds, wheel chairs, desks, auto clubs, diathermy machines and wheelchairs which are made and manufactured in Western Australia by an organization or wheelchairs for kids during COVID. Uh There was a lot of generosity around the world providing uh P P E uh testing and even vaccines. And Australian doctors for Africa was given a very large donation by an Australian philanthropist which we distributed at that time to the 17 hospitals that were active in. I think it's important. And in fact, critical to listen to local requests everybody's always got bright ideas about how we can help. But really the best way of helping is to try and listen carefully and deliver what people are looking for in Ethiopia. Uh This particular hospital asked if they could develop a bedside patient, pre and post operative vital sign recording system. And so very cleverly, we came up with this, the vital sign sheet and we thought that we were responding to local requests, but we forgot to provide with a clipboard so that it could be rested on with my rose. And most importantly, we forgot to provide people with thermometers and sphygmomanometer. So, although we thought we were listening to local requests, we didn't follow through carefully to provide all the answers to the problem that was presented to us. One of the main things that we try and do is not send junk uh storage is just as much of a premium in an African hospital as it is uh in Australian Hospital or in your own residence at home. And we have to be very careful to make sure that we don't send out of date equipment, equipment that doesn't have a service history and a warranty or some guarantee that it will function into the future. We have to be particularly careful not to clutter up other people's storage at the cost of our own. So this is Graham Wilson. Uh this is a facility all this was donated to us and out of all that. We decided that we could only send one or two box loads because we've been listening to what people were asking for in Madagascar. And we decided that uh this, this material and equipment was not appropriate for various reasons, uh perhaps just labouring the point. But in Madagascar, we renovated an orthopedic outpatient clinic and, and hospital ward. And these were the people, the Malagasy people who were involved in that process. As we tried to listen to their request, we had an architect, we had the, the chief of service. Uh We had the director of orthopedics, a doctor vero and we had many nurses, construction people. And as we were trying to deliver something, we're very careful to listen to the local request to make sure that it was fit for purpose and it was what they actually wanted. Uh I've learned over the years that it's very important not to make a false promise or even give a false hint. So the C arms is a good example. We're always being asked for C arms in order to improve the range of clinical practice. Hip fractures need see arms, pelvic and acetabular fracture management needs to have a C arm and many other orthopedic interventions need a C arm. These are very expensive for us and in general, at the moment, we're holding back from, from promising people to see arms. Uh the hint that we might be developing something that is affordable for uh lesser developed countries uh might be a promise but I try not to make a false promise at a more simple level. A lot of our volunteers have very generously when they've been in country said I've got a text book I can send you when I get home or I've got an old laptop that my child's finished with. I'll send it to you. We encourage people not to do that because it's a world of difference when you're in the cameras, it seems like it's going to be a very easy thing to get a textbook from Perth and consign it back to the doctor and it very rarely happens. So we've been careful to tell all our volunteers and to try and keep in mind really make sure if you make a promise that you have the wherewithal and the ability to fulfill it. And I hope that one of the Australian doctors for Africa's reputations is that we do actually deliver on a promise if we make it possibly the most important thing we've learned is that we should be trying to train and equip local people. This is the plaster section of the pre basic workshop that I was describing to you. Uh This lady is from West Africa. This patient student is from Somaliland and this is one of the first Somaliland orthopedic surgeons who is going to go back to get a PSA when she finishes her course uh next week, uh sorry, next year, this represents, represents a significant advance in Somaliland. The fact that they've got an orthopedic service now, from doctors who have been trained in Ethiopia in association with Australian doctors for Africa. Uh This is actually my son Gideon. We're in, we're in Ethiopia, installing an arthroscopy stack and demonstrating and teaching the first orthopedic arthroscopy this in Ethiopia. Uh with about diagnostic arthroscopy, we get donated quite a lot of very good second hand equipment. This actually is an air driven drill from compressed air. These never breakdown. And in various countries, we've been able to solve the problem of compressed air. Uh these sorts of sets come up all the time and as soon as they do, we're able to replenish the missing screws and convert them into excellent sets which we then donate to the places that we go to. And one of the simplest things that we can do is take an inventory of needed simple plates and screws. We purchase them from several reliable suppliers in India. We've done the metallurgy. We've brought these screws back to Australia and bench tested them for their breaking strength and their head screw off torsion strength. And these are every bit as good as wherever else you would by orthopedic implants from. And they are between 1/6 and 1/8 of the price of our conventional supply chains. So it's relatively easy to ask a donor if they'll uh give us $1000 which is sufficient to provide enough plates and screws for about 40 operations. This is the equipment part of training and equipping. I found it thrilling over the years to build relationships and trust, not only trust in us but trust in local people. Uh This is Claud Martin from uh oh Alliance. Uh This is Professor Baroque, a most famous and extremely constructive and inclusive professor of orthopedic surgeons at the Black Line Hospital. And this is the former Minister of Public Health from uh Ethiopia. This one is just a recent shot in Bahadir uh where we've included the hospital director uh and the orthopedic surgeons uh to help make constructive plans. I've actually known each of these orthopedic surgeons for a long time now because they were initially residents and now they are consultants in their own hospitals and we have a lot of mutual supportive relationship and trust between ourselves. It makes it makes Australian doctors for Africa, reliable partner and it makes it good, fun interacting with such positive and enthusiastic young people. Something to be proud of. Last year in Somaliland, Australian doctors for Africa were uh perhaps initiators of the very first Somaliland orthopedic society. At a scientific meeting. We had our first orthopedic surgeons who have been recently trained, come back from Ethiopia. We had a group of old orthopedic surgeons and I'm including myself in that group. Some of us have bad habits and some of us have excellent new habits. The consequence was we had a scientific meeting, we founded the society and I hope that in future years, the Somalia and orthopedic society will mirror the Ethiopian society of orthopedics and traumatology who just celebrated their 25th anniversary. I think the last thing that I've learned and partly from my father, who was such an enthusiastic contributor is to try and complete the cycle. Very important to have a shared goal, both of from donors, from recipients and from the doctors and nurses who are involved, important to achieve it together, paying attention to some of those principles that we've learned. And then it's also important to feedback those results to the stakeholders in terms of uh uh longevity of an organization, engaging with stakeholders and encouraging donors that their money is being used in the correct way with no overheads and with no waste is such an important step in completing the cycle. It's a way of expressing gratitude from all of us and this results in a mutually beneficial and positive cycle. So I found it really important to feedback the results to, to all parties and to express gratitude from all sides. I will say that I have a great sense of gratitude to all the countries and all the junior doctors and nurses and now the senior doctors and nurses that we've worked in. Uh don't hesitate to express that gratitude as I would like to do now. So that's Australian doctors for Africa Short journey. I hope that we can continue into the future. Hope that some of these small lessons might be worth sharing with you. Thank you very much Julian. Thank you very much for that expose of what Advair does and it's great work. And obviously we've worked hand in hand over the years with all the various organizations from walk to the various links that were mentioned. Um Have any questions for Gram from the floor? Uh I'm sorry, I'm absolutely in awe of how you managed to um uh create this project, which is wonderful. Um The thing that impressed me most is how you managed to raise quite so much money. Um Perhaps you could just enlighten us on that. Mm Well, we're actually a lower energy intense organization than we are money, intense organization. Uh We raise money really from family and friends. We have some support from some of the foundations of private hospitals in Western Australia that really it's uh family and friends and uh feeding back to them that the relatively low cost, big impact of that such adventure can have. So, uh it's we, we raise money by arm twisting and the, the usual sorts of wise. Uh Nothing in particular special. Any other questions? Damn up. Got one so great. That's fantastic. Um I was wondering when you're donating equipment from Australia's places? Do you have a system in place for maintaining these or do you come across any issues with breakdown and recovery of things. Thanks. Yes, it's a, it's a perennial problem for us. Uh, we do have some rules and parameters. If it's a piece of equipment, then it has to be serviced. And we do ask the service technicians to give us some sort of, uh, well, not a warranty but some sort of certificate that it will be good for the next 3 to 5 years in normal function. Nonetheless, container ization and truck transport does lead to uh we've lost quite a few see arms the value medical equipment. So we now we have engaged a partnership with medical technologist and recently to Madagascar, we took a medical technology. We usually take orthopedic technicians with us to try and make sure that we can repair to the best of our ability, things in the country. But frankly, second hand equipment is usually at the end of its used by date. And if we can get 3 to 5 years from, from A C arm would be very pleased with that. And often it's the motherboard or outdated electronic. That mean that can't be replaced. It's certainly a concern for us and just, just on that in other places where we have purchased in Hossa in Ethiopia with no to and a oh Alliance and us. We did purchase a G C M and we were sure to purchase at the same time, 10 year service contract to go with that. So break breakdowns and maintenance are very critical. No more questions, Graham. Thank you very much. I might have to buy you dinner when I'm in the path in, later in the summer. Thank you very much. Indeed. Thank you.