He did a remarkable job under the circumstances and his unique skills were greatly undervalued. Ventilation was carried out with the robust, but not entirely efficient, Nuffield 200 via a circle system. Single-use Portex endotracheal tubes were used repeatedly. Pre-operative assessments were absolutely vital as this was often the fist time the patients had ever seen a doctor. The laboratories were efficient and reliable and we rarely had a problem with blood donors from the patients' families.
Anaemia is very common.
There is an extraordinarily high incidence of ischaemic heart disease, hypertension and diabetes in Fiji. The language barrier was a minor problem and both Fijians and Indians tended to give the answers they felt you wanted to hear. The Fijians are remarkably stoical and become increasingly more silent as the pain of their condition increases. Patients presented very late, often after a long boat trip or painful truck journey from the interior. There is still a strong belief in traditional Fijian medicine.