International Elective: Colonial War Memorial Hospital, Fiji

By Devashi Paliwal

I undertook my year 4 overseas elective at Colonial War Memorial hospital, Suva, Fiji in Surgery for 4 weeks in Jan 2023. During this time, I had the opportunity to assist with a wide range of surgeries from different specialties including general surgery, orthopaedics, plastics and reconstructive surgery, paediatric surgery, septics and neurosurgery. It was eye-opening to see how medicine is practised in a resource limited setting in a completely different medical system to Australia, and to witness the stark health disparities in Pacific Island nations. 

Deciding where to do an elective

When I first started searching where to do my overseas medical elective the paradox of choice confused me. There were too many choices and too many variables in my decision making equation with varying amounts of uncertainty and unpredictability. An elective is ultimately a personal experience, and can turn out completely differently for each individual. Navigating these complexities, I identified the following factors to consider when making a decision:

  • Personal curiosity & interests
  • Personal health & safety risk
  • Language barriers
  • Medical experience - researching personal accounts from prior students
  • Travel opportunities 
  • Cultural experience
  • Expenses: flights, food, accommodation, travel

Ultimately, my choice to do my elective in Fiji was primarily driven by my curiosity about how essential and emergency surgical care is provided in resource-poor settings. Additional factors were low health & safety risk (compared to other countries), english & hindi (my mother tongue) being spoken widely aside from Fijian, ample travel opportunities from island hopping to cultural immersion experiences with weekend getaways, and relatively cheaper flights (compared to other countries). 

The elective experience

I still remember my very first and last day. Going in feeling nervous and excited, and not knowing what to expect to leaving a family behind and coming back with a new-found passion for global surgery, eye-opening insights into the healthcare inequity and disparities in the Pacific Islands, and a long-term commitment to working in resource-limited or humanitarian settings in the future. 

A typical day & opportunities

  • 7:30 am: Teaching sessions organised by Registrars, Consultants, and even peers
  • 8:00 am: Ward rounds with opportunities for case presentations, reviewing patients post-op, monitoring their progress, imaging and lab test result interpretations, and documenting patient progress notes 
    • 9:00 am: opportunity to assist with a wide range of surgeries from different specialties, some that I saw are:
    • General surgery: appendectomies, cholecystectomies, hernia repair, mastectomy, hartmann’s procedure, choledo-jejunostomy
      • They also do thoracic and vascular procedures such as massive saddle embolectomy, thoracotomy for pleural empyema resection, pericardial effusion drainage. 
    • Orthopaedics: tons of ORIFs, shoulder reductions under sedation, dynamic hip screw, fasciotomy 
    • Plastics and reconstructive surgery: Burns debridement, tendon repairs, skin grafting
    • Paediatric surgery: several rare congential syndromes, cleft palate
    • Septics: Below knee and Above Knee amputations, wound debridements, abscess drainage, necrotising fasciitis debridement
    • Neurosurgery: spinal and brain abscess drainage, tumor resections, extraventricular drain insertion, laminectomy, epidural haematoma decompression
    • Obstetrics: C-section and normal deliveries, ovarian cystectomy 

I ended up spending 90% of my time in theatres and got lots of opportunities for suturing (simple interrupted, subcuticular, simple continuous, vertical mattress, horizontal mattress, purse string) and special suturing techniques for suturing tendons and skin grafts in plastics. 

  • 9:00 am: Ward work with lots of opportunities to insert IV cannulas, send bloods, post-op skin suturing, insert IDC, wound management and dressing. But most interestingly, I had the opportunity to learn and perform pleuritic taps, ascitic taps, knee joint aspirations, and chest drain insertions under senior supervision and patient consent.  
  • 9:00 am: Neurosurgery clinic (Tues), General Surgery & Orthopaedics clinic (Thursday) provides opportunities to do complete patient workup from history, examination, practising clinical consult skills, management plan, handover to Consultant or Senior Registrar, and Investigations.  
  • 5:00 pm: after-hours emergency surgeries

Luckily, having built rapport with anaesthetists while assisting in surgeries, I was able to gain hand-on anaesthetics experience as well with airway management (bag-valve-mask, guedel, LMA, ETT), lumbar puncture and spinal anaesthesia. 

The sky was the ultimate limit to learning opportunities, there was so much to learn and do at every corner that I even ducked down to ED to do shoulder dislocations, POP/backslabs for fracture reductions, and perform CPR and support the ALS team in ICU. 

I’ve come back with unique experiences and memories of assisting the first and only Fijian neurosurgeon in emergent epidural haemtoma craniotomies at 10 pm, helping with emergent paediatric open appendectomies at midnight, pericardial effusion drainage until 3 am at night, and celebrating with sweet chai early morning watching the sunset from the hospital balcony. I had truly lost my sleep with the amount of love and learning opportunities I was blessed with during my elective.

Visiting the only Hyperbaric Unit in the country

A unique experience was doing a visiting placement at the only public hyperbaric unit in the whole country. Here, I met the only hyperbaric oxygen therapy (HBOT) physician and learnt about the magic HBOT can do for patients with severe necrotising fasciitis, osteomyelitis complicated with sepsis and rescued scuba divers. 

Starking disparities & eye-opening realisations

I visited Fiji for my elective at a very interesting time when it was going through a huge shift in political power from a military coup with a ruling history over the last 16 years to a coalition government. Everyone had their hopes high for a positive change. I learnt the most about the country by interacting with the locals through at-length discussions about their food, culture, social traditions, challenges and blessings of being Fijian. Through this elective, I have come to appreciate the best and the worst in Fiji, and how the massive healthcare disparities are so eloquently masked in the media where Fiji is only portrayed as the ideal pacific dream. 

At the hospital, it was eye-opening to see extremely severe and delayed-presentations and end-stage complications of diabetes, sepsis, and cancer. This was due to three primary reasons – poor accessibility to healthcare as Indigenous Fijian populations are scattered across 300 islands in their villages; and poor health literacy where the Indigenous people preferred their traditional massage and medicines over hospital care, and finally affordability of healthcare due to low socioeconomic status of majority population. The massive privatisation of healthcare in Fiji also presents another paradigm shift in healthcare delivery. 

I was also struck by other unique challenges that Fiji and other pacific islands uniquely face, including shortage of specialists and a limited availability of equipment and resources. 

With only one neurosurgeon and one plastic surgeon in the whole country, surgical care is provided with great limitations. Additionally, there are no cardiothoracic surgeons, vascular surgeons, or interventional radiologists available in the country. General surgeons are left to take care of these cases, often with nothing to offer, and patients are forced to travel to other countries such as India, Australia, or New Zealand if they can afford it.

Although I did my elective in the largest hospital of the country, the limited availability of resources was very evident. All surgeries are performed with only three types of sutures, and often the right size of suture or drain is not available. It was disheartening for me to see surgeons ask the nurses what they had available back in store for every surgery. The laparoscopic equipment is quite rusty and often malfunctions, leading to delay in surgeries. Neuro and ENT teams only have one craniotomy drill, which was donated and broke down during my time, forcing the surgeons to use manual techniques that are invasive and carry a high risk of bleeding and brain damage, but often the only option left for emergent or life-threatening conditions. 

Necessity is the mother of innovation

Despite these challenges, I was awestruck with the innovation that emerged from these resource limitations. For instance, the neurosurgeons had figured out an alternative Extraventricular drainage system using urinary catheters for hydrocephalus cases. Even though there was a high risk of infection, it was inspiring to see patients recover with broad-spectrum antibiotic coverage. Low-cost plastic incubators for newborn neonates was another striking innovation. Urinary catheters were often used as abdominal drains, and abdominal drains often used as chest drains. 

Financial support 

I was gratefully supported by the Medical Women’s Society Elective Bursary and OS-HELP Loan. This financial support really expanded my ability to get the most out of the elective experience without worrying about financial constraints.


I was stunned by Fiji’s natural beauty, and the experience of the ideal quintessential South Pacific dream - swaying palm trees, wonderfully warm climate, perfect sandy beaches and welcoming, friendly people. There is truly no match for Fijian hospitality. My fondest memories from elective travels are obtaining my Open water diving license, doing the world-famous Beqa Lagoon shark dive, and island hopping through Yasawa and Mamanuca islands. 


By the end of my elective, when it was time to return, it felt like I was leaving one family behind for another one here in Australia. In the end, it's the people, food, and culture of Fiji that make it so special. The warmth and generosity of the Fijian people have left an everlasting impression on me, and I’ve come back with a newfound gratitude for life. This elective has been a life-changing experience for me. I highly recommend undertaking an elective in Fiji.