Dr Sarah Welch (right) performing eye surgery in Niue, with assistance from theatre nurse Crystal Siva

Niue Island, ‘the rock of the Pacific’, is one of the world's largest coral islands, sitting in the middle of a triangle formed by Fiji, Samoa and the Cook Islands. Last year marked Niue's 50th anniversary of self-governance in free association with New Zealand, an exciting milestone for its 1,600 residents and the 35,000 Niueans who live in New Zealand and Australia. It also marked the Auckland-based Niue Eye Team’s 10th visit since starting in 2009.

Over the years, our work has evolved to meet the needs of the local population, where there is a large elderly community and high rates of diabetes.

The team is made up of myself, surgeon Dr Sarah Welch and optometrist Debbie Chan from Greenlane Clinical Centre, eye theatre nurse Crystal Siva and retinal screener Raina Tutini from Counties Manukau Health.

We aim to photo-screen all the diabetics, refract and offer glasses or prescriptions to as many people as possible of all ages and undertake safe and effective intravitreal injections and cataract and pterygium surgeries. We also refer a few patients with more complex eyecare needs to New Zealand and undertake training for the local nurses and doctors in eye healthcare.

Upon arrival in September, optometrist Debbie Chan and retinal screener Raina Tutini got straight to work, setting up their clinics in side rooms of the operating theatre at the small but quite modern Niue Foou Hospital. Over the 10 days that followed, they saw almost 300 patients between them

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The rest of the team, surgeons Dr Sarah Welch and myself, plus eye theatre nurse Crystal Siva, arrived three days later. We set up the theatre, with the excellent new operating microscope, generously donated by Zeiss and recently shipped to the island. It was also the first time we have used the CataRhex portable phaco machine, kindly lent to us by Device Technologies. The 5kg unit, made by Swiss company Oertli, took a bit of getting used to, but it performed really well and is a game changer for remote places. We undertook 39 cataract and seven pterygium surgeries, using Artiss tissue glue, which we brought with us for the first time.

The working days were quite long for us, but nothing like those of the two local nurses who assisted us so well. Sione, who has previously done a lot of work with other eye teams in Fiji and Tonga, was sometimes at the hospital at 4am to ensure our instruments were sterilised to start our morning operating lists. We trained him to administer intravitreal injections, with the hope this will be an ongoing service he can provide in Niue. Phyllis – who is also a patient of ours, having undergone corneal transplantation for keratoconus in Auckland a few years ago – went the extra mile to get our patients to the hospital. She would be on the phone calling friends and relatives at all hours and even drove to patients’ homes to pick them up if they could not get transport organised.

Working on a Pacific island always provides unique challenges that require a pragmatic approach to what can and cannot be done. So the teamwork within our group and collaboration with the local hospital staff is vital for a successful trip. The combination of many months of planning, lateral thinking and compromises around equipment and clinical issues, plus the work itself make it so satisfying. But nothing is quite as rewarding as seeing the happy patients, asking us when we are coming back so they can get their other eye done or to bring their relatives to see us.

Planning for our next trip this winter is already underway, with a few new ideas taking shape to further improve Niuean eyecare.

Dr Penny McAllum is a surgeon specialising in refractive cataract surgery, pterygium surgery, corneal transplantation, keratoconus management, allergy management and general ophthalmology. She consults at Eye Doctors, Manukau Superclinic and Manukau Surgery Centre.