annual report - anzgita · eileen natuzzi and mark norrie continue to provide energetic leadership...

Annual Report 2017–2018

2 ANZGITA ANNUAL REPORT 2018

CHAIR MESSAGE 2017–2018Each year we are drawn to new challenges, matched happily by our increasing membership of like-minded, global-thinking colleagues in gastroenterology and GI nursing.

It is a great pleasure for me to present my report for 2018. I am very proud of the enthusiasm, commitment and excellence

of our members and the wonderful team on our Board. Our training programs have been delivered without a hitch throughout the year, much due to the diligence and attention to detail of our leadership in each region in which we operate and the systematic organisation of our overall program lead, Tony Clarke.

ANZGITA continues to grow to address the many needy demands presented to us. Each year we are drawn to new challenges, matched happily by our increasing membership of like-minded, global-thinking colleagues in gastroenterology and GI nursing.

We are so privileged to be living and working in Australia and New Zealand (and indeed some other countries of our membership). Our work is done when we have successfully passed on our knowledge and skills where they are needed.

In Myanmar, we may have nearly reached that point, at least in Yangon. We are now shifting emphasis from there to an active interest in Nepal, one of the poorest countries ravaged by natural disasters, unplanned growth and population expansion.

We have been pleased to support John Croese after his path-finding endeavours to support gastroenterology in Nepal. Peter Katelaris and I had a very informative and wonderfully receptive “scoping” visit to Kathmandu over Easter. The Board has offered a program of engagement to the Nepal Medical College, and we look forward to building capacity in Nepal along this journey.

Ensuring equipment is functional and accessories available across our centres of training and beyond is a serious challenge where resources are so restricted. We are tremendously grateful for the support and commitment afforded by our industry partners in each of our centres. This is truly the Aussie spirit to help! So thank you to all of our sponsors.

A major project of ANZGITA has been the sourcing, installation and funding of appropriate endoscope reprocessing equipment in newly commissioned endoscopy facilities (which we have supported through design) in Honiara (Solomon Islands) and Dili (Timor-Leste).

I have been particularly pleased with current endeavours to assess the functionality of the centres from which our remote trainees come as they work in their home environments. This must be what training and capacity building is about – supporting, assuring and guiding our graduates from hub programs in Suva and Yangon/Mandalay as they return to work in their home services. It’s what makes our outreach visits in Myanmar, funded by an anonymous foundation grant and now managed by our in-country partners in Myanmar, and in the Pacific, supported by DFAT through the RACS’s administered PIP, so important.

I have been honoured to take the role of chairing the World Gastroenterology Organization Training Centres Committee for 2018-2019. I take this as a reflection

of the fantastic work that ANZGITA and its Board have done, clearly recognised as an exemplar by virtue of this invitation to lead the WGO committee and its 23 training centres. We have already helped develop Fiji and Myanmar.

As the year unfolds, we are learning this is a twofold opportunity to pass on our experience to the WGO in assessing outreach centres and to help the WGO develop technologies appropriate for assessing cleaning and disinfection of endoscopes (the WGO ATP project). Di Jones has stepped up to support this activity for the WGO which we plan to roll out in a number of ANZGITA centres.

The backbone of ANZGITA’s work is of course our trainer members, who give so generously of their time to teach and pass on their wealth of knowledge and experience. Those who contributed their precious personal time this year are acknowledged on the following pages. For them, like me, I know their reward comes from the day-to-day interactions with our wonderful partners and trainees, and that these rewards are far more meaningful than anything I can say here. They too, like me, return in awe of the great work of the physicians with whom we work in-country.

ANZGITA needs support from any who resonate with our mission to build capacity in the countries in our region – many of which are the poorest in the world.

The backbone of ANZGITA’s work is of course our trainer members, who give so generously of their time.

3ANZGITA ANNUAL REPORT 2018

The skills they have developed to practice our profession in environments that are not so blessed as our own – an experience that all ANZGITA participating members witness with enormous admiration - are incorporated into their own professional approaches as they return home.

Details of the programs are elsewhere in this report. I am grateful to all the country leads for their commitment. The Board has worked diligently this last year and I thank the directors for their efforts. We thank Warren Bingham who resigned from the Board this year for his contribution, as we have benefited from his insights into industry and empathy with our goals.

Thank you to all our in-country colleagues, donors and industry partners. These are truly “feel good” partnerships where everyone benefits.

ANZGITA needs support from any who resonate with our mission to build capacity in the countries in our region – many of which are the poorest in the world. So for those in a position to do this, please give generously!

Professor Finlay Macrae, AOChair, ANZGITA

Mission & ObjectivesANZGITA’s mission is to support improved health in the people of developing Asia Pacific nations by enhancing the standards of practice of gastroenterology, and the treatment of digestive diseases.

We provide assistance and support in the field of Gastroenterology to people in need through sustainable local projects which:• improve standards of practice and

treatment of digestive illnesses, conditions or disorders

• provide training and skill transfer• encourage, promote and stimulate

interest in the practice of Gastroenterology

• encourage communication, sharing, education, learning and service to others, and

• respond to emergent situations of people in distress.

Papua New Guinea


Solomon IslandsNational Referral Hospital, HoniaraSince 2011

The Pacific is ANZGITA’s most involved engagement and this year marked the 10th anniversary of the first visit to Suva by Finlay Macrae and colleagues. Their objective has not changed over that period – assist the development of gastroenterology services capacity within the local medical fraternity. The engagement, in partnership with Fiji National University (FNU) at Colonial War Memorial Hospital (CWMH), soon included nurses (2009) and has continued to grow and evolve, and trainees from over twelve Pacific Island nations have attended. A Solomon Islands program was first conducted in 2014, with one or more run in each of the subsequent years. Our capacity building work in the region, which has always included equipment support, has seen increased activity this year.

Assoc Prof Jioji Malani and Dr Mai Ling Perman of FNU again organised the Fiji four-week program in July/August 2017 providing a very good learning environment and enabling our nine trainers to work effectively with the trainees alongside our Fiji teaching colleagues. We were delighted that Fiji Prime Minister, Hon. Frank

Bainimarama, chose to open this, our tenth program. The structure of the program was very similar to previous years and 150 endoscopy procedures were conducted by trainees under supervision.

Program Leader Assoc Prof Chris Hair has put considerable effort, including two planning visits, into liaising with our Fijian partners to further improve the training outcomes. Dr Aminiasi Rokocakau of FNU is currently undertaking a one-year fellowship at Royal Melbourne Hospital. This is a welcome development for Aminiasi who previously came to Australia for short-term intensive training arranged by ANZGITA.

Work is currently underway to develop a strategic plan for gastroenterology and hepatology services at CWMH which will enable managed development in the coming years. The pre-existing generous support from C.R. Kennedy for the provision of Fujifilm endoscopes and their maintenance was formalised with an MoU. The in-kind support of other suppliers and the broader healthcare community has also contributed to the success of the program. (See the Supporters page for more details).

A one-week program was delivered in February by two doctor trainers and one nurse at the National Referral Hospital (NRH) in Honiara, Solomon Islands.

A further program will occur in August. On the recommendation of NRH, we are now conducting two one-week programs per year which better meets their needs than a single two-week program. Drs Eileen Natuzzi and Mark Norrie continue to provide energetic leadership for this program. A special thanks to Dr Rooney Jagilly, who has been a wonderful NRH leader and supporter of our programs, who has returned to a clinical role.

A semi-automatic reprocessing system of significant benefit in managing potential cross infection, will be installed at NRH in September 2018. This type of system is described in more detail under Timor-Leste in this report. It is being funded through a generous donation from the Ainsworth Foundation to RACS, which they have kindly agreed to allocate to this project, and a grant from GESA.

In February 2018 Dr Chris Hair and nurse Karen Kempin delivered one-week of intensive training in the developing endoscopy unit at Tupua Hospital in Apia, Samoa. The week successfully focussed on capacity building and the strengthening of services’ provision and care systems. This was a follow-up to the 2017 visit, delivered with the support of the Australian Government’s’ Pacific Island Program (PIP) with which we continue to collaborate.

The Pacific

Papua New Guinea


FijiColonial War Memorial Hospital, SuvaSince 2008

SamoaTupua Tamasese Mea’ole Hospital (TTMH), ApiaSince 2017

During the year, Dr Chris Hair has championed the use of digital technologies to provide more teaching opportunities and better immediate patient care across the massive Pacific region. Through collaboration with Dr Payne Perman (Pohnpei) and Ms Christina Higa (University of Hawaii) four GI tele-health education sessions were held using internet video conferencing. The sessions were attended by around 15 clinicians, many from previous Fiji programs, from over 12 island nations. Whilst the program is still at an early stage, it has already covered a range of topics, and feedback has been positive resulting in a plan for further sessions.

For the first time, digital group chat technology (Viber) was used to bring RACP fellows and ANZGITA volunteers into immediate contact with internal medicine physicians within the Pacific. 37 physicians can already connect immediately including 27 Pacific Island doctors and it has already been beneficial to the treatment of patients. More use will be made of digital technologies in the coming year across all aspects of our work.

FIJI Leader: Assoc Prof Chris Hair, ANZGITA Assoc Prof Jioji Malani, FNU

Partner: Fiji National University (FNU) at Colonial War Memorial Hospital

Trainers: Chris Hair Terence Gavaghan Ian Turner*Paul Clark Jason Hill* Karen Kempin Kathleen McGee* Melissa Fox* Allana Parkes**Denotes first program

SAMOAOutreach Visit

Leader: Assoc Prof Chris Hair, ANZGITA

Partner: National Health Service of Samoa

Sponsor: Australian Government via the PIP program administered by RACS

Trainers: Chris Hair Karen Kempin

SOLOMON ISLANDS Leaders: Dr Eileen Natuzzi, ANZGITA Dr Mark Norrie, ANZGITA Dr Rooney Jagilly

Partner: National Referral Hospital

Trainers: Eileen Natuzzi Dinesh Lal Kristina Dodd

THAILAND

VIETNAM

CHINA

LAOS

MYANMAR

BANGLADESH

INDIA


Two training programs were delivered at Thingangyun Sanpya General Hospital (TSGH) in Yangon in October (two weeks) and then at Naypyidaw General Hospital in March (one week). Also, we were able to provide trainers with ERCP expertise which TSGH had requested. Both programs were very well organised and attended, and all ANZGITA trainers much valued their involvement. 17 trainers (8 doctors and 9 nurses) were involved in the two programs. 26 doctors (a number returning) attended for ‘hands-on’ skills development training and 46 nurses received tuition. Program Leader Dr Greg Lockrey has put in a lot of work supporting these training programs as well as the Foundation Project which has been funded by a very generous donation from an anonymous foundation.

The Foundation Project was started in partnership with Myanmar Gastroenterology and Liver Society and operated out of the Yangon General Hospital (YGH) where the National Endoscopy Training Centre is located. A Project administrator (Dr Hsu Myat) was appointed. Nurse Kim West visited Myanmar for most of September to

establish the outreach visits program to be conducted by nurse educators from the three major hospitals. After some delays a start was made but approvals for visits were slow in being processed and progress was further delayed. However, 9 visits have been conducted and advice and support, including additional training at YGH, provided. The project has allocated funds to support reprocessing equipment purchase at the new TSGH unit.

During the year, the team at YGH concluded it no longer required the form of training provided by ANZGITA. That the maturity of its operations and the ability to support other hospitals has reached this point is an endorsement of the training we have provided since 2014 as part of their broader development program.

It has been made clear to ANZGITA that our help is still desired at several other hospitals, but new partnering arrangements will need to be put in place before we can conduct further programs.

Leader: Dr Greg Lockrey, ANZGITAProf Thein Myint, Director of National Endoscopy Training Centre (NETC)

Partner: NETC and Myanmar Gastroenterology and Liver Society

Sponsor: Myanmar Gastroenterology and Liver Society

Trainers: Mark CornwellHenry DebinskiBrigitte Fitzpatrick*Karen Gower*Jennifer Hanley*Aimi Hino*Thein Htut Melissa JenningsGregory Lockrey Finlay Macrae Katherine Mager Susie Netterfield* Keith Noack* Alison Raitt Peter Tagkalidis* Ann Vandeleur*Denotes first program

MyanmarThingangyun Sanpya General Hospital & Naypyidaw General HospitalSince 2014

Myanmar

TIMOR-LESTE

BALI

WEST NUSA TENGGARA

EAST NUSA TENGGARA


A one-week training program was conducted during the year at Hospital Nacional Guido Valadares (HNGV) in Dili under the program leadership of Dr Chris Kiely. Two programs will be conducted in the 2018 calendar year for doctors and nurses working at the hospital with an interest in developing their endoscopy skills. In 2017, 950 gastroscopies and 200 colonoscopies were performed at HNGV.In early 2018, Chris Kiely, having lived in Dili for two years, returned to Australia. It was through Chris’s efforts that an endoscopy unit was established and training programs commenced in late 2016. As part of further development of a sustainable unit, Dr Celia Santos, Head of the Department of Internal Medicine, came to Australia in June 2018 for a three-month intensive fellowship at Canberra Hospital along with additional engagement at Calvary Hospital. The fellowship was possible due to our success in securing competitive Australian Awards funding from the Australian Government and the generous pro bono hosting of Celia at the two hospitals.

Also, Olympus have committed to on-going endoscope support and provided additional scopes during the year.

The prevention of cross infection through best-practice reprocessing of endoscopes is of critical importance and even more so in developing countries where the incidence of blood borne Hepatitis is very high. Also important is a safe working environment for staff by eliminating exposure to the toxic reprocessing chemicals. To this end, a semi-automatic reprocessing system was ordered from Cantel Medical during the year for installation in September 2018. It is the largest equipment project ANZGITA has undertaken and is funded through a generous donation from the Ainsworth Foundation. Dianne Jones led the investigation and specification work for the system and related issues, e.g. water quality. She was supported by Tony Clarke and Jon Long in determining a system suitable for a developing country. It was important that the solution enabled best-practice reprocessing, was operationally uncomplicated, highly reliable and able to be supported locally for minor issues but with a supplier maintenance commitment.

Leader: Dr Chris Kiely, ANZGITADr Jose Guterres, Executive Director, HNGV

Partner: Hospital Nacional Guido Valadares (HNGV)

Trainers: Chris KielyDianne JonesDamian Harding**Denotes first program

Timor-LesteHospital Nacional Guido Valadares, DiliSince 2016

Timor-Leste


Professor Finlay Macrae, ChairFinlay Macrae AO, MBBS (Hons I Monash) MD (Melbourne), FRACP, FRCP, AGAF, MWO, led the first Fiji training team in 2007 and the establishment of ANZGITA. He has a private gastroenterology practice and remains an active trainer. Finlay is Head, Colorectal Medicine and Genetics, Royal Melbourne Hospital and Professor, Dept of Medicine, University of Melbourne. In 2018 he is Chair of the WGO’s Training Centres Committee.

Ms Alison ByrneAlison Byrne was appointed in October 2016 and leads the Board’s development of donor relationships with businesses, philanthropic organisations and individuals. Alison has over 15 years’ experience in fundraising in the healthcare sector. Since 2014 she has been a senior partnership manager at the Royal Melbourne Hospital Foundation where she established a successful Major Donor program.

Mr Frank Eastaughffe, SecretaryFrank Eastaughffe was appointed in 2015. He is the Public Officer responsible for coordinating much of the administrative work. Previously he worked in senior management and as a professional engineer in the telecommunications and IT industries, based in Australia and Europe. Frank is involved with a number of Not for Profits as a director, advisor and volunteer.

Dr Anthony Clarke, Deputy ChairAnthony (Tony) Clarke Mb, ChB (Cape Town), MRCP, FRACP, FRCP, BBus is responsible for coordinating all training activities. He was a medical practitioner for 40 years and a gastroenterologist and first visited Fiji as a trainer in 2008. His last positions were Director of the Gastroenterology Unit, Clinical Director, Medicine and member of Canberra Hospital Executive.

Assoc Prof Christopher Hair Chris Hair MBBS (Adelaide), BSc, FRACP is an inaugural director and responsible for overseeing our Fiji program and Pacific outreach activities. A consultant at Geelong Hospital and a Clinical Assoc Prof at Deakin University Medical School, he has been a trainer since 2010. Chris is a director of the Fiji WGO Training Centre and focuses on its training model and curriculum development.

Mr Alan Studley, TreasurerAlan Studley MBA, MAICD, FCPA was appointed in 2014 as the inaugural treasurer. He has worked extensively in the Health and Not for Profit sectors in executive roles. He has held both voluntary and paid directorships on numerous Boards for over 20 years. Alan has qualifications in accounting and marketing and has a Masters of Business Administration.

Assoc Prof Alan FraserAlan Fraser MB, ChB, MD, FRACP joined the Board in 2016 and leads our New Zealand relationships and activities. He is an Associate Professor of Medicine at the University of Auckland with over 20 years’ experience. His first program was in Myanmar in 2016. In 1986-87 he was a Medical Officer at Kapsowar Hospital, Kenya responsible for medical, surgical, paediatric and obstetric services.

Ms Dianne JonesDianne Jones OAM, Dip App Sc, B App Sc, FACN, ACGEN is an inaugural director, Nurse Unit Manager, Endoscopy Unit, Logan Hospital, and globally acknowledged for her expertise in safe working in endoscopy. In Fiji in 2009 Dianne, with Catherine Conway, established the nursing component of our Fiji program. She has subsequently been a member of our first teams for all other programs, leading on nursing activities.

DIRECTORSOur directors provide a highly experienced and credentialed spectrum of medical and other expertise.


Mr Jonathan Long Jonathan (Jon) Long is an inaugural director whose work has contributed to the development of highly supportive relationships with the medical device industry in which he has worked for over 30 years across Asia Pacific. He has been responsible for ensuring equipment availability and support needed for the month-long Fiji training programs. Jon also provides equipment management advice to our partners.

Assoc Prof Peter Katelaris Peter Katelaris MBBS (Hons I Sydney), FRACP, FRCP (London), MD (London), AGAF is an inaugural director and leads curriculum planning. He is a clinical academic (University of Sydney) physician with over 20 years’ consulting experience. He was on the first Fiji program in 2008 and remains actively involved. Peter has been the medical lead on AusAID funded field work in India, Vietnam and Indonesia from 1990.

TREASURER REPORT For the operating year of 2017/18 ANZGITA recorded funds inflow of $139,723 and outflow on programs and administration of $99,440 creating a net cash increase of $40,283. Funds have now been consolidated from the original CBA account into Westpac to more easily facilitate direct payments from Australia to support the Myanmar programs.The CBA account was closed at 30 October 2017 with the transfer of $110,152 to the Westpac account. Funds are held in two Westpac accounts being the Community Solutions account used for daily operating expenditures and the Community Solutions Cash Reserve. Total funds held by Westpac at 30 June 2018 were $186,496 with $184,210 in the Cash Reserve and $2,285 in the Community Solutions account.

The total expenditure on in-country programs and projects was $84,160 across Myanmar, Timor-Leste, Solomon Islands, Nepal, Fiji and a clinical fellowship program. Further explanation about the objectives and outcomes for these clinical programs are contained in the Programs Coordinator’s report.

ANZGITA spent $15,279 on non-clinical program expenses being Insurance $5,908 (39%), AGM and other Australian based clinical forums $6,428 (42%) ,general expenses (such as postage, printing, travel) $2,893 (19%) and CBA bank fees of $50. The Board of ANZGITA has acted to ensure that complete insurance coverage is in place to protect the activities of both directors and program clinicians as they undertake their duties in Australia and the five countries in which services are delivered. The Board believes that it has adequate cover in place to protect ANZGITA from all identified risks.

The costs of company obligations include maintaining an appropriate level of risk management via insurance policies covering public liability, travel and directors & officers, holding an AGM and attendance at clinical forums throughout the year. Additionally, ANZGITA has spent $2,893 on administrative costs which represents 3.4% of the combined direct program expenditure of $84,160.

Services provided by directors are on a pro bono basis, the exception being where some directors apply their clinical skills to programs. In such cases travel (but not for doctors) and living expenses are reimbursed as for all trainers. All program participants including directors are reimbursed only after an expense claim has been submitted to and approved by the secretary and then counter signed by the treasurer.

At present ANZGITA does not undertake a formal external audit as the cost of such an activity would outweigh the benefits, given ANZGITA’s funds are principally directed to supported overseas clinical programs in developing countries. The bank balance is reported regularly with management information at both management and board meetings and details are noted in meeting minutes. Payments require a two-step approval process to be completed by the secretary and treasurer. Financial statements provided for the period are P&L Statement, CBA and Westpac Bank Reconciliations, Funds Flow Statement and Program and Administration Expenditure Statement.


C.R. Kennedy Medical Solutions are supporting the WGO Training Centre at the Colonial War Memorial Hospital in Suva, Fiji with endoscopy equipment, services and advice over the next five years. The company has also supported us with the production of marketing materials.

Whiteley Corporation has generously supplied on multiple occasions a range of endoscopy cleaning materials.

Olympus are supporting the Hospital Nacional Guido Valadares (HNGV) in Dili, Timor-Leste with endoscopy equipment, services and advice over the next five years.

Boston Scientific has supported our work in the South Pacific and Timor-Leste with monetary and product donations.

Pentax Medical are supporting the National Referral Hospital (NRH) in Honiara, Solomon Islands with endoscopy equipment, services and advice over the next five years.

INDUSTRY SUPPORT We have had valuable in-kind support from companies across a range of industries.This year we welcomed the following companies:

B-San Events & MarketingB-San Events & Marketing provided staff time to assist with our rebranding, events and marketing activities.

Ckaos InkCkaos Ink provided design services associated with our logo and numerous marketing and communications collateral items.

DS Biomedical DS Biomedical provided endoscopic equipment for Solomon Islands. Three of their technical team put in over 40 hours of their own time to get the kit ready.

A number of other companies continued their generous support:• Fresenius Kabi • Norgine• CK Surgitech• Flolite Industries • Device Technologies • Endomed • Gibson Freight• Wassenburg Medical

Cook Medical has provided products and monetary support through their Charitable Donations, Grants & Sponsorships Scheme.

OUR SUPPORTERSANZGITA gratefully acknowledges the support of all our sponsors, donors and grant providers who have generously supported our work over the year.

MAJOR SPONSORS These organisations have committed long-term, substantial support in an area of operations, often with formalised commitments in the form of a Memorandum of Understanding (MoU):


MEDICAL COMMUNITYThe following organisations from the Medical Community supported us during the year:• SIES 2018 provided discounted

registration and space in their exhibition area.

• GENCA provided complimentary registration and exhibition space at its national conference.

• Royal Australasian College of Surgeons (RACS) through their Asia Pacific Gastroenterology Project Fund supports our work.

• World Gastroenterology Organization (WGO) provides support to the WGO Training Centres in Suva and Myanmar.

The following hospitals and healthcare organisations have supported us in the last year through in-kind donations of equipment or services:• Box Hill Hospital • Geelong Hospital• Cabrini Medical Centre • Geelong Private Hospital, Waurn Ponds• Healthscope Hospitals • The Royal Melbourne Hospital

TRAINERS All trainers donate their time which is a major contribution to our work. ANZGITA offers to reimburse nurses for all their expenses and doctors for expenses other than airfares. To those trainers who also chose not to claim some or all of their expenses we extend our further appreciation.

MONETARY DONATIONSIncreasingly, philanthropy and individual donors play a role as supporters and partners of ANZGITA as we continue to expand our activities. We gratefully acknowledge the following for their generous support:• Ainsworth Family Foundation and

Len Ainsworth, for their commitment of support over five years.

• Graham, Annette and Luke Smorgon for supporting our activities in Nepal.

• Journal of Gastroenterology and Hepatology Foundation for supporting our Pacific programs.

• Boston Scientific for supporting our training programs and development of endoscopic care in the Pacific.

• Ms Yan Li Wang for her liaison work on behalf of an anonymous donor

TRAINING PARTNERS We have training partners in the countries in which our programs operate:

• School of Medicine, Nursing and Health Sciences at Fiji National University

• The WGO Training Centre at the Colonial War Memorial Hospital (CWMH), Suva

• National Referral Hospital (NRH), Honiara, Solomon Islands

• WGO Myanmar National Endoscopy Training Centre, Yangon General Hospital

• Thingangyun Sanpya General Hospital in Yangon, Mandalay General Hospital and Nay Pyi Taw General Hospital

• Myanmar Gastroenterology and Liver Society (MGLS)

• Hospital Nacional Guido Valadares (HNGV), Dili

GOVERNMENTANZGITA, as the host organisation, secured an Australian Awards Fellowship grant for Dr Celia Santos of Timor-Leste for three months intensive training in Canberra.

The Pacific Islands Program (PIP) funded by the Australian Government and coordinated by RACS supported the Samoa Outreach work.

The Fiji High Commission in Canberra again gave assistance in preparation for the Fiji program.

Australian and New Zealand High Commissions and Embassies visited some of our training programs and provided support and advice when we sought it.

The Myanmar Ministry of Health and Sport for permitting our work.

PO Box 2010 Royal Melbourne Hospital Victoria, 3050, Australia

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annual report - anzgita · eileen natuzzi and mark norrie continue to provide energetic leadership...

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