Bridging the blue: narrative review of neurosurgical access, aeromedical retrieval, and telehealth in Fiji and the pacific.
Journal of Clinical Neuroscience · 2025-10-30 · Other / unclear
Abstract
BACKGROUND: The Pacific Islands face formidable barriers to timely neurosurgical care, driven by geography, limited resources, and fragile referral systems. Fiji functions as a regional hub but remains constrained by centralization, distance, and workforce limitations. OBJECTIVE: To synthesize available evidence on neurosurgical access, aeromedical retrieval, and telehealth across Fiji and neighboring island states, identifying gaps and opportunities for system strengthening. METHODS: A structured narrative review was conducted following the Standards for Narrative Reviews (SANRA) guidelines. Searches were performed in PubMed, Scopus, and Google Scholar for English-language publications from January 2000 to July 2025 using predefined keywords and Boolean combinations ("Fiji" OR "Pacific Islands") AND ("neurosurgery" OR "neurotrauma" OR "traumatic brain injury" OR "stroke") AND ("telemedicine" OR "aeromedical retrieval" OR "air evacuation" OR "global surgery"). Reference lists were hand-searched, and gray literature from the World Health Organization (WHO) and Pacific Ministries of Health was included. RESULTS: A total of 164 records were identified and 42 retained for qualitative synthesis (29 peer-reviewed and 13 Gray literature sources). Records were grouped thematically according to Global Surgery 2030 (GS2030) benchmarks. Fiji reports high incidence of traumatic brain injury and stroke with substantial pre-hospital mortality. Neurosurgical services are centralized in Suva, Lautoka, and Labasa, leaving outer islands dependent on costly, weather-sensitive aeromedical retrieval. Early telehealth pilots demonstrated feasibility but lacked sustainability. The 2024 rollout of satellite internet (Starlink) offers new potential for real-time imaging transfer, remote consultation, and coordinated retrieval activation, though evidence from prospective pilots remains limited. CONCLUSION: Fiji's emerging role as a regional stabilization and tele-neurosurgery hub highlights a feasible model for strengthening neurosurgical access across the Pacific. A tiered network linking national hospitals to tertiary centers in Australia, New Zealand, India and France could reduce inequity if supported by regional policy frameworks, workforce upskilling, and outcome monitoring.
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Tags
Helicopter & air ambulance · Equity & disparities · Interagency collaboration · Interfacility & critical care transport · Low- and middle-income settings · Prehospital physicians · Telemedicine
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