Interplast celebrated an incredible 40 years of work in 2023. The success of the organisation in that time has been due to the enthusiasm and quality of the volunteers, who donate their time and expertise both locally and abroad. Interplast’s ability to accomplish so much in the changing world of volunteer surgical missions was due to the model of service provision. This rapidly evolved from short-term medical service trips to a greater focus on education and training for local health care professionals. Interplast is now proactively adapting to ongoing changes within partner country health care services. In more recent years we have continued to focus on capacity building and also strengthening health care services in partner countries, when opportunities arise.

The COVID-19 pandemic and its global effects led to new and different requests for assistance from the countries with which we work. Individual and group mentoring was provided, and online education modules developed. This was achieved only through the valuable contribution of volunteers and the dedication of Interplast staff. The local partners find the education modules useful for continuing professional development and the modules continue to be accessed. These resources have proven to be a useful supplement to traditional learning and teaching by visiting teams. Not all of this education is clinical, with examples including a Women in Medical Leadership webinar, requested by Mongolia, and gender, equality, disability and social inclusion training. The latter is now a focus for the World Health Organization (WHO) and other organisations, including the Australian Government’s Department of Foreign Affairs and Trade, to help improve gender equality and reduce inequalities of access to health care services, both of which are United Nations’ Global Sustainable Development Goals.

In 2023, we returned to overseas work. It was gratifying to be warmly welcomed back and receive positive feedback on the work that we do. In particular, our responsiveness to local needs and capacity building were considered to be empowering for the health professional service providers in our partner countries. The pandemic led to loss, mainly through redeployment or overseas recruitment of many nursing and allied health staff. This makes the training of replacements, especially perioperative staff, a current priority in many countries. Interplast was invited to attend the Pacific Heads of Nursing and Midwifery meeting in Fiji in September 2022 where the first edition of Standards for perioperative nursing in Pacific Island countries and territories1 manual and online training package2 was launched. Our Pacific partners are also struggling with management of diabetic foot disease and performing many amputations. This is a significant burden on both the health care system and the community. We are working with them to improve early management of diabetic wounds, thus reducing the burden of care and also improving rehabilitation and prosthetic services.

There are several successful models for volunteer organisations that provide both high quality health care service and aim to improve local health care systems, a mission consistently achieved by our visiting teams. The characteristics these models share include long-term commitment; reliability and transparency; working collaboratively with local health professionals; understanding the local health care system including cultural norms; and working in a sustainable way. Central to all successful models are mutual respect, interpersonal relationships developed over time, and the trust that develops when individuals and organisations act with integrity—this takes time and repeated visits to establish.

Interplast is working to meet the new standards recommended for global volunteering,3 including:

  • volunteering for development, rather than only service provision

  • responsible volunteering, addressing local needs and ‘doing no harm’

  • impactful volunteering which includes evaluation of outcomes, as well as measurable and sustained improvements aligned to the country’s national goals and the United Nations’ Sustainable Development Goals.

Photography of clinical cases and local environments has always been part of plastic surgery and Interplast’s activity, including fundraising. There is now increased recognition of the ethical implications regarding the use of photography, as well as the risk of inappropriate use of images, especially due to difficulties with informed consent and the potential for power imbalances when people are seeking care. Interplast annual reports and publications highlight appropriate rather than gratuitous use of clinical images.4 Photographs are used because they are relevant and respectful of the individual and local culture. There is an increasing focus on proper informed consent being obtained and documented, giving information that consent can be withdrawn, and ensuring that patients and local staff are accurately represented and acknowledged. I suggest surgeons consider these issues when using clinical images in presentations and publications for any purpose.

Interplast has faced many challenges and hurdles in our first 40 years and what future challenges will be is hard to predict. Some organisations have been impacted by a reduction in the numbers of volunteers. We have not had this problem but we do have a high demand for volunteers with specialised skills, including paediatric anaesthesia, burns and cleft care. A variety of factors including cost-of-living pressures have impacted on fundraising for many organisations, including Interplast. There is an increasing awareness of the problems of climate change and the environmental impact of health care services, particularly surgical operating theatres.5 Our local partners and Interplast are beginning to consider ways to address this. We would welcome suggestions as it is a particularly complex problem that will require a collaborative and innovative response.

I would like to thank all our amazing volunteers who have contributed so much time and skill over the years. Also, our donors, supporters, staff and partners who have all demonstrated their ongoing commitment to the vision of Interplast. The challenges for the next 40 years will need to be faced with flexibility and openness to ongoing change, but the mission and values remain the same. Working in partnership with people in Asia and the Pacific, through relationships built on trust, we intend to continue to support our partner countries to provide the best heath care possible into the future.