Nurses Taught New Skills To Help Island Women

Village Nurses at New Microscopes learn how to identify and treat female infections. “In more than 15 years of teaching medical students, I have never encountered learners as competent or enthusiastic as the nurses of Kiritimati (Christmas Island),” says Dr. Woehrle. Dr. Woehrle is second from right and Dr. Levi to her left at microscope.

Village Nurses at New Microscopes learn how to identify and treat female infections. “In more than 15 years of teaching medical students, I have never encountered learners as competent or enthusiastic as the nurses of Kiritimati (Christmas Island),” says Dr. Woehrle. Dr. Woehrle is second from right and Dr. Levi to her left at microscope.

On PIMA’s first Women’s Health Team visit to Christmas Island last year, hundreds of island women came forward who had been suffering in silence with female infections, many for months, afraid to be seen by a man doctor.

This year, the team brought speculums and microscopes and trained all the female nurses to identify and treat these infections at the village level. For the second year, the team was led by Dr. Theresa Woehrle from LaCanada, California, who teaches medical students at the University of Southern California Keck School of Medicine, and was aided by USC clinical instructor Dr. Lori Levi, OB/GYN, from Pasadena, California.

By Dr. Theresa Woehrle

Give a man a fish and you feed him for today; teach a man to fish and you feed him for a lifetime.

This was the guiding principle of the Pacific Islands Medical Aid Women’s Health Team during our recent visit to Kiritimati (Christmas Island) to teach the nurses to evaluate and treat women for common gynecologic conditions.

Last year, the team had the honor of visiting Kiritimati and evaluating and treating nearly 300 women who had not had access to vaginal exams. Although we were able to help many women during that visit, we realized the greatest impact would be to train the nurses to see and treat women at the village level.

This year, we returned armed with PIMA-donated microscopes for each village nurse and all the materials the nurses would need to evaluate their patients.

On the first day of our visit, we had a class on how to perform a speculum exam and how to differentiate vaginal infections using the microscope.

The nurses were eager, enthusiastic, and very quick learners.

The following days, we went to each of the villages to set up the microscopes and work with each nurse as she examined her patients in her village clinic where both patients and nurse feel comfortable and at home.

In addition to performing a speculum exam and using the microscope to identify vaginal infections, the nurses learned how to perform a cervical exam using acetic acid (vinegar) to assess for possible early changes similar to what is discovered in a pap smear.

This is known as visual inspection with acetic acid (VIA) and is used in resource-poor areas such as Kiritimati where there is no pathologist who can read a pap smear.

In more than 15 years of teaching similar skills to medical students in the U.S., I have never encountered learners as competent or enthusiastic as the nurses of Kiritimati.

We felt a great amount of pride in our students as they each received a certificate of learning on the final day of our visit and a great deal of gratification knowing that by teaching the nurses, we were able to impact the health of thousands of women who would receive much needed care at the village level for years to come.

A Boat 4 Christmas Islands

Initial efforts go swimmingly

Catamaran

Mere months after its inception, the campaign headed by the Pacific Islands Medical Aid (PIMA)-affiliated Boat Committee to secure a vessel for emergency medical transportation between the islands of the Pacific nation of Kiribati is already making waves.

A fortuitous connection with a contact in the sailing world brought Dr. Elizabeth Beale, an endocrinologist with the University of Southern California who has spearheaded the campaign, in touch with Chris Bone, the managing director of marine conservation group OceansWatch and an experienced yachtsman with knowledge of the Pacific islands.

After an initial discussion regarding what type of boat would be required to meet the needs of the Kiribati people and PIMA, Bone recommended a Wharram catamaran, an open-deck vessel inspired by Polynesian double canoes.

He also expressed interest in pursuing a joint venture in which PIMA would handle medical missions among the islands of Kiribati and OceansWatch would crew the boat and conduct marine conservation and humanitarian work.
Meanwhile, Carlton Smith, the founder of PIMA, visited the islands in mid- March and discussed the boat campaign with Kiribati government officials. In addition to expressing enthusiasm about improved transportation between the islands, they provided more information about the logistics of the project.

Ideally, the craft would be able to carry five or six people in addition to its crew, as well as up to 500 pounds of medical supplies, produce from the outer islands of Tabuaeran and Teraina, or other resources.

Moorings and docks are available in lagoons on Kiritimati and Tabuaeran, but there is no dock or safe landing area on Teraina. Local motorboats would have to shuttle people and supplies through the surrounding coral reef.

Although medical emergencies would be relatively rare, Smith envisioned regular runs between the islands for general medical care and other transportation needs, in addition to staving off boredom among crew.

Kiribati officials agreed that PIMA should take the lead on managing the boat as a charitable contribution. They also suggested a trial run to determine whether a Wharram catamaran meets space and safety requirements.

Several issues remain up for discussion, including whether a representative from PIMA should attend an annual gathering of Wharram catamaran experts and enthusiasts in Islamorada, Fla., in May. Other potential steps include developin a cost–benefit analysis and a fundraising plan.

Initial estimates suggest between $60,000 and $80,000 would be needed to purchase a catamaran that would meet the needs of the Kiribati people, although more research is needed.

The Mission

As one of the world’s most isolated and impoverished nations, Kiribati is in urgent need of medical support and supplies. The island nation’s 100,000 citizens benefit from a small hospital on Kiritimati, but residents of far-flung Tabuaeran and Teraina islands are difficult to reach during medical emergencies.

A well-stocked and sturdy vessel would enable the critically ill and injured to be transported during emergencies and allow medical staff to visit the outer islands, improving quality of life and bringing peace of mind to the Kiribati people.

The goal of the A Boat 4 Christmas campaign is to assess the needs of Kiribati residents, determine the requirements for a seaworthy vessel capable of safely navigating the distances between the islands, and securing funding and other resources to locate, purchase, supply, maintain, and crew such a vessel.

Next Boat Committee Meeting

Tentative Date: May 23, 2013, 6:30 p.m.

Email beale@usc.edu to join mailing list