Iakobwa Now Learns to Walk; Shriners Brings About Miracle

Iakobwa Kabong could only walk on his knees and shuffle around on pieces of cardboard back on Christmas Island in Kiribati before he was admitted to Shriners Hospital for Children in Honolulu. And he didn’t have use of his hands. He would push himself forward on his knuckles and use the cardboard like a sled along the rough ground.

Iakobwa in wheelchair at airport heading home after more than a year at Shriners Hospital for Children in Honolulu.

Iakobwa in wheelchair at airport heading home after more than a year at Shriners Hospital for Children in Honolulu.

After a little more than a year at Shriners Hospital and multiple surgeries, Iakobwa (pronounced ya-ko-bah) can now stand and has use of his hands. With exercises and the use of a walker, he should soon be walking on his own, say the doctors at Shriners.

Iakobwa, now 18, was brought to Shriners under a program initiated with Shriners and Pacific Islands Medical Aid several years ago. Shriners takes care of all medical needs and we at Pacific Islands Medical Aid provide financial help for food, lodging, local transportation and translation services.

“We are eternally grateful to Shriners Hospital, it’s leader Dr. Craig Ono, MD and all the physicians, nurses and support staff involved in Iakobwa’s miracle,” said Carlton Smith, president of Pacific Islands Medical Aid (PIMA). “And thanks to our many good hearted donors who helped make this happen.”

Iakobwa needed a dozen surgeries to help correct his malformed legs and hands, Smith said, and he was able to spend more than a year at the hospital in Honolulu with his mother during that time.

Intrepid PIMA volunteer Kaitibo Timon in Honolulu, who was born in Kiribati, helped with translations and local transportation during the entire time, Smith said.

After hundreds and hundreds of hours of therapy, Iakobwa was sent on his way back to Christmas Island with a walker, wheelchair and electric scooter… all thanks to Shriners Hospital for Children!

Shriners nurse and social worker Cindy Shimabukuro said Iakobwa first arrived at Shriners Hospital in Honolulu on April 25, 2017 with a diagnosis of arthrogryposis. “He has undergone many procedures and surgical interventions since his arrival and the young man who came to us unable to stand and would walk on his knees, is now able to stand and walk short distances with a walker.

Throughout his stay, she said, Iakobwa has demonstrated strength and dedication to work toward his goal of walking. She also credits Iakobwa’s mother who was his ‘biggest cheerleader.’

“They were wonderful members of our Shriners Family Center always supporting others. We already miss this family’s positive attitude and strength,” she said.

PIMA Heart Team Sees 177; Nine Require Cardiac Surgery

Our intrepid heart team has returned home after seeing 177 patients in a week’s time on isolated Christmas Island in the central Pacific, where they identified nine needing life-saving surgery.

Nine heart patients heading for surgery. Plans are underway now to bring the nine patients to Baylor Scott White Heart Hospital in Plano, Texas for surgery, says team leader cardiothoracic surgeon Dr. David Moore, M.D.

Team members on the island were divided into small units for their one-week stay and were able to perform 176 heart echoes on adult patients and 975 rheumatic heart disease-screening echoes for children at local schools on the island.

In addition, team members offered educational talks to teachers and students about rheumatic heart disease, its causes and cures… where many islanders suffer as a result of undiagnosed and untreated rheumatic fever in children that results in heart disease later in life.

Counseling Patient: Volunteer cardiothoracic surgeon Dr. David Moore, M.D., counsels patient on Christmas Island after tests show the patient needs heart surgery to correct the effects of his rheumatic heart disease. In just one week, the PIMA Heart Team saw 177 patients with 176 echos and 9 patients identified for surgery back in the U.S.

Counseling Patient: Volunteer cardiothoracic surgeon Dr. David Moore, M.D., counsels patient on Christmas Island after tests show the patient needs heart surgery to correct the effects of his rheumatic heart disease. In just one week, the PIMA Heart Team saw 177 patients with 176 echos and 9 patients identified for surgery back in the U.S.

“We are really proud of our professional team members who volunteered time and expertise in helping the good people of Kiribati, where the need it great,” said Carlton Smith, president of Pacific Islands Medical Aid.

The physician and medical officer in charge for the Kiribati Ministry of Health on Christmas Island, Dr. Teraira Bangao, says ‘the team worked very hard when they were here… they did a great job… starting out each day at 8:30 a.m. and working straight through to 6 p.m.”

“We are so thankful to the team members and everyone at Pacific Islands Medical Aid and look forward to their next visit,” he said.

In this humanitarian outreach, Dr. Moore and his team of heart surgeons at Cardiac Specialists in Plano, Texas and Baylor Scott White Heart Hospital in Plano will provide surgeries and hospitalization for the patients, while Pacific Islands Medical Aid provides all housing, meals and local transportation in the Dallas area for the patients and their chaperones, and the Kiribati Ministry of Health provides round trip airfare.

Please help support this life-saving program with your donation. Here is Dr. Moore’s report.

By Dr. David Moore, M.D.

Rheumatic heart disease remains a major global health concern primarily affecting young adults in the developing world.

This is particularly true in many of the islands of the central and western Pacific.

Our team from Baylor Scott White Heart Hospital in Plano, Texas recently returned to Kiritimati (Christmas Island) in the Republic of Kiribati with the support and coordination of Pacific Islands Medical Aid.

 

Team members included Dr. David Moore, CV surgery; Dr. Steve Mottl, cardiology; Michael Rampoldi, echo cardiographer, Candice Rampoldi, echo assistant and echo data collection; Amy Moore, trip coordinator and data management; Sherry Swanson, Baylor Heart Hospital social services; and Tom Roma, school education program.

Little Ones Included: All islanders, young and old, showing signs of possible heart disease were checked out by our volunteer heart team on their most recent visit to Christmas Island in Kiribati, where nine were identified for life-saving heart surgery back in the U.S.

Little Ones Included: All islanders, young and old, showing signs of possible heart disease were checked out by our volunteer heart team on their most recent visit to Christmas Island in Kiribati, where nine were identified for life-saving heart surgery back in the U.S.

In the course of our week on the island, we functioned as two teams; one evaluating patients in the clinic at Ronton Hospital and the other focusing on education regarding prevention of rheumatic heart disease (RHD) as well as echo screening in the primary schools.

Echo screening of asymptomatic children allows for early detection of RHD with the identification of subtle abnormalities in the heart valves. Children with these findings can then be started on prophylactic penicillin injections preventing subsequent episodes of Strep Throat and thus avoiding further immune response and valve damage.

A total of 950 children were screened by our team over a period of four days. At the same time, children, teachers and some parents received education on the prevention of RHD, emphasizing hand washing, appropriate coverage for cough, and the need to see a physician or nurse for treatment of sore throats.

At the clinic, our team evaluated and obtained an echo on 175 patients. Two children with congenital heart disease were identified, three adults with probable coronary artery disease and eight patients with rheumatic heart disease were diagnosed.  The adult patients will be brought to Baylor Scott White Heart Hospital in Plano, Texas for additional testing and surgery. The children with congenital heart disease will be referred to an appropriate facility for surgical correction.

Our team appreciates the opportunity to continue this good work made possible by Baylor Scott White Health Care System, the Republic of Kiribati Ministry of Health and Pacific Islands Medical Aid.

We are grateful to the people of Kiritimati (Christmas Island) for their warm hospitality and support.

Diabetes Attack Team Plans Twice Yearly Expeditions

Plans are now nearing completion for a comprehensive campaign to fight diabetes in the Line Islands of Kiribati, where adult onset rates are among the highest in the world… more than 30 per cent of adults suffer with Type 2 adult onset diabetes, according to results of our recent Pacific Islands Medical Aid studies.

Our PIMA team plans to spend two weeks on Christmas Island (Kiritimati), Tabuaeran and Teraina this August and return to the islands twice each year for follow-up and training.

“We are very proud to announce the formation of a top-notch team to help address this critical need, invited by and working alongside Kiribati Ministry of Health personnel in the islands,” said Carlton Smith, president of Pacific Islands Medical Aid.

“Leading the team is Dr. Elizabeth Beale, diabetologist and professor at the University of Southern California, who has been to Christmas Island previously to study the effects of this terrible disease on the local population and begin planning a comprehensive program to help alleviate the suffering,” Carlton said.

Joining Dr. Beale is Dr. Julie Chatigny DPM, podiatric specialist with Central Coast Foot and Ankle Specialists in California and Dr. Michael Goran, PHD, Professor of Preventive Medicine, Childhood Obesity Specialist. University of Southern California.

Diabetes Team Planning: In one of several planning meetings to prepare for upcoming Diabetes Team expedition to the Line Islands in Kiribati this August are (from left) Dr.Lydia Lam, trauma and critical care professor at Keck School of Medicine, University of Southern California; Dr. Julie Chatigny, podiatric specialist, Central Coast Foot and Ankle Specialists; and Dr. Elizabeth Beale, endocrinologist and professor at University of Southern California.

Diabetes Team Planning: In one of several planning meetings to prepare for upcoming Diabetes Team expedition to the Line Islands in Kiribati this August are (from left) Dr.Lydia Lam, trauma and critical care professor at Keck School of Medicine, University of Southern California; Dr. Julie Chatigny, podiatric specialist, Central Coast Foot and Ankle Specialists; and Dr. Elizabeth Beale, endocrinologist and professor at University of Southern California.

Helping put together this great team is our Pacific Islands Medical Aid Director of Medical Service, Dr. Lydia Lam, MD, FACS, professor of Clinical Surgery and Emergency Medicine at Los Angeles County-University of Southern California Medical Center. She is also associate program director of the Trauma/Critical Care Fellowship at the Keck School of Medicine, University of Southern California.

Dr. Beale said the mission approach will include a clinical program for adults and research-based prevention program in children and adolescents.

In the clinical program, Drs. Beale and Chatigny will visit Kiritimati and outer islands for two weeks and conduct one-day clinic and educational sessions at the various villages. They will focus on consolidating work initiated in foot care in 2017, identifying patients at risk for diabetes related foot problems and how to reduce the risk of foot injury and amputations.

Dr. Beale will also evaluate management of diabetes in pregnancy and both will conduct an initial assessment of diabetes on the outer islands of Tabuaeran and Teraina.

Dr. Beale said that Dr. Goran visited Christmas Island in March of 2017 and assessed nearly 400 school children where a high prevalence of pre-diabetes was identified.

This year, she said, children will be re-evaluated with A1C testing and those with diabetes will be referred for medical care.

Additionally, she said, annual visits under the direction of Dr. Goran will conducted to maintain a data base to track diabetes development in the school children and effects of interventions.

Intrepid Volunteer Physicians Venture To Aid Eye Patients

Advance Eye Team: Flanking Dr. Jack Mason ( second from left ) and Dr. Larry Falk are Kiribati biomedical officer Taaren, at left, and nurse Iokabwa, who helped with patients and distributed hundreds of pairs of eyeglasses. Both Taaren and Iokabwa serve at the small Ronton Hospital on Christmas Island, where eye surgeries will take place this summer.

Advance Eye Team: Flanking Dr. Jack Mason (second from left) and Dr. Larry Falk are Kiribati biomedical officer Taaren, at left, and nurse Iokabwa, who helped with patients and distributed hundreds of pairs of eyeglasses. Both Taaren and Iokabwa serve at the small Ronton Hospital on Christmas Island, where eye surgeries will take place this summer.

Two of our intrepid Pacific Islands Medical Aid volunteer physicians have returned from two isolated islands in Kiribati in the Central Pacific where they identified 41 blind and nearly blind islanders needing cataract surgery and dispensed hundreds of pairs of long distance vision and reading glasses.

Veteran PIMA volunteer physician and general surgeon Dr. Larry Falk, along with ophthalmologist Dr. Jack Mason, both from Ukiah, California, ventured to the islands of Tabuaeran and Teraina …where there are no doctors …to examine and diagnose patients in advance of our Eye Surgery Team going to Christmas Island next month to perform the surgeries.

Patients will be brought to Christmas Island (Kiritimati)by boat aboard the sailing vessel Kwai, owned by Brad Ives from Hawaii, a long-time friend of PIMA.

Larry and Jack were joined by senior male nurse Iakobwa and Taaren, the biomedical officer at Christmas Island’s Ronton Hospital.

Here is Dr. Larry’s account of the expedition.

By Dr. Larry Falk, MD

Dr. Jack Mason and I recently had the pleasure of working on the islands of Tabuaeran and Teraina in Kiribati, under the auspices of Pacific Islands Medical Aid and upon the invitation of the medical officer in charge in the Line Islands, Dr. Teraira Bangao and Ministry of Health of Kiribati.

We were invited to screen patients for eye diseases in anticipation of a PIMA-sponsored cataract surgery team scheduled later this Spring. Jack is an ophthalmologist and I am a general surgeon volunteer with PIMA. Although Jack had been fishing on Christmas Island in the past, this was his first chance to volunteer his professional services with Pacific Islands Medical Aid.

Eye Exam on Tabuaeran: Volunteer ophthalmologist Dr. Jack Mason from Ukiah, California examines young eye patient on isolated island of Tabuaeran. Behind Jack is team leader Dr. Larry Falk along with local Kiribati nurse.

Eye Exam on Tabuaeran: Volunteer ophthalmologist Dr. Jack Mason from Ukiah, California examines young eye patient on isolated island of Tabuaeran. Behind Jack is team leader Dr. Larry Falk along with local Kiribati nurse.

We arrived on Christmas Island, spent four days at the small hospital there, then bundled up our equipment and took the small plane to Teraira (Washington Island).

We were quartered in the abandoned formerly British colonial headquarters and slept under a mosquito net.

In two days, we saw many patients and were able to enlist multiple cataract and non-cataract referrals.

Our final stop was at Tabuaeran (Fanning Island) where we stayed at a comfortable tropical hotel setting on an island, like Christmas, that has a huge lagoon. We saw patients with the help of the local Ministry of Health Clinic staff.

Jack encountered a wide range of clinical problems among all of these patients. These included minor issues such as presbytopia (nearsightedness), pterygia and dry eyes as well as more series pathology.

There were 41 patients judged to be suitable for cataract surgery. Diabetes is a common problem and Jack evaluated patients with diabetic retinopathy related issues. Other issues included untreatable blindness, old eye injuries, tear duct malfunction, posterior capsular apacification, a cancer of the eye and ocular trachoma. One six-year-old girl had bilateral subluxation of her lenses which could result in blindness.

Overall, there was an overwhelming burden of ocular pathology among the patients we had the privilege of seeing. Appropriate referrals were made and care was rendered where possible.

A group of 41 patients will be referred to the PIMA-sponsored cataract surgery team later in the year, led by Drs. Paul Imperia and Paul Jorizzo, both of Medford, Oregon.

It was a humbling and rewarding experience to have the pleasure of working with Dr. Teraira and optical technician Iakobwa as well as the rest of the capable Ministry of Health staff at each of the clinics. We are grateful to each of them, to the patients and to Carlton Smith of Pacific Islands Medical Aid.

Advance Team Identifies Cataract Patients

Our advance eye surgery team, led by long-time Pacific Islands Medical Aid volunteer Dr. Larry Falk, M.D. , along with recently-retired ophthalmologist Dr. Jack F. Mason, M.D., has just returned from the isolated islands of Tabuaeran, Teraina and Kiritimati in the Central Pacific where they identified more than 50 islanders needing cataract surgery.

In addition, hundreds of islanders were examined and received reading and long distance vision eyeglasses, donated by PIMA with your generous donations, and dispensed by local nurses.

In late April, patients will be brought to the small hospital in Kiritimati for cataract surgery, where volunteer eye surgeons Drs. Paul Imperia and Paul Jorizzo from Medford, Oregon will lead. This will be their third Pacific Islands Medical Aid trip to the Line Islands in Kiribati, where they have already performed nearly 200 successful eye surgeries.

See Dr. Falk’s report, including photos, in next month’s newsletter.

Team Fights Cervical Cancer, Continues Training Program

High rates of uterine cancer plague Pacific Island nations and threaten the lives of adult women who have no means of early detection or treatment.

To help stem the tide and provide preventive treatment, our volunteer Women’s Health team has just completed it’s third mission to Christmas Island in the isolated island nation of Kiribati, where they treated nearly 100 women and continued an educational program to help local doctors and nurses identify and treat uterine pre-cancer.

Members included our team leader, Dr. Theresa Woehrle, M.D.,MPH and ob/gyn Dr. Judy Hall Chen, M.D., professor of obstetrics and gynecology at Keck School of Medicine, University of Southern California.

And thanks to your donations, Pacific Islands Medical Aid has been able to donate portable equipment to help identify and treat early signs of cervical cancer in island women. Here is Dr. Woehrle’s report:

By Dr. Theresa Woehrle, M.D., MPH

Dr. Judy Chen and I have just returned from our women’s health trip to Kiritimati (Christmas Island) and we could not be happier about the outcome. From beginning to end it was a great trip.

Working closely with Dr. Baranika Toroman (the sole ob/gyn on the island), the team was able to see nearly 100 women for cervical cancer screening.

Dr. Judy also trained the local staff in the use of a hand-held ultrasound (also donated by PIMA). This was especially useful in the isolated and remote village of Poland on Christmas Island where women find it very difficult to come to the island hospital for prenatal ultrasound.

Most importantly, we found that with the support and encouragement of Dr. Baranika and Dr. Teraira Bangao (the island’s medical officer in charge) and their nurses, the local program continues to identify and kill pre-cancer cells.

By identifying early changes, they have saved many women from cervical cancer.

Children from Tarawa Get Heart Surgery

For the parents of 2 year old Iotua Nenetaake and Bwabwane Meeia, 10, it’s a dream come true that their children have been saved, thanks to the efforts of Pacific Islands Medical Aid, the leader of HeartGift Texas and heart surgeon Dr. Camile Hancock Friesen at Dell Childrens’ Medical Center of Central Texas in Austin.

Ready to Go Home - Children from Tarawa in Kiribati are ready to go home after successful heart surgery in Austin, Texas. Sitting between children is their heart surgeon, Dr. Camile Hancock Friesen of Dell Childrens Medical Center of Central Texas. Second from right is Sonya Keeling, International Director of HeartGift of Texas, who arranged help for the children. Others include parents of the children and Kiribati Ministry of Health nurse/translator.

Ready to Go Home – Children from Tarawa in Kiribati are ready to go home after successful heart surgery in Austin, Texas. Sitting between children is their heart surgeon, Dr. Camile Hancock Friesen of Dell Childrens Medical Center of Central Texas. Second from right is Sonya Keeling, International Director of HeartGift of Texas, who arranged help for the children. Others include parents of the children and Kiribati Ministry of Health nurse/translator.

The children, their mothers and Kiribati Ministry of Health nurse have now all returned to their home island of Tarawa in the Central Pacific following successful heart repair surgery for both children.

Congenital heart problems for each child were first discovered by our volunteer heart team leader, cardiothoracic surgeon Dr. David Moore of Baylor Heart Hospital in Plano, Texas and his team, traveling to far-away Tarawa last year.

Surgery was made possible with the help and leadership of Ms. Sonya Keeling, national patient coordinator for HeartGift Texas, who’s efforts made it possible for the children to come to Dell Childrens’ Medical Center.

Ms. Keeling said both children “were amazing in their recovery from surgery. Having them here has been such a great experience for all of us involved,” she said.