PIMA Departs Kiribati as Nation Sides with Communist China

Dear friends of Pacific Islands Medical Aid;

As you may be aware, the Kiribati government has severed ties with the democratic nation of Taiwan and signed a pact with Communist China, in exchange for millions and millions of dollars in aid.

In doing so, the Kiribati government had to agree with the Communist government’s “one China policy,” maintaining that the nearly 24 million who live in freedom on Taiwan should be citizens of Communist China, where basic freedoms of speech, press, religion and assembly are denied.

The Communist government has said it will take over Taiwan by force, if necessary.

For fifteen years now, we at Pacific Islands Medical Aid have offered the free services of great American doctors, medical supplies and equipment to the nation of Kiribati. Volunteer physicians from other democratic nations in the region …Australia, New Zealand, Japan and Taiwan have for years also helped the Kiribati Ministry of Health.

The Taiwan government has given Kiribati millions in aid each year. Japan has made donations of infrastructure. Australia has helped train the nation’s nurses. New Zealand has offered medical grants and employment for Kiribati citizens.

We were first encouraged to offer our help to the good people of Kiribati by Member of Parliament Ieremia Tabai, the first freely-elected president of the Republic of Kiribati, a staunch defender of democratic values. One of PIMA’s current board members, Dr. David Langston, was raised in Ieremia’s home.

Of the switch from Taiwan to Communist China, Ieremia last week questioned the health of the democracy in Kiribati where he says even civil servants are afraid to speak out. He also criticized the state’s radio station for not airing opposite views despite multiple attempts to get airtime.

Our efforts in Kiribati are now over, but we look back with great satisfaction that we have been able to help thousands in that poor island nation.

Looking forward, we hope to be able to offer the same level of humanitarian aid to other island nations in the Pacific that support democracy like the Marshall Islands, Nauru, Tuvalu and Palau.

Carlton Smith, president
Pacific Islands Medical Aid, Inc.

A Big Thanks to Sherry and CryoLife

Absolutely critical to our success with heart patients from the Central Pacific are new heart valves needed to replace defective human valves in the dozens of islanders brought to the U.S. for life-saving surgery.

CryoLife cardiovascular specialist Sherry Shaw of Plano, Texas and the firm she represents, On-X Life Technologies, Inc., have been absolutely essential in our humanitarian program by donating world-class artificial heart valves to Pacific Islands Medical Aid (PIMA) through Baylor Scott White Heart Hospital in Plano and team leader, cardiothoracic surgeon Dr. David Moore of Cardiac Surgery Specialists in Plano.

“We cannot thank Sherry enough for organizing her company’s fabulous donations and for her continuing support of this worthwhile program,” said Carlton Smith, PIMA president.

Sherry said it is “a humbling honor to be part of such a worthwhile endeavor with such an excellent heart team and hospital.”

CryoLife is a leader in tissue processing and medical devices, such as the On-X prosthetic heart valves used in cardiac surgical procedures, Carlton said.

PIMA Team to Establish Island Rheumatic Heart Disease Clinic

Following the return home of six more islanders from Kiribati having received life-saving heart surgery in Plano, Texas, the heart team returns this month to Christmas Island to set up a Rheumatic Heart Disease Clinic in conjunction with the Kiribati Ministry of Health to follow up on patients and review new cases.

Dr. David Moore, MD

Dr. David Moore, MD

“More than 45 Kiribati islanders all together have been saved with heart surgery provided free of charge by the team, led by Dr. David Moore, MD , cardiothoracic surgeon from Cardiac Surgery Specialists in Plano, Texas and Baylor Scott White Heart Hospital there … and his incredible team,” said Carlton Smith, president of Pacific Islands Medical Aid, Inc.

“What is needed now is a program to monitor all patients who have returned to their home islands, and to establish a way to identify new cases,” Carlton said.

The team is scheduled to depart toward month’s end and will remain on Christmas Island for one week to help get the program going, Carlton said. Joining Dr. Moore will be Dr. Kelley Hutcheson, MD, cardiothoracic surgeon, echo specialist Jessica Gilbert and social services director Sherry Swanson, both from Baylor Scott White Heart Hospital in Plano.

Dr. Moore said that he and his team “are looking forward to working with the medical personnel on Christmas Island, under the direction of medical officer in charge Dr. Teraira Bangao, to establish a more robust program for rheumatic heart disease patients.”

Here is Dr. Moore’s story:
By Dr. David Moore, MD

Rheumatic Heart Disease (RHD) remains a worldwide health issue with prevalence in the remote islands of central and western Pacific.

In May of 2018, a medical team from the Baylor Scott and White Heart Hospital in Plano, Texas travelled to Kiritimati (Christmas Island) to conduct echo screening and evaluate patients with suspected RHD.

A group of patients were identified with severe mitral, aortic and tricuspid valve disease. Several patients with symptoms of coronary artery disease were also noted.

In October, nine patients, accompanied by local island physician Dr. John Tekanene traveled to Baylor Scott White for further evaluation and surgery.

Five patients received open heart surgery for valve repair or replacement and one patient underwent coronary bypass surgery. All patients recovered well and returned home safely.

The medical team from Plano will return to Kiritimati later this month to work with local medical personnel in establishing an RHD clinic on the island. This clinic will carefully follow patients who have had valve surgery, managing medications and anticoagulation.

Patients with a history of rheumatic fever will be treated with prophylactic penicillin injections, and echo screening done for patients with heart murmurs and symptoms consistent with RHD. A data base of RHD patients will be established and patients seen at regular intervals for medical management.

Patients identified with severe RHD will be evaluated carefully for heart surgery and appropriate patients brought to Baylor Scott White Heart Hospital in Plano for operation.

The support of the Kiribati Ministry of Health, Baylor Scott White Heart Hospital in Plano, Texas, and Pacific Islands Medical Aid, (PIMA) is greatly appreciated as this work continues.

Diabetes Program Underway To Prevent Threats to Life

With more than 30 percent of adults in the Line Islands of Kiribati suffering with Type 2 Diabetes and its life-threatening effects, Pacific Islands Medical Aid is undertaking its largest program yet.

Under the leadership of Diabetes Team leader and endocrinologist Dr. Elizabeth Beale from the University of Southern California, we are making regular visits to Christmas Island (Kiritimati) to treat the disease, hire and train local aides to assess issues before they become life threatening, in concert with the Kiribati Ministry of Health and it’s medical officer, Dr. Teraira Bangao.

Under the program, we have now hired two nurse’s aides to work throughout the island exclusively to monitor and assess diabetes patients.

Our great volunteer podiatric physician and surgeon, Dr. Julie Chatigny, chief executive officer and president of Central Coast Foot and Ankle Specialists in Templeton, California, has just returned from Christmas Island on this, her third trip there, to begin training the newly-hired aides and advance educational awareness.

– Here is her report –

By Dr. Julie Chatigny, DPM, AACFA

Kiritimati Island
January, 2019

It’s the beginning of something bigger…

On this third trip to Kiritimati, I was able to meet and train two new Diabetes Community Workers (DCW) to perform diabetic foot examinations with the intent to decrease limb and life-threatening foot wounds and prevent amputations.

Thanks to Carlton Smith, president of Pacific Islands Medical Aid, the amazing doctors and researchers at USC, the Kiribati Ministries of Health, the doctors and staff on Kiritimati island, and the philanthropic donation from Mr. Atul Dhubalia, the Diabetic Foot program has begun.

Upon arrival to the island, I was pleasantly surprised to find the diabetic foot examination handouts that were provided at the trip in August, 2018 were hanging on the wall at the front desk at the Ronton hospital.

     

Meet the new Diabetes Community Workers (DCWs) Tanoataake (Tanny) and Teraka.

We spent Thursday, January 24 at the Ronton hospital teaching and examining patients during the weekly diabetes clinic. Tanny was new to medical care, but was quick to learn the medical terms and the importance of the diabetic foot examination. I donated a laptop computer, and Tanny and I sat together and created a database to keep track of all of the foot examinations that would be performed.

Friday, January 25 began with patient rounds and meeting Teraka, the DCW. Tanny and Teraka joined us for patient rounds to experience patient care and see the results of diabetic foot infections on patients who did not seek medical treatment in a timely manner. It just so happened that Dr. John and I performed surgery for a diabetic foot infection on Teraka’s mother that morning. This made Teraka’s new job very real, and he quickly understood the importance of what he was taking on.

 

   

On arrival to the island, I presented Dr. John with a gift only a surgeon could love: new, sharp osteotomes and heavy mallets. He was thrilled.

    

The rest of Friday Tanny and Teraka practiced performing foot examinations on the hospital staff and gathering information for the database.

Monday, January 28
Dr. John, Tanny, Teraka, and I drove the London Clinic where we introduced Tanny and Teraka to and talked with the head nurse. We discussed what the DCWs would be doing and the importance of their work. She was happy to accommodate the two DCWs and even agreed to change the diabetic clinic from Thursdays to Wednesdays so that Tanny and Teraka could be present.

Next, we drove to the Banana clinic. Teraka and Tanny were introduced to the head nurse and they discussed their new jobs and the importance of diabetic foot examinations and patient education. Since Teraka resides in Banana, he would be the DCW assigned to the Banana clinic on Monday and Tuesdays.

    

While in Banana, we also went out in the Community to locate a few of Dr. John’s patients who had not been seen in the diabetic clinic in a timely manner. We were able to locate and assess two people. This woman below had a blood glucose that was so high that it would not even register on the glucometer. She was transported back to the Banana clinic where she was to receive a saline bolus and insulin.

Tuesday, January 29
The morning Dr. John, Tanny, and I drove to Tabwakea clinic. We introduced Tanny and discussed his new job and importance of the diabetic foot examination and patient education. Since Tanny resides in Tabwakea, he would be seeing patients at the clinic on Mondays and Tuesdays.

At lunchtime, the wonderful doctors and hospital staff provided me with a “Good-bye” lunch so that I would not have to dance by myself at an evening party. The trip was a huge success. The Diabetes program is off and running with two new DCWs.

    

Next steps…

Once Tanny and Teraka are comfortable with their new job duties, we plan to expand their duties by:

  • Adding in the school children’s heights and weights.
  • Pending further IRB approval, we would like to get fasting or random glucose measurements as well.
  • Adding nail and callus reductions (that will need to be taught on-site during another trip)

Another Shriners Miracle

Little six-year-old Raebine Tibweana has just returned home to Christmas Island in Kiribati after more than two months at Shriners Hospital for Children in Honolulu, where she underwent successful surgeries for two displaced hips and treatment for involuntary muscle contractions.

“It’s another miracle performed by the wonderful physicians and nurses at Shriners Hospital in Honolulu,” said Carlton Smith, president of Pacific Islands Medical Aid, Inc. (PIMA) “She’s on her way to recovery and will return to Honolulu in a year’s time for reevaluation,” he said.

Tebweana and other children from the isolated central Pacific nation of Kiribati needing orthopedic intervention come to Honolulu as a result of a special agreement between Shriners, PIMA and the Kiribati Ministry of Health, Carlton said.

Under this worthwhile program, Shriners sends physicians to Kiribati once a year to examine needy children and place them on a priority list for help. Shriners provides all medical care without cost, under the direction of chief of staff Dr. Craig Ono.

The Kiribati Ministry of Health pays for round-trip airfare for the child and chaperone (most often a parent), and PIMA takes care of visa fees and provides all necessary housing, transportation and translation services on Honolulu.

New Diabetes Program To Hit Devastating Island Epidemic

By Dr. Elizabeth Beale, M.D., MRCP

Treatment Underway: Pacific Islands Medical Aid volunteer diabetologist Dr. Elizabeth Beale, University of Southern California professor, ( second from right ), begins treatment instructions on diabetic patient with the help of the local island doctor and nurses.

Treatment Underway: Pacific Islands Medical Aid volunteer diabetologist Dr. Elizabeth Beale, University of Southern California professor, ( second from right ), begins treatment instructions on diabetic patient with the help of the local island doctor and nurses.

We are pleased to announce the launch of the Pacific Islands Medical Aid Kiritimati Diabetes Program, to provide year-round diabetes education, patient treatment and monitoring in that isolated region of the Central Pacific … where the need is great.

Over the last ten years, Pacific Islands Medical Aid (PIMA) under the leadership of it’s president, Carlton Smith, has sponsored several trips to Kiritimati (Christmas Island) by diabetes and obesity specialists, where type 2 diabetes has reached epidemic proportions…. More than 30 per cent of the adult population suffer with this destructive disease.

In the summer of 2018, the Christmas Island doctors and the visiting diabetes team agreed that the island community would be well served by establishing a program that allows for diabetes education and monitoring year-round by local diabetes community workers.

We discussed our plans with Dr. Lydia Lam of the University of Southern California Keck School of Medicine, who has volunteered on Kiritimati several times and who has coordinated many visits there by medical specialists.

Dr. Lam approached philanthropist Mr. Atul Dhablania, a supporter of international medical aid projects through the USC Institute on Inequalities in Global Health, who has generously donated $10,000 a year for three years to the PIMA Diabetes Team to establish the diabetes program.

Last resort: Without appropriate care and medication, often the last resort is amputation, done quite often in the islands. Our hope is to help reduce the enormous burden of this destructive disease.

Last resort: Without appropriate care and medication, often the last resort is amputation, done quite often in the islands. Our hope is to help reduce the enormous burden of this destructive disease.

In discussions with local doctors on Kiritimati, it was agreed that two local diabetes community workers (DCWs) be hired full time. Local ob/gyn Dr. Baranika Toroman, has selected two candidates each of whom have excellent rapport with their local communities, basic nursing experience and good language and computer skills.

Their work conditions and salary will be similar to those of nurse aides on the island and they will work under the supervision of the island’s senior nurse and the local physician and diabetes team doctor, Dr. John Tekanene, under the Kiribati Ministry of Health medical officer in charge, Dr. Teraira Bangao. Salaries will be paid by PIMA through the Kiribati Ministry of Health.

Amputations and death due to foot infections and ulcerations are currently a devastating problem on the islands, and yet in most cases are preventable.

So our first goal is to establish a foot care program.

Late this month, our DCWs will be trained by Dr. Julie Chatigny, DPM, who is scheduled to arrive on the island Jan. 23. She will first teach them to conduct basic foot examinations and to maintain high-quality medical records.

Problems identified will be discussed with local medical staff so they can implement an appropriate plan of care. Weekly reports will be sent to Dr. Chatigny and her podiatric surgery colleagues in the U.S. The PIMA team will monitor the findings and identify areas needing improvement such as educational materials, specialized equipment and medications.

Islanders Suffer: Islanders in the central Pacific nation of Kiribati suffer greatly, where more than 30 per cent of the adult population has Type 2 diabetes. Our initial goal is to establish a foot care program and to establish a foundation of sustainable diabetes prevention and care in the Line Islands of Kiribati.

Islanders Suffer: Islanders in the central Pacific nation of Kiribati suffer greatly, where more than 30 per cent of the adult population has Type 2 diabetes. Our initial goal is to establish a foot care program and to establish a foundation of sustainable diabetes prevention and care in the Line Islands of Kiribati.

Once the foot examination program is running smoothly in the next few months, the DCWs will begin giving diabetes related educational sessions across the island, coordinated with each village’s different Village Welfare Committees, and held in schools, churches, maneabas (local meeting houses), and in some workplaces.

In mid 2019, we plan to train the DCWs to assist in our work in the schools, where the focus will be on identifying the causes of the diabetes epidemic and finding ways to address this, under the direction of Dr. Michael Goran, PhD, who is the program director for Diabetes and Obesity at Children’s Hospital in Los Angeles and professor of pediatrics at the Keck School of Medicine of USC. His team includes Dr. Jasmine Plows, PhD; Ms. Claudia Rios, MS, RD; and Ms. Skylar Steinberg, BS.

Our overall goal with the PIMA Diabetes Program is to establish a foundation for sustainable diabetes prevention and care on Kiritimati (Christmas Island) in Kiribati and help reduce the enormous burden of this destructive disease

We thank all those who have helped establish this program and look forward to sharing our progress with you.

(Dr. Elizabeth Beale, MD, is the PIMA Diabetes Team program leader and Diabetologist with the University of Southern California Keck School of Medicine in Los Angeles. Dr. Julie Chatigny, DPM, is a podiatric physician and surgeon and president and owner of Central Coast Foot and Ankle Specialists in Templeton, California).

Volunteer OB/GYN Helps on Tarawa; Observations Aim to Help Outcomes

One of our most highly regarded ob/gyns has returned home to Mount Sinai Hospital in New York after spending two weeks on far-away Tarawa in the Republic of Kiribati, helping the obstetrics department at the main government hospital there.

“It was a great experience and one that I hope to do again and again,” according to Dr. Maria Teaiwa-Rutherford, MD, assistant professor at the department of obstetrics and gynecology, Icahn School of Medicine Mount Sinai Hospital.

“I was there for two weeks and spent time with the obstetrics team consisting of two physicians, including one physician from Cuba who spoke no English or I-Kiribati, two registrars and four interns,” she said. Her observations, in her own words:

P.S. We at Pacific Islands Medical Aid were blessed to have found Dr. Maria. She has relatives who live on Tarawa in Kiribati. Hope she can return again and again.

By Maria Teaiwa-Rutherford, M.D.

Since they had midwives doing deliveries, they mostly needed my help with gynecology. We did rounds every morning on the in-patients, saw patients in the emergency room and gynecology clinics.

At the end of the day, I would sit with the interns on the labor floor and go over triage patients with them, taught them how to use the ultrasound (they rely on the ultrasound tech but I have always liked to do my own.) I think they enjoyed seeing that.

I taught the interns and residents some simple office procedures like endometrial biopsies. I think the hands-on teaching was much appreciated.

The power went out during a c-section surgery and I asked the people to shine their smartphone flashlights into the field.

The power went out during a c-section surgery and I asked the people to shine their smartphone flashlights into the field.

The attendings take calls every night for a week and all the C-Sections happen overnight so they are often tired and take breaks or nap which is totally reasonable. They gave me one day on the OR and I think it was a nice break for them.

The power went out during a C-Section and I asked people to shine their smartphone flashlights into the field.

I was shocked at the number of anemic patients admitted for blood transfusions. A typical admission was abnormal uterine bleeding with a hemoglobin of 6 requiring a blood transfusion. I saw probably 10 patients like this in two weeks. The blood bank cannot keep up with those demands and after the first unit of blood, the patient is told to go find blood donors.

Needed is education about diet and getting enough iron and vitamin C. The staple of rice and fish is not helping anyone’s iron stores!

I was also surprised at the volume of deliveries. The Tarawa Hospital does 150-200 deliveries a month and has a 15 percent C-Section rate.

Overall it was an incredible trip. I definitely plan to return.