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)