In early August I was very fortunate to make my second trip to Kiritimati (Christmas Island) with PIMA, this time accompanied by 2 Masters of Public Health students from the Institute of Global Health of the University of Southern California: Alexandra (Nikki) Anderson and Brooke Lejeune-Chanman. Our goal was to obtain a better understanding of the prevalence of non-communicable disease on the island in order to help plan further medical aid, and also to assess factors that might explain the very high prevalence of type 2 diabetes in Kiribati.
In 2 weeks we surveyed over 500 islanders. We conducted in-depth questionnaires, body measurements and fasting blood glucose. In a subgroup of nearly 200 participants we also conducted a detailed dietary recall, measured a full fasting lipid panel and took buccal swabs for genetic analysis.
It will take us several months to enter and analyze the data but we look forward to being able to share our findings by the end of the year. In the meantime I would like to take this opportunity to highlight some of the many people who contributed to this trip and to thank them for their assistance. Sincere thanks goes to each person and group who participated for their generous and enthusiastic support.
- To our colleagues and friends in the medical community of Kiritimati: Dr Teraira Bangao and Dr John Tekanene and all the nurses and staff who helped us including Tarannang, Nana, Maria, Tekoriri, Tamato, Taiiri, Ira, Kuta, Nunkay, Ruta, Julia, Tebikea and Kiaman (and of course Taaren). We appreciated your willingness to do all the translating we needed, for helping with the recruitment and the consent process and your hard work in collecting data. We are particularly proud of the fact that so many team members obtained the CITI Human Subjects certification course online prior to our arrival which enabled us to carry out the survey according to the high ethical standards that are appropriate as well as required by USC. This would not have been possible without the internet capabilities now available in the new Ronton Hospital Annex and installed by PIMA. Now that the team has Human Subjects certification future studies will be much easier to organize. Thank you too for our warm welcome, your hospitality during our stay and for our wonderful send-off.
- To the Institute of Global Health and Department of Preventive Medicine at the University of Southern California: thanks for choosing 2 outstanding students to help develop the project and to come along and share the work and fun, as well as for the financial support provided for this project. Both Brooke and Nikki have said they want to return and continue with the work and keep in touch with their new friends. Special thanks to Ivette Flores who helped guide the project through the early planning stages and for making sure it became a reality.
- To Linda Chan PhD friend and colleague and statistician par-excellence at LA County, who is always available with expert help when needed despite an incredibly busy schedule.
- To Dr Jaimie Davis and Amanda Vanni for assistance with the design of the project and for teaching us how to conduct the dietary recalls.
- To Dr Hooman Allayee: for adding the genetic analysis side of the study. We look forward to hearing about your findings.
- To the IRB of USC: especially Marie Reyes and Dr Darcy Spicer for their conscientious and careful assistance with this project (the first international study I had attempted) and especially for helping us to get approval “under the wire” to start on time in Kiritimati.
- To my colleagues in the Division of Endocrinology and Diabetes at USC: especially Dr Anne Peters who first put me in touch with PIMA and has continued to support my involvement, and Dr Tom Buchanan for giving his approval for my participation.
- To the team at Abaxis: Ron Blasig, Rick Betts, Jeanne Blake and Ruby Baniaga. We appreciate your loan of the Piccolo Xpress labs through your Philanthropic Loaner Agreement. Without the Piccolo’s we would not have been able to do the first-ever assessment of lipids in this part of the world. The labs were put through their paces for over 2 weeks: in equatorial temperatures and running off a car battery in the tiny clinic at Poland and 3 different maneabas (meeting centers) in Banana …and did a great job.
To Erin Bonovetz and the Perrigo Company: thank you for your generous donation of 1,500 of the most accurate fingersticks and glucometers currently available. We used them every day and they served as the backbone for assessment of glucose in the study and we believe will significantly contribute to the value of our findings.
- Of course last and not least I have to thank PIMA for initiating and coordinating the trip, for making sure we had everything we needed to do our project and for working to make the trip as enjoyable as possible: nothing seemed to be too much to ask…well maybe one thing: as Carlton and I scrambled between immigration and tight flights in Honolulu with 4 month old Baby Inga and his suitcase lovingly packed by his Mom in Banana, 2 precious Piccolo Labs, our own carry on luggage with laptops, four large suitcases packed with sea shells, gifts from our colleagues on Kiritimati, 500 data forms and 200 mouth swabs not to mention passports, visas, health documents and boarding cards, I suggested it might be nice to take a dozen or so Hawaiian pineapples home with us as gifts. Just for a second I thought Carlton might have thought this was a bit much to ask and I thought that I might just have blown my chance of being invited back again. But we all know he WOULD have let me buy them. Thank you Carlton. It was the trip of a lifetime. For those of you who didn’t get a pineapple: now you know why.
by Elizabeth Beale MD
Assistant Professor in Clinical Medicine
Division of Endocrinology and Diabetes
Keck School of Medicine
University of Southern California