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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).

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.