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