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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.

Iakobwa Now Learns to Walk; Shriners Brings About Miracle

Iakobwa Kabong could only walk on his knees and shuffle around on pieces of cardboard back on Christmas Island in Kiribati before he was admitted to Shriners Hospital for Children in Honolulu. And he didn’t have use of his hands. He would push himself forward on his knuckles and use the cardboard like a sled along the rough ground.

Iakobwa in wheelchair at airport heading home after more than a year at Shriners Hospital for Children in Honolulu.

Iakobwa in wheelchair at airport heading home after more than a year at Shriners Hospital for Children in Honolulu.

After a little more than a year at Shriners Hospital and multiple surgeries, Iakobwa (pronounced ya-ko-bah) can now stand and has use of his hands. With exercises and the use of a walker, he should soon be walking on his own, say the doctors at Shriners.

Iakobwa, now 18, was brought to Shriners under a program initiated with Shriners and Pacific Islands Medical Aid several years ago. Shriners takes care of all medical needs and we at Pacific Islands Medical Aid provide financial help for food, lodging, local transportation and translation services.

“We are eternally grateful to Shriners Hospital, it’s leader Dr. Craig Ono, MD and all the physicians, nurses and support staff involved in Iakobwa’s miracle,” said Carlton Smith, president of Pacific Islands Medical Aid (PIMA). “And thanks to our many good hearted donors who helped make this happen.”

Iakobwa needed a dozen surgeries to help correct his malformed legs and hands, Smith said, and he was able to spend more than a year at the hospital in Honolulu with his mother during that time.

Intrepid PIMA volunteer Kaitibo Timon in Honolulu, who was born in Kiribati, helped with translations and local transportation during the entire time, Smith said.

After hundreds and hundreds of hours of therapy, Iakobwa was sent on his way back to Christmas Island with a walker, wheelchair and electric scooter… all thanks to Shriners Hospital for Children!

Shriners nurse and social worker Cindy Shimabukuro said Iakobwa first arrived at Shriners Hospital in Honolulu on April 25, 2017 with a diagnosis of arthrogryposis. “He has undergone many procedures and surgical interventions since his arrival and the young man who came to us unable to stand and would walk on his knees, is now able to stand and walk short distances with a walker.

Throughout his stay, she said, Iakobwa has demonstrated strength and dedication to work toward his goal of walking. She also credits Iakobwa’s mother who was his ‘biggest cheerleader.’

“They were wonderful members of our Shriners Family Center always supporting others. We already miss this family’s positive attitude and strength,” she said.

PIMA Heart Team Sees 177; Nine Require Cardiac Surgery

Our intrepid heart team has returned home after seeing 177 patients in a week’s time on isolated Christmas Island in the central Pacific, where they identified nine needing life-saving surgery.

Nine heart patients heading for surgery. Plans are underway now to bring the nine patients to Baylor Scott White Heart Hospital in Plano, Texas for surgery, says team leader cardiothoracic surgeon Dr. David Moore, M.D.

Team members on the island were divided into small units for their one-week stay and were able to perform 176 heart echoes on adult patients and 975 rheumatic heart disease-screening echoes for children at local schools on the island.

In addition, team members offered educational talks to teachers and students about rheumatic heart disease, its causes and cures… where many islanders suffer as a result of undiagnosed and untreated rheumatic fever in children that results in heart disease later in life.

Counseling Patient: Volunteer cardiothoracic surgeon Dr. David Moore, M.D., counsels patient on Christmas Island after tests show the patient needs heart surgery to correct the effects of his rheumatic heart disease. In just one week, the PIMA Heart Team saw 177 patients with 176 echos and 9 patients identified for surgery back in the U.S.

Counseling Patient: Volunteer cardiothoracic surgeon Dr. David Moore, M.D., counsels patient on Christmas Island after tests show the patient needs heart surgery to correct the effects of his rheumatic heart disease. In just one week, the PIMA Heart Team saw 177 patients with 176 echos and 9 patients identified for surgery back in the U.S.

“We are really proud of our professional team members who volunteered time and expertise in helping the good people of Kiribati, where the need it great,” said Carlton Smith, president of Pacific Islands Medical Aid.

The physician and medical officer in charge for the Kiribati Ministry of Health on Christmas Island, Dr. Teraira Bangao, says ‘the team worked very hard when they were here… they did a great job… starting out each day at 8:30 a.m. and working straight through to 6 p.m.”

“We are so thankful to the team members and everyone at Pacific Islands Medical Aid and look forward to their next visit,” he said.

In this humanitarian outreach, Dr. Moore and his team of heart surgeons at Cardiac Specialists in Plano, Texas and Baylor Scott White Heart Hospital in Plano will provide surgeries and hospitalization for the patients, while Pacific Islands Medical Aid provides all housing, meals and local transportation in the Dallas area for the patients and their chaperones, and the Kiribati Ministry of Health provides round trip airfare.

Please help support this life-saving program with your donation. Here is Dr. Moore’s report.

By Dr. David Moore, M.D.

Rheumatic heart disease remains a major global health concern primarily affecting young adults in the developing world.

This is particularly true in many of the islands of the central and western Pacific.

Our team from Baylor Scott White Heart Hospital in Plano, Texas recently returned to Kiritimati (Christmas Island) in the Republic of Kiribati with the support and coordination of Pacific Islands Medical Aid.

 

Team members included Dr. David Moore, CV surgery; Dr. Steve Mottl, cardiology; Michael Rampoldi, echo cardiographer, Candice Rampoldi, echo assistant and echo data collection; Amy Moore, trip coordinator and data management; Sherry Swanson, Baylor Heart Hospital social services; and Tom Roma, school education program.

Little Ones Included: All islanders, young and old, showing signs of possible heart disease were checked out by our volunteer heart team on their most recent visit to Christmas Island in Kiribati, where nine were identified for life-saving heart surgery back in the U.S.

Little Ones Included: All islanders, young and old, showing signs of possible heart disease were checked out by our volunteer heart team on their most recent visit to Christmas Island in Kiribati, where nine were identified for life-saving heart surgery back in the U.S.

In the course of our week on the island, we functioned as two teams; one evaluating patients in the clinic at Ronton Hospital and the other focusing on education regarding prevention of rheumatic heart disease (RHD) as well as echo screening in the primary schools.

Echo screening of asymptomatic children allows for early detection of RHD with the identification of subtle abnormalities in the heart valves. Children with these findings can then be started on prophylactic penicillin injections preventing subsequent episodes of Strep Throat and thus avoiding further immune response and valve damage.

A total of 950 children were screened by our team over a period of four days. At the same time, children, teachers and some parents received education on the prevention of RHD, emphasizing hand washing, appropriate coverage for cough, and the need to see a physician or nurse for treatment of sore throats.

At the clinic, our team evaluated and obtained an echo on 175 patients. Two children with congenital heart disease were identified, three adults with probable coronary artery disease and eight patients with rheumatic heart disease were diagnosed.  The adult patients will be brought to Baylor Scott White Heart Hospital in Plano, Texas for additional testing and surgery. The children with congenital heart disease will be referred to an appropriate facility for surgical correction.

Our team appreciates the opportunity to continue this good work made possible by Baylor Scott White Health Care System, the Republic of Kiribati Ministry of Health and Pacific Islands Medical Aid.

We are grateful to the people of Kiritimati (Christmas Island) for their warm hospitality and support.

Heart Team: More Than 40 Saved

More than 40 lives have been saved to date by our Pacific Islands Medical Aid heart surgery program, thanks our donors, the leadership of cardiothoracic surgeon Dr. David Moore of Baylor Scott White Heart Hospital in Plano, Texas and dozens and dozens of great volunteers.

What began as an outreach to Christmas Island in the isolated nation of Kiribati several years ago has grown to encompass the wider island nation of 33 islands in the Central Pacific where many young patients suffer with heart valve disease, brought about by untreated rheumatic fever when they were very young.

“Among all of the medical programs we have undertaken,” I think we are most proud of the heart surgery initiative,” said Carlton Smith, PIMA president.

With the help and support of the Kiribati Ministry of Health, our team has visited the islands with diagnostic tools to identify the most urgent cases and arrange for them to be brought to the U.S. for open heart surgery, Carlton said. Team members, led by Dr. Moore, include cardiac sonographer Michael Rampoldi of Baylor Scott White and nurse Amy W. Moore.

Your donations have allowed us to provide housing, at Homewood Suites in Plano, meals and local transportation, while dozens of supportive surgeons working with Dr. Moore and medical professionals at Baylor Heart Hospital have pulled together to make this happen.

“It is our hope to be able to return early next year to Christmas Island and neighboring isolated… and seldom visited… outer islands of Tabuaeran and Teraina,” Carlton said.

HeartGift Austin to the Rescue

Two little children diagnosed with congenital heart defects by members of our PIMA Heart Team in Tarawa late last year will be literally saved by HeartGift Austin this month.

Under the direction of HeartGift’s national patient coordinator Ms. Sonya Skilling, the two patients, their mothers and Kiribati Ministry of Health nurse are scheduled to arrive in Austin Oct. 15 so that the children can have life-saving heart surgery there.

Two year old Iotua Nenetaake, a little boy from the isolated atoll in the Central Pacific called Nikunau, was diagnosed with a ventricular septal defect.

Bwabwane Meeia, 10, from the island of Tarawa, was also found to have a congenital heart defect.

“We are forever grateful to HeartGift Austin and Ms. Skilling for organizing and underwriting this life-saving effort”, said Carlton Smith, PIMA president.