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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.

Blind Islanders Can See Again; Team Performs 48 Surgeries

Helping the blind to see again.Few things are as rewarding as watching the joy on a cataract patient’s face when the bandages first come off and he or she can see again after being blind for years.

The expression of wonder and happiness makes all the effort worthwhile.

For the fourth time in six years, our great eye surgery team, led by Oregon ophthalmologists Dr. Paul Jorizzo and Dr. Paul Imperia, have returned home after completing 48 eye surgeries, this time on patients from Christmas Island (Kiritimati), Teraina and Tabuaeran in the Line Islands of Kiribati.

“Most were cataracts and the outcomes were universally excellent,” Dr. Jorizzo said, “with many patients seeing for the first time in several years.”

He said the excitement of people being able to return to their normal lives was contagious, “leaving us moved and feeling fortunate that we were able to participate in the experience.”

This year’s eye surgery expedition required a lot of pre-planning and organization, according to Carlton Smith, president of Pacific Islands Medical Aid, Inc. (PIMA) He said an advance team, led by long-time PIMA volunteer, general surgeon Dr. Larry Falk and ophthalmologist Dr. Jack Mason, traveled to Christmas Island (Kiritimati) and the neighboring islands of Tabuaeran and Teraina to examine and assess eye patients and prepare a list of patients for surgery back on Christmas Island.

Happy patients lined up, recovering. So excited to see again.Then, patients were brought by boat and plane to Christmas Island for surgery at the small hospital there, Carlton said, under the direction of the medical officer in charge for the Kiribati Ministry of Health, Dr. Teraira Bangao.

Surgery supplies and loaned equipment was provided by Seeing Eye Expeditions (SEE International) in Santa Barbara, California, “a wonderful organization that we have worked with over the years,” Carlton said.

In addition to Dr. Paul Jorizzo, Dr. Paul Imperia, Dr. Larry Falk and Dr.Jack Mason, the surgery team consisted of ophthalmologist Dr. John Welling, nurse Laura Imperia and nurse Jessica Jones, from Medical Eye Center in Medford, Oregon.

“We were blessed to have such a great team help the good people of Kiribati,” Smith said, “and we look forward to being able to continue this worthwhile effort.”

If a picture is worth a thousand words, we have attached a volume’s worth in our newsletter this edition. As you look at the faces, just imagine the feelings of the patients at the moment they are able to see again.

Here is Dr. Paul Jorizzo’s story, in his own words:

By Dr. Paul Jorizzo, MD

Our eye team returned to Christmas Island for the fourth time. Patients at Christmas (Kiritimati), Fanning (Tabuaeran) and Washington (Teraina) had been screened by Dr. Larry Falk and Dr. Jack Mason, who, in addition to addressing their medical needs, found 50 patients in need of surgery.

Happy patient can see again after cataract surgery.  Happy patient can see again after cataract surgery.  Happy patient can see again after cataract surgery.  Happy patient can see again after cataract surgery.

A substantial coordinated effort to get patients and supplies to Christmas Island was greatly aided by Dr. Falk, Carlton Smith at PIMA, Surgical Eye Expeditions (SEE) International and the motor sailing vessel Kwai.

High quality surgical microscopes and supplies arrived along with the patients from the outlying islands prior to our arrival.

Under the guiding eye of Dr. Teraira, Dr. Paul Imperia and Dr. Jack Mason efficiently performed pre-operative examinations and measurements. Dr. Larry Falk was miraculous in finding ways to make all of our equipment work.

From blind to sight, in one day!

Meanwhile, the operating room team of Dr. John Welling, Laura Imperia RN and Jessica Jones, RM, joined me in setting up the operating room to accommodate two patients simultaneously.

With surprising efficiency, we were operating the next morning. Thanks to excellent screening, the majority of patients were profoundly blind… many blind bilaterally.

With the help of the Kiribati nursing staff, we completed 48 surgeries in one week. Most were cataracts and the outcomes were universally excellent, many patients seeing for the first time in several years.

The excitement of people being able to return to their normal lives was contagious, leaving us moved and fortunate that we were able to participate in the experience.

Paul and I had visited Christmas Island on several occasions prior to our surgical trips and hoped to find a way to give back to the warm people that we had visited. We are so appreciative of Carlton Smith and Pacific Islands Medical Aid, and the wonderful team at SEE International for helping us fulfill our quest.

We look forward to our next trip.

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.

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.