13.11.2018 - The family and diabetes - diabetes concerns every family.
Suzanne Rockett is volunteering as a Diabetes Nursing Adviser with Nonga Hospital in East New Britain, Papua New Guinea. She is accompanied by her husband, Spencer Rockett. Here, she writes about her work in East New Britain, and the community’s plans for World Diabetes Day, November 14.
East New Britain, Papua New Guinea, has the highest recorded rate of Type 2 Diabetes (T2DM) and diabetes-related amputations throughout the whole of PNG.
Back in 1982, an Endocrinologist and his team from the Royal Melbourne Hospital spent time in Nonga Hospital observing and treating diabetes patients and their complications. It was noted that the Tolais Community appear to have a higher risk of developing diabetes, and though it not entirely clear as to exactly what the causes are, there are clearly some genetic, and possibly environmental, factors.
About Type 2 Diabetes
“Diabetes is a chronic long term progressive disease characterised by hyperglycaemia (high blood glucose level). Either when the pancreas does not produce enough insulin or when it cannot effectively use the insulin it produces. It is a multi-system disease and the result of hyperglycaemia over time leads to serious damage to many of the body systems....”
-World Health Organisation 2016, International Diabetes Federation (IDF) 2016, Dr Rowan Hillson MBE (2015)
It is estimated that 158.8 million adults aged 20-79 years are living with Diabetes in the Western Pacific region, a regional prevalence of 9.5%. More shockingly over half of all these cases (54%) remain undiagnosed.
-IDF Diabetes Atlas, 8th Edition.
In 2016, Dr Al Maha – Leading Physician for the New Guinea Islands – decided to tackle the alarming growing rates of T2DM within the province.
With the help of stakeholders and local businesses, The Frangipani Friendly Clinic was brought into fruition. The name for this clinic always brings out a smile and demonstrates Dr Al Maha’s vision to capture the entire local community and understanding of the demographics and traditions of the local Tolais community. They are often shy in coming forward, sometimes due to lack of understanding or fear of health providers.
The clinic is one of only two clinics in the whole of PNG that offer free healthy screening checks. When we say “free”, we mean “free at the point of care delivery” as this clinic has regular funding from various large local businesses, and regular donations from church and community groups, which help fund the testing equipment, without which they could not operate.
The clinic opened in 2016 and has a little over 40,000 registered diabetes patients, 80% of whom had organ damage or unhealed diabetes-related foot ulcers when they first presented.
The clinic has two purposes: to “promote healthy lifestyles, encourage the community to take control of their health and make it their responsibility to attend regular ‘healthy screening’, and also to manage patients with diabetes by offering twice weekly Diabetes Clinics with a dedicated medical team who have a special interest in diabetes.
The clinic sees as many as 60 patients during each of their twice-weekly diabetes clinics, and as many as 20 per day at the healthy screening drop-in sessions.
Once a week on a Friday, the team go out to Outreach clinics, whether that be a company, stakeholders, or a local community or school, where Healthy Lifestyle Counselling is providing followed by healthy screening checks.
This year, outreach days have covered schools (education for pupils on healthy lifestyle, and then screening the teachers), various large local businesses and have screened over 800 people.
I was privileged to join the team in February this year.
The Frangipani Friendly Clinic offers healthy checks and diabetes management that include addressing the micro and macro vascular complications that diabetes brings. Delivering health care in PNG comes with many challenges, such as a lack of funding for basic diabetes medications and lack of resources such as manpower and equipment. However, notwithstanding these challenges to care delivery, the clinic offers care for diabetes patients that equals care in New Zealand, and I’m not sure whether any diabetes clinic in NZ will have a one-day clinic full with 60 patients …
In discussion with the fantastic Nursing Officers Ashwin Lau, Julianne Rupen, and Veronica Mafu, Angela Waula, we all set to work to offer some clear and simple health education guidelines and tools – aimed at both groups of patients that attend the clinic – the diabetes patients and also the healthy screening patients.
In May 2018 we launched Papua New Guinea’s first Healthy Eating Plate, with 7 health goals – right here in the heart of East New Britain. The Taiwanese have special links with Nonga Base Hospital and earlier this year two diabetes dieticians and an endocrinologist came out for several weeks and offered their collegial support for these new tools – which is both exciting and very encouraging.
World Diabetes Day is organised by the International Diabetes Federation (IDF) to help promote awareness of diabetes to generate interest for large communities to come forward at get tested.
The Theme for WDD 2018 will run for two years and is “the family and diabetes”. There are some very common messages that indeed hit hard in East New Britain – for example IDF highlights that Diabetes drives one in four families further into poverty – this can be easily identified with in East New Britain, as Metformin (the worldwide leading, gold standard first line treatment) is not funded, and patients have to pay for this medication at a huge cost of 9-20 kina per week.
The Frangipani Friendly Clinic and Nonga Hospital, together with the local provincial health teams, St Mary’s Hospital and local government health teams, will be standing united as one team (a first for the province) to mark World Diabetes Day 2018. We will be at Kokopo Market on 13 November 2018 with an awareness/education tent along with live presentations offering education and information regarding both healthy lifestyles and diabetes.
We have a new slogan we have been using (with thanks to the HIV prevention team at Nonga):
Which will complement the IDF World Diabetes Day 2018 overriding themes:
I’ve been very fortunate in that Mark Abbott, a friend of ours from the UK, and his building company generously supported our fundraising for VSA before our Papua New Guinea Adventure began. In November he came out to visit us all the way from the UK, leaving his wife and young children at home.
He has continued to offer support, this time by coming with over 250 pairs of sterile surgical gloves and five glucose metres. The surgical gloves are in very low supply, preventing many surgeries from taking place. On average it takes six pairs of gloves for one operation.
Mark has stepped up again to help sponsor our World Diabetes Day event and provided funding to enable me to access professional printers to print high-quality reusable posters and leaflets - helping educate and empower the people of East New Britain. He has also funded the professional printing of 12 copies of my 12-page diabetes and hypertension prescribing guidelines - six copies for each hospital.
The entire East New Britain community will feel the benefit of surgeries being able to be carried out safely and the ability to take diabetes screening to rural communities will have a far-reaching effect as statistics tell us that over 50% of people with type 2 diabetes remain undiagnosed within their communities. Our heartfelt thanks to our dear friends Mark and Emma at Abbott Building UK Limited.