The 322 islands that make up Fiji expand across 7,054 square miles in the southwest Pacific Ocean. The Fijian people celebrate a rich culture full of traditions, but over the last few generations they have begun to see a dramatic change in their health, and not for the better. After more than 100 years of colonial influences and their integration into the global economy, Fijians have experienced a shift away from their traditional diets and a decrease in physical activity. The effects of these changes are only now truly coming to light, and with them, a medical crisis is emerging.
The portion of the Fijian population suffering from non-communicable diseases (NCD) is growing at an alarming rate. This form of disease is the number one cause of death and disability in the world. Diabetes, a type of NCD, is becoming increasingly prevalent in the Pacific Island Region. In fact, the prevalence of this disease in areas such as Fiji is ranked among the highest in the world. (WHO, 2010)Diabetes, as you have most likely heard, is becoming a growing issue for many nations worldwide. The addition of processed sugars in our food, increased consumption, and decreased physical activity have all resulted in diabetes becoming a concern for a growing portion of the US population as well. While most of the world faces this similar medical trend, Fiji’s health care system, or lack there of, makes it very unlikely that they will be able to overcome this on their own.
So what is diabetes?
Diabetes, or diabetes mellitus, is condition that causes an individual’s system to have difficulty processing sugar. In our bodies, the pancreas, liver, and fat cells make up the three major components involved in breaking down and absorbing sugar. Most scientists believe diabetes to be caused by two biological failures. The first occurs when our pancreas loses the ability to produce the hormone insulin. This hormone, in a healthy individual, is released into the blood stream when sugar levels spike and trigger the body’s cells to take up the sugar for processing and storage. The second biological failure which contributs to diabetes is the liver and fat cells’ inability to respond adequately to the insulin. When either of these failures occurs, the result is a potentially dangerous blood sugar level that cannot be properly regulated.
Today, there is no cure for diabetes. The treatment for an individual with this disease is intensive and requires regular maintenance. The patient must keep up with a drug curriculum to regulate their blood sugar levels, as well as maintain a healthy diet and an active lifestyle. If this disease goes untreated, there can be a number of complications. These include fatigue, increased thirst and urination, vomiting, lowered immune system, and tissue death (usually in the feet).Because of the intensive treatment regime and the high prevalence rate, the Fijian people are struggling to get access to proper treatment. The sheer number of people with this disease results in tremendous pressure being placed on Fiji’s healthcare system. Because of this, the nation is experiencing constant depletion of their drug stocks and limited access to wound dressing.
Treatment, however, is not the only issue they are encountering. Limitations on funds and access to modern technology make diagnosis of this condition difficult. Three out of every four Fijians suffering from diabetes go undiagnosed. When this happens, the disease goes untreated until it is too late.
Many people in Fiji live on the poorer end of the economic spectrum. This fact, when paired with undiagnosed diabetes, ends up creating a self-feeding downward spiral. Because people living in poverty have a higher risk of unhygienic living conditions, this exposes their symptoms to environmental factors that can dramatically worsen their state. Factors such as walking barefoot, rodent bites, and foot injuries can cause infections to develop in the already prone tissue of the affected individuals feet. When untreated, the resulting tissue death in these extremities can lead to amputation. These amputations are typically associated with increased morbidity and mortality rates that feed back into worsening the patient’s financial situation and medical condition.In addition to a lack of healthcare funding, Fiji has a dwindling number of healthcare providers to address this growing medical crisis. In Fiji, there are only 0.4 practicing physicians to every 1000 people. In fact, Fiji has one of the lowest ratio of doctors per capita in the world according to the World Health Organization (WHO).
In situations like these, when things look bleak, one non-profit working to turn the tide on diabetes is called “Sea Mercy.” Sea Mercy is a new up-and-coming healthcare charity that has developed a fleet of ships and volunteers to help the people of Fiji in their battle against diabetes.
Richard Hackett, the president and founder of Sea Mercy, first became fascinated with the southwest Pacific when, at the age of 14, he first read Treasure Island. With the a love for exploring these islands spurred by this novel and his later found love for sailing, he and his wife made a point of making it to the picturesque islands of Fiji for a vacation. “When you are enjoying the moment, snorkeling, and enjoying the sunset, you sometimes can’t help but realize the help people need,” he said while reminiscing. This was a thought he kept with him and in 2000 he began to search for a way to help the Fijian people.Researching into the difficulties the people of Fiji were facing, he continued his search for the best way to aid these people. In the beginning, spreading his cause by only word of mouth to his friends and family, his ideas were slow to gain momentum.
While Rich was researching and collaborating with friends and supporters, back in Fiji, political changes were being made. In 2010, Dr Abdul Wahid Khan was appointed the new president. As a general practitioner with a select interest in the study of diabetes, he realized the importance of their healthcare system, and just how much it was lacking. The government had tried for years to set up a better infrastructure in the islands but the financial burden was too great. In an effort to help this situation, the new president put new regulations into effect that would allow help to come from outside organizations.
In 2012, Rich said he realized there was never going to be the perfect financial moment that they had been waiting for, and decided to set his dream in motion. With a newly laid political path in Fiji, Sea Mercy was born.
What they thought would take 3-5 years took 6 months. In 2013 the program was officially started. With only one vessel, they did a first run. As with most first tries at something new, they found mistakes were made. However, they learned from these mistakes and soon had a second vessel join them to help their support their efforts.By 2014, a part of their program was going to be disaster relief. Tropical Cyclone Ian, the strongest storm ever recorded in that country, had just struck Tonga. It caused significant damage to people’s homes and agriculture, and hundreds were evacuated and relocated to emergency shelters. Sea Mercy sent their two ships in to help and had one of their first successful runs. Later that year they added Fiji to their network of healthcare hubs, and then Vanuatu.
Despite the need of the people and new political assistance, everything did not always go smoothly. Rich recalled a time it took nearly 3 weeks to get the paperwork to send over food and medications. “Somebody always wants to make money on the deal,” he said.
In addition to bringing over basic supplies, food, and medications, Sea Mercy also focuses on finding trained medical professionals to volunteer their time to help the Fijian. The doctors help train the medical staff living at each location to use more reliable modern techniques for diagnosing and treating diabetes as well as other diseases. A key part of medical care is having an informed population. Both doctors and patients need to be informed about the condition in order to get progressive, consistent results.
One step missing in a basic care can make all the difference to a patient. For example, at one of the locations, a dentist who volunteered his time to help provide dental care, found a situation that accentuated this idea. When he arrived at the island, most of the children and adults had nice white smiles. Their teeth appeared to be well taken care of until he took a closer look. When he finally got a chance to examine them, he found that nearly all of their teeth had begun to rot. Everyone in the village knew that it was important to clean their teeth and did so, but no one knew they had to brush the back side of them as well. Because of this one missing step, their teeth, while they looked clean and healthy when they smiled, were all in fact rotting away from neglect as food and plaque was left to remain behind them.With diabetes, the patients had to understand that just taking the medications was not enough to control the disease. They had to be taught about proper nutrition and muscle building exercises to keep them in better shape.
Dr. Patricia Wu, the head of the Department of Endocrinology at Kaiser Permanente in San Diego, California, is a specialist in Endocrine Diabetes/Metabolism, is one of the doctors heading to Fiji this summer to assist in the work of Sea Mercy. Dr. Wu spends her time in research, teaching, and directing the diabetes care program at Kaiser. She discussed with me the importance of collaboration when treating diabetes patients.
As the director of the diabetes care program, she has to help coordinate between primary care physicians, health educators, and nutrition departments. The expansive scope of treatment for diabetes patients makes it essential that different healthcare professionals work together in order to attain optimal results. In addition to this coordination, she also works with the directors of hospitals. In the US, one-third of patients in the hospital have diabetes. Because of the extra accommodations sometimes needed for people with this condition, it is becoming increasingly important that hospitals be properly equipped to care for these people.
Being very knowledgeable about the disease, she discussed with me the true importance of going to Fiji to properly understand why it is they are facing this issue on such a large scale.A major issue she pointed out was the sugars added to our processed food and sweetened drinks. Combined with a lack of education about proper exercise, these two factors are fueling the fire of a disease running rampant in our society. In Fiji this is especially an issue as traditional high-starch diets are being abandoned in favor of cheap, processed foods withlong shelf lives, imported white rice, and noodles. With advertisements and tourism supporting unhealthy living revolving around flashy, tasty drinks and cheap, easy food, Fiji is headed down a path leading away from cultural tradition and direct toward serious health problems.
With this, she also emphasized the necessity of a proper infrastructure for the healthcare system. “If you can’t even offer vaccinations … you can’t begin to deal with conditions like diabetes. Diabetes is not immediate,” she said.
This infrastructure is what Sea Mercy is trying to supplement. On their own, this struggle in Fiji was an unsolvable problem for the government. With the developing inter-island system of Sea Mercy’s floating health clinics, however, they hopefully will clear a path to the creation of a more permanent and reliable structure. With money and volunteers going towards expanding this network and bringing people help and supplies, they are well on their way to making a positive lasting impact on the area.
When volunteers travel to Fiji with a mission of helping make a difference for these people, they not only contribute to this great cause, but also learn from the people and experiences along the way. Rich spoke about this, saying, “You walk away going, ‘that was worth it’. You can’t really put a price on [the experience]. You measure it by the lives changed and what you walk away with.”
The future for Fiji is beginning to look brighter. A disease that once had a firm grip on the population now has a potential opponent. Hopefully, with new legislation to promote healthier living, and non-profit organizations like Sea Mercy working to bring in the additional medical care the people need, we can finally hope to turn the tide in Fiji’s fight against diabetes.