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Apr 09
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By Barry Barford

By | Aid shipments affected by COVID-19 | No Comments

Photo courtesy Freightwaves.

It’s sometimes hard to comprehend the speed at which COVID-19 has spread within Australia and around the world – it’s just four weeks since the virus spread was declared a pandemic. During that time two container loads of medical equipment and supplies shipped for DAISI to Sopas District Hospital have arrived in Papua New Guinea, but what options for shipping remain over the coming weeks?

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The extent to which freight movements have been affected depends on the mode of transport. Air freight, most of which is carried on passenger aircraft, is severely restricted owing to the suspension of most international flights by Qantas, Virgin and the airlines of neighbouring countries. Pacific Air Express continues to operate a dedicated freighter service from Brisbane to the Solomon Islands, Papua New Guinea and Vanuatu. Express delivery companies such as TNT, DHL and Toll are offering restricted services subject to availability of flights.

Sea freight remains largely unaffected, although schedules have had to be adjusted to allow for the 14-day transit time between ports required by many countries. However, this situation may change as Pacific Island nations take action to protect their vulnerable communities. Already the Solomon Islands have imposed a 14-day quarantine period (before ships can enter port) on arrivals from any international port, unlike most other island nations which specify particular ports. Less-than-container-load (LCL) services are still operated by Kalgin Global Logistics and Vanguard Logistics from Sydney,Melbourne and Brisbane, but these too rely on the regular schedules of carriers like Swire Shipping.

Among the countries assisted by DAISI, only Papua New Guinea and Fiji have so far reported cases of COVID-19. As at midday on Thursday PNG had two cases and Fiji 15, with neither country reporting any deaths. However, it should be noted that elsewhere in the Pacific numbers are rising. French Polynesia, which in the last week of March had reported 18 cases, now has 51. And New Caledonia which at the same time had seven cases now has 18.

Resumption of normal freight services is unlikely to come soon and it could get worse before it gets better, but a gradual easing of restrictions could occur depending on the success or otherwise of each country’s efforts to contain the spread of the virus. By any measure the situation locally is nowhere near as dire as in Europe and the US, and for that we can be thankful.

Author: Barry Barford is DAISI’s Shipping & Logistics Officer and a member of the UK-based Humanitarian Logistics Association.

Apr 06
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By Dr Elvis Japhlet

By | Second and third container arrive at Sopas | No Comments

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Sopas Hospital staff in front of the second shipping container delivered this year.

On behalf of Sopas District Hospital staff, community and Enga Provincial Health Authority (EPHA), I would like to thank Doctors Assisting In South-Pacific Islands (DAISI) and its executive for the first and second containers of medical equipments/supplies received this year with value more than one million kina.

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Our extreme gratitude is extended to Horten Medical/various hospitals in Australia/individuals/organisations/companies that have assisted and/or donated these medical equipments/supplies, and the Owen Miller Foundation largely responsible for paying for freight charges.

These donations will truly go a long way in saving the lives of many people in the highlands of PNG particularly Enga Province.

This is indeed a huge blessing.

Special thanks to so many individuals in particular Dr Gary McKay, Roshini McKay, Mark Taffa, Matt Rickard, Christophe Berney, Carina Chow, Adelene Ong, Jessica Lim, and all DAISI team members (cannot mention all their names as too many) who have visited Sopas District Hospital and all who have contributed in one way or the other towards these supplies.
God Bless you all!

 

Dr Elvis Japhlet is the head surgeon at Sopas District Hospital in the remote highlands of PNG, and has been working together with DAISI to improve the delivery of surgical services to Enga Province. 

Mar 27
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By Michael Kabuni

By | COVID-19: the situation so far and challenges for PNG | No Comments

Papua New Guinea (PNG) became the first country in the South-Pacific to declare a state of emergency (SOE) in response to COVID-19.

 

Section 226 of PNG’s Constitution lists an “outbreak of pestilence or infectious disease” as grounds for declaring a national emergency. With more than 470,000 confirmed cases and over 20,000 deaths worldwide at the time of publication, the first recorded case in PNG on 13 March 2020 was sufficient reason for the National Executive Council (NEC) to declare an SOE. Among other things, the SOE gives the government the power to control the movement of people, vehicles, and goods; maintain and regulate transport; and regulate or prohibit use of public roads.

The emergency lockdown, which prevents the movement of people between provinces and puts restrictions on international flights, will only last for 14 days, subject to an extension of another 14 days. All schools and universities have shut for two weeks starting on 23 March. Non-essential services are shut, including most government departments, the courts and small businesses. The only exceptions are essential services such as banks, hospitals and shopping malls.

This blog gives a summary of the statistics, the situation in PNG leading up to the SOE and some of the challenges PNG faces.

What do the statistics look like?

According to the National Health Department’s Situation Report issued on 13 March – the latest publicly available data – 25,262 people entering PNG have been screened since January. Almost 3,000 have been identified as ‘persons of interest’, of which 2,230 are being actively monitored and 697 have completed the 14-day follow-up period.

A rapid response team comprised of medical professionals has investigated 16 people. Of those investigated, 14 samples were collected, with 10 testing negative for coronavirus while four samples are pending results. The other two did not meet the case definition for coronavirus and were not tested. Sixteen other individuals who were in direct contact with the first positive case are currently being quarantined.

First confirmed case

The SOE comes after the first confirmed case of COVID-19 was reported in Bulolo District in Lae, Morobe Province. On 13 March, a 45-year-old Australian man employed by Harmony Gold Mine in Bulolo returned from a trip to Spain, one of the hardest hit European countries for coronavirus. He did not show COVID-19 symptoms of coughing, flu or fever at the Jacksons International Airport, where a basic test for temperature and a self-administered travel history and health form was all that was required to enter PNG. But 24 hours after transiting to his workplace in Bulolo, he began to show signs of flu and a slight fever and was immediately isolated.

Swabs were taken and sent to the Medical Research Institute in Goroka for testing. Three announcements followed. First the Health Minister Jelta Wong declared a probable case, and Prime Minister James Marape followed up by declaring the result as negative. Further tests were conducted and the prime minister confirmed the positiveresult for COVID-19. Police Minister Bryan Kramer then stated on Facebook that the inconsistent results were due to faulty test equipment, and that requests had been made for further testing to be conducted in Melbourne.

Challenges for PNG

While the government responded to the confirmed case by immediately declaring an SOE and 14-day lockdown, the varying test results and inability to detect the virus at Jacksons International Airport has led to widespread criticism on social media. It has also shone a light on the key challenges PNG faces in relation to the pandemic.

First, there is no way of knowing whether there are other positive cases of COVID-19 in PNG. When the World Health Organization (WHO) declared COVID-19 as a global public health emergency on 30 January, PNG relied on screening done at airports in Singapore, Hong Kong and Australia to determine whether passengers could enter PNG. The government is now calling for anyone who has entered PNG since 7 March to come forward for testing. This includes those who travelled with the man who tested positive in Bulolo, who had himself travelled from Singapore to Port Moresby before transiting to Lae. Even the Chief Medical Officer for the emergency committee set up under the SOE, Sam Yockopau, has suggested that COVID-19 may have entered PNG since December 2019 but only presented as the common cold or flu.

Second, is poor health infrastructure. The initial swabs were flown to the Medical Research Institute in Goroka, which has the test equipment. However, there are no isolation facilities for anyone testing positive. Initially an isolation ward was delegated at the Port Moresby General Hospital, but the Nurses Association protested, arguing the lives of more than 1,000 patients would be at risk if coronavirus was brought into the ward. Things may improve when 10,000 AusAID donated COVID-19 test kits, which are awaiting clearance, are released for distribution around the country. The UN is also setting up 30 temporary isolation wards.

Third, managing the PNG–Indonesian border. Indonesia has the highest death ratefrom coronavirus in the world at 9.3%. The 820 kilometre border with Indonesia has long been a challenge for understaffed and ill-equipped immigration officials and the PNG Defence Force. It will be a massive task to immediately lockdown the movement of traditional border crossers – people living within the vicinity of either side of the border.

Fourth, there is the challenge of funding. PNG has been struggling with high debt and low revenue over the past few years. The government has requested an aggregate K860 million (US$252 million) from the IMF, ADB and World Bank to fight COVID-19. The World Bank component (US$20 million or K68.2 million) will be spent on priorities identified by WHO and PNG’s National Department of Health in its National Emergency Response Plan. These priority areas include: modular isolation facilities for priority provinces; laboratory equipment and supplies to expand testing facilities, including financing for specimen transport; training and technical assistance for infection prevention and control, and rapid response in priority provinces; and risk communications. The funding from the ADB (US$50 million or K170.5 million) and IMF (US$182 million or K620.7 million) will be used to fund priorities identified in the National Emergency Response Plan.

Conclusion

The PNG government has not handled the initial case of coronavirus well, but subsequent quick action has been impressive. The declared SOE was the best decision for PNG given the dire state of the health system and lack of access to health facilities outside of urban centres. Most PNG provinces are isolated due to lack of road networks, so if the air and sea travel restrictions are effectively implemented, it will reduce the spread of the virus if other positive cases are detected. However, if it does spread, it will be very difficult to bring under control. The success of the SOE will also depend on how the funds are managed. After the last SOE declared in 2018 in Southern Highlands following the devastating earthquake there, K450 million(US$132 million) was allocated for disaster relief. Even then, there were complaints of lack of funding affecting disaster response. Diligent management and timely allocation of the funds is important for fighting COVID-19.

 

Author Michael Kabuni is a Teaching Fellow in Political Science at the University of Papua New Guinea.

Mar 26
0

by Dr Sepehr Lajevardi

By | All 2020 DAISI trips cancelled | No Comments

Unfortunately due to COVID-19 pandemic, and lock-down measures, it has been announced today to all DAISI members, and our partnering colleagues in the South Pacific, that all trips for 2020 have been cancelled.

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Prof Peter Hewett, the Solomon Islands Program Officer stated today ” It is most unfortunate, but I  think this was inevitable and the best decision”, an opinion echoed by Dr Carina Chow & Prof Christophe Berney both surgeons heavily involved in DAISI trips planned for Papua New Guinea later this year, with Dr Chow stating “I think this was a smart move in this crazy time”.

DAISI partner surgeons Dr Elvis Japhlet & Dr Kennedy James from Sopas Hospital and Alotau Hospital in Papua New Guinea, and Dr Rooney Jagilly from National Referral Hospital in the Solomon Islands today shared their agreement that such a move was “in the best interest of the public good”.

“Our heart goes out to these vulnerable nations, with no telling how they will cope with the pandemic, but at the moment our presence there would be more a hindrance than a help” advised Dr Danny Kozman, Co-Vice Chair for DAISI.  “Special thanks also goes to those unsung heroes in the South Pacific who are integral to the planning and organisation of DAISI trips.  Not to forget also those from the PNG and Solomon Island’s Medical Board including Ms Francina Ega and Ms Pou Haro responsible for processing the over 70 applications for temporary medical registration, which unfortunately will now not be used for 2020”.

All volunteers who require help with organising refunds for their flight and accommodation should contact staff@daisi.com.au  An update to all those involved will be issued towards the end of the year, to allow volunteers and patients who missed out this year to be included next year.

Author: Dr Sepehr Lajevardi  is a member of DAISI. 

Mar 24
0

By Tess Newton Cain and Dan McGarry

By | Coronavirus (Covid-19) in the South Pacific | No Comments

What has happened in the South-Pacific this week?

  • French Polynesia is one of the worst-affected South-Pacific states, with 18 confirmed cases. Half were discovered in people recently returned from France, only one has been hospitalised so far, the others remain in isolation.
  • New Caledonia now has seven confirmed cases. Radio Rhythme Bleu reports that a crowd of about 60 people attacked the territory’s only international airport to protest against continuing air service.
  • Papua New Guinea announced its first confirmed case on 20 March. The person was flown to Australia on Sunday and the government is attempting to track down everyone who may have come into contact with him.
  • Fiji has four confirmed cases, three of which are from the same family: a man, his mother and his one-year-old nephew. Both the 47-year-old woman and the baby appear to have contracted the virus from the 27-year-old man, who is a flight attendant. Fiji Times reports they’re stable. A fourth case was announced Tuesday. He was identified as a 28 year-old man who traveled from Sydney to Suva last Sunday.
  • The island of Aneityum in Vanuatu is in lockdown following reports that passengers or crew from the cruise ship Voyager of the Seas may have interacted with locals during an overnight visit on 11-12 March. On Tuesday the New South Wales government said seven people onboard the ship, which disembarked in Sydney on 18 March, were diagnosed with Covid-19.
  • Samoa reports that six test results for Covid-19 had come back negative. Seven further samples have been sent to New Zealand for laboratory testing, and results are pending for these cases.
  • Solomon Islands had three suspected cases, but all tested negative. Meanwhile the country’s central bank has revised its growth prediction for the economy to 2% in 2020 with the governor flagging the possibility of a recession
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Papua New Guinea’s prime minister James Marape announced a two-week state of emergency in the country beginning on Tuesday, after the first case of coronavirus was confirmed.

What are South-Pacific governments doing?

  • Papua New Guinea: A two-week state of emergency began on Tuesday, with measures including stopping all domestic flights; no movement from one province to another for a 14-day period except for approved cargo, medicine and security personnel; the bringing froward of school holidays to start on Monday 23 March; all non-essential workers to stay at home; and for all people who arrived in Papua New Guinea from 7 March to report in to a government hotline. The Australian government has provided an additionaln US$500,000 (PGK1.7m) to assist with preparations for dealing with the impacts of Covid-19.
  • Fiji: The city of Lautoka, where the first three cases were detected, is in lockdown with road blocks and patrols. The military has been called up to assist with perimeter security. The government is urgently seeking 82 passengers on three flights, whom they believe may have been in contact with the confirmed cases. The prime minister has urged people to avoid non-essential travel within Fiji.
  • Solomon Islands: the country announced a 90-day ban on arrivals of cruise ships and yachts on 20 March and has reduced international flights. All international travellers are required to self-isolate for 14 days on arrival.
  • Vanuatu: State-owned carrier Air Vanuatu has suspended all international flight operations. Inbound travel on other carriers is restricted to citizens, residents, diplomatic corps and humanitarian workers responding to the Covid-19 crisis.
  • Samoa: A state of emergency has been declared and borders are closed. Public gatherings are restricted to no more than five people. Failure to comply may lead to a fine of up to US$3,400 or a period of imprisonment of two years.
  • Tonga: A state of emergency has been declared. Borders are now closed. Nightclubs and bars will be closed from 25 March and gatherings of more than 20 are prohibited.

Authors: Tess Newton Cain is a Pacific analyst and writer for The Guardian. Dan McGarry
Dan McGarry is the media director of Vanuatu Daily Post and Buzz FM 96 in Port Vila, Vanuatu

 

Mar 18
0

By Nili Hali

By | Future DAISI Trips Suspended | No Comments

DAISI Founder and Colorectal surgeon Dr Gary McKay suspended all future DAISI trips to the South Pacific indefinitely from 18th Mar 2020 due to COVID outbreak. “It was not a decision made lightly, with ultimately safety concerns taking priority” says Dr Gary McKay.

Currently Papua New Guinea has no reported cases of Coronavirus (COVID-19), with more than 100 cases now diagnosed in Australia, mostly from Sydney.  “It is more likely that we will infect those in Papua New Guinea than the other way around” says DAISI team leader Dr Carina Chow, who ultimately made the decision today to cancel the trip after safety concerns and after considering the interests of all involved.

The team of six volunteers from Brisbane  (some from Mater Hospital where some of Brisbane’s first coronavirus cases were reported last week) was to include two surgeons, one anaesthetist, and three nurses.

“I feel for all those involved in the planning of these trips and specially those patients in PNG who will miss out on much needed surgery as a result, but ultimately it is a decision between cancelling elective surgery versus risking bringing coronavirus to some of the most remote, vulnerable and medically-ill equipped regions in the Highlands of PNG.”

At this stage it is hoped that the trip will be postponed to later in the year rather than cancelled completely.

“We have today also cancelled a team to Solomon Islands and are watching the situation closely” says DAISI Chairman a/Prof Matt Rickard, who himself is scheduled to volunteer in Papua New Guinea in May later this year emphasising “at this stage the May trip is going ahead, but a final decision will be made one month before the planned trip’s departure depending on the current status of the coronavirus.”

Author Nili Hali is a DAISI member, Barrister and DAISI’s legal advisor.  Nili worked as a lawyer for the United Nations in The Hague. Nili has a keen interest in humanitarian issues, including the welfare of women and children.

Mar 11
0

by Christophe Berney

By | DAISI Charity Ball postoned due to coronavirus | No Comments

DAISI made the difficult decision today to postpone the planned Winter Solstice Charity Ball scheduled to occur at Novotel Manly Pacific on 20th June 2020.

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This follows the World Health Organisation’s upgrading yesterday of coronavirus as a pandemic, with Director-General Tedros Adhanom, urging all nations to “take all necessary measures to slow further spread and to protect health systems from becoming overwhelmed with patients seriously ill with coronavirus (COVID-19)”

There is also mounting pressure from various medical fraternities in Australia to ban large public gatherings until the coronavirus is under control. Today Federal Labor MP Mike Freelander, who has also worked as a doctor for 40 years is quoted by ABC reporter Stephanie Dalzell as stating “I don’t believe people should be attending large gatherings because of the risk of spread,” Dr Freelander said “If we don’t slow down the onset of the coronavirus I’m very concerned with the onset of winter and the influenza season, our systems are going to be completely overwhelmed.” This was echoed by many medical & surgical societies, including General Surgeons Australia, and The Royal Australasian College of Surgeons, who have put on hold all major public gatherings.

At this stage the DAISI Charity Ball will probably remain at the Novotel Manly Pacific, but a specific date has not been established. We really need to see how long this pandemic lasts for.  Ideally a Charity Ball end of 2020 if not early 2021 will occur.  DAISI is grateful to Novotel Manly Pacific which has waived the usual cancellation fee in this situation. “It is a wonderful thing when corporate organisations such as Novotel behave in such a responsible manner”, “normally cancelling an event like this would cop a huge cancellation fee” says Charity Ball organiser and previous DAISI Chair Dr Sepehr Lajevardi.

Originally a “Winter Solstice” fancy dress theme,  it is unclear at this stage the theme for the future charity ball.

Once a date is decided, the event will be promoted, and tickets will become available for purchase online.  All money raised will go towards supplying surgical equipment for planned laparoscopic and endoscopic training in Papua New Guinea and the Solomon Islands.

 

Author Prof Christophe Berney is the Co Deputy Chair of DAISI and part of the organising committee for the annual DAISI Charity Ball.  Prof Berney is Conjoint Professor with the University of NSW with expertise in colorectal, upper GI, thyroid and hernia surgery and regularly volunteers with DAISI to the Solomon Islands & PNG.

Mar 10
0

By Nili Hali

By | Coronavirus concerns result in cancelling of volunteer trip to Papua New Guinea. | No Comments

DAISI trips scheduled for March and April to the remote Highlands of Papua New Guinea have been cancelled today due to coronavirus concerns.

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“It was not a decision made lightly, with ultimately safety concerns taking priority” says Dr Carina Chow, DAISI member and colorectal surgeon from Brisbane in charge of the planned 6 member volunteer team.

Currently Papua New Guinea has no reported cases of Coronavirus (COVID-19), with more than 100 cases now diagnosed in Australia, mostly from Sydney.  “It is more likely that we will infect those in Papua New Guinea than the other way around” says DAISI team leader Dr Carina Chow, who ultimately made the decision today to cancel the trip after safety concerns and after considering the interests of all involved.

The team of six volunteers from Brisbane (some from Mater Hospital where some of Brisbane’s first coronavirus cases were reported last week) was to include two surgeons, one anaesthetist, and three nurses.

“I feel for all those involved in the planning of these trips and specially those patients in PNG who will miss out on much needed surgery as a result, but ultimately it is a decision between cancelling elective surgery versus risking bringing coronavirus to some of the most remote, vulnerable and medically-ill equipped regions in the Highlands of PNG.”

At this stage it is hoped that the trip will be postponed to later in the year rather than cancelled completely.

“We are watching the situation closely” says DAISI Chairman a/Prof Matt Rickard, who himself is scheduled to volunteer in Papua New Guinea in May later this year emphasising “at this stage the May trip is going ahead, but a final decision will be made one month before the planned trip’s departure depending on the current status of the coronavirus.”

Author Nili Hali is a DAISI member, and DAISI’s advisor in all legal matters. Nili is a barrister for Chalfont Chambers, and prior to this served as a lawyer for the United Nations in The Hague. Nili has a keen interest in humanitarian issues.

 

Mar 03
0

By Sepehr Lajevardi

By | Practice Guidelines Smartphone App Takes Off in The Solomon Islands | No Comments

The NRH Paediatrics team using the Guideline Host app in Honiara, Solomon Islands

Until recently, health professionals in the Solomon Islands had limited access to independent, evidence-based, therapeutic information, either due to the lack of availability, remoteness,  or because access was so prohibitively expensive.

Thanks to a partnership of Therapeutic Guidelines Foundation (TGF) with the Solomon Islands Ministry of Health (MOH) and the National Medicines & Therapeutics Committee (NMTC), health practitioners in the Solomon Islands now have free smartphone access to their own Solomon Islands Guidelines Host app.

The Therapeutic Guidelines Foundation (TGF) original program was established in 2007 to support the quality use of medicines and development and distribution of guidelines in less developed counties, including many of those in the South Pacific.

However, for many it was still inaccessible, with conventional  copper wire and fibre-optic cable based technology difficult to role out to this nation of almost one thousand islands spanning more than 27,000 square kilometres.

In recent years significant developments have occurred in satellite network telecommunication technology.  This has resulted in a skyrocketing increase in the use of mobile phones in the country, particularly amongst young adults, who make up more than 60% of the Solomon Island’s population.
With this new technology, even the most remote regions of the Solomon Islands now have relatively speedy access to internet with smartphones now the principle modus operandi for accessing the internet in the country.

In May 2018, the first edition of the Solomon Islands Guidelines Host app for smartphone was launched.  A few teething issues were encountered and tweaked, and on 21 January 2019 the updated version of  the Solomon Islands Guidelines Host app was released.

This app was developed to make local guidelines easily accessible for health practitioners at the point of care. This is particularly important for the Solomon Islands, where the provincial hospitals and medical centres are quite remote, and otherwise cut off from the National Referral Hospital in the capital city Honiara.  Without this app and technology, dedicated staff and resources and local health professionals would need to be invested in developing local guidelines. Barriers to printing and distributing hard copies of these guidelines would then result in poor dissemination, and usage of these guidelines.

 

4F7EAC49-0FD5-4965-98D5-9296EA9755DEOld hard copy guidelines now available in app form and tailored to the Solomon Islands. 

This app has not only therapeutic drugs practice guidelines but also practice guidelines for most specialty areas such as paediatrics, emergency medicine, medical oncology and obstetrics and gynaecology.  It also gives access to the nation’s Essential Medicines List (EML) and medical equipment formulary.

In addition to free access to these resources, the app provides regular clinical updates tailored specifically to the Solomon Islands, with local guideline development made in consultation and collaboration with the Solomon Islands MOH and NMTC.

“Having access to multiple local treatment guidelines on ones’ phone anytime improves the efficiency and effectiveness by which a Solomon Islands health workers can treat their patients and thus improves the quality of care they provide, ” says Dr Rooney Jagilly, a seniour surgeon from National Referral Hospital, in Honiara who made significant contributions to the guidelines contained in the app.  “I would like to thank Therapeutic Guidelines Ltd for their kind assistance in supporting us in this regard.” Not to forget also the significant contribution also made by the late Permanent Secretary Dr Tenneth Dalipanda.

 

This app is also incredibly valuable for so many reasons. It serves for teaching purposes, and for setting standards and policies amongst the wide distribution of health practitioners throughout the nine provinces. With a growing number of new and relatively “green” overseas medical graduates returning from Cuba, the app is particularly useful for medical decision making providing treatment algorithms for common complaints for the less experienced doctor.

The app and its easy accessibility also allows unity in purpose for visiting overseas specialists volunteers and organisations, of which there are many in the Solomon Islands.  The app gives them clear indication of available resources and locally established practices and protocols, potentially making their transition and contribution easier, and more in line with the nation’s key objectives.

With further refinements and additions since, the app is today being disseminated to all visiting overseas specialist volunteers.  It is highly recommended to use and become familiar with prior to embarking on a volunteer trip to the Solomon Islands.

We look very much forward to further contributions and updates to the app in the years to come.

 

For more information on the app, and future updates you can email Ms Reddy Kamini  RKamini@nrh.gov.sb  or Mr Solomon Bosa SBosa@nrh.gov.sb or the TGF program manager Mieke Hutchinson-Kern internationalprogram@tg.org.au

 

Author Dr Sepehr Lajevardi is co-founder of DAISI and previous DAISI Chairman. Dr Sepehr first volunteered in the Solomon Islands in 2015.

 

 

Dec 22
0

By Dr Matthew Malone

By | Post COVID resumption of DAISI trips | No Comments

If the news reported that crocodile or shark attacks were to blame for 20 people losing their legs in 1 month alone, there would likely be a call to arms. This problem is actually occurring as we speak, except crocodiles or sharks are not to blame… Its Diabetes.

I was recently invited by DAISI to visit the Solomon Islands on a fact-finding trip to look into and report on the extent of diabetes related foot disease. I have worked across the UK, Middle East and Australia and further consulted across the globe in the area of diabetes foot disease. I have been exposed to varying levels of healthcare and worked in areas with different populations and incidences of diabetes foot disease. However, the extent of this problem in the Solomon Islands is disturbing. Diabetic Foot Disease, including foot ulcers are amongst the most common complications of uncontrolled diabetes. People with diabetes are more susceptible to developing foot ulcers that are slower to heal and more prone to infection. Currently in many Pacific countries, untreated, infected diabetic foot ulcers are leading to multiple amputations and sometimes death. The true extent of foot disease in the pacific islands is largely estimated, because there is no accurate record keeping.

I visited the National Referral Hospital in Honiara and had the opportunity to spend the day with a wonderful general surgeon Dr Rooney Jagilly. Dr Jagilly heads up the general surgery ward, a ward consisting on 50 beds. Alarmingly, such is the extent of the diabetes foot disease that 50% (25 beds) of the ward were solely dedicated to people with diabetes foot disease. Many patients had extensive leg amputations or surgery to remove large sections of the foot, secondary to infection and sepsis. The surgeons, the nurses and all ward staff work effortlessly, but are faced with significant challenges that include a never-ending tide of new people needing beds for diabetic foot disease, the lack of basic health infrastructure and support, and a lack of some basic woundcare necessities. In addition, the problem of managing diabetic foot disease in the out-patient setting paints a similar picture. I also spent the day working in the diabetes-wound clinic. The clinic treats between 30-50 patients with diabetic foot ulcers per day, with minimal resources. In the face of such adversity, I was overwhelmed by the nurses and doctors, that despite the inherent lack of equipment or support, strove to provide the best care they could for each patient, with so little.

What was glaringly obvious to me was that this is a massive problem in need of support. I am not the only person to recognise that diabetes and its complications are a scourge on the pacific islands. In 2015 the International Diabetes Federation reported the astonishing statistic that Pacific island countries or territories accounted for eight of the top ten in the world for diabetes prevalence. About 40% of the Pacific island region’s population of 9.7 million has been diagnosed with a noncommunicable disease, notably cardiovascular disease, diabetes and hypertension. These diseases account for three quarters of all deaths across the Pacific archipelago and 40–60% of total health-care expenditure.

The table below shows the change in diabetes prevalence for selected low- and middle-income countries of interest to Australia, with Australia included as a comparator.

 

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Fig 1. Diabetes prevalence rates in Australia versus South-Pacific Nations.

With a doubling of diabetes in the South Pacific in the last quarter of a century it can only be viewed as an epidemic worthy of serious concern and consideration.

With this in mind DAISI has thought it necessary to begin to address the burden of illness particularly as it relates to inpatient admissions to National Referral Hospital, the major referral hospital in Solomon Island’s Capital Honiara.

Dr Matthew Malone is the current Head of Department for the High-Risk Foot Service at Liverpool Hospital in Sydney and a Senior Research Fellow with the Liverpool Diabetes Collaborative Research Unit at the Ingham Institute of Applied Medical Research Sydney. In December 2019 Dr Malone travelled to National Referral Hospital (NRH), Honiara, Solomon Islands to organise and conduct a two day diabetic foot clinic, as part of a pilot program intended to improved the management of the diabetic foot, and reduce admission and amputation rates.