Am. Samoa Health Department, Hospital Host Symposium

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Presentations raise need to address NCDs, specifically diabetes

By Teri Hunkin

PAGO PAGO, American Samoa (The Samoa News, Oct. 22, 2013) – There may be gridlock in Washington, and a gargantuan "failure to communicate" on the part of some in our nation’s capitol, but here in American Samoa, two of government’s most important entities—the Department of Health (DOH) and the territory’s only hospital, LBJ Tropical Medical Center, have embarked upon a new era of collaboration and cooperation which has not been seen for quite a while, if ever.

LBJ Hospital CEO, Joseph Davis-Fleming and Department of Health Director Motusa Tuileama Nua have a shared vision for the territory. They are not at cross-purposes; their mandates are somewhat different, but they acknowledge that in the end, they work toward the same goal — to increase the good health and well being of the community which they serve, the people who make up the territory of American Samoa.

In a move which many called "historic" the two government entities joined forces and brain power to organize and co-host a medical symposium for the territory this past weekend — the first of its kind, and a landmark session which involved local, regional and worldwide health care speakers.

According to program organizers, one of the main reasons for the symposium was "to bring all of these people together who can enact change." Samoa News understands that it was the positive and proactive insistence of LBJ’s Chief Medical Officer, Dr. Akapusi Ledua that put this historic gathering on the calendar.

A pre-symposium reception was held on Friday, October 18 at the Tradewinds Hotel, where LBJ’s Chief Executive Officer Joseph Davis-Fleming introduced the symposium and its speakers. Lt. Governor Lemanu Peleti Mauga and his wife were in attendance, and the Lt. Governor spoke briefly, acknowledging the importance of the dialog about to take place.

On Saturday, October 19, the Lee Auditorium in Utulei was the site for the event, which included a day full of informative research, thoughtful insight, and provocative question and answer sessions.

Called "American Samoa Health, Now and Vision for the Future," the program contained morning sessions devoted to Non-Communicable Diseases (or NCDs) with a focus on the complications of Diabetes Mellitus, Type 2, which has seen exponential growth and is now considered at epidemic levels in American Samoa, as well as across the Pacific.

Facilitating the morning discussions were local doctors Mike Favazza, MD and Annie Fuavai, MBBS as they heard from our surgeons and internal medicine doctors on the subjects of diabetic foot infections and limb amputation caused by nerve damage; the high numbers of hemodialysis patients entering the dialysis clinic due to kidney failure; and the high risk of blindness (diabetic retinopathy) which affects too many of our aging population.

Dr. Judith DePue, who is a clinical professor of Psychiatry and Human Behavior at Alpert Medical School at Rhode Island’s Brown University, followed those presentations with the results of a study conducted in American Samoa to evaluate the effectiveness of a culturally adapted, primary care based team of Community Health Workers (CHWs) to increase patients’ understanding and control of their diabetes.

Dr. DePue noted that the shortage of health workers is a problem in many remote and underserved communities around the world, and with funding from the National Institute of Health, she and her team partnered with ASG’s Department of Health a few years ago for this study, and an outreach approach using lay health workers — aka Community Health Workers — was decided as the best way to educate and support diabetic patients and their families.

These community health workers would serve as a bridge between local people and professional health care providers, and these types of programs are utilized around the world, she said.

Following a description of the research and design methods used in the study, Dr. DePue confirmed that culturally sensitive nurse/CHW teams improved diabetes control in American Samoa as evidenced by increased primary care usage, decreased use of emergency room facilities, and most importantly, a clinically significant improvement in mean HbA1c, a measurement of long term blood sugar levels.

NCDS — Let’s declare a state of emergency

The final presentation of the morning was given by the former head of PIHOA— the Pacific Island Hospital Officers Association—and former Minister of Health for the Republic of Palau, Dr. Stevenson Kuartei, who minced no words about the epidemic of NCDs.

He said, "The NCDs were declared a health crisis in 2009. Today we heard the words ‘crisis, crisis, crisis’ multiple times. Are we in a crisis or not? And if we are, what are we doing about it?"

Dr. Kuartei noted that in Palau, as here, the biggest burden upon the economy and upon health services are NCDs. He said, " Across the Pacific region, the human resources to address NCDs do not exist—or are very sparse."

Again he asked, "If this is a crisis, what are we doing about it?" He said there is a "lack of urgency" about the facts; and if it is a crisis, "we must address it as such." He called NCDs nothing less than a "social disaster" and said we need to treat it that way, because it "threatens upcoming generations, socio-economic dynamics, and national security."

"If it’s a disaster" he said, "Let’s declare a state of emergency, with an incident command system, and the whole of society involved."

Referring to Einstein’s definition of insanity ("Doing the same thing over and over and expecting different results) he said, "If we continue to do things as they have always been done, we will lose."

Dr. Kuartei’s clarion call also came with recommendations. He said, "We have the means to influence this vulnerability," and we need to adopt "a more holistic approach" — one which we in the Pacific understand, with our strong families." He also recommended legislating a "sin tax" on those things which are harmful to health, such as tobacco, alcohol and high fat, high sugar foods, which will give government the money to combat NCDs.

He said in closing, "If we want to go fast, we go alone; if we want to go far, we go together."

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