Lauren and Ray from Motivation Australia conducted a one week rapid assessment of the current status of diabetic foot care at Tungaru Central Hospital (TCH) in Kiribati. MA have been working with the Tungaru Rehabilitation Service (TRS) at the same hospital since 2008. In Kiribati MA are partnering with the Ministry of Health and Medical Services (MHMS). All amputations are performed at TCH, which is the main hospital located on South Tarawa. Data gathered by the MHMS Health Information Unit shows that a total of 89 lower limb amputations were performed there in 2015.
The scope of this initial project visit is to understand the current status of diabetic foot wound management in Kiribati; and undertake consultations with the Ministry of Health and Medical Services (MHMS) and key stakeholders in order to plan activities.
TCH medical personnel consulted, all described a similar situation with diabetic foot wounds to that experienced by MA in Samoa in the Diabetic Foot Clinic there; people with diabetic foot wounds seek medical assistance very late (for various reasons), by which time their wounds are large and infected, which almost always leads to surgical debridement or amputation. Many factors contribute to the situation in Kiribati such as the high rates of uncontrolled diabetes, barefoot walking, a lack of health information, distance from services and the cost of travel, fear of hospitalisation and amputation, changes in lifestyle, etc.
In 2014 the International Diabetes Federation reported that Pacific Island countries accounted for eight of the top ten countries in the world for diabetes prevalence, with some rates as high as 37% (Kiribati’s published rate is 26%). The increasing burden diabetes is placing on social and health systems in the region, makes the prevention and treatment of diabetes complications a priority.
Foot wounds (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. Currently in many Pacific countries, untreated, infected diabetic foot ulcers often lead to multiple amputations and sometimes death.
The Regional Amputation Prevention (RAP) project is a multi-country initiative by Motivation Australia (MA) in direct response to the rapidly rising rate of diabetes related amputations in the Pacific Region. This first phase of the RAP project is funded by the Australia Government and LDS Church Charities.
Through the project MA will provide technical support and assist in coordinating external inputs in order to support I-Kiribati medical and rehabilitation personnel to establish and sustain a Diabetic Foot Clinic. The aim is to contribute to the MHMS achieving a reduction in diabetic-related amputations from 90 (base line in 2011) to 68 (2019 target in the Strategic Plan), and aligns with the MHMS Strategic Plan (2016-19) Objective:
“Strengthen initiatives to reduce the prevalence of risk factors for NCDs, and to reduce morbidity, disability and mortality from NCDs” and Strategic action 1.5: “Strengthen initiatives around prevention, detection and management of diabetes and its complications.”
The MA team would like to thank everyone who participated for their time and valuable contributions. We are grateful to the hospital personnel who patiently assisted us to learn about a situation which is no doubt challenging for them in the frontline delivery of health services. Special thanks to Tekoaua Tamoroa, Chief Officer in Charge, Tungaru Rehabilitation Service (TRS) for facilitating our visit.