This is a personal “From the Field” story by Direct Relief Employee, Susan Fowler, Advisor, Program Resources and Development.
The boat arranged by the village chief arrived on schedule, and we loaded it with medical goods then climbed aboard. I was accompanying a medical team, organized by the U.S.-based Loloma Foundation, and we were traveling by boat around the Yasawa Island group in northwestern Fiji. The team, which consisted of three physicians, an optometrist and his assistant, and the project director, was conducting medical clinics and delivering critically needed medical products, such as medications, first aid and clinic supplies, and screening and diagnostic equipment items, to regional nursing stations.
The Loloma Foundation was established to support the limited healthcare and educational services in Fiji. Every year, the Foundation distributes medical materials, including Direct Relief-donated products, to inadequately-supplied hospitals, clinics, and nursing stations located throughout the island nation. In collaboration with Scripts Memorial Hospital of San Diego, the Loloma Foundation also organizes teams of medical professionals to travel to Fiji to conduct medical clinics in extremely difficult to reach areas such as the Yasawa Islands. These coral and volcanic islands stretch out for approximately 80 kilometers and can only be reached by boat or seaplane. They are rarely, if ever, visited by Ministry of Health physicians.
Major health issues in Fiji include bacterial and fungal skin infections, muscle and joint pain, ear and respiratory infections, filariasis, hypertension, and traumatic injuries. Nursing stations have been established on selected islands and each station is staffed by a trained nurse/midwife who provides basic services to the local community or geographic division. The most critical issues with regard to the availability and quality of healthcare services in Fiji include the number of individuals a nurse may be responsible for taking care of (up to 3,500), the cost and logistical difficulties required to reach a nursing station, and the chronic shortage of medical products and diagnostic tools available.
Yasawans, like most rural Fijians, live a subsistence lifestyle by fishing (both reef and deep sea) and growing/harvesting fruit and vegetables, such as cassava, yams, breadfruit, papaya, bananas, and pineapple. Many Fijians still live in bures – traditional one-room homes with woven mat walls and palm thatched roofs. Most villages do not have electricity or running water. Village life is very communal, and frequent ceremonies and religious services bring people together. Before a clinic begins, the village chief, his spokesman, and other ranking villagers hold a kava (drink made from the crushed root of a pepper plant) ceremony to welcome us.
Our first stop in the Yasawa Islands was to the village of Yasawa I Rara. After being transported to the shore we walked to the village community center where stations for the various physicians had been prepared. The nurse responsible for the area had arrived early and had already started to hand out patients’ medical record cards to those waiting in line. He also worked closely with the physicians all day to provide context, to help translate, and to schedule any required follow-up.
As the incidence of hypertension and diabetes has been rising in Fiji in recent years, all adults received blood pressure and blood glucose screenings before their consultation with one of the physicians. The dermatologist screened hundreds of people as bacterial, fungal, and parasitic skin infections are extremely common among both adults and children. She provided customized treatment plans for each person using an assortment of systemic and topical medications. Micronutrient deficiencies are also an issue in Fiji and vitamin A deficiency, due to the limited diet on outer islands, can put children at risk for vision problems and limit their ability to recover from serious illnesses.
To address these concerns, I worked with the nurse and local school to provide high-dose vitamin A to all village children between the ages of one and 15. Supplements to continue this distribution program (only one capsule is required every six months) for the next 18 months were left with the nurse.
There was also a long line to see the optometrist who was able to diagnose an array of vision problems as well as prescribe prescription eyeglasses, reading glasses, or sunglasses which were then dispensed on site. Cataracts and other eye disorders are common among the rural Fijian population, especially among women who typically spend four or more hours each day fishing on the reef. If a patient can arrange to get to the host hospital – an expensive proposition with the high cost of fuel – they can receive surgery to restore their sight.
Yasawa I Rara was only one of the many island villages that we visited during our time in Fiji. The villagers were extremely grateful for the opportunity to obtain medical screenings and care and upon leaving we were often thanked with songs, dancing, and handmade gifts. In addition, each nursing station visited received a midwife kit, diagnostic and testing equipment, and an assortment of medications and supplies. These stations will now be on the official Loloma Foundation list and will receive a supply of medical goods every six months.