Primary Care Practitioners Training on Diabetes Management

Venue: Studio 6

Date: 1st November 2014

1.  Salutations
2.  Thanks

Thank you for the invitation to be here, and I want you to know that, not only am I glad to be here today, but I am also thankful that you all have made time to be part of this event.

I know that we have a diverse group of experts this afternoon, and that  this is the 2nd training for this year on Diabetes Management. Its good to see you all here this afternoon…..all the facilitators and the participants.

During the past few weeks that I have been at the Ministry, I have been visiting the different heath facilities in the Central Division—the hospitals, the health centres , the nursing stations, the various offices, Mataika house and so forth.

It has given me a better understanding of what is being done in the public sector on Health.  I have seen the pressures faced by our health workers.

I have seen the cramped offices, consultation rooms, recorder rooms and pharmacies in which they work.. I have seen the lack of storage space.

I have heard of the difficulties that zone nurses have to face in trying to get to they communities that that they serve.. and they walk, take the public transport, use their own cars, or hitch rides just to get there.

I have heard first hand.

I  have seen with my own eyes the haggard faces of doctors who see up to 90 patients a day and of nurses who work alone in nursing stations seeing up to 90 people a day…

I have become aware of  the constraints that have to be contended with, and the mountains that have to be climbed.

So I want you to know that since I have become Minister of Health and Medicine in late September, my respect for Health professionals has grown in leaps and bounds.

I applaud you all, and I hope that this program adds impetus to what we are all trying to achieve.

However, everyday there is a clamour across this nation for better service in the health sector, for more efficient service, for more effective and more caring service.

There is a clamour for more effective approaches ,for more effective service.

There are rising expectations of what is expected and what is desired from the Health sector.

We have to contend with all of these issues and we must raise the ante… service delivery levels will have to be improved. What we have achieved in the past will have to be surpassed. The status quo is not good enough anymore.

Over the past two days in the Ministry we have been formulating our Annual Corporate Plan for 2015…setting out what we aim to achieve in all the areas that we cover..and the list is extensive.

We have also addressed the important issue of creating a stronger culture in the Ministry that is focussed on building a workforce that is caring and compassionate, and focussed on delivering this through our service levels.

We have focussed also on strengthening the  deployment of the systems that we have established for improving data collection, conversion of this into information and knowledge so that the whole sector can be improved ..so that we can deliver better services.

We have taken note of the importance of continuing with longer term efforts to revolutionise systems…of deploying systems, or monitoring and evaluating systems to make sure that they work..and at the same time address the everyday complaints in the sector.

I know that the ultimate way of addressing issues in this vast sector is by system changes, by process changes and by changing mindsets…that is a mammoth task , but it must be done, and I will give my very best to make it happen.

I have always believed that people who understand problems best, are those who face those problems everyday..those who work there..the workers themselves.

I believe that if you give them exposure to new ideas and concepts that it will be those very workers who will themselves be best able to identify what the root cause of problems are, to develop solutions and to fix those problems.

I have believed this for many years..and it has been at the heart of my management and leadership philosophy. This is  why I am a great believer in the concepts of Quality Circles, Cross- functional Quality Improvement teams and the like.

I am also a great believer in the  importance of leadership…and if leadership is doing the right things…if leadership has the rights values.. and if you can see those values coming through in the behaviour of leaders..that this will have an impact on the people who work under them and who work with them…and in this way attitudes and culture in any organisation can change.

This is something that I will work on in the Ministry together with the everyone in the Ministry…..to bring about the enhancement of service delivery. To make a difference.

However, I know also that we cannot make a great improvement to Health just by focussing on actions within my Ministry.

Heath issues require a whole of government, whole of health sector and whole of nation approach. That must be our focus . It requires everyone working towards the ultimate vision of a healthier population.

Developing a healthy population may require looking at legislations in areas other than just health—it will require looking also at trade issues, taxation issues, education issues and so forth.

It requires also a stronger partnership between the public and private sector…so this program  being an example of that public private partnership…is exactly what I am talking about.

3. Diabetes Management

Since assuming this position I have come to learn a lot about the rate of diabetes, and have learnt that the rate of diabetes in the Pacific and in Fiji is among the highest in the world. That is not a record of which we are proud. It is something that needs to be addressed.

This month is an important month for NCDs—first of all November is NCD month. And second, World Diabetes day falls on 14th of November.

The data provided to me shows that the rate of diabetes jumped from 19.6 % (STEPs survey of 2002) to 29.6% (STEPs Survey 2011)

The occurrence of diabetes related amputation has been recorded as 1 in every 12.6 hours

80% of the surgical wards in our divisional hospitals are occupied by Diabetes patients.

The Diabetes centre  has conducted foot care trainings to nurses, provided foot kits, developed the foot care manual and now through the help of the World Diabetes Foundation, two surgeons will be coming to train our surgeons on lower limb saving techniques.

Diabetes complications encompass more than just health complications.

The Ministry of Health & Medical services has a wide variety of programs focussing on addressing premature deaths and disabilities related to NCDS through screening and SNAP(Smoking, Nutrition, Alcohol and Physical Activity) intervention….advocating for healthy lifestyle through the Wellness concept to improve the service deliverables

The Government has set its target to reduce the gap in health and health equities.

We recognise the burden of NCDs on individuals, families and health systems and recognise the need to work in collaborations with other stakeholders to discuss the way forward for the health of our people

This is an approach to be used for Diabetes Management, and it is an approach to be used in looking at other aspects of health. This is why we intend to  organise a Forum on Health in which we will invite stakeholders to come forth and give us their feedbacks and to come up with suggestions on the way forward to improve the Health sector in Fiji. This Forum will be organised in November of this year.

Coming back to diabetes, Government is committed through its manifesto to ensuring NCD medications are available and that pharmacy hours are extended.

A big vinaka vakalevu to Diabetes Fiji …our main sponsor for this training and the team at Diabetes Centre in Suva for bringing together the very people that look after our peoples health.

I take my hat off to Diabetes Fiji for the work that it is doing.. and I applaud the initiatives that it has put in place

We need more focussed forums like this that brings together Private Practitioners and doctors based at government health facilities to tackle other issues such as cancer, cardiovascular diseases and emerging new diseases.

The sharing of learning, the passing on of learning …it all creates a strong base upon which to make improvements. Creating knowledge is a strong and important step in taking up the fight on diabetes.

4. Our Aim as Government

Our aim as a Government is to improve the lot of everyone in this country.. and in the health sector we want to improve the health of everyone here in Fiji.

In battling NCDs and Diabetes we do face an uphill battle. We must fight.. we cannot just lay back and let others decide our fate. Change will always come..it can be change for the better or change for the worse. We need to be people who do something about such changes…. Who do not just recognise that the change is taking place and do nothing about it.  No, we must choose to do something.

The prevention of NCDs is a massive challenge, and is something that will require a whole of government, and indeed a whole of society approach.

The management of Diabetes is obviously something that we have to take a whole of sector approach…the Health sector that is approach.

We need to work together across the different boundaries and silos that we put ourselves in…to share ideas, to share concerns, to learn together…so that together we can enhance peoples lives.

I have no doubt that this program will give all over you new knowledge…that you will learn a lot .

I hope this program will not only expand your learning but that it will also do a number of other things.. that it will act as a catalyst for other things…that you will become more productive in preventing and controlling diabetes…that you will build strong networks that can then continue this work.. that you will build a strong network here that will continue this work…and that we will all together move Fiji closer to where we want to be in terms of diabetes management.

That is the bottom line.

I wish you a great teaching, sharing and learning experience.

Nutrition to Reduce the Risk of Cardiovascular Disease

What is cardiovascular disease (CVD)?

According to the World Health Organization, CVD is responsible for the most deaths worldwide with more people dying from cardiovascular related conditions than any other cause.  Hypertension (high blood pressure) and coronary heart disease (disease of the vessels supplying blood to the heart) are the most common diseases of the cardiovascular system, and cases of both hypertension and coronary heart disease are rising rapidly in Fiji, due to the change in lifestyle in recent decades.  Other diseases of the cardiovascular system include rheumatic heart disease, caused by damage to the heart muscle and valves by rheumatic fever from streptococcal bacteria, congenital heart disease which are malformations existing at birth, cerebrovascular disease which is the disease of vessels supplying blood to the brain, responsible for stroke and peripheral arterial disease which is the disease of the arteries in the arms and legs.

 

How is lifestyle related to CVD?

Around 80% of cases of coronary heart disease are related to lifestyle factors including smoking, excessive alcohol intake, inadequate physical activity and an unhealthy diet that is high in processed and nutrient poor foods.

Having an unhealthy diet and inadequate exercise may show up in the body as being overweight or obesity, hypertension or raised blood sugars – these are all risk factors for developing CVD.

How does my nutrition affect my heart?

Eating a balanced diet that includes a variety of different, healthy foods and plenty of fruits and vegetables is one of the most important things you can do to keep your heart healthy and reduce your risk of CVD. Here is the latest information in nutrition and heart health.

Fruits and Vegetables

  • Fruits and vegetables are packed full of vitamins, minerals and antioxidants, which are essential for our body to function optimally. When our body does not get these nutrients, it is difficult for our body to be healthy and we are more susceptible to disease and illness.
  • They have fibre, which not only keeps us regular, but fibre also helps to slow down digestion in our bowel, keeping us fuller and also helping to reduce cholesterol.

Cholesterol

  • Cholesterol is essential for our health, it is important for the structure of our cell walls and making hormones. However too much of the wrong kind of cholesterol can be bad for our health and increase our risk of CVD.
  • Cholesterol in our diet only makes up a small amount of cholesterol in our blood, as our body makes its own cholesterol – it is mainly saturated fat in our diet that increases our blood cholesterol.
  • There are different types of cholesterol, HDL Cholesterol (Good) and LDL Cholesterol (Bad).
  • Foods to Avoid(that increase bad cholesterol/decrease good cholesterol):

Chicken skin, visible fat on meat, all fried foods, fried fish, cakes, pastries, biscuits, white bread, processed meats such as sausages and deli meats.

  • Foods to Include (help to decrease bad cholesterol/increase good cholesterol):Colourful vegetables and fruits (fresh, tinned or frozen), lentils, dhal, chickpeas and other legumes, grain bread, baked or steamed fresh fish, unsalted nuts, avocados

Salt

  • High salt intake contributes to high blood pressure or hypertension and puts you at risk of CVD. Too much salt increases the pressure of our blood, which can damage our blood vessels, putting us at risk of stroke and other CVD.
  • Salt is in most foods we eat, but high amounts are found in processed foods and processed meats, even if they don’t taste salty!
  • High salt foods include – all take away foods, stir-fry noodles, curries etc. Noodles, bread, butter, breakfast crackers, chips, bongos, sausages, pizza, bottled sauces, tinned fish and deli meats.
  • We can get enough salt naturally from the fresh foods we eat and there is no need to add salt to our meals that we cook at home. It is difficult to control the amount of salt you consume when eating out, as there is often a lot of salt added in cooking as a flavor enhancer.
  • The more salt we use, the more our taste buds get use to it, so reducing salt can initially result in food tasting very bland, but taste buds will get used to the new tastes in just a couple of weeks and you will be able to taste the natural flavour of foods again!
  • The best way to reduce your salt intake is to eat only fresh foods, avoiding processed foods where possible, and make use of herbs and spices for flavour – dhania, mint, basil, chili and other spices – these are cheap and add heaps of flavor!

Meat

  • Meat can be very healthy for us as it contains many vitamins and minerals such as Iron, Vitamin B12 and Zinc, but it can also contain high amounts of saturated fats that increase our cholesterol – we should keep our serves of meat to the size of the palm of our hand, and the thickness of the palm of our hand.
  • The best meat to eat is lean meat, the meat that has low amounts of fat, these are – chicken without the skin, red meat without visible fat and freshfish and shellfish. BBQ meat is generally very fatty.
  • Avoid processed meats such as sausages, salami and other deli meats as these are high is saturated fat and salt.

Fish

  • Fish is very low in saturated fat and contains Omega 3’s a healthier type of fat that helps to protect our heart, increase good cholesterol and decrease bad cholesterol. Salmon, tinned salmon, tinned and fresh tuna and sardines have the high amount of omega 3’s.
  • Fresh fish is better as tinned fish often has a lot of salt added to it, but if you choose a low salt variety (less than 450mg per 100g) this may also be a good option.
  • Shell fish do not contain as much omega 3 fats, however they do contain good amounts of minerals such as zinc, iodine and selenium
  • Avoid seafood that has been fried or battered as this will be high in saturated fat and increase your risk of CVD, despite the health benefits of the seafood.
  • Aim for 2-3 servings of fish each week.

References and further information

World Health Organisation – Cardiovascular Disease

Food and Nutrition in Fiji, A Historical Review – Volume 2, Nutrition Related Diseases and their prevention, Chapter 20 – Cardiovascular diseases, 1991.

Dietitian’s Association of Australia – Nutrition A-Z

Heart Foundation Australia – Food and Nutrition Facts

Better Health Channel – Cholesterol

Cyclone Dengue

 

Written By: Website Administrator

31/03/2014

Authors: DrDevinaNand and Dr Eric Rafai

 

Global

Approximately 40% of the world is at risk of Dengue (≈2.5 billion people). There are 50 – 100 million cases of Dengue every year. Almost 500 000 require hospitalization and 25 000 cases die annually.

Dengue fever has been reported in over 100 countries in Africa, the America’s, the Caribbean, Eastern Mediterranean, South East Asia and the Western Pacific regions.

Dengue fever outbreaks commonly occur in populated urban and residential areas of tropical nations. The disease is distributed along the distribution of the vector (agent that carries the disease). In this case, the vector is the mosquito (in particular the Aedesaegypti). The distribution remains 40˚North to 40˚South latitude.

 

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Figure 1: Map of distribution of Dengue Cases Globally (source WHO Dengue training ppt)

 

The yellow areas are where there is known risk of transmission of Dengue Fever. The red dots denote areas such as Hawaii, Galapagos Islands, Sudan, Nepal, Bhutan and Madagascar where Dengue re-emerged in 2000-2006 after many years of being in remission.

 

Regional

The region has been experiencing Dengue outbreaks before the 1950’s in countries like American Samoa, Cook Islands, Fiji, French Polynesia, Guam, Kiribati, New Caledonia, PNG, Solomon Islands, Tonga, Tuvalu and Vanuatu. Resurgence in outbreaks was documented from the 1970’s.

Fiji is vulnerable to dengue fever outbreaks that occur at neighbouring Pacific Island countries. Our vulnerability is related to travel through our country and hub for trade in the Pacific. The same dengue 3 & Dengue virus serotype 3) outbreak in Fiji occurred in the Solomons, Vanuatu in 2012 and Kiribati early this year

French Polynesia, Queensland (Australia) and possibly Tonga are currently reporting DEN 3 outbreaks..

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Figure 2: Map of distribution of endemic and non-endemic countries for Dengue in the Western Pacific Region. (source: WHO)

 

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Figure 3: Map of distribution of outbreaks as at 10/03/14 in the Western Pacific Region. (source: http://www.spc.int/phs/PPHSN/)

The Republic of Fiji

Fiji declared an outbreak in December 2013 and commenced immediately on its outbreak response that is not limited to enhancing clinical management of cases, monitoring the disease in affected and unaffected areas, increasing public awareness, prevention strategies, targeting clinical interventions, mobilizing community groups, government and stakeholders. Currently there is over 15, 446 suspected cases of Dengue notified to the Ministry of Health. There have been 12 confirmed deaths.  About   10% of these cases in Fiji are hospitalized. The initial outbreak was centered in the Central division in December; it has peaked in the Western division with the Northern division showing an increase in numbers.

Other Diseases in Fiji may mimic to Dengue Fever

The symptoms of Dengue fever include fever with:

  • Nausea or vomiting
  • Muscle or joint pains
  • Severe headache or pain behind the eyes (retro-orbital pain)
  • Rash

 

The Warning signs include:

  • Any bleeding (gums, nose, blood in stool, vomiting blood, vaginal bleeds, bruising or bleeding under the skin)
  • Persistent vomiting
  • Abdominal pain
  • Restlessness or lethargy

 

However, it is important to understand that the symptoms and signs are similar to other infectious diseases in the region. These include:

 

  • Leptospirosis ( endemic in Fiji)
  • Typhoid fever (endemic in Fiji)
  • Influenza ( seasonal in Fiji)
  • Zika virus (New Caledonia, Cook Is., French Polynesia)
  • Chikungunya virus (New Caledonia, PNG)
  • Other viral illnesses such as West Nile virus.

 

Leptospirosis and Dengue fever can be fatal if the person remains untreated at home and comes to the hospital very late in the course of the disease

It is very important to consult a doctor if you are having any of the symptoms mentioned above so treatment can be received early and precautions taken to prevent others from falling sick.

It is also important to protect oneself and family from the bite of mosquitoes.

 

Conclusion

The Republic of Fiji is not alone in experiencing dengue outbreaks. Other countries in the Western Pacific Region are experiencing the same challenges including the more developed nations such as Queensland, Australia. Globally, the Americas, South East Asia and Africa continue to experience dengue outbreaks.

The only effective responses are to work together, every individual, community and institution to reduce the breeding of mosquitoes by destroying man-made containers that breed mosquitoes, protecting ourselves from getting bitten by mosquitoes, protecting people suffering from Dengue from being bitten by mosquitoes and transferring the disease, and educating everyone around us in the importance of consulting a doctor when someone falls sick.

References

  1. Bhatt et al. (2013). The Global Distribution of Dengue. WHO database
  2. http://www.spc.int/phs/PPHSN/
  3. Singh N., Kiedrzynski T., Lepers C., Benyon E. S. (2005). Dengue in the Pacific –  an update of the current situation Retrieved from https://www.spc.int/phs/pphsn/Publications/PHDSurveillance/Surveillance-pages111-119.pdf.
  4. World Health organization Dengue Training Slides