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1. What is Ebola virus disease?

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.

Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo, and the other in a remote area of Sudan.

The origin of the virus is unknown but fruit bats are considered the likely host of the Ebola virus, based on available evidence.

The current outbreak in West Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.

The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, having only recently emerged from long periods of conflict and instability. On August 8, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern.

As of 31^st October 2014, Guinea, Liberia, and Sierra Leone, are reported as countries with widespread and intense transmission with 13,567 cases and 4,951 deaths reported. Three countries, Nigeria, Spain, and the United States of America are reported as countries with Limited Transmission with 25 cases and 9 deaths. Additionally, Senegal and Mail are Countries with travel-associated cases.

 2. How do people become infected with the virus?

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has occurred through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest. It is important to reduce contact with high-risk animals (i.e. fruit bats, monkeys or apes) including not picking up dead animals found lying in the forest or handling their raw meat.

Once a person comes into contact with an animal that has Ebola, it can spread within the community from human to human. Infection occurs from direct contact (through broken skin or mucous membranes) with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people. Infection can also occur if broken skin or mucous membranes of a healthy person come into contact with environments that have become contaminated with an Ebola patient’s infectious fluids such as soiled clothing, bed linen, or used needles.

Health workers have frequently been exposed to the virus when caring for Ebola patients. This happens because they are not wearing personal protection equipment, such as gloves, when caring for the patients. Health care providers at all levels of the health system – hospitals, clinics and health posts – should be briefed on the nature of the disease and how it is transmitted, and strictly follow recommended infection control precautions.

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Persons who have died of Ebola must be handled using strong protective clothing and gloves, and be buried immediately.

People are infectious as long as their blood and secretions contain the virus. For this reason, infected patients receive close monitoring from medical professionals and receive laboratory tests to ensure the virus is no longer circulating in their systems before they return home. When the medical professionals determine it is okay for the patient to return home, they are no longer infectious and cannot infect anyone else in their communities. Men who have recovered from the illness can still spread the virus to their partner through their semen for up to 7 weeks after recovery. For this reason, it is important for men to avoid sexual intercourse for at least 7 weeks after recovery or to wear condoms if having sexual intercourse during 7 weeks after recovery.

3. Who is most at risk?

During an outbreak, those at higher risk of infection are:

• health workers;
• family members or others in close contact with infected people;
• mourners who have direct contact with the bodies of the deceased as part of burial ceremonies; and
• hunters in the rain forest who come into contact with dead animals found lying in the forest.

More research is needed to understand if some groups, such as immuno-compromised people or those with other underlying health conditions, are more susceptible than others to contracting the virus.

Exposure to the virus can be controlled through the use of protective measures in clinics and hospitals, at community gatherings, or at home.

4. What are typical signs and symptoms of infection?

Sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical signs and symptoms. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.

Laboratory findings include low white blood cell and platelet counts, and elevated liver enzymes.

The incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days. The patient becomes contagious once they begin to show symptoms. They are not contagious during the incubation period.

Ebola virus disease infections can only be confirmed through laboratory testing.

5. When should someone seek medical care?

If a person has been in an area known to have Ebola virus disease or in contact with a person known or suspected to have Ebola and they begin to have symptoms, they should seek medical care immediately.

Any cases of persons who are suspected to have the disease should be reported to the nearest health unit without delay. Prompt medical care is essential to improving the rate of survival from the disease. It is also important to control spread of the disease and infection control procedures need to be started immediately.

6.         Diagnosis (testing for Ebola)

 It can be difficult to distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus infection are made using the following investigations:

• antibody-capture enzyme-linked immunosorbent assay (ELISA)
• antigen-capture detection tests
• serum neutralization test
• reverse transcriptase polymerase chain reaction (RT-PCR) assay
• electron microscopy
• virus isolation by cell culture.

Samples from patients are an extreme biohazard risk; laboratory testing on non-inactivated samples should be conducted under maximum biological containment conditions.

7. What is the treatment?

Severely ill patients require intensive supportive care. They are frequently dehydrated and need intravenous fluids or oral rehydration with solutions that contain electrolytes. There is currently no specific treatment to cure the disease.

Some patients will recover with the appropriate medical care.

To help control further spread of the virus, people that are suspected or confirmed to have the disease should be isolated from other patients and treated by health workers using strict infection control precautions.

8. What can I do? Can it be prevented?

Currently there is no licensed vaccine for Ebola virus disease. Several vaccines are being tested, but none are available for clinical use right now.

Raising awareness of the risk factors and measures people can take to protect themselves are the only ways to reduce illness and deaths.

Ways to prevent infection and transmission

While initial cases of Ebola virus disease are contracted by handling infected animals or carcasses, secondary cases occur by direct contact with the bodily fluids of an ill person, either through unsafe case management or unsafe burial practices. During this outbreak, most of the disease has spread through human-to-human transmission. Several steps can be taken to help in preventing infection and limiting or stopping transmission.

• Understand the nature of the disease, how it is transmitted, and how to prevent it from spreading further.
• Listen to and follow directives issued by Ministry of Health & Medical Services.
• If you suspect someone close to you or in your community of having Ebola virus disease, encourage and support them in seeking appropriate medical treatment in a care facility.

9. Is it safe to travel?

The geographical distance between the affected countries and Fiji, combined with the lack of direct flights and limited incoming travellers, contributes to this low risk. However, preparedness for EVD in Fiji is essential.

The risk of infection for travellers is very low since person-to-person transmission results from direct contact with the body fluids or secretions of an infected patient.

 Fiji and the Pacific have a low risk of transmission.

However, individuals should avoid travel to high-risk areas where Ebola is known to be widespread.

WHO’s general travel advice

• Travellers should avoid all contact with infected patients.
• Health workers traveling to affected areas should strictly follow WHO-recommended infection control guidance.
• Anyone who has stayed in areas where cases were recently reported should be aware of the symptoms of infection and seek medical attention at the first sign of illness.
• Clinicians caring for travellers returning from affected areas with compatible symptoms are advised to consider the possibility of Ebola virus disease.

10. What about health workers? How do they protect themselves from the high risk of caring for sick patients?

Health workers who treat patients with suspected or confirmed illness are at higher risk of infection than other groups.

• In addition to standard health-care precautions, health workers should strictly apply recommended infection control measures to avoid exposure to infected blood, fluids, or contaminated environments or objects – such as a patient’s soiled linen or used needles.
• They should use personal protection equipment such as individual gowns, gloves, masks and goggles or face shields.
• They should use personal protective equipment such as individual gowns, gloves, masks and goggles or face shields.
• They should not reuse protective equipment or clothing unless they have been properly disinfected.
• They should change gloves between caring for each patient suspected of having Ebola.
• Invasive procedures that can expose medical doctors, nurses and others to infection should be carried out under strict, safe conditions.
• Infected patients should be kept separate from other patients and healthy people, as much as possible.

11. What about rumours that some foods can prevent or treat the infection?

WHO strongly recommends that people seek credible health advice about Ebola virus disease from their public health authority. While there is no specific drug against Ebola, the best treatment is intensive supportive treatment provided in the hospital by health workers using strict infection control procedures. The infection can be controlled through recommended protective measures. Fiji’s food and water sources are safe from Ebola.

12. What is being done about the Ebola in Fiji?

• A Multi-Agency Technical Advisory Group (MATAG) for Ebola was assembled in early August that includes the MoHMS, Ministry of Defense, Ministry of Foreign Affair, Airports Fiji Limited (AFL), FIRCA, Fiji Ports Authority, Ministry of Tourism, etc. and Agencies such as WHO, FHSSP.
• In order to coordinate a system wide level of preparedness and response to suspected/confirmed case of Ebola Virus Disease, a special Ebola Preparedness and Response Plan has been drafted with Specific Standard Operating procedures completed.
• Development of an inbound passenger supplementary health arrival card completed and implemented at Nadi International Airport
• The EVD response plan identifies 3 levels of action advocated by MATAG: Level 1: No potential or confirmed cases of EVD in Fiji. Level 2 Case (s) of imported potential or confirmed EVD (no local transmission; level 3 case(s) of potential or confirmed EVD (associated local transmission in Fiji).
• Budget Requirements Developed for the 3 Level Responses but a priority budget list for Personal Protective Equipment (PPE) is currently with the Australian Government through the Fiji Health Sector Support Program (FHSSP) for the Level 1 support.
• Awareness and training of health staff and officers at the border offices have begun. WHO will be providing further training on encounters and PPEs
• To test the efficacy of EVD protocols, the 1^st Round Desktop Simulation Exercise was conducted on the 22/10/14 with WHO; the 2^nd Round full operation simulation exercise was conducted on 5^th November 2014 at Nadi International Airport and Lautoka.
• Defense Ministry have been advised to debrief (quarantine) returning Peacekeepers (from Liberia) and Fiji to complete the 21 days incubation period. This currently planned with the UN to occur in stages either at Liberia or upon arrival in Fiji
• Public Awareness on Ebola conducted via Radio Talk shows on 29-11-14 with Assistance Minister for Health (iTaukei and Hindi).
• Awareness on Ebola to other Government Ministries, Departments and Agencies and vital stakeholders
• The progressive updates monitored fortnightly and updates provided to Health Executive Management and to Cabinet via Minister of Health & Medical Services

13. What is the Ministry of Health doing to address the Ebola Concerns?

Levels of Preparedness

Fiji MoH activated a taskforce in preparing for Ebola and this taskforce consists of several Ministries, departments and stakeholders. Health preparedness and response to Ebola like any emerging infectious disease has a four pronged approach. This is through;

1. International Health Regulations (IHR)
2. Surveillance at Borders (Point of Entry)
3. Clinical Management
4. Public Health Management

International Health Regulations (IHR)

• The IHR outlines health regulations that members countries abide to
• In the case of EVD, IHR recommends that there should be no general ban on international travel or trade
• Travellers to Ebola affected and at-risk areas should be provided with relevant information on risks, measures to minimize those risks, and advice for managing a potential exposure.
• Under IHR each member State should be prepared to detect, investigate, and manage Ebola cases;
• The general public should be provided with accurate and relevant information on the Ebola outbreak and measures to reduce the risk of exposure.
• There should be capacity strengthening whereby states should be prepared to detect, investigate, and manage Ebola cases; this should include assured access to a qualified diagnostic laboratory for EVD
• Members States should be prepared to facilitate the evacuation and repatriation of nationals who have been exposed to Ebola.

Surveillance at Borders (Point of Entry)

• The second level of preparedness and control for EVD is at international points of entry, where routine surveillance is heightened.
• Under normal circumstances, international travelers are required to fill arrival cards. In this case, a special EVD arrival card will be administrated at an International Ports of Entry (POE) to all travellers and they are to indicate whether they have recently visited a country reporting cases of EVD and have any symptoms.
• Those with positive travel history as well as symptoms will be treated as a case under investigation (suspected case) and isolation protocols will commence. Passengers who have been in an EVD affected country in the past 21 days will be taken aside and asked questions to assess exposure. They will be then given a ‘Conditional Release’ or ‘Conditional Release with Controlled Movements’ and provided with guidance on follow up by health workers.

Clinical Management

• This approach deals with clinical management of suspected and confirmed EVD cases.
• Here MoH is to ensure the patients suspected or confirmed to have EVD receive proper care while maintaining proper Infection Prevention Control (IPC) procedures and preventing transmission to health care workers.
• It should be noted controlling infection in health-care settings is paramount as Human-to-human transmission of the Ebola virus is primarily associated with direct or indirect contact with blood and body fluids and transmission to health-care workers is o the most significant.

Public Health Management

• The final level of preparedness is through public health awareness and raising awareness of the EVD within community.
• Good contact tracing and surveillance of contacts of suspected EVD cases is essential to break Ebola transmission

Fijis Ebola Preparedness and Response Plan

In order to coordinate a system wide level of preparedness and response to suspected/confirmed case of Ebola Virus Disease, a special Ebola Preparedness and Response Plan has been drafted.

This plan is organized into two phases. The preparedness phase provided is to serve as a guide to all stake holders on the essential actions and activities that must be implemented before there is an alert of a suspected case. The alert phase details four key areas of action during an alert of a suspected/confirmed case i.e. preparedness and control at international points of entry, surveillance and epidemiological investigation, clinical management, and risk communication.

14. Who can I contact for more Information?

If you have any further enquires about Ebola please contact Dr Mike Kama at Mataika House on Phone: 3320066  or email mnkama02@gmail.com

You can also send your queries to MLO, Ministry of Health 3314088 or 8905053.

15. Useful Links on Ebola

 http://www.who.int/en/

http://www.who.int/csr/disease/ebola/en/

 http://www.who.int/mediacentre/news/ebola/en/

http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html

Venue:  Nadi Civic Centre
Date:  14^th November 2014

Bula Vinaka, Namaste, Good Morning

–                Distinguished guests, teachers, students, ladies, gentlemen and valued members of the community,

I have the pleasure to be here today with you all to launch the World Diabetes Day for Fiji, here in Nadi Town. When we speak of ‘launching’ this day, there is no celebration to be had. We are not celebrating the presence of Diabetes in our communities, but rather trying to raise awareness, educate and motivate our people to help prevent, reverse and stop this killer disease.

As many of you know (Type 2) Diabetes is one of our main non-communicable diseases, or what we call ‘NCD’s’ in Fiji.  Currently, 80% of deaths in Fiji are due ‘NCD’s’. These are ‘lifestyle diseases’ and occur when we adopt unhealthy behaviours like smoking, eating an unhealthy diet, drinking too much alcohol/yagoona and not engaging in physical activity. These are not diseases you catch from other people, but occur as a result of how we choose to live our lives.

During the….conference in Honiara in 2011, the NCD’s status of the pacific was decalared a ‘crisis’

As many of us now know, Diabetes is one of the leading causes of death for our people in Fiji. This disease does not discriminate.  It affects people from all cultures and backgrounds, male or female, young or old, rich or poor.

According to WHO, worldwide, one person will die from Diabetes every 8 seconds. In Fiji, currently 30% of people have Diabetes and this number is expected to reach 50% in the next 5-10 years if this crisis continues to be ignored. It is estimated that there is 1 lower limb amputation every 12 hours, which means 2 per day and aprox. 730 in one year. The youngest Type 2 Diabetic in Fiji is only 11 years old.

The presence of Diabetes has significant consequences on maintaining our own health and ‘wellness’ in life., Wellness incorporates the body, the mind and the spirit at all stages in our lives. We know that diabetes leads to devastating health outcomes. This can include blindness, nerve damage, kidney disease, disability through amputations, erectile dysfunction (sexual problems in males), heart disease, stroke and premature death. According to our research at MHMS, it has been proved that answering the question whether Cialis cures or gives a temporary effect, it is worth noting that a single reception will be effective only for people with mild potency disorders, but not enough for those who suffer from a severe form of erectile dysfunction.

The WHO states that any person that dies before the age of 70 has died prematurely – that means, they’ve died before their time. For Fiji, due to our NCD crisis we have lowered that rate to 60 years of age as many people will not reach the average lifespan that is enjoyed by others in the world.

Diabetes affects each and every one of us from an individual, community and national level.

Individually, a person with diabetes faces countless burdens of this chronic disease on a daily basis. Maintaining blood sugar levels, controlling their diet, taking care of their feet and taking medication are just some of the problems faced daily by those suffering this disease.

The complications of Diabetes leads to increased illness, time off work and increased financial strain on ourselves, our families, our communities and our nation as a whole. For NCD’s, our government allocates $400,000 each year to prevent these lifestyle disease that are killing our people. Imagine what our nation could do with these funds if we were not at this crisis point with NCD’s.

Why is our rate of Diabetes so high?

The answer is quite simple. We have gone from a healthy lifestyle to an unhealthy one. Smoking, a diet high in fat, salt and sugar, our alcohol/kava intake and our lack of physical activity have led to the rise in these NCD’s, particularly Diabetes. Our diet has transitioned from our traditional culture:

• Changing from traditional staple foods to refined foods,
•  Instead of fresh local food à eating processed foods,
•  Increase in individuals calorie consumption from past years to present, that is portion size, –  we choose quantity over quality 

What can we do?

It comes down to 3 things, our mouth, our muscles and our mind.

We need to create positive behaviour change in ourselves to create healthier lifestyles.

We need to focus on the gifts of life to be ‘well’ and stay ‘well’. This means:

• Breathing –  fresh air (no smoking)
• Eating a healthy diet… low salt, sugar, fat… eating 5 serves of fruits/vegetables each day
• Drinking – water…. Limiting alchohol, /kava
• Moving – getting your 30 mins of moderate intensity exercise each day
• Thinking – positive thinking. Motivate yourself and your family to choose healthy behaviours.
• Resting – sleeping 6- 8 hours/ night
• Reproducing – (at right age)

(Closing statement suggestion)

 From Michelle Obama:

We can make a commitment to promote vegetables and fruits and whole grains on every part of every menu. We can make portion sizes smaller and emphasize quality over quantity. And we can help create a culture – imagine this – where our kids ask for healthy options instead of resisting them.

 Thank you all for your attendance & I declare the Western Division World Diabetes Day Launching open.

God Bless Fiji.

VENUE:  Ministry of Forestry Conference Room, Lautoka

Date: 14^TH NOVEMBER 2014

Divisional Managers

Participants

Facilitators in the National Nutrition Survey Training, Western Division

Greetings……………….

Congratulations, this week’s training confirms that the 2014 National Nutrition Survey is happening in the West! We know how difficult it is to plan and organise surveys of this magnitude. It requires dedication and commitment to accomplish the tasks.

The prospect of gathering new information that will enable us to make comparisons with the past situation is exciting, because it will tell us how things have changed overtime (for the better or worse!) and how effective our intervention programmes have been. Being able to continue gathering nutrition related data every 10 years is an achievement in itself. We should be proud of this – we are the only Pacific Island country that has done this since 1983 on a regular basis.

I would like to stress the importance of the work you are about to embark on, which relates to the value of data. A lot of important decisions are based on the information that you are going out to gather, therefore, you need to put in your best effort to gather reliable information.

I am sure the training you have undergone throughout this week has provided you with the required knowledge and skills to carry out the data collection exercise and I urge you to continue to seek clarification with your coordinators on areas which you are not too sure about.

We all know that we have serious nutrition-related problems such as under-nutrition (anaemia amongst women, malnutrition amongst infants & young children) and over-nutrition (obesity).  The survey findings will give us further insights into why these problems have persisted. Such information will provide guidance on the formulation of evidence- informed policies and intervention programmes.

There have been an increasing number of surveys being undertaken in Fiji which will make your work even more challenging so it is important that you prepare yourself well before visiting selected households in your survey sites. Households need to be convinced that the time they spend with you answering the many questions in the survey will benefit everyone in Fiji.

Your approach to the householders, your patience and your professionalism are important in winning their confidence to cooperate with you.

With those words, I wish to add my best wishes in the challenging work ahead of you and I have much pleasure in declaring the NNS Training close and Launch the National Nutrition Survey for the Western Division.

VINAKA VAKALEVU

Venue: FNU School of Food and Beverages

Date: 6th November 2014

Colleagues,

Development Partners,

Representatives of the various Civil Societies,

Representatives of the media,

Ladies and gentlemen,

Hundreds of Fijians are dying today from a disease—-hundreds are dying or falling sick because of their own poor choices.

Hundreds of Fijians are falling sick and indeed dying right now because of NCDS.

We are losing the battle against non-communicable diseases. It is very likely that every person here has already experienced the sickness or even death of a family member from NCDs.

I said earlier that we are losing the battle against NCDS..but I believe that we can make inroads on NCDS..that we can have an impact on it.

That is why I am glad to be here today, because what we launch here today is something that can help this country get back on track.

I am told that the Khana Kakana is the first of its kind, a completely Fijian guide to eating simple, healthy and affordable recipes that uses locally grown, seasonal produce.

Khana Kakana is a healthy cookbook that will give Fijians the information and inspiration they need to change their diets and get healthy.

November is NCD month…so this is just the right time to launch this booklet and to promote healthy ways of living.

NCD’s like heart disease, diabetes, cancer and lung disease are crippling our great nation. They are the biggest killers in Fiji.

We throw up our hands and we get scared when we hear about Ebola and HIV/AIDS. All these diseases are dangerous but they have a far smaller impact on this country than NCDS. Diabetes rates in Fiji and the Pacific are among the highest in the world.

We need to start shouting and getting agitated about NCDs and its effect on our people. It affects those that get sick and it affects everybody else because it affects the economy of this nation.

The problem is , that NCDs and its impacts creeps up on us. NCDS develop slowly and because of this is we do not panic when we hear of NCDS.

However, the stark reality is that 80% of deaths in Fiji are NCD related.

NCDs are having an impact on life expectancy and families are losing their loved ones earlier than expected. Our health system and our economy are struggling under the burden of NCD’s.

The most important thing however is that we are robbing ourselves of longer, healthier and happier lives and a lot of this has to do with unhealthy lifestyles and bad habits that lay the foundation for NCD’s to develop.

We Fijians love our food and we love life, you can’t have one without the other, but your enjoyment of each all depends on quality and quantity.

Right now, many is not most of our food choices are bad ones, we are turning away from the most perfect, healthy, natural and nutritious foods that grow on our islands and instead, we are eating unnatural, low quality, plastic- packaged foods that are high in chemicals like fat, sugar and salt. These foods are making us sick.

All around us, in our villages, in our backyards we have plots of land, little pieces of land that can be used to plant vegetables. This is something we can all start doing.

We have become too dependent on foods that are harmful to our health because we have changed our lifestyle from subsistence living where we grow, catch and eat our own natural foods, to relying on low quality foods that can be bought from the shops.

That is something we must change.

We, as individuals, have the power to improve our health, and to lower our risk of NCD’s with a wellness approach; eat healthy, natural foods, exercise daily, drink less alcohol and more water and stop smoking.

These simple steps are the building blocks for a healthier and happier life.

Your health is in your hands, and with this cookbook in your hands, you have everything you need to take control of your health, and your future.

The cookbook launches today on the Ministry of Health’s Facebook page, available for online viewing and download and we have several thousand hard copies to giveaway.

It holds 48 beautifully designed pages of health advice, healthy recipes, gardening tips and Fijian stories of wellness, and it is completely free.

Khana Kakana gives you the why and the how of healthy eating, so all we need now is a commitment from you to change your life for the better.

This cookbook was developed by the Ministry of Health’s Wellness Unit and would not have been possible without the generous support of our partners:

• Red Cross Australia’s Small Grants Program and Australian Volunteers for International Development.
• Funding support from the Australian High Commission’s Direct Aid Program and the Fiji Health Sector Support Program.
• We would also like to thank Fiji National University Food and Beverage school for their support of this launch and their help in preparing the delicious, healthy lunch you are about to eat!

There were many people that the team met along the road to making this cookbook, they shared recipes, and smiles and were the inspiration for this cookbook, some are also featured in these pages, we would like to thank them for their time and their inspiring stories too.

Our wish for a longer life is in our hands. And it really depends on our eating habits.

We hope this cookbook inspires you to live a beautiful and healthy life, a longer life and a life free from disease.

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 2^nd 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 14^th 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.