News and insights brought to you by the International Diabetes Federation

Group picture in Papua New Guinea

Suzanne Rockett is a British trained Registered Nurse (RN) who spent one-year volunteering as a Diabetes Nursing Advisor within the Tolai community in Kokopo, Papua New Guinea. The Tolai are the indigenous people of East New Britain. They are recognised as having a predisposed risk of diabetes on top of their risk as Pacific Islanders and an Indigenous people. Suzanne wanted to give back, volunteer her specialist nursing skill and help to tackle diabetes in Papua New Guinea.

Papua New Guinea (PNG) sits in the Southwestern Pacific. Kokopo is the capital of East New Britain – a small group of Islands referred to as The New Guinea Islands. The estimated population is 8 million with over 850 languages and many traditional tribal villages and customs. East New Britain has the highest recorded rate of type 2 diabetes (T2D) and diabetes related amputations throughout PNG.

First weeks of volunteering

My first weeks volunteering I joined ward rounds, sat in diabetes physician appointments and worked alongside the nursing staff who prepared patients for their appointments. I was overwhelmed by the absolute lack of both basic and sophisticated resources that were missing every day. The impact of this coupled with cultural differences and how this translated into care delivery was often brutal for example, patients would come out of a below the knee amputation and there would be no dressings or pain relief, instead a pillow case placed gently over the wound.

The Frangipani Friendly Clinic (Nonga Base Hospital) was founded by Dr Al Maha in 2016. The clinic is one of only two clinics in the whole of PNG that offer free healthy screening checks. The clinic has regular funding from various large local businesses and regular donations from church and community groups which help fund the testing equipment which would not be operating otherwise. There are over 40,000 registered diabetes patients, 80% who at point of registration present with target organ damage or unhealed diabetes foot ulcers.

To promote healthy lifestyles and encourage the community to take control of their health the clinic offers twice weekly diabetes clinics with a dedicated medical team who have a special interest in diabetes. Delivering health care in PNG comes with many challenges, such as a lack of funding for basic diabetes medications, lack of resources such as manpower and equipment. The clinic on average sees as many as 60 patients during each of their twice weekly diabetes clinics and on the healthy screening drop-in sessions as many 20 per day.

The patients travel from rural villages: often a three hour walk at 5 am to catch up to 3 or 4 local buses. More often they leave not fully understanding their diabetes diagnosis, and unlikely to fill their prescription which would equal the cost of their family monthly budget with a long, arduous journey back home.

Dr Al Maha set up the clinic to combat the rapidly rising numbers of amputations – one of the many complications of undiagnosed and or untreated diabetes. Metformin is rarely prescribed (due to both financial and cultural challenges) and insulin is a rarity and a huge expense. I discovered that general knowledge on diabetes was low and there is confusion between T2D and type 1 diabetes.

I felt like the owner of snow globe shaking up the environment and watching life resettle and the picture change.

Helping to educate, and understand

I set up two eight-week workshops for all staff across both hospital sites, which were hugely well attended and received, something I had not really anticipated. Everyone I met listened, soaked up every single piece of information and then acted on their improved knowledge. I felt like the owner of snow globe shaking up the environment and watching life resettle and the picture change. I am not convinced that I would afford such graciousness to volunteering professionals entering my workplace suggesting different ways to work.

Weekends were spent playing basketball with the local children and at churches. Volunteering had become a way of life and I was keen on making some success. My lessons on health promotion now have a home in almost every church and school in Kokopo. I connected with the local Christian radio show and the impact was astonishing. The clinic was suddenly overwhelmed, and we were seeing up to 50 people a day for healthy screening with new patients telling us “we listen on the radio.” The clinic provides workplace screening on Friday’s and suddenly we were booked up for the next 4 months.

Nutrition education empowers

At our first drive of the year March 2018 at the local council offices, I begun to understand that this community were unsure what a healthy balanced plate could look like. The basic concept of ½ half a plate of vegetables, and ¼ protein and ¼ carbohydrates was introduced.

The fizzy drink challenge was next. A local company alongside all the giants produces in mass supply sugar fuelled fizzy drinks. You rarely find a diet or no sugar option. The sugar information was met with astonishment and disbelief that companies would produce and heavily advertise products that damage health. A long steady process of education begins to take hold. Everywhere you look around Kokopo – the healthy eating plate is strong, for local businesses, the ENBP Market Authority, and church communities have come together to embrace the knowledge and the power of understanding what to eat.

Metformin makes a difference

The hospital CEO welcomed my thoughts and we discussed Metformin. I was encouraged to discuss with patients and ask them to find a way to pay for this. I recorded the results. Again, the CEO’s door was wide open. Incredibly he managed to find funding for all in-patients with diabetes to receive Metformin. Ten weeks and we saw a noticeable difference in recovery, shorter hospital stays and the uptake of a drug that has very little side effects and has such powerful protective factors across all areas of health. A drug that suits the demographics of rural communities with often little food or ability to get into the township – with next to no risk of hypoglycaemia.

Leaving Papua New Guinea

Before leaving for PNG, many supplies were donated from local businesses, and from people all over the world. People send or arrive with all kinds of gifts: metres, strips, leaflets, plastic healthy eating plates, prescription glasses, sterile surgical gloves and so much more.

My time was also almost up. My focus had to shift to what lasting resources to leave behind. Something like 40 plastic resource folders: including as much information I had and using every opportunity to take sneaky copies at various business houses and local council offices. These were received with gratitude and nurses were organising for further copies for community members to photocopy and use for their own communities. Sustainability and capability building at its best.

Reflecting on my year “in the land of the unexpected”. The Tolai are a straightforward community, if you show them a smile, it will be returned. Being open and warm is all the Tolai community need to share their loyalty and love. Humans need connections with those around us.

I shall forever remain in debt to the entire community who opened their hearts and minds and welcomed me not only as a volunteering nurse, but also as a friend to share a small part of their long challenging ride.

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