Three Ukuleles and a Bowl of Kava
Friday was a memorable evening at Tavu Tavu a fine local restaurant owned and operated by Allen Peterson. Friday was time for local music. I arrived early and was fortunate to get the only remaining seat on the veranda. The musicians were three Fijians with big ukuleles and indeed a large bowl of kava. The music was delightful island music, a lot different from Hawaiian music. As other guests arrived, I found myself the accidental dinner companion with a couple from Paris and a crewmember from the sailing vessel Galileo. I promised to publish my remarks under the above title, and appropriate the title is from this most delightful island of Taveuni. We had just finished the last of the Fiji Health Festivals, ten in all. I had missed the beer party, and getting here early was my gain. So, with kindest deference to my dinner companions, I will share my thoughts on Health Fairs and this Fijian style festival in particular.
Briefly, the Fijians were fierce warriors and proud people of the land with a highly developed social order. The Fijian stands tall, looks you in the eye and makes you his friend for life. You become part of his oral history. By Western standards, he has a very dignified bearing. One notices the high intelligence and strikingly good memory as well as the communal life style.
Nearly half of the population is Indian or Indo-Fijian. These are hard working farmers and merchants. Largely Hindu or Muslim, up before sunrise with a prayer, their population is dropping a little with many leaving for school in other countries.
Fiji consists of 333 islands, located 18̊ south of the equator and 180̊ east or west of the prime meridian, on the international data line. Look for the Fiji Islands straight south of Adak. Their time zone is three hours earlier but a day later than ours in Alaska. Suva is the capital, located on the largest island of Viti Lavu. The islands were populated 3,500 years ago. The immigration came largely from Vanuatu. Ledged has it that the earliest people were Masai who sailed the Indian Ocean by voyaging canoe. That theory might account for the tall stature of many Fijians and a similarity of appearance to the Masai of today. The total population of the islands has now grown to 825,000. The islands include dense jungle, ranging too high grasslands with coniferous trees. There is a dry side and a wet side, much like the Big Island of Hawaii.
Health Fairs Around the World
In other parts of the world where scientific medicine is well developed the Health Fairs trend towards entertainment, education and high priced tests paid for by the participant. Public Health will be present for the advancement of their own educational, environmental or epidemiological agendas.
In Russia where medicine is just emerging from generations of neglect, and with a near absence of public health the medical schools are eager co-sponsors of the health fairs. In Mexico there is both a participation of public health and medical schools with objection arising only from remote indigenous shamans. A high incidence of cervical cancer in Mexico was found to be associated with papilloma virus on the cervix wherein early detection and treatment can prevent the cancer’s development. Because of the rather easy treat ability of the infected cervix, there was local enthusiasm for screening. Furthermore the potential benefit overcame the added privacy issues of a pelvic exam in a semi public place. Soon, if not already, there will be a vaccine for the papilloma virus. Merely making this papilloma virus problem known to participants may have a positive effect on longevity in an educated population, but where the relationship to modern medicine remains tenuous, the actual on-site treatment of the viral infected cervix is desirable.
Fiji benefits from an emerging medical system based on coexisting public hospitals and clinics along side of private medicine. Ultimately this may be the best combination. There is also an enthusiastic and widely disseminated family planning program. The standards are as yet in a developmental stage and often compromised by lack of funds.
Obviously, there is a difference between a health initiative in the totally undeserved under developed areas, the areas of limited developing technology (LDT) and the regions enjoying a tradition of scientific medicine. The LDT environment of emerging medical science demands care that the newly emerging delivery system has not yet met. Answering that need in part with a health festival requires a partnership with the established emerging health system while delivering opinion and treatment consistent with current medical standards. This must be done without antagonizing the establishment and while achieving reasonable and probable follow-up by that established system. With a life expectancy of less than 47, one would like to offer a longer survival, rather than expressing an attitude of "this is good enough for here," or "that’s the way we have always done it." For instance, one would like to see the educated use of glucometers by diabetes II patients. One might well prefer to use regular insulin with each meal by injection in place of extensive near overdose of oral hypoglycaemics. Nasal insulin may be available within a year. In the long run tight control will reduce cost and extend longevity. This is just one example.
It serves well to reiterate the interaction and at times conflict between public health (the common good) and quality patient care (One on one). Briefly, in issues of hazardous materials, the environment, immunizations and epidemics, the top down authority of public health seems self-evident. Similarly, quality care depends entirely on first the patients choice and second on the physician or surgeon satisfying that trust. The process must simultaneously motivate patient compliance and the chosen subordinate institution's excellence in supporting the delivery of that service. Patient care comes first, not the administrative or economic needs of the chosen institution.
Conflict can develop when the needs of the community run counter to the needs of the individual. Isolation in times of epidemic is one example but there are others.
Public health departments develop statistics to define the population and highlight the areas of desirable intervention. The Health Fair should do no less and where possible in concert with public health, in this case the Ministry of Health. Measurement of a population in a statistically significant way is not easy.
The burden of various conditions: disease, deleterious lifestyles, environmental hazards, can be summarised as disability adjusted life years. (DALY) This is an aggregate measure of premature mortality, morbidity and disability, which can also be used for analysing cost-effectiveness of intervention1
The Health Fair as a constructive health intervention is, none the less, an intrusion on the status quo. While patients or participants may stand in long lines for information, the freebies and the fanfare, both local health facilities and providers are likely to view the health fair as an intrusion. For the Health Fair, local leaders enlist cooperation from the community and the government ahead of time.
The Fiji Health Festival was highly organized by Fiji Rotary Clubs and facilitated by a Rotary International grant for three years. The tireless efforts of the several Fiji Rotary Clubs and their sponsors resulted in an initiative involving multiple communities and the screening of a significantly large percentage of the population. The goal was to carry out education screening and treatment and encourage responsible healthy lifestyle choices. A partnership between the Ministry of Health and the organizers included education from various NGOs screening for blood sugar levels, blood pressures, obesity, cholesterol, vision, hearing and evaluation by volunteer doctors from Australia, New Zealand and America.
The effort included an ambitious nine venues in 5 towns and villages, including Suva, Nadi, Nausori, Lautoka and Taveuni. Two day festivals were held in each location. Over 3,600 participants were processed, plus an impromptu one day clinic on the island of Ovalau. A continuing commitment to medical treatment placed greater emphisis on the local providers resulting in greater coordination and better follow up. In Nausori, local clinic records were made available. Hemoglobins were not screened for due to cost. Cholesterol reagent strips were in short supply. Each participant had a random glucometer blood glucose test, blood pressure, height and weight. Somewhat unique to the Fiji Health Festival was a spirit of triage based on the nature of the problems. In greatest demand was the free eye glasses with eye exams by volunteer optometrist from New Zealand, Australia and locally. A mobile dental van and a team of technicians lead by volunteer and local dentists were well organized. They offered restorative dental care and tooth extraction while maintaining a semi sterile environment. ENT (Ear Nose & Throat) was well served by the surgeon from Auckland. Medicine was very much improved by the participation of local providers. The formulary was more than adequate. The dietitians, family planning and cancer education displays were adequate as well.
At least 50% of the population was seriously obese, maybe 40% with diabetes II, many undiagnosed and most grossly under treated. At least another 40% of the women were anemic by virtue of grand multi parity without antenatal care and iron replacement. Scabies was pandemic especially on Taveuni. Many of the infants suffered from impetigo complicating the scabies. It will take a major community based imitative to eradicate this infestation.
Another high percentage of the Indo-Fijians complained of neck and spine pain without nuchal rigidity --- suggestive of chronic undiagnosed central nervous system infection or infestation. There may, indeed, be unrecognised epidemiological questions. Tune in next year.
So, later in the evening at Tavu Tavu the rest of the crew comes in singing. The beer and pizza was a success but so was the whole mission. Fiji will always be remembered as a most beautiful, most romantic place. More than the land there is the people. The beauty and diversity of all will remain unforgettable, from the incomprehensible Ausi, the eyes and dignity of the Fijian to the beauty and industry of the Indo-Fijian. You are in my heart.
Briefly, the Fijians were fierce warriors and proud people of the land with a highly developed social order. The Fijian stands tall, looks you in the eye and makes you his friend for life. You become part of his oral history. By Western standards, he has a very dignified bearing. One notices the high intelligence and strikingly good memory as well as the communal life style.
Nearly half of the population is Indian or Indo-Fijian. These are hard working farmers and merchants. Largely Hindu or Muslim, up before sunrise with a prayer, their population is dropping a little with many leaving for school in other countries.
Fiji consists of 333 islands, located 18̊ south of the equator and 180̊ east or west of the prime meridian, on the international data line. Look for the Fiji Islands straight south of Adak. Their time zone is three hours earlier but a day later than ours in Alaska. Suva is the capital, located on the largest island of Viti Lavu. The islands were populated 3,500 years ago. The immigration came largely from Vanuatu. Ledged has it that the earliest people were Masai who sailed the Indian Ocean by voyaging canoe. That theory might account for the tall stature of many Fijians and a similarity of appearance to the Masai of today. The total population of the islands has now grown to 825,000. The islands include dense jungle, ranging too high grasslands with coniferous trees. There is a dry side and a wet side, much like the Big Island of Hawaii.
Health Fairs Around the World
In other parts of the world where scientific medicine is well developed the Health Fairs trend towards entertainment, education and high priced tests paid for by the participant. Public Health will be present for the advancement of their own educational, environmental or epidemiological agendas.
In Russia where medicine is just emerging from generations of neglect, and with a near absence of public health the medical schools are eager co-sponsors of the health fairs. In Mexico there is both a participation of public health and medical schools with objection arising only from remote indigenous shamans. A high incidence of cervical cancer in Mexico was found to be associated with papilloma virus on the cervix wherein early detection and treatment can prevent the cancer’s development. Because of the rather easy treat ability of the infected cervix, there was local enthusiasm for screening. Furthermore the potential benefit overcame the added privacy issues of a pelvic exam in a semi public place. Soon, if not already, there will be a vaccine for the papilloma virus. Merely making this papilloma virus problem known to participants may have a positive effect on longevity in an educated population, but where the relationship to modern medicine remains tenuous, the actual on-site treatment of the viral infected cervix is desirable.
Fiji benefits from an emerging medical system based on coexisting public hospitals and clinics along side of private medicine. Ultimately this may be the best combination. There is also an enthusiastic and widely disseminated family planning program. The standards are as yet in a developmental stage and often compromised by lack of funds.
Obviously, there is a difference between a health initiative in the totally undeserved under developed areas, the areas of limited developing technology (LDT) and the regions enjoying a tradition of scientific medicine. The LDT environment of emerging medical science demands care that the newly emerging delivery system has not yet met. Answering that need in part with a health festival requires a partnership with the established emerging health system while delivering opinion and treatment consistent with current medical standards. This must be done without antagonizing the establishment and while achieving reasonable and probable follow-up by that established system. With a life expectancy of less than 47, one would like to offer a longer survival, rather than expressing an attitude of "this is good enough for here," or "that’s the way we have always done it." For instance, one would like to see the educated use of glucometers by diabetes II patients. One might well prefer to use regular insulin with each meal by injection in place of extensive near overdose of oral hypoglycaemics. Nasal insulin may be available within a year. In the long run tight control will reduce cost and extend longevity. This is just one example.
It serves well to reiterate the interaction and at times conflict between public health (the common good) and quality patient care (One on one). Briefly, in issues of hazardous materials, the environment, immunizations and epidemics, the top down authority of public health seems self-evident. Similarly, quality care depends entirely on first the patients choice and second on the physician or surgeon satisfying that trust. The process must simultaneously motivate patient compliance and the chosen subordinate institution's excellence in supporting the delivery of that service. Patient care comes first, not the administrative or economic needs of the chosen institution.
Conflict can develop when the needs of the community run counter to the needs of the individual. Isolation in times of epidemic is one example but there are others.
Public health departments develop statistics to define the population and highlight the areas of desirable intervention. The Health Fair should do no less and where possible in concert with public health, in this case the Ministry of Health. Measurement of a population in a statistically significant way is not easy.
The burden of various conditions: disease, deleterious lifestyles, environmental hazards, can be summarised as disability adjusted life years. (DALY) This is an aggregate measure of premature mortality, morbidity and disability, which can also be used for analysing cost-effectiveness of intervention1
The Health Fair as a constructive health intervention is, none the less, an intrusion on the status quo. While patients or participants may stand in long lines for information, the freebies and the fanfare, both local health facilities and providers are likely to view the health fair as an intrusion. For the Health Fair, local leaders enlist cooperation from the community and the government ahead of time.
The Fiji Health Festival was highly organized by Fiji Rotary Clubs and facilitated by a Rotary International grant for three years. The tireless efforts of the several Fiji Rotary Clubs and their sponsors resulted in an initiative involving multiple communities and the screening of a significantly large percentage of the population. The goal was to carry out education screening and treatment and encourage responsible healthy lifestyle choices. A partnership between the Ministry of Health and the organizers included education from various NGOs screening for blood sugar levels, blood pressures, obesity, cholesterol, vision, hearing and evaluation by volunteer doctors from Australia, New Zealand and America.
The effort included an ambitious nine venues in 5 towns and villages, including Suva, Nadi, Nausori, Lautoka and Taveuni. Two day festivals were held in each location. Over 3,600 participants were processed, plus an impromptu one day clinic on the island of Ovalau. A continuing commitment to medical treatment placed greater emphisis on the local providers resulting in greater coordination and better follow up. In Nausori, local clinic records were made available. Hemoglobins were not screened for due to cost. Cholesterol reagent strips were in short supply. Each participant had a random glucometer blood glucose test, blood pressure, height and weight. Somewhat unique to the Fiji Health Festival was a spirit of triage based on the nature of the problems. In greatest demand was the free eye glasses with eye exams by volunteer optometrist from New Zealand, Australia and locally. A mobile dental van and a team of technicians lead by volunteer and local dentists were well organized. They offered restorative dental care and tooth extraction while maintaining a semi sterile environment. ENT (Ear Nose & Throat) was well served by the surgeon from Auckland. Medicine was very much improved by the participation of local providers. The formulary was more than adequate. The dietitians, family planning and cancer education displays were adequate as well.
At least 50% of the population was seriously obese, maybe 40% with diabetes II, many undiagnosed and most grossly under treated. At least another 40% of the women were anemic by virtue of grand multi parity without antenatal care and iron replacement. Scabies was pandemic especially on Taveuni. Many of the infants suffered from impetigo complicating the scabies. It will take a major community based imitative to eradicate this infestation.
Another high percentage of the Indo-Fijians complained of neck and spine pain without nuchal rigidity --- suggestive of chronic undiagnosed central nervous system infection or infestation. There may, indeed, be unrecognised epidemiological questions. Tune in next year.
So, later in the evening at Tavu Tavu the rest of the crew comes in singing. The beer and pizza was a success but so was the whole mission. Fiji will always be remembered as a most beautiful, most romantic place. More than the land there is the people. The beauty and diversity of all will remain unforgettable, from the incomprehensible Ausi, the eyes and dignity of the Fijian to the beauty and industry of the Indo-Fijian. You are in my heart.
posted by Clancy Hughes | 9/14/2005 10:48:00 AM
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