The Management of Diabetes and other lifestyle diseases in Papua New Guinea

In the past, diabetes and so-called Lifestyle diseases was virtually unknown in Papua New Guinea.  The village lifestyle offered us great health benefits as we had a high-fibre, low-fat diet and we lived very physically active daily lives.

In contrast to village lifestyles of our foremothers and fathers in the years gone by, we eat more fat, less fibre and we live a far less physically active day to day life.  Furthermore we are “in over our heads” with the mental demands of the modern world which we are aspiring to be a part of. We are stretched as individuals, families, villages and as a country between two worlds. One, the modern, western, materialistic world, based on the so-called “free market economy” and the traditional world of our ancestors.  This “stretching”, places a great stress on our minds, bodies, relationships and ultimately our health.   

The current wave of Papua New Guinea unprecedented economic growth propels us into  and while more and more citizens are enjoying the lifestyle that their new found wealth is bringing them we are seeing an explosion of “lifestyle” and chronic diseases like Diabetes, High Blood Pressure, Heart Problems, Strokes, Kidney Problems and other chronic illness such as Asthma and Chronic obstructive airway diseases and mental illnesses like depression and anxiety, and addiction to alcohol, drugs and gambling. 

 

Often people with chronic illness become very confused as they get lost in follow up and from one doctor to another their treatment is changed sometimes on an ad hoc basis and lacking standardization based on Evidence Based Medicine.  But thankfully Papua New Guinea has now released the first edition of the – Diabetes – Clinical Practice Guidelines.  This will now lead to a more standardise management of diabetes and act as a catalyst for the establishment of proper diabetes and lifestyle clinics throughout the country. 

According to a WHO 2005 Report, 80 % of chronic diseases occur in low- and middle-income countries (Like Papua New Guinea) and it is estimated that 7.1 million people will die annually as a result of elevated blood sugar levels.

 

The International Diabetes Association, predicts that between 2010– 2030 Type 2 diabetes will increase by a walloping 140% in PNG, from 76,709 in 2010 to 172,000 in 2030.

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In the 1st Diabetes – Clinical Practice Guidelines for PNG, which was recently launched it states that: “Hospital statistics show that diabetes has increased since 1980. A pilot survey in a working population in Port Moresby in 2008 showed that 10% had a high blood sugar level with no symptoms of diabetes. The STEPs national prevalence study in 2008-9 (funded by WHO) showed that 14.4% of adults aged 15-64 years had a fasting blood sugar level of ≥ 6.1 mmol/L”.  This is a serious problem and one which mainly affects our educated working class, urban dwellers”. 

Many of these people do not even know that they have diabetes until they present with diabetes complications – which includes – kidney failure, heart attacks and stroke, erectile dysfunction etc.

The Port Moresby General Hospital, the biggest tertiary hospital in Papua New Guinea is not equipped with the necessary resources to be able to properly manage most of these complications and therefore it is very important that people take more responsibility in looking after our own health and do what they can to stay fit and healthy in order to prevent the development of these conditions in the first place and if they do happen to develop these conditions, delay the onset of their complications.

Prevention is better than cure!

Especially when there is no cure or the cure is very difficult attain due to lack of resources, such as is the case in PNG.  For example a heart attack is caused by blockage of one or more of the arteries supplying the heart. This blockage is formed by long term damage to these arteries and the deposition of fat within their inner walls (atherosclerosis). 

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The treatment of such blockages involves special procedures and expertise which we do not have in PNG and are unlikely to have for many years to come.  However, it is well accepted in the international medical community, that there are certain “modifiable risk factors” which places an individual at a higher risk of developing atherosclerosis and if these are recognized early and managed properly (“modified”), their risk of developing atherosclerosis and a heart attack and other cardiovascular illnesses can be markedly reduced.  Some of the important modifiable risk factors include:

  1. Smoking
  2. Hypertension (High Blood Pressure)
  3. Hypercholesterolaemia
  4. Diabetes Mellitus
  5. Stress
  6. Obesity

We all know that regular exercise and a balanced healthy diet leads to a healthier self, but with conflicting commitments to work, family and traditional obligations, finding the time and motivation to do these things can be challenging, especially when trying to do so in isolation without the benefit of being part of a team.  But we must also know that if we don’t find time for these things…we will have no choice but to make time for illness when it eventually comes.

Healthcare workers should work closely with individuals to initiate and maintain appropriate lifestyle changes through dietary and exercise programs with the focus on prevention and or delaying the onset of lifestyle diseases and or their complications. The lifestyle disease healthcare team and clinics should be a source for motivation for individuals. Easy to read written information about specific conditions should be available for individuals so they can be empowered with appropriate knowledge of their condition(s) in order to have a sense of control and a sense of “being able to do something” to help themselves.

Regular following-ups, based on the Diabetes Clinical Practice Guidelines should be done to assess progress, identify problem areas and make appropriate decisions on specific lifestyle or pharmaceutical treatment per the guidelines.

Some of the tests that need to be done on a regular basis as part of the long term care of people with diabetes and other lifestyle diseases include:

  • Blood glucose levels
  • HbA1c, Urinary Micro-albuminuria (important tests to assess glucose control and detecting early kidney problems.
  • Lipids – Including cholesterol
  • Blood pressure
  • Body Mass Index (BMI) and waist circumference
  • Foot examinations
  • Eyes checks and organizing ophthalmologists review where appropriate.
  • Nerve function – Monofilament test.

About Dr. Poyap J Rooney

Dr. Rooney is a medical doctor who has gained both his undergraduate medical degree and more recently his post graduate masters degree in clinical biochemistry at the University of Papua New Guinea.
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27 Responses to The Management of Diabetes and other lifestyle diseases in Papua New Guinea

  1. Dorothy Kasawen. says:

    My name is Dorothy Kasawen. I am a known Diabetic and at present am getting treatment at St. Mary’s Medical Centre here in Port Moresby. I noticed that the Doctors do not take time to refer patients like me for better councelling. ie; Diet, Exercise and other matters related to being a Diabetic.

    I have been a diabetic since 1994. Diagnosed in Rabaul ENBP.
    Recently I have been having swelling aroung the mouth area especially after taking Metformin. I am currently on Metformin (TDS) and Daonil (Once a day). I am also having chest pains but only slightly. My sugar levels have gone up as high as 17mmols.

    Are there any other medications besides these two I have mentioned?

    Need more advice. Please help me to help myself!

    Thank you. Dorothy

  2. Delilah Alois says:

    Hi there Dr.Poyap.
    My name is Delilah Alois. I came across your page when I was looking up some information about life style diseases in PNG. Im actually preparing a presentation to share with friends, family members and communities of where I live on what life style diseases are. I have a part time activity promoting health products that are derived from plants and are recognised world wide. It only came into PNG last year. I read Dorothy”s comment and I feel for her. The products are from K-link international and they are Liquid chloropyll, Organic Bio-green and the one thats world’s best health care is known as KINOTAKARA. Realising the trend PNG is heading as per your report, we should really put our health first. I really like the products because of their benefits which are; Cleansing, Balancing,Activating and Building the body defence system. I’m currently in Lae. Please find my e-mail address below.

  3. Kelu Vanua says:

    Dear Dr. Poyap
    We would like to feature some of your post in our healt information boot during the up and coming Morobe Show, we are more focus on life style deceases in PNG, prevention, cure and treatments and most importantly where this services/treatment are available.

    I hope you can share some of the life style deceases so we can educate our people,

    Thank you for your time and consideraito;

    Regards
    Kelu Vanua

  4. Andrea says:

    Hi Dr Poyap,
    my name is Andrea and I am the sub editor for the New Age Woman magazine. I am writng an article about diabetes in PNG and I was wondering if you could tell me where your clinic is located and if you’d give me permission to use some information in your article as references in my New Age Woman article?

    • Feel free to use any information from my blog Andrea. My clinic is based within the Paradise Hospital and you or anyone else can make a booking by contacting the ladies at the reception there. Ta. Poyap

  5. Andrea says:

    thanks very much

  6. Hi, i am a student from the school of medicine and health sciences and i am currently working on a proposal write-up on the impact a community pharmacist can impart in the managemnet of lifestyle diseases especially diabetes and hypertension.

    • plis advice or give any detail if you have come across any research carried out based on the above proposal write-up

      • Hi Salome, I haven’t come across any such research in PNG but i know that in Australia the pharmacy and pharmacists play a very important role in diabetes care. Apart from dispensing drugs they also provide education material and other paramedical aids and treatment like footwear, creams, etc…please don’t hesitate to contact me if you which to discuss your reseach…i am also doing research on diabetes and plan to do a community based awareness as i go out to collect my data.

  7. Varina Iobuna says:

    Hi Dr Rooney, Iam Varina Iobuna Iam a nurse and Iam currently studying at University of Technology, Sydney. Iam interested in diabetes education as I believe more emphasis need to be put in the area of health promotion to “prevent the onset of life style disease or delaying complication” . However, I do not have a certificate in diabetes training but Iam interested in working and networking with the diabetes educators or practice nurses . Do I have to be certified to become a trainer ? or is there a recognised organisation where I can register to be a member? Your feedback would be very much apreciated.
    Thank you.

    • Hi Varina,

      I practice in PNG. Are you asking about PNG setting or Australia? In Australia i believe you have to get specific training to be a diabetes educator. Not so in PNG where as a registered nurse with an interest in diabetes you can get involved as a diabetes and lifestyle disease educator.

  8. Varina Iobuna says:

    Thank you very much Dr Rooney for your humble and timely response. Yes , I was referring to PNG setting as I don’t have much exposure in this area which I want to be more involved in.

  9. Stella says:

    Salome, look up literature. Search under the NDSS (National Diabetes Services Scheme) in Australia. Community pharmacists in Australia have a collaboration with GPs for continuity of care for those living with diabetes. There are also other programs run by pharmacists to help those with diabetes and also many are team players in lifestyle counselling. I think you can start in small ways by encouraging adherence with medications and encouraging lifestyle changes.

  10. Julie says:

    Hi I am a diabetes nurse in NZ and am starting insulin on a patient from PNG. He will return in September. can you please advise if insulin is funded in PNG and if so what types. Thanks

  11. Niumi Warkia says:

    Good morning. My name is Niumi Warkia. I have recently been diagnosed as a diabetic. I would really like to attend any diabetes awareness counseling/workshops etc. Also I’d to know where would be the best place to purchase lancets etc.

  12. Antonia Atio says:

    I am a student from the Medicine and health sciences and I am doing my research on prevention and management of type diabetes in elderly people. If you have some information about this topic, could you help me?

  13. Robyn says:

    Hi Dr. Rooney, I am currently studying at Victoria Uni, Wellington and I want know if you have some data on overconsumption of sugar in Adults in urban areas of PNG? I am doing a paper on that can’t seem to find comprehensive info on the websites.

    Your feedback is high sought,

    Cheers,

    Robyn

    • Hi Robyn, There is no official scientific data specific data on that as far as I know however I can tell you that from my observation sugar is consumed in large amounts. In the rural areas it serves as a good source of quick energy and balances out with the high physical activity of our rural folks. In the urban areas this habit is prevalent even amonst folks who live a more sedentary lifestyle.

      Sorry I could not be of more assistance

  14. Kathrina Arin says:

    Hi Dr Poyap,
    I’m a finale year student in the school of nursing in Madang Province. We’ve been given a task on the current lifestyle diseases of PNG and I came across your article. I just wanna say that you’ve done a great research and I look forward to see more of these. Thanks for your knowledge though, you really helped me a lot in putting my assignment together.

    • Thank you for your word Kathrina and I am glad you found the info on my blog of good use to you. There certainly is a lot of work in all areas of health in PNG. Lifestyle diseases is well and truly here and is here to stay. Best wishes in your studies.

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