A journey of a thousand mile begins with a single step – what is the immediate things the Government of PNG (GoPNG) should do about diabetes?

In countries with more developed economies the generally accepted wisdom is that it is more cost beneficial overall to invest resources (MONEY) into preventing or at least delaying the long term complications of diabetes rather than facing the huge costs of treating people who will eventually develop (earlier than if they were properly managed through well known and validated treatment) the long-term devastating complications of .diabetes which includes:
• Adult blindness
• Early heart attacks
• Strokes
• Chronic kidney disease
• Leg amputations and
• Nerve problems

According to the very large study recently published in the Lancet journal, NCD Risk Factor Collaboration (2016)

The burden of diabetes, both in terms of prevalence and number of adults affected,                has increased faster in low-income and middle-income countries than in high-                      income countries.

Diabetes has increased most dramatically in Pacific island nations and in the Middle              East and North Africa region, which now have the highest diabetes levels in the                      world. In Polynesia and Micronesia, where prevalence is highest, more than one in                five adults have diabetes. In Nauru and American Samoa, the number is nearly one                in every three men and women. NCD Risk Factor Collaboration (2016).

One of the principle investigator in this study, Professor Majid Ezzati and as cited by Wighton K (2016) stated that “…the data (from the study) reveals that the disease has reached levels that can bankrupt some countries’ health systems”.

These findings should be extremely concerning to all Papua New Guineans.

The smaller island nations mentioned above have small populations and therefore are able to collect, collate and have these data available for planning purposes. For us in PNG, to the best of my knowledge, we do not have a national database for diabetes and my guess is that any figures that is out there in the international diabetes literature is a gross underestimation of what the real situation is.

Despite these alarming numbers and our knowledge of them, it seems to me that there is a total lack of enthusiasm from the PNG Government to allocate the appropriate level of funding to develop the type of infrastructure and expertise that will be required to curb this tsunami of diabetes and lifestyle illness that can, if we ignore it, in affect severely pull us back as a nation. Undermining whatever gains we may have achieved in our short history
The country’s largest tertiary hospital, Port Moresby General Hospital (PMGH) which also serves as the teaching hospital for the University of Papua New Guinea has perhaps the busiest diabetes clinic in the country. This clinic runs every Tuesday and is led by Dr. Loyde Ipai.

Despite being severely under-resourced, Dr. Ipai and his team and doing the best with what they have and have managed to at least keep the clinic going till now. BUT THEY NEED MORE GOVERNMENT SUPPORT

The 1st Step

As an immediate measure our government must move as swiftly as possible to ensure that the PMGH diabetes clinic is well equipped, both with the appropriate point of care diagnostic and diabetes monitoring equipment and also invest into increasing the number of personnel with appropriate expertise. So apart from doctors specialising in or with a special interest in diabetes we also need more diabetes educators, podiatrists (health professionals who take care of feet), optometrists, counselors, dieticians and others who will form a chronic health care team that has the patient in the centre.

The idea would be to create a PNG Diabetes Centre of Clinical Excellence at PMGH which can also serve to provide training to people from other centres throughout PNG so that similar sites can begin to proliferate throughout the country.

While the benefits of having such a centre established would be immense and immediately visible and measurable, it must be appreciated by people and organisations who may want to be a part of such development that this is not a straight forward job and as much as possible the drivers of such a concept must aim to integrate into and synergise with the existing health facilities and medical education institutions.

The details of how this “Diabetes Centre of Clinical Excellence” may look like and operate is out of the scope of this article but my hope is that this important 1st step is taken.
How ready and willing is the GoPNG to take this first step?

From my perspective, as a strong advocate for improvement of diabetes care in PNG if I were asked to assess the government’s readiness to make changes to improve the provision of care to our diabetic patients I would say we are at a “pre-contemplative” stage, i.e the GoPNG is not even contemplating making any real investments into curbing this big problem. My fear is that the level of devastation caused by the long term complications of diabetes in the general population will reach tragic proportions at before the government start contemplating making investments as a reactionary approach. I hope my pessimism is wrong.

 

References
1) NCD Risk Factor Collaboration (2016), “Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4•4 million participants”, Lancet; 387: 1513–30

2) Wighton K (2016) , Imperial College London, available at http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_6-4-2016-18-52-11#authorbox, accessed on 22/11/2016

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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