The Goodwill Ambassador travels to a small island state where leprosy prevalence is still high and steps back in time to visit a former island of isolation.
|PLF’s Wayne Uan|
While the elimination of leprosy as a public health problem has progressed at the national level in countries with populations over 1 million people, in small Pacific island nations such as Kiribati, the Federated States of Micronesia and the Marshall Islands, the prevalence of the disease remains high. In October, I made my first visit to the Republic of Kiribati to see the challenges it faces.
Kiribati is situated more or less in the middle of the Pacific. With a population of around 100,000 people, it consists of 33 coral atolls and islands spread across a vast area of ocean stretching about 3,900 kilometers east to west and around 2,100 kilometers north to south.
Ms. Erei Bonebati Rimon is Kiribati’s national leprosy control program manager. She told me that every year the country sees around 100 to 200 new cases of leprosy, giving it a prevalence rate of at least 10 times the WHO target for elimination. By the time of my visit, Kiribati had recorded 121 new patients in 2015. Tawara atoll is the capital and many cases are concentrated in South Tarawa, where about half the nation’s population resides.
|(Top, above) Skin camps run by the Pacific Leprosy Foundation (PLF) in Kiribati|
There are only three people in the leprosy program and funding and resources are limited. One of the program’s big challenges is accessing Kiribati’s small, isolated outer islands that can only be reached by infrequent boat services.
The New Zealand-headquartered Pacific Leprosy Foundation (PLF) is active in Kiribati. I went to visit a skin clinic renovated by PLF in Tungaru Central Hospital in Nawerewere district. There I met an 11-year-old girl who is receiving treatment for leprosy and a 16-year-old boy who is being treated for leprosy reaction.
One of the characteristics of leprosy in the Pacific is the high number of child patients — accounting for around one third of new cases. Ms. Rimon told me that Kiribati is now entering details of new cases on a database and examining the family members of anyone who has been diagnosed.
After calling at the home of a young man who is taking a course of multidrug therapy (MDT), I went to see 62-year-old Kimwaere Mikaere. He is among several dozen people affected by leprosy that PLF has assisted through a welfare program. The program, which is overseen by the capable Wayne Uan, helps them develop income-generating skills ranging from cultivating fruit and drying fish to book-keeping.
With assistance from PLF, Kimwaere has purchased an electric compressor pump. He fills tires and cleans cars for a living. Working 12 hours a day, he makes at least 20 Australian dollars, but sometimes as much as 30 dollars in a country where the average wage is much less. Starting the business has given him confidence, he said.
|Kimwaere Mikaere started a business on Kiribati with PLF’s help|
Next I went to see a skin camp run by PLF in North Tarawa. Around 100 people had gathered in the village assembly hall. Blue sheets had been used to partition space into four separate consultation areas. Loud chatter filled the air. PLF calls this activity a skin camp rather than a checkup for leprosy so as not to reinforce stigma. In this way, leprosy is treated as just one disease among many, and this approach seems to be having the intended effect.
North Tarawa is made up of several islets. On my third day in Kiribati I traveled about an hour by boat to Abaokoro Island. Wading ashore, I walked for five minutes along a track to the island’s only clinic. There I met with several patients.
|Residents of P.J. Twomey Hospital in Fiji|
One was a 6-year-old boy. White patches had appeared on his arms, legs and back. He had been diagnosed with leprosy and had been taking MDT for three months. I was pleased to hear that he was being treated normally by his classmates. Generally speaking, Ms. Rimon told me, there is less discrimination than in the past because people see fewer advanced cases of leprosy and have a better understanding of the disease.
Also at the clinic was a 16-year-old girl. She had been brought to the clinic by her mother, whose grandmother had been quarantined on Makogai Island in Fiji, where I would be traveling next. This woman knew the importance of early diagnosis, and so had brought her daughter to the clinic when she noticed patches on her skin.
Before I left Kiribati, I met with President Anote Tong. I said I appreciated that Kiribati was grappling with many public health issues, but hoped its efforts against leprosy would continue. The health ministry, meanwhile, has set a target of achieving leprosy elimination by 2018. I look forward to the day when Kiribati marks this important milestone.
From Kiribati I travelled to Fiji. Fiji sees only a handful of new cases of leprosy a year; in recent years almost all new patients have come from outside the country, mostly from Kiribati or Tuvalu. The country eliminated leprosy as a public health problem in 1993.
A century earlier, Fiji — specifically the island of Makogai — was the center of leprosy care in the South Pacific. The government bought the island to use as a leprosy colony and built the Central Leprosy Hospital there.
|At the cemetery on Makogai Island, where 1,500 patients and staff are buried.|
Makogai operated as a leprosy colony between 1911 and 1969. The hospital was mostly staffed by Roman Catholic sisters, who volunteered to nurse the patients. Over its 58-year history, it saw some 4,500 patients. They came from all over the South Pacific, including New Zealand, Australia, Samoa, Tonga and the Cook Islands.
As the incidence of leprosy declined, the facility was closed in 1969 and the remaining patients either returned home or were transferred to P.J. Twomey Hospital in Tamavua, Suva, which opened the same year and remains the central TB and leprosy hospital in Fiji today.
Before visiting Makogai, I went to Twomey Hospital, where I met with elderly residents who had experienced life on Makogai. They included 66-year-old Peni Vuniciva, who showed me a painting he had made of the island that he had produced from memory. What struck me in talking with the residents was that they did not have a bad word to say about Makogai, although they remembered how hard it had been hard to part from their families.
Peni accompanied me to Makogai the next day. He was making his first trip back in decades. Leaning on a cane, he was overcome with emotion at times as he recalled the old days. I was particularly struck by his fond memories of those who looked after the patients and how much their kindness had meant to him.
I toured the island for a glimpse of its past. I saw the separate wards for men and women, and what remained of the cinema, church and prison — the latter mostly used for locking up drunks, I was told.
I also visited the island’s cemetery, where 1,500 people are buried. In some cemeteries I have visited, patients and staff were laid to rest in separate areas, but on Makogai they rest side by side. It seemed to symbolize the good relationship that existed between the patients and those who cared for them.
Makogai is now a marine protected reserve and government research station. It is also an important place in the history of leprosy in the South Pacific. I hope Fiji will play its part in preserving this heritage of humanity.