During the last month, I’ve had the privilege of living and working in a medical clinic on a remote South Pacific island off the coast of Fiji known as Batiki. The island, only 12 square kilometers in size, is home to 234 native Fijians spread across four villages. The island and its people were devastated by Cyclone Winston in February 2016 as a Category 5 storm — the most powerful storm to ever make landfall in Fiji.
The inhabitants of Batiki have slowly recovered, but rebuilding continues (particularly in the harder-hit villages) and the stories of the day the cyclone came ashore continue to haunt those who live there. Most of the villagers are subsistence fishermen and farmers and live in simple structures without any running water or electricity. While there are solar panels that allow for the charging of simple devices and a few indoor lights, there is no refrigeration and there are no indoor appliances for cooking. The only source of drinking water comes from rain, which is stored and collected in barrels via a gutter system from each home.
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The islands of the South Pacific have some of the highest rates of Type 2 diabetes in the world and obesity is a problem, particularly for the women and middle-aged men. Many natives remain undiagnosed and under-treated due to lack of resources and awareness of the disease. Earlier this year, I met with an organization called SeaMercy founded by philanthropist Richard Hackett and made what is likely the most important decision of my life: I agreed to join their expedition to Batiki as the medical team leader. Now that I’m back in the U.S., I am forever changed and feel obligated to share my story.
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Life on Batiki
While life on Batiki can be difficult, particularly for Westerners, there is much to be learned there. Unlike in the U.S., there’s not a focus on possessions and the accumulation of wealth — rather, these people value community, family, good health and relationships. Their willingness to help one another, to share resources and to work to support the village as a whole — a sense of selflessness — is inspiring, to say the least. Many villagers have been exposed to the outside world (through social media) and are aware of modern conveniences, and several of the men have traveled to the mainland to work to earn money for their family and friends.
However, each and every person that I met said they would prefer to stay on Batiki rather than embrace a more modern way of life. To them, the community of Batiki and its villages are what make life worthwhile. The natives of Batiki are quite religious, and most identify as Methodists — everyone goes to church services three times every Sunday. During the week, the women work to prepare three meals a day from what’s available on or around the island. Most meals consist of cassava (a root vegetable similar to a potato), pumpkin (similar to squash) and occasional fresh fish. The men work as farmers go fishing in small “longboats” along the reef that surrounds the tiny island. These people make the most of what they have and are able to do so much with so very little. They take nothing for granted and utilize all that’s around them.
Health Care on Batiki
While there’s a nurse permanently stationed on the island, there’s no hospital or regular physician presence, and there are very limited health care resources. When I arrived on Batiki, I was introduced to the nurse and my team, and I immediately went to work. We found a reasonably well-stocked pharmacy with basic antibiotics, blood pressure medications, oral diabetes medications and some emergency supplies.
Many of the volunteers brought medical supplies with them, and we were able to improve the stock of the clinic. The clinic has no running water and no good way to sterilize instruments for use — boiling water and alcohol were our best options. We opened the clinic and were quickly flooded with interested patients. In fact, the entire primary school showed up all at once. Over the next two weeks, we saw most of the island’s inhabitants, even making house calls when required. We collected data on the rates of high blood pressure and diabetes, identified and treated many new cases and found several cases of relatively rare diseases such as lupus and neurofibromatosis.
Thanks to a donation by Alive Cor, I was also able to screen each patient for heart rhythm disorders by using a mobile phone to obtain an clectrocardiogram in less than 30 seconds.
Lessons Learned from Batiki
My visit has left me forever changed, and my world view is quite different than it was before my trip. I have a greater appreciation for what we have in the U.S. and for my role as a health care provider. In Batiki, I practiced medicine in its purest form: I listened to patients and made diagnoses without fancy tests; I used clinical intuition and the physical exam.
As I traveled home and have had time to process my time living among the villagers, I have realized several important points:
1. Health care in the U.S. is a privilege, and we must do more to reduce waste so that all can have access to high-quality care.
Practicing medicine on Batiki helped me realize that expensive tests are not always needed — medicine is meant to be an interaction between doctor and patient, and outcomes are best when that interaction is allowed to take place without restrictions of time and place. Those on the island of Batiki have limited access to advanced therapies. They don’t even have the option of an expensive treatment for disease. Medicine in the islands is all about prevention and minimalist approaches to treatment. In the U.S., we spend far too much money on expensive drugs when generic, basic drugs may be just as effective. Patients in the U.S. expect the doctor will make them better and that they have no responsibility for their own health. In Batiki, villagers showed a true interest in modifying lifestyle and engaging in improving the health of not only themselves but of their families in friends. The sense of community drives and motivates each villager. We in the U.S. can learn much from this approach.
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2. Health care does not have to be expensive to be good.
Moving back to basics in medicine provides a real benefit to patients and can reduce costs. During my time on the island, the only tests I ordered were a simple point-of-contact finger-stick check for diabetes and a mobile phone-generated EKG. I made complex diagnoses without expensive tests. We were able to practice medicine without fear of predatory lawsuits or pressure from hospital or practice administrators to see more people in less time.
3. We must make the most of the time we have with family and friends.
Even with all of the harsh realities that living on a remote island brings with it, every villager I met was truly happy. They were always smiling and always made family and community a top priority. I did not see mental illness — depression, anxiety, unhappiness. Joy was evident in the kids as they played rugby or ran along the beach. The adults enjoyed conversation every night and played games, as well. There was no stress about the next day or the next week. They all live in the moment.
4. Happiness comes from within, not from possessions.
While it has been said many times, money cannot buy happiness. These villagers are not focused on accumulating wealth; they only want to provide food, clothes and shelter for their families. Like anyone in the western world, each person does want to provide a better life for their children, so some men travel to the mainland or to New Zealand to work on farms for extra money. On the island itself, efforts are underway to raise funds for new construction and infrastructure by selling coconut oil that’s made by each family in the village. Each jar of oil comes with a message from the family who makes it, and the funds that are received are shared among the villagers and will be used for community projects.
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What’s Next?
I plan to return to Batiki next year. I am interested in how well my patients are doing with the management of their diabetes and high blood pressure. In addition, I’m hopeful that the dietary counseling and lifestyle modification strategies that we introduced have reversed the course of many of these diseases. I would like to expand the clinic and make sure we’re able to see more patients throughout the South Pacific on neighboring islands. For now, I’ll be setting up a telemedicine clinic with the island nurse — it is my hope that I’ll be able to provide remote consultations when needed.
From a personal standpoint, I am forever changed. I’m learning to live in the moment, and I have a greater appreciation for family and friends and all the benefits we have here in the U.S. There’s much work to be done, and I look forward to my return to the island next summer.
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Health, Family and Lifestyle: What Americans Can Learn from Island Villagers of the South Pacific originally appeared on usnews.com
