Monthly Archives: August 2017

Lessons Learned from The South Pacific: Implications for US Healthcare

Kevin R. Campbell, MD, FACC

For the last several weeks I have been working as a medical volunteer on a remote island off the coast of Fiji called Batiki.  Home to 234 natives, Batiki has no running water, and no electricity (other than solar generated power).  The inhabitants are subsistence fishermen and farmers and are filled with joy and a real sense of community.  While on the island, I found extremely high rates of high blood pressure and moderate rates of type 2 diabetes, but overall, I found a very happy and healthy indigenous population.  Previous research has shown that the South Pacific islands have the second highest rates of type 2 diabetes in the world–but there were fewer cases on Batiki than I expected.  My time on Batiki has led me to reflect on the beauty and passion of its people and how we, as Americans, can learn so much from them when it comes to living a happy and healthy life…

 

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(Image with permission, courtesy of Sea Mercy)

Life on Batiki: Back to Basics

I traveled to the South Pacific as the medical director of a charitable organization known as Sea Mercy.  This organization was formed by businessman Richard Hackett as a way to respond to the devastation caused by tropical cyclones over the last several years.  Many islanders lost everything—homes, families, possessions and many still struggle to survive. Yet they are incredibly resilient and continue to enjoy the simple lives that they have

During my time on the island, I was fortunate enough to spend two weeks living with the villagers in Mua (one of four villages on Batiki) as a guest in the home of the island Chief.  I was able to learn a great deal about the culture and values of the Fijians and I gained a great deal of insight into what really makes us healthy—its not always expensive healthcare plans and pricey name brand medications.  In the case of the villagers of Batiki, much of what makes them healthy is their ability to do so much with so little.  They live off of the land around them and they do not seek care for routine aches and pains.  It was not uncommon for me to see patients in my makeshift clinic that were suffering from orthopedic injuries for months or years.  Many had sprains, healed bone breaks and old cuts—but all continued to work and play.

In addition, the focus on family and community—on supporting one another—seems to result in an increased emphasis on group activities and family meals.  For example, almost every night, the men of the village—both young and old—played rugby games for hours.  The girls played a game called “net ball” and also enjoyed volleyball.  The children loved to swim and run up and down the beach.  Dinners are family events and everyone gathers around a tablecloth placed on the floor to eat together.  While the meals are NOT well balanced—far too carbohydrate heavy and lacking in proteins and vegetables—they are family events.

In the clinic on Batiki, a government paid nurse provides healthcare services for the entire island (four villages) with very limited supplies.  She has no running water or power in the clinic and has a variable stock of diabetes medications, Blood pressure medications, anti inflammatory medications and vaccines.  Due to cultural stigma with seeing a doctor or nurse, it is often difficult to get villagers to come to the clinic and many diseases go undiagnosed and untreated.  In order to overcome this when I was on the island, I made house calls to protect patient privacy.  Rather than use imaging tools and expensive tests, I made complex diagnoses such as Lupus, Neurofibromatosis and others, simply by history and physical examination.  I spent more time talking to patients and their families and did not spend any time imputing data into a medical record or filling out billing forms.  The focus was on the PATIENT.  Imperical treatment and follow up helped confirm most diagnosis and also resulted in a refinement of a patient’s therapy.  In the US, we are far too obsessed on testing and often forget about the power of the patient interaction.

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(Batiki nurses station–photo courtesy of Dr Kevin Campbell)

So, What Can We Learn from Healthcare on Batiki?

One of the founders of modern medicine, Sir William Osler once said that “if you listen to the patient long enough, he will tell you what he has”.  This has been proven to be very true over the years and has been the basis for the doctor patient relationship for decades in the US healthcare system.  Unfortunately, we no longer value the doctor-patient relationship in the US.  Those that mandate the way in which healthcare is delivered (not doctors, mind you), value billing and coding documentation via electronic medical records far more than they value the time a physician spends with a patient connecting on an interpersonal and very human level.  On Batiki, healthcare is both more complicated and actually a lot simpler, all at the same time.  While resources are scarce and you must carefully choose when to use antibiotics or other drugs that are common in the US (and in short supply there), you also are not weighed down by bureaucratic paperwork, rules and regulations.  The patient is the focus of the interaction, not the computer.  There are no practice or hospital administrators—only a team of nurses and doctors who want to get a job done.  On the island, medicine returns to its purest form—listening to symptoms, observing the patient and making a best guess as to the diagnosis based on available data.  Patients heed the advice of the physician and actually WANT to follow the treatment plan.  They do not come in to the clinic as the “worried well” or looking for pain medications—they seek care for problems that they cannot manage any other way.  Both doctors and patients benefit from every single interaction because each and every interaction is unique and unrushed.  Doctors are not stressed due to unmanageable patient volumes and patients are not upset at wait times.  Everyone is happy to be alive and everyone is working towards a common goal—better health and a happy life.  Those in power in Washington DC could learn a lot about healthcare from my friends in Batiki.  Rather than catering to special interests and allowing costs to spiral out of control, focus on what matters most—THE WELLNESS of the PATIENT and the PREVENTION of disease.  If we shift gears and change our paradigm, we all be better for it.  I expect that healthcare costs will stabilize and that outcomes may even improve.  Currently we spend more money per capita on healthcare than any other industrialized nation yet our outcomes are not nearly the best in the world—so, in my mind, something has to change.  I think we must look to the far away parts of the world for guidance.

How Has Batiki Changed Me?

After my experience on the island, I am forever changed—I like to believe that I am now a better physician, a better person as well as a better husband and father.  My brothers on the island of Batiki have taught me many valuable lessons—most importantly, I have learned to live in the moment and to appreciate the little things in life.  I am grateful for many things that I once took for granted—a warm shower, a soft bed, a healthy meal and time spent with family and friends.  For now, it is my hope that my “Batiki transformation” will allow me to do a better job advocating for my patients and will allow me to  inspire others to continue to fight for a better healthcare system in the US today.

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(Photo of Batiki, Courtesy Dr Kevin Campbell)