Search

Circumcision of neonates and young boys, is a frequently performed elective surgical procedure, and is one of the oldest known surgical procedures. When properly performed circumcision prevents phimosis, paraphimosis, and balanoposthitis and has been shown to decrease the incidence of penile among men and cervical cancer among the women sexual partners of circumcised men. It may also result in a decreased incidence of urinary tract infection, sexually transmitted infections and HIV infection. Circumcision also has its own inherent risks. The risk are mainly associated with the procedure (pain, bleeding, inflammation) also included post operative infection, poor healing, excess foreskin removed leading to minor or major loss of sensation, accidental cutting of the glan penis, and cross infection if performed with un-sterile instruments especially during ritual circumcision. To make an informed choice, parents should be given accurate and unbiased information and be provided the opportunity to discuss this decision.

This paper describes the recruitment and participation of Pacific people in a large hepatitis B screening programme undertaken in Auckland, New Zealand between April 2000 and December 2002. Thirty three percent (32,700) of the adult Pacific population was screened, with coverage highest among the Tongan community (50%) largely though the efforts of two active ethnic specific Pacific and non-Pacific providers using combinations of language-targeted promotion, outreach visits and opportunistic recruitment at general practice visits. Important differences were found in recruitment methods and patterns between Pacific populations and for different age groups. These findings suggest that funders, planners and providers of health programmes need to respond to the diversity within Pacific communities, and understand the importance of ethnic-specific providers when mobilising large numbers of people for population health interventions.

Many Pacific Islands Countries (PICs) by their geographic location, isolation, and lack of resources, are at risk for both environmental and man-made disasters. Disaster management (DM) and mitigation is frustrated by the general underdevelopment of DM planning and lack of adequate emergency medical services (EMS) to deal with daily emergencies let alone large-scale emergencies and disasters. To address this, the U.S. Centers for Disease Control and Prevention (CDC) developed and implemented the Pacific Emergency Health Initiative (PEHI) to review and make recommendations regarding the current level of DM/EMS development of select PICs. As a practical next step, a collaborative demonstration project--the CDC--Palau Community College Pacific Center for Emergency Health--was established in the Republic of Palau with the purpose of providing training and technical assistance in DM/EMS development for the region. In September 2001 the Center conducted two simultaneous training programs addressing Public Health Disaster Planning (one-week) and pre-hospital First Responder Care (two-weeks). Sixty participants included public health planners, physicians, and fire and police officials from eleven PIC jurisdictions and representatives from the Secretariat of the Pacific Community, South Pacific Applied Geoscience Commission, and the Fiji School of Medicine. Eleven country and state public health disaster plans were initiated. Post 9-11 the Center has increased relevance. Through CDC's PEHI additional Center training programs are planned through FY 2003.

The Palau Area Health Education Center (AHEC)--a program of the University of Hawaii's John A. Burns School of Medicine (JABSOM) and based at Palau Community College--was established in 2001 in response to the recommendations of the 1998 Institute of Medicine (IOM) report--Pacific Partnerships for Health--Charting a New Course for the 21st Century1. One of IOM's core recommendations was to promote the training of the primary health care workforce among the U.S.-Associated Pacific Islands. Since its inception in 2001, the Palau AHEC has coordinated overall 37 postgraduate and undergraduate courses in General Practice and Public Health taught by the University of Auckland Faculty of Medicine and Health Sciences and the Fiji School of Medicine's School of Public Health and Primary Care (SPH&PC) in Palau, Yap State, and the Republic of the Marshall Islands. Currently 139 physicians, nurses, health administrators, and environmental health workers are registered as active students in Palau (58), Yap State (22), and the RMI (59). Notably, the Palau AHEC and the SPH&PC have worked in an innovative partnership with the Palau Ministry of Health to operationalize the MOH's public health work plan to implement a comprehensive community health survey of all 4,376 households in Palau, interviewing 79% of the total population, to determine Palau's health indicators. To accomplish this, the SPH&PC developed and taught a curriculum for Palau physicians and public health nurses on how to design the survey, gather, and analyze data in order to develop and implement appropriately responsive intervention and treatment programs to address Palau's old and newer morbidities. In early FY2005, two other Micronesian AHECs--the Yap State and Commonwealth of the Northern Mariana Islands AHECs--were funded through JABSOM administered grants which will also address the primary care training needs of Micronesia's remote and isolated health workforce.

Objective: Breast cancer is the most common cancer for many Pacific Islander American populations, but virtually nothing is known about the cancer risks and screening behaviors of many specific ethnic subgroups. This paper examines the breast cancer risk, knowledge, attitudes, and screening behaviors of Tongan-American women., Design: Research activities were conducted in 3 phases: determination of cancer proportional ratios using data from the California Cancer Registry, exploratory focus groups conducted with 22 women, and self-administered surveys from 303 women (for a response rate of 92%)., Setting and Participants: Survey respondents were Tongan-American women aged 40 years and older, residing in Los Angeles and Orange Counties., Results: The breast is the most common cancer site for Tongan women, followed by the cervix and uterus, lung and bronchus, and stomach. The proportion of all cancers accounted for by breast cancer is lower among Tongan women (0.8) compared to White women. We found low rates for all types of breast cancer screening: only 40% of respondents had ever performed a breast self-examination (BSE); 26% ever received a clinical breast exam (CBE); and 25% ever received a mammogram. Many misperceptions existed about breast cancer causes, signs, and symptoms as well as the role of screening in detecting pre-symptomatic cancers., Conclusions: Much emphasis needs to be placed on improving early breast cancer screenings among Tongan-American women, including comprehensive community education, culturally tailored and linguistically appropriate materials, and improved access to low-cost screening sites.

This paper describes and compares the infant care practices and beliefs of Maori, Tongan, Samoan, Cook Islands, Niuean and Pakeha (European) caregivers residing in Auckland, New Zealand. Focusing on four areas--sources of support and advice; infant feeding; infant sleeping arrangements; and traditional practices and beliefs--it explores inter-ethnic similarities and differences and intra-ethnic tensions. The international literature indicates that there can be significant cultural variation in infant care practices and in the meanings attributed to them. There is, however, little New Zealand literature on this topic, despite its importance for effective health service and health message delivery. Participants were primary caregivers of infants under 12 months. An average of six focus groups were conducted within each ethnic group, resulting in a total of 37 groups comprising 150 participants. We found similarities across all ethnic groups in the perceived importance of breastfeeding and the difficulties experienced in establishing and maintaining this practice. The spectrum of behaviours ranged widely with differences most pronounced between Pacific caregivers, especially those Island-raised, and Pakeha caregivers, especially those in nuclear families. Amongst the former, norms included: the family as central in providing support and advice; infant bedsharing; abdominal rubbing during pregnancy; baby massage; and the importance of adhering to traditional protocols to ensure infant well-being. Amongst the latter, norms included: strong reliance on professional advice; looser family support networks; the infant sleeping in a cot; and adherence to Western biomedical understandings of health and illness. Maori caregivers bridged the spectrum created by these groups and exhibited a diverse range of practices. Intra-cultural differences were present in all groups indicating the dynamic nature of cultural practices. They were most evident between Pacific-raised and New Zealand-raised Pacific caregivers, with the latter attempting to marry traditional with Western beliefs and practices.

Cancer is becoming an important cause of morbidity and mortality in Niue. Analysis of a cancer register showed an overall age adjusted rated of 11.3 and 9.9 per 10000 among males and females, respectively. A significant increase in the trend of cancer during 1952 to 1985 cannot be explained by improved registration alone. This study when compared with other data sources on Niue indicated a gross under-reporting of cancer (over 70%). The establishment of national registers for chronic diseases like cancer is the most accurate, economic and technically achievable way to provide population-based information for the small Pacific Island states.

The Pacific Health Dialog (PHD) is a Journal of Community Health and Clinical Medicine with a Pacific. focus. A analysis of all nine PHD issues from 1994 to 1998 was made for origin of author and content. Tally sheets were used to compile data from which the tables were constructed. The results showed that of the 15,000 journals printed 70% were distributed to Pacificans. There were 287 items published by 489 authors of which 37% were Pacificans who were also the first or only author in 37% (excluding the authors of book reviews, editorials reprints, letters and abstracts). The contents of PHD have all been written in English even though the policy allows for any major Pacific language. Therefore a monolingual journal has emerged in spite of a multilingual policy. There has been minimal dialogue or discussion in PHD and not much of the content has been challenged, so the papers have become monologues by the authors. Thus we have a monolingual monologue. PHD is donor dependent with a hand to mouth existence. Funding covers only part of the expenditure and the balance comes from a 'labour of love' from many people. Despite this, PHD continues to grow. The development of PHD has demonstrated that a participatory media can increase the Pacificans role in health information dissemination throughout the Pacific. Many of the Pacific authors (73.5%) have never published previously. Since 1994 PHD has come a long way and contributed much to pacific based research. It addresses a wide variety of topics and problems and not just the need for medical information. PHD has become the prototype for regional health communication in terms of participation, ownership, development, maintenance and its use of 'labour of love' resources.

Researches of and among Pacificans have been largely externally initiated, funded and controlled. It has become an imperialist tool to colonize, oppress and control the aspirations of Pacificans. This case study shows that research imperialism thrives in Tonga. Economic and social efficiency can be achieved through local initiatives by native researchers. Such an alternative approach must replace foreign data prospectors, "mosquito scientists" and "parachute consultants". This study provides a rapid assessment methods for monitoring research performance among Pacificans.

The inaugural meeting of the Pacific Health Research Council (PHRC) was held at Sonaisali, Fiji 12-14 Oct 1998. It was attended by representatives of eight Pacific Island countries and five Pacific Island institutions. The organisation is designed to provide three levels of membership: Pacific Island countries; Pacific Island institutions; and individual Pacific Island researchers. An executive committee was appointed and given the task with the special objectives: to promote and strengthen health research by Pacific people and; to develop Pacific people capacity to exert more control and ownership of data generated through research. In the past Pacific health research has often been driven by external agendas and there is a need to increase the capacity among Pacific Island people to conduct action oriented research. An initial collaborative project for the PHRC is in the area of injury prevention and control. Implementing tasks of the PHRC will require the use of distant consulting and co-ordination to provide ongoing technical assistance, to manage multi-centre activities, and to share ideas and concerns etc. Hence, PHCR will be interested in participating in evolving telehealth networks in order to adequately address these tasks. In the spirit of cooperation and co-ordination, the PHRC can be expected to become actively involved in these emerging developments.

Aims: To define ethnic origin and verify the diagnosis of sudden infant deaths among Pacific peoples in Auckland 1988-1996, and to elicit soci-econonic and demographic characteristics., Methods: Police (P47) and coroner reports were analysed for an ethnic classification and diagnosis. Postneonatal and sudden infant death syndrome (SIDS) register and New Zealand Information Services data were analysed for additional Pacific cases. Rates of Pacific SIDS in Auckland calculated. A Pacific SIDS database was developed and families were tracked. Face to face interviews covering the SIDS event were undertaken with selected families. Data were coded, stratified and a thematic approach to analysis was utilised., Results: There were 52 cases of SIDS and the ethnic origins were: thirteen Samoans, nine Cook Islanders, seven Togans fifteen multiple ethnicity, and eight could not be verified. The annual rates of Pacific SIDS varied from less than one (in 1989) to 4.5 (in 1995) per 1000 Pacific live births. 34 cases (65%) couldd not be contacted and eighteen were traced. Nine in-epth interviews were conducted with caregivers of these cases. All babies had slept in the supine position, seven were breasted, and five of the mothers were non-smokers. Eight babies sept in the same room with their primary caregiver, with seven sleeping in their own bed. All of the mothers had had continuous access to childcare and support from their families, and seven had had previous children. Grief counselling for partners and children was identified as necessary by almost all the mothers. CNCLUSIONS: This preliminary study concludes that the rate of Pacific SIDS increased in 1995 and remains a serious problem. Ethnic misclassification and under reporting of SIDS cases is apparent among Pacific infants. There is a need to establish a national infant mortality database that collects accurate data incorporating standardised ethnic specific categories. Official routine and data sources also need to incorporate standardised ethnic specific categories. A national prospective study is required to study SIDS in Pacific communities as a basis for effective prevention strategies.

This paper uses findings from the Maori section of a multiethnic infant care practices (ICP) study undertaken in Auckland, New Zealand/Aotearoa, in 1998. It aims to increase understanding of present day Maori infant care practices in order, firstly, to inform infant health message and service delivery to Maori and, secondly, to understand the context of practices that comprise modifiable risk factors for SIDS. Publicity about modifiable SIDS risk factors since the early 1990s brought about a significant reduction in the national SIDS rate but the Māori rate reduced more slowly and in 1998 was still three times that of non-Māori. The ICP study was a qualitative study that, for the Māori section, involved seven focus groups and a one-on-one interview comprising 26 caregivers of under 12 month old infants. This paper focuses on five selected areas explored within the ICP study: sources of support, customary practices, infant feeding, infant sleeping arrangements and smoking. It discusses both valued infant care norms and factors that inhibit changes known to reduce SIDS risk. It argues that valued practices need recognition in order to make messages effective. It also challenges the emphasis on individual behaviour change as the primary means to reduce SIDS risk and argues that there is a need to extend prevention strategies beyond simple behaviour change messages to include structural change to reduce 'non modifiable' risk factors.

Health workers often communicate to people from a position of power rather than focusing on the needs of the receivers. This is usually clouded with jargon and the so-called principles of scientific accuracy. Often the use of science is to justify the health worker's position rather than to precipitate actions to promote health and achieve people's control over their lives. Communication involves a tripartite reciprocal interaction between the sender, receiver and the medium. This involves both science and art specific to the message, language, values and participants. If the ultimate purpose of communication is healthful action and community control, then scientificness of the explanations must be secondary. Therefore the art of getting the message across must be the priority rather than it being scientifically sound. This conflict is discussed in relation to experiences in the Pacific Islands. The communication of health risks in the Pacific involves the multi-tiered translation of scientific concepts and language into those of the target populations. The scientific concepts are usually occidental and need to be translated into vernacular worldviews and languages. Experiences in and examples from the Pacific have challenged the primacy of scientific explanations over the need to minimise health risks and increase of community control. For health promotion to succeed in multicultural and multilingual Pacific, New Zealand and Australia, the art and science of communicating health risks must be titrated against scientific explanations to appropriately and primarily promote health.

Health information is essential for proper management and deployment of limited resources in the health services of the Pacific Islands. There have been numerous efforts to establish and strengthen sustainable information systems but the common feature of these attempts has been the very limited achievement. Subsequently, the use of information as a management tool has been abandoned in favour of 'gut feeling', hearsay and adhocry. In the last decade health planning and primary health care activities have necessitated the re-emphasis of monitoring and surveillance of health and health service indicators. Therefore a revival of interest in health information systems is taking place. A review of national health information systems in the Pacific showed that routinely collected data remained largely untouched by human thought. The contributing factors to the current inertia are examined with suggestions on how to elevate health information from its current lowly status to its rightful place as an essential tool for management. The special problems of small island states, like limited resources, geographical isolation, natural barriers to technology, and diverse cultural milieu, will be examined in relation to an appropriate health information system for Pacific Island countries in the twenty-first century.

Development in the Pacific has largely ignored the importance of health as a pathway and an outcome. This paper reviews the effects of development on health and health services in the region. It aims to highlight the plight of development that happens without considering the sociocultural and physical environments of the small island countries. The review shows that health and social conditions in the Pacific are deteriorating. The process of development has been externally controlled without community participation. Pacific leaders have been preoccupied with economic development and have not been cognisant of health and social consequences. During progress an enjoyable life can be achieved through sustainable development with community participation. However, indicators of economic growth in the Pacific do not correlate with those of health. The increase of rape, suicide, drug abuse, sexual promiscuity and crime suggests that Pacific islanders are increasingly disillusioned by the present developmental approach: they have ceased to enjoy life before death. It is suggested that decentralized development planning with community involvement, integrating health and social considerations, would be the way out of this dilemma.

History, economics, culture, and politics have created health systems that can no longer meet the health challenges in the Pacific. An analysis of the health situations in the region revealed health trends, health service deficiencies and the various issues that need to be addressed. The morbidity and mortality experience in the Pacific has been approaching that of the developed countries. The contributing factors to diseases and death have been changing but other health issues, such as matters pertaining to environmental sanitation, management, health information, food and nutrition, ethnic pluralism, colonialism, and technological arrogance, may exacerbate these experiences. To appropriately meet these constraints, the health services need reorientation. However, these need new types of health leadership. Doctors, being the most socially acceptable and politically powerful, should be trained for this new leadership role. This training must be guided by the biopsychosocial model to produce community health physicians. This is being undertaken at the Pacific Basin Medical officer Training Program, Pohnpei. It is characterized by an integrated, community-oriented, student-centered, career-ladder and competency-based approach. The graduates will then provide the leadership and catalyst for the needed health service reorientation.

Methods of inpatient management of children with diarrhoeal diseases (DD) in 1978 and in 1980 were compared to assess the use of oral rehydration salts (ORS) and a national antidiarrhoeal programme (NAP). Inpatient notes of 369 children admitted with DD were reviewed. The management of DD differed significantly but the clinical outcome was similar, with the exception of the case-fatality rate. All deaths occurred within the first 24 h of admission, indicating that this difference was attributable to improved management of DD in the community rather than changes in the inpatient treatment regime.

The village health worker (VHW) pilot scheme in Tonga was reviewed three months after implementation. The scheme was acceptable to the regional health workers and the communities the VHW were serving. There were demands from most for the VHW for the community to have more than one VHW, build a clinic, and to increase the emphasis on curative medicine. There was no demand for a health prevention or promotional role. The rate of recorded illnesses has increased but health seeking behaviour remained unchanged. This scheme has provided an opening for the Ministry of Health to implement equalizing strategies to merge the practice and the political rhetoric of primary health care and community participation.

The first cases of human brucellosis in Tonga are discussed with emphasis on a general review of the disease. The need for awareness and animal screening is highlighted.

A simple and inexpensive assessment of cardiac murmurs and school health problems was conducted in an isolated island in the kingdom of Tonga. The prevalence of rheumatic and congenital heart disease in the population of 'Eua was 0.5% and 0.15%, respectively. The incidence of rheumatic heart disease for 1985 was 0.8 per 1000 population. The screening of 1106 students, who were aged five to 12 years, showed skin disease to be the most important problem. All identified cases were treated and referred for follow-up. The total cost of this study was US $281.48. This exercise demonstrated an alternative approach to maximizing the use of health resources as well as maintaining the skill and morale of health workers in isolated areas.

The prevalence of kava (Piper methysticum), alcohol and tobacco consumption in Nuku'alofa (urban) and Foa (rural) are described. Current kava consumption was males 48% and females 1%. Prevalence was significantly higher among rural males. Current alcohol consumption was almost exclusive to the urban population and predominantly male, but only 2 (1%) rural males were current alcohol consumers. 169 (84.0%) of the rural males were irregularly or had ceased consuming alcohol. Tobacco consumption also showed a significant male predominance. There was a significantly higher total tobacco consumption in the urban population. Concordance of the three habits was evident among males with 27 concordant positive (expected = 5.98) and 46 concordant negative (expected = 6.60). It appears that kava, a traditional Pacific beverage may have lost ground to alcohol as urban Tongans adopt a more cosmopolitan life style. Kava, if proved relatively harmless, may be promoted as a less unhealthy alternative to tobacco and alcohol.

A cross-sectional study of urban and rural Tongans showed the prevalence of hypertension to be 8.4%. Hypertension occurred more often in urban men than in women. Systolic blood pressure (BP) showed a significant increase with age in all groups, except among rural men. Multivariant discriminant analysis identified the characteristics that were associated with a raised BP. The independent variables were selected for entry into the analysis on the basis of their power to separate BP categories, using Rao's V as the generalized measure of distance between groups. Age and body build (BMI or Fatsum) accounted for most differences between normotensive and hypertensive persons, especially in women. The fasting plasma glucose level was a significant discriminating characteristic for both men and women. The packed red cell volume was the most powerful single discriminating characteristic in men and the serum triglyceride level in women. The use of each characteristic to classify individuals by BP category may help clinicians to use cross-sectional data when deciding on the treatment of raised BP.

All liver histology records from Tonga during 1970-79 were reviewed, including 42 biopsy and one necropsy specimens. Primary hepatocellular carcinoma was the histological diagnosis in 13 (30 percent). The age standardised incidence rate for confirmed cases are: males 2.9 and females 1.5 per 100 000. These are unremarkable compared to some reported rates, but many of these areas have included a high percentage of unconfirmed cases. Other diagnosis included cirrhosis (14), cholangiocarcinoma (2), metastatic carcinoma (2), cholangitis (2), hepatic fibrosis (2), and actinomycosis (1). The difficulties of diagnosis and areas for further studies are discussed.

A case of falciparum malaria in Tonga occurring in a tourist is reported and discussed with the emphasis on awareness of imported diseases to the Pacific.

Disaster victims have been thought to be disoriented and irrational to express their needs. Therefore they have been largely assessed through external observers. However, this study in the South Pacific Kingdom of Tonga suggests that disaster victims were capable of prioritising their needs to guide the provision of immediate help and later rehabilitation programmes. Some inconsistencies in the experiences of this study sample compared to large developing population centres (e.g. low disease prevalence after the cyclone) highlight the need for special consideration of small island states separate from those of the developing continents. Overall, this study explored a method of giving the community an opportunity to participate in their rehabilitations after a disaster. The validity of this approach needs to be tested for other communities.

A post-cyclone assessment of the health and nutritional status of preschool children at Ha'apai, Tonga Is, showed lower disease incidence and an unchanged pattern of illness. Height and weight measurements indicated nutrition problems to be chronic and perhaps unrelated to the effects of the disaster. This study supports the hypothesis that natural disasters do not generate new diseases or necessarily lead to disease outbreaks.

Expensive health facilities have failed to meet most health needs. This perceived failure has been interpreted as failure of scientific medicine with subsequent alienation of health facilities. It is therefore necessary to develop primary health care (PHC) programmes shaped around the life patterns of the population it serves. This paper discusses the similarity between marketing concept and providing PHC, and as it was applied to development planning in a village of the Kingdom of Tonga. The issues, circumstances, and approaches discussed, reflect what is desirable from the villagers' viewpoint. In the absence of epidemiological data, there was greater reliance on the villagers' observations to rank priorities. The process of arriving at the final objectives used the marketing approach to provide direction and guideline for discussions for the problems. Marketing can be of assistance in the search for more acceptable and accessible health service and will help to focus on the communities' perspective of their total needs.

The process of ageing, the place the elderly hold in the South Pacific societies and the care they receive as they move from adult independence to geriatric dependence varies considerably in different Pacific Polynesian populations. This provides unusual opportunity to examine the physical changes of ageing in people of the same broad genetic make-up exposed to environmental changes brought about by urbanization. Epidemiological surveys carried out since 1962 among New Zealand Maoris, Tongans, Cook Island Maoris in Rarotonga and Pukapuka, and Tokelauans living in Tokelau and following migration to New Zealand, provide the main data base for this presentation. The pattern of blood pressure, body weight, serum lipids and clinical disorders show considerable variation which relate most closely to the adoption of westernized life-style and moving into an urban environment. Analysis of the ECG pattern, in Pukapukans, in whom blood pressure shows only a minor increase with age, compared with age and sex-matched subjects studied in Newcastle, England provide insights into the ageing heart. An examination of mortality based on risk factors at entry shows an inverse relationship of serum cholesterol to total mortality in New Zealand Maori men and women, in Tokelau men but not women. Increasing systolic blood pressure was related to mortality in New Zealand Maori men, Tokalau men and Caucasian women, but not in the other race sex groups. The pattern of ageing and risk factors must clearly be examined in individual populations because while death is the end the pathways vary.

Seven and eight year old primary school children were interviewed to rapidly assess food consumption patterns during a drought in Tonga. Of the 158 children interviewed, 11 (7%) reported hunger in their households and four (2.4%) reported one meal per day. Carbohydrate consumption was high but protein and vegetables were low. This simple study provided crude but useful and timely information for decision making.