The aim of the project is to develop, adapt and implement sustainable systems of care in Tonga to improve diabetes care and reduce diabetes related foot and eye complications.
Expected impact
15 teams consisting of a doctor/physician assistant and a nurse trained in diabetic foot care
A 50% reduction in mortality at the surgical wards
A 50% reduction in the number of amputations
60-70% of registered diabetes patients screened for diabetic eye complications at least once a year
Results to date
The "Barriers to Access" survey has been completed based on 200 patient interviews. Respondents were asked which barriers they experienced related to living with diabetes: personal, community, environment or in the service at the diabetes centre. The majority of respondents said that they main barrier was ‘personal' which indicates a lack of adherence to awareness campaigns and medical advice.
A retinal camera has been procured for the Tongan National Diabetes Clinic and staff has been trained. This has more than doubled the capacity of the Tongan health system with regards to diabetic eye care.
3,100 eye screenings leading to more than 200 laser therapies for patients at the main island as well as at the outer islands has been conducted.
Project details
The burden of diabetes in Tonga - especially the preventable diabetes complications - is putting an enormous strain on the health care system.
In the island kingdom in the middle of the Pacific Ocean, 18% of the population suffer from diabetes. A proportion increasing continuously over the last decades. As a result, Tonga has experienced a corresponding rise in diabetes related complications including eye and foot problems.
Since services caring for patients with diabetes related complications are not available at a local level, prevention of these complications is essential.
Approach
This project is carried out by The National Diabetes and Cardiovascular Prevention and Control Centre at Vaiola Hospital in the Tongan capital Nuku'alofa in collaboration The Diabetes Unit at the Australian Health Policy Institute at the University of Sydney. The latter will mainly contribute with expert advice when needed.
Focus is on secondary prevention specifically early detection and management of foot and eye problems. Attention will be on developing and improving systems of care, follow-up and management in order to reduce the number of diabetes related complications.
The project has three main components:
Assessment of barriers to access of care
Foot care
Eye care
The first component is initiated immediately after project implementation has been commenced. Tonga has experienced a high degree of non-compliance with follow-up visits to the health facility among diabetes patients. This may have fatal consequences for the patient.
In order to identify the reasons for the non-compliance, a survey of 200 diabetes patients with irregular follow-up will be conducted. The patients are interviewed in order to elicit barriers to accessing proper follow-up and care.
A total of 15 teams consisting of a doctor/physician assistant and a nurse from existing diabetes clinics will receive the Step-by-Step training. The training will be carried out on the main island and in the two other main island groups in Tonga and will consist of two training sessions - basic and advanced level - with a one year interval with subsequent supervision from the project team. Upon completion of the basic training, the teams establish foot care clinics as part of their routine care for the diabetes patients in their clinics.
This component is expected to reduce amputations and the number of visits for dressings. Thus, all will benefit: the staff will gain new skills, the patients get better care and the burden on the health care system from admissions and complications due to diabetes will be reduced.
The third component regarding eye care includes supply of a non-mydriatic fundus camera to enhance the level of eye screening in the country. Training in the use of the camera is provided to 3 staff members. The camera will be based on the main island, but screening visits to the outer island will be done semi-annually.
It is expected that this emphasis on screening will lead to earlier detection of eye problems, and consequently reduce the need for surgery which is not locally available.
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