Samoan traditional healers and their impact on patients not seeking medical care at LBJ Medical Center and the call for physicians along with medical professionals to educate patients about their illnesses are some of the many issues that were raised during a panel discussion over the weekend at the inaugural Medical Symposium held at the Governor H. Rex Lee Auditorium.

Through a joint effort between the LBJ hospital and the Health Department, the symposium — which attracted off-island delegates and speakers — was a “historical and landmark event” to bring together medical professionals “to really combat these non-communicable diseases in the territory,” said Dr. Mike Favazza, a physician at the LBJ hospital and one of the two facilitators for the event.

He also acknowledged and thanked LBJ's chief medical officer Dr. Akappusi Ledua, the “brain child” of the symposium, which is to advance the territory as a leader and ambassador for health in the Pacific.

The morning session panel discussions included questions and comments from some of the more than 40 attendees, which included off island guest speakers and presenters.

CULTURAL AND TRADITIONAL HEALERS

One of the questions came from Professor Ian Rouse, the dean of the College of Medicine, Nursing and Health Science at the Fiji National University. He said one of the big issues across the Pacific is that people know they are not well, but they don’t look after themselves.

He wanted to know if it's part of the American Samoa culture or something else that causes the territory's residents not to take care of themselves, referring to the high statistics of diabetics locally.

Dr. Seakerise Reece Tuato’o, the vice-chief of Internal Medicine at LBJ responded that he does not think “it’s a culture thing”, and noted that “sometimes people just don’t have the money to come to the hospital even though... we provide ‘affordable care’ in which the patient” pays almost nothing.

“We don’t have a solution. I believe the [DOH] small clinics are more accessible... [and] we’ve been having outreach clinics,” said Tuato’o, who was one of the presenters during the morning session. He said the medical professionals in the territory just have to continue to put the message out to the community — via radio and television programs — to utilize the clinics.

Dr. Ernest T. Oo, chief of the LBJ's Ophthalmology Department said it’s his philosophy that if people are sick, they must visit the doctor; “but if they don’t, we have to find a way to do it” even if he goes to visit the patient. 

LBJ’s chief of staff and Emergency Room physician Dr. Annie Fuavai pointed out that “traditional healers still play a role in this” and noted in the ER, “we hear all sorts of reasons why people are not looking after themselves.”

She acknowledged that “financial” reasons are one while the other is traditional healing. She said word of mouth from one patient to another prompts one person not to see the doctor but instead, opt for a traditional healer, especially when that patient hears the doctor is going to cut off their limbs.

“And amazingly, with all the educational programs that we have, they still go back to traditional healers for comfort and for treatments. So it is something that we need to look at on this island,” Fuavai said. “I think Fiji also has the same problem with the traditional healers.”

She also said that American Samoa is a “high risk community... not only are we Polynesians, but our culture also plays a major role. For example, we love to eat and food shows hospitality, so it's something that we cannot get away from.”

Additionally, there is a wide availability of fast food on island.

“Culture, traditional healers, availability of fast food, and food [itself] — it’s multiple factors,” contributing to the high risk population, said Fuavai, who was one of the facilitators for the symposium.

EDUCATING PATIENTS

Dr. Fred Uhrle called for medical professionals in American Samoa to do more to help educate patients about their ailments and the need to have a robust primary care program team to monitor patients.

Uhrle, who is a physician with the VA Clinic in Tafuna, was among the guests invited to the symposium. “When the patient fails, I look at it as a failure on my part and not providing the education that they need to understand the things that they have. We need to do a better job at that, to prevent it,” he said.

He also supported comments made earlier by Dr. Faiese Roby of DOH that “we need a robust primary care program team that will teach patients and monitor patients.”

“We’re basically — and I include myself — putting out fires and like the firemen, they run out of water; and you don’t have everything there, to take care of patients,” said Uhrle, “We need better education, we need better primary care to provide the services that are necessary.”

He also echoed comments made earlier by another physician that a lot of these patients after they are saved by doctors end up being readmitted back to the hospital “with another worse [situation] because they never got back to primary care for management.”

Uhrle pointed out that the “hospital recently tried to develop a program that could bridge those patients to where they could be safe and kept out of the hospital and hopefully prevented from being readmitted to the hospital.”

“But that program is discontinued, because of a misunderstanding on our views on what is necessary to take care of these patients,” Uhrle said. “We as physicians and nurses, need to be out in the forefront and standing for our patients.”

Uhrle didn’t identify the program that was discontinued by LBJ. However, Samoa News should point out that late last year, the previous hospital administration and board of directors launched the Care Management Service program, which was intended to improve the quality of life for those patients with Non-Communicable Diseases, or NCDs, and to reduce the mortality and morbidity rates associated with those conditions.

It was also to make sure that patients take their medication and ensure that orders by physicians are followed with the goal that patients are not readmitted back to the hospital.  The program was eliminated when the new LBJ board took office early this year. Hospital financial constraints have also been cited as the reason for the program’s demise.

POLITICIANS' INVOLVEMENT

Sitia S. Lemusu of DOH told the gathering that she wished lawmakers and politicians were present during the symposium. She said medical professionals are currently faced with “struggles and challenges” due to the lack of resources — for example, manpower.

Additionally, there is also a lack of supplies — the “very simple things such as no testing strips, no urine cups. It’s not accessible or available to us on a daily basis.”

She said these are issues that can be highlighted to politicians and legislators because a lot of funding goes to the hospital, but when it comes to primary care “you have tiny and strapped money available.”

“We have to flip that around, if we’re going to take care of the problem with NCDs in American Samoa,” Lemusu said, noting that a lot of things just come down to the availability of money.

She said medical professionals can counsel and educate patients but without the proper tools, there is not much they can do.

American Samoa Nurses Association official Tofiga Tufele told the audience that they are all health providers — some have been in the profession for many years while others have just started.

“To me, we’re all politicians and we’re all members of health providers. And as health providers, like doctors and nurses, we shouldn’t look back at... traditional leaders. Yes, we have our culture but let's stress the education and go out and do it,” she said, and asked health care providers “not to cry out for things to bring in, so we can do our job.”

“We go out and do it. It’s our community from the young ones to the adults. Let's go out and teach them, to be a healthy community, teach them about the [healthy] foods, teach them about exercising,” she said and noted there shouldn’t be excuses made for “blocking our vision… for the good health of our community.”

More details on the symposium later this week.