A passenger boat travelling between North and South Tarawa. Kiribati, March 2023. © MSF/Nicolette Jackson
On a beach in a village in South Tarawa, the piles of rubbish littering the beach are everywhere. Locals have constructed barriers (built out of rubbish, tyres and sometimes cars) to protect the banks from sea surges and king tides. Kiribati, March 2023. © MSF/Nicolette Jackson
Food and water security are chronic problems
Kiribati people (known as i-Kiribati) have high rates of obesity but conversely the Doctors Without Borders / Médecins Sans Frontières (MSF) team has been seeing more and more malnourished small children.
What is striking compared to other countries I have worked in where there has been malnutrition, is that many adults here are overweight. That’s the other end of poor nutrition; large numbers of people with diet-related NCDs such as type-two diabetes. It’s difficult to grow fruit and vegetables here and accessing healthy, nutritious food is not easy. Most food is imported, and it’s high in fat and sugar.Dr Jo Clarke, Paediatrician
Burden of disease
Kiribati’s health burden is complex. The prevalence of communicable diseases such as tuberculosis and leprosy are some of the highest in the Pacific[2]; it faces a non-communicable disease crisis with the second highest rates, among low-middle income countries, of premature deaths due to type-two diabetes[3] and infant mortality rates are ranked some of the highest in the region[4].
The burden of diseases is immense for such a small country,” says Dr Tinte Itinteang, Kiribati’s Minister of Health and Medical Services. “Maternal mortality, one of the worst in the region; infant mortality about ten times that of Australia and New Zealand and one of the worst in the region. These things have not happened overnight and some of them have been getting worse over the last ten years.
A Kiribati resident at Tebikenimwakina community in South Tarawa who have no land to live on, so they build on land that was part of the lagoon. They fortify it with tyres, cement walls and piles of rubbish and palm fronds in a vain attempt to limit damage from king tides. Kiribati, March 2023. © MSF/Nicolette Jackson
The tyranny of size
Kiribati only has a population of 120,000 people, half of whom live on just one island, South Tarawa, which is also where the capital, Tarawa, is located. The remainder live on the outer islands, of which there are 33 in total.
Kiribati’s size and its remoteness impact the government’s ability to provide comprehensive healthcare. One of its biggest obstacles is a lack of qualified medical personnel.
Kiribati lost 30 of its most experienced nurses to labour mobility schemes in Australia and New Zealand over the last 12 months and many of its doctors migrate to other countries for professional opportunities, says the Director General of Health Dr Revite Kirition. “We’ve had doctors that never returned from their medical training; they finished their post-graduate training and they just decided to leave Kiribati.”
Doctors Without Borders has been working in Kiribati since October 2022, in partnership with the Ministry of Health and Medical Services, to improve maternal and paediatric care.
An Doctors Without Borders paediatrician, obstetrician, midwife and paediatric nurse are working alongside i-Kiribati ministry of health staff to provide health care in the country’s main hospital and to help build capacity among local health staff. An Doctors Without Borders team has also worked on the outer islands, training nurses on neonatal care and screening for women who have high-risk pregnancies due to the very high rates of gestational diabetes.
In the paediatric ward at Tungaru Central Hospital South Tarawa, Doctors Without Borders paediatrician Dr Joanne Clarke is working alongside i-Kiribati colleagues from the Ministry of Health and Medical Services. Kiribati, March 2023. © MSF/Nicolette Jackson
Remoteness impacts access to essential medical supplies
Dr Clarke has seen first-hand how difficult it can be for the Ministry of Health and Medical Services to secure the essential medical supplies and drugs that they need.
“There's been struggles with pharmacy supply and equipment supply. We're quite remote, so it takes a lot of time for something to travel here by boat or by plane. We recently faced a problem with a lack of therapeutic food for malnourished children when we needed it.”
Moannara Benete, who leads the country’s central medical stores says it is very challenging for Kiribati to access the essential and lifesaving drugs needed in time and at a fair price. “When the F75 and F100 therapeutic milk that we use for malnourished babies finally arrived in Kiribati it had expired, because it took eight months to get here from Europe.
I don’t think we have procurement power or negotiation power. We should work with our Pacific neighbours so we can secure the essential medical supplies we need as a region. It is a critical situation we face, and we need urgent assistance.”
[2] TB & Leprosy in the Pacific
