Dr James Fong
Suva, January 29, 2022
Our data show that we are through the worst of this third wave.
Our employers can also vouch for this given the decreasing of Covid-related absences from work but safety measures must continue to protect the most vulnerable.
We have seen relatively low rates of hospitalisation and deaths in this wave due to our high rate of vaccination and have not had to create any extra space in our treatment facilities or mortuaries. But among the fatalities we have recorded, there is a clear trend: Most are unvaccinated, suffer from serious comorbidity, and died at home.
Next stage of response
This trend tells us that the next stage of our response involves a more holistic view of the medical realities the nation faces.
After nearly two years of non-stop Covid-19 coverage, I fear that this issue, which is by far the Number One killer of our people, has become secondary in our national discourse.
But the suffering it creates is not second to any threat our people face to their wellbeing. The doctors and nurses I lead see the brutal face of this epidemic every day. We know that it is a burden that has persisted long before Covid, in fact long before I became a doctor, and it demands our urgent attention as part of our resilience-building in a Covid-endemic world.
Therefore, I am calling for a national reset for our national discourse on the health of our people. We need a new focus, from the media and members of the public, on what is most deadly and that is the epidemic of Non-Communicable Diseases (NCDs) in this country.
The Ministry of Health and Medical Services Wellness Unit and Diabetes Fiji published NCD-related statistics from 2020. In a year dominated by almost nothing but Covid-19 headlines, we lost an estimated 5700 Fijians due to NCD-related causes. These lives were ended too soon by silent killers like diabetes, stroke, heart disease and others.
Covid-19 here to stay
We know that Covid-19 will be endemic in Fiji; that means the virus will never go away, like the common flu. It is our duty to engage in health-seeking behaviour that builds our resilience to the virus. That means taking steps to keep ourselves healthy, like eating more nutritious foods, exercising regularly, and getting vaccinated and boosted when we are eligible.
Because the NCD epidemic is such an underreported crisis, I worry that not enough of us know about the resources we have available at the Ministry to save lives from these diseases.
The NCD burden has built up over many decades. These diseases are not viruses like Covid-19. You cannot catch them from other people. These diseases take root through bad habits, developing over an extended timeline of months to years.
The burden these diseases place on our society and health system is enormous amounting to over F$400 million annually. It does not mean that the government spent over F$400 million failing to combat NCDs, as one reporter wrote. A disease burden is a measure of lost potential.
If you add up every lost hour of productivity due to medical procedures, loss of mobility due to injury or amputation, and loss of life due to NCDs, the estimated cost to the country amounts to more than $400 million each year.
This all goes to show how and why our perception of health priorities needs to change.
Partnership with global bodies
Working with key partners WHO, UNDP, UNICEF, World Bank and other organisations such as Diabetes Fiji Inc, Fiji Cancer Society, Medical Services Pacific, Empower, Lifeline Fiji, National Committee On Preventing Suicide, Substance Abuse Advisory Council, we have evolved a network of avenues to help to provide prevention and care services for NCDs.
We have clear and evolving guidelines on Diabetic Care, especially on diabetic foot care. A Training package called the PEN (Package of Essential NCDS) has been deployed to health personnel as an ongoing program to help equip them with the knowledge to be able to counsel patients and provide interventions appropriately. Together with NCDs, we have included programs to screen for and provide care for Rheumatic Heart Disease.
The Ministry had committed to facilitating regular outreach services and undertaking community-wide health awareness and promotion activities well before this pandemic. We recognise that decentralising public health and clinical care remains the one means to ensure we reach all who need to be reached.
Opportunity for better treatment
The pandemic has created an opportunity to identify and treat NCDs with greater accuracy. We needed to rapidly identify as many vulnerable Fijians as possible –– including those who were undiagnosed with NCDs –– to prioritise them for vaccination.
We now have accurate and consistently maintained registries of patients with a chronic diseases that will allow us to reach out to them with advice and medications. Apart from face-to-face services access, we worked with strategic partners, including DFAT and NGOs in Fiji to enable virtual care access through Telehealth number 165 for services such as Covid care, cardiac care, surgery, cancer treatment, eye treatment, and mobile medication support in cooperation with partners like Diabetes Fiji, Medical Services Pacific, and Fiji Cancer Society.
The line is currently being reviewed to engage in service provision to supplement the face-to-face clinics. The three divisional hospitals team also has a roving team that provides mobile support for patients.
The Wellness team has engaged institutions and organisations through the virtual modes and has run sessions on Wellness and NCDs for the Ministry of Youth and Sports and Fiji Sports Commission, youth leaders and ambassadors to empower them as champions in their communities. The Wellness unit has worked with the Fiji Sports Commission, Ministry of Youth and Sports and WHO to develop videos for keeping physically active in pandemics and lockdowns.
Awareness Campaign
The Wellness unit has run an all-out awareness campaign through social marketing programmes, articles in the dailies; Visual media coverage, including the My Kana app and nutrition; radio messages; the Wellness Fiji and National Food and Nutrition Center Facebook pages; interviews on Fiji One and Fiji Two Breakfast, shows and NCD workshops.
Division by division, we are taking this campaign to the grassroots, conducting home visits to conduct check-ups, operating local clinics offering NCD-related care, building capacity among healthcare staff, virtual training sessions and informing people of our telehealth system.
When we have deployed mobile vaccination teams to reach vulnerable NCD patients, we have also arranged for deliveries of medicine and offered special outpatient treatment to those who need to be treated at home.
Other times, we arranged for these patients to be treated by private practitioners.
This work is ongoing. There are many more people we need to reach with good information so that they can prevent the rise of NCDs, and with reliable diagnosis and treatment to save lives.
Changing daily habits, which sometimes have been entrenched for decades is not easy. It requires patience, empathy and resolve but it is worth helping our loved ones, and it is worth it to help ourselves.
Responding to Covid-19 advancement
Targeting NCD-related care and addressing the root causes of these diseases is vital to our response to the inevitable progression of Covid-19 towards becoming endemic.
I am the Permanent Secretary for Health and Medical Services and it is my duty and my team’s duty to help Fijians contend, not only with a single virus or variant, but with all diseases, all viruses, and all of the health challenges they face. Combating NCDs is part of our Covid-19 response and part of a larger effort to build a healthier Fiji.
So, I am asking members of the media and the broader community to help us get the message out on how we can stop this scourge together.
Fake profile on social media
On a personal note, I was told that someone has been posting using a fake profile using my likeness. I do not have any public social media profile, so if you see someone using my image, please report the profile. I put out all of my public messages on the Fijian Government and Ministry of Health and Medical Services Facebook, Twitter, and Instagram pages.
I have no issue with being made into a ‘Meme,’ but please do not try to pretend to be me on social media.
