News Room

The Healthcare Environment in Nauru and Medical Assistance from TCVGH
Overseas medical assistance in Nauru is one of the most important programs of International Medical Service Center (IMSC) in Taichung Veterans General Hospital (TCVGH). Both regular medical checkups for former and current presidents as well as frequent international medical referrals to TCVGH have demonstrated trust of the Government of Nauru in TCVGH. The Hospital not only periodically dispatches on-site doctors to Nauru, but also provides medical missions that include cardiovascular, ophthalmological, orthopedic and other essential surgical services.
Clinical services in Nauru are provided by the Naoero Public Health Centre and the Republic of Nauru (RON) Hospital. The Naoero Public Health Centre covers non-communicable diseases, such as diabetes, hypertension, chronic renal diseases, dental and ophthalmological diseases, and also provides outpatient follow-up for the Republic of Nauru Hospital, for instance, DOTS, home care nursing, rheumatic heart disease and vaccination services. The Republic of Nauru Hospital is a principal health facility. It provides inpatient, outpatient and emergency services, such as emergency room, internal medicine, surgery, pediatrics, obstetrics and gynecology. Subspecialties are also available, such as anesthesiology, psychiatry, radiology and pain control in orthopedics. Therefore, general surgery, such as appendectomy, choledocholithotomy, percutaneous transhepatic drainage, double-lumen catheter insertion, simple skin tumor excision and biopsy, debridement and amputation can be performed routinely.Three senior general medical officers (SGMO) and six general medical officers (GMO) are responsible for ER and inpatient care. The staff of medical team come from the Philippines, Kiribati and Nigeria. More importantly, the team also includes native Nauruan physicians, which is beneficial for the local community.
The on-site doctors from Taiwan serve at the Naoero Public Health Centre. Their responsibilities include treating chronic and common diseases, as well as providing medical education. They also coordinate with the Republic of Nauru Hospital to provide medical consultation. Communication with local people is mainly conducted in English. Most of them speak English, and only a few dialect-speaking patients need nurses to translate. The population of Nauru is about 12,000, with the life expectancy of about 60 years. The prevalence of obesity and diabetes prevalence are among the top ten countries in the world. Diabetes-related complications are the leading cause of death and disability. Therefore, how to promote people’s health and avoid diabetes-related complications are the main tasks of our medical team.
Challenges of the Medical Environment in Nauru
There is much difference between Nauru’s and Taiwan’s medical environment, the burden of diabetes, public health and economy issues, and health system strengthening are all the problems need to be solved.
Diabetes is a big burden on people's health in Nauru. Many people had complications at the time of diagnosis of diabetes, such as unhealed chronic diabetic foot, which was associated with peripheral neuropathy unawareness, diabetic nephropathy with chronic renal disease, proteinuria and retinopathy. For example, at one of the home visits, the patient knew that she had diabetes until she had stroke with weakness of the right limbs. However, her husband was also amputated and wheelchair-bound due to diabetes. She needed to take care of her husband with her disabled hands after discharge from hospital. It was difficult to image how heavy the burden is for the family.
Amputation is also a big issue here. Many people need to go to diabetic foot department in the Public Health Centre for dressing. Most of these patients are young and not knowing that they are at high risk for diabetic foot (due to diabetic neuropathy) at the beginning. They often start with an inadvertent small wound and eventually end up with uncontrollable infections which need to be amputated. According to the surgical statistics of RON Hospital, 87 patients received amputation surgery during 2015-2019. Once they are amputated, there is no appropriate rehabilitation to help them get back to social life. Owing to the COVID-19 pandemic, there has been no more import of prosthetic legs for a long time. These amputated patients are relatively young and supposed to be the breadwinner of the family. Once they become bedridden, there must be a big impact of financial burden for the family.
Regarding the public health and economy issues, many things that are accustomed to Taiwan, such as the recommended portion of vegetables to starch in each meal and the importance of fruit and vegetable intake; benefits of exercise; patients should be isolated if they have airborne disease such as tuberculosis; and avoid touching unclean water, are not a common sense here. The above things could simply be divided into two types: either “can’t do it” or “don’t want to do it”. For example, the high unit prices of vegetables and fruits result in the diet with over-seasoned meat and a lot of starches. As for children with tuberculosis, owing to limited living space, they may have the chance to spread the germs to their brothers and sisters. The lack of clean water sources causes trachoma infection in children commonly. “Don’t want to do it” means the lack of motivation: the lack of motivation to visit the doctor regularly to control blood pressure, cholesterol and diabetes; and to exercise regularly due to overweight or degeneration of the knee joints despite the fact that exercise is good for health. To change dietary habits and improve public health, the Taiwan Technical Mission in the Republic of Nauru holds seminars about healthy eating at the Public Health Centre regularly, educates the local people how to make low-fat and low-salt dishes with vegetables available on the island. It is more important to give the right ideas for preventing diabetes rather than treating them with medications in Nauru.
In reference to the health system strengthening, it has a high turnover rate of doctors and lacks permanent medical specialists in Nauru. For example, not all patients with acute coronary syndrome are treated in a standardized procedure. I helped them build the protocol to treat and care for patients with myocardial infarction, and asked ER to join the process. I am happy with the result that three patients with myocardial infarction are treated with thrombolysis successfully. I also figure out the reason why the ER doctor did not initiate the treatment at the time of diagnosis. Taiwan have sent many doctors to Nauru, and they may build the protocol for common diseases in their specialty. However, as time goes by, the protocol would be forgotten after they left Nauru, and everything will need to start over again. Making the protocol internalized throughout the local medical system is the only way to continue helping the local patients. I left my contact information to the local doctors when I left Nauru, and I am glad that I still can answer questions and interpret ECG for them. Moreover, there are still patients treated in line with the protocol I built after I left Nauru.
Providing medical assistance in Nauru for three months is not a long period. I would like to thank the Taiwan Embassy and the Taiwan Technical Mission. Without their helps, I was not able to work smoothly during this period, especially in the COVID-19 pandemic. It was honor for me to have this opportunity to provide medical services in this pleasant Pacific Island country in my life. It was also a good memory worth mentioning in my life.