Health on Wheels

Free Medical Camps to the Rural Villages of Fiji

As the name implies, Health on Wheels is about taking healthcare to those who are unable to access medical services because of their socio-economic situation. Many of us take for granted our relative ease at being able to go to a public health care facility or a private GP. However, there are many less privileged in Fiji who are not able to enjoy this. Health on Wheels is helping in that area of need. The Sai Prema Foundation takes a well-equipped medical team and a Mobile Hospital into the rural areas where we set up camp and encourage the entire community to take advantage of the free services available. Brief summaries of each department are included in this report.

Triage/Health Screening Report

Triage/Health Screening is usually the first point of contact for the patients once they are registered. At the Sai Prema Foundation Fiji’s Health on Wheels Medical Camps, Health Screenings have been run by triage nurses of Korovou Health centers, assisted by staff members from Smart Lab, Diabetes Fiji and volunteers from the Foundation. For all the camps, they check patients’ blood pressure, blood glucose, height, weight and BMI (Body mass index). Based on the findings, they are referred to the appropriate medical professional for further investigation. Smart Lab, in conjunction with the Fiji Cancer Society have also provided screening for Prostate cancer for males over the age of 40.

Up until August 2017, more than 1,500 patients have passed through the Triage department in total. The department provides crucial coordination and pre-treatment information for all the other health professionals to ensure smooth operation of the camp overall.

For all the Health on Wheels Medical Camps, there have been values and medical awareness workshops done for the villagers. The workshops have been conducted by Mr. Indra Deo, a former director of National Food & Nutrition Center, and a member of the Sai Prema Foundation Fiji. He has been assisted by other Health on Wheels volunteers. These workshops focus on the holistic view of health, addressing the physical, mental and the spiritual needs of the villagers.

Bro. Indra Deo often talks about the 5 human values of truth, peace, love, non-violence and right conduct which are universal to all religions. Villagers are also educated on diet and lifestyle. They are made aware of the prevalence of Non-Communicable Diseases (NCD’s) and its long-term complications especially if not kept in check. At some of these workshops, free dental kits and soap bars were also handed out to the participants to further drive home the message of good oral/personal hygiene.

General Practitioners Report

The General Practitioner team is an integral part of the Health on Wheels Medical Camps by Sai Prema Foundation Fiji. The team consists of volunteer doctors, mostly from the private sector who are sometimes assisted by a doctor from the Korovou hospital and a nurse practitioner from Lodoni Health center (for medical camps in the Tailevu region). Some private General Practitioners make an enormous sacrifice by even closing their own medical center to come and assist in the camps. In addition, 2 general physicians from the CWM hospital have been assisting in many medical camps with their vast experience across the medical specialities. Between 3 and 6 doctors are present in each medical camp. The doctors see triaged patients and this is usually one of the busiest areas of the camp. Till August 2017, the doctors have collectively seen more than 1300 patients. The consultation includes history taking and a thorough examination of the patient, with an explanation of their diagnosis and management. On many occasions, patients see doctors for a specific medical issue and in other instances, it may be for screening of their blood sugar, blood pressure or other similar issues. The most common medical conditions seen are skin infections, respiratory infections, and non-communicable diseases such as diabetes, hypertension and overweight/obesity. With regards to skin disease the most common conditions are fungal infections such as tinea corporis and tinea versicolor, abscesses, impetigo and scabies. Patients who need further investigations and management are referred to the nearest tertiary hospital or medical center with a detailed referral letter. Those who are critically ill are transferred to the nearest hospital for admission and further care. The general practitioners feel very satisfied providing free services to the villagers and the smiles on the patients faces is the only reward that the doctors desire.

Dental Clinic Report

Up until August 2017, approximately 400 patients have been examined by the dental team of Sai Prema Foundation Fiji’s Health on Wheels Medical Camps. The dental team consists mostly of volunteer dentists, dental technicians and assistants from the private sector and Fiji National University. They are assisted by the divisional health center (Korovou Health Centre) who provide their staff and as well as the dental equipment and some consumables. During these camps, the dental team provide the villagers with free consultations, oral examinations, fillings and extractions. Complicated cases are usually referred to health centers/divisional hospitals for further investigation/treatment. As part of oral health promotion, Colgate toothpastes and toothbrushes were handed out to the patients seen. These were kindly donated by Colgate-Palmolive.

Sai Prema Foundation Fiji also pays the Ministry of Health and Medical Services for all dental treatments provided to adult patients, however, dental treatment fees for Pediatric patients were provided by the Ministry without cost to the Foundation.

Together with free dental checkups and treatment where required, educational counselling is also provided to patients to ensure that they maintain good oral hygiene. Props are also used to show patients including children how to properly brush the teeth. Dental hygiene issues are commonly encountered at the village level, and with proper treatment and guidance, patients have left the medical camps happy with the treatment and knowledge that they have received.

Eye Clinic Report

The Pacific Eye Institute (PEI) and/or staff from the Eye Department (part of the Colonial War Memorial Hospital or CWMH) support Sai Prema Foundation Fiji’s Health on Wheels free Medical Camps by sending their staff to conduct free eye examinations including prescribing free eye glasses where required for rural villagers. So far, at least 300 patients have been examined. Patients requiring further investigation and/or treatment are also referred to the Pacific Eye Institute in Toorak, Suva. Reading glasses, donated by Health on Wheels volunteers, have also been handed out to the villagers where needed.

Some of the conditions encountered include short and long sightedness, cataract and common eye infections such as viral and/or bacterial conjunctivitis. Counselling is also provided to diabetic patients to ensure that they maintain good control of their blood sugar levels and blood pressure which also have a beneficial effect on their eye health. Children who sometimes struggle in school have also been found to have poor eye sight which leads to lack of focus and headaches (usually easily solved with prescription eye glasses).

Dietetics Report

A couple of volunteer dieticians have participated in Sai Prema Foundation Fiji’s Health on Wheels free Medical Camps, and provided counselling on types of food, portion sizes, salt and sugar intake and exercise. In some of the camps, some patients who were considered obese were referred to their local health clinics for further management.

Diet & lifestyle is a crucial part of overall health and well-being to prevent non-communicable diseases such as diabetes, obesity, hypertension etc. One of the biggest advantages of having a dietitian present at the medical camps is that it allows for patients to seek guidance in the comfort of their village/nearby school surroundings where they are more likely to open up about challenges that they face with regards to managing their diet and lifestyles.

The counselling provided by the dietitian (in conjunction with the general practitioners) can potentially help prevent pre-diabetic patients from becoming diabetic for example by counselling on foods which are less starchy (a common problem with Fijians who consume a lot of starchy root crops like cassava), less salty and unhealthy fried foods. Instead these can be substituted with more of leafy green vegetables like belle and dalo leaves which can be sourced and/or grown locally.

Obstetrics & Gynaecology Report

The Oxfam Wellness Centre for Women in Toorak, Suva regularly send their team of doctors and nurses to the Sai Prema Foundation Fiji’s Health on Wheels free Medical Camps to do free obstetrics and gynaecological checks for women in the villages. Until August 2017, more than 100 women have been examined during these camps. Women are also given advice on personal hygiene, family planning, infertility and general reproductive health. Some women have had their breasts examined for lumps (possible cancer), and also pap smears have been conducted when required to detect possible cases of cervical cancer which can be treatable especially if detected early. A few cases have been referred back to the Wellness Centre in Suva for further examination. Also, young women have been counselled on prenatal and postnatal care. Fiji has a high birth rate especially in rural areas. Together with GP’s, a gynaecologist can provide much needed assistance for women living in rural areas who would not have access to such screenings otherwise.

Pharmacy Report

The pharmacy department is a part of the Sai Prema Foundation Fiji’s Health on Wheels free Medical Camps Project for the poor and underprivileged. The department is run by a couple of pharmacists who are part of the Sai Prema Foundation. Along with pharmacists, other volunteers including pharmacy assistants, dispensary technicians, pharmacy students and volunteers have assisted with regular Medical Camps since its inception. Medications are sourced from a variety of donors including the Ministry of Health (via the Fiji Pharmaceutical Services), through internal funding (coordinated, packed and sourced from TappooCity Chemist) and through donations from pharmaceutical suppliers, wholesalers and monetary donations from friends, families and fellow members.

All medications are dispensed completely free of cost to patients that attend the camps. Once a patient is issued a prescription by the volunteer health professional (GP/Dentist etc.), then they will bring this to the pharmacy (usually setup in one of the classrooms of the school camp site) where these would be prepared and then dispensed, and the patient counselled about the safe and effective use of the medication to ensure that they receive the best primary health support and care.

As of August 2017, approximately 800 prescriptions and 1,500 items have been dispensed. The most commonly dispensed medications include anti-fungal tablets/topical preparations, antibiotics, painkillers, de-worming tablets and scabicides. Blood pressure and diabetes medications have also been dispensed along with various other primary care medications.

The pharmacy department is one of the integral parts of the Health on Wheels program to bring reliable healthcare to the door steps of the rural poor and needy population who would otherwise not be able to afford such care due to issues such as the prohibitive costs and/or lack of transport available to travel to the nearest health center, associated treatment costs etc. We have also realized from our initiatives that patients are a lot more willing to positively engage and open up to health professionals about their health problems in their local environment rather than in a hospital setting which is out of their comfort zone. A lot of effort is also taken to educate patients about diet and lifestyle activities, which if taken on board, would treat or prevent future health problems from occurring such as diabetes and other non-communicablediseases.