Facing epidemic of amputations and death, Pacific Islanders fighting diabetes


Her shortness of breath, the pain in her chest and the numbness in her left arm and leg worried Maruia Teamo enough that she hesitantly tried to prepare better meals for her family.

Her husband hated it. So, every time the 39-year-old mother made a healthier meal, she also made him something he’d like. Tempted by his dinner, she always snuck some herself. She wasn’t getting better. She felt alone.

Teamo hoped that would change when she signed up for a brand-new free class on healthier living last month. Instead, the class provided the scare of her life. She took a blood pressure test on the first day. Normal systolic blood pressure falls in the range of 100 to 120, and 140 is high. Teamo’s systolic BP was an alarming 180.

Given that and her weight, she is at high risk of joining a vast epidemic sweeping the South Pacific, where diabetes is killing or maiming thousands each month.

“I got scared, and when I told my husband he was more scared than I was,” she said.

Their fright is real.

Doctors perform an amputation every 12 hours in Fiji, where a third of the population of nearly 300,000 is diabetic. Tonga is home to the world’s highest male obesity rate, and an estimated 15,000 Tongans in a population of 106,000 suffer from the diabetes, according to TVNZ.

Teamo’s home of Tahiti is part of the chain of islands that comprise the nation of French Polynesia, where 70 percent of the population is overweight and 40 percent are obese. Nearly 1 in 6 who live here suffer from Type 2 diabetes, a largely preventable, noncommunicable disease.

The suffering deeply troubles Tonga’s king, Samoan village chiefs, presidents, prime ministers and ministries of health. Each is searching for solutions.

Calling diabetes “a real scourge,” President Édouard Fritch last year imposed a 25 percent tax on sugary drinks in New Polynesia to combat the disease and its costs. Samoa has launched a major diabetes awareness campaign. Similar efforts are underway in New Zealand, Vanuatu, Papua New Guinea and more.

Success story

Many are looking at Teamo’s class for answers. Five weeks into the 12-week course, she and her family are changing. She has slashed portion sizes, increased her fruit intake and begun to exercise carefully. She loves the natural support group the class created for her. Even her concerned husband, Tunui, was willing to change for her.

“It feels like I’m taking control of my life,” she said after a bird flew through doors open to welcome breezes on a muggy morning. It strutted around the room. “Now I cook what I like. Since the first meeting and setting my goal to lose weight, my family is eating what I eat. And my husband comes back from his job on a commercial boat each weekend with fruits from other islands. Every morning, we have smoothies with those fruits.”

She credits the class and its colorful manual, “Eat Healthy and Be Active,” which has gained the interest of kings, presidents and chiefs since it was launched in Tahiti in February and in other South Pacific lands last August by The Church of Jesus Christ of Latter-day Saints.

The class and the manual are a clear sign of the depth of concern here. They were developed specifically by the faith’s Pacific Area presidency for this area of the church, overseen by the area president, a native of American Samoa named Elder O. Vincent Haleck. The class is offered through the church’s Self-Reliance Services programme and is only the second course in the worldwide church created at the area level to address a specific area need.

Amputee hospitals provided some of the motivation.

“An amputation is an ambulance at the bottom of the hill,” said Elder Ian S. Ardern, a member of the area presidency. “We’re trying to be the ambulance at the top of the hill. We’ve introduced this diabetes initiative in an effort to prolong happiness.”

When King Tupou met with the church’s president during his tour of six island nations last week, he asked President Russell M. Nelson to urge the church members who make up 60 percent of his country to live a healthier lifestyle.

“(The king) stressed the importance of education and a healthy lifestyle,” President Nelson said. “I told him I’d tell the people to be more obedient to the king, and he said they’d be ‘more obedient if it comes from you.’ I said, ‘All right, I will talk about a lifestyle that’s healthy and the importance of education.”

“Diabetes is affecting people everywhere and killing them at an early age,” Elder Haleck added. “The king has been very gracious in allowing us to bless the lives of people in Tonga. We are here to help them. We are their brothers.”

Female chief

The first woman high chief in the history of Samoa is Taiai Savali, 42. She leads her village from her home in Upper Hutt, a city outside New Zealand’s capital of Wellington, where last month she finished facilitating an “Eat Healthy and Be Active” class with her husband, Pio Savali, also 42, who once represented a Samoan side in international rugby sevens tournaments.

They had a big task ahead of them. The class is designed for groups of 12, but 27 showed up on Day 1, when they learned that Type 2 diabetes is largely preventable. The World Health Organisation says diet and physical activity interventions are more effective than medication

Every week, the Savalis measured their class members’ waists in centimeters and weight in kilogrammes. Every six weeks, they tested each person’s glucose count and blood pressure. The participants recorded everything in their own free personal manual, which included colorful charts showing ranges and risks. Participants reported weekly whether they got 30 minutes of physical activity and drank eight glasses of water a day, and whether they ate more fruits and vegetables, smaller portions and fewer unhealthy sugars and fats.

And less salt. Salt is Teamo’s biggest weakness, she said.

One Tongan man joined the Savalis’ class in Upper Hutt a week late. He weighed 348 pounds. His other numbers showed his health was on the border between yellow and red on the chart. Yellow is medium and red means a person is at high risk for diabetes. The man lost 61 pounds in 11 weeks, weighing in at 287. His numbers now border between yellow and green, or low risk for diabetes.

Relatable lessons

Pio said the lesson on portion sizes was critical.

“Island people, if you give them a big plate, they’ll eat it ’til it’s gone,” he said. When they learned about what foods were high in calories and carbohydrates, they were surprised by how much they were eating. Most tried to change immediately.

“Very early in the class, many told us in the sharing portion of class they had sacrificed a little bit of sugar or a little bit of chocolate,” he said.

The Savalis changed, too.

“We’ve gone from big dinner-sized plates to using small bread plates,” Taiai said. “We’ve said to the kids it’s OK to go and fill the bread plate a second time, but we don’t pile food on it like we’re never going to eat again.”

For 12 weeks, the Savalis taught the importance of portion size, healthy habits, planting a garden and understanding stress. When the class ended, 25 of the original 27 had stuck with it. Taiai’s skills as a former TV news anchor may have had something to do with it. Or Pio’s sincerity and credentials as a rugby player and coach. But they say it was the course, which calls for a facilitator-participant method rather than a teacher-student method.

The only problem for the Savalis’ large class was that no room in their meetinghouse was big enough to set up a facilitation-style meeting the way the church trained them to do.

Still, the facilitation method worked, letting everyone share and feel supported, Taiai said.

Her sister, who joined the class, credited another factor.

“The manuals are so relatable to our people,” Elizabeth Betham said. “The people interviewed and photographed in it are from Samoa. We know these people. They are people our people our familiar with.”

Back to the future

Changes in eating habits are a major reason that Fiji, Samoa and Tonga make the world’s dreaded top 10 list for diabetes prevalence. One reason is the importation of fast food.

“Before, people fished and picked their own food off the fruit trees on their property,” said Elder Meliula Fata, the Samoan Area Seventy of The Church of Jesus Christ of Latter-day Saints. “Now fast food has come and taken the place of the previous diet. People have land but are lazy to plant. Now we have a food initiative to encourage people to plant vegetables and supply their own food for themselves instead of going to shops to buy frozen foods.”

On a warm Friday morning at the Lotopa Garden nestled behind a chapel near the Apia Samoa Temple, workers water seedlings that supply “Eat Healthy and Be Active” class participants from 14 Latter-day Saint stakes on Upolu Island. Every class participant is assigned to visit the garden and choose seedlings to plant in their own gardens. The variety is wide — from cabbage to tomatoes, watermelons to eggplant, pineapple to papaya.

The seedlings are free, and business is brisk. The workers start new seedlings almost every day.

In congregations all over Upolu Island, class participants gather to exercise in new Zumba classes and around their dinner tables to meals with more vegetables and fruits.

Leadership in several nations has noticed, including in Samoa.

“The Ministry of Health has approved these programs and wants us to go to the schools to present it,” Elder Fata said. “They want to join ‘Eat Healthy and Be Active.”

Same boat

“You can go to temples in many places in the Pacific area now and find people gathered together outside giving their best shot at daily exercises,” Elder Ardern said. “It’s about the freedom you gain when you’re healthy.”

He said a man in Australia told him two weeks ago, “I’m a really disciplined person, but I’ve never been disciplined with my diet. This program has helped me. Now I’m half the man I used to be.”

Diabetes is insidious, according to Ardern.

“Diabetes is not the territory of overweight people alone,” he said. “We have to make sure people understand that. Some people just have it in their genes that they’re going to be more susceptible to diabetes, and being overweight adds to that susceptibility. Healthy living decreases that susceptibility.”

The classes began on the island of Tahiti in February once translation of the manual into French was complete. It is now in English, Samoan and Tongan, too. Teamo is looking forward to class on Wednesday night because it will be the halfway mark and a nurse will check her blood pressure for the first time since her scare.

Teamo said the first lesson asked participants to act in faith, and the woman who teaches teenagers in a seminary class four nights a week dove right in.

“I went home and prayed to Heavenly Father that he would help me eat less and feel better so I would be better able to serve him,” she said.

Restricted by her shortness of breath, Teamo has increased her exercise cautiously by playing ball with her 11-year-old daughter and her friends and taking them to the beach to walk and play. She walks more and watches less television.

She is grateful for her new friends in the class.

“We’re all in the same boat,” said one, Annette Maiterai, 45, a mother of two with great energy and even greater joy in the 9 pounds she has lost so far. “We embarked on the same voyage. When someone falls off the ship, we pick him back up and put him back on the boat.”