Perspectives From the 2017 Medical Mission to Batiki

In this article, we hear from Kevin Campbell, MD and Suzy Feigofsky, MD, FHRS about their experience traveling to the remote island of Batiki, Fiji as part of Sea Mercy’s RISE program, which helps empower remote islanders to a healthy and self-sustaining community through health, education, and agricultural-based programs. Dr. Campbell recently led a medical team August 6-19th to provide care to Batiki’s natives. 
Dr. Campbell is an electrophysiologist and was recently named CEO of PaceMate™. Dr. Feigofsky is an electrophysiologist with Iowa Heart Center in Carroll, Iowa.

The RISE Batiki Experience

By Suzy Feigofsky, MD, FHRS

The journey to Batiki was truly extraordinary. We sailed on the Uto Ni Yalo, a traditional Fijian sailing vessel. The excitement on board was palpable as we were off to begin our adventure. Unfortunately, Mother Nature had other plans, with 30 knot winds and 15-foot swells preventing us from making it to our destination at first. 

It was on our maiden voyage when I first realized that all of my years of advanced training could not do much in the middle of the Pacific Ocean. Of the 35 volunteers, 27 had become seasick. A three-hour journey turned into eight hours, and we were separated from our medical supplies. We pooled all motion sickness medicine on board and were depleted after hour 7. People were becoming dehydrated and cold. It was on this boat that I realized we had a solid medical team. We found electrolyte powder and did the best we could with what we had. Fortunately, we made it to a resort island and everyone recovered quickly.

Batiki is a beautiful island, with equally beautiful people. The medical clinic is sponsored by the government, and one nurse cares for the whole island. Tale, the Batiki nurse, was much better trained than I had anticipated, and the clinic had more supplies than I expected. What was unexpected, and surprising, was that there was no running water or electrical access in the clinic. There was a nebulizer machine, but no way to use it. There was no way to clean instruments or sterilize them. Tale departed shortly after our arrival due to a death in her family. She left a “community health worker” to assist us, but we were basically on our own. 

The first day of clinic, the entire school showed up at once — yes, the ENTIRE school! Our pediatrician was due to arrive the following week. Ann, our family practice physician, helped this adult specialist navigate the unfamiliar. Thankfully, the children were very patient — not one complained during the long wait. I allowed everyone I saw to listen to their own heartbeat. The look on their faces was so special and heartwarming. The clinic was stressful, but we made it through. Other than a tricuspid regurgitation murmur, the exams were uneventful. All children were a healthy weight and incredibly active. 

That afternoon, we learned that nothing happens after lunch. On Batiki, the afternoon is meant for rest, play, food preparation, and showering.

It was quickly apparent that the diet on Batiki is very carbohydrate heavy. Rice or noodles are served at nearly every meal, with cassava (a root vegetable). There is fresh fish or crab, if someone in the family can catch them. There are chickens on the island, but they roost in the forest and the villagers have a hard time finding their eggs. Catching a chicken for food has also proven to be a challenge for villagers. If a fresh source of protein is not available, they use canned tuna or corned beef. There is cabbage and a spinach-like green on the island called “bella”, as well as pumpkin squash. 

After a few days on Batiki, I came to realize that there was little variation in the daily meals. At the end of my two weeks, I am happy not to eat white rice or cassava for the foreseeable future. 

We went into the experience expecting to see a lot of diabetes and atrial fibrillation. That hypothesis was blown out of the water — all but one of the diabetics were previously diagnosed. I saw only one case of atrial fibrillation. He was literally the last patient I treated on my last day on the island.

I was surprised at the amount of hypertension, particularly in men in their 30s. They were also more likely to be obese or overweight. I suspect these gentlemen travel to or live in Suva or Nadi to help provide for their families and village. They tend to eat more of a Western diet and drink alcohol. On the contrary, the elders, as a whole, were extremely healthy.

The non-cardiac cases were quite interesting. On one of our first days, we saw a woman with the most impressive malar rash I have ever seen. She also had joint pain. Kevin started her on a steroid burst, and by the time of our departure, her rash and joint pain were gone.

We also saw a case of neurofibromatosis who presented with “painful boils”. He had café au lait spots and multiple neurofibromas. Several days later, we saw another patient with several lesions on his head that have been present since childhood.

It was at this moment that I appreciated the impact of social media. With permission, I posted this patient’s photo to the Physician Moms Group (PMG) on Facebook, which consists of over 60,000 female physicians. I had a diagnosis within seven minutes! The lesions were plexiform neurofibromas. We are going to have the nurse on Batiki do a family tree and genealogy research to find out if the two gentlemen are related. I suspect there are other cases of neurofibromatosis waiting to be discovered. By far, this was the most fascinating case on Batiki.

What I was completely unprepared for was taking care of the volunteers. I expected infectious diarrhea and scrapes, etc., but I did not think to study coral injury. I am grateful that Sea Mercy had a satellite and internet access. We ended up with two volunteers with coral injury and infection. One progressed rapidly and required medical evacuation to Suva for surgical debridement. We did not have ciprofloxacin to cover pseudomonas, and instead had to pool the doses we brought for infectious diarrhea in order to have enough for our two patients. 

However, what proved to be most challenging was trying to balance Western medicine with the holistic and religious beliefs of several of the volunteers. Personally, I am very open minded and tolerant. However, when a patient opts out of wound irrigation for wormwood oil and prayer, I have a serious problem. Practicing medicine with limited resources was extremely challenging; having my medical judgement undermined was infuriating.

I leave this experience a changed woman. I have made many lifelong friends. My family in Mua Village was extremely generous with their food and kindness. I will certainly return to Batiki. I hope to have made an impact on the island, but I suspect I received more than I gave. 

Wading In (Literally) and Helping Others on Batiki: I am Forever Changed

By Kevin R. Campbell, MD, FACC

As a physician and electrophysiologist, I feel compelled to help others. However, while practicing in the comfort of a large medical center in the United States, I am isolated from the realities of healthcare in other less fortunate parts of the world. While we can certainly donate money and advocate for charities that work abroad, it is not the same as going there yourself and sharing your time and talents. 

For years, I have contemplated traveling to a remote part of the world in order to engage as part of a medical service team. However, the time was never right — there were always obligations at my practice and other deadlines to be met. Finally, I decided this year to make a medical relief mission a priority — and I am so thankful that I did. Nothing in my training could have prepared me for this trip — it was one of the most challenging (and rewarding) experiences of my entire career. 

How It All Began

About three years ago, I met Richard Hackett, President of Sea Mercy and RISE Program Director. This organization was created to provide help for those who had been devastated by tropical cyclones in the South Pacific islands. Cyclone Winston — the most powerful cyclone to ever make landfall in the Fijian islands — completely destroyed entire villages, leaving inhabitants with little hope of recovery. After the devastation of Winston, what started as a fleet of sailing vessels and volunteer captains designed to help natives on remote islands rebuild after natural disasters, expanded into a comprehensive relief program — bringing agricultural education, medical, dental, and eye care to island inhabitants all throughout the Fijian islands. After several months of discussions, I ultimately (with the blessing of my wife and family) agreed to not only go to Batiki, but to lead the medical efforts there.

Shellshocked on Arrival — That’s an Understatement! 

The excitement of the trip was only matched by my anxiety and fear of the unknown. I remember packing as much as I could into a backpack, and then gathering donated medical supplies and placing them in a suitcase. I tried to learn as much as I could about Fijian cultures and customs before I arrived, but nothing really prepares you for the experience. Fijians are loving, happy, and welcoming people, and they almost always have a smile on their face. However, they are quite rigid in their village customs, and it is important to follow protocols (such as no head coverings, no sunglasses, and nothing carried on the shoulders) while walking or visiting in the villages. 

After a very rough sail to the island that ultimately took two days and two attempts due to 15-foot seas and high winds, we arrived on Batiki. The island is surrounded by coral reefs and is quite treacherous to navigate. Our boats were able to get into the bay close enough for us to wade ashore in waist-deep water. The arrival process was overwhelming and quite emotional — the entire village greeted us on shore and began to sing for us as we waded ashore. We were then taken to the village community hall for a welcoming ceremony called a “sevusevu”. During this ceremony, we are officially inducted into the village as members by the Chief, and we, in turn, present the Chief with a gift of kava (a root that is then prepared and served as a ceremonial drink during the Kava Ceremony to follow). Once the ceremony was over, we were escorted to our respective accommodations and met our host families. It was quite a shock to realize that the island had no running water and no electricity other than solar panels, which provided some light at night. After settling in with our families, we then went to work at the nurse’s station on Batiki. The clinic also had no electricity, no running water, and very limited supplies. We worked closely with the nurse, who has the responsibility of caring for all 235 island inhabitants, to determine the best way to begin offering our medical services. We set up a triage area and began seeing patients. We realized very quickly that we would be relying on clinical judgement and one another. We also had no good way to sterilize instruments and no immediate means to power up our laboratory (which consisted of a hemoglobin A1C machine). Thankfully, Dr. David Albert and the AliveCor team donated several of their devices, so we were able to screen all villagers for atrial fibrillation. 

I was amazed by the people that we had the privilege of caring for in the clinic. We saw babies, kids, teenagers, adults, and the elderly. I even had the chance to make a few house calls to those who were unable to walk to the clinic. We saw a wide variety of pathology, ranging from diabetes to hypertension as well as a case of lupus and neurofibromatosis (none of which we had any laboratory confirmation of). All of our patients were inspiring — they were able to do so much with so little, and they were all so grateful for even simple remedies that we could provide for common ailments. The entire experience in the clinic was humbling, and I feel honored to have been able to care for the villagers on Batiki.

Ready to Return Next Year! 

After leaving my “Batiki family,” I quickly realized just how much I missed my work there. I was afforded an opportunity few physicians will ever have — to practice medicine in its purest form — doctor helping patient without ANY government or regulatory interference. We worked with very limited resources, and relied on the tools that Sir William Osler perfected in the early days of medicine — listening, observing, and doing a physical exam. It was incredibly gratifying to help those with such immense needs. While there were certainly times when the job was overwhelming, and the living conditions and cultural differences were challenging, the gratitude and smiles on the faces of the villagers made it all worthwhile. I would like to challenge all members of the EP community — nurses, techs, physicians, and administrators — to reach out and help others across the world. Medicine is global and the need for good care is universal. Consider joining me and Dr. Suzy next year as we journey back to Batiki!

For more information on how YOU can get involved, visit the SeaMercy website (www.seamercy.org) or contact Richard Hackett at info@SeaMercy.org.