Noncommunicable diseases (NCDs) are the leading cause of premature death in Pacific Island countries, accounting for 75% of all deaths. Among these, diabetes and cardiovascular diseases are the most prevalent. Dr Rooney Jagilly, head of the surgery department at Solomon Islands' National Referral Hospital (NRH), has witnessed this shift firsthand over his 32 years of practice. When he started, diabetes was rare, but now it’s a crisis.
“We’re seeing a dramatic increase in NCDs, including diabetic foot disease, which is overwhelming our healthcare system,” Dr Jagilly explains. “It affects people of all ages, leading to early deaths and disabilities, which ripple through families and communities.” In Solomon Islands, diabetes is expected to rise as traditional diets are replaced by processed foods and sedentary lifestyles. This surge is expected to strain healthcare resources and threaten lives.
The twin scourge of diabetes and diabetic foot
Diabetes is a chronic condition where the body is unable to sufficiently break down sugar, leading to high blood sugar that damages nerves and blood vessels. Uncontrolled diabetes is a leading cause of lower limb amputation, kidney failure, heart attack, stroke, and blindness.
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The impact of diabetes on blood flow, nerve function, and pressure makes it especially dangerous for the feet. Without proper care, wounds become infected, and delayed treatment often results in amputation or even death. Photo: WHO/R. Serrano
Dr Jagilly said that at NRH, 60% of surgery ward inpatients have severe diabetic foot wounds. Many patients seek care too late, leading to amputations or even death. The disease’s impact on blood flow, nerve function, and pressure makes it especially dangerous for the feet. Without proper care, wounds become infected, and delayed treatment often results in amputation or even death.
Dr Jagilly emphasizes the strain on resources: “Diabetic foot disease consumes significant time, medications, and staff hours. It’s unsustainable.”
Diabetes is so insidious that The Lancet in 2023 described it “a defining disease of the 21st century.” It added: “How the health community deals with diabetes in the next two decades will shape population health and life expectancy for the next 80 years. The world has failed to understand the social nature of diabetes and underestimated the true scale and threat the disease poses.”
It’s preventable
However, diabetes and diabetic foot disease are preventable with early detection, monitoring, and education. Theresa Ferani Mateaki, a nurse and national diabetes and diabetic foot facilitator, highlights the importance of daily foot checks and early intervention. “By the time patients seek help, it’s often too late,” she says. “Regular checks can save lives and limbs.”
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Theresa Ferani Mateaki, a nurse and national diabetes and diabetic foot facilitator, highlights the importance of daily foot checks and early intervention. “By the time patients seek help, it’s often too late,” she says. “Regular checks can save lives and limbs.” Photo: WHO/R. Serrano
In 2024, the Ministry of Health and Medical Services (MHMS), supported by WHO, launched a national program to address diabetes and its complications. The program coaches healthcare workers and aims to reach 80% of the population by 2026, with a focus on screening, management, and prevention. It has two components: coaching, which strengthens workforce skills, knowledge and competency; and quality improvement, which targets health facilities with a transformational process to strengthen health systems.
The program will be scaled to cover 80% of the population by December 2026, with quality improvement interventions to strengthen service capacity. WHO will work in partnership with MHMS to support the national scale-up and resource procurement for primary healthcare facilities, enabling strong screening, management and prevention of diabetes-related complications.
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In 2024, the Ministry of Health and Medical Services, supported by WHO, launched a national program that coaches healthcare workers and aims to reach 80% of the population by 2026, with a focus on diabetes screening, management, and prevention. Photo: WHO/R. Serrano
Over 300 health workers have been coached, and more than 20 nurse champions, like Theresa, are leading the charge. “We’re seeing progress,” says Theresa. “Patients are more proactive in caring for their feet.”
Despite these efforts, Dr Jagilly stresses the importance of prevention. “Once diabetes takes hold, it’s hard to manage. But early action can save lives, limbs, and livelihoods.”
WHO thanks the New Zealand Ministry of Foreign Affairs and Trade and the Institute of Philanthropy for their contributions towards making this work possible.