Kiribati, a country spread across dozens of atolls in the central Pacific, is one of the most remote and geographically dispersed countries in the world. It is also one of the most vulnerable countries to the impacts of the climate crisis.
Doctors Without Borders/Médecins Sans Frontières (MSF) has been working in Kiribati since October 2022, in partnership with the Ministry of Health and Medical Services, to improve maternal and pediatric care. An MSF medical team is working alongside Ministry of Health staff to provide pediatric and maternal health care in the country’s main hospital and to help build capacity among local health staff.
An MSF team has also worked on the outer islands, training nurses on neonatal care and screening for women who have high-risk pregnancies due to the very high rates of gestational diabetes.
Climate change exacerbates disease risks
Kiribati is experiencing air and sea temperature rises, storm surges, high winds, erosion, drought, and flooding. This poses direct and indirect threats to human health, including injury, disease outbreaks, and malnutrition.
In June 2022, the government declared a state of emergency because of prolonged drought. Kiribati’s water table is prone to salinization. The water is replenished by rainfall, but when there's no rain, people's access to clean water is limited.
“The water in wells is becoming more brackish [salty] so it's no longer suitable for drinking,” said MSF pediatrician Dr. Jo Clarke. “A lack of fresh water makes sanitation in the community more difficult, heightens the risk of diarrhea and skin infections, and makes it harder to grow food.”
A complex health burden
Kiribati’s health burden is complex. It has the highest prevalence of communicable diseases such as tuberculosis and leprosy in the Pacific; the second highest prevalence of non-communicable diseases among the world’s low-middle income countries; and it has some of the highest 2 diabetes and infant mortality rates in the region.
Though there are also high rates of obesity on the island, the MSF team has been seeing more and more malnourished small children.
“What is striking compared to other countries I have worked in where there has been malnutrition, is that many adults here are overweight,” said. Dr. Clarke. “That’s the other end of poor nutrition; large numbers of people with diet-related noncommunicable diseases such as type 2 diabetes. It’s difficult to grow fruit and vegetables here and accessing healthy, nutritious food is not easy. Most food is imported, and it’s high in fat and sugar.”
“The burden of diseases is immense for such a small country,” said Dr. Tinte Itinteang, Kiribati’s Minister of Health. “The maternal mortality and infant mortality rates are among the worst in the region. The infant mortality rate is about 10 times higher than in Australia and New Zealand. These things didn’t happen overnight, and some of them have been getting worse over the last 10 years.”
Barriers to comprehensive health care in Kiribati
Kiribati only has a population of 120,000 people, half of whom live on just one island, South Tarawa, which is also where the capital, Tarawa, is located. The country comprises 33 islands where the remainder of its population lives.
Kiribati’s size and remoteness impact the government’s ability to provide comprehensive health care. One of the biggest obstacles to providing care is a lack of qualified medical personnel.
Over the last 12 months 30 of Kiribati’s most experienced nurses left to jobs in Australia and New Zealand, and many of its doctors have also migrated to other countries for professional opportunities, said the Director General of Health Dr. Revite Kirition. “We’ve had doctors that never returned from their medical training.”
Remoteness impacts access to essential medical supplies
Dr. Clarke has seen first-hand how difficult it can be for the Ministry of Health and Medical Services to secure the essential medical supplies and drugs that they need.
“There's been struggles with pharmacy supply and equipment supply,” he said. “We're quite remote, so it takes a lot of time for something to travel here by boat or by plane. We recently faced a problem with a lack of therapeutic food for malnourished children when we needed it.”
Moannara Benete, who leads the country’s central medical stores, says it is very challenging for i-Kiribati to access essential and lifesaving drugs needed in time and at a fair price. “When the F75 and F100 therapeutic milk that we use for malnourished babies finally arrived in Kiribati, it had expired, because it took eight months to get here from Europe,” she said.
"I don't think we have procurement power or negotiation power. We should work with our Pacific neighbors so we can secure the essential medical supplies we need as a region. It is a critical situation we face, and we need urgent assistance.”