Marshall Islands Diabetes Wellness Center

Many hands make light work: Volunteers gather for a work party to clean and paint the building that will house the Diabetes and Wellness Center.

Majuro – More than 30 volunteers turned out March 12, 2006 to clean an old wing of the Majuro Hospital and unload a 40-foot ocean container filled with supplies and equipment for the new Diabetes Wellness Center being established by Canvasback Missions in the Marshall Islands.
 
Program Director Bob Chung (Seattle, WA) was amazed by the participation: "We had student missionaries, members of the Delap SDA Church, the current president of the Guam Micronesia Mission, the past president of the Guam Micronesia Mission, and even a couple of hospital employees.  The community has been so supportive; they have been a great blessing to us."

Left: Helpers unload a hydrotherapy unit. Right: Even the youngest volunteers enthusiastically pitched in to help clean up the clinic.

Chung was also amazed at the speed and efficiency with which the build-out was coming together in a place normally run at a slower-paced "island time". "Needless to say, with so many helpful hands, we were able to complete the cleaning of the facility, unload the container, AND get started on the painting.  We're on track to have the facility ready to start the program in a couple of weeks…"

"The program" is the Diabetes Wellness Program that, in 2005, Canvasback Missions won approval to establish in the Marshall Islands. The goal of the program is nothing less than to transform the health of the Marshall Islands people, by reversing the effects of diabetes, a deadly trend that began 60 years ago when western occupation brought refined western foodstuffs to the tiny nation.

The Diabetes Wellness Center will be an outpatient clinic occupying a vacant wing at the Majuro Hospital. The center will be a vital resource for more than one-third of adult islanders who now suffer the debilitating consequences of diabetes.

Chung was responsible for procuring all of the supplies needed to build out the clinic as well as the supplies and equipment needed to furnish it. Refrigerators, stoves, books, medical supplies and equipment, weight stations, elliptical trainers and exercise bicycles were just some of the items packing every square inch of the 40-foot ocean container that Canvasback shipped to the island in February. Then on March 9, Chung arrived in Majuro with carpenter Norman Cruthers (Fruitport, MI) and assistant Matthew Choi (Seattle, WA) and a two-week deadline to unload the container and complete the center.

Chung says that prayer, faith, and local support all helped to fast-track the process.

"Thompson Keju, one of the hospital administrators, was instrumental in getting the container released. He stated that in all his years with the hospital, he has never witnessed a container go through customs, local government, and be released and delivered to the hospital in one day.

"This is clear evidence of the relationship that Jamie and Jacque Spence have developed with the people of the Marshall Islands over the past 25 years through their good works, and clear evidence of God's plan and will to use Canvasback to address the diabetes problem in the islands."

Above: Student Missionaries turned out in force to
help clean and paint the clinic.

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Although hard statistics are lacking, the government of the Marshall Islands estimates that 30 percent of its people have diabetes. Through Canvasback’s Diabetes Wellness Program Canvasback they have been provided an historic opportunity to literally transform the health of the men, women and children of their entire nation. Even more important, the biblical and scientific principles taught at the center will have the potential to change the health of a nation whose children currently are at great risk of developing diabetes in their lifetimes.

To realize this vision of health for the island people, Canvasback is partnering with Loma Linda University, the Guam Micronesia Mission, and the Marshall Islands Ministry of Health Services in an approved scientific study to track the long-term results of lifestyle intervention.

Loma Linda University is overseeing the research aspects of the program, which is intended to prove whether or not lifestyle intervention can work for people in poverty circumstances and in an environment where food sources and cooking techniques are limited. In the long run, this important research has the potential to benefit the lives of impoverished people worldwide.

The program is the realization of a dream for mission founders Jamie and Jacque Spence, who are serving as principal investigator and chief operating officer. They are joined by a team of exceptional individuals who the Spence’s say were "chosen by God" for their experience and unique abilities to contribute to the success of the project.

Serving as co-principal investigator is John Kelly, M.D., MPH (Loma Linda, CA), an epidemiologist specializing in lifestyle intervention to treat disease. A faculty member of the Loma Linda School of Public Health and president of the American College of Lifestyle Medicine (www.aclm.net), Dr. Kelly was instrumental in authoring the grant that is making the program possible, and bears primary responsibility for ensuring that scientific rigorousness of the program’s research components.

Serving as the program’s medical director is Ralph Harris, M.D., (Coeur d’ Alene, ID), whom Dr. Kelly describes as the program’s "hands and feet—he makes things happen." Among Dr. Harris’ responsibilities are: coordinating the program onsite, serving as liaison with Marshallese officials, training the Marshallese medical staff and monitoring patients during the study. Harris is a pediatrician and a pediatric nephrologist with extensive missionary, clinical, academic, and medical management experience. He is also a charter member of Canvasback Missions, a friend for 25 years who smilingly remembers when "the mission was just an embryo."

Now semi-retired, Harris has maintained an interest and involvement in diabetes research throughout his career. He also served with Canvasback on a 1991 mission to the Marshall Islands, and says that these passions converged when he took the position of medical director for the diabetes and wellness program.

"It all came together pretty well," he says of this new challenge. "It looks like the Lord opened the doors for me to make a contribution again."

And how are the efforts going so far?

"The Lord is really blessing us," Harris says. "We can really see His leading; He has opened the way for us to make significant strides."

Brenda Davis, R.D., (Kelowna, B.C.) is assuming two challenging roles as health educator and dietician. In addition to developing lecture materials for the program, Davis will be training the hospital kitchen staff how to prepare healthy foods.

A registered dietician and nutritionist, Davis has authored five books and is the past chair of the Vegetarian Nutrition Diabetic Practice Group of the American Diabetic Association. Davis is also an internationally acclaimed speaker, recently completing a seven-month U.S. tour where she spoke to thousands of health professionals and lay people. She has been a featured speaker at nutrition, diabetic, medical and health conferences throughout the world.

"We are very fortunate to have such highly qualified professionals leading this program," says Jamie Spence, Canvasback’s founder and president. "God is providing us with a great foundation to build on."

Arrival in the islands of program missionaries (from left): Paul Davis,
Cory Davis, Brenda Davis, Bob Chung, Matthew Choi, and Ralph Harris.  

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Changing the future health of an entire nation is not an undertaking for the naïve nor the faint of heart. Fortunately, Canvasback’s team of experienced professionals is neither.

Dr. John Kelly, who will supervise the data collection process, says the realistic goal set for the first year of the study is to treat 60 individuals with diabetes through the lifestyle change program and compare them with a control group of 60 individuals receiving "usual care," which means not much until serious problems such as kidney disease and blindness occur. (After the trial, patients in the control group will be given the opportunity to enroll in the lifestyle program if they choose.)

"Studies show that keeping blood sugar below 140 reduces the ill affects of diabetes," Kelly says. "Our goal in the Marshall Islands is to keep it as low as possible. After the six month trial we will compare the results to see how the disease status has changed and how the patients have included lifestyle changes in their daily routine."

In February 2006, Kelly and other program leaders Harris and Davis spent three weeks at the SDA Wellness Center in Guam with six Marshallese health workers who have been designated to run the diabetes and wellness program in Majuro. Among the health workers, several had elevated blood sugars and several were previously diagnosed diabetics. All were amazed to see their own blood sugars drop precipitously as the weeks progressed, and they returned to Majuro enthusiastic about bringing a similar program to their nation.

As the team dietician, Brenda Davis has her work cut out for her in teaching the islanders how incorporate inexpensive, nonperishable, healthy food into their diet. "People in the islands don’t know what barley is or even beans," she says. "These foods could be imported as easily as the junk food that they are getting now."

Davis was shocked by the eating habits she observed when she first arrived in Majuro. "Their diet is ‘junk’ from morning ‘til night," she says. "For breakfast, they eat cookies dipped in dry Kool-Aid, or donuts or sugar cereal. The teachers say the students bring chips, candy and chocolate to school for lunch. They have white rice and SPAM, corned beef or fish for dinner."

When asked what she thought could be accomplished during the six-month trial Davis said very matter-of-factly: "We are hoping to reverse diabetes in the experimental group. People with diabetes get very sick very young and require a lot of treatment. It’s a fast downward spiral ending in renal failure. If we’re successful, the Marshall Islands government has every intention of setting up an intervention program. We must convince them that they can save an awful lot of money by doing so."

Dr. Kelly says that he, too, is optimistic about the program’s future in the islands. He says that goals for the second year of the study–in addition to continued monitoring of the original 60 patients–are to expand the program to include 120 to 200 patients and to introduce an educational program among the pediatric and adolescent population. Kelly is careful to note, however, that a long-term study of three to five years is needed to demonstrate the full impact of the lifestyle change program. "At that point," he says, "we will be able to turn it over to the Marshall Islanders to run."

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From a structure slated for demolition to a state of the art facility; with surprising speed the Diabetes Wellness Center has become the center of excitement in the Marshall Islands. With all the scraping, scrubbing, painting, building, organizing and heavy lifting behind them, the volunteers could momentarily step back and admire the beauty of what they had accomplished. 

And beautiful it is. The a large commercial kitchen and demonstration area are lined with shelves full of neatly stacked cookware and the exercise room is filled with brand new equipment. A furnished lecture hall, spacious aerobics studio, tidy waiting area and private examination room are perfectly arranged in anticipation of the grand opening, a few short weeks away.

The modern commercial kitchen is equipped with an overhead mirror for cooking demonstrations and stocked with cookware for hands on learning.

"It's been fun," says program director Bob Chung, understating the countless hours of sweat equity that have gone into making the facility shine. "The team has been so committed, and the island people are so excited to have us out there; it has been fun."   

To celebrate the completion of the build-out, the team threw a dinner party for the Marshall Islands health officials. The meal featured gourmet vegan food and was designed to give the attending officials a taste of what would be taught during the program. All were surprised and delighted by the meal. Chung remembers one doctor saying saying "I never thought I could enjoy a meal so much that didn't have meat in it."  Assistant Secretary of Health also expressed eagerness to experience the full program once it begins.

Cory and Brenda Davis (left and right front) and student missionary volunteers created a gourmet vegan meal to introduce the program to Health Services officials.

Asst. Secretary of Hospital Services Sandy Alfred (left), Dr. Zachriaias Zachraias, and and other health officials were pleasantly surprised that delicious food could be so healthy.

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With great fanfare, the doors opened to the brand new Diabetes Wellness Center on May 11, 2006. More than 100 health officials, dignitaries and public attended the standing room only grand opening celebration. Majuro’s 50 piece brass band entertained the crowd, and a youth organization called "Youth to youth in Health" performed skits and dances.

Speaking at the ceremony was Canvasback Founder and President Jamie Spence, along with Marshall Islands Minister of Health Alvin Jacklick, U.S. Ambassador Greta Morris and other Marshall Islands dignitaries. Spence’s address recounted the early days of the ministry, he and his wife Jacque put up all of their savings and began building the world’s largest sailing catamaran for the purpose of bringing health care to the outer islands of Micronesia.

"Even back then, as we sailed among the outer atolls with our crew of physicians and dentists, ministering to the island people and teaching the health assistants and dental nurses, the ravages of diabetes were evident," he said. "Not long after, Marshall Islands President Amata Kabua went to Weimar Institute in California and learned that lifestyle, nutritious food and exercise can control diabetes and prevent many degenerative diseases. President Kabua asked us to develop a Diabetes Reversal program for his people, and the dream was born.

Spence went on to detail the dedication, hard work and answered prayers on the part of many people that brought the dream for the new center to fruition. He ended by saying, "My personal burden is for the children, who are currently at great risk of developing diabetes in their lifetimes. If we can save even some of them from the crippling and life-shortening effects of diabetes, then my dream really will have come true."

	"I would like to take this opportunity, on behalf of Mr. President, to express our sincere appreciation for all the staff of Canvasback who have in some way contributed to this success." Alvin Jacklick Marshall Islands Minister of Health
	"The Diabetes Wellness Center will help support two of the most important goals of our US - RMI amended compact...that is promoting better health and improving education in the Marshall Islands." Greta Morris U.S. Ambassador to the Marshall Islands
	"I’m elated that God has allowed me to participate in the beginning of this first important step in reversing the deadly progress of diabetes in the Marshall Islands." Jamie W. Spence Founder, Canvasback Missions, Inc.

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First Participants See
Dramatic Changes

Program director Bob Chung was thrilled to witness the enrollment of the program's first eager participants. "The Diabetes Wellness Program is, from my perspective, God's will unfolding in front of our eyes," he said. "People are being touched and lives are being changed in the Marshall Islands through this program. They are becoming healthier, as witnessed by the changes in their blood sugar, weight, cholesterol, etc. "These improvements translate into people coming off or reducing their need for medication. People's vision is clearing so that they can read at night again. They no longer need to have their grandchildren massage their legs because of the pain. Symptoms related to gout are disappearing, allowing them to walk again without pain."

"These folks are working the program so far, and God is blessing. For some of them it is like a miracle! They cannot imagine their disease is actually going away. And using such simple, easy methods." -John Kelly, MD, MPH

Co-principal investigator John Kelly has also been encouraged by the initial progress reported by the patients. He tells of a patient named Kenye, who has been on medications for diabetes and high blood pressure for years. She told him "I'm feeling more energetic, and even my neighbors say I am looking stronger. People told me my diabetes was too far along to be reversed, but I told them 'We'll see...' and joined the program anyway." Dr. Kelly told her she was doing very well and that, "Yes, we would see that lifestyle changes can stop and even reverse diabetes in most people."

Teaching the islanders how to cook delicious meals using inexpensive, nonperishable, healthy food is the responsibility of Brenda Davis, RD.

Brenda Davis, team dietician and health educator, couldn't be more excited about all the changes she is seeing in the participants. "Some of these people have had years and years of excruciating pain in their feet from gout. Within days of being on the program their pain just disappeared. Now they're walking all over! Every single person has seen remarkable changes. They have lost 10-15 pounds, they're walking every day and are sleeping better at night. People everywhere are saying it's just a miracle!"

Through diet and exercise, Marshallese men
and women have experienced dramatic changes
in health over just a few short weeks.

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by Ralph D Harris, MD, MBA

Eight long months! Why would one take so much time from a busy, interesting, stimulating career to go out on a long arduous journey to the other side of the world? Who would want to leave the beauties of "God’s Own Country," as Northern Idaho is known, with its rivers and lakes and mountains and outdoor recreation? All in exchange for the unending confinement of a rather barren tropical coral island 30 to 40 miles long and only 100 to 200 yards wide, with its scorching temperatures, oppressive humidity, and absence of seasonal variation?

Two to three weeks, yes! Sure, most of us would be attracted to a brief interlude on a visit to the romantic South Pacific. Don’t several teams of medical, dental and nursing personnel respond each year to Canvasback Mission’s persuasive invitation for a short spell of volunteer service; the warm feeling that comes with a brief opportunity to practice medical skills in an under-served part of the world? Surely we all need the chance at least once in a lifetime to get away from the daily grind, the tension of productivity and accountability…

But eight long months? And alone, with no wife and no grandkids? Who would consider leaving the lifestyle comforts of home behind for that long? Away from the technology of computers, regular daily mail and newspapers, the conveniences of reliable cell-phone service, and credit cards and CNN? How does one survive in a one-room apartment, with frequent cold showers, uncertain laundry facilities, no home-cooking, and only a limited set of clothing from a stuffed old suit-case? Sure, it is fascinating to experience a completely different culture, with unusual customs and values and new ways of looking at things. But eight long months?

Well, it’s not all that bad! Very soon one is consumed with the challenges of setting up all the details of a rigorously scientific research project. Hundreds of answers must be found for a myriad of questions nobody had even thought of before. New ways have to be invented to meet the challenges of the local culture. An old, dirty, neglected building, about to be demolished to be resurrected, rebuilt, cleaned up, renovated and completely furnished with everything to transform it into a state-of-the-art health center, unequaled in the whole of the south seas. Local personnel have to be recruited, interviewed, employed, motivated and mentored to grow into the support staff, destined to eventually take over the project and adopt the new methods and ensure sustainability when the expatriates finally leave.

The 10,000 diabetic patients on the island had to be reached, screened and recruited, even through the limitations of a foreign language, and inefficient mass media, to be convinced that there is hope. They needed to be persuaded that their inexorable fate of pain and suffering and weakness, with their inevitable toll of endless medications, multiple surgeries, prolonged hospitalizations and denial of expensive procedures to reverse the devastating complications, can be avoided. And not by some new magic potion, but merely by being willing to change lifelong habits, which had long developed into ingrained customs and which had now become a part of the national culture.

They had to be willing to use their sapped energy to engage in strenuous physical exercise. They had to be willing to give up the rich, processed, refined, fat- and sugar-laden foods, imported by the wise, respected Americans over the last 40 to 50 years. Instead, they had to be willing to accept the premise and the promise that locally-grown green vegetables and fruits, which could only be cultivated with difficulty in the rocky, salty coral soil, and which traditionally were only good for feeding the pigs, that these foods were the ones to be consumed, if the relentless progression of diabetes and its complications were to be averted.

With all this to do, hardly any time was available during the 12- to 14- hour days to experience loneliness or frustration … except when one found yourself at night in one’s lonely room, with the thoughts of home and the missed warmth of loved ones…

But thanks be to God for the end of each week, with the peace and joy and rest of the Sabbath! Thanks be to our Maker for opportunities to test the hypotheses of our favorite research interests. Thanks be to our Guide and Mentor for opening new doors for rewarding service, again. Thanks for the support and warm fellowship of co-workers!

Thanks to our Father for the opportunities to work with His dear responsive island children. Thanks to Him for their renewed joy and commitment, the sacrifices and hard work they are willing to expend. Thanks for the transformation in character and values as they appreciated the dramatic results of increased well-being, of steadily-falling blood sugars, blood pressures, blood lipids and body weights. Thanks for the increase in hope and the renewed zest for life, with the promise of longer disease-free years. Yes, above all, thanks for the newly-ignited faith we saw in so many, so often.

These are the rewards which make it all worthwhile, which call us back and which move us to say "Yes we will go again!"

The Diabetes Wellness Program requires the assistance of health professionals who have a heart for service and a passion for wellness as well as being experts in their fields. These individuals must rearrange their busy lives in order to commit several months to working with the program in Majuro.

Meet some of the most recent additions to the wellness center staff:

Judy Payne, RD

Judy's role is one-on-one nutritional counseling and developing materials for the program manual.

Judy is well qualified for this role, having spent 17 years in the mission field. She helped start the Schools of Nutrition at both Peruvian Adventist University and Montemorelos University. She also taught at Chile Adventist College and coauthored a diet manual for health care facilities in South American countries. Judy is also a past president of the Adventist Dietetic Association.

"I’ve gone to many, many countries and seen a variety of situations and know the needs out here," she says. "Now that I’m semi-retired I can spend a little time and answer some of those needs, especially when it involves nutrition…Personally I think that this is how one keeps up their own faith experience, by being of service to somebody else. It gives you a certain satisfaction knowing that you’re doing something and accomplishing something."

Evelyn's role is training cooks managing food service for the program.  

Evelyn teaches at Andrews University in Berrien Springs, Michigan and is the nutrition director for the Michigan Conference of Seventh-day Adventists. She has been conducting wellness programs for 30 years, promoting a plant-based diet. Judy is also a past president of the Adventist Dietetic Association.

"I have just been delighted to be here, working with Brenda and John Kelly and others," she says. "This is just an incredible team with amazing skills. Judy has a lifetime of experience working in many countries creating dietetic programs so she’s got a wealth of knowledge. Brenda and I have such a similar philosophy of cooking and teaching. I don’t think I could have teamed up with anyone who is more closely aligned."

Evelyn says she has been busy from 6:30 a.m. to 9 p.m., preparing foods for the program, creating recipes and trying to integrate as much locally-grown foods as possible. "Our emphasis is on eating unrefined foods and bringing them back to the original foods grown on the islands as much as possible," she says.

"Our goal here is to reverse diabetes. And I have seen it work in my practice and in the wellness programs I do, and it’s exciting to come to this island and to impact the island. I think the participants that are involved in this program are high impact in the community, and their influence is just going to be felt everywhere. We have administrative people in the government, we have teachers, and people in all walks of life, and we hear them talking about how they are sharing the information with others.

"It is just very, very exciting to be part of this community and see the potential that’s available."

Stay tuned and stay informed about the progress of the Diabetes Wellness Program. If you are not currently receiving our Quick-E-News email newsletter and would like to, please subscribe here.

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