From Joseph Camillo (24 June 2010)

Response to “Rotuma islanders refuse to change diet and lifestyle”

I have a problem with this statement from FBCL and the Doc in Rotuma:

1. How long has the Doc served in Rotuma to qualify him to make that statement?
2. What are the baseline data and figures?
3. How many deaths within a comparative time frame can he justify the statement?
4. What are the stats per District?
5. What foods is he stating are contributing factors towards NCDs?
6. Can statements coming out of Rotuma be vetted by the Council and/or DO first so that it represents both sides—fair and correct?
7. What are your views on this news item?
8. If this is a major problem or an issue in Rotuma what are the reps from each itu’u doing about it—both on the Island and here in Suva?
9. How can Civil Society contribute?
10. I ask for all of above as I was in Rotuma in 2001 and 2005 and it was not in the agenda as a concerned item when I met with Council of Chiefs at Maftoa, Itumuta.

Joseph I.A Camillo
Ter: Riamkau (Faguta) and Termatau (Noatau)

From Ragfuata Kamoe Ralifo (25 June 2010)

Well, the heading of this article potrays such a strong and negative opinion on our people.

I wonder what is the purpose of this article, is it to create awareness?

Dr Nadakuitavuki, refuse,insistence,barriers . . . . these words used,it seems that you have already given up on our people on the Island,please give us figures of any studies done to prove your point,create some awareness programmes to asisst and help our people to change their lifestyle if your statement is correct.

Generally I am sure that our people,families and loved ones in Rotuma would all like to live a healthy lifestyle.

Ragafuata Kamoe Ralifo (Malha'a)

From Henry Enasio (27 June 2010)

Surely the learned doctor wouldn't have made the comments without any hard evidence to qualify his statement. It'll be very naive of him to do so without any raw data to base this allegation on; he needs published statistics for support. Otherwise he's going to be inundated with all sorts of responses and innuendos. Unless of course the FBC Reporter had conjectured this to exaggerate and put a sensational spin on the comment to mesmerise the community and justify to his peers the essence of his trip and the hospitality Rotuma afforded him.

My understanding of NCD is simply the type of diseases we create for ourselves, such as obesity, diabetes, high blood pressure, stroke, heart attack etc. that are not transmitted from others, but are caused by, amongst other things, our diet, alcohol consumption, cigarettes, lack of exercise, and lifestyles. True, many of these NCDs can be prevented through a change in lifestyle and balanced diet with a lot of taro, yam, cassava, breadfruit, 'ikou, vạti, lumu, fish, ifi, coconuts, shellfish and fruits that are plentiful in the island, and whenever available, milk to make the meals photo complete. But the appetites must be an exercise in moderation.

Certainly the NCDs are not restricted to Rotuma only, but are spread throughout the country and are very prevalent in developed countries where fast and junk food are readily available and consumed without temperance and adequate exercise.

My great grandma lived to 113 years and her daughter (my grandma) was 100 years old when she died from pneumonia contracted as a result of a filariasis campaign. Also I had two aunties who lived to 97 and 93; my grandfather lived to 86 and my dad, who started smoking when he was 13, lived to 76 and my mum to 70. All ate that simple diet that Mr Coka mentioned that we in Rotuma "will not move away from the type of food they eat and argue that this is how their ancestors live and they cannot move away from it as it is traditional." The only exception to this is that my family are hard workers and they walked and that was their recipe for longetivity.

Mr Coka's article is devoid of any truth about our traditional diet. which he belittles and blames for the cause of "high rate of NCDs .... and a lot of deaths on the island ''.

Of course lifestyle is much more than just diet, which I hope Mr Coka will be keep in mind when he next ventures out into a contentious issue such as "our traditional diet ."

Henry Enasio

From Alan Howard (27 June 2010)

The data that I am familiar with suggests that Dr. Nadakuitavuki is quite correct about the transition from communicable to non-communicable diseases (NCD) on Rotuma, but he is badly mistaken to blame the traditional diet. Indeed, the traditional diet, described by Henry Enasio (above) was extremely healthy. That diet, along with plenty of exercise required by the traditional lifestyle, resulted in a people described by early European visitors as healthy and well-built. Diseases introduced by the Europeans (measles, influenza, whooping cough, etc.) were the main causes of death following European intrusion until the introduction of antibiotics in the 1950s.

The transition to non-communicable diseases can largely be attributed to the adoption of a non-traditional diet high in fat, salt, sugar, preservatives and other additives to processed foods, in conjunction with a decline in vigourous exercise (walking to and spending long hours in the bush vs. using motorised transportation & sitting around drinking kava, etc.). This transition to so-called "modern diseases" has occurred all over the world, and quite notably in the Pacific Islands. That a rise in obesity, diabetes, hypertension and their resultant medical conditions has occurred in Rotuma was documented in 1996 in a survey by Dr. Temo Kilioni (see his report, which I have uploaded). Note the high rates of obesity in the report. Early European visitors to Rotuma described the people as "well built," "well proportioned," "who could have served as sculptor's models," with no mention of obesity. Even when I was on Rotuma in 1960, obesity was a rarity.

Indeed, one could make a much better case for Rotumans to regain their healthy status by returning to the traditional diet and lifestyle. In my opinion, it is the loss of that lifestyle that is the the main threat to the health of Rotumans on the island today.

I must conclude by saying that I, too, found Dr. Nadakuitavuki's language, as reported by Mr. Coka, offensive and ill-considered.

From Dr Enasio Aisake Morris

Having read the related article and the correspondence that followed, I felt that at least one of the medical personnel should comment on this issue.

I do agree with Dr Nadakuitavuki’s comments that Non-communicable diseases (NCD) are prevalent in Rotuma. This problem is not isolated to the island as similar trends have been noted in other Pacific countries as well. In fact, NCD is now a major public health problem among the Pacific Islands and amongst Westernized Countries including Australia.

We don’t need any further studies in Rotuma to tell us about a problem that is common knowledge to us. What we actually need is to accept the current observation studies and start implementing strategies to counter this epidemic disease.

I am sure that Dr Nadakuitavuki’s comments have been taken out of context. In addition, I do not see any reason why Rotuma’s medical officer’s comments need to be screened by non medical personnel especially as it relates directly to health issues on the island.

We need to start implementing intervention and preventative strategies by involving relevant stakeholders on the island and the ministry of health to counter this epidemic. One must understand that change in behaviour takes time and unless we accept that we do have a problem than health promotion strategies and interventions that follows will be non-futile.

As for the Mortuary issue, I believe this should be taken back to the Council of chiefs meeting in Rotuma so that the people are consulted on this issue, as this seems to be a recurring request and interest. I do understand Dr Nadakuitavuki’s views on this but I believe it is best for the people of Rotuma to make this decision, as it will basically affect them.

As a final note I would like to thank the Subdivisional medical officer Rotuma for his good work on the island and I am sure that the people of Rotuma, like my parents are so thankful for his tireless contribution

Dr Enasio Aisake Morris
Emergency Physician
Senior Medical Officer NSW Health & Ex Medical Officer Rotuma

Response from Henry Enasio