Doctors Without Borders/Médecins Sans Frontières (MSF) officially launched medical activities in the equatorial Pacific island nation of Kiribati in October—a place where diseases have a massive impact on people’s lives and a climate change hotspot.
Kiribati is the only country in the world to touch all four hemispheres. The 32 atolls—and one raised coral island—lie between Australia and Hawaii and collectively cover just 313 square miles [811 square kilometers] of land in a vast ocean area of nearly 1.4 million square miles [3.5 million square kilometers]. Some of Kiribati’s eastern islands take a week to reach by boat from the main island.
Half of Kiribati’s total population of approximately 120,000 people live in the capital, South Tarawa, on Tarawa atoll. The main island, comprised of slim strips of land shaped like a boomerang, can barely accommodate all of the people there. A result of a high birth rate of 26 births per 1,000 people, and urbanization on South Tarawa due to migration from outer islands, overcrowding exacerbates health and social problems. The country is also facing significant and growing environmental issues related to climate change and rising sea levels.
“Kiribati has one of the highest burdens of disease in the world, including the highest incidence of leprosy, one of the highest of tuberculosis and diabetes, and some of the lowest access to primary health care,” said Alison Jones, MSF’s medical coordinator for Kiribati. “There are clear needs here that are not being met.”
The impact of climate vulnerability
The people of Kiribati—or i-Kiribatis—are directly threatened by a changing climate. In fact, the vast majority of households reported climate impacts years ago, with 81 percent already feeling the effects of sea level rise in 2016.
Kiribati’s small land mass is particularly vulnerable to a rising sea—the highest point on Tarawa atoll is less than 10 feet [three meters] above sea level. Evidence of land shrinkage due to erosion is everywhere. In some places, uprooted trees lie where picnic spots and beaches once were. Homes are abandoned as the water comes closer and sandbags line the edges of the coast like chains of reinforcement. At full moon high tide, waves crash across the main causeway and flood homes.
Along with erosion, the salinization of underground water sources and soil, warmer air temperatures, more frequent and exceptionally high ‘king tides,’ and droughts are increasing.
Another problem with the shrinking land is the threat to agriculture as most i-Kiribati are subsistence farmers, especially on the outer islands, but this has been declining in recent years. Fishing has also been affected as the impact of overpopulation and climate change on reef fisheries, coastal fisheries will soon not be able to meet food needs. Overall, Kiribati is estimated to need 50 percent more food by 2030 to sustain the growing domestic demand.
“A huge number of the current health issues are directly linked to climate change,” said MSF Dr. Darren Pezzack, who was part of the first MSF team to work in Kiribati. “Rising sea levels, in particular, is one of the major things that is having a huge impact, particularly on people’s access to fresh water which in turn impacts their ability to sustain agriculture.”
Food insecurity is not only due to extreme weather; lifestyles are changing. Many young people no longer produce and prepare food in traditional ways and, instead, prefer the convenience of imported foods. Fresh produce is not widely accessible. A pumpkin can cost $20, and a watermelon can cost $32—well out of reach for most people as minimum wages are approximately $1 per hour.
The climate crisis is a health crisis
Human health is dependent on the health and sustainability of the planet. For example, not being able to farm or afford fruits and vegetables—as well as a move away from traditional diets of fish, babai (swamp taro), breadfruit, and coconuts—has implications for people’s health. The majority of people now eat a lot of white rice, imported sugary drinks, and canned and processed foods.
It’s estimated that 38 percent of men and 54 percent of women are obese, yet 25 percent of children under five years old are underweight. Non-communicable diseases (NCDs) are now recognized as the leading cause of health problems in Kiribati.
“Here you see the collision of planetary health and NCDs that is unseen anywhere else,” said Dr. Lachlan McIver, MSF tropical diseases and planetary health advisor. McIver added that small island states like Kiribati are the “canaries in the coalmines of climate change.”
Of the risk factors for NCDs like diabetes, 70 percent of adults between the ages of 18 to 69 have three or more. The rates of diabetes, in particular, in Kiribati are high and increasing; among women aged 45 to 69, more than 44 percent have diabetes.
Implications for pregnant people
MSF’s team in Kiribati includes a pediatrician, midwife, and general medical practitioner—all working to support the Ministry of Health and Medical Services to improve maternal and neonatal health outcomes. This team is working to improve diabetes detection and management and hypertension related to maternal health in the Southern Gilbert Islands, based at Tabiteuea North.
“Diabetes in pregnant people is of particular concern as the condition can be high risk for mothers and babies who require access to specialized care for management during labor, delivery, and after birth,” said MSF’s project medical referent in Kiribati and midwife Sandra Sedlmaier-Ouattara.
Currently, any high-risk pregnant people on the outer islands have limited access to secondary care and must leave their families behind to be flown to the capital Tarawa for specialist care until they deliver and after, if needed.
Other MSF activities in Kiribati include working to improve newborn care in the first 24 hours of life through training and mentoring midwives, nurses, and doctors in the universal Helping Babies Breathe program, as well as case management, in Tabiteuea North, and Tarawa. MSF teams also support labor and delivery and neonatal care at the Southern Kiribati Hospital.
