Vision in American Samoa: Casey Eye Institute’s Collaboration across the Pacific
The islands of the U.S. territory of American Samoa lie midway between Hawaii and the New Zealand in the South Pacific. Balmy trade winds and tropical ocean surround these five islands that are home to 55,000 predominantly native Samoan residents. The territory’s land ownership is village based and 90% communal and supports a strong traditional Samoan culture based on family, church, song, dance, and drawing a livelihood from plantations and the surrounding ocean.
Current state of eye care in American Samoa
Geographic isolation and societal transitions weigh heavily on health and medical care in American Samoa. The recent modernizing of the Samoan diet and lifestyle (e.g. sedentary office work) best explains the now epidemic proportion of diabetes there. Half of all adult Samoans now face the threat of diabetic injury to the blood vessel of the eye (WHO STEPS study). The intense tropical sun induces cataract and pterygium (a fleshy growth across the eye surface) affecting 43% of Samoans living in adjacent Western Samoa (among the highest rates in the world). Our years of work in American Samoa confirm that avoidable blindness from these and other causes are common and in need of answers. A lack of healthcare professionals and difficulty accessing education to keep their skills up to date are the greatest challenges to health improvement in American Samoa according to the World Health Organization. Ophthalmology care in American Samoa is provided by just two ophthalmologists at the Lyndon B. Johnson Tropical Medical Center at the Pago Pago harbor. Ben Siatu’u, M.D., and his colleague Salofi Laititi, M.D., will serve as the ophthalmologists at LBJ Medical Center into the future, with Dr. Siatu’u taking on the role as the only eye surgeon. Mitchell Brinks, M.D., M.P.H. of the Casey Eye Institute previously directed eye care in the territory for three years in the 1990’s.
Casey Eye Institute and American Samoa collaboration
The Casey and American Samoa are developing long term strategies to cooperatively address their eye care needs. We are building a vision where we work together to educate and empower eye care professionals to deliver the best in modern eye care at L.B.J. Tropical Medical Center. The foundation programs supporting the achievement of this vision will in turn empower American Samoa to solve the challenges of avoidable blindness in the territory.The understanding and skill in international settings for OHSU faculty and ophthalmology residents will grow with cooperative exchanges of knowledge and experience with our colleagues in the Pacific.
These programs include:
- Providing the educational and logistical support for Samoan doctors to become high quality ophthalmologists - clinically, surgically, and as leaders in public health. Dr. Ben Siatu’u received expert guidance from CEI faculty, with recent training trips to Pago Pago by Mitch Brinks, M.D., M.P.H., Andreas Lauer, M.D., John Clements, M.D., and Devin Gattey, M.D. Dr. Siatu’u is well on his way to becoming a key leader in eye care in the Pacific Island region. His leadership, winning personality, and ability to deliver high quality eye care is the foundation for improving clinical care and public health initiatives for eye health and prevention of vision loss in American Samoa.
- The important role and contribution of many eye care fields are now receiving support from this collaboration. We are working to provide educational programs for professionals in all of these aspects of eye care: Clinical nurses that work alongside the eye doctors in the clinic deliver important components of exams, diagnostic tests, treatments, and patient education. We will provide a dual site education program where online coursework integrates with training at OHSU and on-site at LBJ Tropic Medical Center.
- Biomedical engineering – the field of caring for the specialized instrumentation crucial to visualizing and studying the health of the eye is a critical unmet need in the territory. No specially trained technicians are available in American Samoa and now instrumentation lies broken and unable to be used to help in the effort.
- Health care administration is one of the most complex and challenging fields of management. This powerful component of delivering quality care, especially in a low resource setting, is often overlooked for the great contributions it can make in this field. Community health workers and general health worker education is where the power of eye care education multiplies in a way that can impact an entire population. We are working to provide education on diabetes, sun exposure, worker safety and other subjects to these eye care workers. With this information, nurses, community health workers, and village leaders distributed throughout the Islands would be able to: inform population about preventative eye care; inform the population about eye care services and improve recruitment of patients to clinical care centers; and increase the quality and efficiency of triage and referral for eye patients.
We will also work together to enhance public health campaigns tailored to the unique cultural, geographic, and health profile setting of American Samoa. These programs will deliver educational messages to improve public understanding of eye disease, better access to vision health screening programs, and improve the population’s access to care. On the horizon are opportunities to harness high tech ophthalmic imaging and data transfer systems to go out into rural areas to provide access to screening and referral resources for Samoans at risk of eye disease (e.g. people with diabetes). Delivering the best in education demands experience in an international education site that is both safe and demanding. This gives OHSU ophthalmology residents the opportunity to work and learn in a diverse setting, managing severe pathology, contributing to eye care resources, and gaining real understanding of health care strategies in low income locations. Resident Daniel Lattin, M.D., recently returned from a trip in March, and explains, “Our trip to American Samoa is one I won’t soon forget. I’m grateful for the opportunity to contribute in the ongoing efforts to give the gift of sight to the people of this beautiful island. I hope our efforts make their lives a bit brighter.”