Maintaining balance for a long voyage.

This article introduces cultural aspects of health, using Hokule'a, the voyaging canoe, as a model for maintaining balance on a long voyage through life. Maintaining balance encompasses physical, nutritional and mental health. This triangle is crucial for the well-being of a person. In the stress of the modern world we often disregard the basics in an effort to become more efficient and more productive, neglecting physical activity, eating fast foods instead of healthy meals, and forgetting our mental well-being. Eventually, this can lead to devastating co-morbidities. We discuss balanced nutrition, physical activity, and mental health, relating to living on the canoe, with lessons that can be applied to daily living.

Characteristics of Marshallese with Type 2 Diabetes on Oahu: A Pilot Study to Implement a Community-Based Diabetic Health Improvement Project.

OBJECTIVES: To determine the feasibility of a resident physician-based, culturally appropriate method of decreasing the disease burden of Type 2 Diabetes Mellitus (DM2) in a group of Pacific Islanders, Marshallese living in Hawai'i. METHODS: Thirty one Marshallese with diabetes who live on the island of Oahu, Hawaii were recruited. Baseline health status of the participants was characterized. Health parameters included HgbA1c, random blood sugar (RBS), lipid panels, body mass index (BMI), blood pressure, and medical history, along with qualitative information. A focus group was held with participants prior to beginning the curriculum to determine cultural views on diabetes, health, treatment, and to identify potential obstacles to health improvement. A DM2 educational curriculum culturally relevant to Marshallese populations was then started, including instruction in lifestyle modification, adherence to medication regimens, and planned quarterly assessment of health improvement. RESULTS: Baseline quantitative analysis revealed Marshallese with diabetes to be obese and hyperglycemic, with average BMI of 30 kg/m(2), RBS of 285, and HgbA1c of 9.3. Qualitative analysis revealed that nearly half the participants admitted to symptoms of severe hyperglycemia. The initial focus group had a substantial turnout. Attendance rapidly declined, becoming so low that classes were eventually terminated. However, in two participants who attended more than three classes there was evidence of major improvements in HgbA1c, cholesterol, and qualitative markers, which were sustained after one year. CONCLUSIONS: This pilot study of Marshallese with diabetes on Oahu showed that the majority had poor glycemic control with secondary co-morbid conditions. Although many barriers exist for successful implementation of a diabetes health improvement project in this group, the groundwork for translation of this project to the Republic of Marshall Islands (RMI) has been laid; curriculum translation and patient recruitment is currently underway to advance the project.

Cancer in Kosrae State, Federated States of Micronesia.

Little is known about the impact of cancer and the extent of cancer-related services in Kosrae. The purpose of this study, funded by the National Cancer Institute, was to document the state of cancer awareness and services in Kosrae and to begin to identify cancer-care needs. Findings suggest that cancer is the eighth-leading cause of death in Kosrae, although a number of factors contribute to a possible undercount of cancer cases. Cancer-related services are limited. A number of needs were identified, and an action plan was developed based on three priority areas: 1) establishing a cancer registry; 2) increasing public awareness about cancer risk, prevention, and detection; and 3) expanding cancer screening and detection programs.