Julie M. Chatigny, DPM, AACFAS

I arrived in Honolulu on 3/13/2017 and met up with Dr. Michael Goran and one of his former students, Skylar Steinberg, to discuss our plans and goals of our week in Kiritimati. I, being a foot and ankle physician and surgeon with a clinical emphasis on diabetes, and Dr. Goran, being a well-published, highly respected researcher in the field of pediatric obesity and diabetes found that we had very similar interests and goals, as well as, many questions. First and foremost, what is contributing to the high incidence and prevalence of type 2 diabetes mellitus?

We left Honolulu on 3/14/2017 just after noon, had a three-hour flight, and arrived in Kiritimati on 3/15/2017 as we had crossed the international dateline. Our travel companions included about twelve fly fishermen from the United States seeking a week-long catch-and-release adventure fishing for bone fish, giant trevally, and trigger fish.

Upon arriving at the Cassidy International Airport, we were greeted in the airport’s VIP lounge by Dr. Teraira Bangao, several members of the Ministry of Health, and staff with a beautiful flower headpiece and cold coconut milk. We were provided a rental car and followed Dr. Teraira to our accommodations at The Villages. 

As it was evening when we arrived to The Villages, we were not going to start work until the following day. We took a walk along the main road from The Villages toward London. We stopped to watch kids and young adults playing soccer, saw many people walking along the road carrying bags of rice and coconuts, people riding bicycles and motor scooters, and people at their homes getting ready for the evening. What struck me the most was that nearly every person we encountered was not wearing shoes. Even walking along the asphalt road and riding bicycles, people were barefoot. 


Over the next several days, I spent time at the London Hospital where I worked with Dr. Teraira Bangao, Dr. John Tekanene, and their incredible staff of nurses, pharmacists, and a midwife. Together, this group of people treat everything from congestive heart failure to pneumonia to diabetic foot infections as well as have a maternity ward. At the hospital, I helped Dr. John debride a diabetic foot and leg ulceration and infection, drained a heel abscess that had extended proximally along the tarsal tunnel jeopardizing a woman’s leg, and diagnosed a tendinitis due to a flatfoot deformity. Dr. John and I attempted to perform a below-the-knee amputation on a non-diabetic man with Buerger’s disease (thromboangiitis obliterans) which had resulted in infection and gangrene from smoking, but he and his wife continued to refuse the amputation.
Although Dr. Elizabeth Beale was unfortunately unable to accompany us to the island, she was paramount in organizing medical items to donate to the hospital and clinics. She developed a foot exam form and her daughters put together medical illustrations and folders to provide to the hospital and clinic staff. When I brought in the items and folders, the medical staff was greatly appreciative, but a bit overwhelmed. I met with the nurses and Dr. John individually to explain the folders and how to go about a diabetic foot exam. Again, it seemed a bit overwhelming and the nursing staff did not seem to understand the importance.
I decided to take a different approach and learn as much as I could about what people ate and drank, did for entertainment, why they presented to the hospital and clinics, and better understand the culture so I could figure out a better plan to educate the health providers and staff.
Also, as Dr. Goran and Skylar collected their data, they identified several children under the age of 18 years old who had a HgbA1c > 6. As I was located at the hospital while they were out at the schools, one of the nurses drove the identified children to the hospital where I interviewed them and collected information on their diets and knowledge about their parents and diabetes.
The following is a summary of what I learned over the week I was visiting the island:

  • Fish Raw, salted / canned Mackerel, fried White Rice
  • Canned Spam
  • Canned Ham
  • Crackers
  • Cookies
  • Bread Fruit
  • Bread with frosting-type spread Pumpkin
  • Uncooked Top Roman noodles 


  • Sugar water 3 large spoons (ladle-size) of sugar in 1 Liter of water. Soda, non-diet
  • Coconut water
  • Toddy
  • No regular, plain water 
It’s rude to offer a guest of your home a drink of water. You need to offer a sugary beverage. People often seek the medical aid of a “healer” before they will seek medical help from a doctor. Average life expectancy is 55 years old.
High infant mortality rate.
People often have > 4 children. 
People do not recognize the correlation of consuming sugar and having diabetes. For example, a husband and wife came to me to learn how to read their glucometer. They kept stating that the Metformin was causing their sugar to be high. It took several attempts and several different descriptions for them to finally understand that the sugar they ate and drank was causing the high blood sugar and that the medication was helping them, not hurting them.
I now have a much better understanding of what needs to be accomplished as far as education and assisting with intervention. It will definitely take time and a multidisciplinary team of dedicated individuals to set realistic short-term goals with the long-term goal of helping the people of Kiritimati live a longer, healthier life.
The people of Kiritimati were warm and welcoming. I appreciate their patience with me asking all of my questions. I am especially thankful to Dr. John as we were able to spend many hours together learning from each other. Thank you to Carlton Smith for this incredible opportunity; Dr. Elizabeth Beale for seeking me out, your help and organization; Dr. Beale’s daughters Alexis who has an incredible talent for medical illustrations and Stefi (and her boyfriend Eric) who put supplies together and met me half way to deliver them; Dr. Teraira for helping make our journey so comfortable and successful; Dr. Lydia Lam for your insight and recommendations; and thank you to everyone that helped make this organization a success. 



Million-dollar smile
From left; Britta Mosser, Elena Clarfield, Camille Wormser, Taylor Colby, Eloise Massett and Skylar Steinberg attend the Operation Smile International Student Leadership Conference, held at Georgetown University in Washington, D.C. July 30-Aug. 3. Photo by Marc Ascher

Malibu High students learn leadership skills and how to make a difference through Operation Smile.

By Melonie Magruder / Special to The Malibu Times

Last week, six Malibu High School students took a step toward becoming philanthropic leaders of tomorrow by attending the International Student Leadership Conference in Washington, D.C. The event has been hosted for the past 20 years by Operation Smile, the nonprofit organization that travels to needy countries and performs operations—free of charge—to repair facial deformities on thousands of children who might otherwise spend their entire lives hidden away from the rest of the world.

The Malibu High students—Camille Wormser, Britta Mosser, Skylar Steinberg, Elena Clarfield, Taylor Colby and Eloise Massett—are members of the MHS Operation Smile Club and were invited to attend the leadership conference as the next generation to whom the torch of philanthropy will be passed.

Dr. Bill and Kathy Magee founded Operation Smile 30 years ago in response to a “life-changing” experience in the Philippines, Kathy Magee said. He was a pediatric plastic surgeon and she was a pediatric nurse when they agreed to accompany some friends to the South Pacific nation with the goal of helping 40 extremely poor children who had been born with cleft palates.

“We saw 250 children turned away from our field camp,” Magee said last week in a telephone interview. “It broke our hearts. These children usually spend their lives living in huts, shunned by society. This surgery was the only hope for their future.”

When the Magees learned that the group did not have plans to return to the field camp, in a place called Naga City, they decided to step in. They organized like-minded friends, scrounged donations of supplies and even secured a check from television evangelist Pat Robertson’s “The 700 Club” to fund the trip before heading back to the Philippines.

Their generosity was received with gratitude and overwhelming need for more help.

“It just snowballed on us,” Magee said. “We started getting requests from Kenya and Southeast Asia. We realized pretty quickly that this would only continue to work if we developed on-the-ground partnerships and started training local resources.”

The logistics are daunting and rely heavily on volunteer help. Operation Smile shows up after plenty of advance community organizing, sets up a field hospital, performs hundreds of surgeries over the course of a week, then trains families and local hospitals on how to care for the patients.

But if Operation Smile were to continue to expand, it would require training local teams to create their own fundraising apparatus, as well as organizing a source for ongoing volunteers. The Operation Smile Club was born.

“Our friend Danny Rosen started the clubs 27 years ago and they’ve spread to high schools all over the country and even universities,” Magee said. “High school kids think, ‘I’m only one person. What can I do?’ Operation Smile clubs take them on missions around the world and these kids come back changed. They see the poverty and say, OK, I can do this much. With a team, I can make a difference.”

Operation Smile’s International Student Leadership Conference (ISLC) aims to prepare those young people for just such a mission. Five hundred youngsters from more than 20 countries assembled in our nation’s capital last week to meet new friends, develop team-building skills and learn effective volunteer organizing. In doing so, Magee said, they learn to live the ISLC’s credo to “Ignite Change!”

Taylor Colby will be a senior at Malibu High in the fall. She is a member of the Operation Smile Club and recently completed training for her first mission trip to the Philippines in November.

“I will help educate parents and their children on how to care for themselves after the surgery,” Colby said. “Hydration therapy, good oral hygiene, good nutrition—it’s all a part of making sure that this surgery is a success.”

Colby explained how one of her jobs is to teach burn prevention, since many patients sustain facial burns because they do so much cooking over open fires. She will give presentations through interactive wordplay and posters, usually aided by a translator. She said that the Operation Smile Club has inspired her to get involved and do something.

“In Malibu, we don’t see a lot of poverty or people really struggling,” Colby said. “I know my first mission will take me out of that. At the conference, I’m meeting people I would never have met before and we’re beginning to see how we can make a difference.”

Eloise Massett was first drawn into the Operation Smile Club at MHS through her older sister. She said she only just began to understand the impact the organization was making on the world.

“Upon seeing my sister and others… after they returned from their missions, I became really motivated to go on one myself,” Massett wrote from the conference. “Everyone comes back a changed person, and I really look forward to the day I see the smile on a child’s face after surgery.”

Operation Smile is preparing its core mission to continue.

“Through the clubs, we’ve trained kids who go on to work for PR firms or fundraising groups or become surgeons who operate on missions,” Magee said. “After 30 years, we’re getting ready to pass the baton to a new generation of Operation Smile volunteers. Because where else do you get the chance to really change a kid’s life?”

To learn more about Operation Smile, go to: www.operationsmile.org.Skylar Steinberg









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