Rob Ferguson's family’s crusade against diabetes: Empowering communities through education and service

Dedicating his life to the service of others, Dr. Rob Ferguson, Intermountain Health Peaks Region chief medical officer, and his wife, Andrea, founded Amanaki Fo'ou in 2014. Amanaki Fo'ou (Tongan for “A New Hope”) is an organization dedicated to eliminating diabetes among indigenous populations. 

“From the start of our marriage, Andrea and I wanted service to be part of our family culture,” said Dr. Ferguson. “It is a curious story, though, how a reconstructive surgeon became involved with mitigating the effects of diabetes as a focus of that service.”  

As part of his practice, Dr. Ferguson would be called in to assist with patient limb salvage.  

“Where my practice was in Salt Lake City, many wonderful members of the community were South Pacific Islanders,” he said. “It was not uncommon to have a patient from that community present with diabetic foot wound sepsis without a realization prior to that hospitalization that they were diabetic.” 

Dr. Ferguson would assist with reconstructive surgery for these patients, and many told him the same thing had happened to their family members in Tonga. Several patients asked if he would ever consider coming to Tonga to help them. 

“When an already-scheduled mission trip to South America fell through one year, we decided that we were going to follow through with switching our focus to the South Pacific.”  

Within two weeks of that decision, Dr. Ferguson was in Tonga for the first time to meet with healthcare providers there. He learned that more than 60% of their surgical ward admissions were diabetic foot wound sepsis patients.  

Partnering with their new Tongan colleagues, the Fergusons developed a strategy based upon principles from Intermountain’s Advanced Training Program to address education, behavior modification, and medical training.  

“We put together a collaborative team that would be focused on training rather than only operating for two weeks then leaving; we wanted to train at the public level, the clinic level, and the surgical level in order to address diabetes and its various complications,” said Dr. Ferguson. 

Six of the top ten nations with the highest per capita rate of diabetes are in the South Pacific. Tonga is in the top five in the world for Body Mass Index (BMI) per capita so the people were struggling with noncommunicable diseases that are associated with obesity, hypertension, kidney failure, loss of eyesight, loss of limbs, and more. 

Dr. Ferguson evaluated previous international efforts in Tonga to address diabetes. He and Andrea realized that the material was not relatable for this nation. There were incorrect assumptions that people already understood concepts of portion size, carbohydrates, or glucose. They knew he’d have to take a different approach, and one that was culturally sensitive. 

“It became clear to us that in Tonga the people pay more attention to their family, royalty, and religious leaders than they do their doctors,” said Dr. Ferguson. “They’re a very religious, family-oriented nation, so we knew if we wanted them to understand what we were teaching, we would need to work closely with those groups.” 

He and his team worked with religious leaders and a cultural advisor on what materials and language to use. The ‘Amanaki Fo’ou team partnered with the Ministry of Health, the Ministry of Education, Tonga Health, the royal family, and other local leaders and organizations in Tonga. Once these individuals understood the vision, they became advocates for the work. 

Over the years, Dr. Ferguson and his team have trained wound care clinicians and surgeons and have done a lot of community training. They also brought the training to churches, which had an enormous success rate. There was a 53% decrease from 2014 to 2019 in diabetic foot sepsis cases. The hospital team also achieved a decrease in rates of major amputations, and hospital stays decreased from two months to less than two weeks. 

With their partners in Tonga, they introduced programs like healthy schools and healthy churches to promote better health practices. They started a garden program to address the transition that had taken place from consuming home-grown foods to eating mostly packaged foods.  

“Much like the work we do at Intermountain, this work is also focused on caring for the poor and vulnerable, and helping people live their healthiest lives possible,” said Dr. Ferguson. “It’s looking at social determinants of health to determine what’s causing health issues in these communities.  That’s how we figure out how we can start to affect lasting changes for the better.” 

Watch a video about Dr. Ferguson’s team at work below.