Pacific Partnerships for Health Charting a Course for the 21st Century (1998) / Chapter Skim
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2 Regional Health and Health Care Services Overview
2 Regional Health and Health Care Services Overview
Pages 23-54
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From page 23... ...
(Specific information on the health care services in each jurisdiction is provided in Appendix D.) The chapter concludes with an appendix describing the recently concluded Pacific Basin Medical Officers Training Program (PBMOTP)
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Although not counted in the census, numbers of citizens from the freely associated states living in American Samoa, CNMI, Guam, and Hawaii have been estimated to assess the impact of the Compacts of Free Association on Hawaii and U.S. territories.
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TABLE 2.1 Total Population, U.S.-Associated Pacific Basin Jurisdictions and the United States, 1997 Jurisdiction Total Population American Samoa CNMI Guam FSM Chuuk Kosrae Pohnpei Yap RMI Palau TOTAL, Pacific Basin jurisdictions TOTAL, United States 58,070 5 8? 846 1 55,22S 1 05,506 53,3 1 9 7,317 33,692 1 1,178 59,246 1 7,22: 454,1 18 260,372, 1 74 NOTES: Total population is the total number of people residing in the jurisdiction.
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1990 1997 2000 2010 Guam FSM RMI American Samoa CNMI Palau FIGURE 2.1 Population estimates for U.S.-Associated Pacific Basin jurisdictions. selected years, 1950-1997, and projected, 1998-2010.
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This is most notably so in the freely associated states. The health care systems must dead with health conditions typical of those of both developed countries (e.g., diabetes, heart disease, and cancer)
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and represents preliminary 1996 data; the goal for infant mortality rate set in Healthy People 2000 (USDHHS, 1996) is 7 per 1,000 live births.
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Unfortunately, such data are not readily or consistently available from all jurisdictions. It is important to note that Pacific Islanders have not generally been included in most Heoithy People 2000 objectives (in fact Epstein reports that out of the hundreds of Healthy People 2000 objectives, only eight address Asian Americans and Pacific Islanders directly and none address the U.S.-Associated Pacific Basin jurisdictions [1997~.
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From page 30... ...
NOTES: Data for the six jurisdictions are based on: 1990 Census reports for the areas, American Samoa census, 1995; CNMI census, 1995; FSM census, l99A; Guam census, 1995; RMI census, 1988; and Palau census, 1994. Median age for the United States is from the Bureau of the Census, Current Population Survey, 1995.
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31 or in o .
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. Disease Prevention and Health Promotion Immunization Rates As indicated in Figure 2.6, immunization rates for most jurisdictions come close to or actually surpass those for the United States.
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Binge drinking is a common practice throughout the freely associated states, most notably on days when government workers receive their paychecks (Marshall, 1979~. So, while alcohol may not necessarily be drunk every day, on those days that it is, it is drunk to excess.
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From page 34... ...
does not appear to be a problem in the freely associated states at this time; a recent survey found only one current user of hard drugs in FSM (Micronesian Seminar, 19979. Suicide Suicide has become one of the leading causes of death in many of the jurisdictions.
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From page 35... ...
Similar movements to decentralize the health care delivery system have been tried in the ensuing decades, but have been thwarted repeatedly primarily because of staffing shortages and budget cutbacks. It is hoped with the recent addition of 70 PBMOTP graduates within the freely associated states and American Samoa who have been specifically trained in community health that future efforts at decentralization will meet with greater success.
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From page 36... ...
The purposes of collecting data and setting goals, it seemed, were only to receive funding; they were not seen as methods of improving health care services. Many people interviewed during the site visits expressed the desire for greater flexibility in the way in which grant funds are administered and used so that federal programs can be adapted to better address local needs.
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, outpatient clinic data, public health clinic information (with special information regarding rates of, for example, Hansen's disease, sexually transmitted diseases, tuberculosis, immunizations, and prenatal care) , dispensary data, incidences of notifiable (reportable)
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. Use of Military lFIealth Facilities Although the Compacts direct the secretary of defense to make military facilities available to citizens of the freely associated states, those facilities do not normally treat the patients, except in emergencies.
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On the site visits, committee members were told that traditional practitioners such as foo foos in American Samoa and surhanos in Guam continue to provide important health care services to many islanders. Presently, it appears that traditional and western-style practitioners rarely interact or consult one another regarding a patient's treatment (for more details on traditional health practices and beliefs please refer to the assessments in Appendix D)
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From page 40... ...
The U.S. government, in turn, provides the majority of funding for that financing, either directly, as in the case of American Samoa, or indirectly, through Compact and Covenant funding, as in the case of the freely associated states and CMNI.
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From page 41... ...
The ranks of physicians have grown significantly in recent years as a direct result of the training of 70 new indigenous medical officers through PBMOTP described in the appendix to this chapter. Medical officers from the PBMOTP have received five years of formal medical school and clinical experience in Pohnpei and have undergone a two-year internship in their own jurisdiction.
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Many of the current dental practitioners are expatriates, including one National Health Service Corps dentist in RMI, or are nearing retirement (PIHOA, 1997~. Shortages of dentists, dental officers, dental therapists, dental nurses, and dental aides and technicians are already being experienced in all the freely associated states.
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Almost all of the students entering the Pacific Basin Medical Officers Training Program (PBMOTP) had to take special remedial classes in English, math, and science to come up to speed in these areas.
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From page 48... ...
of Medicine and the University of Papua New Guinea as regional centers for postgraduate medical education (WHO, 1995~. The DOI, first in cooperation with the PBMOTP and currently with the Pacific Basin Medical Association, has established formal ties with the Fiji School of Medicine to provide postgraduate education to Micronesian medical officers.
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The Pacific Basin Medical Officers Training Program (PBMOTP) enrolled its first class of students in 1986.
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The admissions board nominated better-qualified individuals. The program hired top-quality faculty, many of whom were Pacific Islanders with good credentials and who served as positive role models (as did the medical officers who had already been graduated from the program)
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Returning home also helped students reconnect with their communities and allowed them to spend time with their families. Upon successful completion of the 5-year program and a filial qualifying examination process, students became medical officers and received a diploma in Community Health, Medicine, and Surgery from the John A
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The founders of PBMOTP instituted several policies to address concerns about medical officers leaving the islands once they had completed training. For example, the medical officer license granted to PBMOTP graduates is recognized only in FSM, RMI, and Palau.
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Their absence was particularly problematic given the many cultural restraints and taboos associated with indigenous male health professionals caring for female patients, especially regarding reproductive health issues. Continuing Education and Training for PBMOTP Medical Officers Now that the medical officers have received their basic training and have begun to practice formally, they will be the mainstay of the physician workforce, particularly in Palau and throughout the FSM states.
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From page 54... ...
However, if such a program were to be replicated, the committee recommends working more closely with existing local educational institutions rather than setting up completely new but temporary institutions.
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