The quarterly PIHOA E-Newsletter features news, upcoming events, and resources for the U.S. Affiliated Pacific Islands health community. 
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Volume 2, Issue 4
Quarter 4: December 2017
A Message From the PIHOA Board President

My dear fellow Board Members, Health leaders, and PIHOA Secretariat,

A very Merry Christmas and a Blessed New Year to you, your staff, and your families!

As we ring in the new year, we are hopeful but are reminded of our challenges and struggles to bring good health to our people in our jurisdictions. PIHOA and its members have been key players in helping us overcome those challenges. 

Let us continue to be active participants and contributors that fight for health to be always accessible, available, and acceptable.  PIHOA is and can continue to be the source of making our voices loud and clear and while we hear about possible funding cuts to Public Health, we need to look for ways to make this organization stronger and more viable.

Looking forward to more great discussions with all of you and hearing your thoughts and ideas in the upcoming 2018 meetings and conference calls. 

A big thanks to PIHOA Secretariat Executive Director, Emi Chutaro and her staff for their exceptional work throughout the year.  

Be safe everyone and have a healthful 2018!
-CEO Esther Muna, CNMI CHCC & PIHOA Board President
Recap of the 62nd PIHOA Executive Board Meeting!
The 62nd PIHOA Executive Board Meeting was held in Honolulu, Hawaii from October 3-5, 2017.

The meeting brought together key national stakeholders, Pacific development partners, and U.S. federal agency leadership to discuss health issues of regional significance.

Key topics that were discussed by the PIHOA Board and Associate Members included, opportunities for cross-cutting partner engagement, advocacy and technical support with the U.S. Department of Health and Human Services Region IX (HHS Region IX) , Office of State, Tribal, Local, and Territorial Support (CDC OSTLTS) , Association of State and Territorial Health Officials (ASTHO) and the Secretariat of the Pacific Community (SPC) , the Mass TB Screening in the Pacific, telehealth/telemed implementation, expansion and opportunities for the USAPIs, the RMI Nurse Practitioner Training Program, medical training and internship opportunities in the USAPIs, updates from the USAPI laboratories, and an update on health information and data-driven policies and interventions in the USAPIs.
A very interesting and long topic of discussion focused on the PIHOA - CDC OSTLTS engagement and coordination in the USAPIs. CDC OSTLTS Director, Dr. Jose Montero touched on CDC OSTLTS performance improvement by providing public health agency accreditation, public health improvement training, community health assessment and health improvement planning and national public health performance standards in the USAPIs.

At the end of the meeting, the PIHOA Board and Associate Members reflected on the presentations and topics that were discussed during the meeting and set goals on key priorities through official communiques, resolutions and recommendations. 
PIHOA Sponsored Dinner from left to right, CDC OSTLTS Director, Dr. Jose Montero, CNMI CHCC CEO Esther Muna, Guam DPHSS Director James Gillan, PIHOA ED, Emi Chutaro, and CDC OSTLTS ' Mr. Bill Gallo
PIHOA Executive Board Member and Palau Minister of Health, Dr. Emais Roberts asks a question during the CDC OSTLTS Panel discussion with Dr. Jose Montero.
PIHOA Executive Board Member and American Samoa Department of Health Director, Mr. Motusa Tuileama Nua comments on the progress in American Samoa in regard to the Zika Surge Emergency and Response Preparedness Project
RMI Assistant Secretary from the Office of Health Planning, Policy and Statistics, Ms. Francyne Wase-Jacklick gives an update on ASTHO's current project in the RMI in regard to performance management and quality improvement
March 26-30, 2018

The 63rd PIHOA Executive Board Meeting is confirmed for March 26-30, 2018 in Pago Pago, American Samoa.

Meeting invitations and a draft meeting agenda will be sent out in the next month. Please contact the PIHOA Secretariat Headquarters if you have any questions at 808-537-3131.
PIHOA's Zika Surge Emergency and Response Preparedness Project Close-out on December 31, 2017!
This Sunday, December 31, 2017 will mark the final closeout day for the PIHOA Zika Surge Emergency and Response Preparedness Project's  Regional Team. After December 2017, all Zika Project embeds will either return to their home locations or in the case of American Samoa, be brought on staff by local agencies. Thus far, one out of the four embeds in American Samoa have been hired. Plans are still at work to hire all others. The focus of the embeds was to help each USAPI jurisdiction create well coordinated policies, procedures and standard operating procedures across agencies in order for more streamlined response to emergencies, natural or man-made.  There is still much work to be done in the USAPI jurisdictions in regard to Zika, but it is the hopes of PIHOA that the Zika Project Regional Team have contributed some small positive measure. Below is a summary of a few close-out activities conducted by the Zika Project Regional Team.
The USAPI Regional Comprehensive STI, HIV and Viral Hepatitis Planning Workshop was held in Tamuning, Guam at the Sheraton Laguna Guam Resort in early December 2017. The Zika Project Regional Team was in full support and participated in workshop activities. See article below for more information on the workshop.
In order to help with the slow procurement process in Guam, members from the General Services Agency (GSA), Division of Environmental Health (DEH ), and PIHOA held a meeting to seek out solutions. The DEH has placed a representative at the GSA to track items ordered and correct any shortfalls associated with them.
Two Zika Project Regional Team members return home. Mr. Remi Charlebois (Left) completes bio safety assessments and Ms. Elodie Vajda (Right) gets published in the Journal of Medical Entomology for the new mosquito found in Guam a few months ago.
Chemical items are now being rotated every three months in Kosrae, FSM, however illegal dumping is still occurring. Mr. James Hawkins with BEHST Inc. arrived in Kosrae, FSM to complete work on Kosrae’s After Action Report (AAR) for their Vector Control Program. Mr. Hawkins findings will be added to the overall Vector Control AAR, which also includes assessments of American Samoa and Majuro's Vector Control Programs.  
Ongoing efforts regarding the Zika Project include the Mosquito Lab in Guam, Zika Project Evaluation, After Action Review and Report and Preparation for the next Zika and Vector Control Summit. Key accomplishments for the Zika Project in 2017 include the first Zika and Vector Control Summit in the USAPIs, the Mosquito Lab opening in Guam, the STI, HIV and Viral Hep workshop in Guam, and major ongoing clean up activities in Kosrae, Chuuk, and American Samoa. 
From the PIHOA Board & Secretariat, we would like to send out a special THANK YOU and APPRECIATION to all of the Zika Surge Emergency and Response Preparedness Project's Regional Team for their amazing work and commitment to our island nations!
USAPI Regional Comprehensive STI/HIV/Viral Hep Planning Workshop in Guam, December 6-8, 2017
The recent U.S. Affiliated Pacific Islands (USAPI) regional comprehensive sexually transmitted infections (STI), human immunodeficiency virus (HIV), and viral hepatitis planning workshop was held in Guam from December 6-8, 2017.

The workshop was funded by the Centers for Disease Control's National Center for HIV/AIDS, viral hepatitis, sexually transmitted diseases (STD) and tuberculosis (TB) Prevention ( NCHHSTP ) and co-facilitated by PIHOA staff and the Guam DPHSS' , Bernie Schumann.
Representatives from Palau, CNMI, FSM National, Pohnpei, Yap, Kosrae, Chuuk, Guam and the Marshall Islands all gave an update on the current STI/HIV/viral hepatitis situation and programs in their countries.

The aim of the workshop was to develop a draft regional plan to strengthen USAPI systems and capacities to improve and expand on current STI/HIV/Viral Hep prevention and control efforts.

A key workshop objective was to support USAPI health agencies to implement their respective programs funded by the recently advertised NCHHSTP Notice of Funding Opportunity (NOFO) for integrated HIV/STD/Viral Hep/TB service delivery in the USAPIs.
American Samoa Department of Health hosts the joint Lymphatic Filariasis Elimination Planning Workshop
The American Samoa Department of Health (AS DOH) hosted the joint lymphatic filariasis elimination planning workshop in Pago Pago from November 29-December 1, 2017.

The workshop was organized by the World Health Organization Western Pacific Region ( WHO WPRO ) and attended by health staff and leadership from ASDOH and Western Samoa Ministry of Health , and colleagues from the WHO Samoa and Geneva offices, James Cook University , CDC Center for Global Health ( CGH ), and PIHOA .
The aim of the workshop was to discuss and finalize joint and local planning efforts and timelines to roll-out mass lymphatic filariasis (LF) elimination campaigns in the two Samoas through mass screening and drug administration. 

The two campaigns are part of global efforts to eliminate LF supported under WHO’s Global Strategy to Eliminate Lymphatic Filariasis (GSELF). 
CDC CGH recently provided funding to PIHOA to provide technical and administrative assistance to ASDOH to roll-out their LF elimination campaign planned to commence in January 2018. Both Palau and RMI have been recently validated by the WHO as having successfully eliminated LF, and hope American Samoa can join them within the next few years.
USAPI Research Spotlight
Ms. Irish Tutii Evaluated Palau's Breast and Cervical Cancer Screening Program
Ms. Irish Tutii, the Cancer Registrar in Palau had her first manuscript published this month in the Hawai'i Journal of Medicine & Public Health. Her manuscript is entitled: "Breast and Cervical Cancer Screening in Palau: Have We Improved Early Detection and Survival?" In this publication, Ms. Tutii evaluated Palau's Breast and Cervical Cancer Screening Program and made valuable recommendations. This publication was a product of the regional Operational Research course. PIHOA's Dr. Haley Cash and Dr. Mark Durand served as facilitators for this course. The publication can be found HERE .
Ms. Brittany Meyer established a Gestational Diabetes (GDM) prevalence and evaluated GDM screening and treatment practices in America Samoa
This summer, Ms. Brittany Meyer, an Master's in Public Health (MPH) student from the University of California-Los Angeles ( UCLA ) completed her summer internship in American Samoa under the supervision of Dr. Haley Cash and in collaboration with the American Samoa Department of Health (AS DOH) MCH staff, Dr. Anaise Uso, Ipu Eliapo, and Ruta Rupeti.
Through extensive data collection with local staff, Ms. Meyer was able to establish a prevalence of Gestational Diabetes (GDM) in American Samoa, as well as evaluate current screening and treatment practices. Ms. Meyers found that the GDM prevalence to be 14.2%, which is higher than U.S. estimates. Ms. Meyers also found that were gaps in screening and treatment referrals that should be addressed. This was an exciting project for the USAPIs given the lack of GDM data in the region.
PIHOA Representation at the New Zealand International Visitor Leadership Program Meeting in Honolulu on November 16, 2017
Each year, the International Visitor Leadership Program (IVLP) brings thousands of emerging foreign leaders to the U.S. for a 3-week tour, during which time they meet with their American counterparts to discuss a theme.

The IVLP at the Pacific and Asian Affairs Council, consists of the local international education nonprofit that serves as the Hawaii programmer for the IVLP , the U.S. Department of State's premier professional exchange program requested a meeting with the Hawaii CDC representative, Bill Gallo ( CDC OSTLTS ), for a delegation of 10 experts from New Zealand representing journalism, government, nonprofit, academic, and private sector organizations, on a variety of subjects including CDC's role and work in the Pacific.
Mr. Gallo invited a PIHOA representative, Dr. Angela Techur-Pedro, PIHOA’s Pacific Basin Primary Care Office Coordinator to participate in this discussion too. Discussion topics mainly focused on lifestyle changes related to health and disease; and the potential innovative use of media (social media, radio, print messages) within the Pacific Islander context to address the common culturally-oriented practices that perpetuate preventable risks of Non-Communicable Diseases (NCDs) among the Pacific Islanders.
In November 2017, the American Samoa Department of Health's LBJ Hospital Opens a Chronic Kidney Disease Clinic
On Wednesday, November 22, 2017 the American Samoa Department of Health's (AS DOH) LBJ Hospital opened a Chronic Kidney Disease Clinic. The number of dialysis patients in American Samoa continues to rise and is now approaching 200.

The project uses the shared LBJ Hospital and the AS DOH Electronic Health Record to identify patients needing visits, medication adjustments and basic education about their condition.

Planning for this project was a joint effort of LBJ Hospital Staff, AS DOH staff, PIHOA and the CDC Center for Health Promotion and Chronic Disease Prevention ( NCCDPHP ).
Data-For-Decision Making (DDM) 805: Computing for Public Health Practice held in the RMI from November 6-13, 2017
From November 6-13, 2017 the RMI Ministry of Health and Human Service's Marshall Islands Epidemiology and Prevention Initiative Cohort underwent the Data-For-Decision Making (DDM) 805 course, focusing on computing for public health practice in Majuro, RMI.

The course was facilitated by PIHOA's Performance and Health Information Systems Coordinator, Dr. Mark Durand and PIHOA Consultant, Ms. Jill McCready. The course is one of five courses in the DDM program, which is a product of the Pacific Public Health Surveillance Network ( PPHSN ). The program originated as a set of outbreak epidemiology and response workshops created by the U.S. Centers for Disease Control and Prevention ( CDC ).
Students who pass all five courses are awarded a post-graduate certificate in applied epidemiology from the Fiji National University (FNU) . Epidemiology technicians should be able to gather data with attention to maintaining its quality, to operate well designed surveillance systems, to perform straightforward data analysis, and to present and explain routine reports and analysis results.

DDM-805 consists of didactic sessions, hands-on sessions for practice in using Excel and EpiInfo7 as tools for public health work and student projects (analysis of data sets related to their usual jobs). The first part of the course consists of an online study module which covers epidemiology principles and was given over six weeks prior to the intensive face-to-face session in November 2017. The face-to-face session featured six days with a run-through of didactic sessions covering learning objectives, basic practice using data software, and completion of course projects, which were built on standardized electronic poster templates and presented orally to facilitators. 

Twelve participants from the RMI took part in the DDM 805 course this past November 2017. Engagement in the course by students was excellent. Most participants worked far beyond the scheduled agenda, into the evening and night on their course work. Suggestions for improving course delivery and for concepts needing more review were solicited at the end of each day of the plenary sessions. Course facilitators met for debriefing every evening after class to adjust the following day’s lessons based on student observations and feedback. All participants completed the course, the practical work and the Final Exam.

DDM-805 is a very challenging course and as indicated by assessment results, less than half of the participants met course objectives adequately, though evaluations suggest that participants found the course very useful to their day-to-day jobs. Because of the high level of effort displayed by participants and the difficulty of the course material, additional class sessions are being offered to participants who did not make a passing grade with opportunity to refine project presentations and re-take a summative written exam.
Eagle Scouts Bring Donated Medical Supplies to the RMI
RMI Minister of Health and Human Services, Kalani Kaneko and PIHOA Executive Director, Emi Chutaro pose for a photo with Eagle Scout, Mr. Austin Licina during a ceremony of appreciation for Mr. Licina and his troop
The Honolulu-based Boy Scouts of America Troop 4, in partnership with the RMI Ministry of Health and Human Service (RMI MOH), Hawaii Pacific Health , the Matson Foundatio n and American Customs Brokerage Co, Inc . donated excess medical supplies, filling a 40ft container to Majuro, RMI as part of their Eagle Scout Community Service Project. The value would be greater if we took the actual purchase price of items such as patient exam tables, but it was significant none-the-less. 

The container as well as shipping was donated from Matson . The container was loaded November 4 th  and arrived in Majuro on November 25 , 2017. The Eagle Scout Troop conducted a Ka Ipu Aina clean up at Kalaeloa Campgrounds on December 2 , 2017 facilitated by the Matson Foundation in conjunction with the Hawaii Department of Parks and Natural Resources to offset any extra shipping tariffs.
Having just lived in Australia for two years, Mr. Licina had an interest in studying international relations when he starts college next Fall and decided this Eagle Scout Project would give him a chance to get some practical experience. He wanted to reach an overseas population that has ties to the United States when serving a beneficiary community. As you probably know, the RMI is geographically close to Hawaii, but they do not have nearly as many opportunities for the same level of access and quality of health care. Mr. Licina said that “he felt this Eagle Scout Community Service Project could help in some small way.”

Mr. Licina is the son of LTC Derek Licina from the U.S. Army Medcom RHC-P, who has been working very diligently within PACOM and with PIHOA to support more medical engagements in the USAPIs. Mr. Derek Licina said this project highlights what can be done with persistence and grit, stating that Mr. Austin Licina does not have a high school degree and no money, but with a few contacts, a phone, email and personal office calls, he was able to coordinate a significant donation of medical equipment and supplies from Hawaii Pacific Health , to the RMI MOH , with a grant from the Matson Foundation to cover the container and shipping costs (though a Parks and Recreation Clean-up project), and the support of the American Customs Broker, Inc to help with the customs paperwork.

On Tuesday, December 12, 2017 the RMI Minister of Health and PIHOA Board Treasurer, Kalani Kaneko held a ceremony at the PIHOA Headquarters in Honolulu to thank Mr. Licina and his Eagle Scout Troop for their amazing work and donation to the people of the RMI. A certificate of appreciate was presented to Mr. Licina from PIHOA and the RMI MOH. Minister Kaneko also extended his thank you to Mr. Licina on behalf of the RMI President and Cabinet, Kommol tata!
Donated items are loaded into the Matson Container
Eagle Scout Troop, volunteers and Matson Staff pose for a photo
Donated medical supplies getting ready for shipment
Packing the donated medical supplies
More donated medical supplies
More donated medical supplies
PIHOA Board Members and Secretariat Staff Attend the 68th World Health Organization Regional Committee for the Western Pacific Meeting in Brisbane, Australia on October 9-13, 2017
The 68th World Health Organization Regional Committee for the Western Pacific Meeting (WHO WPRO) was held in Brisbane, Australia on October 9-13, 2017. PIHOA Board Members and Secretariat Staff attended the meeting, representing the USAPIs and addressing the health issues and priorities in the six USAPI jurisdictions. Delegates discussed and endorsed resolutions on a number of issues that affect the health and well-being of the Region's nearly 1.9 billion people.

Priority resolutions that came out of this meeting was, eliminating major infectious diseases, including measles and rubella, as well as mother-to-child transmission of HIV, hepatitis B and syphilis, financing of priority public health services, strengthening regulation of medicines and the health workforce, improving food safety, and health promotion for sustainable development. For more information on meeting resolutions, decisions, journals, reports and presentations visit the 68th WHO Regional Committee for the WPRO Meeting website HERE .
The RMI Nurse Practitioner Training Program (NPTP) Updates
The RMI Nurse Practitioner Training Program (NPTP) is into its fifteenth month and about 3 more months to complete, scheduled for March 2018. There are 15 students remaining from the 17 that started off with the program. The students are having both classroom and clinical placements, enthusiastically caring for the community members with upskilled knowledge and clinical skills. Below are a few photos of the NPTP students during a two week community survey for assessment in Laura, Majuro from October 23-November 3, 2017.
The purpose of the door-to-door interviews conducted by the NPTP students with community members was to assess and diagnose the health of the Laura Zone on the Majuro Atoll. From this community assessment survey, NPTP students will work with community members to plan, implement, and evaluate strategies to improve the health status of their community.
The NPTP is being conducted in the RMI by the   Fiji National University's School of Nursing (FNU) . The program is  funded by the  U.S. Department of Interior (DOI)  that will end in March 2018. The NPTP graduates will increase dramatically RMI’s Clinical Primary Care capacity and demonstrate that Nurse Practitioner Training can be successfully conducted in the Freely Associated States. By the next 63rd  PIHOA  Executive Board Meeting held in Pago Pago, American Samoa from March 26-30, 2018, the RMI looks forward to the graduation of its new Nurse Practitioners!
Local & National Events

January 10, 2018
Location: Honolulu, Hawaii

February 10-13, 2018
Location: Arlington, Virginia

March 5-8, 2018
Location: Honolulu, Hawaii

March 14-16, 2018
Location: Atlanta, Georgia

March 26-30, 2018
63rd PIHOA Executive Board Meeting
Location: Pago Pago, American Samoa

Spring 2018
Pacific Islands Preparedness and Emergency Response Summit
Location: Pago Pago, American Samoa

May 22-24, 2018
Location: New Orleans, Louisiana

October 4-6, 2018
Location: Chandler, Arizona
Merry Christmas & Happy New Year from the PIHOA Board & Secretariat! Wishing you all a fruitful and healthy 2018!
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If your agency or organization would like to contribute to the Quarterly PIHOA   newsletter, please  contact us . Content should be of interest to public health professionals in the U.S.-Affiliated Pacific Islands, and should concern the public health and healthcare system field and related activities.