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 4, Issue 2
Quarter 2: July 2019
PIHOA News
6th Annual AUL and PIHOA LabNet Meeting Held in Guam
The 6th Annual Association of USAPI Laboratories (AUL) and PIHOA LabNet Meeting was held in Guam from May 21-24, 2019.  About 30 participants attended and participated in the biennial meeting from all of the USAPI laboratories, except Majuro Hospital Lab.  

Participants included the USAPI laboratory managements and laboratory quality officers, PIHOA laboratory partners such as Fiji National University and Pacific Pathology Training Center (PPTC) , New Zealand laboratory representatives and the laboratory network services representative of the Caribbean Public Health Agency (CARPHA) . 
PIHOA Regional Lab Coordinator, Ms. Uluiviti with laboratory partner agencies
PIHOA Regional Lab Coordinator, Ms. Uluiviti, Guam DPHSS Deputy Director, Ms. Duenas and PIHOA Deputy Director, Ms. Janet Camacho
Dr. Thane Hancock delivering the AUL/LabNet meeting opening remarks
The Deputy Director of the Guam Department of Public Health and Social Services (Guam DPHSS) , Ms. Laurent Duenas gave the meeting’s opening remarks.  Dr. Thane Hancock, the Centers for Disease Control and Prevention (CDC) communicable disease regional epidemiologist based at the PIHOA Guam office, delivered the keynote address on the topic of “ CDC efforts in enhancing EPI and LAB collaboration in the USAPI.”

The main meeting objectives were to conduct SLMTA training on “Effective procurement and inventory of supplies” and “Creating an effective laboratory operating budget,” develop AUL regional tasks to enhance the PIHOA Regional Laboratory Strengthening Initiative Workplan 2019-2022 and strengthen the PIHOA laboratory network through collaboration and exchange of information with laboratories in the region and with partner organizations and institutions.
Mr. Peter Judicpa, CDC Immunization Project Advisor
Group work session on day two of meeting
Meeting facilitators, Mr. Mainaqelelevu & Ms. Uluiviti
Day one of the meeting included reports and updates from the USAPI laboratories, Guam Public Health Laboratory (GPHL) and laboratory partners.  Day two was dedicate to training on effective procurement and inventory of supplies and creating an effective laboratory operating budget, facilitated by Mr. Manasa Mainqelelevu, PIHOA Regional Laboratory Program Specialist. 

PIHOA Regional Lab Strengthening Coordinator, Ms. Vasiti Uluiviti facilitated a session on developing plans for laboratory preparedness and response to an infectious disease outbreak on day two.   CDC Immunization Program Advisor for the USAPI, Mr. Peter Judicpa also provided an overview of measles status in the region and CDC efforts for vaccine-preventable infections in the USAPI.
New AUL Office bearers for 2019-2021
Group presentation winners with their awards (gift vouchers)
Administrative support provided by PIHOA's Mr. Regie Tolentino & Ms. Matilda Ward
Meeting outcomes include AUL members development of sample operational lab budgets and sample lab preparedness and response plans of an infectious disease scenario, election of new AUL office bearers for the 2019-2021 years, reviewing and finalizing the AUL strategic plan with priority areas and action items for implementation between 2019-2021, and establishing new collaboration and lab networking with the Caribbean lab services network ( CARPHA ).   CARPHA has willingly shared the template for the Lab Response Checklist for Infectious Diseases used in the Caribbean.

65th PIHOA Executive Board Meeting Documents

Click HERE for meeting presentations
Epidemiologists and DDM graduates from the USAPI attend and present at the 2019 CSTE Annual Conference
From June 2-6, 2019, the 2019 Council of State and Territorial Epidemiologists (CSTE) Annual Conference was attended by American Samoa’s maternal and child health epidemiologist, Ms. Mata’uitafa Faiai, as well as Data for Decision Making (DDM) graduates Ms. Delpihn Abraham, from the Pohnpei Department of Health Services (DHS) , Ms. Mindy Sugiyama, from the Palau Ministry of Health , and Ms. Leiema Hunt, a Brigham Young University Masters in Public Health student and PIHOA summer intern.  Ms. Abraham presented data from the Pohnpei Rapid High School Surveys, and Dr. Haley Cash presented data from the Guam Walkability Assessment.  
2019 Annual Cancer Council of the Pacific Islands Meeting
The 2019 Annual Cancer Council of the Pacific Islands (CCPI) meeting was held in from April 22-25, 2019 at the John A. Burns School of Medicine (JABSOM) in Honolulu, Hawaii. The four-day meeting consisted of topics that ranged from the success of current work being done in regards to comprehensive cancer control, regionalism, sustainability and building health care capacity in the U.S.-Affiliated Pacific Islands (USAPIs).

The CCPI provides the overall direction for regional comprehensive cancer control in which members are from the USAPI jurisdictions cancer comprehensive cancer control coalitions and committees. Partner organizations like the University of Hawaii , U.S.Indo-Pacom and PIHOA also attended the CCPI meetings.

The CCPI meeting was featured in an article on the JABSOM website where Ms. Dioreme Navasca, Racial and Ethnic Approaches to Community Health (REACH) Program Associate in JABSOM's Family Medicine & Community Health Department stresses the importance of partnerships.

“One of the biggest highlights of the meeting is the partnership between various organizations such as the Pacific Island Health Officers’ Association , UH and the United States Pacific Command on health provider training towards a more holistic approach in cancer control and prevention,” said Ms. Navasca. Ms. Navasca is also a PIHOA consultant and holds the role of Regional non-communicable disease Program Support Officer.

The main role of the CCPI is to improve the health and welfare of the people of the Pacific Islands through the development of programs and best practices activities and education, cancer program planning and outreach purposes. The CCPI is also a PIHOA Affiliate Member.
Don't Miss Out on the Pacific Cancer Project ECHO and Telehealth's Monthly Sessions

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Click HERE for the tentative schedule of topics for the duration of the Pacific Cancer Project ECHO and Telehealth Series!
Palau Conducts a Walkability Assessment
In March 2019, volunteers from the Palau Bureau of Public Safety and the Palau Ministry of Health Non-communicable Disease (NCD) Unit conducted an audit of streets throughout Koror to assess the “walkability” in this area. Data collected from these audits will be used during a Walkability Institute to be conducted later in 2019. 

The purpose of this Walkability Institute is to bring together various stakeholders from different sectors throughout Palau in order to review findings from the Walkability Assessment and develop collaborative projects to be implemented in Palau to improve walkability. The overall goal of this project is to make streets in Koror more pedestrian and cyclist friendly in order to increase physical activity levels.  

This project is being supported by the U.S. Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity , and technical assistance for the Walkability Audit was provided by CDC / PIHOA’s NCD Regional Epidemiologist, Dr. Haley Cash.
Public Health Interns Begin Work in Micronesia
Three public health interns will begin their training in Micronesia in July 2019 with assistance from the Pacific Island Health Officers Association (PIHOA) Pacific Islands Public Health Training Center (PIPHTC) .  This includes an undergraduate public health student from the University of Arizona’s Zuckerman College of Public Health , who will be rotating through various programs with the Pohnpei Department of Health , and will receive direct financial assistance through the Western Region Public Health Training Centre , of which the PIHOA PIPHTC is part.  
 
The intern from the University of Arizona has worked in a variety of international settings in the past, and is excited to be experiencing the Pacific for the first time.  She plans on pursuing a career in international health, alongside a masters degree in epidemiology, or possibly medical school, and is thankful for the financial and other support provided to her by the PIHOA PIPHTC in this effort.  
Additionally, two medical students, who come under the Hawaii Micronesia AHEC , which is located at the John A. Burns School of Medicine of the University of Hawaii , will receive logistical support in undertaking their internships in Micronesia.  These students include a doctoral public health student from the University of Hawaii , who will also be working in Pohnpei, and who is originally from the Commonwealth of the Northern Mariana Islands.  This student is thrilled to be doing her internship in Micronesia, and hopes to use the experience she gains to continue to work in the Pacific following graduation.  And finally, a third intern will be working with the community health center in Chuuk.   
 
Additionally, the PIHOA PIPHTC is also assisting the Hawaii Micronesia AHEC in the placement of two medical students in Pohnpei for elective rotations in international health.  Past placements have included masters students from the University of Hawaii who were placed in Pohnpei, a masters student from the University of Nevada Reno who was placed in Fiji, a fourth year medical student from the University of Arizona , and several medical and public health students from Australia.
 
The PIHOA PIPHTC is a local performance site of the larger Western Regional Public Health Training Center , and is funded through a grant from the U.S. Health Resources Services Administration (HRSA) . Stay-tuned for the next PIHOA E-Newsletter to learn more about these public health interns.
American Samoa Conducts their Hybrid Survey Dissemination Workshop
American Samoa conducted its Hybrid Survey dissemination workshop in May 2019 following the release of their Hybrid Survey report.  Participants from the American Samoa Department of Health, Department of Human and Social Services , and other community stakeholders spent two days reviewing their recent survey results, and using these data to prioritize health issues and appropriate interventions.  Technical support for this workshop was provided by Dr. Annette David from Guam Health Partners, LLC and the CDC / PIHOA’s Non-Communicable Disease Regional Epidemiologist, Dr. Haley Cash.
ASTHO Hosts Second Climate and Health Summit in Honolulu, HI
The Association of State and Territorial Health Officials (ASTHO) held their second Insular Area Climate and Health Summit here in Honolulu, Hawaii from June 4-7, 2019.

The meeting convened territorial health leaders and staff to discuss agency priorities related to the impacts of climate on health. A two-day vector borne disease GIS surveillance workshop followed the meeting.

PIHOA Executive Director, Ms. Emi Chutaro and Deputy Director of Programs and Operations, Ms. Janet Camacho also attended the meeting. Thank you ASTHO for a successful meeting!
2019 PPHSN Meeting Held in Fiji
The 2019 Regional Pacific Public Health Surveillance Network (PPHSN) Meeting was held in Nadi, Fiji from June 3-7, 2019.

PIHOA Regional Health Information Management Systems Coordinator, Dr. Mark Durand and U.S. Centers for Disease Control and Prevention (CDC) career Epidemiology Field Officer for the U.S.-Affiliated Pacific Islands (USAPIs), Dr. Thane Hancock attended the meeting.

The meetings primary objectives was to provide an update on the implementation of, and discuss challenges for the six service networks of PPHSN , to encourage reflection and identify country-level priorities and opportunities that technical partners can leverage for a coordinated and collaborative approach by the human, animal and environmental health sectors and to discuss the capacity of Pacific Island countries and territories in making the Pacific region safe and secure from infectious diseases and other public health threats. 

The PPHSN is a voluntary network of countries and organizations aimed to improve public health surveillance and response in the Pacific in a sustainable way. Member countries of the network identify the PPHSN as a valuable resource in terms of diseases surveillance and outbreak response.
SLMTA Training Continues in Yap, FSM
From April 8-26, 2019, PIHOA Regional Laboratory Program Specialist, Mr. Manasa Mainaqelelevu continued Strengthening Laboratory Management Towards Accreditation (SLMTA) Training in Yap, Federated States of Micronesia.

SLMTA is a structured quality improvement program that teaches laboratory managers how to implement practical quality management systems in resource-limited settings using available resources. With a series of short courses and work-based improvement projects supported by site visits and mentoring, SLMTA is designed to achieve immediate, measurable improvement in laboratories.
In February 2016, Mr. Mainaqelelevu and PIHOA Regional Laboratory Coordinator, Ms. Vasiti Uluiviti attended a two week SLMTA  training in Johannesburg, South Africa. Subsequent to the presentation of the SLMTA initiative to the PIHOA Board of Directors at the 59th PIHOA Executive Board Meeting in Majuro, RMI in March 2016, Yap volunteered to be the pilot lab for the SLMTA initiative in the USAPI.

SLMTA kicked off in Yap, FSM in December 2016 with the training on the  WHO Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist for the Yap Laboratory staff; and the implementation of the initial lab audit using the SLIPTA checklist. SLMTA trainers, Mr. Mainaqelelevu, Ms. Uluiviti and master SLMTA Trainer from Malawi, Africa, Mr. Elde Paladar co-facilitated the commencement of the SLMTA journey in Yap.

Fast forward to June 2019, Yap State continues to lead the rest of the region as the first Pacific Island laboratory to take the lead in the SLMTA initiative. SLMTA was created by the U.S. Centers for Disease Control and Prevention (CDC) , in collaboration with the World Health Organization (WHO) Regional Office for Africa, the Clinton Health Access Initiative , and the American Society for Clinical Pathology .
CDC Hosts Prevention and Control of Chronic Disease and Associated Risk Factors DP19-1901 Grantee Meeting
From June 24-28, 2019, U.S.-Affiliated Pacific Island (USAPI) jurisdictions attended the Centers for Disease Control and Prevention (CDC) grantee meeting, Prevention and Control of Chronic Disease and Associated Risk Factors in the U.S.-Affiliated Pacific Islands, U.S. Virgin Islands, and Puerto Rico CDC-RFA-DP19-1901 in San Francisco.

This meeting focused on the National Center for Chronic Disease Prevention and Health Promotion Island Programs with members from the Pacific Chronic Disease Council (PCDC) and the Pacific Partners for Tobacco-Free Islands (PPTFI) , both PIHOA Affiliate Members.

Topics discussed during the meeting include an overview of accomplishments that occurred during DP-14-106, highlight lessons learned that can be applied to DP-19-1901, an overview of 1901 core and oral health strategies and activities, 1901 performance measures, surveillance status across the USAPIs, tobacco policy initiatives, priority interventions for diabetes, diabetes self-management program training and much more. PIHOA Regional Public Health advisor, Mr. Robert Greathouse conducted the grants management training plan session. The purpose of this session was to assess recipients' preferences regarding a grants management training plan, including topic areas, content and format.
American Samoa Conducts Basic Screening Survey (BSS) for Oral Health Training
From May 28-30, 2019, b asic screening survey (BSS) for oral health training was conducted in American Samoa to improve oral health surveillance in the country and assist with the Needs Assessment 2020.

The training was a combination of U.S. Territorial oral health program needs and technical assistance presentations, data analysis using data collected from previous days and hands on training.

Participants also visited Aunu'u Island for a site visit of the Head Start School, conducted a clinical visit to the adult population at Tafuna Family Health Center (TFHC), mainly with maternal and child health patients, and made a visit to the LBJ dental clinic.
This was a collaborative effort between the American Samoa Department of Health, LBJ Tropical Medical Center,  Association of State and Territorial Dental Directors - ASTDD , Pacific Island primary Care Association (PIPCA) ,  World Health Organization (WHO) , and PIHOA .
2019 Annual Meeting for the Association of Public Health Laboratories (APHL) Held in St. Louis, Missouri
PIHOA Regional Laboratory Coordinator, Ms. Vasiti Uluiviti attended the 2019 Annual Association of Public Health Laboratories (APHL) Meeting in St. Louis, Missouri from June 3-6, 2019.

" After 12 years, our paths cross again. I met up with Dr. Edmund Desmond at the 2019 APHL annual meeting," said Ms. Uluiviti, stating that this was a special meeting indeed.

Dr. Desmond is now the new laboratory director for the Hawaii State Laboratory (HSL) . Ms. Uluiviti worked with Dr. Desmond when he was the laboratory director for the Microbial Disease Laboratory in Richmond, California, where the U.S.-Affiliated Pacific Island (USAPI) laboratories used to refer tuberculosis specimens for culture between 2003-2006

Ms. Uluiviti said, "The USAPI laboratorians look forward to progressing collaborative partnership with the Hawaii State Laboratory (HSL) with Dr. Desmond now on-board."
ASTHO and Partners Lead Business Improvement Work in RMI
In April 2019, the ASTHO (Association of State and Territorial Health Officials) Performance Improvement, Research and Evaluation team led business process improvement work in the Republic of the Marshall Islands (RMI). A memorandum of understanding and three accompanying standard operating procedures (SOPs) in grants management, procurement, and recruitment were developed and reviewed with the participation of the five cabinet-level agencies charged with implementation.

Pictured above during the signing of the SOPs are (from left to right) the Public Service Commission , the Attorney General’s Office, the Ministry of Health and Human Services (RMI MOHHS) , the Ministry of Finance , and the Office of the Chief Secretary. The work is a collaborative effort involving ASTHO , Centers for Disease Control and Prevention (CDC) , PIHOA , and the RMI MOHHS .

Additionally, ASTHO facilitated cross-agency conversations to helped broker agreements to work on reducing the number of signatures required for relatively small-cost requisitions, establishing standing orders for pharmaceuticals and lab supplies that will be completed on a yearly or bi-yearly basis and expedited procurement procedures for outbreaks and other public health events that do not yet rise to the level of national emergencies covered by the National Disaster Act.
PIHOA Spotlight - USAPI Success Stories
Dr. Anaise Uso, MCH Program Coordinator
American Samoa Department of Health
A Data for Decision Making (DDM) Success Story

“Completing all four modules and final project for the Data for Decision Making (DDM) course not only improved my professional growth in data analysis and public health surveillance but it also enabled me to apply class projects (infographics, program data reports, data dashboards, work flow charts, standard operating procedures) I completed as tools that I am now utilizing daily in my line of work,” said Dr. Anaise Uso, the Maternal and Child Health (MCH) Program Coordinator for the American Samoa Department of Health (ASDOH) and DDM graduate.

Dr. Uso continued to share how it is very important to obtain valid and reliable data before, during and after an outbreak, but analyzing and reporting back to the community and key stakeholders about resources and interventions implemented to stop the outbreak in a timely manner is also critical to get buy-in and much needed financial support to manage and control such an outbreak.

Dr. Uso shared that her experience in the MCH program she manages for the ASDOH follows the same concept.  HRSA requires the program to report on local health status for women and children including children with special health care needs by carrying out a Needs Assessment every five years.  They are also required to prioritize these health needs, generate a workplan and implement activities to improve these problems and then report back to key stakeholders (including the community) and the grantor regarding the health outcomes achieved from these efforts. 

Dr. Uso stressed that having the ability to analyze data and generate reports whether on a monthly, quarterly or annual basis will need time, effort and manpower.  Having limited resources justifies the need for cross-training the current workforce to improve the process and the services that are required for them to provide as public health workers.  To date, two MCH staff have completed the DDM class and two are almost done (one or two more modules). 

“Because I have completed DDM, I see the value and benefit and have now supported and ensured that four additional MCH staff are registered for the new cohort to start later in July 2019.  Even though the MCH program has a full time Epidemiologist now working since October 2018, having data clerks trained to be Epi Techs via this DDM course will make the MCH Epi’s work more efficient in terms of data integrity, reliability, validity and reporting them to decision makers in a timely manner,” said Dr. Uso.
She added that all trained MCH personnel will be responsible for reporting all federal mandated MCH Data reports including vital statistics; maternal, infant and child mortality and morbidity rates; Rheumatic Heart Disease; Zika; Children with Special Health Care Needs; Oral Health; and other social determinants of health.

Before taking DDM, Dr. Uso used to provide school-based dental preventive services in elementary schools territory-wide.  She utilized excel spreadsheets and was able to analyze data using pivot tables before DDM.  But after DDM Dr. Uso was able to accomplish a lot more coming into her new administrative position of managing the MCH Program for the ASDOH.  Some of these accomplishments include, providing better graphs and table summary reports, generating appropriate data dashboards and infographics that were not only comprehensive but also accurate and scientifically correct which were disseminated to key stakeholders and legislatures and generate program policies, standard operating procedures, and flow charts.

Dr. Uso said, “After taking DDM I worked closely with our MCH Data Tech to initially monitor and track pregnant women diagnosed with Zika during the 2016 outbreak and utilizing the laboratory cumulative line-list and the MCH Newborn and Postpartum data sets to provide weekly reports at the Unified Health Command standing meetings.  Now, I am applying these skills to other areas within the program.”

Dr. Uso’s advice to prospective candidates in the USAPI hoping to take DDM is to come out of your comfort zone and learn basic public health surveillance skills that you can apply to your every-day routine and how DDM will only benefit you, your program, your agency and the community that you serve.

“Trust that you will have fun during these classes because the instructors are not only qualified and have first-hand experience with each of your Pacific Island jurisdictions but they are very supportive, helpful and committed to making students excel in these classes,” said Dr. Uso.
Ms. Mindy Sugiyama, HRIS/IT Consultant
Palau Ministry of Health
Improving Human Resource Management One State at a Time

PIHOA Human Resource Information System (HRIS) and IT Consultant, Ms. Mindy Sugiyama from the Palau Ministry of Health (Palau MOH) is responsible for human resource data collection such as developing tools to collect basic HR workforce data, provides technical assistance (TA) in the installation and adaptation of HRIS software, provides HRIS training and mentoring, and provides other training needed for the USAPI to build capacity in the area of data collection, analysis, and reports.

Ms. Sugiyama’s most recent HRIS TA work in the region focused on training new HR and Quality Assurance (QA) staff at the Yap State Department of Health Services (Yap DHS) including additional staff identified by the Yap DHS Director on the use of the HRIS system to meet local HR needs and provide training to ensure that the system is used effectively and efficiently to support human resource management.  She also developed HR reports as needed by the State.  

The HRIS System Ms. Sugiyama uses,  OrangeHRM is a free web based HR software that is the leading open source Human Resource Information System (HRIS) in the world.   OrangeHRM  provides a better platform built for managing HR processes and provides a great HR professional workflow and operations system.

"Yap State Department of Health Services (Yap DHS) fully utilizes the system for all their HR needs such as tracking employee's time and leave and do their evaluations electronically for both employee and supervisor.  They also utilizes data to justify HR budget to hire additional or needed staff and utilizes data to identify staff training needs," said Ms. Sugiyama.

Ms. Sugiyama has also been working with the Chuuk Community Health Center (CCHC) in which she helped install HRIS software and trained HR personnel on the utilization of the system. This include assisting in the development of HR tools to collect HR data, drafting of HR Policy and Procedures Manual, drafting of Position Descriptions and assisted in the development of other HR forms as needed by CCHC.

Ms. Sugiyama added that "Chuuk Community Health Center (CCHC) utilized the system to identify providers whose medical licenses have expired and the number of CE's/CME's they needed to maintain their medical licenses."

Chuuk Community Health Center (CCHC), Yap State Department of Health Services (Yap DHS) and Kosrae State Department of Health Services (Kosrae DHS) are utilizing the HRIS system to manage all HR data for ease of maintaining, tracking and reporting the following; employee details, time and leave management, performance evaluations, medical licensing such as tracking of medical licenses expiration dates to include the number of CE's CME's needed, passport and visa for expats employee to ensure that passports and needed documents are tracked to verify expiration and renewal dates, ease of retrieval of HR workforce needs for local and international reporting such as the number of health care providers (doctors, nurses, etc), level of education, workforce training needs for HR succession planning, aging reports, and HR budget needs like salary, compensation, housing, etc. to project the amount of money needed to support health workforce.

"The HRIS system also allows states to scan and upload individual documents for each employee for ease of storage and retrieval when the need arises. The system is an Open Source (Freeware) that has no cost to states when basic infrastructures are in place," said Ms. Sugiyama.

The system also serves as a place holder to collect basic HR data (personnel information, qualifications like educational background, work history, training, language spoken, and tracking of licenses such as medical licenses, salary details, time and leave management, performance etc. until states are ready to invest in a professional and or enterprise versions that are very expensive. The Database runs on mysql thus data is easily extracted and migrated to other systems.

A few challenges identified during Ms. Sugiyama's training include staff turnover as repeated state visits needed to be conducted to re-train new staff on the use of the system and limited time as her visit has conflicts between consultant and state schedules. Basic IT infrastructure needs for some states can be improved such as the server, network and IT personnel to maintain the system.

Because of Ms. Sugiyama's success in the Federated States of Micronesia, multiple requests for her technical assistance started coming from other USAPI jurisdictions. This week, Ms. Sugiyama will be traveling to American Samoa for an HRIS system site visit.
Ms. Maria Marfel, Laboratory Manager
Yap State, Yap Memorial Hospital
A Story for Future Laboratory Professionals

“I went to a community college in Michigan and from there came interested in becoming a doctor.  I applied for medical school at Michigan State University in Lansing got accepted but the problem was finances.  I was still interested in the health field and I was advised to a cheaper college, which was Central Michigan University and that’s where I ended up, majoring in biology with a minor in chemistry.  After taking courses I was introduced and learned about the medical lab program and that’s where my interest for lab started,” said Ms. Maria Marfel, Laboratory Manager for the Yap Memorial Hospital.
 
Ms. Marfel has been the Laboratory Manager for Yap Memorial Hospital since 1997 and prior to that she was the Laboratory Technician since 1989.  Ms. Marfel shared how in Yap State and throughout the region, there is a wide spread of emerging diseases and how it’s becoming a critical source of knowing what’s happening in Yap in terms of infectious diseases.
 
Ms. Marfel said, “Eight percent of diagnostics made by doctors are made from clinical lab results.  Our lab has been a useful department of diagnostics when helping doctors treat patients as we play a critical role in helping them make the right diagnosis.”
 
She stressed the huge impact  Strengthening Laboratory Management Towards Accreditation (SLMTA)  training from PIHOA Regional Lab Coordinator, Ms. Vasiti Uluiviti and Mr. Manasa Mainaqelelevu,  PIHOA Regional Lab Program Specialist has had on improving the lab in terms of workforce development.
 
SLMTA is a structured quality improvement program that teaches laboratory managers how to implement practical quality management systems in resource-limited settings using available resources. With a series of short courses and work-based improvement projects supported by site visits and mentoring,  SLMTA is designed to achieve immediate and measurable improvement in laboratories. 
 
Like all career fields, succession planning is crucial to identify and develop individuals who will take over positions.  In this case, lab positions, so we asked Ms. Marfel what advice she had for high school or college graduates interested in a career in medical lab sciences.
 
“My advice is to let them know that there are other fields in health besides being a doctor or nurse and one of them is medical lab sciences.  There are multiple lab positions, such as a lab technician and medical entomologist with various specialties like microbiology and hematology,” said Ms. Marfel.   
 
Ms. Marfel added that Yap Lab participates in career day for high school students, exposing and educating them on the career path of lab sciences.  Yap Lab has five students currently enrolled in a diploma in medical lab sciences program, four of these students being their first year and just finished the first module.  Mr. Marfel is looking forward to having two expats at the Yap Lab who will become training officers to make sure training is done on a weekly basis. She is also looking forward to what the future holds for Yap Lab.
 
“I wanted to thank PIHOA because the progress made in Yap basically happened because of PIHOA ’s support of many years through Vasiti.” 
New Masters Program to Strengthen Pacific Health Services
Earlier this month at the Pacific Public Health Surveillance Network (PPHSN) Coordinating Body Meeting in Nadi, Fiji, new postgraduate diploma and masters in field and applied epidemiology programs were announced.

“The FNU Senate has approved the newly reviewed Post Graduate Diploma and Masters of Applied Epidemiology Program. Students who complete the Postgraduate Certificate in Field Epidemiology program (formerly called the Data for Decision Making [DDM] program) will qualify to enrol in the Diploma, and those who score an average of 65% will qualify to enrol in the Masters program,” Dr Donald Wilson, Head of the School of Public Health and Associate Professor of Epidemiology and Biostatistics at Fiji National University (FNU) , explained.

These new diploma and masters programs, which are accredited by FNU , form part of a three-tier capacity development program of PPHSN on Strengthening Health Interventions in the Pacific (SHIP).

The first level of the SHIP program, known as the Data for Decision Making (now the Postgraduate Certificate in Field Epidemiology), which was revived by PPHSN partners in 2013 in response to a request from Pacific Ministers of Health, caught a lot of interest in the Pacific, especially in the U.S.-Affiliated Pacific Islands (USAPIs) .

More than 300 health officers from 17 Pacific Island countries and territories completed at least one of the five modules of this course at the end of 2018.

During the PPHSN meeting, a DDM-SHIP Manual W orkshop was held to translate the new DDM-SHIP PGCFE-PGDAE FNU curriculum into an operationally deliverable form. Dr. Mahomed Patel has been commissioned by the Pacific Community (SPC) to develop the Handbook along with several technical assistance providers, including PIHOA Regional Health Information Management Systems Coordinator, Dr. Mark Durand and U.S. Centers for Disease Control and Prevention (CDC) Career Epidemiology Field Officer for the U.S.-Affiliated Pacific Islands (USAPIs), Dr. Thane Hancock.

Other TA providers include Dr. Jojo Mereilles and Jocelyn Cabarles of SPC , Dr. Ramneek Goundar of FNU , and Dr. Louise Fonua of Tonga. This involved three days of discussion regarding various delivery issues. Stay tuned for the next PIHOA E-Newsletter for an update!
Pohnpei Kicks Off their Hybrid Survey
The Pohnpei Department of Health Services (DHS) recently conducted a comprehensive four-day training with staff who will be conducting their 2019 Hybrid Survey.  These surveyors will conduct interviews, physical measurements, and biochemical measurements on 2,100 randomly selected adults throughout Pohnpei.  These data will help Pohnpei DHS to better understand the burden of non-communicable diseases (NCDs) in Pohnpei in order to design effective health programs and provide necessary services. This training was led by Ms. Delpihn Abraham ( Pohnpei DHS ), Ms. Stephanie Kapiriel ( Pohnpei DHS ), Ms. Maybelline Ipil (Marshall Islands Epidemiology & Prevention Initiatives), and Dr. Haley Cash, the CDC / PIHOA’s Non-Communicable Disease Regional Epidemiologist.
Pilot Regional Risk Communication Training Held in Guam
In response to Pacific Island countries and territories requests, a two-day pilot Regional Risk Communication training was developed and conducted in Guam from June 13-14, 2019 to support the U.S.-Affiliated Pacific Island (USAPI) Ministries and Departments of Health and other government sectors to strengthen their national risk communication capacity. 

Risk communication is the real-time exchange of information, advice and opinions between experts, community leaders, officials and the people at risk and provides a critical component of any public health emergency response ( WHO definition). Recent global health emergencies and those most acutely felt in the Pacific, including the H1N1 influenza pandemic (2009) and Zika virus (2013), highlight major challenges in communicating and engaging with affected populations during times of crisis. 
This training is the first of its kind for the Pacific—a collaboration between multiple partner agencies to develop a uniform and tailored Pacific risk communication training package. The training involved a mix of public health emergency preparedness (PHEP) coordinators, public information officers, epidemiologists, project and program coordinators, surveillance officers, hospital preparedness coordinators, public health educators, first responders, law enforcement officers and crisis counselors from all six of the USAPIs.

The training was developed and facilitated by Ms. Rose Aynsley ( WHO ), Ms. Christelle Lepers ( SPC ), Ms. Donda Hansen ( CDC ), Ms. Nili Larish ( CDC ), Ms. Lisa Briseno ( CDC ) and Ms. Billie Hiraishi ( PIHOA ). The materials incorporated key topics and guidance from all four agencies. Training sessions covered introduction to risk communication principles, psychology of a crisis and risk assessment for risk communication response, strategic communication and audience analysis, messaging and developing an event risk communication plan, communication channels, partner coordination and risk communication planning, working with media and social media and monitoring and adapting messages.

Many thanks to the Guam Department of Public Health and Social Services (Guam DPHSS) for hosting the training and providing logistical support!
Pacific Health Security Coordination (PaHSeC) Working Group

The training was developed as part of a Pacific Health Security Coordination (PaHSeC) Working Group initiative. PaHSeC is a voluntary agreement between the PaHSeC partners to closely collaborate and coordinate activities that build national and regional health security through accelerated IHR implementation for emergency preparedness and response.

PaHSeC Working Group partners include WHO , CDC , SPC , PIHOA , Department of Foreign Affairs & Trade , Ministry of Foreign Affairs & Trade and World Bank . PaHSeC partners meet on a regular basis to collaborate on health security activities and initiatives, and how they can better support requests from Pacific Island countries and areas.

During the Seventh Pacific Heads of Health Meeting in April 2019, a risk communication survey was distributed to Ministers and Directors of Health to evaluate risk communication capacity in their jurisdiction. Survey results showed that all jurisdictions were interested in receiving risk communication training noting numerous challenges they experienced when communicating during emergencies.

Additional risk communication training was requested by participants following the Regional Risk Communication Training. The PaHSeC Communication Working Group hopes to continue their efforts with the USAPIs and also implement similar training in the South Pacific.
Seventh Pacific Heads of Health Meeting Held in Nadi, Fiji
PIHOA Executive Board Members and Secretariat Staff attended the Pacific Community's (SPC's) Seventh Pacific Heads of Health Meeting held in Nadi, Fiji from April 3-5, 2019. The objective of the meeting was to review, discuss and make recommendations on universal health coverage (UHC) and primary health care, the healthy islands monitoring framework, Human Resources for health, non-communicable diseases (NCDs), health security and reproductive maternal and newborn child and adolescent health. Meeting documents can be found HERE .

The SPC is the principal scientific and technical organization in the Pacific region owned and governed by 26 country and territory members. They focus on major cross-cutting issues, such as climate change, disaster risk management, food security, gender equality, human rights, non-communicable diseases and youth employment. SPC is also a PIHOA Affiliate Member and works closely with the Secretariat Staff on various projects.
Medical Supplies for the RMI

In April 2019, medical supplies was delivered to the RMI Ministry of Health and Human Services (RMI MOHHS) in Majuro, RMI. The supplies specifically went towards supporting the RMI School Health Promotion Program.

School health education programs can reduce risk behaviors such as tobacco use, poor nutrition, lack of physical activity, drug and alcohol use, as well as actions that increase stress, and risk of injury, and violence.

Because these behaviors are amenable to change, quality school health promotion programs taught by trained and certified health educators provides the best opportunity to promote positive health behavior among children and adolescents.
ASTHO Meets with Guam DPHSS Staff to Initiate 2019 Systems Improvement Capacity Building Projects
From May 21-24, 2019 the   Guam Department of Public Health and Social Services   and   ASTHO (Association of State and Territorial Health Officials)   met to initiate 2019 systems improvement capacity building technical assistance projects by providing context, laying the foundation for peer-to-peer sharing, and setting expectations for continued collaboration.

Topics discussed included, performance management and quality improvement self-assessment, performance management system, quality improvement framework, and group exercises regarding Guam's performance management systems. PIHOA deputy director, Janet Camacho and Regional Public Health Advisor, Robert Greathouse also attended the meeting.
2019 IATA Shipping of Trainers and Shippers Conducted in CNMI
Due to an urgent need requested by the CNMI Commonwealth Health Care Corporation ( CNMI CHCC ) Laboratory in Saipan, an IATA shippers’ trainer and training of shippers was delivered in country from May 29-30, 2019.

Four CNMI CHCC laboratory staff were trained on the 2019 IATA 60th edition dangerous goods regulations.

Outcomes from the meeting include; one newly trained IATA shippers’ trainer and three newly certified IATA shippers with valid certificates for two years from the date of training.

Outbound Saipan shipments of Category A and B have been a challenge since 2005. Outbound shipments from Saipan, CNMI with shipments directly tendered to United Airlines is now possible through collaborative teamwork among United Airlines , CNMI CHCC administration and PIHOA .
Yap State to Aquire Three Okeano Vakas To Deliver Upgraded Health Services to the Neighboring Island Population
This June 2019, the Yap State, Federated States of Micronesia took delivery of the first of three Okeano vaka vessels which are scheduled to arrive this year. Okeanos is a non-profit foundation with the mission to empower Pacific Island people to implement traditionally based sustainable sea transportation to ensure independence, cultural revival and ocean stewardship.

A crew has already been trained and hired for the first of the Yap Okeano vakas.  A vaka is powered by sail and/or coconut oil fuel, can sleep eight passengers, plus four crew members and can carry three tons of cargo. 

A third of Yap's population of 22,000 lives in the neighboring islands of Yap state , which stretch 400 miles east of Yap proper.  In recent years, due to the cost of fuel and chartering of conventional field ships, transport services have been limited.

The vision of Yap State Governor Henry Falan is to establish regular monthly service to Yap outer islands using the Okeano vakas. Dr. Aileen Taureg, Director of Health Services for Yap State (Yap DHS), plans to use Okeanos to deliver upgraded health services to the neighboring island population. Pohnpei State and the RMI have also recently acquired Okeano vakas.

In the coming months, a Yap DHS team will conduct site visits to Yap neighboring islands for assessments of dispensaries using recently-endorsed Standards and Monitoring Framework for FSM Outlying Health Centers and Dispensaries. The Hybrid Survey, once complete in the neighboring islands, should also provide good information for planning of enhanced services for health in which the Okeano vakas will play a vital role. 
SLIPTA Baseline Audit Conducted in Palau
From May 27-June 14, 2019, PIHOA Regional Laboratory Program Specialist, Mr. Manasa Maninaqelelevu conducted the Stepwise Laboratory Quality Improvement Process Towards Accreditation(SLIPTA) training in Palau at the Belau Hospital Laboratory to strengthen the laboratory systems.

SLIPTA is a framework for improving quality of public health laboratories in developing countries to achieve the requirements of the ISO 15189 standard. It is a process that enables laboratories to develop and document their ability to detect, identify, and promptly report all diseases of public health significance that may be present in clinical specimens. 
Other Pacific Island Health News
On May 21-24, Guam's senior leadership and quality improvement council worked with the ASTHO (Association of State and Territorial Health Officials) staff to strategize efforts to improve Guam's culture of quality. This included facilitating a self-assessment activity to identify gaps and opportunities to strengthen Guam's quality improvement plan and implement a performance management system. The discussions have been valuable in identifying opportunities and challenges.
On May 23, 2019, the U.S. House Committee on Natural Resources: Democrats  held a hearing on Medicaid funding for the U.S. territories to learn more about their Medicaid funding challenges. PIHOA Board President, and  Commonwealth Healthcare Corporation  CEO Esther Muna shared the health challenges the CNMI and other territories face with Medicaid! If you missed the live feed, check it out HERE .
From June 10-12, 2019 the Centers for Disease Control and Prevention (CDC) held a Community Assessment for Public Health Emergency Response (CASPER) training in Guam for public health representatives and emergency management officials from the U.S.-Affiliated Pacific Islands (USAPIs). Later that week, majority of the meeting participants attended a two-day, pilot Regional Risk Communications Training. 

On June 3-4, the ASTHO (Association of State and Territorial Health Officials) and Centers for Disease Control and Prevention (CDC) hosted the ASTHO / CDC Heart Disease and Stroke Prevention Learning Collaborative in Guam. The meeting provided an opportunity for project teams from the CNMI, Guam, and Palau to refine action plans and strategies to implement rapid hypertension management and control initiatives.
On April 26, the Governor of Guam, Lourdes Leon Guerrero signed a proclamation declaring the month of May as “Nurses Month” together with Acting Lieutenant Governor, Tina Muna Barnes and Chairperson for the Committee on Health and Human Services, Senator Therese Terlaje.
Stayed updated on all important news coming from the CNMI Commonwealth Healthcare Corporation (CNMI CHCC) press releases! Contact the CNMI CHCC 's Communications and Public Relations Specialist, Ms. Zoe Travis at communications@chcc.gov.mp . You can also stay updated by following the CNMI CHCC on Facebook and Twitter at @cnmichcc, at their website at www.chcc.gov.mp or calling them directly at (670) 234-8950.
Local & National Events

July 9-10, 2019
Location: Noumea, New Caledonia

July 9-11, 2019
Location: Orlando, FL

July 11-12, 2019
Micronesian Islands Forum (MIF)
Location: Chuuk, FSM

July 15, 2019
Location: Online Webinar

July 15-19, 2019
Sub-Regional Blood-borne Pathogens Training
Location: Pohnpei, FSM

August 6-8, 2019
13th Pacific Health Ministers Meeting
Location: Pape'ete, Tahiti, French Polynesia

September 10-13, 2019
Location: Washington DC

September 17-30, 2019
Location: New York, NY

September 23-25, 2019
Location: Bethesda, MD

October 22-24, 2019
Location: Minneapolis, MN

November 18-22, 2019
Location: Honolulu, HI

February 2020 (tentative)
PIPER SUMMIT
Location: TBD

April 20-23, 2020 (tentative)
Cancer Council of the Pacific Islands (CCPI)
Location: Honolulu, HI
Other News & Resources
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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.