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 3, Issue 2
Quarter 2: June 2018
12 Micronesian Students Represent the First Graduating Class of the Doctors and Dentists for Tomorrow Program in Pohnpei, FSM
Twelve future physicians and dentists have graduated from the Doctors and Dentists for Tomorrow (DDFT) program at the College of Micronesia-FSM , having received their Associate's Degrees, and are now in the process of applying for medical and dental school for 2019 in Fiji. The twelve Micronesian students represent the first class of DDFT students. A second class of twelve DDFT students will graduate in 2019, and it is hoped that additional classes will follow, as DDFT seeks to train the future Micronesian healthcare practitioners and leaders of tomorrow. 

DDFT is a joint program of the College of Micronesia-FSM , the John A. Burns School of Medicine at the University of Hawaii , and PIHOA , in concert with local partners, such as the Pohnpei State Division of Health Services . DDFT is an intensive basic science preparatory program for high-performing Micronesian high school graduates. DDFT students undertake two-and-one-half years of intensive applied basic science training at the College of Micronesia-FSM , before proceeding to medical school at regional partner schools, such as the University of Fiji , Fiji National University , or the University of Papua New Guinea .

DDFT is unlike any other program in the Northern Pacific. Students are taught using problem-based learning (PBL), which is the mode of instruction at regional medical and dental schools. Instead of lectures and memorization, students learn pathology, biochemistry, anatomy, physiology, medical psychology, and medical microbiology through applied case studies. These applied case studies are nearly identical to the ward rounds that students will participate in when they arrive in medical school, and include high-pressure critiques from clinical faculty members, which many students describe as acutely stressful, but also a great learning experience. Through solving real-life medical problems, students learn not only the basic sciences, but the medicine they will one day practice in Micronesia. Students also participate in rotations at Pohnpei State Hospital, Dental Services, and Public Health, where they see the material they are learning in application on real patients.

In referring to the unique nature and difficulty of the DDFT program, Dr. Paul O. Dacanay, stated that, "This program is hard! As a faculty, we make it that way, because we only want the best and the brightest caring for the people of Micronesia in the future. The fact that these students have succeeded and are now applying to medical school is a testament to their hard work and dedication."
The 12 graduates were honored at an awards dinner held on May 17, 2018, where they received special awards and recognition. Also honored were the family and friends who have supported the students during their time in the DDFT program.

Dr. Greg Dever, PIHOA's Human Resources of Health Coordinator addressed the graduating class referring to all of the graduates that, "You are the future of your country. You are treasures that your country and region can look to for healthcare leadership in the decades to come as you treat and inspire the people of the FSM."
During the awards ceremony, DDFT Faculty member, Dr. Brian Mangum noted, "We are intensely proud of the accomplishments of these students! They have worked hard for the past two years. But this is only the beginning of their journey to becoming the doctors and dentists for tomorrow. They will now progress to medical school, where they will use the knowledge they have gained in the DDFT program to excel in their studies, so that one day they can return and care for their own people, and thus ensure the future health and well-being of all Micronesians."
DDFT Eliuel K. Pretrick Award for Academic Excellence in Health Careers
Dr. Pretrick was the first Secretary of Health for the Federated States of Micronesia and a founding member of PIHOA back in the 1980s. Dr. Pretrick was also JABSOM Dean Terence A. Rogers' close colleague and friend and together, along with PIHOA , they forged the development of the Pacific Basin Medical Officers Training Program (PBMOTP). With the permission of the Pretrick family, the DDFT program bestowed the first ever Eliuel K. Pretrick Award for Academic Excellence in Health Careers upon Ms. Scarlett Lebehn (with a $100 cash stipend) as the top DDFT student of the graduating cohort. The bestowing of this award for the top student will continue as long as the program. Ms. Lebehn pose with PIHOA's Dr. Dever and her family during the award ceremony.
All 12 graduate are applying for entry to both the University of Fiji and Fiji National University to begin their medical or dental studies in early 2019 and have committed themselves to returning to practice in the FSM upon graduation.

"These young women and men are committed to the FSM. They have learned about the health challenges facing the region, as well as both clinical and public health approaches to face these challenges," stated Mr. Robert Spegal, DDFT Program Manager.
The 12 graduates have already chosen which specialties they would like to pursue, based upon their clinical exposure, as well as research into which specialties are most needed in Micronesia, including general surgery, pediatrics, obstetrics and gynecology, psychiatry, pathology, and ophthalmology.


64th PIHOA Executive Board Meeting
September 3-6, 2018
Honolulu, HI
RMI Nurse Practitioner Training Program Graduates and Starts 12-Month Internship Program at Majuro Hospital
The Nurse Practitioner Training Program (NPTP) is a joint project of the RMI Ministry of Health and Human Services (MOHHS) , Fiji National University School of Medicine, Nursing & Health Sciences (FNU) and the Pacific Islands Health Officers' Association (PIHOA). Candidates are prepared for primary care practice and upon successful completion are awarded a post‐graduate diploma as nurse practitioners. This Saturday, June 9, 2018 the NPTP graduation will be officiated by Dr. William MacKay in Majuro, RMI with 12 candidates receiving post-graduate diplomas as primary care nurse practitioners.

NPTP graduates are now undertaking a 12-month internship program which will prepare them to be fully licensed nurse practitioners in the RMI, effectively tripling the number of indigenous medical providers delivering care in the RMI. They will especially be instrumental in improving preventative services delivery in public health clinics and outlying health centers.

The internship includes six rotations, each of two months duration in outpatient department, reproductive health clinic, pediatrics, labor and delivery, human services/mental health, and public health clinics at Majuro Hospital. There are two interns assigned to each of the rotations during each two-month block.

All of the rotations are outpatient rotations except for the labor and delivery rotations where interns get more practice with managing normal labor and delivery patients, and care of newborns and mothers post-partum. The outpatient department rotation also includes practice in the emergency room of patients with diabetic foot ulcers, with repair of lacerations and with incision and drainage of abscesses. Click HERE to learn more about the NPTP Interns.
TB Lab Training Conducted in Palau from April 24-May 1, 2018
A Tuberculosis (TB) laboratory training was held in Palau from April 24-May 1, 2018. This activity was a collaboration between PIHOA and the Palau Ministry of Health . The purpose of the training was to s trengthen the Palau TB program through the enhancement of the Belau National Hospital (BNH) laboratory services by providing training for 4 BNH laboratory staff on TB specimen processing including quality sputum collection, Ziehl Neelsen staining method of acid-fast bacilli; AFB smear microscopy, reading, interpretation and reporting; Genexpert testing of TB specimens, result interpretation and reporting; and TB lab data management.

The training provided continuous education (CE) sessions to the BNH Staff on the importance of ensuring the collection of quality sputum specimens for effective TB lab diagnosis in Palau. The training was also an opportunity to review and update the BNH TB Standard Operation and Procedure (SOP) Manual.

The training was a combination of lectures and practical sessions with the major emphasis on AFB microscopy through blind slide reviews of AFB-stained slides, result interpretation and reporting. The training heavily emphasized hands-on blind slide review and reporting of stained AFB smears throughout the four weeks. The elements of assessment for the TB lab training included: weekly quizzes; final theory and practical examinations.
The trainees and trainer
Blind slide review in the lab
Demonstration of TB specimen preparation for Genexpert TB testing by Carmin Pipit
Trainees taking the final exam
All trainees successfully completed the training, passing both the theoretical and practical components of the training assessment. Two additional staff were trained in additional to the existing staff who are in charge of TB specimen testing. The reviewed TB lab SOP manual is pending insertions of more SOPs for implementation by the BNH lab. A good turn-out during CE session by the BNH staff on May 1, 2018 with about 24 attendees that included nurses, doctors and the lab staff. Issues and challenges relating to the prevention of quality sputum collection for TB lab diagnosis across the USAPI were emphasized. For effective TB diagnosis, PIHOA's Regional Lab Coordinator, Ms. Vasiti Uluiviti recommends the BNH lab frequently update the TB program and clinicians on the status of salivary specimens received to facilitate improvement of quality specimen.
Continuous Education (CE) session at the Palau Belau National Hospital cafeteria on May 1, 2018!
New Faces of PIHOA
Dr. Tamara Buhagiar, PhD, MSc
Project Management Specialist,
Lymphatic Filariasis Elimination Program,
Pago Pago, American Samoa
Dr. Buhagiar has 17 years of experience in the field of medical entomology and parasitology with a particular focus on mosquitoes and the pathogens they transmit to humans, including West Nile virus, dengue, Zika, and filarial worms. She is a Canadian-Australian, and spent the last 12 years in the tropical north of Australia where she completed her PhD in 2010, and continued to work as a Research Fellow and Mentor to Doctoral students in the College of Public Health, Tropical Medicine and Veterinary Sciences at James Cook University
Prior to moving to Australia, Dr. Buhagiar lived in London, where she completed her MSc in Medical Parasitology at the London School of Hygiene and Tropical Medicine . In 2003 she graduated with a combined Honours BSc in Biology and International Development Studies from the University of Winnipeg in Canada.

You will now find Dr. Buhagiar and her family in the middle of the South Pacific Ocean, on the beautiful islands of American Samoa where she has had the privilege of living for the last two months. Dr. Buhagiar is working closely with the American Samoa Department of Health (AS DOH) as the Project Management Specialist for the Lymphatic Filariasis Elimination Program. The program is part of the World Health Organization’s (WHO) Global Program to Eliminate Lymphatic Filariasis. Dr. Buhagiar said, "I am excited and optimistic about the current program as we have a strong PIHOA team both supporting and working directly on the project, as well as other key collaborators from the AS DOH , U.S. Centers for Disease Control (CDC) , and the WHO . The first round of the Mass Drug Administration ( MDA) is scheduled for September 2018, and planning is currently underway. 
Mr. Robert "Uti" Gebauer
Community Liaison & Outreach Coordinator,
Lymphatic Filariasis Elimination Program,
Pago Pago, American Samoa
Mr. Robert Gebauer or Ut i for short is from American Samoa and is a returning independent contractor to PIHOA. Prior work experiences have included assignments to FSM and RMI.  Uti’s consultation centers on Grant Management and Systems Review. Uti’s professional experience spans over 30 years and is primarily in the Banking and Financial Services. Starting off as a teller to becoming a Senior Vice Present of several Community based Banks in San Francisco. 
Uti holds a Bachelor’s of Science degree from the University of San Francisco in Behavioral Leadership with an extensive background in Finance and Economic Modeling.  Prior experiences have included assignments with numerous municipalities in economic development, such as work done on several islands in Hawaii and cities in California, such as San Francisco and Oakland.
After living off island for over 30 years in the United States, Uti returned home to help take care of his ailing mother in 2013 and then started working for a local based bank and then moved into Federal Grant Management.  This took on a new facet of financial awareness and gained momentum to becoming the lead for all Federal Grants for the American Samoa Government as the Grants Manager.  In addition to being the Grants Manager, Uti also held other positions, such as being the Accounts Payable Manager and Cash Management Specialist all at the same time. These positions continued until moving into private consultation that allowed Uti to be part of PIHOA to assist with other Island Nations, such as Pohnpei, FSM and Majuro, RMI. 

Currently Uti is working in American Samoa on a team with the American Samoa Department of Health for the Lymphatic Filariasis Program as the Lymphatic Filariasis Community Liaison and Outreach Coordinator.
The Lymphatic Filariasis Program is still in the planning stages but is expected to be in full force, as we get closer to the launch date in September 2018. This program is a joint collaboration between CDC , AS DOH , WHO , and PIHOA .  The main program objective is to eliminate the threat of Lymphatic Filariasis in American Samoa by providing a Mass Drug Administration (MDA) to all residents with in the American Samoa islands (Tutuila and the Manu’a islands). 
In addition to working for PIHOA and AS DOH , Uti is an avid entrepreneur and owns several businesses on island including a Bed and Breakfast, Boutique and Property Management and Landscaping business.  
Dr. Grayson Brown
Regional Entomologist,
Hagatna, Guam
Dr. Grayson Brown joined PIHOA in March 2018 as the Regional Entomologist and s co-located at the PIHOA Guam Office in Hagatna and the new Guam Department of Health and Social Services (Guam DPHSS) DEH Mosquito Lab where he supports the on-going operations of the Guam DEH Lab. Dr. Brown has also been conducting site visits, providing technical assistance and rapid assessments throughout the region. Dr. Brown comes to PIHOA with a Bachelor's of Science in Biology from Florida State University (FSU) and his Masters Degree in Entomology from Washington State University (WSU)
Dr. Brown also earned his Ph.D in Entomology from WSU in 1978 under well-known medical entomologist of the mid 20th century, Dr. Maurice James. Dr. Brown also has 40 years of experience as a college professor, 120 refereed research publications, three patents, and nearly 40 graduate students that completed graduate degrees under his supervision.

Dr. Brown's particular area of expertise is organizing, coordinating and directing disease vector control operations for public health agencies with extensive expertise and experience in program development for municipalities in the U.S. and internationally. Dr. Brown is internationally known for his work in Africa, South East Asia and South America, with 15 years of involved vector management work in Peru and Brazil. Dr. Brown has particular expertise in training and leading vector control teams under field conditions.

Dr. Brown is the former President of the Entomological Society of America , which is the largest organization of professional entomologists in the world. He is also a member of the Scientific Advisory Board of 4 multinational corporations. Prior to joining PIHOA , Dr. Brown was the consulting entomologist for five municipalities and four states.

Dr. Brown wanted to spend the last years of his career on the front lines of vector control borne disease and the U.S. Affiliated Pacific Islands (USAPIs) fit that description perfectly. "It's an opportunity to do important work that benefits people's lives, in an entomologically fascinating and beautiful part of the world," said Dr. Brown.

His first impressions of vector management across the USAPI region is that the public and environmental health departments have trained and dedicated leadership and many islands have early career and enthusiastic supervisors for their vector control management programs. Dr. Brown mentioned that, "These supervisors only need some modest equipment and entomological leadership and I am here to help with both of those needs."

Dr. Brown says that his goals and objectives as the PIHOA Regional Entomologist is to improve vector management and reduce vector borne diseases across all inhabited islands in the PIHOA network. "I hope to network the individual islands' programs into a regional, coordinated program that can serve as a model for other island nations of the world," said Dr. Brown.
PIHOA Provides Assistance to the American Samoa Department of Health Lymphatic Filariasis Elimination Program
This Spring 2018, PIHOA contracted two consultants, Dr. Tamara Buhagiar and Robert "Uti" Gebauer to provide technical and administrative assistance to the American Samoa Department of Health (AS DOH) Lymphatic Filariasis (LF) Elimination Program in Pago Pago, American Samoa.

The LF Elimination Program is a join effort between the two Samoas (American Samoa and Western Samoa), the World Health Organization (WHO) , the Centers for Disease Control and Prevention Center for Global Health (CDC CGH) , and PIHOA . The Program is part of WHO's Global Program to Eliminate LF.
LF is caused by infection with filarial worms that are transmitted by mosquito bites. The WHO's Global Program to Eliminate LF aims to eliminate the disease as a public health problem by 2020 by conducting Mass Drug Administration (MDA) and controlling morbidity. Once LF elimination targets have been reached, cost-effective surveillance strategies are critical for ensure that any areas of ongoing transmission or resurgence are quickly identified and managed.

Dr. Buhagiar and Mr. Gebauer are working with the AS DOH Staff to prepare for the launch of the Mass Drug Administration (MDA) for population-wide elimination of LF in American Samoa. The launch is set for September 2018. Dr. Buhagiar and Mr. Gebauer's work also includes supporting the AS DOH's Neglected Tropical Diseases (NTD) Program. Keep a look out for the next PIHOA E-Newsletter for an update on the ongoing LF Elimination Program efforts in American Samoa.
Pacific Island Regional Vector Laboratory (PIRVeL) Now Offering Region-Wide Mosquito Identification Services
The island countries and territories of the Western Pacific have experienced increasing frequency in outbreaks of vector-borne human diseases. Each island nation is too small to fully support a strong vector management program, but can collectively do so.

With the leadership of the Guam Division of Environmental Public Heallth and PIHOA , as well as the support from the Centers for Disease Control and Prevention (CDC) , the World Health Organization (WHO) and other partners, the Pacific Island Regional Vector Laboratory (PIRVel) was established in 2017.
With the arrival of Regional Entomologist, Dr. Grayson Brown in Guam in March 2018, the regional mission has begun to expand at a rapid pace. PIRVeL is now offering region-wide mosquito identification services and have started to work with many on islands on how to improve their vector management programs. Additional services such as PCR testing of mosquito pools for pathogens, deploy-able emergency response teams for outbreak and disaster situations, insecticide resistance testing support, etc. will be available soon.
Ms. Aileen Benevente, the manager of the Saipan vector management team posing in her current lab. A proposal to create a more adequate facility is currently in the works.
One of the Saipan vector surveillance team members collecting larvae from a tire next to a school. Most of their surveillance is based on larval collection with collected larvae being reared to adulthood for identification.
Dr. Brown and Saipan vector surveillance team member working together in the field to collect larvae. Pictured on the right is a typical ovitrap used in Saipan, tucked away in cinder blocks, just above a little place. Just a black plastic cup, partially filled with grass infused water, and a tongue depressor provides an ovipositional substrate for Aedes mosquitoes.
PIRVel hopes to continue to evolve to the point that it becomes an internationally recognized facility that can support a diverse research, education and outreach community. They also encourage interested scientists to contact them directly regarding collaborative projects with professionals interested in vector research. Stay updated by liking PIRVel's Facebook page HERE ! Keep a look out for the next PIHOA E-Newsletter or E-Blast as PIRVel will have a resourceful website up and running in the next few weeks.
Dr. Brown being used as bait and collecting the mosquitoes using a mechanical aspirator operated by vector control team member Tamara Shimizu in Guam.
At this site (left photo), the collection was about 15 landing mosquitoes per minute, all aedes albopictus, with about one third of which were males.
Guam vector control team member, Chie Takase setting a trap near the PIRVeL. Now with a way to store dry ice, they should be able to increase the trap catch substantially.
Palau kicks off the Data for Decision Making (DDM) Program
The delivery of the first module of Data for Decision Making (DDM) took place from May 14-18, 2018 in Palau. DDM is a five module Certificate program accredited by Fiji National University . The first module is “Introduction to Surveillance” that teaches the fundamentals of data surveillance and involves hands-on mapping of existing surveillance systems to identify strengths and weaknesses.  
The RMI Ministry of Health and Human Services tackle down spending issues with support from the ASTHO, CDC and PIHOA
The Republic of the Marshall Islands Government Leaders signed an agreement aimed at improving the flow of funding within government, particularly related to the Ministry of Health and Human Services (RMI MOHHS) . The MOHHS met in May 2018 with the Association of State and Territorial Health Officials (ASTHO) , the Centers for Disease Control and Prevention (CDC) , and PIHOA to discuss ways to improve the timely drawdown and use of U.S. federal funds.
The one-day meeting focused on inefficient practices and polices in government, and recommended improvement for key business processes; garnering support for recommended improvements from ministry partners; and developing an action plan for implementing recommended improvements across ministries. At the end of the meeting a Memorandum of Understanding (MOU) was signed among the MOHHS , Finance, the Public Service Commission, the Office of the Attorney General, and the Office of the Chief Secretary.
Students Complete the Second Module of the Data for Decision Making (DDM) Program in Ebeye, RMI
The second module of Data for Decision Making (DDM) took place in May 2018 in Ebeye, RMI. DDM is a five module certificate program accredited by Fiji National University. The second module is “Public Health Surveillance," providing an overview of classic epidemiology principles as applied to public health surveillance. Participants were trained on the key aspects of surveillance, methods of surveillance, data and indicators, data management and communication of key messages of information products. This is the first unit in Ebeye to undergo an ambitious project to produce Epi-Technicians and improve surveillance and health information systems. Participants will complete training on all five DDM modules by late January 2019.
2018 IATA Shipping Re-Certification Training Held in Palau
From May 16-17, 2018 an IATA shipping re-certification training was held in Palau to train three staff members from the Palau Ministry of Health and two staff members from the Palau animal shelter.

The purpose of the re-certification training is to strengthen and maintain the capability of the Belau National Hospital's (BNH) lab and associated institutions in Palau to ship clinical and/or biological specimens for off-island reference laboratory confirmatory testing of infectious diseases.
TB and Leprosy Screening Underway in Majuro, RMI
In March 2017, a joint effort between the   RMI Ministry of Health and Human Services (RMI MOHHS) , the World Health Organization (WHO)  , Centers for Disease Control and Prevention (CDC) , and  PIHOA , a mass screening and treatment program for tuberculosis was conducted on the densely populated island of Ebeye in the Republic of the Marshall Islands.

This June 2018, the similar TB and Leprosy project has kicked off in Majuro, RMI! This will be a much larger project than the screening in Ebeye as the population is larger and the project will include screening children, especially for leprosy.
The TB and Leprosy project plans to screen 26,600 people and treat all active and latent TB in Majuro for adults and children. Screening began on June 4, 2018 and is expected to last for 15 weeks, until mid-September 2018. The TB treatment, follow-up care, and TB prevention activities will continue until November 2016. The Hansen's screening will be done on adults and children over two years old. Diabetes testing will also be done for adults undergoing workup for TB, adults who are TST(+), and adults referred for HD testing.

This project has estimated that 93 volunteers will be assisting with this project, which will be eight groups of 10 to 15 people over the duration of three weeks per group. These volunteers are TB doctors, nurses and epidemiologists from the USAPI region and the U.S. Keep a look out for the next PIHOA E-Newsletter for an update on the ongoing Tb and Leprosy Free project in Majuro, RMI.
Photo Section
Local & National Events

June 10-14, 2018
Location: West Palm Beach, Florida

June 25-29, 2018
American Pacific Nursing Leaders Council (APNLC) Meeting & 40th Anniversary Celebration
Location: Guam

June 26-27, 2018
Location: Atlanta, Georgia

June 26-28, 2018
Location: Noumea, New Caledonia (SPC HQ)

June 27-29, 2018
W HO Meeting on Health Information System Strengthening in the Pacific Island Countries
Location: Suva, Fiji

July 15-27, 2018
Location: Yap, FSM

June 16-20, 2018 (tentative)
Northern Pacific Environmental Health Association (NPEHA) Meeting
Location: Guam

August 6-9, 2018 (tentative)
PIHOA Regional Laboratory Training Workshop
Location: Guam

September 3-6, 2018
64th PIHOA Executive Board Meeting
Location: Honolulu, Hawaii

September 25-27, 2018
Location: Alexandria, Virginia

October 8-12, 2018
21st Pacific Basin Medical Association (PBMA) Conference
Location: Koror, Palau

November 10-14, 2018
Location: San Diego, California

December 10-14, 2018 (tentative)
Cancer Council of the Pacific Islands (CCPI) Meeting
Location: Honolulu, Hawaii
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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.