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 1
Quarter 1: March 2017

A message from the PIHOA Board Vice President

It is such an honor for all of us here in the Commonwealth of the Northern Mariana Islands (CNMI) and especially the staff and management of the Commonwealth Healthcare Corporation (CHCC) to host the health leaders of the USAPIs as well as our partners for the 61st  PIHOA Executive Board meeting to be held on the island of Saipan. 

The last time we hosted was back in 2013, on my first year as the head of CHCC and it was the time when the PIHOA executive board interviewed Emi Chutaro for her position as PIHOAs Executive Director.  It was one of the best decisions we made together as a Board and I was fortunate to be a part of it.  I am sure all of us share the excitement of again coming together as health leaders to make positive changes for the health of our people. 

The CNMI/CHCC leaders and I are looking forward to more fruitful discussions and presentations on vital issues that affect the health and well-being of the people of the USAPIs.  Emi and the Secretariat staff developed a great agenda that covers the major issues we all deal with in the region and in our territories and countries.  Thank you, Si Yu’us ma’ase, and Ghilisow for all their hard work and dedication and for the patience and assistance offered to the CHCC team in preparation for the upcoming meeting.  

So we hope to see all of you at the 61st PIHOA meeting.  Welcome, Hafa Adai and Tirow!

-CEO Esther Muna, CNMI CHCC


PIHOA Welcomes Newest Administrative Embed

While there has been much success in the fight against the spread of the Zika Virus in the Pacific Islands, there is still much to be done.  In January 2017 PIHOA stepped up its efforts by embedding four new team members.  All are experts in their respective fields.  Mr. Adren Hervey in Majuro, Mr. Leroy Harris in American Samoa, Mr. Osker Dugger in Guam, and Mr. Oudrey Hervey in Kosrae. All are retired military Veterans with combined  average of 25 years each.  The focus of the embeds is to help each Island create well coordinated policies, procedures and standard operating procedures across agencies in order for more streamlined response to emergencies, natural or man-made.

Mr. O. Hervey speaks with Kosrae's Governor Jackson about the need for government involvement in continued community clean up efforts.
Mr. O. Hervey address leaders of Kosrae's Administrative team. Discussions were on the importance of  well coordinated policies,  procedures, and SOPs.
Acting Hospital Director Rinehart William  and Mr. O. Hervey talk over strategy to improve Administrative Support.
Mr. O. Hervey finds new home in Kosrae, FSM.
Strengthening Laboratory Management Towards Accreditation (SLMTA) kicks off in Yap, Federated States of Micronesia!
Funding from CDC through the Association of Public Health Laboratories (APHL) enabled the President of the Association of the USAPI Laboratories (AUL), Mr. Manasa Mainaqelelevu and PIHOA’s Regional Laboratory Strengthening Coordinator, Ms. Vasiti Uluiviti  to attend a two week Strengthening Laboratory Management Toward Accreditation (SLMTA) training in Johannesburg, South Africa in February 2016. Subsequent to the presentation of the SLMTA initiative to the PIHOA Board of Directors at the PIHOA 59th 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 on December 5-9, 2016 with the training on the WHO Step-wise Lab 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. Manasa Mainaqelelevu, Vasiti Uluiviti with the assistance of the master SLMTA Trainer from Malawi, Africa, Mr. Elde Paladar co-facilitated the commencement of the SLMTA journey in Yap.

It is to be noted that SLMTA began in Africa in 2009, and this is the first time that SLMTA is venturing into the Pacific Islands, with the Yap Hospital Lab being the first Pacific Island laboratory to take the lead in this initiative. The SLMTA journey into the Pacific, particularly Yap, FSM was featured in the 2016 SLMTA Newsletter available here.
Don't Forget to Register for the 61st PIHOA Executive Board Meeting from March 28-31, 2017 in Saipan, CNMI!
Click  HERE to register!
Monitoring Alliance for NCD Action (MANA) Technical Working Group meet in Fiji in December 2016

In March 2016, the PIHOA Board charged the PIHOA Secretariat to partner with the MANA (Monitoring Alliance for NCD Action) group develop accountability mechanisms for monitoring NCD response across the Pacific). This purpose of this workshop was to complete work on the MANA Dashboard (including data definitions). The finalized Dashboard is to be presented to the Heads of Health meeting in April 2017 for endorsement, then on to the Pacific Health Ministers meeting later this year.

The PIHOA Board has also charged the Secretariat with providing technical assistance for completion of the Dashboards for each member (except CNMI) in 2017. We wish for the Dashboard to align and support the good work that has already been done in the USAPI by PIHOA and its partners regarding the regional roadmap, the NCD Policy Commitment Package, and the USAPI NCD Monitoring & Surveillance Framework. PIHOA’s Regional PM/QA/QI and Health Information Management Systems Coordinator, Dr. Mark Durand’s input during the three day workshop was aimed at both refining the quality & relevance of the dashboard items and definitions and also of assuring alignment with USAPI work.

The workshop consisted of an item-by-item review of the draft instrument with agreement about inclusion of items and grading of levels of compliance for each item made by consensus. Participants included Wendy Snowden of WHO, Erin Passamore of SPC, Solene Bertrand of SPC, Si Thu of SPC, and Mark Durand of PIHOA.

Administrative Support and Vector Control Update from the Regional Zika Surge Response team

Using an all of government, all community approach, we seek to develop overall planning, execution, and reporting of Zika-related administrative preparedness and response training and associated institutional capacity development activities targeting relevant local health agency programs and staff, including but not limited to: local Public Health Emergency and Preparedness (PHEP) and Hospital Preparedness Program (HPP) Coordinators, ancillary services staff (lab, pharmacy, medical supply, etc.), finance and administrative staff, and local EpiNet/Emergency Response teams (often comprised of other sector representatives in addition to health agency staff). 

Mr. Adren Hervey, Admin Embed and Mr. William, Vector Control, discuss matters at the local dump i0n Majuro, RMI.
Local dump is now the highest point in Majuro, RMI.
Photo of old tires in Majuro, RMI being used for decoration.
Here is a close-up of the old tires in Majuro, RMI. Without filling or putting holes in them, they turn into mosquito breeding grounds.
Key accomplishments for the Regional Zika Surge Response Team include; continued progress of Pest Control and Vector Spray in Majuro, RMI, Chuuk, FSM and Kosrae, FSM, as well as increasing community involvement programs, Government involvement and senior and mid-level training of policies and finance. 
Photo of Chuuk, FSM BEFORE community clean-up.
Photo of Chuuk, FSM  AFTER community clean-up.
Mass Tuberculosis Screening Underway in Ebeye, RMI
WHO and CDC staff in Ebeye.
Ebeye Island, Republic of the Marshall Islands (Photo: Anjojo Kabua).
As a joint effort between the  RMI Ministry of Health World Health Organization (WHO) CDC , and PIHOA, a mass screening and treatment program for tuberculosis is being conducted on the densely populated island of Ebeye in the Republic of the Marshall Islands.  Overall, its been a very successful start to the ambitious screening program.  Trainers from WHO and CDC arrived in early February 2017 to begin preparations. 10 tuberculosis doctors, nurses and epidemiologists from the US Mainland arrived on February 16, 2017 to help screening and work with the Ebeye TB program.  Training by RMI, CDC and WHO was completed on February 17.

The Ebeye TB Program and the RMI Ministry of Health launched the project with a community parade on Saturday, February 18 with a ceremony held on Monday, February 20, with an opening prayer, speeches, and a ribbon cutting event.   After the opening ceremony, screening for tuberculosis, diabetes, high-blood pressure, and Hansen’s disease began.  This team of TB doctors, nurses and epidemiologists will stay until March 10, and will be replaced by another team of experienced TB clinicians, nurses and epidemiologists. The RMI Ministry of Health Public Health teams from Ebeye and Majuro also did an amazing job.

Screening Results Showed:
  • A total of 645 people were screened last week
  • Screening for Tuberculosis: 
  1. TB cases are screened with a chest x-ray and TB symptoms
  2. If the chest x-ray is abnormal, the GeneXpert sputum test is performed
  3. Week 1: 78 people were sent for GeneXpert testing
  4. Week 1: 4 people were diagnosed with TB for treatment
  5. Week 1: 12 people were determined to need additional tests, and samples will be collected and sent to the laboratory in Hawaii
  • Screening for Hansen’s Disease:
  1. Hansen’s disease screening is done by visual check of the skin
  2. Week 1:  3 people were sent to Dr. Thein for evaluation
  • Screening for Diabetes:
  1. If not controlled by diet and exercise, diabetes can lead to blindness, heart attacks, kidney disease
  2. In the Pacific, diabetes is also a major risk factor for developing tuberculosis
  3. Diabetes is diagnosed by a blood test called HbA1c
  4. Week 1:  Total number of people with diabetes: 179 (34% of those over age 21)
  5. Week 1:  42 people with diabetes were newly diagnosed last week
  • Screening for High Blood Pressure:
  1. If not controlled, high blood pressure leads to strokes and heart attacks
  2. Week 1:  Total number of people with high blood pressure: 204 (39% of those over age 21)
  3. Week 1:  46 people with high blood pressure were newly diagnosed

Kommol Tata WHO, CDC, RMI Ministry of Health and Mass Tuberculosis Screening Project Volunteers

RMI Ministry of Health in Ebeye leads a kick-off parade for the screening.
Majuro staff assisting with the screening. Here the TB staff participate in diabetes testing.
Every morning, the new TB cases are reviewed with the clinical team.
Two GeneXpert machines (one on loan from Majuro) are used to process TB samples.

DDM Delivery Completed in Yap and Kosrae, FSM

After a year of hard work, all four Data for Decision Making course modules and independent projects have been completed in Yap and Kosrae.  10 students have completed the program in each State.  These independent projects will serve as ongoing surveillance products to be used moving forward.  These new DDM grads have much to be proud of!

Kosrae DDM graduates show off their certificates.
Yap DDM graduates show off their certificates.

Pacific CHOR Project Successful in Kosrae and Palau

Building regional health workforce capacity in early child health monitoring is a key window of opportunity for monitoring the NCD crisis in the USAPIs. Through funding support from the Centers for Disease Control and Prevention (CDC) through the National Association of Chronic Disease Directors (NACDD), the PIHOA Pacific Child Health and Obesity Research (CHOR) Project partnered with the University of Hawaii Children Healthy Living (CHL) of the Pacific to build and strengthen health workforce capacity in early child health monitoring in two target sites of the USAPIs.

The project adopted CHL's "culture of research model" for anthropometric measurements using a regional unified, standardized protocols for high precision and reliability of anthropometric measures and "train the trainer model" for sustainability of the capacity building training.  Using a modified Zerfas Criteria, 18 trainees (10 Kosrae; 8 Palau) completed anthropometric measurement standardization assessment in weight, height, length, and head. All others (5 Palau) completed some but not all anthropometric measurements standardization. 
Photos from the Kosrae, FSM AMT Certificate of Completion Awards with the Kosrae State Director of Health Services, Dr. Livinson Taulung, University of Hawaii at Manoa Professor and Expert Anthropometrist, Dr. Rachel Novotny, and trainees Patricia, Stephanie, and Betsy-rose.
Photos from the Palau AMT Certificate of Completion Awards with University of Hawaii at Manoa Professor and Expert Anthropometrist, Dr. Rachel Novotny, Palau Project Assistant Elchesel Wilfred, and trainees Alfred, Rosemina, and Liberei.
Microbiology Enhancement and Skill-up Training at Guam Public Health Laboratory: March 2015 – October 2016

The Guam Public Health Laboratory (GPHL) embarked on a two-year long training on microbiology enhancement and skill-up training in March 2015 that was successfully completed in October 2016.

This was a training collaborative partnership between the Pacific Community (SPC) and PIHOA with the Guam Public Health Laboratory (GPHL). GPHL focused on four main fundamental objectives including: One, to provide training to skill-up microbiology lab diagnostic capacity. Two, to provide preparatory training for the enhancement of public health food and water microbiology lab capacity. Three, to provide technical assistance to strengthen lab-based surveillance of PPHSN outbreak-prone diseases. Four, to assist in the establishment of the Guam Public Health Laboratory microbiology to a L2 laboratory level and to be able to provide microbiology diagnostic assistance to L1 labs in the USAPIs.

The training was in five phases and each phase delivered at different intervals. The training objectives for each phase were:

  1. Phase 1 – March 24th – April 3rd 2015: Introduction of General Diagnostic Methods in Microbiology.
  2. Phase 2 – May 11th - 27th 2015: Laboratory Diagnosis of Outbreak-prone Diseases of Public Health Significance and Antimicrobial Susceptibility Testing.
  3. Phase 3 – October 26th - 30th 2015: Strengthening of laboratory-based surveillance of and laboratory diagnosis of outbreak-prone diseases of public health significance.
  4. Phase 4 – Oct 17th – 21st 2016: Introduction to Food Microbiological Analysis
  5. Phase 5 – Oct 24th – 28th 2016: Review of the Agents of Bioterrorism  

Preparation of microbiology culture media

Three GPHL staff were trained consecutively from Phases 1 – 5. Compilation of the lecture Powerpoint presentations and delivery of the training were co-facilitated by the SPC and PIHOA consultants/trainers. Training supplies and consumables including culture media and American Type Culture Collection (ATCC) quality control bacterial strains were purchased through the financial support of SPC using the PIHOA Revolving Fund. A key outcome of the GPHL training is the re-instatement of GPHL’s lab capacity for culture, isolation and identification of Neisseria gonorrhoea in genital specimens. GPHL has participated and passed two College of American Pathology (CAP) proficiency surveys for culture and identification of N. gonorrhoea, therefore, is in compliant with the CLIA regulations for this additional lab testing capacity.

Alan performing inoculation of culture media.
Lea reading a gram stained slide.
Joy documenting investigation steps during culture reading.
Celebrating two years of successful training! Hard work pays off.
Doctors and Dentist for Tomorrow Program (DDFT) Launch Heartbeat Newsletter
Check-out the Heartbeat Newsletter for progress on the DDFT Program at the College of Micronesia (COM-FSM) supported by PIHOA through funding from the UH JABSOM’s Area Health Education Center (AHEC).  The aim of this program is to take recently graduated high school students and put them through an intensive series of STEM courses. 

COM-FSM has been a great partner and supporter of this effort, along with the FSM Department of Health and Social Affairs ( FSM DHSA) and UH JABSOM AHEC. The program is designed to enable young students from Micronesia who are interested in careers in medicine and/or dentistry, as well as other health careers, greater success in pursuing advanced health degrees, and is a critical step in ensuring a cohort/pipeline of young individuals  successfully qualifying for and staying the course in their respective health career endeavors. 

The DDFT Newsletter, The Heartbeat, has been created by the PIHOA and COM-FSM DDFT Faculty Team. 

Check-out the latest videos put together by the DDFT Faculty Staff!
Click HERE for video
Click HERE for video

Palau NCD Hybrid Survey Data Collection and Cleaning Completed

Over 1,700 adults in Palau were surveyed from May 2016- January 2017 as part of their NCD Hybrid Survey.  This was a collaborative effort between many partners within Palau and multiple support agencies.  These data are now in the process of being analyzed and a report will be available in the upcoming months.  Congratulations to Palau for completing a successful survey! 

Suzette Brikul is hard at work cleaning data.
Israella Reklai trains surveyors on data collection using tablets.
Vector Control, Lab and Site Visits for Zika Surge Response Team
Each jurisdiction has a vector control plan that includes agency responsibility areas, Human Resource needs, budgets, and trigger point for emergency spraying. Last month, the Zika Surge Response Team focused on, assessment of high-risk areas in each jurisdiction and an abatement plan.

They prioritized getting the mosquito lab up and running in Guam as well as setting in place a system for each jurisdiction to ship mosquito samples for identification and analysis as well as plan in place for each jurisdiction to collect mosquito samples on regular basis.

PIHOA's Zika Surge Response Vector Control Team meets with Guam DPHSS to discuss next steps to opening the long awaited mosquito lab.
Other priorities include, taking a look at best practice from around the world and adopt those that apply, repository of published literature of studies as well as recommendations from WHO, SPC and other partners in the area and coordination with NEPHA. Ongoing efforts include, community clean up in Guam, creating vector control plans, implementing policies, procedures and SOP coordination, financial management and getting the lab up and running in Guam.
The Republic of the Marshall Islands Hosts Noncommunicable Diseases (NCD) Summit in December 2016

The Republic of the Marshall Islands NCD Summit was held in Majuro, RMI in December 2016. The RMI NCD Sumit was initiated by Dr. Kennar Briand, the Secretary of Health for the RMI Ministry of Health (RMI MOH) to increase engagement of ministries and sectors outside of the RMI MOH in response to the declared emergency of NCD in the Marshalls. It was well attended by cabinet members, secretaries and senators. The meeting was opened by President Hilda Heine, who re-iterated her commitment to action regarding the NCD response, and who issued concluding remarks at the end of the Summit requesting preparation of a Cabinet Paper aimed at establishment of a high-level task force.

There was not a clear set of priorities for action that came from the Summit, though a number of promising areas regarding actions by schools, R&D, and related to enforcement were presented and discussed.  Assistance rendered by PIHOA includes planning of the summit and the keynote address by Dr. Mark Durand, PIHOA’s Regional PM/QA/QI and Health Information Management Systems Coordinator, who assisted with drafting the steering committee’s RMI 1st NCD Summit Resolution. 

Photo Section
"Island Soldier" Trailer
Check out this new trailer on the upcoming release of "Island Soldier," a close look at Micronesians entering the US armed forces, and a clear call for our island veterans to be accorded fair and equal treatment when they return home after defending and honoring that which is the American Dream. Click HERE! 
Local & National Events

March 4-7, 2017
Location: Kansas City, Missouri

March 15-17, 2017

March 24-25, 2017
Pacific Islands Infectious Diseases Conference
Location: Guam

March 27-31, 2017
Location: Saipan, CNMI

March 30-April 1, 2017

April 3-5, 2017

April 24-26, 2017
2017 National Oral Health Conference
Location: Albuquerque, NM

April 25-27, 2017
Location: Suva, Fiji

April 25-28, 2017
Location: Atlanta, GA

May 1-5, 2017
5th LabNet Meeting-Lab Biosafety Training and AUL Meeting
Location: Guam

May 31, 2017

June 4-8, 2017
Location:  Boise, Idaho

June 6-9, 2017
Location: Rockville, MD

June 11-14, 2017
Location:  Providence, Rhode Island

September 20-21, 2017
Location:  Capital Hilton in Washington, D.C.

November 4-8, 2017
Location:  Atlanta, Georgia
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