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 3
Quarter 3: October 2019
American Samoa starts another round of DDM
In July 2019, PIHOA started another round of Data for Decision Making (DDM) delivered in American Samoa. Twenty-four students passed the first module (EPI826-2) and will continue to complete the DDM program over the next year. EPI 826-2 provides an overview of public health surveillance and surveillance systems. The course topics include the purpose and application of various surveillance systems, as well as covers the process of developing surveillance systems and the selection and evaluation of key indicators.
Hands-on work included the development of surveillance flowcharts, surveillance plans, and standardized reporting templates. Upon completion of all four didactic modules and development of a project, passing students will receive a Certificate in Field Epidemiology from Fiji National University (FNU) . This course was facilitated by local epidemiologists, Aifili Tufa and Mata’uitafa Faiai, PIHOA intern, Leiema Hunt, and PIHOA consultants, Dr. Mark Durand and Dr. Haley Cash.
66th PIHOA Executive Board Meeting
Honolulu, HI
November 18-22, 2019

For meeting details and registration, click HERE !
Micronesian Chief Executives endorse and sign the Regional Health Committee's two proposed resolutions at the 24th Micronesian Island Forum in Chuuk, FSM
Every year, the Chief Executives of Micronesia meet to discuss and establish regional cooperation on a variety of issues that are of mutual concern to the region. Known as the Micronesian Islands Forum (MIF), this annual summit brings together the six governors and three presidents of Micronesia, as well as policy representatives from the US-affiliated Pacific Islands (USAPIs). In July 2019, the 24th MIF Summit was held in Chuuk, FSM. The Regional Health Committee (RHC) at this year's summit included FSM National Department of Health Services Acting Secretary of Health Mayleen Ekiek, Chuuk Department of Health Services Director Julio Marar, Kosrae Department of Health Services Director Livinson Taulung, Yap Department of Health Services Deputy Director Dominic Taruwemai, and PIHOA Executive Director Emi Chutaro.
Key topics shared during the RHC's presentation included USAPI military veterans' rights and equitable access to quality healthcare services, the growing impact of antimicrobial resistance (AMR), strengthening USAPI healthcare facilities management competencies and systems, and the RCH's proposed resolutions for MIF consideration. The Micronesian Chief Executives unanimously endorsed and signed the Regional Health Committee’s two proposed resolutions; 1) concerning access to quality and comprehensive healthcare services for Pacific Island Veterans of the US Armed Forces and their families; 2) concerning strengthening USAPI health department capacities and systems to effectively address the health security threat of antimicrobial resistance (AMR).
Blood-borne pathogens training held in Pohnpei, FSM
In July 2019, a week long blood-borne pathogens training was held in Pohnpei, FSM. Bloodborne pathogens are viral or bacterial microorganisms that exist in blood or other body fluids and that can cause disease in humans, including but not limited to; Hepatitis B, Hepatitis C, and human immunodeficiency virus (HIV). Workers exposed to these pathogens risk serious illness or death. Exposure to blood and other body fluids occur across a wide variety of occupations.

Health care workers, including medical lab personnel, emergency response and public safety personnel, and other workers can be exposed to blood through needlestick and other sharps injuries, contact between mucous membrane broken skin and infected body fluids. Workers and employers should take advantage of available protective equipment and work practices to prevent exposure to blood and other body fluids. Being a healthcare worker, it is important to know the microbiology of these various types of bloodborne pathogens, the infections they cause, and the types of laboratory methods used to detect and confirm their presence.
At the end of the training, participants were able to list and categorize the selected bloodborne pathogens and the infectious disease they cause, describe the microbiology and transmission of the infectious diseases, describe the laboratory methods used to confirm the detection/presence of the selected infectious diseases, explain the importance of infection prevention and control in the laboratory environment and discuss the various biosafety levels and practices and infectious waste management. The training was led by PIHOA Regional Laboratory Program Specialist, Mr. Manasa Mainaqelelevu. Mr. Mainaqelelevu co-facilitated the training with Ms. Salanieta Duituturaga and Ms. Reapi Waqa.
Meet our summer intern, Leiema Hunt
Ms. Leiema Hunt is originally from American Samoa and is currently pursuing her Master’s in Public Health (MPH) degree at Brigham Young University (BYU) . Ms. Hunt completed her public health internship this past summer at the PIHOA Honolulu office working with Dr. Haley Cash, the NCD Regional Epidemiologist for the USAPIs.

During her internship Ms. Hunt was able to help facilitate the Data for Decision Making (DDM) course delivery in American Samoa, put data sharing protocols in place for the American Samoa Hybrid Survey, and develop infographic factsheets (see infographic below) for the American Samoa Department of Public Health (AS DOH) to use. We wish her the best of luck in the second year of her MPH program and look forward to watching her do great things in the islands.
Applications for summer 2020 internship in Pohnpei now open
The PIHOA Pacific Islands Public Health Training Center (PIPHTC) is inviting applicants for a new round of international health internships to commence summer 2020. These internships are based in Pohnpei, Federated States of Micronesia, and involve working in a range of settings with a special emphasis on public health-based programs focused on disease prevention.  
Applicants must be current undergraduate, graduate or doctoral students in a health-related field. Preference is given to those who are studying at programs in the USAPI, Hawai`i, California, Nevada, or Arizona. A stipend of $3,500 USD is available to defer the cost of transportation, housing, and other expenses. Pacific Island candidates are encouraged to apply. Previous applicants have come from public health, medicine, and international development programs, and have been placed with the Pohnpei State Department of Health and the Pohnpei State Hospital, where they were involved in a wide-range of projects. Past interns have emphasized how much they enjoyed their time in Pohnpei working alongside amazing people from a range of backgrounds, and how it strengthened their desire to pursue a career in international health, especially in the Pacific. 
For more information, please see the  information page , along with the  application , at the University of Arizona’s  Western Region Public Health Training Center (WRPHTC) website. Additional  internships , primarily located in the Western United States, are also available through various WRPHTC partners.  The PIHOA PIPHTC is part of the WRPHTC , a consortium of public health training sites located across the Western United States and the USAPI, and is supported by a grant from the Health Resources Services Administration (HRSA) .  
Roundtable discussion with the United States Surgeon General
On July 31, 2019, US Surgeon General Jerome Adams traveled to Honolulu to meet with various leaders and organizations, including the  University of Hawaii’s John A. Burns School of Medicine (UH JABSOM)  students and faculty. During his visit to  JABSOM , Dr. Adams listened to community health advocates in a Round Table Discussion involving  UH  faculty and organizations who are active in health in Hawaii and throughout the Pacific Region, including  PIHOA , the  Pacific Islands Primary Care Association (PIPCA) Kokua Kalihi Valley (KKV) Community Health Center  and  We Are Oceania (WAO) .
PIHOA  Deputy Director Janet Camacho and Regional NCD Epidemiologist for the USAPI, Dr. Haley Cash attended the roundtable discussion as well as PIHOA Executive Director, Emi Chutaro, who joined remotely to share current challenges and success stories across various public health programs in the USAPIs. 

The roundtable session concluded with discussion on opportunities to further coordinate and strengthen partnerships to help improve health and healthcare for the USAPI community.

Read more  HERE  from  JABSOM’s UH  Med Now.
Pohnpei State Hospital Lab wins 2019 PITCA poster competition
Since 2007, Diagnostic Lab Services (DLS) in Honolulu, Hawaii subcontracted PIHOA for the provision of technical assistance and lab training for all TB lab-related activities in the USAPI. This includes the co-facilitation with DLS and Centers for Disease Control and Prevention (CDC) of the plenary and lab breakout sessions during the annual Pacific Islands Tuberculosis Controllers Association (PITCA) meetings. This year’s PITCA meeting was held in Palau from September 9 to 13, 2019. 

This was an exceptional PITCA meeting as it was the first time ever that posters were presented during the meeting. As an outcome of the 2018 PITCA meeting in Saipan, CNMI last year, all USAPI TB lab techs agreed to compile and present a poster at the 2019 PITCA meeting. Other members of the USAPI TB program (nurses, program managers, etc.) followed suit and presented posters as well at this year’s meeting with a total of eight poster presentations.

To advocate and encourage participation in the poster presentation, it was decided that all participating lab poster presenters would be part of a poster competition. Four USAPI labs presented a poster at the 2019 PITCA meeting with an emphasis of the work in their jurisdiction. 
Belau National Hospital Lab presented a poster on performance of Xpert MTB/RIF assay in the diagnosis of suspected TB cases in Palau, Guam Public Health Lab (GPHL) presented correlating Xpert® MTB/RIF assay cycle threshold values to acid fast bacilli smear results and culture isolation of  M. tuberculosis  in Guam, Pohnpei Hospital Lab presented on how poor quality sputum compromises the outcome of the AFB smear microscopy result, and Yap Hospital Lab presented on the unique case of common challenges in TB management in Yap.

Dr. Alfred Lardizabal from the Global TB Institute , Dr. Subash Yadav from WHO and Ms. Donna Wegener from the National TB Controllers Association judged the lab posters. The winner of the 2019 PITCA lab poster competition was Pohnpei State Hospital Lab. Pohnpei State Hospital Lab was awarded a choice of three lab textbooks of their preference, purchased by PIHOA, to build up their collection of resources for their lab library.
Kosrae conducts its Hybrid Survey dissemination workshop
Kosrae completed its first-ever Hybrid survey this year to understand the current prevalence of NCDs and risk factors. Stakeholders then participated in a dissemination workshop September 4-5, 2019 to review the new data and learn how to utilize these data to prioritize health issues, and identify appropriate action plans. 

One participant commented that the best part of this workshop was learning “all the new ways of classifying data and identifying priorities making it easy for decision making, prioritization, and planning.”
New Indo-Pacific Command's initiative aims to strengthen infrastructure and improve health care workforce within the Pacific islands
On August 6, 2019, more than 100 people gathered at the  University of Hawaii’s John A. Burns School of Medicine (UH JABSOM)  to attend the “Finding Sustainable Healthcare Solutions for Oceania” conference. The U.S. military is launching a new effort to support and coordinate health care efforts across Pacific islands and discussed the new U.S.Indo-Pacific Command ( U.S. INDO-PACOM) initiative. Participants included military doctors, local physicians, academics, public health workers, U.S. government officials, USAID officials, pacific health organizations and associations, and embassy officials from Palau, the Marshall Islands and the Federated States of Micronesia. 

Rear Admiral Louis C. Tripoli addressed the group, emphasizing that the U.S. INDO-PACOM does not want to re-invent the wheel but rather learn about existing programs, leverage current resources and improve the efficiency and effectiveness of ongoing regional health care efforts. He noted that the U.S. military already supports health care in the Pacific island nations and territories, but this initiative would be a more collaborative effort to find solutions that are both sustainable and self-sufficient. RDML Tripoli attended the 65th  PIHOA  Executive Board Meeting in Palau this past March, starting the conversation with USAPI Ministers, Directors and Secretaries of Health on ways the U.S. INDO-PACOM can better support and strengthen infrastructure and improve the health care workforce within the Pacific islands.
USAPIs participate in HRSA Title V MCH Block Grant Reviews
All six USAPIs attended HRSA Title V Maternal Child Health (MCH) Block Grant reviews in Honolulu this August. These reviews are conducted annually to provide constructive feedback to jurisdictions regarding their MCH programs supported by HRSA Title V MCH funds. Feedback provided during the review process helps the MCH programs to continue to strengthen their work in order to improve the health of women and children in the USAPIs.

More information about the HRSA Title V MCH Block Grant funds can be found HERE .
PIHOA Board Member Spotlight
Dr. Aileen Tareg, DrPH
Director, Yap State Department of Health Services

Dr. Aileen Tareg, Director of Yap State Department of Health Services (Yap State DHS) joined the PIHOA Board earlier this year as an Associate Member.

Dr. Tareg received her Master of Public Health and Doctor of Public Health degrees, both in health education, in 2006 and 2012, respectively from Loma Linda University in California. Her background is in tobacco cessation and education, but she has also been doing work in the non-communicable disease field since 2014.

Dr. Tareg’s priorities as the Yap State DHS Director include creating a state tax for betel-nut purchase and creating a separate health division for the neighboring islands, which have been long neglected. She would also like to finish Yap’s wellness center project, which she started prior to her directorship and make it a fitness/community support center where people can be more engaged in personal health as well as join others in addressing exercise, nutrition, weight loss and behavior change (cessation for alcohol, tobacco, betel-nut).

Dr. Tareg shared that Yap’s biggest challenge includes dealing with the neighboring islands, which are far removed from the main island while transportation is scarce and very unreliable. She said they have a few staff out there and they have not yet created a reliable, systematic way to keep them adequately trained and well-supported with supplies and manpower.

Dr. Tareg reflected on the challenges as a new director and effectively leading through change. Managing changes such as redistribution of the work in the department, making structural changes, and trying to find the right roles for each person that brings out their best work can be scary. She is aware of the leadership it will take to navigate during these transitions.

When asked about what is valuable about being a PIHOA Board member, Dr. Tareg said, “It's been great networking and talking with other health officers around the Pacific. I think I've learned a lot from what's being shared of the work that's being done and it's great knowing where to turn to ask for advice and resources for what we need in Yap.”

As a PIHOA Board member, Dr. Tareg hopes to lead health-based efforts in Yap to ensure they have a strong health system that will also provide help in return to the sister Oceania jurisdictions.
PIHOA Board Members and Secretariat Staff Represent the USAPIs at the 13th Pacific Health Ministers Meeting in Tahiti
From August 5-8, 2019,  PIHOA  Executive Board Members and Secretariat Staff represented the USAPIs at the  13th Pacific Health Ministers Meeting (PHMM)  in French Polynesia. The meeting covered various topics of regional significance such as universal health coverage (covering primary care reforms, health information systems and human resources for health), climate change and health, Pacific health security, noncommunicable diseases, immunization and vaccine preventable diseases, and water, sanitation and hygiene (WASH). 

The health impacts of a changing climate were a focus of the meeting, with ministers acknowledging the climate crisis, and endorsing a roadmap to address climate-related threats to safe drinking water, food security, resilient health infrastructure, and secure shelter in the Pacific. Additionally, health security, an essential requirement in one of the most disaster prone regions, was also a key focus, with ministers committing to develop and fund national health security action plans to fill gaps in emergency preparedness and response capacities, and sustain gains already made. For meeting documents and presentations, click  HERE !
American Samoa launches their second round of the Lymphatic Filariasis (LF) Mass Drug Administration (MDA)
On Monday, September 23, 2019, the  AS DOH , in collaboration with the  CDC , the WHO  and  PIHOA , launched the second round of their Lymphatic Filariasis (LF) Mass Drug Administration (MDA). Lymphatic Filariasis (LF) is a vector borne neglected tropical disease that causes damage of the lymphatic system and can lead to lymphedema (elephantiasis) and hydrocele in infected individuals.

The medication regimen is provided to all eligible persons in the community to interrupt the transmission of LF. American Samoa is in its second year of the LF MDA initiative with the goal of eliminating the disease as a public health problem in the island nation.
WHO WPRO Director, Dr. Takeshi Kasai visits PIHOA Offices
In September 2019, the WHO WPRO Director, Dr. Takeshi Kasai made courtesy visits to the PIHOA Guam and Honolulu offices. In Guam, Dr. Kasai met with the PIHOA staff, consultants, CDC staff placements and former PIHOA Board President and Director of Guam DPHSS, James Gillan. Dr. Kasai was given an overview of accomplishments from PIHOA's DDM program, lab strengthening initiative and emergency preparedness response efforts in the USAPIs.
Dr. Kasai concluded his courtesy visit in Honolulu where he met with the U.S. INDO-PACOM interagency group, RDML Tripoli, component surgeons, HHS staff, CDC staff, CDC quarantine staff and PIHOA. During his visit to the PIHOA Honolulu Office, Dr. Kasai met with PIHOA Executive Director, Emi Chutaro, NCD Regional Epidemiologist for the USAPIs, Dr. Haley Cash and  Pacific Islands Primary Care Association (PIPCA)  Executive Director, Clifford Chang. Topics discussed include the regional epidemiology unit activities, regional human resources for health initiative, regional lab strengthening initiative and the USAPI community health centers.

Ms. Emi Chutaro and Ms. Janet Camacho, PIHOA Deputy Director attended the Seventieth Session of the WHO Regional Committee for the Western Pacific in Manila from October 7-11, 2019. PIHOA Board President and  Commonwealth Healthcare Corporation  CEO, Esther Muna also attended the session to discuss public health challenges in the USAPIs.
The PIHOA Regional Lab staff successfully completed quality control and method validation training to improve USAPI labs
In August 2019, PIHOA Regional Lab Strengthening Coordinator, Vasiti Uluiviti and Regional Lab Program Specialist, Manasa Mainaqelelevu successfully completed the quality control and method validation training in Johannesburg, South Africa. The nine-day training is usually taught as a university course; however, the course instructor and technical consultant was absolutely remarkable in delivering this sophisticated and complex subject in the simplest way possible that it can be easily understood by the attending laboratorians.

Quality Control (QC) is much more than just plotting the Levy-Jennings charts. The aggregated average pre-test score of previous course participants is 12%, indicating huge knowledge deficiency. This deficiency results in not only poor QC practice, but also laboratory managers’ inability to justify resources necessary to conduct an effective QC program. There is a need to expand this training to help laboratories achieve accreditation.
“A lot of new information was gained from this training, things that we were never taught when undertaking the courses in medical lab science, but are expected to be taught at the workplace. Being taught at the workplace was something most of the attending training participants never experienced at all,” said Uluiviti.  She continued to share how the training was indeed an eye opener in providing hints as to how to investigate QC issues especially when patients’ results are not making sense or not correlating well with the doctor’s clinical findings.

Training topics included selection of the most suitable lab testing equipment relating to the equipment’s intended use and the effective use of Levey-Jenning QC charts and its proper root cause analysis using Westgard rules to investigate QC problems that affect the patient results. This is an important topic to be taught to medical technologists and lab technicians especially in the clinical chemistry and hematology areas that perform lab tests using lab analyzers and equipment.
Helpful information was obtained on the introduction of new lab methods and verification that needs to be present to ensure that the results produced are valid, and determination of the right reference intervals or ranges for patients' test results.

This course will be supported by the PIHOA Regional Lab staff for the CLIA-regulated labs in the USAPI. The PIHOA Regional Lab staff will also advocate to all USAPI lab managements and to the PIHOA Board at the 66th PIHOA Board Meeting this November that they are available to assist in the selection of any lab and analyzer equipment they wish to purchase. The PIHOA Regional Lab staff plan on attending the Strengthening Lab Management Towards Accreditation (SLMTA) training of trainers (TOT) next year.
TB and Leprosy Free Chuuk project to start in March 2020
The Chuuk State Department of Health Services (Chuuk DHS) will soon begin an island-wide TB screening and treatment project. The goal is to identify, evaluate and treat both active and latent TB infection (LTBI) cases among adults and children living on Weno, Tol, and Polle islands. The 30-week project will take place between March and September 2020, with follow-up and treatment teams continuing to work until October 2020. This was done in Ebeye in 2017 and Majuro in 2018.

The project is targeting more than 20,000 people to screen, diagnose and treat TB in the community. According to the National Tuberculosis Controllers Association (NTCA) , the published rate of TB disease in Chuuk is well over 300/100,000, however, the work in neighboring Ebeye and Majuro Islands demonstrated a rate of over 1000/100,000 among adults, increasing to 2,400/100,000 among adults with poorly controlled diabetes.

In addition to finding and treating active TB, the project aim is to test and treat adults and children with LTBI, screen for Hansen's Disease (HD), and provide diabetes screening for adults found to have active TB, LTBI, or HD. For new TB cases that are infectious, the project will also include a household contact investigation to ensure residents undergo TB screening and are offered TB prevention.

The project is seeking trained individuals with significant TB experience who are willing to volunteer their time and energy for this innovative, large-scale project. These volunteers should be a mix of clinicians, nurses, and epidemiologist and or data support. The project is supported in collaboration with the National Government of the Federated States of Micronesia , the Chuuk State Government, U.S. Department of Interior (U.S. DOI) and PIHOA . Each volunteer is expected to provide at least three weeks of high-intensity time to the 30-week project.

If you are interested in volunteering for this project, sign up via the volunteer form HERE . For additional information please contact CDC TB Medical Officer, Dr. Richard Brostrom at [email protected] and Tennessee TB Elimination Program Medical Director, Dr. Jon Warkentin at [email protected] .
PIHOA Secretariat Staff visits key partners
PIHOA Visits the U.S. DOI
PIHOA Visits the FDA
August 2019 was a busy month for the  PIHOA  Secretariat staff as they visited multiple federal partners to share the work that PIHOA is engaged in throughout the USAPIs. PIHOA  Executive Director, Emi Chutaro and Deputy Director Janet Camacho along with other program and fiscal staff met with key partners from HRSA, U.S. DOI, Food and Drug Administration (FDA), Association of State and Territorial Health Officials (ASTHO), CDC Center  for  State, Tribal, Local, and Territorial Support (CDC CSTLTS), CDC Fort Collins and HHS Region IX.
During their visit to CDC headquarters in Atlanta, the PIHOA  Secretariat met with leaders from CSTLTS, the Center for Global Health, the National Center for Emerging and Zoonotic Infectious Diseases, Epidemiology and Laboratory Capacity for Infectious Diseases, the National Center for Environmental Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention ,  National Center for Chronic Disease Prevention and Health Promotion, the CDC Foundation, Center for Public Health Response, National Center for Immunization and Respiratory Diseases and the Office of Grant Services (OGS). 
PIHOA Visits CDC Fort Collins
A highlight during the visit to CDC headquarters in Atlanta was the presentation by PIHOA Executive Director Ms. Emi Chutaro and PIHOA Board President Esther Muna to CDC partners on U.S. Pacific Regional Priorities and Achievements in 2019. The lunch and learn, hosted by the National Partnership Branch in CDC CSTLTS, was well received by participants who were provided an overview of PIHOA and the Pacific regional priorities, highlights of some achievements under PIHOA 's CDC partnership cooperative agreement, and ways forward for continued CDC- PIHOA engagement.
Take preventative measures with the ongoing Dengue outbreak in the USAPIs and follow your local Department or Ministry of Health on social media for the latest buzz
Other Pacific Island Health News
Local & National Events

October 22-24, 2019
Location: Minneapolis, MN

November 6-8, 2019
Pacific Basin Medical Association (PBMA) Meeting
Location: Pohnpei, FSM

November 11-15, 2019
Pacific Islands Primary Care Association (PIPCA) Meeting
Location: Honolulu, HI

November 13-15, 2019
Location: Honolulu, HI

November 18-22, 2019
Location: Honolulu, HI

February 2020 (tentative)
Location: TBD

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

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 USAPIs, and should concern the public health and healthcare system field and related activities.