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 3
Quarter 3: September 2017
A Message From the PIHOA Executive Director

Dear Pacific Colleagues,
FY17 ended with a bang on June 30, 2017. Reflecting back over the last 12 months, the accomplishments have been significant. To highlight just a few:
1. PIHOA leadership completed and endorsed PIHOA's Strategic Framework for Action 2018-22.

2. Completed full Data for Decision-Making (DDM) delivery to all the FSM states and FSM National , and are now in the process of submitting final documents to the Fiji National University (FNU) for successful DDM completers to confer Epidemiology Technician Post-Graduate Certificates. What an accomplishment for the FSM , and thank you to our partners, SPC , CDC OPHPR , CDC NCCDPHP , and FNU for making this a reality! As of August 2017, DDM delivery was also completed in American Samoa, and has kicked off in RMI and Guam. 

3. Kicked off the Strengthening Medical Labs Towards Accreditation (SLMTA) in December 2016 in Yap, FSM, and have completed 2 of 4 segments, including pre-SLMTA audit of the Yap Hospital Lab and 1 st  SLMTA training workshop. This is a very promising start, and Yap is leading the way for the other FAS labs towards attaining international accreditation.  

4. Recruited 32 consultant subject matter experts (SMEs) under our Regional Zika Surge Response project funded by CDC OPHPR : 3 co-located at Kosrae DHS, 7 co-located at RMI MOH , and 6 co-located at AS DOH , with the rest comprising a deploy-able regional team based out of PIHOA’s Guam office. The SMEs provided a range of services, local training, systems development, and other technical support in the areas of laboratory, epidemiology, vector control and management, administrative preparedness, IT, incident command operational support, data entry, mosquito identification and surveillance, mosquito abatement and breeding site assessments, and risk communication/community mobilization.
5. An exciting development from the Regional Zika Surge Response work has been the continued support for the growth and expansion of both the Guam Division of Environmental Health (DEH) Mosquito Lab and Guam Public Health Laboratory as potential future regional reference laboratories.  Guam Public Health Lab has recently passed, with 100% proficiency test scores for PCR testing of Zika, Dengue and Chikungunya, with CNMI now sending some samples to Guam for testing; and, the Guam Division of Environmental Health Lab now has a brand-new facility in Dededo, next to the Community Health Center. Learn more about the new mosquito species in Guam by checking out a recent interview with the Guam DEH team assisted by PIHOA’s Regional Entomologist, Ms. Elodie Vajda (Zika SME consultant). via KUAM News . LINK TO INTERVIEW .

Many challenges remain, but the continued dedication and hard work of many is self-evident in these accomplishments, and made only possible through strong partnerships, coordination, and collaborations across multiple agencies, funders, and local Pacific colleagues. 
In closing, I want to sincerely thank the PIHOA Board leadership, our funders and partners for making all the accomplishments in FY17 a reality. In particular, I want to thank our Pacific colleagues at the local health departments, hospitals and Community Health Centers in CNMI, Guam, American Samoa, FSM, RMI, and Palau, CDC partners at OPHPR , CSELS , NCCHSTP , NCCDPHP , and OSTLTS , HRSA , HHS Region 9 and HQ , SPC , FNU , UH JABSOM , University of Arizona , ASTHO , APHL , DOI , and regional Pacific professional associations such as PIPCA, CCPI , PBMA , AUL, to name a few. Thank you all, and looking forward to a fruitful FY18. 
-Emi Chutaro, PIHOA Executive Director
Recap of the PIHOA Zika and Vector Control Summit!
The PIHOA Zika and Vector Control Summit was held on June 26-29, 2017 at the Holiday Resort and Spa in Guam . The summit’s theme was “Breaking Down the Silos for Preparedness and Management of Emergencies and Disasters in the U.S. Affiliated Pacific Islands (USAPIs).”

During the four-day Summit, participants critically discussed and reflect on jurisdiction and regional responses to recent Zika outbreaks and other arboviral infectious diseases in the USAPIs.

The summit brought together members from across all Government levels, including USAPI Hospital Managers, Finance Directors, Procurement Directors, and Epidemiology Surveillance and Vector Control Specialists.

Summit participants were able to develop policy statements and recommendations for health leadership and regional partner consideration and action for targeted investments in strengthening public health emergency response and preparedness systems and capabilities at both the jurisdictional and regional levels. The Summit also provided participants the opportunity for continuing professional development in a range of core public health emergency response and preparedness capabilities using a multi-sectoral, team and problem-based learning approach.
Zika Summit participants watching jurisdiction leads present on the strengths and weaknesses identified through the Table Top Exercise conducted earlier that day.
Judy Won Pat ( PIHOA Consultant) sharing valuable insight on what she observed during the Table Top Exercises and her work with PIHOA's Zika Project.
Dr. Helentina Garstang ( Majuro Ministry of Health ) and Tuvuki Ketedromo ( Majuro Environmental Protection Agency ) presenting on RMI’s Zika response. 
Ken Williams (PIHOA Consultant) from Top End Pest Control presenting on “Safety Data sheets and Pesticide Labels” to jurisdictional vector management and environmental health officials during the vector control portion of the Summit. 
Panel discussion led by Emi Chutaro (PIHOA’s Executive Director). Panel members (L-R): Paul Jagals ( WHO Consultant), Joanne Maireng Sengebau ( PIHOA Consultant), Clifford Chang (PIPCA), Dr. Matthew Shortus ( WHO ), Martin Adams ( GSS Health ), Dr. Cameron Webb ( Univeristy of Sydney ), Dr. Thane Hancock ( CDC ), and Vasiti Uluviti ( PIHOA ).
Joanne Sengebau ( PIHOA Consultant) presenting an after action report on the PIHOA Zika Surge and Vector Control Projects in Palau. The report highlighted what the project accomplished, strengths and weaknesses and suggestions for ways the jurisdictions should move forward. 
62nd PIHOA Executive Board Meeting, October 3-5, 2017
'Ohana Waikiki East by Outrigger Hotel
For the updated meeting agenda and additional meeting information, click HERE.
NCD Hybrid Surveys are taking off in the region!
Attendees of the Palau Hybrid Survey Dissemination Workshop show off their healthy hearts

The “Hybrid Survey” is a collaborative approach to the collection of key adult health indicators. This methodology combines indicators from multiple surveillance systems ( CDC BRFSS , WHO STEPS , SAMHSA NOMs , CDC NHANES , etc), and allows large adult population-based face-to-face surveys to be supported by various support partners. This model allows limited resources and staff capacity to be used effectively. These “Hybrid Surveys” have been piloted in the USAPIs to fill adult surveillance gaps, specifically regarding non communicable diseases (NCDs).

In June 2017, Palau held a dissemination workshop to share the results of their Hybrid Survey conducted from May-December 2016. During this workshop key stakeholders and community members reviewed the results and used the data collected to strategize NCD efforts. This was similar to the Dissemination Workshop held in CNMI in October 2016 to highlight their Hybrid Survey results.
Left: Suzette Brikul ( Palau MOH ) training her Marshallese colleagues. Right: Marshallese Surveyors practicing their interview and biochemical measurement skills.
Top: Suzette Brikul ( Palau MOH ) giving interview tips to her American Samoan colleagues. Bottom: American Samoan Surveyors practicing blood pressure and biochemical protocols.
In July 2017, surveyor training's were held in RMI and American Samoa to kick off their Hybrid Surveys. These training's were conducted by Dr. Haley Cash ( CDC / PIHOA ), Suzette Brikul ( Palau MOH ), Dr. Erin Passmore ( SPC ), and Alyssa O’Hair ( SAMHSA’s CAPT). 

We were especially excited to have Suzette based on her experiences managing the Palau Hybrid Survey. Data collection in both jurisdictions is currently ongoing and will continue through December. To promote their Hybrid Survey, the American Samoa Department of Health developed this fabulous promotional video (see video to the right).
Congratulations ASTHO on Celebrating your 75th Anniversary!
The PIHOA Board President, Director James Gillan ( Guam DPHSS ) and PIHOA Vice President, CEO Esther Muna ( CNMI CHCC ) presenting plaque to new ASTHO Board President, John Wiseman and koa bowl to former ASTHO Executive Director, Paul Jarris at the 2017 ASTHO Policy Summit, Anniversary and Annual Meeting in Washington D.C. from September 19-21, 2017.
The PIHOA Secretariat visits CDC Headquarters 

The PIHOA Secretariat Staff traveled to Atlanta, GA to participate in a site visit at the Centers for Disease Controls and Prevention (CDC) Headquarters from August 7-11, 2017. The PIHOA Secretariat Staff included, Ms. Emi Chutaro, PIHOA Executive Director, Dr. Mark Durand, PIHOA Regional Health Information and Management Systems and Surveillance Coordinator, Dr. Angela Techur-Pedro, PIHOA's Pacific Basin Primary Care Office Coordinator, Ms. Vasiti Uluiviti, PIHOA Regional Laboratory Coordinator, and Ms. Luana Bass, PIHOA Finance Officer.

The purpose of the site visit was for the PIHOA Secretariat Staff to meet with CDC officials and share PIHOA's current activities in the USAPIs and challenges and accomplishments in the region. Ms. Chutaro presented select priority health issues, diversities, vulnerabilities, and associated public health and health security implications for populations in the Pacific region. Ms. Chutaro emphasized that "there's a huge appreciation for funding as funding is critical, but the question is, is that funding designed appropriately to meet our context specific issues and challenges?" This is one of the challenges the USAPI region experiences across different departments.
The PIHOA Secretariat program and technical staff shared updates related to their area of work. Ms. Uluiviti gave an overview of the PIHOA Regional Lab Strengthening Initiative in which she focused her presentation on four main areas; 1) lab capacity building in the USAPIs, 2) infectious disease surveillance, public health and laboratory preparedness in the USAPIs, 3) tuberculosis surveillance in the USAPIs, and 4) the medical laboratory workforce in the USAPIs.

Dr. Durand presented on strengthening performance management, health information systems and epidemiology capacity in the USAPIs. Dr. Durand shared success stories, lessons learned and next steps with the Data for Decision Making (DDM) Program. Dr. Durand also summarized the on-going issue of NCDs in the USAPIs and how DDM is an excellent means of improving communicable diseases (CD) & NDC surveillance and other routine reporting for health.
Dr. Techur-Pedro presented on the human resources for health and work force development programs PIHOA is currently involved with in the USAPIs such as the HPSA/MUAP/P designations, National Health Service Corps (NHSC) recruitment, the Nurse Practitioner Training Program (NPTP), the Palau Medical Student Internship Program, human Resource management training, and much more. Dr. Techur-Pedro stressed that a critical challenge for the USAPIs is having sustainable health professional workforce resources and how it is vital towards strengthening the health care systems and improving outcomes in the islands.

Ms. Chutaro also shared that PIHOA's overarching goal is to "strengthen local and regional health system capabilities and community resilience against local and external health threats in line with stated Pacific regional health priorities (Health Islands Vision)." By doing so, PIHOA is focusing on seven areas geared towards health systems strengthening such as; 1) Ancillary and Support Services, 2) Health Information Management Systems, 3) Performance Management and Quality Improvement, 4) Human Resources for Health/Workforce Development, 5) Strategic Engagement, Coordination and Resource Mobilization, 6) Regional Policy and Leadership Development, and 7) Advocacy.
For many years, the CDC has been a huge support system to PIHOA and the Pacific. PIHOA would like to thank the CDC for their constant support, partnership, and commitment to the USAPIs.
Check-out the PIHOA Secretariat Staff Presentations at the CDC Site Visit
Ms. Emi Chutaro's opening presentation at the PIHOA / CDC site visit.
Ms. Vasiti Uluiviti's presentation at the PIHOA / CDC site visit.
Dr. Mark Durand's presentation at the PIHOA / CDC site visit.
Dr. Angela Techur-Pedro's presentation at the PIHOA / CDC site visit.
Updates from the RMI Nurse Practitioner Training program
The RMI Nurse Practitioner Training (NPT) program is into its twelfth month and about 6 more months to complete. There are 15 students remaining from the 17 that started off with the program.
The students are having both classroom and clinical placements, enthusiastically caring for the community members with upskilled knowledge and clinical skills. In late July, they were trained on PEN facilitated by WHO . They have also just completed Integrated Management of Childhood Illnesses (IMCI) training this week which the faculty facilitated.
Later in the month and through to November, students (with community members) will have opportunity to assess and diagnose the health of Laura zone, and to work with the community members to plan, implement, and evaluate strategies to improve the health status of their community.
The NPT program is being conducted in the RMI by the Fiji National University's School of Nursing (FNU) . The program is funded by the U.S. Department of Interior (DOI) that will end in March 2018. The NPT graduates will increase dramatically RMI’s Clinical Primary Care capacity and demonstrate that Nurse Practitioner Training can be successfully conducted in the Freely Associated States Nations. By the next PIHOA meeting, the RMI looks forward to the graduation of its new Nurse Practitioners.
M indy Sugiyama (Palau MOH) publishes a manuscript on Gestational Diabetes in Palau
Mindy Sugiyama, an Epidemiology Specialist with the Palau Ministry of Health (Palau MOH) had her first ever first-author manuscript published. Her paper entitled “Assessment of Gestational Diabetes and Associated Risk Factors and Outcomes in the Pacific Island Nation of Palau” was published in July 2017 in the Maternal Child Health Journal. In her research Mindy identified risk factors for developing Gestational Diabetes (GDM) in Palau, and also found that women with GDM were five times more likely to have a neonatal death than women without GDM in Palau. 

Mindy is a graduate of the Data for Decision Making (DDM) program. This paper was a product of the recent Operational Research (OR) course offered to graduates of DDM. We are very proud of Mindy! Please check out her manuscript HERE !
PIHOA representation at the annual Pacific Islands TB Controllers Association (PITCA) Conference

Back (L-R): Senibua Wainiqolo (LBJTMC Lab), Nomin Dora (Majuro Hosp Lab), Vasiti Uluiviti ( PIHOA ), Evelyn Tomokane (Palau Hosp Lab). Front (L-R): Daisy Phal (Yap Hosp Lab), Dr. Angela Starks ( CDC Mycobacterium Reference Lab).
The annual PITCA meeting was held on September 11-15, 2017 at the Hilton Hawaiian Village in Honolulu, Hawaii. PIHOA was represented by Ms. Vasiti Uluiviti, PIHOA's Regional Laboratory Coordinator and other partners.

This five-day conference provided training and networking opportunities for TB professionals in the Pacific Island regions. The conference was comprised of plenary sessions and breakout sessions. During the half-day breakout sessions, attendees separated into four groups for TB trainings specific to their role, which include, Clinicians, Nurses and outreach workers, Laboratorians, and program managers.

L-R: Brelinda (CNMI), Vasiti Uluiviti ( PIHOA ), Kerri Shaw ( Australian Respiratory Council ), Marice Rabauliman (CNMI), Amanda Christensen ( Australian Respiratory Counci l).
L-R: Connie Olikong (Palau TB Program), Kasian Otoko (Chuuk Hosp Lab supervisor), Margarita Aldan (CNMI Public Health Director), Vasiti Uluiviti ( PIHOA ), Marcie Rabauliman (CNMI TB Program), Brelinda Taimanao (CNMI TB Nurse).
The American Samoa TB Program Team: Dr. Saipale Fuimaono (TB Physician), Esther Fouvale (TB Nurse), Mary Mataia (American Samoa Dept. of Health Lab Manager), Vasiti Uluiviti ( PIHOA ).
With Guam Team: Vasiti Uluiviti ( PIHOA ), Alice (Guam TB Program ), Lea Nisay ( GPHL TB Lab Tech).
Updates from the Doctors and Dentist for Tomorrow Program
The Doctors and Dentist for Tomorrow (DDFT) program is in its third year and is currently training two cohorts totaling 30 students from all the states of the FSM. The First Cohort (now 13) commenced training in June 2016 and is currently in its fourth semester of a five semester program that will lead to a formal COM-FSM Associate of Sciences Degree. The Second Cohort (now 15) just completed a rigorous basic human sciences summer semester which has prepared them for four challenging semesters of foundation human sciences studies.
THE DDFT program is based at the College of Micronesia-FSM , funded through a Health Careers Opportunity Program (HCOP) grant and is a cooperative effort that includes COM-FSM , PIHOA and the John A. Burns School of Medicine (JABSOM) . The primary purpose of the DDFT is to increase the numbers of students from the FSM that will be eligible for and successful in matriculating in FNU’s Medical and Dental Schools. The DDFT will also prepare students to enter upper-level bachelor’s degree programs that prepare graduates for postgraduate medical and dental studies in the Philippines, Taiwan, Hawaii and the U.S. Mainland. 
FNU’s Faculty of Medicine has accepted an invitation by COM-FSM to visit Pohnpei State and review the DDFT Program to assess the suitability of DDFT students for studies at FNU . After reviewing some of the academic barriers to success by island students at FNU , strong features of the DDFT program include:

1) wrap around Study Skills training, 2) integration of the health sciences into the English reading and writing classes, 3) early introduction of problem based learning (PBL) courses to encourage enhancing lifelong adult learning skills, 4) preliminary human anatomy and physiology course training to increase knowledge in the human sciences and fluency with the human sciences vocabulary, 5) computer training to strengthen search engine skills to support PBL courses in the human sciences and 6) early introduction to clinical medicine and dentistry through hands-on supervised rotations at Pohnpei State Hospital and Clinics. The First DDFT Cohort will graduate in May 2018.
PIHOA Zika Surge Emergency and Response Preparedness Project Regional Team visit American Samoa
The PIHOA Zika Surge Emergency and Response Preparedness Project Regional team met with the embedded PIHOA Zika Project staff in American Samoa in August 2017. 

The meeting was a technical visit to see how the staff was doing now that PIHOA is fully engaged in the carryover, and to address any questions or concerns with their new roles. 

American Samoa is the only jurisdiction that was granted a one-year carryover for the Zika Project. All others were granted 90 days which will become final on September 30, 2017.
During the visit to American Samoa , the PIHOA Guam staff consisting of Mrs. Andrea Whitt and Mr. Kinsey McFadden sat in with the Health Resources and Services Administration (HRSA) and the American Samoa medical leads at the Tafuna Health Center.

One of the topics discussed was the Zika Supplemental Grant. PIHOA would like to thank the HRSA representatives and Director Tuileama Nua and his staff at the American Samoa Department of Public Health for their hospitality!
You can now find future videos regarding PIHOA projects and activities on our new YouTube Channel HERE!

Photo Section
Local & National Events

September 27-29, 2017
Location: Washington D.C.

October 3-5, 2017
Location: Honolulu, HI

October 3-5, 2017
Location: Honolulu, HI

October 10-12, 2017
Pacific Island Primary Care Association (PIPCA) Meeting
Location: Honolulu, HI

October 9-13, 2017
Location: Brisbane, AU

October 12-13, 2017
Location: Honolulu, HI

October 19, 2017
Location: Honolulu, HI

November 4-8, 2017
Location: Atlanta, Georgia

December 11-14, 2017
Location: Honolulu, HI

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