Outcomes of Healthcare in Kosrae, Pohnpei and F.S.M.

Emily LeutgebEllie Steiner

Ryan Johnsen Adam Koenig

Tyler Aronstein

Introduction to Outcomes of Healthcare

• Outcomes are defined by:o What happens after care has been provided

Perceived Quality of Care by Patients How healthy is the Population Customer Satisfaction

o How to improve it

Three Stages of Health and Illness in Micronesia

1. Introduction of infectious diseaseo Increased ship contact during the 1800so Considerable population loss on all islands

2.   Introduction of western medicineo Following WWIo Improved santitationo Brought infectious disease under control

3.  Shifting burden of illnesso Jobs multiplied, disposable income grewo Westernization of dietso Focus more on non-communicable diseases

 Today:  Micronesia still faces the lingering effects of the older disease burden while trying to combat the new illnesses associated with the modern life style.

The Numbers

Stat Old New

Life Expectancy (1994) 65.2 Years (2009) 69 Years

Infant Mortality (1994) 46/1,000 (2009) 39/1,000

Diabetes (1956) 8 (1976) 522

Heart Disease (1956) 192 (1976) 1,494

Categories of Disease1990-1994 1995-1999 2000-2003

Circulatory system disease

111.35 103.60 119.62

Respiratory Disease 62.04 52.08 59.81

Endocrine, Nutritional, and Metabolic Diseases

34.83 59.20 57.24

Digestive System Disease

16.83 15.55 18.46

Mental and Behavioral Disorders

0.78 0.75 0.47

Source: Vital Statistics Unit, FSM Department of Health and Social Affairs

The Dentist in Kosrae

• They have good access but how is it being used?o Transportation Problems

• They are receiving the same quality care that people in the United States are.

• Beatle Nut

The President of F.S.M.

• Health care is the third most funded by the government

• His opinion on the NEW nursing program at the F.S.M.

• Mis-allocation of funds due to Compact Free Association

• Exercise

Adam’s Pharmacy Visit• Constipation + Pills = Diarrhea• Cost Effective• Physiological Response• No questions asked, no health history considered

Suicide Rate/Psych issues in Micronesia

• Number of suicides has risen sharply in Micronesia since the 1960so Suicide rates now being amongst the highest in

the world• Lack of mental health facilities• "Burden of mental health goes hand-in-hand with

rapid urbanization and social changes such as poverty and physical illness" (Global Health Care)

• Suicide prevention programs in high schools• Leading cause of death for 15-24 age group

Kathy Benjamin

• Coordinator of the new nursing program at the College of Micronesia

• Preceived vs. Actualo Traveling abroad for medical care

Tour Guide in Kosrae Hospital

• Have surveys worked for responses?• New ideas for receiving input on healthcare

Various Locals - JoJo the Bus Driver

Various Locals - Josh the teacher• 10th Grade Earth Science Teacher• From California• Avoided Kosrea medical help at all costs

o Preventativeo Found help from family in the States

Various Locals - Airplane dude

  

                "I think they're doing the best they can"

Misuse of Resources

• Old Ambulance vs. New Ambulance• HIV/AIDS Surveillance  and HIV Prevention Projects for the

Pacific Islandso $203,006  in Grantso Condoms in bathroom

The Facts

• CDC reported that the FSM does not require vaccines for any person. 

• Healthcare is at a higher level than the rest of the pacific region related to United States focus.

What Should The FSM Do To improve Outcomes?• Increase Diabetes Resources• Expand “Go Local” and Other Educational Programs about Staying Healthy

o Preventative services like exercise facilities and changing the mindset of “normal” living

• Better Medical Documentationo Birth Certificateso Death Certificates

• Make a Cancer Registry• Better Education Programs to Defer Social Stigmas

What Should Future Researchers Do?

• Surveys DO NOT WORK!o Strive for personal contacto Face-to-Face Surveyingo Incentive Based Surveyingo Invest in the areas being researched

• Enjoy your time!

Sources

• CDCo  http://www.cdc.gov/HIV/topics/funding/state-awards/

fm.htm• WHO

o  FSM Health Profile http://www.who.int/gho/countries/fsm.pdf

•  Health Issues in the Federated States of Micronesiao  Mortality Analysis of Registered Deaths in the FSM from

1990-2003o Disease in Micronesia: A Historical Survey

• Cancer in Kosrae• Cancer in Micronesia• Global Health Care by Carol Holtz