Please enter data and material here concerning what you have found concerning the predisposing characteristics in the Federated States of Micronesia (FSM) of the people in the country. Be sure to define what predisposing characteristics are, so others reading this will understand the material also.


Wiki Outline: Elise, Spencer, Justine, Max & Sean
Predisposing Characteristics



1) Demographics
a. •Population: 107,154
b. •Age Distribution
i. –0-14 34.8%
ii. –15-64 62.3%
iii. –65+ 2.9%
c. •Sex Ratios (ratio of boys to girls in each age group). The amount of males decrease in relation to females as age increases.
i. –0-14 1.05
ii. –15-64 0.99
iii. –65+ 0.74
iv. external image clip_image002.png
d. •Ethnic Groups
i. –48.8% Chuukese
ii. –24.2% Pohnpeian
iii. –6.2% Kosraean
iv. –5.2% Yapese
v. –4.8% Outer Yapese Islands
e. •Religion
i. –52.7% Roman-Catholic
ii. –40.1% Congregational
f. •Population Growth Rate 2010: -.284%
i. –Birth Rate: 22.57 births / 1,000 pop.
g. •Infant Mortality Rate: 25.2 deaths / 1,000 births
i. –Death Rate: 4.40 deaths / 1,000 pop.
ii. –Net Migration Rate: -21.01 / 1,000 pop
h. •26.7% live below poverty line
i. •Literacy Rate: 89%
i. –91% for males, 88% for females
ii. –Only 66% graduate from primary school
j. •Proportion of Population with…
i. –Potable Water Access 82.8%
ii. –Improved Sanitation 23.5%
iii. –LT Living Arrangement 93.9%
k. •Homes with electricity
i. –Urban 81.2%
ii. –Rural 30.4%
l. •9,162 registered vehicles
a. 17.5% of roads are paved (42/240 km
m. Source:
i. "CIA - The World Factbook." Welcome to the CIA Web Site — Central Intelligence Agency. Web. 23 Jan. 2011. <https://www.cia.gov/library/publications/the-world-factbook/geos/fm.html>.

2) Health Beliefs (Most of the information has come from presentations and conversations of health professionals in the area)
a. Younger Population & Urban population
i. They believe in Modern Medicine and are more likely to use it/utilize it when they are sick.
ii. They will use traditional medicine, but will refrain if it is deemed unsafe by their physician
1. EX: When women are giving birth, they will sometimes use or take herbs to help relieve the pain and uncomfortableness of giving birth. Unfortunately, some of the herbs will induce labor, which is something that the midwives & doctors want to avoid especially if they are in pre-mature labor. At this point, medical professionals advise them against taken them and they comply.
b. Older Population and Rural Population
i. More into traditional medicine
ii. They are often use instead of, or on top of modern medicine because its what they trust (they don’t necessarily understand parameters around using some of modern medicine).
iii. EX: Second presidents sister has some sort of chronic disease that requires her to take modern medicine. She feels that they do not help and often make her worse so she takes herbal medicine on top of it. The president believes that this combination is what is making her worse and is having adverse effects on her ability to fight her disease.
c. Giving Birth
i. They do not believe in using epidurals or any other pain relieving drugsà Thus they do not use epidurals in birth
ii. They do not scream during birth because women are taught by their elders (i.e. mothers and grandmothers) that this is a sign of weakness and women should not scream during this time.
iii. Women are more likely to walk around during birth than American Women in order to help deal with contractions.
iv. They will wear a string around their waist in order to keep their uterus and baby in, despite the fact that the midwives tell them that it is ok not to wear it.
v. After Birth, the mother takes home the placenta and plants with a plant (i.e. a tree) that has a long life span and continually grows. This becomes the babies plant and it symbolizes their life as well as their birth.
vi. Abortions are illegal, except for when the mother is in danger of losing her life.
vii. Contraceptives are discouraged by religions
1. School officials and other medical professionals have been trying to put condoms, etc in the bathrooms but they are often stolen by people who do not believe in contraceptives.
d. Family Life and Health Care
i. (more in Kosrae) family performs some of the personal care in the hospital and often stay around the clock to be with their family members. They do the bathing and changing, etc.
ii. They do not necessarily believe in putting the elderly in nursing homes, they often take care of them and treat them quite well. For example, Rudy’s grandfather lives at home with the rest of the family and they help him get around as well as treat them with respect.
1. This puts a burden on the younger generation to take care of the older generation.
3) Education in Micronesia
a. US changed the face of education in Micronesia starting in 1962 by construction schools and increasing the amount of funding going towards education. This increased from 50 to 240 millions from 1962-1970. These newly constructed schools had teaching positions filled by Peace Corps volunteers starting in 1966 .From then on, many students have American teachers and were enrolled in some sort of public or private school.
i. Schools are similar in structure to that of the US in that it is a liberal system focusing on:
1. English Instruction
2. Social Studies (often modified to fit their own culture and teach cultural traditions)
3. Science Instruction
4. Physical Education
5. Language Arts
b. Have both public and private schools
i. Most Private Schools are religious and offer religious instruction. EX: Seventh Day Adventists Prep School (k-12) in Pohnpei
c. 8 years of public schooling is required of all residents
d. 7.3% of GDP is spent on Education each year
i. However, a 2009 publication from the Ministry of Education states that they spent 35, 691,210. This extraneous money comes from the money given to them by the Compact of Free Association as well as other Federal & NGO grants.
ii. Source:
e. 60% of elementary school graduates are accepted into high school each year.
f. Total enrollment, including the Marianas, is 8,000. 1,200 graduate each year.
g. Literacy Rate: 89% Male, 91% Female.
h. According to the 2000 Census and the FSM Government Website, the amount of schooling the population has received is as follows:
i. –No Schooling: 12.3%
ii. –Kindergarten: 1.0%
iii. –Elementary: 36.0%
iv. –High School: 32.3%
v. –College: 18.4%
i. upper level education
i. •No 4 year institutions in the area.
ii. •College of Micronesia offers 2-3 year associate degrees in Business Administration, Nursing, Liberal Arts & Education.
iii. •Around 2,000-3,000 students go abroad each year for college.
iv. •Issue
v. –Despite this, graduates from both programs end up in service sector (fixing cars, work around the house, etc) instead of any sector that contributes to GDP.
vi. some argue that the vocational schools in the area as offered by places like the COM could help get people of the young generation employed, but those were designed mostly to dabble in academia in order to prep them for more “college-like” learning instead of actually teaching them a trade. Even people in with these types of education end up working in the service sector (like fixing cars, etc) and not necessarily helping the economy.

vii. Many say that graduates of both programs would like to go into white collar jobs and have high expectations, but it ends up putting large demands on the state for government jobs and additional services for an enhanced lifestyle. This ends up costing the government a lot of money and make them unable to pay their own way
viii. –Most college graduates do not come back to Micronesia
j. Sources
i. Hezel, Francis X. "The Price of Education in Micronesia, Micronesian Seminar Articles." Micronesian Seminar | Home. 1989. Web. 27 Jan. 2011. <http://new.micsem.org/publications/articles/articles.php?aid=39MVE>.
ii. Lorak, Nidel. "The Portfolio Budget Statements: Ministry of Education Portfolio (2008-2009)." Uscompact.org. Web. 22 Jan. 2011.
k. medical education
i. •No medical training available on any of the FSM states, except for practical nurses.
ii. –Most medical professionals brought from surrounding countries
iii. •Are well trained, but not necessarily similar in caliber to a US RN.
iv. –Scholarships available for citizens in FSM to attend medical schools.
v. •Issue:
vi. –All Four States facing a critical shortage of properly trained nurses, especially since current task force will be retiring soon.
vii. – Estimated: 150 nurses will be needed
viii. –Not an attractive field since pay is not competitive and schooling is not local
ix. •Solution
It is proposed that a Nursing Program be established at the College of Micronesia – FSM (COM-FSM). This effort would be consistent with COM-FSM’s mission to provide quality higher education and assist with the job training needs of the nation.

To establish a Division of Community Health Sciences, the following tasks need to be accomplished:

- The administrative decision on the part of COM-FSM to pursue this opportunity
- The employment of the needed expertise to accelerate Program Development. This expert would be tasked with the following:
o The development/submission of a self-study report to be used for grant applications and possible accreditation processes.
o The application for pertinent public and private sector grants,
o The completion of the development and integration of new and existing curriculum, including:
§ The development of supporting resource materials
§ The development of clinical and other institutional MOAs
§ The recruitment/training of tutors and resource faculty
o The development and implementation of program policies and materials for the admission, matriculation, and graduation of students.
o The development of the mechanisms to provide a viable fiscal infrastructure for the COM-FSM Division of Community Health Sciences, and
o The development of an adequate timetable, and development and assessment plans to guide the above activities.


x. –This will help create a more stable infrastructure within the hospital and provide better health care to all citizens.
Sources (Medical Education)
i. Proposal to Establish a COM-FSM Nursing Program and Division of Community Health Sciences for the FSM." Letter. 9 Dec. 2002. College of Micronesia-FSM. Web. 23 Jan. 2011. <www.comfsm.fm/.../nursing/Nursing%20Proposal%20for%20Board%2012-9-02.doc>.
ii. Lecture from COM-FSM day, as well as conversations with nurses.

4) Social Structure
a. Family Life
i. •The Japanese intrusion and WWII had a strong influence on family life
ii. •Because of the atrocities committed by the Japanese, there is a strong emphasis on family and closeness
iii. •Families were originally close but hardships pushed for even more family support
iv. •This was evident during our feast in Pohnpei
v. •Extended family
vi. •Ceremonies and WWII songs were used for story-telling, humor, and distraction among others.
b. •Large family
i. •Lack of contraceptives due to lack of communication and religious beliefs
ii. •53% Roman Catholic
iii. •Hierarchy of Families
iv. •Sakau ceremony
v. •Grandpa being cared for. Importance of elders
vi. •Elder’s authority always rules
c. Employment
i. •22.7% unemployment rate
ii. •Resorting to a sedentary lifestyle
iii. •Lack of motivation or lack of jobs or both?
iv. •64.7% of the population is in the service industry
v. •tourism, restaurant owners, craft items (from shell, wood, and pearls)
vi. •34.4% Industry employees
vii. •construction, fishing
viii. •.9% Agriculture
ix. •2/3 of the labor force is employed by the government, which is where the highest salaries are
x. •Lack of private industries
xi. •Government can not support this high of a percentage
xii. •26.7% of the population is below the poverty line
Sources:
a) CIA - The World Factbook." Welcome to the CIA Web Site — Central Intelligence Agency. Web. 23 Jan. 2011. <https://www.cia.gov/library/publications/the-world-factbook/geos/fm.html>.

5) Diet
a. Why Eat Taro?
i. It is rich in Zinc, Calcium, Iron and Fiber.
ii. It can be cooked in a variety of ways, making it very versatile.
iii. Used with pre-mature babies to give them nutrients
b. 6 top diseases associated with diet and nutrition in the FSM
i. Obesity, diabetes, heart disease, cancer, mal nutrition, and vitamin A deficiency
c. shift in dietary patterns from indigenous, high fiber, healthy local food to energy dense, imported food with low nutritional value
i. Most foods now in the Pohnpeian diet are imported, refined and overall less nutritious (i.e. white rice, spam, fatty frozen chicken, soft drinks)
d. Rice is one of the most consumed items with Micronesia.
i. It is supposedly “cheaper” than some locally grown foods and easier to make in modernized families that are settling in Pohnpei where free time is scarce.
ii. 96% report eating rice frequently, which is 3-7 days/week
iii. over 80% of Pohnpei’s population in 35-55 year old age group are overweight or obese.
iv. Story time: Felicia, a Peace Corps Volunteer, said that her host family feeds her rice with every meal and snack and that the portions are quite large. Much larger than they should have been.
e. Traditional Pohnpei diet was made up of locally grown food rich in minerals, vitamins, and fiber, mostly carbohydrate staples (i.e Taro). Because of this, they had to grow their own food and got a lot of exercise by working in the fields.
f. To combat this, they are trying a Go Local Movement (from presentation).
i. They hope by doing this they will decrease vitamin A deficiency, increase exercise and overall eat healthier
1. A 2000 study found that over half of kids under age of 5 have vitamin A deficiency.
ii. Also believe in the CHEEF benefits of going local
iii. Source:
1. Englberger, Lois, Geoffrey Marks, and Maureen Fitzgerald. "Insights on Food and Nutrition in the Federated States of Micronesia: a Review of Literature." Public Health Nutrition 6.1 (2002): 5-17. Print.
6) Genetics: Achromatopsia & Micronesians
a. What is Achromatopsia?
b. The Micronesians
i. The disease is incredibly common on the island of Pingelap, which is an island of Pohnpei.
1. The Island Population is 3000
2. 5-10% of the population have the disease, while 30% of the population are carriers of the disease
ii. It became prevalent after Typhoon Longeiki in 1775
1. All but 20 people perished from the Typhoon.
2. 4 generations after the Typhoon, citizens of the island started exhibiting symptoms of the disorder, it became even more prevalent in generation six.
3. Patient 0 was Nahnmwarki Mwanenised (the Chief of the Island at that time)
a. Hypothesis: There was a significant amount of inbreeding on the island in order to repopulate the island more quickly. It is hypothesized that he and his descendants were carriers and/or had the disease and spread it throughout the island. This is a prime example of Bottlenecking effect.
iii. Sources For this section:
1. Windsor, Richard L., and Laura K. Windsor. "Achromatopsia and Color Blindness." The Low Vision Gateway. Vision Enhancement Journal. Web. 24 Jan. 2011. <http://www.lowvision.org/achromatopsia_and_color_blindnes.htm>.
2. Wise, Julie. "Pingelap: Island of the Color Blind." Byrn Mawr, 7 Jan. 2002. Web. 24 Jan. 2011. <http://serendip.brynmawr.edu/biology/b103/f01/web3/wise.html>.