Recent Changes

Friday, February 18

  1. page The Environment edited ... o Patients are referred specifically to hospitals in Hawaii, Guam, and the Philippines · Tota…
    ...
    o Patients are referred specifically to hospitals in Hawaii, Guam, and the Philippines
    · Total spent on health in 2008=$32.7 million (including all spending for health by the national and state governments, the social health insurance schemes, and household out-of-pocket (WHO)
    ...
    and hepatitis.
    References:
    Central Intelligence Agency. www.cia.gov
    ...
    Micronesia. http://www.fsmgov.org/index.html
    Government of the Federated States of Micronesia. President Mori’s Signs $35 million FSM
    Budget for FY2010: September 9, 2010.
    (view changes)
    5:16 am
  2. page Personal health practices, use of health system edited Please enter data and material here concerning what you have found concerning the personal health p…
    Please enter data and material here concerning what you have found concerning the personal health practices and the use of the health services in the Federated States of Micronesia (FSM) of the people in the country. Be sure to define what personal health practices are and how you measure use of health services, so others reading this will understand the material also.
    {health behaviors class handout.doc}
    Class Handout
    Health Behaviors
    Bridget Anderson, Ingrid Castro, Domonique DeWild, Melissa Jones, Billy Utter
    Personal health practices
    Utilization of services:
    - “Only go in if we have a stomach ache or tooth ache” – Senator Dion
    - People go into the doctor too late, when things have gotten bad.
    - Babies are born in hospitals with midwives and not at home.
    - Older people do not trust modern medicine. Younger generations more readily trust and use modern medicine.
    - Micronesians still use local/herbal medicine.
    - Most of dental service is extractions. There is no fluoride in water.
    - Kids have weaker teeth, mostly due to diet, while adults have stronger teeth because their traditional diet.
    - We found inconsistencies in finding information about regular check ups and dentist appointments.
    - Abortion is illegal, due to cultural beleifs.
    What services are they using:
    - Contraceptives are put them in the bathrooms in Pohnpei to give privacy, but all are gone within an hour.
    - 76.1% of youth are sexually active in Micronesia. Over 50% of youth in Micronesia have never used protection against STIs.
    - Condoms are at hospitals and stores but people don’t want to buy openly.
    - There is no sex education in schools.
    - Mental health patients are treated in the jail. There are daytime observations but most end up on streets.
    - Emergency services are severely lacking.
    - Midwives and hospitals are more frequently used for birthing.
    - There are no nursing homes available for care of the elderly.
    Do they exercise/pay attention to diet:
    - No parks, possibly due to lack of land and resources.
    - Chores and gardening are their exercise, these activities have decreased due to western influences.
    - Expired food in stores.
    - Some people walk. Difficulties arise with muddy and narrow roads. Along with fending off dogs.
    - People used to canoe. But not as much anymore with motorboats and not knowing how to build canoes.
    - Most Micronesians do not swim.
    - They don’t climb trees for coconuts or fruit as much any more.
    - Basketball is played by youth here and there.
    - The University of Micronesia in Pohnpei has basketball, bad mitten and volleyball. (no track, soccer, tennis – lack of land and equipment)
    - Diet: new addition of rice and processed foods. Examples include, black label spam, sugary drinks, and chips.
    - There is no snacking. Three big meals a day, according to family feast in Pohnpei.
    - Eat lots and lots of rice.
    - Making sakau and performing traditional dances, this can be a form of exercise.
    - In Pohnpei people rarely eat local foods, and rely on imports.
    Habits:
    - Beetle nut is frequently chewed all day long by both men and women.
    - Sakau- workout to make it. Common at traditional feasts.
    - Smoking, cigarettes remain a prominent habit.
    - Marijuana is smoked locally on both islands.
    - Drinking alcohol is not common in Kosrae but is drank more frequently in Pohnpei.
    - Bucket showers are used along with river bathing. There is little sanitary water.
    - Youths sneak off to have unprotected sex in the forest.
    What is missing:
    - Mental health facilities and care.
    - Oncologists.
    - Sufficient transportation to the hospitals.
    - Parks and after school programs.
    - Health and nutritional education in schools.
    - Optometrists, especially a need because of the vitamin A deficiency.
    - Sex education.
    Personal Conclusions
    -We may see that they are missing things but from their perspective they may not know what is “missing”. They may not know the options that are available and may be content with what they have.
    Jungle Lovin’ Check-up Game Questions:
    1. What is the most common procedure performed by the dentist in Kosrae?
    2. Where are babies most commonly born in Pohnpei?
    3. What age group utilizes modern medicine most often?
    4. True or False: Most Micronesians go to the doctor for regular check-ups?
    5. True or False: Abortion is illegal.
    6. What disease statistics does Pohnpei keep a close record of?
    7. What preventative measures are teenagers in Micronesia not practicing?
    8. Where are mental health patients sometimes sent in Pohnpei?
    9. Which medical professionals assist mothers during birth?
    10. True or False: Nursing homes are a common service provided for the elderly.
    11. What used to be Micronesian’s primary forms of exercise?
    12. True or False: Most of the pop in Micronesia is not expired.
    13. What form of exercise is currently the most common in Micronesia?
    14. What are the two most common foods consumed in Micronesia?
    15. What cultural tradition provides a good source of exercise?
    16. What negative effects do poor diet and exercise have?
    17. What is common practice with placentas after babies are born?
    18. What recently imported habit runs rampant through the jungles of Micronesia?
    19. What is the largest meal of the day in Micronesia?
    20. What is the most common location for youth to engage in sexual activities?
    21. What is the most common way of bathing?
    22. What is the most common vitamin deficiency in Micronesia?
    23. What is a commonly seen side effect of that deficiency?
    24. What is the biggest problem with people not getting to the hospital in good time?
    25. What form of health and sex education is present in schools?
    26. How many oncologists are on the island of Pohnpei?
    Final Question:
    According to Francisco, what Four A’s affect health behavior?

    (view changes)
    5:10 am

Friday, January 28

  1. page Enablinlg resources edited Please enter data and material here concerning what you have found concerning the enabling resource…
    Please enter data and material here concerning what you have found concerning the enabling resources in the Federated States of Micronesia (FSM) of the people in the country. Be sure to define what enabling resources are, so others reading this will understand the material also.
    According to the Andersen Behavioral Model, enabling resources involve the physical facilities provided to a population that will provide them with care, such as the hospitals, physicians, nurses and other care providers. They also consist of the means of which people receive this care and their accessibility so care, such as health education, insurance, funding, etc.
    Analysis of Healthcare Expenditures
    Background:
    The Federated States of Micronesia has an annual national income of $272.4 Million as of 2009, consisting of a $239 Million GDP and extensive foreign assistance, accumulating to $33.4 Million. Of that $272.4 Million nation income, $31 Million is channeled through Public Health initiatives (17%), local hospitals of dispensaries (54%), general administration (6%), referrals to foreign institutions (11%), or other. The largest portion of this $31 Million (96%), is contributed by the government, which accounts to nearly 19% of the entire government budget expenditures. The remaining $1 Million is out-of-pocket expenditures.
    In recent history the Federated States of Micronesia has gradually increased its spending and financial emphasis on health care (7% increase per capita in the past decade). However, results remain elusive. Micronesia has reported a 56% increase in communicable diseases and a 54% increase in non-communicable diseases in the past 20 years. Putting these reports, along with statistics such as infant mortality and life expectancy, in perspective by comparing them against those of similar Pacific nations the need for reformation of the Micronesian health care system becomes clear. Experts have pointed out several potential areas of inefficiency and/or areas that are in need of drastic reform. These include, but are not limited to, the current trend of outsourcing patients to institutions of Guam, the Philippines, or Hawaii, the ultimate utilization of resources and funding, the relatively large emphasis on curative care rather than preventative, and the lack of health education and awareness. However, with such a stringent budget which carries so many outside influences and stipulations, our discovery of Micronesia's need of reformation in regards to the financial aspect to its health care system rather than simply more funding offers a glimmer of hope, however small.
    Facilities:
    The Kosrae hospital is a public hospital that consists of 45 beds and 5 divisions. The genders are separated by room. There are 13 doctors who work at the hospital, most of which are considered “medical officers” as opposed to specialized physicians. Many of these doctors were educated in Fiji or the Philippines. There are 26 nurses who have been trained internationally. There are no mental health facilities, however there is a small isolated psychiatric ward located at the hospital.
    The Pohnpei hospital consists of 96 beds and multiple wards, including a room for birthing and midwifery. The wards are separated by gender. There are 20 physicians; few are specialized, and the hospital only has one anesthesiologist. There are 45 nurses, and a nursing program is being started at the College of Micronesia.
    Education and Health Promotion:
    Studies have found that in the FSM, approximately one in every five babies is born to a teenage mother (Johnson, 2002). Because of the culture and religion in Micronesia, sexual education in the schools is very limited. Contraceptives are often provided in the schools, but not socially and culturally acceptable. For dental health, the dentist in Kosrae claims that dental health promotion is one of their major goals at the moment. Yearly check ups are being performed more often, but dental health could be improved greatly.
    There are over 100 dispensaries located on the islands of Micronesia, and 5 are located on the island of Pohnpei. These are important for those living far from the main hospitals in the city. Lastly, diet promotion is an important enabling resource. The “Go Local” campaign in Pohnpei is an example of this.
    Problems:
    In the FSM, there are many problems with health accessibility. One major issue is transportation on the islands. Functioning vehicles are limited, and roads are often in poor condition or not present at all. There are only two ambulances located on Kosrae and Pohnpei, and no helicopter at all. Staffing is another concern. Many of the doctors are not necessarily specialized at all, meaning that they are only familiar with basic procedures. Nursing shortages are present on both islands as well. At both hospitals, staff members claimed that the islands often loose doctors or nurses to other countries, such as the U.S. or Guam, where the salaries are more.

    (view changes)
    11:54 am
  2. page Predisposing Characterisitcs edited Please enter data and material here concerning what you have found concerning the predisposing char…
    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. {file://localhost/Users/elisevreede/Library/Caches/TemporaryItems/msoclip/0/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>.

    (view changes)
    11:30 am
  3. page Enablinlg resources edited ... Analysis of Healthcare Expenditures Background: ... Micronesia has a an annual national…
    ...
    Analysis of Healthcare Expenditures
    Background:
    ...
    Micronesia has aan annual national
    ...
    extensive foreign assistanceassistance, accumulating to
    ...
    Of that $272. 4$272.4 Million nation
    ...
    out-of-pocket expenditures.
    In recent history the Federated States of Micronesia has gradually increased its spending and financial emphasis on health care (7% increase per capita in the past decade). However, results remain elusive. Micronesia has reported a 56% increase in communicable diseases and a 54% increase in non-communicable diseases in the past 20 years. Putting these reports, along with statistics such as infant mortality and life expectancy, in perspective by comparing them against those of similar Pacific nations the need for reformation of the Micronesian health care system becomes clear. Experts have pointed out several potential areas of inefficiency and/or areas that are in need of drastic reform. These include, but are not limited to, the current trend of outsourcing patients to institutions of Guam, the Philippines, or Hawaii, the ultimate utilization of resources and funding, the relatively large emphasis on curative care rather than preventative, and the lack of health education and awareness. However, with such a stringent budget which carries so many outside influences and stipulations, our discovery of Micronesia's need of reformation in regards to the financial aspect to its health care system rather than simply more funding offers a glimmer of hope, however small.

    (view changes)
    12:01 am

Thursday, January 27

  1. page Enablinlg resources edited Please enter data and material here concerning what you have found concerning the enabling resource…
    Please enter data and material here concerning what you have found concerning the enabling resources in the Federated States of Micronesia (FSM) of the people in the country. Be sure to define what enabling resources are, so others reading this will understand the material also.
    Analysis of Healthcare Expenditures
    Background:
    The Federated States of Micronesia has a annual national income of $272.4 Million as of 2009, consisting of a $239 Million GDP and extensive foreign assistance accumulating to $33.4 Million. Of that $272. 4 Million nation income, $31 Million is channeled through Public Health initiatives (17%), local hospitals of dispensaries (54%), general administration (6%), referrals to foreign institutions (11%), or other. The largest portion of this $31 Million (96%), is contributed by the government, which accounts to nearly 19% of the entire government budget expenditures. The remaining $1 Million is out-of-pocket expenditures.

    (view changes)
    6:32 pm

Wednesday, January 26

  1. page The Environment edited Anderson Model: The Environment Scott Woodside, Tori Heinonen, Colin Ferrian, Mac Webb, Melanie S…
    Anderson Model: The Environment
    Scott Woodside, Tori Heinonen, Colin Ferrian, Mac Webb, Melanie Schowalter
    Politics
    · FSM Constitution similar to that of the U.S.
    o 3 separate branches at the national level: Executive, Legislative, and Judicial
    o Declaration of Rights similar to the US Bill of Rights
    § Specifies basic human rights and also includes a provision protecting traditional rights
    · Differs from the US system in that most governmental functions (not including foreign affairs and defense) are carried out at the State level
    · Congress: 14 senators
    o One from each state elected for a four-year term and ten who serve two-year terms
    o Chuuk= 6 seats, Pohnpei=4, Yap=2, and Kosrae=2
    · President and Vice President elected to 4 year terms by Congress
    · Current President=Emanuel Mori and Vice President= Alik L. Alik
    · Former UN Trust territories of the United States
    · Compact of Free Association between the United States and the FSM took effect on November 3, 1986.
    o The Compact establishes the FSM as an independent nation and the United States provides substantial annual grants to add to local revenues to run public sector operations
    o 2 Funding periods:
    § 1986-2003: 1 billion
    § 2004-2023: 1.8 billion dollars
    Economy
    § The leading popular industries are subsistence agriculture and fishing
    o Subsistence agriculture is self-sufficient farming where farmers focus on growing enough food to feed their families.
    o Less than 10% of the labor force farms and less than 7% of the export revenue come from the agricultural sector.
    o The planting decisions are made with an eye towards what the family will need the following year rather than market prices
    o Commercial fishing $20 million annually in licenses to the FSM government for the right to operate in the territorial waters.
    o This accounts for 30% of the domestic budgetary revenue.
    o Export of marine products, mainly re-exports of fish to Japan, account for 85% of export revenue.
    § The primary source of revenue in the economy is the US government.
    o Under the terms of the compact of free association, the US pledged to spend around $170 million a year on the FSM.
    o The FSM is only able to control $79 million dollars $170 million, and the other $61 million are assigned to Micronesian departments by the US government. This occurs in order to prevent the US money from falling into the corruption that occurs throughout the islands.
    § Half of the working class in the FSM is employed by the US government. With 85,800 people in the workforce, after 22% of unemployment, a total of 42,900 people are employed by the government. The government employs 39% of the entire population.
    § The average income of healthcare professionals is divided 10-fold from the US to Kosrae. Dr. Nicholas, the dentist from the Kosrae hospital, told us that his salary in California was $250,000 and it dropped to $24,000 in Kosrae.
    o The healthcare professionals all agreed that they believed they should be paid more. They are in a constant struggle with the government to agree on a salary. Dr. Nicholas said that he was expecting a 40% increase within the next year, however the other doctors believed this was only speculation.
    Environment
    · Agricultural activities provide more than 60% of the food consumed, and employ nearly 50% of the labor force on a full-time or seasonal basis
    · Because of extensive volcanic uprising, soil is composed of a nutrient-rich top layer and porous second and third layers. Combined with heavy annual rain accumulation, this causes the soil to become extremely fertile and conducive to extensive farming
    · FSM has numerous endemic fruit and vegetable varieties including bananas, coconuts, papayas, mangoes, breadfruit, and avocadoes
    · Environmental hazards affecting the FSM include
    o Poor waste management control
    o Decaying batteries/other household toxins seeping into the watershed
    o Over-fishing
    o Exploitation of resources
    o Global climate change
    o Long-term radioactive fallout
    o Poor enforcement methods due to lack of funds
    · Steps in the process of waste management in the FSM include:
    o Education and awareness about the importance of waste control
    o Sorting of trash, recycling, and hazards within each household
    o Creating a system for trash to be picked up by dump trucks
    o Sorting of trash, recycling, and hazards at the in-ground lined waste facility
    o Placing trash in its final destination: the dump or recycling center
    · The conservation, allocation, and use of natural resources is the main issue that ties the Micronesia’s economics, environment, and healthcare together. With proper use of resources, the FSM can provide for the future while preserving the past. (Ex. fishing and farming to completely feed community members and export to other countries to drive a healthy lifestyle and economy.)
    Health Care
    · Each State government in the Federated States of Micronesia maintains its own health services
    o Each State maintains a centrally located hospital that provides a minimum range of primary- and secondary-level services, including both preventive and curative services
    · Six private health clinics in the Federated States of Micronesia and one private hospital
    · 113 dispensaries and community health centers
    · Health services are highly subsidized by the State governments except in the private clinics
    · A referral program exists due to the shortfall of certain types of health services in facilities including specialists and specific diagnostic procedures.
    o Patients are referred specifically to hospitals in Hawaii, Guam, and the Philippines
    · Total spent on health in 2008=$32.7 million (including all spending for health by the national and state governments, the social health insurance schemes, and household out-of-pocket (WHO)
    · Major health issues in the FSM include diabetes, cancer (lung and cervical most prevalent), STIs, cardiovascular disease, stroke, tuberculosis, leprosy, and hepatitis.
    References:
    Central Intelligence Agency. www.cia.gov
    Government of the Federated States of Micronesia. http://www.fsmgov.org/index.html
    Government of the Federated States of Micronesia. President Mori’s Signs $35 million FSM
    Budget for FY2010: September 9, 2010.
    http://www.fsmgov.org/press/pr100189.html
    Samo, M., & Racelis, R.H. (2010). An analysis of FSM national health care expenditures from
    1997-2005. Journal of Community Health and Clinical Medicine for the Pacific, 16(1), 27-39.
    World Health Organization: Western Pacific Region.
    http://www.wpro.who.int/countries/2010/mic/national_health_priorities.htm

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  2. page Personal health practices, use of health system edited Please enter data and material here concerning what you have found concerning the personal health p…
    Please enter data and material here concerning what you have found concerning the personal health practices and the use of the health services in the Federated States of Micronesia (FSM) of the people in the country. Be sure to define what personal health practices are and how you measure use of health services, so others reading this will understand the material also.
    {health behaviors class handout.doc}
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