Health, Nursing, and Premedical Programming
The Federated States of Micronesia has tremendous needs in the health care industry both at present and for the foreseeable future.
At present, hospitals such as Chuuk Hospital and Kosrae Hospital face critical shortages of nurses. Across the four states those nurses who are working in the hospitals are not always competent. In many cases the problems extend well beyond the realm of nursing shortages and incompetent nursing.
As this document is not intended to be an actual proposal, let me bring into this personal examples that exemplify a system-wide crisis in our health care industry.
Last October my seventeen month old baby became seriously ill with dysentery. Four times the IV bag was allowed to run out, introducing air into the IV tube. Twice the nurse attached a new IV bag without removing the air. Both instances might had led to the death or disability of the baby had I not known to ask the nurse to remove the air. Two different nurses had no clue how to set IV drip rates. Although the baby was to be on 35 cc of IV fluid per hour, both of these nurses set drip rates of over 100 cc per hour. Although the baby had been vomiting and had diarrhea, no test was done of his stool until his fourth day of diarrhea. On that day he was placed on Erythromycin. Three days later he was discharged. Two days after discharge the lab results came back. He had an Erythromycin resistant bacterial infection of his intestines. Five days to get a test result back. Why did he get better? His own immune system must have finally knocked the bacteria out of his system. Had his own immune system failed, he might not have survived until the lab test came back. Nurses tried to kill him, doctors failed to serve him, and the laboratory was so slow as to be irrelevant. And this is in one of the hospitals considered to be in better condition in terms of staff and supplies.
An uncle was diagnosed with a broken wrist. The broken wrist had swollen, and the swelling was spreading to the rest of his body, so Kosrae Hospital referred him to Pohnpei. He arrived with his arm in a sling. Pohnpei hospital found nothing wrong with his wrist, but did determine that his kidneys had failed. He was dead within three days.
Although my mother-in-law's high blood pressure does not respond to Procardia, it appears to make her disease worse actually, on two occasions she has been treated with Procardia by the Kosrae hospital when her prescription (obtained on Pohnpei) has run out. Both instances of mistreatment led to prolonged hospital stays to try bring her blood pressure back under control.
My father-in-law became quite weak and unable to move any of his muscles one evening. He collapsed into bed and remained semi-comatose through the night. After a night in bed he was able, with assistance, to go to the hospital. The hospital gave him Tylenol and Bengay and sent him home. The cause of his condition was not sought nor determined.
This nation has a broken and dysfunctional health care system. There are staff shortages and staff in need of training. There is a huge need for training existing personnel and for bringing more people into health care careers in this nation. And both of these are areas in which the College can provide services.
The nation has ahead of it the medical and social difficulties of the HIV/AIDS epidemic. Preliminary data on rates on infection of FSM citizens living in Guam and Saipan suggest that this epidemic will hit as hard in the FSM as in Africa. The nation could easily face a future with half or more of its youth HIV. At least one case is already known in a 15 year old girl.
Coupled with existing high levels of non-communicable diseases (diabetes, heart disease, high blood pressure, kidney disease) and communicable diseases such as tuberculosis, the nation's medical systems will be strained well past the breaking point.
Courses in the health career fields are difficult and challenging, whether it is pre-medicine, practical nursing, or one of many other possible educational programs. The course work is difficult and in the end the pay levels offered in the FSM versus elsewhere provide little incentive for a skilled person to remain in the FSM.
Students prefer fields such as Accounting and Computer Information Systems. Another popular area are the social sciences. Our students are weakest in math and science, the two core areas for health and premedical programs.
The 1999 FSM Health Workforce Development Plan 2000 – 2019 states that in order to meet the demand for nurses over the following twenty year, “the required nursing school intake would be 18 to 20 students enrolled each year from 2000 – 2016.”
Although the Compact of Free Association refunding is an a process under negotiation, initial indications are that the United States will continue to provide funding for health care and related services. Funding for health is, in one proposal, second only to funding for education.
Improved health care has a direct impact on the quality of life for the people of a nation.
The grant would have to include at least two phases. There would have to be an initial planning phase in which specific need areas would be identified and then programs designed to meet those needs. The second phase would be implementation of the programs. Title III funding would be used design, build, and launch health programs across the College system.
This design, build, and launch is not overly ambitious. This is exactly what the previous Title III grant accomplished. The previous grant planned out the necessary technical infrastructure to take the College forward into this computer age, acquired the equipment, then launched the necessary training programs.
Objectives would include addressing the shortage of nurses and redesigning our premedical two year programs. Other objectives would include attracting new students into health fields and providing mechanisms for retaining those students in health majors. In the past we lost the Health Care Opportunities Program grant not because of poor intake, but because so few students went on to pursue degrees in the health fields.
How activities defined would accomplish objectives
General budget estimate with key equipment, personnel, construction costs included
Maslow's hierarchy of needs informs us that you can't deliver distance education or technology to a sick and dying populace. The nation's health care system is in a precarious state, on the brink of free fall once AIDS related deaths start hitting this fragile, understaffed, and undersupplied system. The previous Title III grant was designed to implement technology, now it is the College that should build out the technology including distance education. The best use of Title III funding for the nation at this time would be in the redesign of existing health education programs at the College and the development of new programs.