Ulithi Atoll health assessment: a peek at the health of rural Micronesia.

BACKGROUND: The health challenges of Micronesians are generally well known. However most of the health-related data collection occurs in the population centers and relatively little is known about the health of the residents of Micronesia's rural outer islands. This is of particular concern in the Federated States of Micronesia (FSM) where a large portion of the population lives on the outer islands. To gain a better understanding of the health issues facing the isolated outer islands of Micronesia, a health survey was performed on Ulithi Atoll in Yap, FSM. METHODS: A survey was created by the Yap State Department of Health Services and members of the Ulithian community. The survey was carried out on two of the four inhabited islands of Ulithi Atoll in July 2004. Both island communities actively participated in the survey providing translation and data gathering assistance. RESULTS: It was estimated that a >90% response rate for both islands was achieved. Analysis demonstrated that relative to the U.S., the Atoll's population experienced high rates of obesity (45%), hypertension (29%), and smoking (55%). Sixty-six percent of men surveyed reported alcohol use versus 16% of women. Use of alcohol was markedly lower on Fatharai Island where a Chief had mandated abstinence. Preventative health screening was limited with over 80% of women having pap smear in the past 2 years. In addition, the community identified finances and transportation as the main difficulties in accessing healthcare. CONCLUSION: Overall, the research identified a number of health issues that require closer attention, in particular hypertension, overweight, obesity, alcohol misuse, smoking prevalence, betel nut/ tobacco chewing, and domestic violence. There is indication that the community may be ready to address some of these issues. The value of community action within cultural frameworks is apparent, and there may be potential to extend culturally-based approaches to address a broader range of issues.

The Yap AHEC: an update 2002-2006.

The Yap Area Health Education Center (AHEC) is one of three U.S. Health Resources and Services Administration-funded AHEC programs in the U.S.-Affiliated Pacific Island jurisdictions (together with those in Palau and the Commonwealth of the Northern Mariana Islands). The Pacific Island AHECs are administered through the University of Hawai'i, John A. Burns School of Medicine and were founded in response to recommendations for development of the local health workforce by the U.S. Institute of Medicine in its 1998 report, "Pacific Partnerships for Health". The goal of the Yap AHEC is to build human capacity in the health workforce, and thereby strengthen the health service and improve health status for the people of Yap State. An ancillary goal is to pilot test new approaches to health workforce development, which might be shared with others in the region. These goals have been pursued by building partnerships with colleges in the region, with the new Wa'ab Community Health Center project in Yap and the Yap State Department of Health Services to bring formal college programs for students and health service staff to Yap State. To date, formal relationships have been established with five colleges; Palau Community College (PCC), the College of Micronesia-Federated States of Micronesia (FSM), Fiji School of Medicine (Department of Public Health & Primary Care), University of Hawai'i, Hilo, and the University of Alaska, Anchorage. A total of 143 students have been enrolled in 48 courses in several health worker disciplines, including clinical nurses, health assistant/dispensary managers, community health outreach workers, public health program staff pharmacy technicians and x-ray technicians. In addition to facilitating the delivery of courses in Yap, a new 6-course certificate program has been developed for community outreach workers in collaboration with the College of Micronesia, FSM and the Wa'ab Community Health Center (Wa'ab CHC) in order to support the CHC's innovative health service delivery model. The Yap AHEC has also assisted the College of Micronesia-FSM in the World Health Organization sponsored development of a proposal for the establishment of a nursing program, which is based on the decentralized, on-site (DC-OS) nursing training model that has been pilot tested in partnership with PCC at Yap State Hospital.