Orthopedic surgery in Palau-Current capacity, needs, and future directions.

BACKGROUND: Palau, an island nation in Micronesia, is a medically underserved area with a shortage of specialty care services. Orthopedic diagnoses in Palau remain among the three most common reasons for costly off-island medical referral. The purpose of this study was to assess Palau's current orthopedic surgery capacity and needs to inform interventions to build capacity to improve care access and quality. METHODS: Orthopedic needs and capacity assessment tools developed by global surgical outreach experts were utilized to gather information and prompt discussions with a broad range of Palau's most knowledgeable stakeholders (n = 6). Results were reported descriptively. RESULTS: Finance, community impact, governance, and professional development were the lowest-scored domains from the Capacity Assessment Tool for orthopedic surgery (CAT-os), indicating substantial opportunity to build within these domains. According to administrators (n = 3), governance and finance were the greatest capacity-building priorities, followed by professional development and partnership. Belau National Hospital (BNH) had adequate surgical infrastructure. Skin grafting, soft tissue excision/resection, infection management, and amputation were the most commonly selected procedures by stakeholders reporting orthopedic needs. CONCLUSIONS: This study utilizes a framework for orthopedic capacity-building in Palau which may inform partnership between Palau's healthcare system and orthopedic global outreach organizations with the goal of improving the quality, safety, and value of the care delivered. This demonstration of benchmarking, implementation planning, and subsequent re-evaluation lays the foundation for the understanding of capacity-building and may be applied to other medically underserved areas globally to improve access to high-quality orthopedic care.

Toward Healthy Aging in Palau.

BACKGROUND AND OBJECTIVES: Palau is facing a rapidly aging population and developing a comprehensive national aging policy to address the growing needs of older adults, but more research is needed to understand their circumstances and needs in relation to healthy aging. This study aims to investigate these factors and contribute to developing the National Policy on Care for the Aging. RESEARCH DESIGN AND METHODS: The study adopted a participatory action research design and included focus groups with older adults, public consultations, and stakeholder interviews, providing insights into the needs of an aging population and how to address them. Thematic analysis was conducted to understand the experiences and needs of older adults and possible system changes to address these needs. RESULTS: This study identified the need to recognize cultural changes and optimize social and physical environments to improve the health and well-being of older adults. Older adults are valued in Palauan society, but harmful stereotypes and mistreatment of older adults exist. To address those needs and challenges, our stakeholders proposed a range of services, programs, and policies across sectors to create a healthy-enabling environment. Our findings also highlight the importance of health systems proactively reaching individuals and families to address lifelong health needs. DISCUSSION AND IMPLICATIONS: Our results show the vital role of various sectors in fostering healthy aging and the importance of environmental and cultural perspectives in creating an age-friendly society, which can be an inspiration for other Pacific Island countries.

Patient Characteristics During Early Transmission of SARS-CoV-2, Palau, January 13-February 24, 2022.

Palau had no reported evidence of COVID-19 community spread until January 2022. We chart reviewed hospitalized patients who had a positive SARS-CoV-2 test result during early community transmission. Booster vaccinations and early outpatient treatment decreased hospitalizations. Inadequate hospital infection control practices contributed to iatrogenic COVID-19 and preventable deaths.