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An overview of telehealth resources available in the Federated States of Micronesia
The Federated States of Micronesia (FSM) is a sovereign Pacific Island country that is located in the North Pacific Ocean and is about three-quarters of the way from Hawaiʻi to Indonesia.
FSM has a Compact of Free Association (COFA) with the United States. As part of this compact, FSM citizens are able to travel, live and work freely in the US without immigration and visa requirements.
FSM has four island states – Chuuk, Kosrae, Pohnpei, and Yap with over 600 islands spanning an area of 1,000,000 square miles of the Pacific Ocean. Palikr on Pohnpei Island is the nation’s capital. The total population of FSM as of 2021 is approximately 101,680. Almost 50% of the population are Chuukese/Mortlockese, Pohnpeian 24%, Kosraean 6%, Yapese 5%, Yap outer islands 4%, Asian 1%, Polynesian 1%, other 6%.
FSM has a mixture of public and private health care providers including the FSM Department of Health and Social Affairs, the State Department of Health Services and private independent providers and clinics. Their national health insurance includes government funded MiCare and a Medicaid office for COFA migrants in the US.
In terms of hospitals there is one hospital in each island state and one private hospital, Genesis Hospital and Pharmacy. There are several community health centers in each state with more than 92 dispensaries in remote and rural areas. There are several private health clinics including: Family Clinic and Pharmacy, Sefin Health Clinic, Bersyns Community Health Center, and Pohnpei Family Health Center.
Mixed public + private
National Health Insurance
Non-communicable diseases (NCDs) are the most pressing health issue for all USAPIs. In 2010, the Pacific Island Health Officers Association (PIHOA) declared a regional state of emergency due to NCDs in the region. The leading NCD contributors to morbidity and mortality are cardiovascular disease, diabetes, and cancer. The Disease Control Priorities 3rd Edition (2015), reports that cancer is now the second most common cause of mortality in most of the USAPI jurisdictions.
To further put this in perspective, the incidence of cervical cancer in Micronesia is over eight times higher than the US (79.7 per 100,000 compared to 9.9 per 100,000). The region also has among the highest prevalence of obesity in the world, with some communities reporting as high as 90% prevalence among adults. About 83% of cancers are associated with tobacco use and obesity in the jurisdictions. Behavioral risk factors such as tobacco and alcohol use, lack of physical activity, and unhealthy diets are believed to be the main drivers. These behaviors are modifiable but limitations brought on by geographic isolation, modern lifestyles, and a heavy reliance on imported processed foods make addressing NCDs a unique challenge.
The Federated States of Micronesia experience numerous resource (financial and human) and infrastructure limitations. These challenges have made telehealth adoption and growth slower in the region compared to the other island jurisdictions. Regardless, there have been some spots of telehealth activity throughout the country with Pohnpei State leading the way with telehealth adoption and innovation.
Read the 3rd Micronesian Island Forum Telehealth Resolution.
The PBTRC Pacific Island telehealth concept paper was submitted and presented to the Pacific Island Health Officers Association (PIHOA) Board of Directors that consists of the Ministers and Directors of Health in the US Affiliated Pacific Islands (USAPI). During PIHOAs 63rd Executive Board Meeting, PIHOA Resolution 2018-63-01 was endorsed which called for unified support for the advancement of telehealth. This resolution prompted the leaders of the Micronesian Island Forum (MIF) to adopt Telehealth Resolution (No. 23-04) during the 23rd Micronesian Island Forum held in CNMI. The Resolution was signed by the Presidents and Governors of the USAPI to build regional and jurisdictional capacity and expansion of telehealth in the region. The PBTRC concept paper was included as an exhibit of the Telehealth Resolution (No. 23-04).
Broadband connectivity in FSM has improved significantly since the implementation of submarine fiber optic connections to Pohnpei in 2010. Since then, there has been an expansion of submarine fiber optic connections to the westernmost island of Yap State (mid-2018), Chuuk State (mid-2019), and Kosrae State (mid-2021). In 2020, FSM received $30.8M grant funds from the World Bank to implement the “Digital Federated States of Micronesia” project that includes the connection of outer islands, terrestrial fiber infrastructure build-out to support eGovernment services and economic development.
Under the direction of Dr. Payne Perman, a telehealth room in Pohnpei Hospital was launched in December 2016. Local donors were identified to support the telecommunication costs and equipment. The room is equipped with a 10 mbps up and down link.
In January 2018, Pohnpei Hospital started practicing tele-pathology with the Hokkaido Cancer Center in Sapporo, Japan. Pohnpei transmits digitized images to Japanese pathologists who assist local doctors in identifying abnormal pathology readings for quicker cancer diagnoses and potentially life-saving interventions. Normally, sending the test results off-island would take 2 weeks up to 3 months to get a diagnosis, now they can provide on-the-spot diagnosis within minutes of the consultation. Further, the lab technician in Pohnpei State Hospital was able to process the backlog of 235 pap smear tests from Chuuk State. Read the full story in the Kaselehlie Press (PDF).
Courses offered by POLHN are available to all eligible staff. The following are programs offered through the POLHN:
Program provides primary care physicians specialty knowledge and training through distance learning in order to provide quality services to their patients in rural areas. The specific programs include: Endocrinology/Diabetes, Geriatrics, Behavioral/Mental health.
Similar to other island jurisdictions, the physicians in the Federated States of Micronesia have been able to utilize email, Skype, FaceTime, texting, and messenger applications to communicate with other physicians and/or specialists in an informal type of physician exchange solution. Through the creative utilization of these applications, Physicians are able to consult with their peers to provide recommendations. Although in the FSM, HIPAA compliance is not enforced, if services and/or communication takes place with a provider in the United States, the US federal regulations apply.
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The Pacific Basin Telehealth Resource Center (PBTRC) is an affiliation of the 14 Telehealth Resource Centers funded individually through cooperative agreements from the Health Resources & Services Administration, Office for the Advancement of Telehealth. This website was made possible by grant GA5RH37468 and 1 U1UTH42529‐01‐00 from the Office for the Advancement of Telehealth/Health Resources and Services Administration/HRSA.