Improving Access to Health Care in the Pacific: Q&A with Patrick Abraham

June 10, 2024 | Julia Von Alexander

In their second national health summit, the Federated States of Micronesia (FSM) national- and state-level health leaders, partners, and decision-makers envisioned better health for all through universal health coverage and improved health care. ASTHO participated in this historic conference, in which an important priority area for the next 10 years arose: health infrastructure development and maintenance.

FSM is an independent nation comprised of four states (Yap, Chuuk, Pohnpei, and Kosrae) with numerous outlying atolls, which are only accessible by larger boat and take days or weeks to reach. As discussed at the recent health summit, there is difficulty accessing and delivering health services to remote atolls, requiring state and national governments to work together to reach these underserved populations. The COVID-19 pandemic further exacerbated these needs, requiring prompt action to support prevention efforts for these isolated populations. By improving health care infrastructure in these communities and increasing access to quality prevention and primary care services, the U.S. Affiliated Pacific Islands (USAPI) can address this widespread challenge and improve health outcomes.

FSM has taken steps to improve health infrastructure and prevention efforts, renovating dispensaries (i.e., urgent care clinics) and increasing community partnerships and utilization of community health programs, through the CDC-funded National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities (OT21-2103)—offering a model for how health departments can partner across government levels to serve communities. ASTHO spoke with Patrick Abraham, health disparities project manager from the FSM National Department of Health and Social Affairs, to learn more about FSM’s efforts to improve access to care in some of the most remote and underserved areas of the Pacific.

What is your proudest accomplishment from the OT21-2103 grant?

In collaboration with communities in Chuuk and Yap, we successfully rehabilitated a “super-dispensary” in Satowan Village that will serve other islands in that atoll and are close to fully rehabilitating a dispensary in Woleai. The former serves a large population in the farthest of Chuuk’s remote atolls (Satowan Atoll) and had not been renovated since it was built in 1984. Similarly, Woleai Atoll is the largest of 11 remote atolls in Yap, with approximately 1,000 residents. Traveling to and from these atolls takes five to six days by a large ship, and ships do not travel to these atolls regularly, making local access to care even more important.

The hope is that with the renovated dispensaries, these remote island communities will be better able to access quality health care. These communities have requested this support for years since they must travel by ship to the hospital on the main islands whenever they get sick, and FSM is happy to be able to meet their needs with this project. Secretary Samo had the vision to focus on these sites as pilots to demonstrate the cost-effectiveness of rehabilitating dispensaries in the outer islands. We hope that with the success of these pilot sites, it can show the Congress of FSM and external funders the benefits and help us garner additional funds for similar projects, as we believe everyone should have a fair and just opportunity to achieve optimal health and well-being.

What partners did you work with to make this achievement possible?

We worked with many partners to accomplish the dispensary rehabilitations including the local community, mayors’ offices, municipal government, state government, hospitals, and FSM Transportation, Communications & Infrastructure. Additionally, we worked with the Asian Development Bank to support the construction of living quarters for a doctor and nurse in Satowan.

As the national government, we wanted to ensure community engagement in the truest sense of the word. We listened to our state and municipal governments’ needs and found the resources to meet them. We also made sure to involve everyone in a collaborative process. This was a pillar of our last strategic plan, and we were happy to help realize it.

What advice would you give to other agencies looking to make progress in this area?

Collaboration, especially with the community and local governments, is key. Before we began the project, we informed community members and leaders, the municipal government, and the state government of our plans. In our initial meeting—with a representative who spoke the local language present—we answered community members questions and sat with key leaders, talking through everything in detail and adjusting plans as needed based on feedback. In the end, we were all in agreement and enthusiastic about the project. As the project progressed, we kept community members informed, especially when there were delays.

During the project, we had direct support from community members who helped to clear the land, bring supplies to shore, and cook for the workers. In addition, the mayor’s office played a key role in project management to encourage local ownership and direction. Through this, the community feels ownership of the project, which will help with the sustainability of the dispensary and its maintenance. Bosco Buliche, director of the Chuuk State Health Department, says he is pleased with the renovations in Satowan and hopes to replicate the project. According to him, “Chuuk State’s vision is to build out ‘super-dispensaries’ like the one in Satowan for each of our five Chuuk State remote atoll regions.”

What challenges have you had to overcome?

These atolls are extremely remote. It can take three to four months to get the materials for rehabilitating the dispensaries to the main island, and then we must hire a bigger and more costly ship to take those supplies to the site. Thus, it is important to let your grantor know these timelines and to continue to liaise with the community and contractors to help move the project forward.

What’s next in your agency’s work to advance health equity?

We look to continue the OT21-2103 work to improve access to health care on remote islands through the CDC Public Health Infrastructure Grant. As we did with Satowan, we plan to identify catchment areas for each group of islands and focus on a dispensary to serve them. We also plan to implement telehealth in these dispensaries and would like to construct living quarters for a doctor and a nurse in Woleai.

In addition, as noted earlier, we hope to leverage other partners and FSM Congress to support additional dispensary renovations. Ultimately, we aspire to help FSM increase access to care in remote and underserved areas so we can truly achieve better health for all.