we are able to express our feelings freely and share with the people of Hawaii, regardless of color, race, creed, or religion. That is Hawaii. I am Hawaii. I am kupuna of Hawaii. You want me to sing the song? Ms. HALE. That is what you said. Ms. HILO. "The Message"? Ms. HALE. Yes. Ms. HILO. Would you help me with "The Message"? Senator INOUYE. We in Hawaii are different and we are unique. It is only from Hawaii that we have testimony in music. I am not sure how the reporter Ms. HILO. Excuse me, excuse me. Being here this morning, in fact before I left for Washington, DC, yesterday, I was filled with butterflies, getting on that airplane getting to Washington, DC. And I went to a shop specially to get me a camera so I can take Washington, DC, and all the memories here home to Hawaii, to the kupunas of Hawaii. With no further ado, would you please stand and help me. Oh, what a predicament you put me in. Please help me. Would you please tell them. Ms. HALE. This song was first created in 1313, "Now abiding faith, hope, and aloha," but "aloha" is the greatest of all. [Ms. Hale and Ms. Hilo sing in Hawaiian.] Ms. Apoliona [translating]. Faith, hope, and the third is love, and love is the greatest of all. And if we have faith, hope, and love, all things are blessed. [Applause.] Senator INOUYE. Ms. Hilo and Mrs. Hale, the committee will give you everything you want. [Laughter.] I am certain all of you now realize why we call Hawaii Hawaii No Ka Oi. It is No. 1. If I were the following witnesses, I would beg off. I feel sorry for you. [Laughter.] STATEMENT OF SATORU IZUTSU, PH.D., ASSOCIATE DEAN, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAII, HONOLULU, HI ACCOMPANIED BY: JERROLD M. MICHAEL, M.D., DEAN AND PROFESSOR OF PUBLIC HEALTH, UNIVERSITY OF HAWAII SCHOOL OF PUBLIC HEALTH HONOLULU, HI RICHARD DUBANOSKI, PH.D., DEAN, COLLEGE OF SOCIAL SCIENCES, UNIVERSITY OF HAWAII AT MANOA, MANOA, HI Senator INOUYE. Representing the School of Medicine of the University of Hawaii, Dr. Saturu Izutsu; and the dean of the University of Hawaii School of Public Health, Dr. Jerry Michael; and the dean of the College of Social Sciences, Dr. Richard Dubanoski. Welcome, gentlemen. Who is going to do the singing? Dr. IZUTSU. That is a hard act to follow. Senator Inouye, Mrs. Mink, and Mr. Abercrombie: Good morning. Thank you very much for this opportunity. I am Satoru Izutsu, the associate dean of the John A. Burns School of Medicine of the University of Hawaii. This testimony concerns the continuation and development of a strategy to address the health manpower needs of the Pacific Basin. The overall goal of the program is to address the acute indigenous physician workforce shortage that exists in the United Statesaffiliated Pacific Islands by training the next generation of physicians for the region. To achieve this ambitious goal, the objectives are to graduate medical officers who will return to their respective jurisdictions. The program is in its sixth year of operation. Currently there are 68 students in four classes from the Republics of Belau and the Marshall Islands, the Federated States of Micronesia, and American Samoa. Past testimonies have focused mainly on the purpose of the program, its practical hands-on training scheme, its study-survival skills strategies for educationally disadvantaged students, and emphasis on the preventive, curative, and health management skills critical to the Pacific Basin. In contrast, this testimony will present the significant achievements to date at a time when its first class of 16, 6 women and 10 men, nears the end of their 5-year training. Graduation will be in February 1992. In review of the physician shortage crisis, today there are only 18 clinically active Micronesian physicians, many of whom are about to retire or are in poor health. The few indigenous clinicians are practicing in locales where infectious disease is still the leading cause of death, infant mortality rates of three to five times that of the United States, tuberculosis and leprosy are common, and diseases such as kwashiorkor and vitamin A deficiency in children and diabetes mellitus in adults are increasing in epidemic proportions. To exacerbate the situation, there is an unchecked 3 to 4 percent population growth rate in the region. This means that these countries are doubling their population every 17 to 24 years. This necessitates a dramatic increase in the health workforce numbers. Since the last testimony, the program has fully developed its years 4 and 5 training schemes. The program has matured. For example, the World Health Organization has formally recognized the program in 1989 as a physician training institution. At the 13th meeting of the permanent heads of health services of the South Pacific Commission, the following resolution was passed: "The conference welcomed the establishment of the training programs of the Fiji School of Medicine and the Pacific Basin Medical Officers Training program." PREPARED STATEMENT It is estimated that Micronesia alone will need between 85 to 100 physicians in place by the year 2000. By the end of 1995, the project expects to graduate 85 physicians. In summary, dramatic progress is being made in addressing the physician workforce shortage. The program is going well. The support of this subcommittee has been truly vital and is deeply appreciated. Thank you. [The statement follows:] STATEMENT OF SATORU IZUTSU I am Satoru Izutsu, Ph.D., the Associate Dean of the John A. Burns School of Medicine of the University of Hawaii. This testimony concerns the continuation and development of a strategy to address the health manpower needs of the Pacific Basin and is made at the request of Dean Christian L. Gulbrandsen, M.D., and on behalf of the faculty of the Program. The overall goal of the Program is to address the acute indigenous physician workforce shortage that exists in the U.S.-affiliated Pacific Islands by training the next generation of physicians for the region. To achieve this ambitious goal, the objectives are to graduate Medical Officers who will return to their respective jurisdictions to 1) deliver primary and entry level secondary health care, 2) provide preventive health leadership, 3) assume planning and management responsibilities, and, 4) train and supervise intermediate health care workers. The program is in its sixth year of operation. Presently, 68 students in four classes from the Republics of Belau and the Marshall Islands, the Federated States of Micronesia (FSM), and American Samoa matriculate at training sites located in Pohnpei, Chuuk, Yap, Belau, Kosrae, the Marshalls, and Guam. Past testimonies have focused mainly on the purpose of the Program, its innovative community-oriented and problem and competency-based curriculum, its practical "hands-on" training scheme, its study-survival skills strategies for educationally disadvantaged students, and emphasis on the preventive, curative, and health management skills critical to the Pacific Basin. In contrast this testimony will present the significant achievements to date at a time when its first class nears the end of its five-year training program in December, 1991. In review of the physician shortage crisis, there are only 18 clinically active Micronesian physicians in the FSM, Belau, and the Marshalls - many of whom are about to retire or are in poor health. In the last 20 years less than 10 Micronesian physicians have graduated and returned home either from any of the metropolitan country medical programs or two regional medical schools in Fiji and Papua New Guinea. The few indigenous clinicians are practicing in locales where infectious disease is still the leading cause of death, where infant mortality rates are three to five times that of the United States, where tuberculosis and leprosy are common, and where the diseases such as kwashiorkor and Vitamin A deficiency in children and diabetes mellitus in adults are increasing unchecked in epidemic proportions. Added to this shortage is the reality that there are no indigenous women doctors in all of the FSM and the Marshall Islands administering to the clinical and sensitive personal and cultural needs of the vast majority of the islands' health care clients who are women and children. To exacerbate this situation there is an unchecked 3% - 4% population growth rate in the region which means that these countries are doubling their population every 17 to 24 years. This necessitates a dramatic increase in the health workforce numbers just to keep up with and sustain the current levels of service which are grossly inadequate. As a short term solution, the National Health Service Corps assigned to the region by the U.S. Public Health Service, have done admirably by filling in these physician shortages and also in acting as clinical preceptors for Program students. However, these physician numbers have not been enough to answer the acute manpower needs. Through the support of this Sub-Committee and the planning of the Ministers and Directors of Health of the region, who are the Board of Advisors for the Program, 16 Micronesian medical students (6 women, 10 men) will graduate in February, 1992 and join their 18 physician colleagues in the FSM, Belau, and the Marshalls. Since the last testimony, the Program has fully developed its Years 4 and 5 training scheme. To briefly review, Years 1 through 3 are primarily academic and community-based health outreach activities based entirely in Pohnpei. Year 4 consists of hospital-based in-patient rotations and community health projects located at Chuuk and Pohnpei State Hospitals where the students rotate in an intern-like fashion through medicine, surgery, pediatrics, and obstetrics. Not only are these two hospitals the loci for hands-on medical educational activities, but by the very nature of medical education the Program provides quality direct patient care in these chronically understaffed hospitals. Year 5 is a combination of both hospital and community-based activities which include a month-long psychiatry rotation through Guam, a 16 week community-based rotation through the students' respective jurisdictions, a four-week rotation studying the Primary Health Care systems of Yap or the Marshalls, and a 20 week in-patient rotation, again at Chuuk and Pohnpei State Hospitals. The Program has matured. This is the fruit of the incredible hard work of a committed regional health leadership and the staff of the Program. Some of the milestones of achievement and acknowledgement not only within the region but throughout the Pacific are: 1. Career-ladder Certification: On a regional basis the Program has captured the attention of the health leadership. In 1990 the Program awarded 16 Assistant Medical Officer (AMO) Diplomas to its Year 4 students who then applied for and promptly received from the FSM Medex licensure the mid-level practitioner license for the region. Awarding the PBMOTP students this license is significant in that no such licenses have been issued to a Micronesian in the last 15 years. These students are now employed during school breaks as Medexes and supervise clinics during the school year. If for some untoward reason a student has to drop out of the Medical Officers Program after receiving Medex licensure, this student is an immediate national resource who is highly skilled and employable. The above AMO Diploma follows the awarding of a Health Assistant Certificate (HA) to students who successfully complete their first year in the Program. This is part of the Program's career-ladder-strategy to award in a step-wise fashion appropriate professional certification to Medical Officer students as they achieve increasingly sophisticated levels of primary health care provider clinical proficiency. This is an innovative career-ladder strategy. It is the first such educational scheme to be implemented in a physician training program in the Pacific. 2. Fellowships: The Federated States of Micronesia Office of Health Services in its 1990-1991 World Health Organization (WHO) aid budget set aside funds in fellowship support for Program students to pursue support from the client country from which the majority of our students come. 3. WHO Recognition: On a Pacific basis the World Health Organization formally recognized the Program in 1989 as a physician training institution, has sent consultants to the Program to assist in curriculum development, teaching, and to informally evaluate Program students. 4. A Model and Member of the Pacific Network: Since 1989 a goal of the Program has been to complement the Pacific-wide strategies for level-appropriate physician training in the Pacific. The Program staff has acted as curriculum consultants to WHO with regards to the revitalization of the Fiji School of Medicine. Most recently the Program has been acknowledged by WHO as being a "major focal point" of a medical educational network which is part of a larger WHO strategy to address the physician workforce shortages endemic throughout the entire Pacific. 5. South Pacific Commission: At the Thirteenth Meeting of the Permanent Heads of Health Services of the South Pacific Commission, the following resolution was passed: "Recommendation No. 13. The Conference welcomed the establishment of the training programmes of the Fiji School of Medicine and the Pacific Basin Medical Officers Training Program..." This is the first declaration of acceptance of the PBMOTP by the SPC forum which will open the way for collaborative projects in the future. In just a few short years, the Program has achieved regional and Pacific-wide recognition. It has become a medical educational model in the Pacific, a curriculum consultant to the Fiji School of Medicine, and a "major focal point" of an overall framework in the strategy to address health workforce shortages in the Pacific. These are timely and strategic achievements, for unless the Program fits into the overall Pacific medical educational network, the graduates of this new program will be isolated, not accepted regionally or Pacificwide for their achievement, and potentially denied the satisfaction, self-esteem, and, in more practical terms, the postgraduate training opportunities they will need. In polling the Ministers and Directors of Micronesia, it is estimated that Micronesia alone will need up to 84 physicians in place by the year 2,000 to keep up with the increasing client health service needs of their rapidly expanding populations. It is estimated that of the 68 students currently in the Program 58 will graduate from the Program. Given the projected needs, the health leadership of the region will recommend that at least two more intake cycles be implemented by the PBMOTP to satisfy the projected regional physician workforce needs. In summary, dramatic progress is being made in addressing the physician workforce shortage in the American-affiliated Pacific Islands. The PBMOTP is in its fifth year of training and has developed an innovative Program which has become recognized as a medical education model in the region. In addition, efforts have been made for its graduates to fit within the mainstream of health workforce issues in the Pacific. A further agenda item is the identification of level-appropriate postgraduate training opportunities for the Program graduates. The Program is going well. The support of this Sub-Committee has been truly vital and is deeply appreciated. |