UMAB attempts to reform Marshalls Marylanders pursue help for islands' self-reliance

October 26, 1997|By Frank D. Roylance | Frank D. Roylance,Sun Staff

For more than a year now, doctors at the University of Maryland at Baltimore have been working to help the Marshall Islands devise a health care system better than the wreck left behind after 40 years of U.S. trusteeship over the islands.

"Obviously, if you damage someone, you have some responsibility," said Dr. Claudia Baquet, associate dean for policy and planning at the University of Maryland at Baltimore. "But how do you help them in the long run instead of making them purely dependent?"

Her answer, in a nutshell, is to "invest in and support their self-sufficiency for their own health care."

Baquet got a first-hand look at islands' health problems during an 11-day visit last year, part of a $40,000 contract between UMAB and the Republic of the Marshall Islands to do a health care needs assessment for the nation, and to recommend changes.

"We're recommending kind of an overhauling of the health care system," she said. The Marshall Islands needs a system that is better integrated, and less dependent on outsiders. For example:

If a native of Rongelap develops a tumor, he must wait to be examined by a Department of Energy team during one of their semi-annual medical missions. If he has the flu, he is referred to the U.S. funded health plan that serves residents of the atolls contaminated by U.S. nuclear tests decades ago. A diagnostic test may have to be sent to Hawaii for evaluation. A cataract

won't be treated until another team of specialists arrives.

"You might have different family members getting services from different places. It's not very logical," Baquet said. Better integration would assure that patients get prompt, coordinated care.

Health clinics on islands hundreds of miles from Majuro Hospital need to be "beefed up." The health aides who staff them need regular training, better supplies and equipment. They need improved, 24-hour telecommunications with Majuro for help in stabilizing and managing acute injury or illness. Medical evacuation flights are extremely costly.

The country needs improved record keeping for births, deaths and illnesses. That would assist in allocating scarce resources more logically.

Audio, video and data links -- telemedicine -- with U.S. hospitals would enable doctors at Majuro Hospital to consult with specialists on the management of patients who are now flown to Hawaii for care at huge expense. Health care workers could be offered regular training through "distance learning" hookups.

The hospitals are heavily reliant on costly foreigners. Too many Marshallese train abroad and never return. "They have to get more kids interested in the health professions," Baquet said.

If foreign specialists must be flown in, the islands should establish regular relationships so that such services as cataract surgery can be offered on a predictable schedule.

If the country can reduce the number of patients sent to Hawaii for hospital care or diagnosis, much money could be freed for improved public health education and prevention programs. For example, "there is a big problem with adolescent male suicide right now," Baquet said. "There's a lot of frustration and hopelessness a lot of depression. It should be a national emergency."

Pub Date: 10/26/97

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