Chuuk hospital troubles revealed

A Special Report; Facility visits by expert uncover disparity between Chuuk, Pohnpei hospitals

by Jayne Flores

HAGÅTÑA, Guam (Pacific Daily News): May 13, 2002 - Of the many differences between the hospitals in Chuuk and Pohnpei, the most noticeable to the non-medically trained eye is cleanliness.

Pohnpei State Hospital is nowhere near as state-of-the-art as Guam Memorial Hospital, but most of the facility is air-conditioned, the floors are mopped, and the bathrooms clean.

In Chuuk, an abandoned bucket and mop on a dirty floor near a filthy bathroom signal an attempt to clean the facility. Chuuk Medical Officer Dr. Kino Ruben explained that they have no money for maintenance contracts.

To a doctor, however, the differences between the two facilities are far more drastic.

Dr. Joilo Barbosa, an assistant professor of emergency medicine at Emory University in Atlanta, Ga., recently toured Chuuk and Pohnpei State hospitals with the Ayuda Foundation. The Guam-based nonprofit organization is trying to procure medical equipment and supplies for the hospitals from MedShare International, an Atlanta- based nonprofit group with which Barbosa often works.

Barbosa helped Ayuda assess the medical needs of both hospitals.

In Pohnpei, Mary Lou Hawley, chief of Primary Health Care at the Department of Public Health and former hospital administrator, said the hospital emergency room is equipped with such essentials as a crash cart, intravenous fluid bags and an EKG machine, which monitors a patient's heartbeat. Medical personnel change patients' wound dressings in a separate room.

In Chuuk, the ER consists of four old hospital beds in one room containing a nebulizer for asthma treatments and an old anesthesia machine. The supply shelves are bare. Their lone EKG machine is in another ward. The hospital's single defibrillator, a machine that jump-starts the heart, is broken.

The Chuuk Hospital laboratory is in much the same condition. Water-stained ceiling panels hang halfway off their metal supports over a few microscopes. Lab technicians perform simple tests such as those for anemia, but they have no diagnostic tools. They can't even run urine tests.

Pohnpei State Hospital's full-service laboratory hums with equipment spinning blood and testing it. Lab supervisor Paulino Rosario noted that they can't do pathology exams yet, so biopsies are sent to Honolulu with a two-week turnaround for results.

The hospital is equipped with two new X-ray and film development machines, but no CAT scan equipment.

Chuuk has one working X-ray machine. Its X-ray room is air-conditioned. The walls and floor are coated with grime.

In Pohnpei, the hospital has a sterile operating room staging area - a point past which unauthorized personnel are not permitted.

In Chuuk, nurses have to clean the OR themselves. The staging area between the two operating rooms and the labor and delivery room is not sterile.

"Everything is contaminated," Ruben said.

The Pohnpei hospital pharmacy is fairly well- stocked with drugs. In Chuuk, family members often have to buy medications for hospitalized relatives at outside pharmacies because the hospital has little medication in stock.

The only similarity between the two hospitals is in their medical wards. In both places, the male and female wards are separated. Patients bring their own bedding, and the wards are not air- conditioned. In Pohnpei, Hawley says that's because the doctors want the patients to be treated in the same type of environment that they'll be going home to for recovery.

An infectious diseases ward is under construction at Pohnpei State Hospital to hold tuberculosis and leprosy cases, and psychiatric patients. The hospital also is equipped with a dental clinic, a hemodialysis unit and a physical therapy room.

In the medical records section, Pohnpei has three working computers to record patient information. Hawley said they're trying to automate the records department. Chuuk has a single, old computer sitting amid piles of patient charts.

Pohnpei's total health budget, for its hospital and 10 dispensaries, was just under $5 million in 2001. Chuuk spent close to $3 million on its hospital and 60 to 80 dispensaries that same year.

Monetarily and logistically, officials from both states said a comparison between the two cannot be made. It is far easier, they said, to deliver health care to Pohnpei's 34,000 residents spread throughout the main island and six inhabited outer islands than it is to try to reach Chuuk's 66,000 people, who are spread over 40 islands inside and hundreds of miles outside its famous lagoon.

Barbosa's observations of both hospitals are that in Pohnpei, "as a primary care hospital, they are very decent."

Barbosa noted that they do need better monitoring capabilities - an intensive care unit, a pathology lab and a cat scan machine.

In Chuuk, the situation is far different.

"They don't have the bare necessities," Barbosa said. "Chuuk struggles to give primary care."