In the Field: Kosrae's Health Needs with Dr. Ed Zuroweste

This week, Ed Zuroweste, MD, Chief Medical Officer is in Kosrae, Micronesia on a site visit to provide technical assistance to the new Kosrae Community Health Center, in preparation for its first operational site visit by the Health Resources and Services Administration (HRSA) later this year.  Kosrae is one of four island states of the Federated States of Micronesia, an independent sovereign nation made up of over 600 tiny Western Pacific islands. Under a Compact of Free Association with the US signed in the mid-80s, the US provides grant and program assistance to the FSM in a number of key infrastructure areas, including in health services. 

Kosrae residents have high rates of noncommunicable diseases. In 2012, the Governor of Kosrae issued a Declaration of Health Emergency over the NCD epidemic, which noted that “the prevalence of obesity, diabetes, and hypertension from self-selected populations reveals that 82 percent of the participation in Wellness Program are obese or overweight, 31 percent are diabetic or pre-diabetic, and 29 percent are hypertensive or pre-hypertensive.” The declaration cites additional data from Community Health Club members finding that 95.8% of participants were obese or overweight. Background documents provided to Dr. Zuroweste also added that other health problems among Kosrae residents include “suicide (three times US rates and among the highest in the world); infant mortality (also three times US rates), anemia among pregnant women (twice US rates), and late prenatal care (77 percent in third trimester compared to 17 percent in US).”  

“Traveling halfway around the world to visit a Community Health Center is always an enlightening experience. While there are many cultural differences when you visit an isolated island with centuries of fascinating history, poverty and lack of access to basic primary health care is similar no matter where you find it,” said Dr. Zuroweste. “I found the people of Kosrae and the staff at the health center to be extremely welcoming and accepting of all of the suggestions that we provided to help them on this new journey to provide quality primary health care to their community.” 

Dr. Zuroweste’s trip brought him to Kosrae’s new health clinics, which received startup funds from the Affordable Care Act. The three clinics of the center -- two of which are already seeing patients -- aim to provide 80 percent of the Kosrae population with primary medical, dental, behavioral health, and enabling services within 30 minutes’ walking distance of their homes. As funds from the US decrease over time (as part of the terms of the Compact of Free Association) , the clinics aim to focus strongly on preventative services and community-centered approaches that are effective and cost-saving. 

“This Federal grant is going to drastically change the way health care is provided on the island, moving from one central area of care provision at the local hospital to a more ‘decentralized’ system of primary care health centers close to the communities they serve, providing cost-effective quality primary care to the entire population,” Dr. Zuroweste continued.  Dr. Zuroweste will be returning to Kosrae for the HRSA operational site visit in September.

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