Yap Area Health Education Center
(Federated States of Micronesia)
P.O. Box 1035 Colonia, Yap, FSM 96943
Email: Pius You, Executive Director, firstname.lastname@example.org
Once Yap, always Yap!
The FSM-Yap AHEC is in year 3 of existence and has a 12 member board of healthcare workers and community members that also performs oversight of the new Wa’ab CHC. Thane Hancock, MD is center director. Major accomplishments of the FSM-Yap AHEC include health assistant training for 27, nursing training for 17, radiology technician training for 11, and pharmacy technician training for 9. The Yap AHEC has successfully adapted the College of Micronesia’s (COM) year-long formal curriculum for health assistants and delivered it via distance learning to the health aids in the most remote parts of Yap. The sites are currently most reliably linked with one another by single side band radio that has received replacement batteries and connectivity upgrades as part of the current AHEC grant funding. This is the major health network for this isolated region. Training takes place every morning using this radio system, with the visual support of handouts and textbooks that are distributed in advance by the twice-monthly field ship.
Dr. Yolwa, who speaks the local language of Woleain, travels island-to-island on the field ship at intervals of 1-2 months to distribute materials, reinforce lessons face-to-face and conduct examinations. Previously, Dr. Victor Ngaden, senior physician at the Department of Health Services supervised the practicum training of all 27 health assistants during their stays or visits in Yap proper. He also taught 8 community health workers using the same curriculum, but in Yapese. Dr. Ngaden also supervised clinical nursing rotations at the community health center and central hospital and teaches academic and community nursing to 17 nurses through a partnership between the Palau Community College and the Yap Hospital. Practical nurses who are actively employed in the hospital are provided time to participate in classes on hospital grounds, and perform clinical rotations at the hospital and community health center. With model AHEC funds the Yap AHEC will complete pharmacy technician training, and institutionalize the training for health assistants and nursing students.
Yap AHEC’s New Medical Library
On the tiny island of Yap in the far western Pacific, a new medical library has been created to replace the one destroyed in Typhoon Sudal in 2004. The Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted exclusively to improving the health and health care of all people, working together with Guam’s Ayuda Foundation funded a project to establish this new Yap State Hospital Medical Library. Librarians Arlene Cohen and Alice Hadley of Guam worked with Drs. Mark Durand and Thane Hancock; Medical Library Manager Charlene Laamtal; and Daisy Gilmatam, the Information Technology Technician at the Yap State Hospital to create this new facility.
The Robert Wood Johnson Foundation grant, thus far, covered the purchase of 250 books, cataloging for the books, library management software, a PowerPoint projector and screen, three computers, two printers, as well as the construction of bookcases and computer desks. In addition, Richard Sher of Gaylord, a library supply company, donated a two-drawer catalog and various library supplies to get us started.
Things can move slowly in the tropics and then suddenly race by. This project was one of these. The project originated when Dr. Durand from Yap State Hospital contacted the Ayuda Foundation in Guam about replacing their typhoon damaged library in late 2005. Carlotta Leon Guerrero, Executive Director of Ayuda, contacted Arlene Cohen, then a librarian at the University of Guam, who has worked on library resource sharing and development in Micronesia for over 20 years. Cohen brought in Alice Hadley, medical librarian at the United States Naval Hospital, Guam, to provide her expertise in small medical libraries. The original grant application went to the Robert Wood Johnson Foundation in 2006. After a few rounds of tweaking and revising, Ayuda received the funds in December 2007 for the Yap State Hospital Medical Library.
We immediately began purchasing books and computers and arranging their shipment from the continental United States to Colonia, Yap State, in the Federated States of Micronesia (FSM). Although the FSM is a foreign country, it is also a freely associated state with the United States. Consequently, the US dollar is the currency and the US Postal Service charges the same price as shipping to Hawaii (although much slower). There were many problems with arranging shipping as very large companies often have rigid shipping requirements when shipping to a foreign country. Their systems often cannot provide the customs paperwork needed when using the United States Postal Service or do not even allow the use of the system. This special handling added almost 20 % to the cost of shipping.
Originally, it was planned to send all the books in January by surface mail, taking two or three months (or more) to reach Yap and the trip was scheduled for the first week of April. However, since the only shipping allowed to international locations by the United States book vendor Majors, was by an air courier service, the books arrived well ahead of our trip.
During the first week of April, Cohen and Hadley traveled to Yap to help set up the medical library. While there, they set up the physical library, a card catalog, and an online catalog. They also provided training to the library manager on using the library management software and how to run a library. Training was also presented to almost one-third of the hospital staff on using PubMed and accessing quality health information in the physical library as well as the Internet. They plan to return in November 2008 to provide follow up training for the library manager, and additional staff training on using PubMed and other online resources.
They had hoped to also establish a World Health Organization HINARI account for the hospital to provide direct access to medical literature through PubMed’s LinkOut feature, but this proved to not be cost effective for this small hospital. Instead we used the $1,000 cost of the HINARI subscription to buy more textbooks for the physical library.
Yap State Hospital has 36 in-patient beds and 12 doctors (including one surgeon and one anesthesiologist), and serves both the high island of Yap (population 8,000) and the inhabited outer islands (population 4,000). The lovely facility, built in 1979, is set in a tropical garden with flame trees brightening the yard, and provides both in-patient and out-patient care.
The new medical library is centrally located near the administrative offices and the medical records room in the out-patient department wing. There is an office computer for the library manager and four public access computers with filtered Internet access. The Internet access is slow, but it allows the staff to access online resources including a subscription to almost 70 textbooks in STAT!Ref and hundreds of full-text journals on EBSCO through subscriptions paid for by the Pacific Regional Educational Laboratory (PREL). The library has a PubMed “My NCBI” account that provides tabbed search results with tabs for English language articles, and free full-text making it easier for the staff to find articles they can use.
The library management software is ResourceMate(R) from Jaywell Software. It is an inexpensive, easy to use online catalog and circulation system for very small libraries. Although not designed for hospital libraries, it is easily adapted for such use. One of its most attractive features is that it uses machine readable cataloging records (MARC) and you can either import the records or use the built-in ISBN retrieval feature to search online catalogs such as the National Library of Medicine and the Welch Medical Library at Johns Hopkins, among many other libraries.
While on Yap, Cohen and Hadley also helped the Yap State Public Library Librarian install and use the ResourceMate(R) software at the newly renovated public library, also destroyed by Typhoon Sudal in 2004. In the process, they brought together Laamtal and Gilmatam from the Yap State Hospital with Isabel Rungrad, the Yap State Public Librarian so they could share information between the two libraries about using the software. Before the end of the visit, both librarians were not just sharing expertise, but books and library supplies as well.
Finally, in preparation for the Pacific Islands Association of Libraries and Archives (PIALA) annual conference to be held in Yap on November 17-22, 2008, Cohen and Hadley met with the newly formed Yap State Library Association. They worked on the draft by-laws and preparations for the PIALA Conference.