Connecting Pacific Islands to Specialty Care 

By Houkje Ross


Closing the Gap, Pacific Islander Health • June/July 2000


Residents of the U.S.-associated Pacific jurisdictions live on 104 

islands covering an area larger than the continental U.S. Health 

professionals are in short supply. Hospital care often requires 

travel by plane or boat. Patients needing specialty care may be referred 

as far away as the Philippines or Hawaii. In American Samoa, 30 

percent of the total health budget is devoted to off-island referrals. It 

is no wonder that Pacific jurisdictions are vitally interested in the 

promise of telemedicine 

Using telemedicine can save time, money, and lives. It can even 

be used in cases of emergencies. “For example, it can be used to stabilize a patient enough to be able to move him or her to a place that can 

provide the next level of care,” said Wasem. 

The second type of telemedicine being tested is store-and-forward technology, which captures audio or video clips of medical information and sends them to physicians off-island. Store-and-forward technology can be 

and telehealth. used to send medical imMedical and health ages like X-rays, MRIs, or 

care practices enhanced by CAT scans to radiologists 

the use of telecommunica­ and other off-island spetions and computer tech­ cialists. Each jurisdiction 

nologies—including digi­ has this type of technology 

tal cameras, video and au- provided by the Akamai 

dio transmission, and the project at Tripler Army 

Internet—can help link Medical Center/PRPO. 

physicians in the Pacific The HRSA initiative is 

jurisdictions to colleagues hoping it can be used in 

in Hawaii. They can also new ways. 

link health care workers on Traditionally the techoutlying islands to the hos­ nology has connected phypital or health department sicians at the local hospital 

in their own country or with specialists located at 

territory. tertiary care centers. In 

In an effort to use this 

technology to bring medical information, services and care to the region, the Health Resources 

and Services Administration (HRSA) launched the Pacific Basin 

Telehealth Initiative in 1999. The Republic of Palau and American 

Samoa are now testing two types of technology provided through 

HRSA’s Office of the Advancement of Telehealth (OAT). 

Testing New Telemedicine Possibilities 

The Initiative chose America Samoa to test interactive teleconferencing equipment, which allows health care workers to see a specialist 

in Hawaii or elsewhere through a live video screen. “A wheelchair was 

ordered for a child on the Island, but by the time it arrived he had 

grown, so the chair had to be adjusted,” said Cathy Wasem, director of 

Telemedicine-Telehealth Programs at OAT. “There was no one on the 

island who knew how to adjust the chair.” Teleconferencing equipment allowed health care workers to see how a specialist in Hawaii was 

adjusting the wheelchair. “It was done on the spot,” she said. 

Most islands in the region have a shortage of health care professionals like nurses, pharmacists, radiologists, and laboratory technicians, according to Institute of Medicine’s report, Pacific Partnerships 

for Health. 

Palau, the store-and-forward technologies are being piloted at the super-dispensaries, linking them to the republic’s 

hospital and main clinic. In American Samoa, the interactive technologies are connecting the hospital with dispensaries on two outer 

islands—usually staffed with licensed nurse practitioners and emergency medical technicians. “This will enable ‘front-line’ health care 

workers to access the next level of care,” said Wasem.

 “In the future, we hope to be able to connect health care workers 

at dispensaries and other outlying clinics to continuing education 

classes and seminars,” she added. Because there are no medical schools 

located in the jurisdictions, health care workers miss out on these 

opportunities. “Those involved in the Telemedicine Initiative in American Samoa are becoming excited about the educational possibilities,” 

said Wasem. OAT also plans to develop Listservs for information sharing over the Internet. 

The Initiative is also pulling together an inventory of existing 

telecommunication and telehealth resources in the region. A regional 

telehealth consortium, staffed by the University of Guam, is coordinating the inventory and expects to have it completed in 6–12 months. 

HRSA will also work with other federal agencies operating in the area 

to coordinate telehealth activities. 

For more information on HRSA’sTelehealth Initiative, 

contact Cathy Wasem, HRSA, (301) 443-0202.

Office of Minority Health Resource Center U.S. Department of Health and Human Services