Micronesia’s health system is chronically underfunded

Jack Niedenthal

MAJURO (Pacific Islands Times) – One of the unique aspects of my job as the Marshall Islands Minister of Health and Human Services was spending time with medical staff in hospitals and clinics every day. I frequently visited the various wards and workstations in the hospital. I joined the doctors on rounds every two weeks and we visited every ward in the hospital to discuss unusual and interesting cases with the interns. It was a wonderful and valuable educational experience.

I felt like I knew these professionals well. I went out of my way to make sure I understood their issues, both professional and personal. I tried to address their concerns with the respect they deserved.

Over the years, I have watched these amazing people struggle under pressure. Through continued observation, I have come to admire their decision-making abilities and feel honored to speak up for them when the time comes.

Because the pandemic has required extensive information sharing on a weekly basis among the U.S.-affiliated Pacific Islands, I have been in close contact with many health officials in the region, particularly from the Freely Associated States, and so I know that many of the challenges facing doctors and nurses in the Marshall Islands are the same as those experienced by others in the region.

Medical staff in Micronesia have been facing a disturbing “social cycle”. Seriously ill patients are reluctant to go to hospitals for treatment because of the widespread fear that “patients who go to hospitals often end up dying in hospitals.”

This common belief causes patients to wait until the last minute to go to the hospital, so when they arrive, it’s often too late. Because they don’t act promptly to address what often start out as a minor problem, their condition turns into a complex medical issue. Unfortunately, some end up passing away, which perpetuates this terrible cycle of “If I get sick and go to the hospital, I’ll probably die there.”

During the pandemic, 17 people in the Marshall Islands died from COVID-19. Only three of them died in hospitals, the rest died on arrival. The same trend has been seen in Guam and all other Micronesian countries, where COVID-19 patients who do not want to go to the hospital often die at home, often unnecessarily.

Compounding this horrific cycle, islanders are now quick to post complaints on social media when they see something “go wrong” at a hospital. But you rarely see posts where things “go well”: lives saved, illnesses cured, patients restored to health and reintegrated back into society. The medical staff who accomplish these feats often work in ancient medical facilities with outdated equipment, as they often encounter severe shortages of medicines and medical supplies.

Underfunding is the main issue that has contributed to the weakness of the Micronesian healthcare system. During the pandemic, all sectors of the Marshall Islands government, including health agencies, have experienced severe budget cuts for two fiscal years. Cutting the healthcare budget at such a critical time is cruel to those of us trying to maintain our preparedness and defense systems against the coronavirus.

These cuts have prevented us from giving our health workers a pay raise. If health care was truly a priority for the government, we would not be seeing these cuts at such a difficult time in history, culminating in a 38-month-long health emergency.

“If you want better health care for your citizens,” health leaders always tell politicians at budget hearings, “then you have to pay for it.” In the Marshall Islands, we spend a little over $700 per person per year on health care. In the United States, the figure is over $12,000 per person per year. In fact, Micronesia has a worse health problem than the United States because we have one of the highest rates of diabetes per capita in the world, which contributes to many diabetes-related illnesses.

We have high rates of adult cancer and heart disease on our islands, which we are unable to address, and many of our children are malnourished. These serious and burdensome health problems coupled with a severely under-budgeted health system place a tremendous strain on our medical professionals.

This brings me to a key point: Micronesian medical personnel have always been severely underpaid. Now that climate change is causing disease outbreaks in our region to become more frequent and deadly, we want these Micronesian “soldiers” on the front lines to fight these diseases. Considering what they face every day, these doctors and nurses deserve better pay and more benefits. Higher wages go a long way toward improving attitudes, leading to more productivity and commitment.

This is a theory that has been proven for a century. In 1914, when Henry Ford doubled the wages of auto workers, he immediately achieved incredible work performance in his Detroit auto plants. Employee turnover was low because workers’ loyalty to the company was unquestionable.

If the Micronesian government wants to improve health care for its people, it must immediately upgrade our medical facilities, provide our medical professionals with up-to-date training so they can master the latest technologies, and compensate them adequately.

We had hoped that under the newly ratified Free Association Agreement, the Commonwealth Health System would finally receive the financial support they have been so desperately needing. However, we are now beginning to see what the health budget will look like under the new agreement. I can say that the funding given to this sector still appears to be woefully inadequate, which will result in our hospitals continuing to face budget shortfalls. Very sad.

Healthcare is an effective way to provide benefits to nearly every citizen in the FAS member countries, but this new funding under the agreement looks like another arrangement that is doomed to fail. I really hope I am wrong. Only time will tell… PACNEWS

Jack Niedenthal is a former Minister of Health Services of the Marshall Islands, where he has lived and worked for 42 years. He is the author of For the Good of Mankind: An Oral History of the Bikini People and president of Microwave Films, which has produced six award-winning Marshallese-language feature films. Send feedback to jackniedenthal@gmail.com

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