The U.S. military is launching a new effort to support and coordinate health care efforts across Pacific islands, where even on American soil health services and outcomes lag far behind U.S. states.

On Tuesday, more than 100 people gathered at the University of Hawaii John A. Burns School of Medicine in Kakaako to discuss the new Indo-Pacific Command’s new initiative, the first of a three-day conference intended to launch a year-long planning process. Attendees included military doctors, local physicians, academics, public health workers, U.S. government officials, USAID officials and embassy officials from Palau, the Marshall Islands and the Federated States of Micronesia.

Fresh off a visit to several U.S.-affiliated Pacific islands, Rear Adm. Louis C. Tripoli addressed the group, emphasizing that the Indo-Pacific Command does not want to to re-invent the wheel but rather learn about existing programs, leverage current funding and improve the efficiency and effectiveness of ongoing regional health care efforts.

He noted that the U.S. military already supports health care in Pacific island nations and territories but this would be a more collaborative effort to find solutions that are both sustainable and self-sufficient.

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“It’s important to all of us to do this but it’s not just important, it’s the right thing to do,” Tripoli told attendees. “There are people who really need better health solutions than what they have and I think we have an opportunity to do this for them. ”

In an interview, he told Civil Beat this is an opportunity to leverage the military’s expertise in logistics. He said what’s different about this initiative is “the opportunity to get together with the University of Hawaii and other government agencies to form an outcome that is greater than the sum of its parts.”

“The successful outcome for me would be to develop a health care infrastructure and workforce that’s composed of the people who live there,” he said.

Tripoli noted that U.S. Indo-Pacific Command’s new leader, Adm. Philip Davidson, “believes strongly in this initiative to enhance what it is that we do out here in the Pacific, and also to enhance our relationships with partner nations, territories and the state of Hawaii.”

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The move comes in light of renewed strategic interest in Oceania. The U.S. is building a Marine Corps base on Guam and plans to move thousands of service members from Okinawa there. There are also plans for associated live-fire training ranges across the Mariana Islands.

U.S. Secretary of State Mike Pompeo said Monday that the U.S. has started renegotiating an international agreement with the Marshall Islands, Palau and the Federated States of Micronesia that gives the U.S. military control over vast swaths of the western Pacific.

In May, President Donald Trump met with the presidents of those nations, a historic meeting that followed Chinese overtures in the region. The South China Morning Post reported last year that the Pacific islands are the new “diplomatic battleground” between China and the U.S.

When asked about whether the health care initiative is partly a reaction to China, Tripoli said the Indo-Pacific Command’s efforts are “irrespective of other countries’ activities regardless of what that country is.”

’70 Years Behind The US’

Improving health problems in Pacific islands is an enormous challenge. Infrastructure is often lacking and manpower is irregular. Even Guam, by far the most developed island in Micronesia, lacks some specialists.

Countries and territories operate medical referral programs and are forced to decide who to fund to fly to Hawaii, the Philippines or other places for medical care. Even when money is available, travel between islands is expensive and unreliable, and sometimes patients’ health conditions or immigration status prevents them from getting needed care.

Health care problems are numerous and in some cases, worsening. A new study published Tuesday found that cancer is a growing problem in Pacific islands and noted the International Agency for Research on Cancer expects “that there will be a doubling of new cancer cases in the Pacific by 2040.”

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Dr. Richard Brostrom, who works at the federal Centers for Disease Control and Prevention but spoke at Tuesday’s conference in his capacity as a longtime health provider in the region, said that one survey he did when he worked on Saipan in the U.S. Commonwealth of the Northern Marianas found that 70% of adults had diabetes.

Brostrom currently specializes in tuberculosis and noted the TB rate in the U.S. is 2 per 100,000. On Guam, it’s 50 per 100,000 and has included multi-drug-resistant tuberculosis.

“Guam lags 70 years behind the U.S.,” said Brostrom, noting that 50 per 100,000 was the U.S. tuberculosis rate in 1950. But Guam’s rate is vastly better than most other Pacific islands, particularly the Marshall Islands.

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“In our screening in Majuro there were five deaths in the first month we were there, and they were the ones that got counted,” Brostrom said.

Diabetes, obesity and hypertension are also major problems. A 2016 report by the World Bank found that lack of progress on noncommunicable diseases was hurting Pacific island economics.

Brostrom offered a slew of short-term recommendations, including providing digital radiology interpretation services at Tripler Army Medical Center and implementing regular rotations for specialists at Tripler or other hospitals to visit Pacific islands. Often Pacific island hospital staffs lack radiologists and specialists, including cardiologists, gastroenterologists, dermatologists and oncologists.

He also suggested increasing support for training programs for both disease outbreaks and medical certifications; investing in basic infrastructure like sidewalks and gyms that help people exercise; and sending lightly used military health care equipment to Pacific islands.

What To Expect

Tuesday’s conference wrapped up with attendees discussing potential action steps in small groups and presenting their findings. Most recommended some sort of needs assessment or consolidation of ongoing needs assessments. Several acknowledged the need for cultural competency.

The Department of Defense and other U.S. government agencies plan to meet Wednesday and Thursday to continue discussions. A meeting with the University of Hawaii is scheduled for late August or early September.

Tripoli says that whatever the Department of Defense does will be in response to local needs and gave credit to the expertise of the Pacific Island Health Officers Association.

“Let me reassure you, 100%, that this is not going to be some program where we suppose we know what’s right and provide it to people out there,” he told attendees, adding that he’s developed tremendous respect for the diversity across the Pacific islands.

“There are no solutions out there that will be right for every single problem,” he said. “And if we don’t go about this with a respect for that diversity, then I think we would be doomed to failure … We can’t do this without involving our friends, the people who are out there in these islands.”

Tripoli acknowledged coordinating U.S. government efforts to improve health outcomes won’t be easy.

“This is the one place where logistics trumps everyone else,” he said of the Pacific islands, noting that even telemedicine is hard when dealing with multiple time zones.

Tripoli announced that he’s set an internal goal of one year from Tuesday to make progress. Even though the year will be largely dedicated to planning, he also wants to take action in the next six to 12 months.

“We need to show some progress. We need to have some wins,” he said. “We are going to do everything we can to be aggressive in figuring out what those are and get there. Because if we don’t move this glacier in a year, I don’t think anybody is going to believe that it’s going to happen.”