By Paula Bender, JABSOM News
Featured photo: Dr. Kareem Khozaim (far left) with Lyndon B. Johnson Medical Center staff in American Samoa. Courtesy photo.
The USDA recently issued $42 million in grants for rural development across the United States and its territories, of which American Samoa and Hawai’i received $667,665 to close the gaps in prenatal healthcare for pregnant women in American Samoa.
This rural development investment that will be managed by the American Samoa Medical Center Authority will be used to establish a maternal telemedicine network at the Lyndon Baines Johnson Tropical Medical Center (LBJTMC), in conjunction with the University of Hawaii and the John A. Burns School of Medicine (JABSOM). Years of working together on continuing education, distance learning, health workforce development, cancer prevention, control, and surveillance, and telehealth laid the foundational groundwork for receiving this grant.
JABSOM Associate Dean for Academic Affairs Lee Buenconsejo-Lum, MD, Men-Jean Lee, MD, and Christina Higa and Ginger Porter of the Pacific Basin Telehealth Resource Center (PBTRC) assembled the proposal for the USDA for American Samoa to secure additional, more sophisticated ultrasound and telehealth equipment for American Samoa.
Part of the JABSOM mission includes pursuing alliances unique to Hawaiʻi and the Asia-Pacific region. Several JABSOM and University Health Partners of Hawai`i (UHP) Obstetrics, Gynecology, and Women’s Health (OB-Gyn) faculty and doctors have collaborated with the LBJTMC for several years, including month-long visits, to assist with prenatal care for women in American Samoa’s islands. The in-person visits stopped when the territory halted all external flights and shipments last March because of COVID-19. It is still closed, and there have been no COVID-19 infections.
“Samoa is a lovely place with a rich Polynesian culture. It is relatively isolated, has a population of about 55,000 people, and there is definitely a shortage of doctors,” said Kareem Khozaim, MD, an associate professor at JABSOM and a UHP physician. Khozaim worked and lived in American Samoa from 2014-2017, and has visited each year since for a month, except for last year.
Khozaim added, “Women there are eager for prenatal care and they would prefer to stay in American Samoa rather than fly to Honolulu for specialist services. The grant will make it possible for improvements such as new diagnostic and telehealth equipment so pregnant women living across four different islands can receive maternal-fetal medicine (MFM) specialist services. Although they are not on all four islands, there are six OB-GYNs and healthcare staff on the main island with whom we collaborate. Together we help them manage pregnancy conditions on the ground, and coordinate transport for those with serious issues to Hawai’i.”
“Back in 2016-2018 when the Zika virus was severely impacting American Samoa, the CDC provided funding for an ultrasound machine.
We found a high-definition ultrasound machine that was reconditioned and repurposed, so we helped them purchase it,” said Men-Jean Lee, MD. “That machine was able to detect Zika-related anomalies in the fetus. However, during a visit, we discovered that no one there knew how to run the machine.”
Lee is Chief of Maternal-Fetal Medicine in the Department of Obstetrics, Gynecology, and Women’s Health at JABSOM, a physician with UHP, and the Medical Director of the Fetal Diagnostic Center at Kapiolani Medical Center for Women and Children. Experiences during the site visit and in subsequent interactions with OB colleagues at LBJTMC led to a discussion of how they could support American Samoa with prenatal diagnosis using their images. Video calls were not effective, and neither were screen captures or emails.
“Everyone is so grateful and excited for the grant, but it only pays for equipment,” Lee said. “So we are looking for additional funding for a team from the University of Hawaiʻi at Mānoa and JABSOM to teach healthcare workers in American Samoa how to use the equipment and assist with the launch of this telemedicine program. These types of services and missions are an important part of JABSOM.”
How the funds will be used:
- The proposed project and partnership with the University of Hawai`i will deliver direct services to patients in American Samoa and build the capacity of the local health care providers through the provision of teleguidance and distance learning for the islands of Tutuila, Ofu, Olosega, and Ta’u.
- Recording and transmission of ultrasound images to maternal fetal medicine specialists at the University of Hawai’i in Honolulu.
- The network will provide access to maternal-fetal medicine specialist services not currently available in America Samoa.
- It also will provide improved access to routine care for women who live on American Samoa’s islands.
- Eliminates the need for pregnant women who live on Ofu or Ta’u to travel by an 8-hour boat ride or a 30-minute flight to Tutuila to visit the only hospital in the territory.
