IHE: Marshall Islands

Majuro Hospital was built in the 1980s with funding from the U. S. and serves as the tertiary care center for the Marshall Islands and as the primary care center for most of Majuro. The hospital departments include Internal Medicine, Surgery (and surgical specialities Ophthalmology, Orthopedics, Urology, ENT), OBGYN, Pediatrics, Rehabilitation, ER, Pharmacy and Public Health.

Students will be working at Majuro Hospital and with the public health outreach teams.

Major medical issues on the island include: diabetes (and surgical complications), hypertension, TB, STDs, pneumonia and family planning. The Marshall Islands have also recently experienced an outbreak of measles. To learn more you may want to review some of these papers.

Be prepared to make use of your physical exam skills. Access to labs and other studies is limited.

You can view photos taken by prior IHE students in the Marshall Islands by clicking here.

Another good source of information about the Marshall Islands is Holly Barker's Bravo for the Marshallese: Regaining Control in a Postnuclear, Post Colonial World, 2003.

Clerkships available

* Medicine (wards and clinic) -- up to two students
* Surgery (OR and wards) -- only one student
* OBGYN (working with midwives) -- up to two students
* Pediatrics -- only one student

Dr. Kamal Gunawardane (Surgery) will be your primary contact at Majuro Hospital. Other mentors include: Dr. Maung Win (Surgery), Dr. Virgilio Bong Villaraya (Medicine), Dr. Mai-Ling Perman (Medicine), Dr. Jane Gaucio (Pediatrics), Dr. Jimmy Santos (OBGYN), Dr. Felicidad Cabrerra (OBGYN), and Dr. Kenner Briand (Public Health).

Foreign Language

No knowledge of Marshallese is required. Most of the physicians are expatriates and work with native nurses when interviewing their patients. If you and the other IHE students in the Marshall Islands are interested, a Marshallese language class could be organized at the library. Let us know if this might be of interest to you.

Required Activities

1. 30 minute presentation on a topic of interest to the staff of Majuro Hospital. All physicians (regardless of their speciality) take call in the Majuro Hospital ER, and your topic should review information that would be helpful to them. Suggested topics include: EKG reading, x-ray interpretation, trauma management, cardiac life support, acute abdomen, hypertension, heart disease, differential diagnosis of chest pain, STDs, TB, dehydration and nutrition. Because you will have limited access to the internet and to journals on Majuro, it is highly recommended that you collect all necessary information prior to leaving the United States. Here is a past student presentation.
2. Public health outreach will make up about 50% of your work. You will spend three weeks with one or more of the following public health teams (depending on your interests): diabetes, family planning, immunizations/vitamins, leprosy, and behavioral health.
3. 10 minute presentation for members of the UWSOM administration and Puget Sound Partners for Global Health upon your return to the United States.
4. 5-10 digital photos of yourself with patients and staff on site. Be sure to ask permission from patients and staff before taking any photos.
5. Complete and turn in your activities diary, Evaluation form, receipts and Expense Report form and receipts to Daren Wade, Program Manager, Health Sciences Global Training Resource Center, C-314 Health Sciences Building, Box 356355, University of Washington, Seattle, WA 98195.

Optional

1. ER call: Interested students may choose to take call with the on-call physician in the ER. You are free to make your own call schedule.
2. Visit to the outer islands (e.g. Ebeye) to learn about health care delivery there (cost of travel to the outer islands is the responsibility of the student, and is not included in the IHE stipend).

Traveling to Majuro, Marshall Islands (MAJ)

* No visa is required. (For more information, see the U. S. State Department.)
* Airline: Continental Micronesia
* Flights to Majuro from Honolulu go out on Monday, Wednesday and Friday.
* You may contact Vicki Robbins at (206) 364-0100 (she is the travel agent for the Pacific Islands Continuing Clinical Education Program, Dept. of Family Medicine) for assistance in booking your tickets.

Traveling within the Marshall Islands

Air Marshall Islands, P. O. Box 1319, Majuro, MH 96960, RMI, Tel. (800) 543-3898 or (692) 625-3731, amisales@ntamar.com

Housing

Housing will be arranged by IHG. We hope to find housing close to the hospital with A/C, kitchen, and TV/VCR.

Safety

Beware of the dogs! While there is no rabies on the island, students have reported being bitten or knowing of others who were bitten while walking around on Majuro. Don't walk around at night. Use taxis in areas where there are a lot of dogs around. Report any dog bites to the police.

There has been a shortage of tetanus vaccine on the island, so it is particularly important that you get your booster prior to coming.

You will not be provided with protective TB masks at the hospital. It is important that you bring your own NIOSH-certified particulate filter respirator. A list of NIOSH-approved N95 disposable particulate respirators (including supplier/manufacturer and contact numbers) may be found here.

Traffic accidents are the major cause of injury or death for students in overseas programs. Read more about how to protect yourself at the Association for Safe International Travel (ASIRT) website. The ASIRT has compiled Road Travel Reports for 150+ countries. You can order copies of these reports at no charge. The United States State Department also provides safety suggestions. Finally, you may find this recent article in the New York Times helpful.

Budget

You are required to purchase all items outlined in the budget. You must bring with you needlestick prophylaxis and other listed supplies. This is NOT optional.

This budget is approximate. We have done our best to estimate the costs students might incur. If your costs exceed the stipend you are given, these costs will be your responsibility to cover. If you underspend the budget allocated for a particular item, you may apply the excess funds to any other item in the budget except food. The amount allocated for food is not intended to cover all your food expenses. If you underspend your stipend, you will be expected to return the remaining funds.

Be aware that food is very expensive in the Marshall Islands.

Telephone/Internet

Access is intermittent and slow. You will be able to e-mail family and friends back home, but don't count on being able to do literature searches and download journal articles on the web.

Social events

Social events will be organized with local healthcare workers and other members of the community.

Tourist and other local information

* Republic of the Marshall Islands (a service of the RMI Embassy, USA)
* Marshall Islands Visitors Authority
* Yokwe Divers and Wildfire Sports Fishing
* Pacific Islands Report

Useful Marshallese terms and phrases

Other helpful tips...

- The postal service is unreliable. You must bring things with you.
- Women should not wear shorts above their knees. It's very rude to show your thigh in Marshallese culture. Women should also cover their shoulders.
- Don't wear a bikini unless you are in a very isolated area of a beach. Otherwise plan on wearing board shorts and a tank top on top of a bikini or one-piece bathing suit.
- Other things to bring if you have access to them: suture materials, paracentesis kits, and reagents for basic labs (BUN, Cr, etc).