Tinian Health Care in the Saipan Tribune

Another article was in the Tribune yesterday. I appreciated Secretary Villagomez' viewpoint in all this. My PA license has been exempted from the CNMI regulations so that I can continue to practice here on Tinian and remain legal. Those exemptions are in place only until 31 August 2008. My fear has been that Tinian would be forced to make a decision on hiring a new MD too quickly and not adequately interview and screen to find an MD willing to work here for awhile.

Local

Friday, August 01, 2008

Finding a doctor for Tinian poses challenges

By Kristi Eaton
Reporter

The search for a new Tinian doctor could take six months to a year, according to Public Health Secretary Joseph Kevin Villagomez Thursday.

Villagomez met with several Tinian officials Wednesday to discuss the search for a new doctor after Dr. Ronaldo Toldeo unexpectedly resigned last week from the Tinian Health Center, Tinian's only source of medical care.

Alex Gorman, DPH legal counsel, said the Tinian Health Center is only required to have a medical doctor present 30 percent of the time. A nurse practitioner and physician's assistant are currently working at the facility.

“I want to be optimistic and hopefully within a matter of two to three months [there will be a replacement], but we need to also be realistic and recognize that it could be six months to a year,” Villagomez said.

There are extra obstacles in finding a doctor for Tinian, he said.

“You know it's very difficult to hire a physician for a community like Tinian because of its remoteness,” he said.

Even hiring for a place like Saipan can be difficult, Villagomez said.

“We have a hard time here and we have the population; can you imagine in a lesser populated area?” he said. “It's just more of a challenge.”

Most physicians are used to working and discussing cases with other doctors, something that is not as easy on Tinian, Villagomez added.

“They have to actually pick up the phone and call here,” he said. “Most [doctors] do not work independently by themselves and for Tinian you need to be able to do that.”

The Commonwealth Health Center is using several approaches to deal with and combat the problem, Villagomez said.

Immediately, CHC is keeping constant communication open between the Tinian facility to discuss cases or answer any questions the nurse practitioner or physician's assistant might have.

“They need to have access 24/7 to an emergency room to talk to a physician,” Villagomez said.

A physician from Saipan is regularly sent to Tinian to review charts, countersign prescriptions and perform other tasks, he said.

H. Christina Brown, a family practice doctor from Saipan and former physician at Island Medical Center, traveled to Tinian last weekend to provide care.

The long-term goal, Villagomez said, is to find a permanent replacement.

There are quite a number of locals who read our blog, so I wish to correct a few errors in the above. First of all, I am a Physician Assistant NOT a physician's assistant. Although the mistake may seem trivial, the latter title makes me sound like a person who stands in the room with the MD and helps him/her out. That's not my job. I see patients and then order diagnostic tests, diagnose, treat, and counsel. I also do procedures that are necessary.

Secondly, the regulations for PAs here say that I must have onsite supervision 50% of my time, not 30%. The people of Tinian are being examined, diagnosed, and treated every day by myself and the nurse practitioner. We seek guidance from MDs on Saipan when we need to but we are both well educated and are able to manage the health center for now. Tinian Health Center is still open 24/7 and patients are being seen and treated. Make no mistake about it. The community of Tinian is well cared for. We have not left them without medical care. I would never let that happen.

Terri's Education Continues

I received a phone call yesterday morning from Helen Ewing of AT Still University that I have been accepted into the Doctorate of Health Sciences program. I begin the next step in my education August 25, 2008. I am fortunate that the majority of this program can be done in my very remote location. As I will be working full time, I will work on my doctorate part time and will be complete in 2011. I am very, very excited about this new journey. I have found myself involved in many more areas than just treating patients, and I really felt I needed to pursue a bit more education to better enable me to adequately manage all my different hats.

Can't WAIT!!!!

The local Legislature issues a resolution!

Sixteenth Tinian & Aguiguan Legislative Delegation
Second Senatorial District
P.O. Box 500129
Saipan, MP 96950

Senator Joseph M. Mendiola, Chairman Senator Henry H. San Nicolas, Vice Chairman
Representative Edwin P. Aldan, Floor Leader Senator Jude U. Hofschneider, Legislative Secretary
______________________________________________________________________________________________________
July 14, 2008

Mrs. Terri Clawson
c/o Tinian Health Center Office of the Mayor
P. O. Box 59 Tinian, MP 96952

Dear Mrs. Clawson:

I have the honor to transmit a certified copy of Tinian and Aguiguan Legislative Delegation's Resolution No. 16-03, entitled, “To recognize the contributions made by Mrs. Terri Clawson and to commend her generosity and unselfishness to the community of Tinian,” adopted by the Tinian and Aguiguan Legislative Delegation, Sixteenth Northern Marianas Commonwealth Legislature during its First Day, Second Special Session on July 9, 2008.

Sincerely,

ALICIA DLG. LEON GUERRERO
Delegation Clerk

Enclosure:

TINIAN & AGUIGUAN LEGISLATIVE DELEGATION
Sixteenth Northern Marianas Commonwealth Legislature

SECOND SPECIAL SESSION, 2008
Tinian & Aguiguan Legislative Delegation Resolution No.16-03
Introduced by Representative Edwin P. Aldan, Senators Jude U. Hofschneider, Joseph M. Mendiola, and Henry H. San Nicolas
_____________________________________________________________________________________
A TINIAN & AGUIGUAN LEGISLATIVE DELEGATION RESOLUTION

To recognize the contributions made by Mrs. Terri Clawson and to commend her generosity and unselfishness to the community of Tinian.

WHEREAS, Mrs. Terri Clawson was born on October 13, 1954, in Steubenville, Ohio and is happily married to Mr. Kevan Clawson; and

WHEREAS, through their union, Mr. Kevan and Mrs. Terri Clawson are blessed with five wonderful children; and

WHEREAS, Mrs. Terri Clawson holds a Bachelor of Science Degree in Microbiology from
Brigham Young University, Provo, Utah and recently earned her Masters Degree as a Physician Assistant from Quinnipiac University, Hamden, Connecticut in August, 2007; and

WHEREAS, throughout her career, Mrs. Terri Clawson has worked in various medical care related positions including as a Medical Assistant for several doctors, a Medical transcriptionist, a teacher teaching Medical Assisting at Utah Technical College, and as a consultant to doctors and medical offices for office efficiency; and

WHEREAS, currently, Mrs. Terri Clawson is employed by the Tinian Health Center as Physician's Assistant where her expertise and dedication are well appreciated by the residents of Tinian; and

WHEREAS, because of her dedication and unselfishness, Mrs. Terri Clawson has also given her spare time and money for the betterment of the Tinian Health Center; and

WHEREAS, donations given by Mrs. Terri Clawson include the acquisition of a 14,850 Piccolo Xpress state-of-the-art blood chemistry analyzer, renovation of the Patient Holding Room 1 amounting to $3,000.00, and the payment of labor costs for the repainting of interior of the Tinian Health Center; and

WHEREAS, Mrs. Terri Clawson also provides assistance during her spare time to the Tinian community; and

WHEREAS, the Tinian Legislative Delegation finds it fitting to recognize the contributions made by Mrs. Terri Clawson and commends her generosity and unselfishness to the community of Tinian; now, therefore,

BE IT RESOLVED by the Tinian and Aguiguan Legislative Delegation of the Sixteenth Northern Marianas Commonwealth Legislature, that the Delegation hereby recognizes the contributions made by Mrs. Terri Clawson and commends her generosity and unselfishness to the community of Tinian; and

BE IT FURTHER RESOLVED that the Chairman of the Tinian and Aguiguan Legislative Delegation shall certify, and the Delegation Legislative Secretary shall attest to the adoption of this resolution and thereafter the Delegation Clerk shall transmit certified copies to Mrs. Terri Clawson; to the Honorable Jose P. San Nicolas, Mayor of Tinian and Aguiguan; and to the Honorable Benigno R. Fitial, Governor of the Commonwealth of the Northern Mariana Islands.

Adopted by the Tinian and Aguiguan Legislative Delegation during its First Day,
Second Special Session 2008 held on 9th day of July, 2008, on the island of Saipan,
Commonwealth of the Northern Mariana Islands.

CERTIFIED BY: ATTESTED TO BY:

Senator Joseph M. Mendiola Senator Jude U. Hofschneider
Chairman Legislative Secretary

Mormon Youth revised

I forgot to put down the names of the Mormon youth from Saipan that invaded Tinian:

Nathan Benson, Limson Souelian, Jessica Liu, Bill-gae Puruvseren, Tikla Brown, Carrie Espinoza, Elizabeth Liu, Jenny Villegas, Richard Que, Jari Voultilainen, Chantea Voultilainen.

Book convention and stuff...and more stuff

Here is the banner that will be in our booth at the LDS book convention in Utah. I will be traveling to Utah the first week in August for this convention.

Here is a sample of the post cards we are making to sell on Tinian and Saipan, created from pictures taken by my daughter Liz when she visited Tinian in January.

The workers installing the brickwork along the median on Broadway are amazing! Look at the small pieces they are cutting to fill-in the gaps!

One of the sad things about Tinian is the number of homes that have been abandoned. Either they were destroyed in one of the Typhoons that frequently hit the island, or were never finished by the owner due to lack of funds.
The jungle seems to quickly take-over these abandoned buildings

Which brings up a concern I always have living here: what happens to those living in metal-sided homes, and homes with metal roofs, when the Typhoons hit? It would be like riding out a tornado in a trailer! Most new homes are all made of solid concrete to be able to withstand the extreme weather.

We will all need one of these when the next 'big one' hits the island! There have already been two big typhoons that formed just west of us and hit the mainland northwest of the islands (China and Japan).

this is one of my favorite homes on the island. I love the color and style, and it even has a little 'guest' bungalow in the back!

You can see why I like to walk around Tinian! The pictures never to them justice...

People are always finding creative ways to show off their flowers

Another large cactus on a tropical island... it is the twilight zone...

News and more news...

The missing scooter has been found! It was found somewhere up in Marpo Heights, in good condition, and even with gas still in the tank! The police have it now, but will give it back to us once they are through 'processing' it.

The clinic is in turmoil as the resident doctor has decided not to renew his contract. Both Terri (a Physician Assistant) and Arly Long (a Nurse Practitioner) can only work while under the supervision of a medical doctor. It is now up to the 'powers that be' to find a solution to the problem (otherwise the island will be without medical care). This could be giving them permission to treat patients by using a doctor on Saipan--it is very common to use doctors via phone when in remote areas--or by providing a new doctor. Since it is very hard to make a new doctor suddenly appear (even Saipan is having difficulty keeping doctors), I am sure they will have to work out some type of remote supervision. In any case, there are a lot of people running around trying to keep the clinic up and running.

Here is a copy of the article that appeared in today's paper:

Saipan Tribune
Tuesday, July 29, 2008

Tinian loses full-time doctor
By Kristi Eaton

With the recent resignation of Dr. Ronaldo Toledo, Tinian Health Center will only have a medical doctor on weekends until a replacement is hired full time.

Toledo resigned unexpectedly last week, leaving the facility without a full-time doctor, said Alexander Gorman, Department of Public Health legal counsel.

The facility is only required to have a medical doctor 30 percent of the time. A nurse practitioner and physician's assistant are working full time at the Center.

“At this point, [the Center] is meeting legal requirements,” Gorman said.

The Center is trying to fill the position immediately, he said.

Gorman said the lack of a full-time doctor would not change patient care.

“Any major problems are shipped [to Saipan],” he added.

Gorman said doctors from Saipan would continue to go to Tinian Friday through Sunday until a replacement is found.

H. Christine Brown, a family practice doctor from Saipan, traveled to Tinian over the weekend to provide care.

Gorman said he is unsure if Brown, who was a doctor at Island Medical Center at one time, will return this weekend or if another doctor will travel to the island.

Gardens of Tinian

One of the pleasures of walking around the village on Tinian is to view the variety of gardens that the locals have created around their homes. Many of the plants are completely new to me and make walking a true wonderland:


Many people surround their property with tree stumps that are used to plant flowers in--kind of a 'flower fence'
There are still a number of empty lots around the village, just waiting for someone to build a new home on.

Just another 'lawn mower' working hard at keeping the grass mowed!

Here is another new palm tree I had never seen before.

Roshi's was a popular clothing store when we arrived about a year ago. Just one more sign of the times in the CNMI...

Laundry is an expensive chore on the island, now that the electricity costs have doubled or tripled, so many have gone back to 'air drying' clothes... takes me back to my childhood when I used to help my mother take clothes off the line in the back of our little white house in Utah.

I discovered a wonderful little park tucked away at the end of a dead-end road. Like many projects on the islands, the upkeep is often too expensive to continue..



Many buildings continue to sit uncompleted-- waiting for better times perhaps...

Looking for a lost scooter?!

Over the weekend someone borrowed one of our scooters... It can't be stolen, because on an island this small, there is nowhere to hide... so it was simply borrowed! After all, the key was left in the bike, an obvious sign that it was a 'community' scooter!

We are hoping that whoever borrowed it will bring it back when they are done!

Mormon Youth invade Tinian!

Terri and I had the pleasure of having a large group of young men and women from the Mormon church on Saipan come to the island of Tinian for a few days. There were eleven in total (seven girls and four boys) that descended on the island on Friday afternoon. Most came by ferry, but two (the married couple that was chaperoning the group) came by plane.

Terri and I helped them get settled in the Fleming Hotel, and ended up having dinner at the Fleming Restaurant as a group.

The next morning they came over to the LoriLynne where we have our little studio apartment to eat breakfast. We used our kitchen and the 'communal' kitchen to cook pancakes, eggs, bacon, etc.

After breakfast, we were scheduled to go on a hike. However, the weather was rather wet, so we decided to ride part way up Marpo hill, and then walk the rest of the way up to the Shinto shrine located there. We traveled up the hill stuffed in a car, and using all four of our scooters! As soon as we arrived where we would begin our short walk, it started to rain. Everyone but me had come prepared-- they were going swimming afterwards, so they had shorts or swim suits on! I just got wet...

Here is the group in front of the Shinto Shrine.



After reaching our goal, the group heads back down the mountain to go swimming at Taga beach.

They stuffed so many people in their car, they were coming out the sides!

They even had to double-up on our scooters! After the hike, old man that I am, I went back to shower and rest while the rest of the group went swimming, and whatever other things young people do these days...

Sunday morning they came back to our little apartment for breakfast, and to hold Sacrament meeting together.

They had asked Terri and I to give a short talk after the sacrament service, which we were happy to do. Terri talked about how she and I ended up coming to Tinian-- a result of the providence of God, blessings that came, in our opinion, as a result of our faith and faithfulness over the years.

There is an important principle that Joseph Smith taught, as revealed to him in the Doctrine and Covenants: every blessing we recieve is a result of a specific commandment we obey. This is how it reads:

There is a law irrevocably decreed in heaven before the foundation of the world, upon which all blessings are predictated--and when we obtain any blessings from God, it is by obedience to that law upon which it is predicated (D&C 130:20-21)

Terri has always wanted to expand her medical knowledge, and to work in a small clinic, in a secluded area, where she could get to know the people she was serving. Just as Abraham and Sarah were never too old to have children (God found a way), Terri was not too old to have her dream come true (God found a way). Even though many colleges turned Terri down due to her age (yes, this really happened), but doors were opened, and she received her Masters Degree as a Physician Assistant.

We then had to choose where in the world we would travel so Terri could work (I could go anywhere, as I would be writing). More inspiration came, and the rest is history: we are living out our dream on Tinian island.

The principle we shared with these young men and women is very simple: if you keep the commandments of God, and do your best to faithfully serve Him, God will bless you. Sometimes those blessings may be delayed longer than you might like them to be (in Terri's case, they were delayed thirty years), but they will come--and the waiting just makes the blessings all the more precious.

Anyway, it was a great weekend. Besides, having a house full of people singing hymns, instead of just the three of us (Terri, me and Ramon), was a wonderful experience. We hope they will return again. The only dissappointing thing was that the group was supposed to be larger--a group from Guam was going to join us also, but for some reason they could not come. Perhaps next time!

A trip to Saipan

Terri had to go to Saipan for some meetings, so I tagged along. Our flight there was a new experience for us...an even smaller plane than any we had flown before! It was a four seater with the wing on top of the plane rather than under.

As usual, the small planes fly slow enough, and low enough, to get a great look at the islands. It is always amazing how a 'bird's-eye-view' gives one such a different perspective on the world one lives in! While on the ground, with the jungle massed around you, everything seems so secluded, and separate, and isolated. But once you are in the air, the isolation disappears, and you can see how close everything really is to each other.
Here is a view of Runway Able and the bomb pits at the north end of the island.
Here is the north point of the island of Tinian

Once we were on Saipan, one of the errands we ran was to the Youth Correctional Center to give some books to one of Terri's patients who happened to be 'stationed' there for the summer...

Here is Terri heading in to get cleared to visit. I stayed outside and read a book... I've had the privilege of being in prison before (don't jump to conclusions!) and never relish the idea of putting myself behind iron doors.

Here is a view of Saipan as we headed back to Tinian with a patient in tow. Another of our 'errands' while in Saipan was to pick up a patient who had gone to Saipan for treatment, and be with him for his trip back to Tinian.

Here is another view of the north fields on Tinian from the air

The West coast of Tinian

A view of the work being done at the airport-- another runway is being built to help with the growing air traffic on the island. Right now we have one runway for landing, take-off, and for plane taxi to the terminal. When more than one plane is trying to land or take-off, it gets rather crowded. By making another runway, even just for plane taxi, it leaves the runway open for what it's best for: landing and take-offs.

Here Terri and her patient arrive safely on Tinian. As you can see by Terri's expression, flying is always fun! It is one of the best parts of living on a small island.


On a recent walk around the village I came across more 'bus stops'. I always find these amusing. I have never seen anyone use them, but they are all over the island-- perhaps emergency shelters for the frequent rain?

Here is a little 'patch of heaven' someone has been working on in their yard. A small shelter, and lots of plants and flowers.

The flowers are slowly being placed along the edge of the property to surround them with beauty
They have used the coconuts in an unusual way to decorate one of their trees

This weekend we will be having a lot of visitors on Tinian. A youth group from our church on Saipan is coming to Tinian for a couple of days to experience the beaches. I'm sure our four scooters will be put to good use by them.

It's nice to be back!

One of our favorite places to eat is the Broadway Restaurant in the Dynasty Casino. Of course, we may be a bit prejudiced, as our good friend Ramon is a chef there! We don't go very often, as it is an 'all you can eat' buffet, so we only go on special occasions.

It is still humorous to me that there are cactus on the island!

The flowers in front of the local Catholic church always enhance the view of the Savior.

There are many old buildings on the island. I always try to picture what it would have looked like 'in its prime'. There was a great deal of beautiful architecture that had once graced the island.

While some buildings continue to crumble into oblivion, others are being built to take their place! Here is another construction project that is just beginning, across the street from the amphitheater being built.

Work on the new amphitheater continues to progress.

Soon the roof will be ready for the concrete to be poured.

Here is how the other areas are progressing...

There is a lot going on at the Medical clinic that is impacting Terri's work. Dr. Toledo, after having experienced some medical problems, has decided not to renew his contract. This means that Terri and Arly Long will, for at least a few months, have to manage all the medical problems by themselves-- including the 24 hour on-call. There may also be some of the nurses leaving to work in Saipan. Add to this the fact that the clinic has been trying to become a federally qualified location (so that they can receive federal funding), which, as you can imagine, is a bureaucratic nightmare, and it makes for quite a lot of issues to deal with.

But Terri always comes through with her knowledge and professionalism. We will be going to Saipan this week so Terri can meet with the 'powers that be' to discuss all of the stuff going on, and also new legislation that will effect PA's.

Terri has the best way to cut through all the confusion and chaos: focus on the patients! She knows that as long as she is faithfully treating her patients, everything else is just window dressing...