<3rd issue> (Aug. 19, 2013) / <4th issue> (Jan. 14, 2014)

<3rd issue> Tidings from Around the World (Aug. 19, 2013)



Pohnpei, Micronesia (Hospital)


The Pohnpei State Hospital, where I work, is a single-story concrete building which is 35 years old. There are 90 beds and the departments include General Internal Medicine, Surgery, Pediatrics and Obstetrics. 2,000 people are admitted per month and each department consists of a large room capable of treating 14 patients, and one private room. There are 3,000 out-patients visiting each month. There are neither patient registration cards nor signs to guide patients, but also no complaints from them either. Although the repair work for a leak in the roof, and renovation work including plumbing have been done recently under the aid of the U.S., the facilities are old. There tend to be medicine shortages so generic medicine is purchased from nearby pharmacies. The staff includes 20 doctors (out of 60 in Micronesia) and 60 nurses, and altogether there are 260 personnel as well as consigned workers. There are no facilities for diseases which require detailed examinations such as a cancer. Therefore these patients go to Guam or the Philippines for check-ups or to receive treatment/operation.


One of the things affecting the hospital management is the fact that there are only a few people who are enrolled in medical insurance and so many people are not able to pay for medical fees. The government sets numerical targets for many details such as encouraging people to join medical insurance programs, shortening the length of hospital stays, and keeping 80% stock of frequently used drugs etc., but there is a huge gap with the current status of the hospital.


My position is hospital QA (Quality Assurance Service) and my job is the business of hospital improvement. I visit 40 sections with my counterpart quarterly to investigate, evaluate and publish the actual conditions. In addition, there is a set of standard activities including investigation of medical accidents and checking maintenance conditions of the manuals. My assignments are not only at the state hospital but also spread to the pharmacies and health centers which belong to the health department of the state. By the way, each state of Micronesia has its own languages. English is the common language and it is already hard for me to keep up with this, but I get totally lost when they start using their language during essential points of the meeting. I write in my journal every day and review the events of the day to be sure that my work is complete.


I send my counterpart daily reports on my supervision of the hospital wards, out-patient clinic and bathrooms, as well as the details that I learn in conversations with the staff with the photos of defective facility parts of the hospital ward, poor food management, cleaning, and failure to save electricity, etc. attached. There are many more items than one can count. I also provide a few suggestions weekly to my chief and counterpart as a result of my work.


The problem is “who” carries out these improvements. I've been thinking about a project which could be young people-centered. Nobody knows how much they could do but as one result, I hope they will realize the problems that their mother country faces. I wish them to be aware that initiatives should be taken by themselves; to work and sweat by themselves to move out from the current tendency to depend on other countries.


I come up with many ideas while I’m walking around the hospital. I divide such ideas to the issues which need immediate attention and the ones which are part of the bigger picture or future priorities so that I do not make myself confused. The word for myself to live by now is “ekis ekis (bit by bit). 


The current problem, which refers Micronesia as a whole, is that the financial supports from the U.S. are going to be decreased and eliminated over the next 10 years. The economic reconstruction is the pressing issue, and the situation is that all kinds of budgets are reviewed and reduced. Additional problems such as a shortfall in human resources, difficulty finding successors and lacking of leadership provision or less willingness to challenge/improve are seen. I hope they consider it as a saying “Tough times bring opportunity” and become the independent country in real meaning.


It’s going to be a long-term commitment to deal with the problems all over the hospital and to improve the system, especially which has been well-established in the past 35 years. I don’t want to urge conclusions but to value the process to work and make efforts together with the people with mutual awareness of the issues. Their interests to Japanese people and good quality products from Japan are very high and I have confidence that my efforts are valued and respected.


I’m trying my best and hoping to be able to assist them to find the successful ways to take.


August 2013,

Tetsuo Ohfuji, JICA Senior Volunteer 








<4th issue> Tidings from Around the World (Jan. 14, 2014)



The 1st 5S seminar


Happy New Year to all. At the beginning of the year, I, as a former staff of UOEH, wish everyone continued success.


It has been one year since being dispatched to Pohnpei, Federated States of Micronesia (FM) as a JICA senior volunteer. I have one more year to finish my term.


We’ve just had a seminar organized by the 5S committee at Pohnpei state hospital on December. “5S” stands for seiri (organizing), seiton (tidying), seiso (cleaning), seiketsu (cleanliness) and shitsuke (discipline). The 5S committee was established in August 2013 with the aim of improving the environment, management and patient service of the hospital. Before its establishment, our suggestions were delivered individually to the leadership of the hospital but now we make suggestions as a consensus of the committee, which is a great deal of progress. The seminar was held in 2 days according to the committee’s vision.


My presentation was about the imageable countermeasures which will suit this country. Especially because the financial aid from the U.S. (which weighs 60% of the national income) will be eliminated in 10 years, my presentation was focused on the following items: a mid-long term operational plan for the hospital, countermeasures for unpaid expenses as the administrative problems, cost-cut for monthly supplies of drugs, clinical materials and electricity etc., implementing a questionnaire to patients, problems of sharing information. (Don’t you think you have heard these themes somewhere before?)


Including the leadership, the people at the hospital are not so good at planning and/or implementing their plans. It is rare that the meetings begin on time. I like their relaxed/sitting back atmospheres but I truly hope that they take this more seriously when it concerns the future of their own country. It really is the time to face it.


Information is not something to keep but rather something to share. It is better to take action on your own rather than wait for someone else. It is crucial to share the updated information of patients how they feel or what they think. I strongly emphasized this in the seminar.


I’m very happy that the word, “5S”, has become well-known in the hospital recently. I’m hoping to present the conclusions of my two-year activities in the following seminar next year. I’m getting greedy now and I wish to achieve a lot of things during my two-year term, for example, resolving the un-implemented suggestions of mine, holding evacuation drills for the hospital, building a common system among the hospitals in the 4 states of FM and beyond. Hospitals may differ as well as their financial bases and manpower, but the way to approach patients should be the same. I feel the human dignity when I see an obese nurse in her white coat taking care of patients. You may think my narrative often is too serious. The fact that my activities are supported by the Japanese tax payers whips me up and keep me on my feet.


Lastly, my conclusions of the above presentation in the seminar are as follows:




1 To know the current situation by means of disclosed data.

2 To find out the way to solve the problem together.

3 Discussion almost finished. It’s time to take a concerted and corrective action immediately.

4 Who is the person to improve the hospital? Not specific person, it’s you, not any one.

5 There are many issues to solve in the hospital. We must move forward to tackle with them little by little.


Kalahngan (thank you)


Photos: Christmas party and workshop etc. in the hospital  

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Photos: A canoe race held as the runup to the 2nd mini-olympics (which will be held in coming July) with the participants from all over Federated States of Micronesia. The workers of the hospital came to cheer.

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(The team with Mr. Ohfuji's counterpart (in red) won the championship.) 

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Photos: The feast after the race is roast pig.

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