Association of the US Affiliated Pacific Island Laboratories (AUL) AUL Accomplishment Kasian Otoko 4 th PIHOA/Lab Net Meeting Guam Marriot August 31 st, 2013

3 RD PIHOA/LAB NET MEETING-MARCH 2011 oEstablish AUL By-Laws oAUL adopt the WHO Pacific Regional Lab Guidelines (once formalized) oImplement LQMS is strengthen compliance or adhere to guidelines (Procuring & Inventory, Documents & Records and Equipment) oCore essential lab tests to be available all the time to support NCD-related activities in own jurisdiction including Urinalysis, Lipid profile, EUC, Glucose, CBC & Pre-transfusion testing)

3 RD PIHOA/LAB NET MEETING – MARCH 2011 oBuild local capacities to address issues concerning diseases (Influenza, HBsAg, HIV, Syphilis, HCV & blood culture) oThe Diploma in Medical Laboratory Science by the PPTC will be the minimum qualifications for Lab Technicians in the USAPI.. New hires to enroll within 6 months & must complete diploma within 2 years of employment. Lab Techs on the workforce to be encouraged..not compulsory oEstablish lab-based surveillance of at least 2-3 common NCDs in the USAPI to lay the ground works, planning, implementation and monitoring effectiveness of our efforts (HbA1c, Lipid panel, PAP Smear)

3 RD PIHOA/LAB NET MEETING MARCH 2011 oIdentified funding sources (WHO fellowship, AUSAID, JICA) to support lab techs in attending laboratory training courses, i.e. PPTC onsite training, attachment courses at FNU, etc. oNeed commitment & total support from the Ministry of Health, Hospital Directors/Administrators to implement a Quality System in the lab. oDesignate one Lab staff as QA Officer to adopt QA/QI program to assure new standards are met

3 RD PIHOA/LAB NET MEETING MARCH 2011 o To address the issue concerning PAP screening in the USAPI. Consider contracting reference lab to do PAP screening. Cost benefit analysis with in-house testing versus referral lab testing. One out of ten jurisdictions performs PAP in-house o Still need to send all positives to reference laboratory. If lab should do in-house PAP screening o Must consider Internal Quality Controls o Must maintain satisfactory performance in external proficiency testing o Must consider the number of tests to maintain proficiency o Shipping cytology stains via ocean freight

AUL CONTACT / LISTSERV oList serve address was created for the USAPI Lab Managers: o Address was created: oSign into PIHOA services at

LAB OPEN DAY EVENTS O The year long series of events was designed to create awareness and promote the medical laboratory science profession amongst High School students. O The impact was remarkable because the general public, communities including state leaders & policy makers were also informed and educated about the importance of a Medical Laboratory Technician’s role in the health care system. oThey recognize the need & importance of a qualified laboratory workforce in the USAPI. oHopefully this type of awareness will translate into legislation & financial support for the laboratory.

LAB OPEN DAY EVENTS O Expected outcome is to increase the number of high school students from each jurisdictions enroll & successfully complete the medical lab science program at any of the institutions supported by AUSAID Scholarship or WHO fellowship in the near future.

SUCCESSFUL LAB OPEN DAY EVENTS O Ebeye, RMIApril 17 th, 2012 o PalauApril 27 th, 2012 o Kosrae, FSMMay 4 th, 2012 o Chuuk, FSMAugust 18 th, 2012 o Yap, FSMSeptember 27 th, 2012 o Pohnpei, FSMOctober 18 th, 2012 o American SamoaOctober 27 th, 2012 o GuamNovember 30 th, 2012 o FSM-wideDecember 6 th, 2012 o USAPI-wideFebruary 8 th, 2012

AWARDED DIPLOMA IN MEDICAL LABORATORY SCIENCE SINCE 2009 o 2009 to present – seventeen (17) lab technicians in the USAPI countries have been awarded the diploma in medical lab technology program o 28 participants accepted in the 2013 cycle.. 7 are WHO sponsored for the full course (1 Majuro, 4 A. Samoa, 2 Pohnpei). 21 are PPTC sponsored for the 1 st course only (Medical Laboratory Technology) – 7 Majuro, 13 A. Samoa, 1 Pohnpei. o PPTC Medical Lab Science course has undergone accreditation process by FNU but they have yet to formalize everything.

USAPI MINIMUM REQUIRED NCD LAB TESTS – NOT YET FINALIZED o Test list is based on the top 4 NCDs & major causes of deaths in the USAPI (Diabetes, CVD, CRD & Cancer) o Diabetes. Blood glucose. HbAic. Urine microalbumin. Urinalysis. BUN/Creatinine. Sodium/Potassium. H&H

USAPI MINIMUM REQUIRED NCD LAB TESTS o Cardiovascular Diseases. CKMB. Troponin I. Lipid Profile (Total Cholesterol, HDL & LDL Cholesterol & Triglyceride) o Chronic Respiratory Diseases. Gram Stain. Culture & antibiotic susceptibility testing o Cancer. PAP smear. Occult blood. PSA/AFP. LFT

USAPI MINIMUM REQUIRED NCD LAB TESTS o Most labs have done their minimum NCD lab tests inventory except for 3 labs (LBJ, Tafuna Health Center & CNMI lab) o We have to consider other Associations’ needs of lab tests to support their own NCD – related objectives. o July 18 th, 2013 – PBHCC suggested the DOA 5 – Test Panel to provide lab-based statistics to show the prevalence of use of abusive drugs in the region, ethanol level and LFT as an indication of alcohol abuse.

CDC/APHL/PIHOA PROJECT RE: INFECTIOUS DISEASE CONTROL IN USAPI o 1 st part completed involving a short assessment survey about our Lab Quality Management System. o 2 nd part in progress – web-based inventory of infectious diseases testing capacity, infrastructure and personnel information.

THE CURRENT AUL MEMBERS ARE oAmerican Samoa. Tafuna Health Center Laboratory. LBJ Tropical Medical Center Laboratory oCommonwealth of Northern Mariana Islands. Commonwealth Health Center Laboratory oFederated States of Micronesia. Chuuk State Hospital Laboratory. Pohnpei State Hospital Laboratory. Kosrae State Hospital Laboratory. Yap State Hospital Laboratory oGuam. Guam Public Health Laboratory oPalau. Belau National Hospital Laboratory oRepublic of the Marshall Islands. Majuro Hospital Laboratory. Ebeye Medical Health Center Laboratory

THE AUL CURRENT FOCUS/GOAL FOR THIS YEAR - Ensure continuous development of the USAPI Medical Laboratory workforce. Set timeline for lab techs already on board to enroll and complete the PPTC Diploma in Medical Lab Science course.Mandate all Lab techs to enroll and complete the two courses offer in 2014 (Phlebotomy, Health, Safety & Infectious Diseases). Identify potential candidates for the 4-years program in Medical Lab Science and assist their enrollment (seek PIHOA Assistance)

AUL wishes to formally seek endorsement by the PIHOA Board of Directors in regards to the following AUL recommendations: 1.PPTC Diploma Medical Laboratory Program as the minimum qualifications for the Non-Regulated USAPI Laboratories. 2.Minimum Required NCD Laboratory tests to be made available in each USAPI labs at all times. 3.Association of the USAPI laboratories formal status as a PIHOA Affiliate members. I want to thank PIHOA for the on going Advisory and technical supports over the past years. AUL would not have come this far without your support.

THANK YOU!!