Pacific Lifeline: Tripler Medics Treat Island Ills

He keeps "before" photos that convey the depth of their misery. From elephantine tumors to ulcerated skin bleeding and oozing to a little boy's open skull, where you can feel his brain thumping up and down, up and down. And he keeps "after" photos that reveal the wonders of modern medicine they could ill afford and wouldn't get otherwise.

Since 1962, when the Articles of Confederation created the American Trust Territories in the Western Pacific, the mostly poor people of the Federated States of Micronesia, Palau, Guam, Marshall Islands, Northern Marianas and American Samoa have been entitled to U.S.-provided medical care. Their governments were supposed to reimburse the United States for care provided, but they, too, mostly are poor.

In 1988, Hawaii Sen. Dan Inouye sponsored a bill to fund treatment of the Pacific Islanders at Tripler. The bill reasoned care not only would represent a major humanitarian outreach to the islanders, but it also would expose interns and residents here to tropical diseases and conditions they wouldn't otherwise see. Such exposure is vital to physicians in training, Person said, because it expands their overall capabilities.

Congress passed Inouye's bill in 1989, allotting $500,000 annually for islanders to travel to and from Tripler. The first patients arrived a year later. More than 2,000 men, women and children have come here since, often for major repairs to their damaged bodies.

"The care was all provided gratis," Person said of the early years of the Pacific Island Health Care Project. "For 300 to 500 patients a year, Tripler spent between $6 million and $10 million. Obviously, we couldn't sustain those costs for long."

Inouye once again helped out, convincing Congress to authorize millions in annual funding to help defray the medical care costs. The fiscal 1997 allocation of $5 million doubles the fiscal 1996 amount. The extra bucks enabled Tripler to care for nearly 200 patients in the first five months of fiscal 1997 and, Person predicted, at least 400 by year's end.

Treatment often includes surgery and covers a host of tropical maladies. For example, rheumatic fever and rheumatic heart disease run rampant in the Pacific, Person said. "Many women in their childbearing years contract the fever. They get pregnant, then develop heart disease, and many of them end up here."

Other diseases Tripler doctors see include tuberculosis, which is widespread, and malignancies of the bowel, thyroid and other organs. Urologists treat large numbers of islanders for kidney stones, also rampant in the Pacific. Many little boys suffer from a condition where the urethra doesn't fuse and their urine just spills out. Genital tract cancer, too, is prevalent.

Orthopedic surgeons operate on islanders with bone infections, while neurosurgeons treat brain abscesses and tumors. Ear, nose and throat surgeons treat numerous cases of mastoiditis -- a condition that causes chronic middle ear infection, not seen in the United States for more than 40 years, Person said.

Vascular and cardio-thoracic surgeons replace heart valves and patch holes between the chambers of damaged hearts. And pediatric surgeons see and treat many children, like one little boy whose photo showed his scalp eaten away by tuberculosis. He's healed now and home again, living a normal life, Person said.

"This project covers a huge area of the world that is medically underserved," Person noted. "Many of these people live in abject poverty, and their governments are also too poor to help them. We may provide the only critical care they'll be exposed to their entire lives."

Tripler commander, Dr. (Brig. Gen.) Warren Todd, champions the Pacific Island Health Care Project for its humanitarian aspects and the training it provides. "Tripler is the national training center for Army medicine," Todd said. "We're in our wartime role every day we come to work. It's vital we learn about the kinds of diseases American service members deployed in the Pacific Theater may contract.

"The Pacific Island health care program allows us to bring in people who normally would not be eligible for DoD treatment, but they're good teaching cases. I'm an infectious disease doctor, and we've cases here I've never seen."

The care Tripler gives islanders doesn't interfere with its primary beneficiary population, Person assured. "The intent was never to have anyone refused or given second-rate care because of this program. If anything, it's enhanced our overall health care. It just makes everybody involved more experienced and more able to cope with our beneficiaries' sicknesses.

"We just try to be good stewards of our resources and provide the best care for all the patients we see."

To this end, Person and the physicians from the various island states he works with have a new weapon in their health care arsenal, telemedicine. Using electronic mail, island medics consult with the Tripler staff, describing patients' conditions, even sending scanned photographs over the Internet.

Holding a photograph of a Micronesian baby with a vascular tumor that has grotesquely twisted the infant's mouth and cheek,Person marveled at the time such link-ups save.

"We got this photo and the physician's description and said, 'Yeah, we can treat this. Within 24 hours we had the baby coming here and getting treatment," he said.

Telemedicine will allow more follow-up, as well, the physician said. "Rather than bringing patients back, we can link up with their health clinics back home, see pictures of them, talk to them and their local physician, and see how they're doing. This really makes a difference in our ability to provide the islanders quality health care."

Whether they see their patients live or over the Internet, Tripler residents gain valuable experience treating rare, tropical diseases, and Pacific islanders live healthier lives.