A modest proposal


Covid-19 has wrought more than its share of havoc on everyone. I don’t bother combing my hair unless I have a video conference, which is what I now call socializing. “Going out” now means “grocery store.”


The events of the past year, not to mention the past two weeks, have led me to avoid the media for the sake of my blood pressure and sanity. But on the whole, my hardship has mostly been annoyances (aside from my current paltry income), so I’m not complaining.


All of which is to say that I have not been on the islands for some time, so the bulk of my observations are based on memory. I can perhaps be accused of losing perspective.


When it comes to making the world a better place, I do not believe in silver bullets. International development, indeed development of all stripes, is littered with the carcasses of grandiose ideas that were supposed to completely solve all problems. I do, however, believe in using something that works, regardless of how incremental the improvement.


On that basis, I present a modest proposal for the improvement of public health and education in the Pacific islands: training select local students to an American standard, or equivalent, for emergency medical technicians or EMTs, people trained in out-of-hospital basic medical care.


I’m not expecting a sudden change to education or the public well-being, but it’s one potential way to address problems with health in general, and roadway safety in particular. Many places, Palau for instance, have recently acquired decent roads, an improvement over pothole studded scars, elevated sewer outlets, and exposed rebar that has killed more than one tire.


Good roads create opportunities for exchange. Good roads also let you drive fast and not pay attention. In a region where drunk driving is already a problem, good roads increase the chances of severe accidents. Potholes have advantages.

“You know he’s drunk if he’s driving in a straight line,” is a common refrain. Funeral homes provided the first mobile medical services in the U.S.; in Chuuk ambulances still pull double duty as hearses.


Europe, North America, Japan and the like have had their own growing pains with roadway safety, and the state police forces of many U.S. states flat-out contain the word “highway,” as in California Highway Patrol.


Public roadways also raise numerous issues of criminal procedure and rights of the accused as enshrined in regional constitutions. For many, in the U.S. and elsewhere, the first taste of the criminal justice system starts at the side of the road. For that matter, the man who was ultimately put to death for the Oklahoma City bombing, one of the worst terrorist attacks in U.S. history, was caught through a routine traffic stop. Micronesia, however, has plenty of lawyers.


Coupled with limited health care capacity and astronomical rates of non-communicable disease, especially hypertension and diabetes, properly trained and equipped technicians can at least provide some help and contribute to better overall health.


EMT training can beget other improvements. Educationally, this training can bridge the gap between theory and practical skills while matching educational objectives with labor market demand.


In other words, students will immediately see anatomy and biochemistry in action and pair education with ability and interest. Don’t call them doctors, EMTs are far from it, but such training can show in real terms that higher levels of expertise will require much more intensive study instead of punting students into a foreign university system that may or may not serve anyone’s needs.

Such initiatives will of course, need proper structure. Governments will need to purchase ambulances suited to local conditions. They will need supplies, medications and personal protective equipment, or PPE, everyone’s new acronym. One key is for governments in question to pay for it themselves, and not recruit outside personnel. Pay a reasonable wage for the area. This will allow jurisdictions to demonstrate both to their own citizens and foreign donors that they’re taking education, economic development, and the health of their own communities seriously.


Lack of education, healthcare and jobs fuels the Micronesian diaspora, after all.

I have no illusions. I have no doubt that a member of the international consultant class will be deemed essential to deliver a training and facilitation seminar complete with a 35-slide Power Point presentation. I can probably write it now. Effective use of Monitoring and Evaluation data to create Best Practices. Convene a task force of at least 15 members that will never manage to get a quorum. Capitalization is deliberate.


I’m sure that ministers of health will need to travel first-class on someone else’s dime to the manufacturer’s factory to personally select the vehicle. Police honor guard and a fire truck water cannon salute when it’s offloaded at the port, of course. But one can hope that leaders will eventually acknowledge that sovereignty is about serving your own people and less about jetting off to international meetings.


Solve every problem? Far from it. But it’s a start, and what we need right now is a fresh start.

Gabriel McCoard is an attorney, who previously worked in Palau and Chuuk State. He is currently weathering the pandemic stateside. Send feedback to gabrieljmccoard@hotmail.com.


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