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FSM national government steps in to address Yap's health care crisis

State doctors, nurses facing probe over strike threat

By Joyce McClure

Federated States of Micronesia President David Panuelo declared an emergency on April 5 in response to the mass resignation of doctors and nurses at Yap State Hospital.

Panuelo directed the FSM National Task Force to assist Yap in “emergency hiring of medical personnel” and explore the possibility of bringing back the doctors and nurses “for as long as the Covid-19 persists.”

Jesse Salalu

Thirty-nine doctors and nurses (not 40 as previously reported) resigned from the state hospital last week after their attempts to negotiate with state leaders were rejected.

The president issued the new emergency directive while the FSM remains under a coronavirus-related public health emergency status until May 31. Yap Gov. Jesse Salalu issued an emergency declaration following the mass resignation last week.

Panuelo authorized the secretary of Justice to assist Yap in investigating the medical staff’s actions— including their threat “to go on an infinite strike”— and to take appropriate legal actions.

Dominic Taruwemai

The health care professionals sent a letter on March 23 to Salalu and Speaker Vincent Figir, according to Dominic Taruwemai, acting director of the Department of Health Services.

The letter was signed by 47 health care workers requesting a meeting to discuss current Yap hospital medical staff benefits and salaries.

“It has been some years since there was a discussion about adequate employee benefits and fair wages for the hospital staff,” reads the letter written on Yap Medical Association letterhead.

Health care workers in Yap, who receive the lowest salaries in FSM, sought to negotiate a benefits package and pay raises. “We hope that we can come to an agreement that is fair and equitable for all parties concerned."

Dr. James Yaingelou, a member of the group, said “chronically low compensation” and its impact on attracting qualified professionals to fill open positions is the top issue for the group. His base salary is $26,000.

The DHS has struggled to fill open positions for many years and the pandemic made matters worse when other states in FSM and islands throughout the region were offering higher compensation.

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The letter ended by stating, “We aim for a speedy resolution but in the event of an impasse, the collective decision of nurses, doctors and other allied healthcare workers under your employment, is to go on an infinite strike that will commence at 7:30 a.m., March 26, 2022.


“We solemnly believe that a strike should only be done as a last resort in the event of a breakdown in negotiations for the sake of all of our people, so our fervent hope is to have an amicable solution before then.”

The intention for including it in the letter, according to Yaingelou, was only “to get their attention.”

The Yap State Constitution prohibits public employees from striking “for the purpose of collective bargaining.”

Salalu convened his cabinet on March 25. They agreed that the strike threat “violates state laws of both PSS [Public Service System] and PSS-exempted positions.”

However, the constitution also states, “Employees shall have the right to form associations for the purpose of presenting their views to the government and shall be free from restraint or reprisal in exercising this right. The government shall give a reasonable opportunity to representatives of such associations to present their views.”

It also states, “The regulations shall prescribe a system for hearing the views of employees on their working conditions, status, pay and related matters and for hearing and adjudicating grievances of any employee or group of employees. These regulations shall ensure that employees are free from coercion, discrimination, and reprisals and that they may have representatives of their choice.”


Moses Limur, the acting attorney general, Elizabeth Phal, chief of personnel, and Taruwemai were instructed to meet with the group instead “to explain the legal ramification of the letter as it is in violation of state laws and including the consequences of going on strike against the government.”

At a meeting the following Monday, the group’s representatives were informed that Phal had been instructed to begin firing the health care professionals “one by one,” Yaingelou said. “They began threatening us.”

Elizabeth Pahl

Yaingelou advised the doctors and nurses to resign rather than face job termination.

If they were fired, they may not get another job in the state or FSM again. Resignation was the best option in this regard, however, it had to be each individual’s personal decision, he said.

The group sent a second letter to the governor on March 28, reiterating their request for a meeting. The governor determined that the group was “in principle” still in violation of the state laws.

After consulting with his cabinet once more, the governor again deferred the requested meeting “until further notice.”

The Yap State Action Plan notes that the resignations “or strike have left the hospital human resources capacity to less than the bare minimum.”

It adds, “the hospital will only be able to barely provide a less than minimal coverage of 3 shifts within 24 hours for the next few days before it collapses because the same people will be working throughout the 24 hours each day of the week.”


The state’s action plan includes a budget of $241,240 “to recruit a permanent, retired and volunteer health workforce from the FSM states, including Yap State” and reward nurses and doctors “who did not participate in the strike.”

The budget breakdown is $91,740 for the recruitment of 22 workers for 30 days at $139 per diem; $15,000 for the recruitment of retired workers for 30 days; $120,000 for three charter flights; and $14,500 for special awards for 29 nurses and doctors.

On April 4, the group was informed that no one had been fired from their jobs and that the resignations were not being honored. “They said we had seven days to respond before terminations would begin,” said Yaingelou.

The group decided to hold off for a couple more days and see if the governor would meet with them. “They were still threatening us,” Yaingelou added.

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