Medical diplomacy in the freely associated states: What the US can learn from Taiwan
Majuro— As the new Compacts of Free Association become reality, the U.S. government should look into how Taiwan uses medical diplomacy to help Pacific island nations by implementing effective and efficient, well-planned healthcare strategies.
During the Covid-19 pandemic, the U.S. provided this region with much-needed medical support and services. As the secretary of health during that entire period, I can say without equivocation that the U.S. was absolutely at the top of its medical diplomacy game.
When the pandemic news first broke, the Marshall Islands was already fighting the worst dengue outbreak we had ever encountered. That outbreak, which began in August 2019, lasted for over a year and rolled right into the early phase of Covid-19. We were the first country in the world to close our borders, yet we were overwhelmed with fear given our limited resources. We had only four ventilators. So, we pleaded for international help.
Several countries came through on one level or another, along with organizations such as the Pacific Islands Health Officers Association and World Health Organization. But no country could match the U.S. The U.S. made sure affiliated countries in the region were given the ability to test locally for Covid-19 early on in the pandemic.
Then came the Covid vaccines from the U.S. In the Marshall Islands, we rolled out the vaccines in December 2020. Anyone could walk in and get vaccinated in about 10 minutes. Covid-19 vaccination rates in the freely associated states are still some of the highest in the world.
Throughout the pandemic, the Centers for Disease Control and Prevention held weekly Zoom calls for health officials in the U.S.-affiliated Pacific islands. The 90-minute sessions included experts and bureaucrats from U.S. government agencies who provided the FAS with the scientific information we needed to fight the breakouts before they occurred.
The FAS became among the very last countries in the world to get a community outbreak of Covid-19 in the late summer of 2022. The U.S. made sure we had therapeutics such as PaxLovid to combat the disease. The U.S. sent in experts from the CDC and Administration for Strategic Preparedness and Response so they could have boots on the ground.
The U.S. must build on these pandemic successes to expand medical diplomacy in the FAS.
The U.S. is already funding routine childhood vaccinations, and a large portion of our annual budget for the Ministry of Health comes to us via the compact and other federal grants. But this assistance must expand beyond financial aid. We need more medical expertise and support for our facilities.
The wheel does not need to be reinvented. Taiwan has created a near-perfect system for the U.S. to study. Taiwan provides medical training for our young people to become doctors and offers programs for our nurses to further their education. Since the inception of this program, we have read the Hippocratic Oath to 11 newly certified Marshallese doctors. These talented young islanders have proved to be extremely valuable to our medical system, which in the past had been dominated by foreigners.
With the certification of local doctors, we have created a great learning environment for our young, Taiwan-educated doctors because we now have a more balanced combination of foreigners and locals. No program like this exists for our young people in the U.S. who might want to become U.S.-certified doctors. They are left to struggle to apply and get into highly competitive and expensive medical schools.
As part of its mission, Taiwan rotates in numerous medical specialists within a year. Our local patients crowd in to see them when they are on island. They offer services such as diabetes screening in the community, wound care, health screening for school children including parasite screening, continuing education such as paramedical training courses and seminars for our medical professionals covering a wide range of useful topics.
During the 2019 academic year, Taipei Medical University-Shuang Ho Hospital dispatched 16 clinical teaching physicians, each stayed one month at the Majuro Hospital. They sponsored NCD clinics and conferences. They provided EENT specialists and pulmonology, neurology, cardiology, otolaryngology, and dermatology services.
Taiwan funded vaccine storage facilities, a gastroenterology unit and training for our doctors in these procedures. Now a desperately needed state-of-the-art oxygen generation system has been shipped and is on the way to the Marshall Islands.
The “Taiwan Medical Center,” located within our main hospital on Majuro, always has an extremely helpful liaison, usually a trained nurse from Taiwan, to coordinate the medical programs they have instituted for our country.
Throughout the pandemic, Taiwan also provided us with funding for portable labs for Majuro and Ebeye and funding for Covid-specific ICU units, and other much-needed Covid-19 supplies and equipment. In the last six years, Taiwan has been helping us upgrade our Health Information Systems, allowing us to move away from paper medical records and go digital so our medical professionals can have quick access to their patients’ information.
We also have had great partnerships with Australia, New Zealand, Japan and other countries that provide funding for internal vaccination missions and medical supplies, such as masks and gowns. Japan provided our health ministry with a beautiful medical ship that now services our neighboring islands.
Not to be outdone, China is sending a 14,300MT medical ship, the Peace Ark, that will make port calls in Kiribati, Tonga, Vanuatu, the Solomon Islands and East Timor to provide medical assistance to Chinese citizens and the islanders. But this is a temporary fix. Taiwan helps us address our issues with permanent fixes, especially in the realm of training our young citizens to be medical professionals and consistent medical missions.
The U.S. has the resources and the capability to improve its medical footprint in this region and get better and more visible bang for their buck.
We need more specialists, such as oncologists, rotating in on a scheduled basis. We also need help with our facilities’ upgrades. Some of us in the FAS are now languishing in decades-old hospitals. While there have been pledges to get construction projects off the ground, we are still waiting.
To increase its visibility to the region’s populations, the U.S. needs to study the excellent Taiwan model of medical diplomacy and then act on it in a serious, timely, methodical and responsible manner.
Jack Niedenthal is the former Secretary of Health & Human Services for the Marshall Islands, where he has lived and worked for 42 years. Niedenthal is the author of “For the Good of Mankind, An Oral History of the People of Bikini.” He is the president of Microwave Films, which has produced six award-winning feature films in the Marshallese language. Send feedback to email@example.com