Generally speaking the number of people served by each clinic is small,
thus the patient load per health assistant is low.
The number of people
served per day at the clinics vary between none to 2-3 per day (unless a
flu epidemic is being fought).
The low numbers of births and deaths per
month further confirm this fact.
homes by house call.
In fact, most care is delivered at
Many clinics have a total population to be served
of less than 200, few attain 500 or more.
The most frequent types of problems seen by the health assistants are
those
problems
common
to
children
and
mothers,
plus
some
chronic
problems of older people (among which diabetes and hypertension are the
most common).
It is not surprising then that health assistants list as
most common symptoms the following: flu (upper respiratory), headache,
stomach,
fever,
diarrhea,
skin
problems,
toothache,
and
diabetic
problems (insulin shots).
Though from the patient loads it would appear there are too many clinics
for number of people served, remoteness, bad weather, lack of transport,
and poor supervision are all commonly a problem making effective access
to health care, even to another island clinic on the same atoll, not
always possible.
Real medical emergencies needing immediate evacuation to a secondary
care facility are uncommon.
in three years.
For some clinics it has been as low as once
Waiting times and
access
in
such cases
has been
extremely variable but usually lengthy and costly, if at all possible.
The frequency of visits by supervisory staff for continuing education,
resupply of medicines,
atoll
to atoll.
and special clinics varies tremendously from
It has been totally dependent on the "field ship"
schedule (see transportation-communication section).
Medical records at clinics vary between none at some, poor to fair at
the majority,
and good at very few.
The forms
are generally too
complicated and the system has broken down due to lack of supervisory
support and encouragement.
Most of the health assistants visited in the survey are middle age to
old.
Most received their training in Majuro from navy corpsmen shortly
after World War II.
Their educational
elementary
Some
school).
of
the
newer
level
is
recruits
low (3-5 years of
have
high
school
education and have been trained in a nine-month health assistant program
18