The Republic of Palau and the Pacific Island Health Care Project (PIHCP).

Physicians from the Republic of Palau have participated in the Pacific Island Health Care Project (PIHCP) sponsored by Tripler Army Medical Center (TAMC) since the projects inception in 1990. The PIHCP was developed to provide exceptional graduate medical educational (GME) benefit to physicians-in-training at TAMC while at the same time to supply the medically underserved indigenous peoples of the United States Associated Pacific Islands (USAPIs) with advanced medical and surgical care. Coordination and management of patient referrals utilizing standard means (telephone, fax, letter) had become virtually impossible. A patient referral submitted via the Internet in December 1997 to the PIHCP from Palau was the stimulus needed to develop a telemedicine solution to the whole referral process. With the technical assistance of Project Akamai and the support of the US Congress, I was able to develop a simple, store-and-forward platform for the consultation and referral of patients Palau. Palau, a country of about 20,000 or 4% of the total population of the USAPIs (> 500,000) submitted > 20% of the cases. from the USAPIs to TAMC. Since that time 2500 cases have been submitted to the PIHCP. Of those cases 511 have been from A spectrum patients with of well described, well documented disease conditions has been provided by the physicians from Palau. Many cases have supporting imagery. Both sexes and all ages are well represented. Patients with cancer lead the list of referred patients. For the last several years the PIHCP provided Palauans with nearly $1,000,000 annually in medical care. The long and collegial relationship between the Republic of Palau and TAMC has been rewarding. This relationship has been strengthened by the PICHP.