CNMI Rep. Sablan sponsors bill H.R. 1466 which will allow non-residents with children 3 years and over to apply for green cards

Kilili Sablan recently sponsored U.S. house bill H.R. 1466 which if passed will allow non-residents with children aged 3 years and older to apply for green cards on January 1, 2015. While there have not been any reports as to how many non-residents will be affected, the number will certainly run in upwards of 10,000.

Hard lines will have to be drawn eventually dealing with foreign workers. The line that is currently contemplated though H.R. 1466 will exclude workers that have worked in the CNMI for over 7 years on January 1, 2015, but do not have children, or that currently have children less than 3 years old. If a non-resident worker has lived and worked in the CNMI for 20 years and currently has a 2 year old child, they would be forced to leave at the end of the transition period in 2015.

In addition to the CNMI CW Transitional Worker Visa Regulations, I am sure that H.R. 1466 will be monitored closely by the CNMI Government and non-resident
 workers.

Commonwealth Northern Marianas (CNMI) Home Health Blog: Tinian Clinic in News Again

Once again, as a reminder to all patients in the Commonwealth of the Northern Mariana Islands (CNMI), we are available for home health services.

Apparently the Tinian Health Center is in the news again due to issues with blood testing. It is reported that Freedom Air refused to deliver certain blood tests from the Tinian Health Center that were to be sent to CHC Hospital in Saipan due to issues with the Mayor's account. Hopefully this issue can be resolved soon. Non-payments of invoices is a major problem in the CNMI and is plaguing the CHC medical referral patients as well. It is estimated the that CNMI is behind hundreds of thousands of dollars in payments to Travel Agencies for tickets to Guam, Hawaii, and the Philippines for medical treatment.

Saipan Tribune Article

Free Health Education or Music MP3's from Amazon.com

I ran across this great deal today, that requires absolutely no purchase at all. Amazon.com as part of their black friday deals is giving away free $3 MP3 credit by using code GET3MP3S. The free code does not have to be used on health related MP3's, but since it is Diabetes Prevention Month, I have some diabetes related suggestions. *Promotional offer valid for a limited time only and subject to change. Promotional offer is valid from November 22, 2010 12:00 AM PST through November 29, 2010 11:59 PM PST. You must redeem the credit by November 29, 2010 11:59 PM PST.

Nursing Cruise Ship Jobs

I recently received an email about finding cruise jobs in Saipan. There are a few cruise ships that actually do stop in the Port of Saipan. I thought the e-mail was a strange request until I saw that the Saipan Home Health Blog was listed as one of the top 25 cruise ship nursing blogs at Nursense.com (number 4).

As far as working as a nurse on a cruise ship, I don't believe that U.S./Australia/Japan visas are required, so I can imagine that the wages are not as high as working in those respective countries. There are benefits involved with working on a cruise ship including travel, and the new experiences people will encounter. I would suggest reading Cruise Ship Jobs : The Insiders Guide To Finding And Getting Jobs On Cruise Ships Around The World for more information.

As far as working in Saipan in a cruise ship or otherwise for foreign applicants, the U.S. federal government was supposed to have transitional visa regulations in place by March of 2011 that would allow for the hiring of immigrants without H1B or immigrant visas, however they have still not been released. I expect within the next few months that the CNMI-Only Transitional Worker Visa regulations will be released that will allow for hiring from abroad. For U.S. applicants, there may be positions available at many government and private sector employers.

Diabetes month takes on a whole new meaning in Saipan

One of the advantages of home health is that we can take care of not only the immediate concern, but also that we can take steps to address the patients lifestyle and prevent future hospitalizations. Sometimes prescription medication by itself is not enough and the patient may need to add exercise, diet changes, and regular self-monitoring to reduce blood sugar. During the month of November, which is Nationwide Diabetes Month, if you are suffering from diabetes, take steps to successfully attack and defend against the disease. I have personally found difficulty purchasing some test strips here on the island, and recently we had a call from a patient asking for test strips from our office. I would advise first checking PHI or Brabu Pharmacy (not in any order) and if you cannot find the strips locally, you should check online. Amazon.com has ACCU-CHEK Aviva Mail Order Test Strips, 50-Count Box and the One Touch Ultra Mail Order Test Strips, 50 CT on sale. If you are homebound and are having trouble managing your blood sugar, you are eligible under Medicare for home health benefits under Part A, paid for 100% by Medicare and with no co-payment and no deductible. Please give us a call today for more information at 670-234-CARE.

AHA Seven Steps: Blood Sugar from Ideation Films on Vimeo.

Pacific Home Health Care, LLC. Video Animation

Pacific Home Health Care, LLC. presents a short clip on how caregiver education and support are available for those taking care of family members or loved ones that are "homebound" or have difficulty leaving the home.

Lower your "high blood" in the CNMI

You could have hypertension, or "high blood" pressure and not even know it. Hypertension, is a condition in which the force of blood against your artery walls is too strong. It also means your heart is working hard to move blood. High blood pressure in its earliest stages produces few symptoms, but over time it can damage your heart, blood vessels, eyes, kidney and other organs. Symptoms usually do not occur until high blood pressure has reached an advanced level of severity. Symptoms of high blood pressure can include:

severe headache, fatigue or confusion, vision problems, chest pain, difficulty breathing, irregular heartbeat, blood in the urine

If is important to check your blood pressure regularly. There are free machines available for use at Saipan pharmancies, and some insurance plans cover self blood pressure monitors.

If you having trouble managing your hypertension, and are "homebound" or have trouble leaving the home, nurses and aides from Pacific Home Health Care, are able to provide you with quality healthcare you deserve in the comfort of your home, including:

Provide a complete physical assessment during every visit
Educate patients and/or cargegivers to properly manage their medications
Provide education about hypertension and the risk factors involved in the condition
Teach patients and/or caregivers techniques to help reduce stress
Teach energy conservation skills to help patients and/or caregivers to maintain higher energy levels
Assist and educate patients and/or caregivers in safely performing activities of daily living
Assess the safety of patients’ homes, then recommend and help implement safety improvements
Educate patients and/or caregeivers about nutrition management and a heart-healthy lifestyle

If you have any questions about hypertension management programs, ask your doctor if a Pacific Home Health Care referral is right for you, or give us a call today at 670-234-CARE (2273)

Saipan Nutrition: Can diabetics eat sweet fruits like mangoes?

It is a common myth that diabetics should not eat certain foods because they are too sweet. Diabetics and pre-diabetics should be concerned about the total number of carbohydrates per serving, and not about whether it is a sugar or a starch. One serving of fruit should contain 15 grams of carbohydrates, and the size of the serving should vary depending on the amount of carbohydrates in the fruit. Whether the fruit is low-carb or high-carb, as long as you eating the same 15 grams of carbohydrates, the effect on blood sugar is the same.

Some examples of serving size of 15 grams of fruit:

1/2 medium banana
1/2 cup (83 grams) cubed mango
1 1/4 cup (190 grams) cubed watermelon
1 1/4 cup (180 grams) whole strawberries
3/4 cup (124 grams) cubed pineapple

In addition to counting carbohydrate intake and reducing serving size, diabetics should be concerned about eating a wide variety of fruits, vegetables, and WHOLE GRAINS, and reducing intake of saturated fat, trans fat and cholesterol.

If you are currently "homebound" or having difficulty getting around the house, and are having trouble controlling your diabetes, there are many options available. Many services are available to Medicare and private insured patients. Coverage may even be available for diabetic footwear at no cost. If you are suffering from diabetes, talk to your doctor about a Home Health Care Referral.
MAYO CLINIC ARTICLE ON EATING SWEET FRUITS SUCH AS MANGOES

Creating a Postpartum Plan for Pregnant Mothers in Saipan

After creating a birth plan, the expectant mother should also create a postpartum plan. When developing a postpartum plan keep in mind:

•Recovery – how will the mother find help for recovery in the first weeks after baby? Will she have supplies on hand to ease aches and pains? Are there any recommendations from the doctor or midwife to follow?
•Sleep – how many hours did the mother sleep before pregnancy? What are some ways she can encourage more sleep?
•Meals – who will do the cooking in the first few days when mom and baby are primarily in bed together? What are some ways to make meal preparation easier during this time?
•Baby care – who can help with diaper changing, bathing and breastfeeding? Will the partner be enough or should a postpartum doula be hired for extra help?

Make a list of volunteers or family members that can assist the mother and hte assigned tasks. For those that may need private help, home health aides in conjunction with skilled nurses may be avialable at no-cost*. Give Pacific Home Health Care a call today at 670-234-CARE (2273) today for more information.

Arrange Baby Stations

Expectant mothers should plan in advance to keep the infant's care items handy around the house or apartment. In each room where the mother and infant will spend time, plan on the following stations:

•Diaper changing – fill a basket or bin with necessary items such as diapers, clean outfit, ointment, wipes and powder, refill daily or as needed.
•Sleeping – any items that will promote sleep such as a cuddly toy, blanket or lavender baby lotion.
•Feeding – for breastfeeding this may be pillows for propping mom and baby, a snuggly blanket and a bottle of water; for bottle feeding this will be clean bottles, formula and any important accessories.
•First aid – keep a first aid kit in several prominent locations around the house as well as any prescriptions the mother or baby are taking. Also keep a notepad next to the medications and write the date and time when medicine is taken to avoid over or under dosing due to sleep deprivation.

Dr. Hocog to make personal home visits to Saipan Seniors

I was in the CNMI Medicaid office recently and saw Dr. Hocog's notice on the counter that he has opened an office behind the CUC Dandan. In addition to his Medical practice he has partnered with the Saipan Office on Aging to assist seniors in their "homebound" program.

Read full article in Marianas Variety

I congratulate Rose Mondala, Director of the Office on Aging for her ideas in helping the local seniors. It is one thing to tell someone to follow good nutrition, and quite another to go to someone's home and do a "cabinet check" and see what they are actually eating. I suspect that the medical needs of many seniors are not being addressed, and the visits by Dr. Hocog are a step in the right direction.

Visiting doctors are not new idea, and there is a national association for visiting Physians.

If you are a local senior or concerned family member that is interested in information about home health, please give Pacific Home Health Care, LLC. a call at 234-Care (2273)

Why do CNMI residents need to check their blood pressure at home?

Monitoring your blood pressure at home offers several benefits. It can:

Help make an early diagnosis of high blood pressure. If you have prehypertension, or another condition that could contribute to high blood pressure, such as diabetes or kidney problems, home blood pressure monitoring could help your doctor diagnose high blood pressure earlier than if you have only infrequent blood pressure readings in the doctor's office.

Help track your treatment. The only way to know whether your lifestyle changes or your medications are working is to check your blood pressure regularly. Keeping track of changes can help you and your health care team make decisions about your ongoing treatment strategy, such as adjusting dosages or changing medications.

Encourage better control. Taking your own blood pressure measurements can result in better blood pressure control. You gain a stronger sense of responsibility for your health, and you may be even more motivated to control your blood pressure with an improved diet, physical activity and proper medication use.

Cut your health care costs. Home monitoring may cut down on the number of visits you need to make to your doctor or clinic. This can reduce your overall health care costs, lower your travel expenses and save in lost wages.

Check if your blood pressure is different outside the doctor's office. Your doctor may suspect that your blood pressure goes up due to the anxiety associated with being at the doctor's office, but is otherwise normal — a condition called white-coat hypertension. Monitoring blood pressure at home or work, where that kind of anxiety won't cause those spikes, can help see if you have true high blood pressure or simply white-coat hypertension.Home and workplace monitoring may also help when the opposite occurs — your blood pressure seems fine at the doctor's office, but is elevated elsewhere. This kind of high blood pressure, sometimes called masked hypertension, is more common in women and those with cardiovascular risk factors, such as obesity, high blood cholesterol and high blood sugar.

Not everyone can track blood pressure at home. If you have an irregular heartbeat, home blood pressure monitors might not give you an accurate reading. In some cases, the type of monitor you use could depend on your physical condition. If you're overweight or very muscular, you'll need to find a monitor with a larger arm cuff. If you have hearing loss, a monitor with a digital display may be more suitable.

Talk to your doctor, or Pacific Home Health Care, LLC. nurse about whether home monitoring is a good option. Keep in mind that a family member or friend who is properly trained may be able to take blood pressure measurements for you.

Blu e-cigarettes offer an alternative to smoking in the CNMI

The CNMI has begun to crack down on smoking which is a definite health risk. Back in September, Governor Fitial signed the "Smoking Act of 2008" into law. Smoking is currently banned in almost all public places with the exception of bars, and casinos. Smoking tobacco is linked to all types of cancer, and can release up to 4000 toxins into the body aside from nicotine, 60+ are known to be carcinogenic.

E-cigarettes have been around since 2003, however they are just becoming widely accepted. The "Blu" brand is a company in Charlotte, North Carolina that has been aggressivein marketing the e-cigarettes in the United States (made in China to U.S. standards). In Manila, smoking e-cigarettes have become so popular that there are signs posted in public places that smoking is banned "except for e-cigarettes".

E-cigarettes produce a vapor similar to fog machines and are the closest thing to actually smoking. It does contain nicotine, however it leaves out the 4000+ toxins that can cause a number of long term health problems. While the effects of taking pure nicotine have not been completely studied, it would appear that nicotine without many of the harmful chemicals is relatively better than smoking real cigarettes. Now only if they were sold here in the CNMI.

To order Blu e-cigarettes online visit http://www.facebook.com/pages/Saipan/Pacific-Home-Health-Care-LLC/109160192465683

Marianas Baptist Missionary passes NCLEX PN Exam

Li Li, a Chinese Emmanuel College Practical Nursing stduent, and Marianas Baptist Academy Missionary recently passed the NCLEX exam on her first try. Li Li is an August of 2009 practical nursing graduate. Li said she plans to seek employment at the Commonwealth Health Center or other private clinics on the island. Congratulations, and I wish her well in her employment search.

I am trying to keep track of any new CNMI laws or bills, but it appears that no one realizes that both the CNMI Labor Law (private employers) and 3 CMC 4434 (government employers) prohibit the hiring any nonresident worker without 2 years of experience. There was an exception in public law 15-45 which allowed NMC graduates to work at CHC, however that exemption expired on January 1, 2010 and was never renewed. Since most private employers are afraid of the CNMI DOL umbrella permit position, and CHC is a government agency, until the CW regulations are issued, these new graduates and NCLEX passers are in a terrible position.

Additionally, does anyone realize that the CNMI Board of Nursing will issue a graduate PN License to any Emmanual College graduate that is good for 1 year? I have never heard of any nurses working under the provisional license.

CHC Hospital Saipan wants to recruit under J1 visa: submits request for Conrad 30 J1 Waiver

As an update to the severe physician shortage at the Commonwealth Memorial Hospital, "CHC" in Saipan, it appears that things are starting to improve. The CHC hospital recently hired 4 doctors, including an anesthesiologist and a family practitioner, and it is my understanding they are currently waiting for a doctor to finish his residency prior to starting employment in May of 2011. Formerly, it seemed as though CHC hospital was trying everything in its power to hire doctors without increasing their salary. There was even serious discussion about abolishing USMLE restrictions to hire experienced physicians from abroad. From the recent hires of up to $250,000 per year, it seems that CHC hospital and the CNMI Department of Public Health have conceded that they must increase the salary scale enacted 20 years ago in 1993.

There are a number of advantages in working in Saipan. Many hospitals require doctors to pay for malpractice insurance which can cost upwards of $30,000 USD per year. Also taxes in the U.S. mainland can eat up 25% of a physician salary. In Saipan there is a rebate of up to 90% of the income taxes and malpractice insurance does not exist. Malpractice suits are capped at $100,000 and are covered by the CNMI government. Due to the easy access to Asian countries and travel opportunities, and under served area status for U.S. applicants and J1 status for foreign applicants, the CNMI is a great deal for a practicing physician even if the salary is less than the mainland.  For more info, read article in the Saipan Tribune.

Exclusive Casino Jack: United States of Money Video 2010

When is this movie coming to Saipan? It doesn't seem to be available online, and I would think it would be quite successful in the Saipan market.

Report or Not To Report to CNMI DOL: Rota Nurses Receive Minimum Wage Backpay.

I question the headline and some of the facts in the Saipan Tribune

This whole story is a big mess. The nurses were ordered by the CNMI DOL to report to Labor to find a new employer. The nurses are still reporting in violation of the DOL order to a CNMI Government facility, and working without getting paid. Apparently $16,000 was appropriated to pay the nurses miniumum wage for the past 2 months, but what exactly does that mean? The nurses have a contract with SEAS Employment Agency, so do they get the $16,000, or does the agency receive the money? And what about the additional $184,000 the CNMI Government owes SEAS?

The nurses are quoted in the Saipan Tribune that they would like to work directly with the CNMI Government because they are not paid on time, but the reason they are not paid is because the CNMI Government is not paying SEAS.

Back in 2003 SEAS supplied most of the nurses to CHC as well. The CNMI Government decided to hire the nurses directly because of the high turnover of the manpower nurses.

SEAS Nurse Staffing Agency has labor permits revoked again.

Read article in the Marianas Variety.

I hate writing about bad news, but it seems that the SEAS Nurse Staffing Agency had all their nurses' work permits revoked, again. Apparently their previous unpaid medical claim of $20,000 is still partially outstanding. There was talk about how the workers weren't paid for 3 months previously and now this. I feel bad for the employees.

Taste of Marianas 2010 Video Clip

Last week I was able to check out the Taste of the Marianas. I'm not very good at estimating crowds, but it looked like about one thousand people at least. The food was great and the entertainment was great as well. In the video, I accidentally looped a few seconds twice. Sorry about that. Otherwise, the footage was pretty good.

New Saipan Youtube Video

I obviously did not make this video, but I thought that it was well made. I think it shows some of the beauty of the island. I believe that H.I.S Tours/Delta has a 2night 3day package from Narita for about $350 which is cheaper than just the flight in the opposite direction. I guess they make money off the tours and lose some money on the package.

20.1 Million Budget for CHC in FY 2011

There was an article in today's paper about CHC eyeing 380 hospital employees for next year with a budget of 20.1 million. That is higher than last year's budget of 19.5 million, however 2009 expenses for CHC totaled 26.5 million. I fail to see how it is possible for the hiring of any new employees. Link in Saipan Tribune

Recently it does seem that the CHC has taken steps in the right direction in the administrative department. There have been 2 training classes in medical coding and their collections should be increasing. Additionally, CHC has recently opened up the idea for outsourcing some of their collection activities to private firms. With over 100 million in collections outstanding, hopefully, CHC and the CNMI Government will be able to tap into some of those funds.

Update 4/16/11*****************
Unfortunately, the medical coding classes have produced less than stellar collection efforts. Due in part to austerity measures, CHC collections have actually decreased. I was watching a local channel and a commercial appeared for reporting fraud in medicaid activities. I believe that the CNMI really needs to watch for improper and fraudulent kickbacks, steering and claims from physicians, health care companies, and their patients. The book, License To Steal: How Fraud bleeds america's health care system by Malcolm Sparrow is a great insight into how some of these fraudulent activities can occur and how they affect the funding of the health care system.