When someone living in Hawaiʻi—especially on a neighbor island—needs advanced medical treatment, receiving that care can often require them to leave home. Imagine the challenge for someone living on an even more remote Pacific island who needs specialized orthopedic surgery to live a functional life.
For complex medical conditions, some patients travel hundreds or even thousands of miles to receive care, creating financial and logistical challenges for families and healthcare systems alike.
JABSOM medical students Philip Lee, Sasha Rovinsky, and Mason Caldwell hope their research can help change that.
The team of second, third, and fourth year medical students published their research in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) with the goal of expanding orthopedic care across the Pacific Islands. The project brings together orthopaedic and global health experts from JABSOM, Stanford University, the University of California San Francisco, the American Red Cross, and the Pacific Islands Orthopaedic Association (PIOA), to examine how countries across the Pacific are working to expand access to orthopedic care.
Rather than identifying a single solution, the team reviewed successful models already being used throughout the region.
“There’s a lot of effective approaches to addressing disparities in the Pacific, but we rarely examine whether these efforts translate into sustainable solutions and the root of the issue,” Lee said. “We designed this project to show that investing in a multi-modal approach– especially a train-in-place model– can improve patient outcomes and a more cost effective solution for local governments."
The study describes three approaches.
Some countries rely on overseas referral programs, sending patients to larger medical centers in Guam, Hawaiʻi, Australia, or New Zealand for specialized treatment.
A second model involves nonprofit surgical teams that travel to Pacific communities to provide care while working alongside local healthcare providers.
Others are investing in "train-in-place" programs, in which experienced orthopedic surgeons travel to Pacific nations to train local physicians over several years. By developing local surgical capacity, these programs allow more patients to receive specialized care closer to home.
Each approach has its strengths. Together, the researchers believe they can create the foundation for a more sustainable system.
"If you have just one model, you're not going to have the best care," Caldwell said. "Continuing investment in training, procurement and policy all have to happen before you can have a proper network of care."
Caldwell grew up in Guam and has seen these struggles firsthand.
“Guam serves as an important referral center for patients throughout Micronesia,” he said. “ We have access to US referral networks. We can send people to Hawaiʻi, and we also act as our own little hub within Micronesia, so we have a lot of patients coming from Chuuk, Pohnpei, Kosrae, all around the outer islands, coming to Guam for this care.”
The publication also highlights Hawaiʻi’s role in expanding care across the Pacific through advocacy and improving research efforts.
“I’m grateful to have support from JABSOM, healthcare leadership across the Pacific, and powerhouse institutions on the West Coast,” Lee said. “JABSOM does a great job exposing the student body to the hardships of under-resourced countries, as well as how to address upstream issues. Instead of developing a better system to send patients off-island for orthopedic care, we asked how we can strengthen local capacity so fewer patients need to leave home in the first place.”
JABSOM students regularly complete clinical rotations throughout the Pacific, building relationships with physicians and communities while gaining firsthand insight into opportunities to strengthen healthcare delivery.
"Students having the opportunity to rotate through these places and build partnerships around the Pacific is awesome," Caldwell said. "You get to see these challenges firsthand and help put that work into the literature."
That collaborative approach also shaped the project itself.
Rather than relying solely on published data, the research team worked directly with leaders of the Pacific Islands Orthopaedic Association, a train-at-home model to develop surgeons who are committed to practicing in Pacific nations.
"The feedback we've received has been that they're really proud to see this program discussed in the academic literature," Caldwell said.
Lee believes these findings will rally support from local governments and push policymakers to invest in sustainable healthcare infrastructure, rather than relying so heavily on humanitarian efforts and overseas referrals.
While the study focuses on Pacific Island nations, Caldwell believes the lessons could also benefit other regions where geography and limited resources make access to surgical care challenging.
“This research is close to home for all of us,” Caldwell said. “It’s part of the Pacific, and we’re all interested in some surgery or surgery-adjacent specialty, so being a part of this is super rewarding. If this can even have the smallest bit of impact on some of these island nations, I think that would be amazing for them to shape their healthcare infrastructure.”