Last Year (2021) Accomplishments

American Samoa remained COVID-free throughout 2021 by continuously implementing precautionary measures for travelers and residents entering the island; requiring COVID testing from travelers before, during and after entrance into the island and a quarantine mandate regardless of test outcome. Aside from travel restrictions, vaccinations were provided in the hospital and clinics across the island. The American Samoa Department of Health (ASDOH) prioritized administering COVID-19 vaccinations once clearance for its use was given. Priority for COVID vaccination was given to first responders and essential workers from the government and private sector; ensuring the protection of employees while offering essential services needed by the community. After months of prioritizing vaccinations for workers within the government and private sector, vaccinations were then made available to everyone in the community. ASDOH, alongside LBJ Tropical Medical Center (LBJ TMC), the Veterans Affairs (VA) Clinic, and other government departments collaborated in an island wide mass vaccination campaign; with the goal to increase the percentage of vaccinated residents in American Samoa. The MCH team dedicated an immense amount of time assisting in the mass vaccination outreaches; registering, vaccinating, updating records, etc. throughout the duration of the outreach. MCH staff also encouraged and referred their clients and anyone within MCH’s population domain to stop by to the closest vaccination site to get their COVID shot.

Aside from vaccinations, changes to address the COVID-19 were made in other areas of the government that provided services to adolescents. The Department of Education launched their Virtual Learning Program to prepare students and staff for changes that will happen once there is a community spread of the coronavirus. LBJ TMC continued to implement restrictions within the clinic and for the wards during visiting hours for inpatient visitations. Local businesses and government agencies required face masks upon entry into any building owned by a business entity or government agency. The American Samoa Government (ASG) also started limiting work hours and had some of their employees work remotely with the exception of frontliners and essential workers. For a territoryʻs first immediate response, MCH staff can vouch it was a great team-effort that has been successful. Yet, it is still an on-going mission to encourage and educate children, especially adolescents, about the importance of receiving vaccinations to prevent and lower their symptoms of certain viruses. 

The progression of children from childhood adolescence to young adulthood is a time period of major change and development; physically, socially, cognitively, and mentally. It is at this phase of growth that adolescents begin to act on their own volition and judgment, assuming individual responsibility for their actions. In recent years, American Samoa’s adolescents have been dealing with a major mental health crisis. This age group, because they’re prone to an extensive amount bullying that may cause self hate, has an increase risk for suicide or suicide attempts. Suicid ideation has been a major issue within American Samoa communities for the past two years and is evident due to the increase of suicide deaths amongst adolescent teenagers. In the begining of 2021, three adolescents were reported to have committed suicide, continuing the increase trend of suicide deaths from 2020.With the shocking increase of suicide rates in the year 2020 following 2021, government leaders and agencies took the initiative in launching youth support groups and programs to take immediate action addressing this problem. The governor also assembled a task force, that consisted of people from both the public and private sector, to specifically address and provide solutions to the crisis that the islands’ youth is facing. The MCH team took part in assisting at the 988 call center during this time, as well as being a part of the different collaborations to help encourage and equip the youth with coping mechanisms to counter depression and suicide ideation.

Partnerships between local non-profit organizations that cater to the adolescent population and the Department of Education (DOE) were strengthened as MCH served as a liaison during this time. Through AMCHP funds, several telehealth equipment were purchased for all high schools in the territory including the Manu’a Islands. This telehealth equipment was distributed throughout the island using a memorandum of understanding between the MCH Program and the EPIC(Empowering Pacific Island Communities) non-profit program. EPIC provided training for school counselors to be able to identify signs of depression and suicide ideation amongst students. Once school counselors a student who is at risk for suicide, they then utilize telehealth equipment to contact providers that would help students counter these ideations and provide counseling and treatment if needed.

The American Samoa Department of Human & Social Services (DHSS) received funds from the Substance Abuse and Mental Health Services Agency (SAMHSA) that helped fund the startup of the 988 suicide hotline. DOH and DHSS worked together to ensure that the 988 hotline was consistently and efficiently working 24/7 to provide service to the community. The 988 hotline is housed in the main DOH building in Tafuna, while services are provided by the DHSS and DOH staff. MCH staff continuously work after hour shifts to cover the lines due to the staff shortage within the behavioral health divisions in both DOH and DHSS. MCH,DOH and DHSS staff were trained to be operators for the suicide line, and are continually being utilized to provide support for adolescents who call the line for help.

• 9-8-8 Suicide Hotline: MCH was centrally involved in ongoing efforts to address suicide amongst young people by being trained as 988 phone operators, learning how to address incoming calls related to suicide, mental health/illness or domestic violence/abuse.

• Strengthening Partnerships: In one of the efforts to work closely with other divisions and agencies aiming to resolve the Suicide and Mental Health crisis, the MCH staff partnered with the DOH Behavioral Health Services Program and the Department of Human and Social Services (DHSS) to work on the Suicide Hotline that is currently available to the community. 

• Intra-agency Referrals: MCH makes it a goal to work closely with other divisions within our local Public Health department in order to provide beneficial services and care to our adolescents. In 2021, we had 3 intra-agency referrals with the Behavioral Health Services Program and also some of our clients’ mothers were able to be referred to the Breast and Cervical Cancer (BCC) Program to get screened.

• Media Awareness: Title V leaders spearheaded the Media Operation working hand in hand to put out as many public service announcements, radio and television advertisements informing the community about COVID restrictions, providing vital information regarding the pandemic, testing-sites and especially COVID vaccines. There were also school and community outreach programs that MCH took part in, with the goal to educate the public on precautionary measures such as hand-washing, social distancing and basically adapting to the new norm of living with and lessening the spread of COVID.

• Cultural Impact:  Suicide continues to be a taboo among many local families and groups in American Samoa, while concern continue to rise amongst the leaders of the territory. Many parents were raised with the practice of intense physical discipline, which influences young adolescents presently to consider suicide. 
• Adapt-ability: Although telehealth systems are in place and ready to be utilized, there is a continuous need to adapt to the new way of connecting to others, for both provider and patient.
• Unprotected Sex leads to Teenage Pregnancy: In 2021, there were adolescents who were tested positive for Sexual Transmitted Diseases (STDs) which include chlamydia and gonnorhea. Out of 41 people tested positive for chlamydia, 25 of them were in the age group of 15-24 years and 22 of them were also pregnant. Out of the 5 women tested positive for gonorrhea, 4 of them were in the age group of 15-24 years. Although the Adolescent age group is 12-17 years, they are very much included in the data collected and reported by the DOH - STD Prevention Program. This is concerning as it can impact the health and wellbeing of these young individuals in the future.

• Lack of Preventive Care: With adolescents becoming highly influenced by peer pressure, suicide, mental health stigma, STDʻs, teenage pregnancy and many other factors, MCH recognizes there is a lack of emphasis on the push for preventive care for this age group. There are no required medical checks prior to the beginning of a school year, and medical staff such as a school nurse and/or physician are non-existent in local school systems, and there’s no apparent funding for this initiative, although it is a definite priority.

• Shortage of medical staff: There is a huge demand and urgent need in nursing, hiring more qualified physicians and specialists to address the health demands from students, especially this population. More emphasis on prioritizing the health needs of adolescents during this critical time of growth needs to be a combined effort. ASMCH staff cannot stress the importance of this challenge and how it affects us as a program but also the different clients and population we serve.

• Systemic Change: During our most recent annual stakeholders meeting with our partners i,e government agencies, private sectors and consumers, some of the representatives voiced out that these challenges are becoming more out of our control due to ineffective and inconsistent systemic changes. There should be more open discussions between teachers and parents, parents and their children but also the adolescents and youth amongst themselves. During the PTA meetings at schools, it would be helpful if more of such meetings would be about addressing the many barriers and challenges this population is facing.