FSM Information Services
President Panuelo Instructs FSM National to Coordinate with Pohnpei State Task Force to Conduct Simulation Exercise in Anticipation of Repatriation of FSM Citizens; Thematically Similar Exercises to Follow in Yap, Chuuk, and Kosrae
PALIKIR, Pohnpei—From June 17th to 19th, 2020, at the instruction of His Excellency David W. Panuelo, President of the Federated States of Micronesia (FSM), and the Governors of the FSM, the National Government in collaboration with the Government of the State of Pohnpei, the Defense Attaché Office of the Embassy of the United States of America, the World Health Organization (WHO), the International Organization for Migration (IOM), and United Airlines, Inc., conducted a series of exercises to assess and simulate Pohnpei State’s capacity and procedures for what to do when the Nation’s citizens stranded abroad are allowed to be repatriated. Although the Government cannot yet confirm a designated date for opening the FSM’s borders in Pohnpei State for the repatriation of the Nation’s citizens, the National and State Task Forces are working the week of June 22nd, 2020 with the aim of seeing if Saturday, June 27th 2020 can serve that purpose. The FSM National Government is coordinating with the States of Yap, Chuuk, and Kosrae to conduct similar exercises with their respective Governments.
On June 17th, after an introductory meeting at the Pohnpei State Hospital’s Conference Room, the National and State Task Forces split into three groups to assess Pohnpei’s Point of Entry, Quarantine, and Isolation areas. These assessments consisted of the completion of standardized forms, interviews, and data-gathering and analysis.
On June 18th, the National and State teams reviewed their assessments and developed tables inclusive of actions to be taken, timelines for completion, and individuals responsible thereof. The day also included a tabletop simulation of how the National and State Governments would respond if a commercial air carrier arrived in Pohnpei State with FSM citizens repatriating, with at least one of the individuals beginning to show symptoms consistent with COVID-19 during the flight.
On June 19th, the National and State teams conducted a live simulation exercise of the previous day’s tabletop scenario. This included agencies playing out their real-life roles, with a school bus acting as a commercial flight, and port, immigration, customs, quarantine, and health officials responding as if the bus’s passengers were citizens coming from a COVID-19 affected jurisdiction. The scenario included a number of potential real-life encounters, such as how to effectively address an individual showing symptoms of COVID-19 whilst on the flight, how to receive and home-quarantine members of the diplomatic corps, and how to brief passengers at Pohnpei State’s designated quarantine facility (i.e. China Star Hotel) on what will happen over their fourteen days of quarantine.
Staff from the U.S. Embassy who posed as incoming diplomatic corps personnel advised that their experience was “really well organized; people were telling me where to go, gave me a mask—but one thing that I think we need to address is regarding the medical certificates. I am not 100% sure if I needed to bring it with me, or have it on me, or where or who to give it to—but overall, it was a good experience.” The simulation for the diplomatic corps staff included getting off the flight, participating in the mandatory health screening, and how to properly enter their vehicle for immediate transport to their home-quarantine site. While all incoming members of the diplomatic corps will be quarantined, due to the Vienna Convention they will be home-quarantined in a manner approximately equivalent to the home-quarantine for His Excellency David W. Panuelo, President of the FSM, and the home-quarantine for Her Excellency Carmen G. Cantor, Ambassador of the USA.
The bulk of the passengers, save for the individual with potential COVID-19 symptoms, went through the mandatory health screening, followed by immigration, customs, and quarantine. One of the passengers, who was keen to speak but on the condition of anonymity, said: “It builds my confidence to work this out, but the problem areas need to be addressed before I think we’ll be comfortable with people coming home. I know you said you’ll mention this in your Press Release, but please emphasize that we need a standard operating procedure for general cleaning—the airport cleaners didn’t wear PPE (personal protection equipment) and were not trained for it. The immigration and custom officers were not trained for properly donning and doffing. This can all be fixed, but it must be said so that our citizens know that we are really working on doing this right. When people come home, it’s the real scenario.”
The Special Assistant to the President for Public Information role-played the passenger showing symptoms consistent with COVID-19. He offered the following remarks for his experience. “While on the bus/flight, I pretended to get short of breath and cough. A member of the flight crew asked me questions about how I was feeling, and when I arrived at Pohnpei International Airport I was escorted by professionals at Pohnpei State Department of Health & Human Services in full medical regalia who kindly segregated me from the general population. There I was taken to an ambulance, and from there to the hospital. Once the ambulance doors opened, I was greeted again by properly-suited medical staff, who took me to the isolation wing. The only criticisms I could offer are potentially petty, but worth noting. The first is that the ambulance’s air-conditioning wasn’t working, and I was in there for a good twenty minutes; a real COVID-19 patient would already be uncomfortable. The second is that getting me into the isolation room was challenging—I don’t recall there being a wheelchair ramp, I recall them having to lift the stretcher or gurney to get me into the hospital. The third is that the room they were putting me into was congested—the staff basically had to contort themselves to get me to my bed. But, once there, they did all the things they needed to do, even when their technology didn’t work right. When they took my blood pressure, the electronic machine wasn’t working—so they immediately switched to doing it manually, for example.”
Following the exercises, the National and State teams described the strengths and weaknesses for the Point of Entry, Quarantine, and Isolation areas in an in-depth debriefing.
For the Point of Entry’s strengths, it was noted that some of these included the presence of standard operating procedures (including protocols for different types of travelers and communications between crew and health authorities); effective role-sharing between crew, health, airport, fire, and rescue personnel, and infection control specialists; and environmental disinfection conducted by specialists from the Environmental Protection Agency and health teams. Visible markings were in place to identify appropriate locations to ensure physical distancing.
For the Point of Entry’s weaknesses, it was noted that some of these included a lack of a “general cleaning” standard operating procedure, and that airport cleaners, immigration, and custom officers were either not wearing PPE and/or were untrained for their use. It was advised that there was a lack of proper disposal guidance and trash bins for used PPE, there was a lengthy waiting period for passport clearances, and no briefing was given to passengers on how they and their bags would be transported to the quarantine facilities.
For the Quarantine Site’s strengths, it was noted that some of these included that the management team was able to manage a distressed individual very well and otherwise adapt on the go, that registration and overall preparation were organized, the briefing to passengers on their stay was clear and helpful, and there were highly visible signs providing information and contact numbers for assistance.
For the Quarantine Site’s weaknesses, it was noted that some of these included the need to conduct additional health-screening measures beyond a temperature check, that phones and wi-fi are presently disabled, that corridor security cameras are presently inaccessible, and that standard operating procedures for waste management and disposal, as well as an emergency evacuation plan (e.g. what to do if there’s a fire or typhoon) must be developed. Further, it was advised that the briefing given to passengers could be improved if it were standardized (such as with a set of talking points) and made more concise.
For the Isolation Area’s strengths, it was noted that some of these included that a call center/hotline has been established and manned by staff who follow standardized procedures; that staff donned their PPE in time before the arrival of the potential COVID-19 patient; the clinical assessment of the potential COVID-19 patient proceeded on time, with decontamination of the ambulance and equipment initiated. PPE doffing occurred in the appropriate area, and hand hygiene signs, posters, and handwashing items were in place.
For the Isolation Area’s weaknesses, it was noted that some of these included that the ambulance only had a driver and doctor (the procedure calls for two medical personnel, not one); that although decontamination of the ambulance stretcher occurred it was not necessarily done properly; that no specimen collection kit was placed in the ante-room prior to the patient’s arrival; that one staff member doffed their PPE in the wrong order; and that the sharps container was both placed near other waste bins, risking misplacement of sharps, and made of cardboard and thus susceptible to disintegration. (Sharps refers to any medical instrument that is sharp or pointy—syringes, scalpels, etc.—and typically these items should be divorced from other types of waste).
Following the simulation exercise and subsequent debriefing, the National and State team agreed to reconvene to implement the Action Plan to address the weaknesses that the exercise unveiled, which at the time of this writing is presently ongoing.
“Part of being transparent means foregoing concerns about what looks and sounds good and focusing on what’s true,” the Honorable Livingston A. Taulung, Secretary of the Department of Health & Social Affairs and Chair of the FSM COVID-19 Task Force, said in a statement following the simulation exercise. “I am very proud of the good work our team has done so far, and extend the National Government’s gratitude to Pohnpei State, the U.S. Embassy, the WHO, IOM, and United Airlines, Inc. for their participation and coordination in these exercises. That said, I trust that the common affirmation from the report on this exercise is that we still have a lot of work to do in the days ahead. When the President and Governors answer the question of when we open our borders, it must be primarily informed by technical and medical experts assessing that we have done all that we can to minimize and mitigate risks to our citizens’ health. This goal is achievable, and will be in reach so long as we continue to support each other.”