The Commonwealth of the Northern Mariana Islands
(CNMI) is a small island chain located 125 miles northeast
of Guam, 3200 miles from Hawaii, and only 1200 miles south
of Japan. The Commonwealth consists of three main islands,
Saipan, Rota, and Tinian and several smaller islands. Though
a trust territory of the United States the CNMI is quite
an international destination. A myriad of ethnic groups
including Japanese, Chinese, Filipino, Korean, and a very
small number of Caucasians join the local population of
Chamorros and Carolinians in the CNMI. The majority of
my time was spent in Saipan, at the Commonwealth
Health Center (CHC) within the CMNI
Department of Public Health.
My work was devoted to developing, implementing, and evaluating
a program to help prevent childhood obesity from a clinical
perspective. When I arrived there were several programs in
the CNMI devoted to combating obesity, however none were clinically
based and very few targeted children and adolescents. The first
month of my stay was spent conducting research on the types
of interventions that have been successful in diverse populations
similar to that found in Saipan. The next several months were
focused around developing the intervention and finding ways
to get it into the community. After two months of development,
the program titled 'OFF THE TV' hit the island as a comprehensive,
clinically based public health campaign designed to help prevent
childhood and adolescent obesity in the CNMI. The program targets
three areas of obesity prevention: Screening, Educating, and
Increasing Awareness. Clinics serving pediatric patients in
Saipan, Tinian, and Rota were asked to participate in the program
and doctors and nurses were trained to deliver the screening
and intervention methods to pediatric patients and their caregivers.
A total of 64 health care professionals within the eight clinics
in the CNMI were trained to use new growth charts and received
instruction on how to educate patients and their caregivers
on ways to stay healthy.
During the first of the twelve scheduled quarterly evaluations,
eight clinics in the CNMI, six in Saipan, one in Tinian, and
one in Rota, were found to be successfully screening all children
between the ages of two and 20. By calculating their body mass
index (BMI) and plotting it on BMI-for-Age growth charts designed
by the Center for Disease Control (CDC), the clinics were properly
evaluating weight status in every patient coming in for a well
child check. Each clinic was also provided with tools to help
increase awareness and educate the community concerning complications
associated with obesity and brief ways to improve health status.
Handouts were distributed to the clinics that offered patients
and caregivers quick tips to help them make healthy choices
and change unhealthy behaviors. Information provided on the
handouts ranged from the amount of television time appropriate
for children to correct portion sizes and ways for kids to
stay physically active.
The most important goal of this project was to unify the medical
community in sending a common message that weight status is
a critical factor in overall health, especially in children
and adolescents. 'OFF THE TV' was developed to serve as a means
by which doctors can increase communication with their patients
regarding weight status and how to make healthy choices in
hopes of preventing childhood and adolescent obesity.
As for my time away from the project, I was investigating the
island, seeing patients in the hospital, or traveling around
Asia. Saipan is home to countless hiking trails, gorgeous beaches,
and a melting pot of diverse culinary delights, all of which
I explored to greatest extent possible. As a third year medical
student, in addition to my work on 'OFF THE TV,' I was invited
to spend time rotating through each department at CHC and spent
countless hours learning as much as I could from a handful
of wonderful attending physicians. Traveling through Asia proved
to be a culturally enriching experience and between visiting
various jungles of Borneo and site seeing in Tokyo, I accumulated
a fair amount of airline boarding passes and memories that
will last a lifetime during my five-month stay in Saipan.
I need to send a special thank you to everyone at the Commonwealth
Health Center, especially Dr. Richard
Brostrom for all the
thoughtful guidance with 'OFF THE TV,' Dr. Michael
Seckeler for ARF, and Dr.
Jenny Linden for the enlightening education
in the field of obstetrics. And of course without the BRAVO!/MHIRT program none of this would have been possible, thank you to
Carol Bender, Genevieve Kenney, and Christine Duddleston.
Rachel Brownstein, MD-MPH candidate 2009, University of Arizona
College of Medicine.
The Commonwealth consists of three main islands,
Saipan, Rota, and Tinian and several smaller islands. Though
a trust territory of the United States the CNMI is quite
an international destination. A myriad of ethnic groups
including Japanese, Chinese, Filipino, Korean, and a very
small number of Caucasians join the local population of
Chamorros and Carolinians in the CNMI. The majority of
my time was spent in Saipan, at the Commonwealth
Health Center (CHC) within the CMNI
Department of Public Health. 
My work was devoted to developing, implementing, and evaluating
a program to help prevent childhood obesity from a clinical
perspective. When I arrived there were several programs in
the CNMI devoted to combating obesity, however none were clinically
based and very few targeted children and adolescents. The first
month of my stay was spent conducting research on the types
of interventions that have been successful in diverse populations
similar to that found in Saipan. The next several months were
focused around developing the intervention and finding ways
to get it into the community. 
After two months of development,
the program titled 'OFF THE TV' hit the island as a comprehensive,
clinically based public health campaign designed to help prevent
childhood and adolescent obesity in the CNMI. The program targets
three areas of obesity prevention: Screening, Educating, and
Increasing Awareness. Clinics serving pediatric patients in
Saipan, Tinian, and Rota were asked to participate in the program
and doctors and nurses were trained to deliver the screening
and intervention methods to pediatric patients and their caregivers.
A total of 64 health care professionals within the eight clinics
in the CNMI were trained to use new growth charts and received
instruction on how to educate patients and their caregivers
on ways to stay healthy.
During the first of the twelve scheduled quarterly evaluations,
eight clinics in the CNMI, six in Saipan, one in Tinian, and
one in Rota, were found to be successfully screening all children
between the ages of two and 20. By calculating their body mass
index (BMI) and plotting it on BMI-for-Age growth charts designed
by the Center for Disease Control (CDC), the clinics were properly
evaluating weight status in every patient coming in for a well
child check. Each clinic was also provided with tools to help
increase awareness and educate the community concerning complications
associated with obesity and brief ways to improve health status.
Handouts were distributed to the clinics that offered patients
and caregivers quick tips to help them make healthy choices
and change unhealthy behaviors. Information provided on the
handouts ranged from the amount of television time appropriate
for children to correct portion sizes and ways for kids to
stay physically active.
The most important goal of this project was to unify the medical
community in sending a common message that weight status is
a critical factor in overall health, especially in children
and adolescents. 'OFF THE TV' was developed to serve as a means
by which doctors can increase communication with their patients
regarding weight status and how to make healthy choices in
hopes of preventing childhood and adolescent obesity.
As a third year medical
student, in addition to my work on 'OFF THE TV,' I was invited
to spend time rotating through each department at CHC and spent
countless hours learning as much as I could from a handful
of wonderful attending physicians. 
Traveling through Asia proved
to be a culturally enriching experience and between visiting
various jungles of Borneo and site seeing in Tokyo, I accumulated
a fair amount of airline boarding passes and memories that
will last a lifetime during my five-month stay in Saipan.
