A team of Tripler Army Medical
Center Ear, Nose, and Throat (ENT)
physicians and Department of the
Army Civilians recently completed a
humanitarian mission to the Federated
States of Micronesia (FSM) where 407
outpatient visits and 234 audiologic
evaluations were provided to a
population in need of care that was not
affordable or accessible to those living in
the region.

"These things are very rewarding,"
said Lt. Col. (Dr.) Philip D. Littlefield,
an otolaryngologist in the ENT Clinic,
Department of Surgery at Tripler Army
Medical Center (TAMC). "These
missions and deployment are the most
satisfying parts of being in the Army
for me. I see myself doing something
meaningful for the world. It certainly
beats the daily grind of email and online
training," said Littlefield. And, he is
certain that the rest of the team agrees.

The Pacific Regional Medical
Command/Tripler Army Medical
Center (PRMC/TAMC) ENT team
members included otolaryngologists
Littlefield and Capt. (Dr.) Kelly L.
Groom, in addition to Department of
the Army Civilians (DAC), Audiologist
Dr. Denby Fukuda, and Physician
Assistant Jeffrey M. Robin.

The mission arose because of past
successes of ENT physicians who have
completed multiple humanitarian
missions in the Pacific region over 10
years, especially to the Republic of
Palau, a larger island group neighboring
FSM. The current mission was
to provide aid to two of the four
Micronesian states, Chuuk and Yap, at
the request of the FSM Department of
Health and Social Affairs on behalf of
the U.S. Department of State.

"Nearly every surgery we did would
have required the patient to go to the
Philippines or Hawaii for
treatment, something the FSM
government cannot afford,
and probably the reason they
were not treated already," said

The initial visit was to
Chuuk for a week, then to
Yap, which is located about
1,000 miles west. The
conditions in Chuuk were
far more austere than Yap.
Overall, the team performed
27 operations between the
two different locations, as well
as multiple clinic procedures,
including 52 neck ultrasounds.

"Some cases do stand
out," said Littlefield. "We
did five thyroidectomies
for large masses. We also did two
mastoidectomies for cholesteatoma.
Cholesteatoma is a serious ear disease
that requires complex surgery, and it
is eventually fatal if left untreated for
many years," said Littlefield. "We also
did a tracheotomy on a lady with a
larynx scarred closed by an infection,
and it took all her effort to breathe in.
She looked absolutely miserable, but was
obviously a lot happier when we were

Littlefield says the vast majority of
patients are very grateful for the care of
U.S. medical providers. They are very
respectful of American surgeons and as
members of the U.S. Army. "They think
we are the very best doctors and are
excited to see us," said Littlefield.
This was not the team's first mission
to FSM. They previously provided aid
to the island of Yap in 2009, but the
current mission was longer and more
focused. The team plans to continue
their humanitarian assistance whenever
they can.

"It is very unusual for civilian doctors
to do this, especially for ear surgery, said
Littlefield. For one, they lose money by
leaving their practices. Also, they tend
not to have the planning and organizing
skills (for these things) that comes with
working in the Army for a while. We
are good at moving gear around the
world and then making it all work in
a rough environment," said Littlefield.

"It's challenging, but fun."
FSM is a grouping of 607 small
islands in the Western Pacific about
2,500 miles southwest of Hawaii,
lying just above the equator. Generally
speaking, the FSM comprises what
is known as the Western and Eastern
Caroline Islands. Chuuk and Yap
are two of the four island states that
comprise the Federated States of
Micronesia. Chuuk state has a total land
area of 49.2 square miles and includes
seven major island groups. Yap state
is made up of four large islands, seven
small islands and 134 atolls (coral reefs),
with a total land aread of 45.6 square miles.