CHCC Services Update: March 30

COVID-19 RESOURCES

COVID-19 Info Line
For information about COVID-19 symptoms and other information. Please call 285-1352/1542/1672 or 1854. Available 24/7.

Mental Health Care Line
For mental health support and coping skills.
please call 285-1856/1857. Available 24/7.

CHCC Facebook: www.facebook.com/cnmichcc

CHCC website: www.chcc.gov.mp

Entrance Screening

All visitors to the CHCC will be screened for symptoms and recent travel, and have their temperature taken. Non-patients with a fever will not be allowed in the facility.

No guests are allowed in the CHCC hospital. Patients who are admitted to the hospital will be limited to one caretaker at a time.

COVID-19 Health Tent

Patients arriving at CHCC with respiratory symptoms or fever will be screened outside of the main CHCC facility in a tent near the main hospital entrance on the upper level.

Monday to Friday 7AM-6PM | Saturday and Sunday 8AM-5PM

Outpatient Services

Family Care Clinic: Monday – Friday (7:30AM -4:30PM) and Saturday (8AM-5PM by appointment only)
Women’s Clinic: Monday – Friday (7:30AM -4:30PM)
Children’s Clinic: Monday – Friday (7:30AM -4:30PM)

Outpatient visits to the clinics are limited to the patient and a maximum of one other person. For example, if a child has an appointment in the Children’s Clinic, only one parent or guardian may accompany them. Parents with multiple children should leave other children with a caretaker. Please plan accordingly.

Outpatient Pharmacy

Monday-Friday: 8AM-6PM
Weekends and Holidays: 8AM-5PM

Patients can call ahead to refill prescriptions at 236-8798. Have your prescription number ready. All patients must be screened at the CHCC main entrance door before visiting the pharmacy. Your cooperation is highly appreciated.

Dental Clinic

The CHCC’s Dental Clinic is currently open for dental emergencies only. Dental emergencies include: heavy bleeding from the mouth, tooth trauma, swelling or infection, and severe toothaches (pain prevents you from eating or sleeping and is does not respond to over the counter pain medication).

Dialysis Center

We are temporarily not allowing visitors and caregivers to sit with patients on dialysis during treatment. Patients on dialysis, please call the CHCC Dialysis Center ahead of time at 236-8303/4 if you are experiencing a new cough, fever, shortness of breath, or any other symptoms that are unusual for you.

Funerals

If you plan to visit the CHCC chapel for a funeral, you will be asked to limit the number of visitors to 10 people in the chapel at one time. This is done to increase the physical space between individuals so we can avoid the spread of illness and protect the safety of our health care facility. Your cooperation is highly appreciated.

Cafeteria

The cafeteria has adjusted their hours to Monday to Friday 7AM to 1PM. We are limiting the number of visitors in the cafeteria to 10 people at one time.

COVID-19: Frequently Asked Questions

March 18, 2020

Q: I’m worried about COVID-19 in the CNMI. What should I do?
A: If you feel well, practice good hygiene and social distancing. Laboratory testing for COVID-19 is only available for extreme cases. There is no voluntary testing in the CNMI for people who are feeling well.

How to practice good hygiene: Wash your hands for at least 20 second with soap and water, avoid touching your face, cover coughs and sneezes with a tissue or your sleeve.
How to practice social distancing: Stay home if possible, and stay away from large gatherings. Avoid close contact with others such as kissing, hugging, or shaking hands. Avoiding close contact with people helps you to avoid catching the virus yourself and passing it on. Even if you don’t have symptoms, you can pass on the virus to someone who may be more vulnerable.

Q. I’ve recently travelled to Guam and want to get tested for COVID-19. Where can I go?
A. If you don’t feel sick, practice good hygiene and social distancing. There is currently no testing available for those who do not have symptoms of COVID-19.

If you feel unwell, but don’t have a temperature higher than 100 degrees Fahrenheit or don’t have difficulty breathing, stay home and take care of your symptoms.

If you feel unwell, and have a temperature higher than 100 degrees Fahrenheit or have difficulty breathing, call your primary care provider or see a medical professional for screening in front of the CHCC main entrance beginning Wednesday, March 18th at 9am. This screening does not include laboratory testing.

If you have been contacted by a Guam public health official to let you know that you have been exposed to an individual that has been confirmed positive for COVID-19, then you should follow strict home quarantine if you feel well, and notify CNMI health officials by calling (670) 236-8209. If you have symptoms, call your primary care provider.

Q. Can I get a test for COVID-19 in the CNMI?
A. No. No laboratories in the CNMI are capable of testing for COVID-19 as of March 16th, 2020. Currently, Guam, which is the closest location for COVID-19 tests in the CNMI, will only accept tests from seriously ill, hospitalized patients who have a very high possibility of exposure and
who meet the surveillance and epidemiology criteria. CNMI and Guam authorities collaboratively decide which cases are high priority to be tested. Patients with no or mild symptoms will not be prioritized for testing.

Q. What treatment is available if someone tests positive for COVID-19?
A. There is no cure for the virus which causes COVID-19. Treatment for individuals who test positive for COVID-19 is limited to managing symptoms while the illness runs its course. If symptoms are mild, home management of symptoms is sufficient. Many people do recover fully from the virus.

Q. I have an upcoming trip planned next week. Should I go?
A. Travel is strongly discouraged at this time.

Q. Should I have my employees work from home?
A. If telework is a viable option for your business, yes.

Q. Should I require my employees to get a medical clearance before coming to work?
A. No. There is no “medical clearance” available for the COVID-19 virus. If an employee is sick, allow them to stay home or seek medical care, if needed. Requiring employees who do not feel sick to get a “clearance” from a medical professional does not reduce the risk of COVID-19 transmission and overwhelms our health care system.

Q. My prescription has run out, and I need to renew it. What should I do?
A. Call your primary care provider to see how you can get your prescription renewed.
If you are on Medicaid, Medicaid has approved medication fills for up to 90 days during this emergency.

Keeping Up with the Coronavirus

Every day, we’re inundated with social media posts and news coverage about the ongoing outbreak of COVID-19 across the world. It can be hard to know what information to trust or where to go for reliable updates and news. Before you click ‘Share’ it’s worth making sure that the post, article, or meme you’re looking at contains information or data from a trustworthy source.

One trustworthy source is your local health department – in this case that would be us! The CHCC shares updates and information with the public in a variety of ways online:

You can also find updates and information from the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO), among many other trustworthy organizations. Regardless of where you’re getting your updates, it’s worth taking a few minutes to fact check and make sure you aren’t spreading misinformation online!

You Can Assist Those at Risk for Suicide

The CHCC Community Guidance Center’s Suicide Prevention Program is committed to addressing the burden of suicide in the CNMI. In addition to providing intervention and counseling services, the program also focuses on outreach and education in the community, as well as promoting suicide intervention techniques through Applied Suicide Intervention Skills Training (ASIST). ASIST workshops are held regularly by the Garrett Lee Smith Youth Suicide Prevention Program (GLS), under the CGC Suicide Prevention Program.

The goal of ASIST is to help people become willing, ready, and able to provide emergency first aid to individuals who are at risk for suicide. During this two-day workshop, participants learn how to:

  • Recognize people at risk for suicide.
  • Identify the key elements of an effective suicide safety plan, and the actions required to implement it.
  • Appreciate the value of improving and integrating suicide prevention resources into our community.
  • Understand other important aspects of suicide prevention, including life-promotion and self-care.

ASIST workshops are open to anyone 16 or older, and are the most widely used suicide intervention training workshops in the world. They offer something to every participant, no matter how experienced. Our trainers are all certified by LivingWorks, the developers of ASIST.

For more information or to sign up for an ASIST workshop, please contact the the CGC Suicide Prevention Program at 664-5483/5433 from 7:30AM – 4:30PM, Monday through Friday, or find them on Facebook @cnmisuicideprevention.

The CGC Suicide Prevention Program provides prevention and intervention services to those who are having thoughts of suicide or have made a suicide attempt. Their mission is to reduce the incidence of suicide behaviors among CNMI residents and increase access to appropriate prevention and intervention services. The GLS program provides services geared at youth and young adults, with financial support from the Substance Abuse and Mental Health Services Agency (SAMHSA).

If you or someone you know may be considering suicide, don’t wait. Reach out to the CGC Suicide Prevention Program at (670) 664-5433, available Monday-Friday from 7:30AM-4:30PM. Outside of those hours, please call the National Suicide Prevention Lifeline at 1-800-273-8255, which is available 24/7.

Stay Home When You Are Sick! A Home-Care Guide

When you are sick, it is important to stay home from work, school, and social events so that you can avoid spreading the illness to others and throughout the community. This is especially important if you are coughing or sneezing. Tiny droplets of fluid fly out of your mouth and nose when you cough or sneeze, which can then get into healthy people’s eyes, nose, and mouth and make them sick. Here are some guidelines for protecting members of your household and the community from catching your illness.

Stay home, except to get medical care.

You can recover from mild illnesses at home. Do not go to work, school, church, or public areas. Do not allow visitors into your home. Members of your household will need to provide support for things like getting groceries, prescriptions, and other personal needs. Drink plenty of fluids and take over the counter medication for your symptoms. Always follow product label instructions.

Call ahead before going to the doctor.

If you have a doctor’s appointment, call your doctor’s office ahead of time and tell them about your symptoms. Clinic staff may also ask about your recent travel history. Calling ahead will allow the clinic staff to give you guidance as to whether you should take appropriate steps to prevent other people from becoming exposed to the illness that is making you feel sick.

Separate yourself from other people in your home.

As much as possible, you should stay in a specific room and away from other people in your home. You should also use a separate bathroom, if available. You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding. After using these items, they should be washed thoroughly with soap and water.

Practice good hygiene.

Cover your mouth and nose when you cough or sneeze. Throw used tissues in a lined trash can and then immediately wash your hands.

Wash your hands often with soap and water for at least 20 seconds. Wash your hands after coughing or sneezing, before and after touching your face, before eating, and whenever your hands are visibly dirty. If soap and water are not available, clean your hands with alcohol-based hand sanitizer that contains 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Handwashing is always preferable to using hand sanitizer.

Clean all ‘high touch’ surfaces every day. High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. It is also important to clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product, including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation.

Monitor your symptoms.

Seek medical attention right away if your illness is worsening or you are developing new symptoms such as difficulty breathing. Before seeking care, call your doctor and give them details about your illness. If you have a medical emergency and need to call 911, notify the dispatch personnel that you have a cough, fever, and/or shortness of breath, especially if you have traveled to Asia in the last 2 weeks or have been exposed to someone who has. If possible, put on a facemask or scarf before emergency medical services arrive.

CHCC Clinic: (670)234-8951

Cannabis and Cancer: What do we really know?

By Dr. Peter Brett, MD – Medical Oncologist

As an oncologist for more than a quarter century, I see several hundred patients with cancer every month. Care involves treating, counseling, supporting and listening to them. More than a third of those diagnosed with cancer will unfortunately die from it, and no one escapes its effects on health. Nearly everyone diagnosed with cancer will ask these questions: How can I make this cancer go away and stay away? How can I get relief from symptoms, such as nausea, pain, and poor appetite? What can I do to improve my sense of well-being? Now that cannabis will be legally available in the CNMI, many of my patients and their family members will want to know whether cannabis can help or hurt, and how it’s used medicinally.

Parts of the cannabis sativa plant can be turned into many products these days, and you can get them into your body in a variety of ways. Cannabis can be smoked, vaped, eaten, and “dabbed” (which involves the flash vaporization of cannabis concentrates applied to a hot surface and inhaled). The plant has more than 100 “cannabinoids,” related compounds that bind to cannabinoid receptors in the nervous system. The main two—tetrahydrocannabinol (THC) and cannabidiol (CBD)— are often put into cannabis products in different ratios. THC is the only cannabinoid that’s “psychoactive,” causing the euphoria of a marijuana high. THC is also formulated as a Food and Drug Administration (FDA) approved drug—dronabinol—which has been around for 30 years. Is cannabis an effective treatment? After a massive review of the current scientific literature published recently by the National Academies of Sciences, Engineering, and Medicine, here’s the truth as I know it, and how I respond to my patients’ questions.

1. Do cannabis products make a cancer go away and stay away? Though there are anecdotal cases of cancers receding with cannabis, there are no major, well-done studies in people that show a general benefit. It’s too bad these studies haven’t been done, and maybe they will be done some day, but in the meantime, we have many proven and effective treatments for cancer that should be considered first. Nevertheless, at some point in their treatment, some patients will opt to try cannabis products with different ratios of THC and CBD, and I think that’s okay, there’s little harm in trying.

2. Are cannabis products effective in minimizing cancer symptoms such as nausea, pain, and poor appetite? Absolutely. However, the effect is only mild to moderate. For severe nausea or pain, we have better treatments, but cannabis products often have few side effects, which can be an advantage. It’s likely that THC helps best with nausea, but both THC and CBD may help relieve pain and improve appetite.

3. Do cannabis products help improve a sense of well-being? Studies show that patients with advanced cancer can have an improved sense of well-being if they use cannabis that contains THC. However, some people don’t like the “high” feeling that THC causes. Here are two real examples, of patients who used cannabis as a medical treatment, which resulted in different outcomes. (Their social and clinical histories have been changed to maintain confidentiality.)

Case One: Patient LS is a 50-year-old woman, a tennis player, with prior sun exposure. She developed a serious skin cancer called melanoma, in the skin of her left arm, three years ago. This was surgically removed, but unfortunately the cancer spread extensively to her lungs a year later. We recommended treatment with immunotherapy (which stimulates immune cells to attack the cancer) which has been approved by the FDA, but the patient opted to try cannabis oil that contained both THC and CBD. Though LS felt a little “spacey” and “forgetful” from the oil, remarkably, the melanoma in her lungs has gradually gone away. Now, two years later, CAT scans show no sign of melanoma, and she’s probably cured. It’s possible the cancer might have spontaneously improved on its own, but cannabis certainly could have played a role.

Case Two: Patient RL is a 60-year-old man, a retired business executive, always in good health. A year ago he was losing weight and experiencing pain. Exam, blood tests, and scans showed he had prostate cancer, and it had spread to nearly all his bones. Chemotherapy and hormonal treatments helped for a time, but the cancer then quickly got worse. RL didn’t try another type of chemotherapy that we recommended, and instead took only cannabis oil with THC and CBD. Although he felt a little better for a few weeks, the cancer continued to grow rapidly, and he recently died.

Bottom Line: Though there are anecdotal cases of cancers receding with cannabis, there are no major, well-done studies in people that show a general benefit.

Hand, Foot, and Mouth Disease: Symptoms and Advice

By Dr. Elizabeth Triche, MD, MPH – CHCC Pediatrician

We have been having a lot of “Hand, foot and mouth” disease, caused by Coxsackie virus, in clinic in the past 2 weeks. It can cause high fevers and blisters or red spots in those areas, as well as cough, runny nose, and loose stools. Kids younger than two can get the rash all over their body, in addition to their hands and feet and mouth. Patients may just have the fever or the rash with no other symptoms.

If your child has this, the virus itself generally isn’t a big deal and their body should get rid of it in a week or so. There is nothing your doctor can do to speed this up (generally no clinic visit is necessary). The big thing is that the mouth lesions can be super painful, so keeping them hydrated and getting them to drink enough can be extremely challenging. IF THEY DO GET DEHYDRATED, TAKE THEM TO THE DOCTOR. Dehydration is very serious, and can be life-threatening. If they are urinating less than usual and it has been more than 6 hours since their last urine, they are already getting too dry. Later signs of dehydration are when they stop crying with tears or the soft spot on a baby’s head starts to appear sunken and they no longer have energy to wake up.

Tips for caring for a child with Coxsackie virus:

  • It’s okay if they don’t eat for a few days if they’re otherwise healthy kids, but they need to be drinking.
  • If they aren’t eating anything, they’ll need to take some drinks with salts in them (such as Gatorade, Pedialyte, or soup broth) to keep the salt levels in their blood from getting low.
  • Ibuprofen/Advil/Motrin is a much better pain reliever for this kind of inflammatory pain than Tylenol/Acetaminophen/MPAP.
  • Don’t give them any acidic foods or drinks (such as orange juice or pineapple) as this burns the open wounds in their mouth. Milk, water, popsicles, and jello are all soothing sources of hydration.
  • If your kid is having trouble drinking because of the pain, you can try “magic mouthwash” a mix of equal parts maalox, benadryl and lidocaine that can be painted on the lesions with a q-tip so they are soothed long enough to drink.
  • Please also note that they are VERY CONTAGIOUS. Be sure to wash your hands meticulously after touching their saliva or stools as they are contagious and shedding virus in these fluids

While this virus is generally self-limited and requires no medication or care from a doctor, we are always happy to see you at CHCC if you have concerns. If you believe someone’s health or life is in immediate danger, please call 911 or bring them to the CHCC Emergency Room. The advice and opinions presented in this article do not necessarily reflect the official views or stance of the Commonwealth Healthcare Corporation.