By Joy White
Despite various challenges, Guam’s health care providers and professionals strive to bring comprehensive health care to the island to address the most prominent medical issues, including heart disease, cancer, diabetes and even mental health.
The top three causes of death in Guam for 2013 and 2014 were diseases of the heart; malignant neoplasms, or cancers; and cerebrovascular disease, or strokes.
Dr. Annette David, director of consulting services of Health Partners LLC, points out that these diseases can impact the economy and are also preventable. Chronic diseases place a financial burden on the patients and their families as the costs of constant medical care build up.
Businesses are also impacted financially. “The employer [is impacted] in terms of increased insurance premiums they will have to pay but also the loss in productivity that happens when you have employees or a workforce that is chronically sick,” David says.
In addition, other lifelong, but mostly nonfatal, conditions that need to be treated but for which no services are available on Guam could be having an economic impact as well. Allergologists, of which Guam has none, treat allergies that could cause loss of productivity for businesses when employees must take sick leave due to bad allergies.
Guam’s workforce needs to be kept healthy, David says, because its supports both the older and possibly ill population as well as the youngest part of the population — babies and youth who cannot contribute to the economy yet.
“You must ensure that your workforce is as healthy as it can be because the implications for the economy are very significant. So a healthy workforce is really fundamental to any sort of development, and a healthy workforce should be a business priority,” David says.
Meeting Guam’s health care needs
“The top three diseases killing the people of Guam are heart disease, strokes and cancers. And obviously diabetes is a huge problem too. Unfortunately, we have a heart attack age median that’s almost 10 years younger than the national average, and that’s sad. There needs to be a lot done in prevention and education,” says Dr. Michael W. Cruz, chief medical officer of Guam Regional Medical City.
The hospital is equipped with specialists to address several of Guam’s top health concerns: a neurologist and neurosurgeon to address neurological concerns that could lead to stroke; an interventional cardiologist, EPS cardiologist and pediatric cardiologist to address cardiovascular concerns; and a fully comprehensive cancer center to include adult and pediatric oncology and radiology oncology.
Since the hospital’s grand opening in July, it has passed several milestones, including the island’s first four open heart surgeries, which took place in December; the island’s first procedure to install a carotid stent; and successes in the urology department in performing minimally invasive nephrectomies.
“It wasn’t a part of our initial plan, but we’ve
developed a very robust pediatric team,” Cruz says. The pediatric team includes a pediatric intensivist, pediatric intervention cardiologist and neonatologist.
In the coming months, the hospital will boost its heart surgery program into a long-term, sustainable department.
While cancer remains a top health concern, professionals in patient services are seeing a change in behavior and availability of resources.
“In our first year of operation, a lot of patients who came through our doors were already at the later stages [of cancer], stage 3 and 4. What we have noticed is that since our inception, we are still seeing patients coming in at stage 4, but more and more they’re coming in earlier,” says Ellie S. Ongrung, program director of patient navigation of Guam Cancer Care, a nonprofit patient navigation organization.
Since its inception, Guam Cancer Care has registered over 800 patients, of which 445 are actively utilizing the services. The remainder has passed away, went into remission or relocated to be near family.
The trend is going toward a better medical community on Guam where a majority of services a cancer patient would need are becoming available for them, Ongrung says.
“It helps a lot, too, that now we have more options available to cancer patients as opposed to before in our first year when we only had two oncologists and one radiology oncologist. Now we have five oncologists and two radiation oncologists. We also have interventional specialists that can do more technical treatments, like intrathecal chemotherapy. More and more patients now are opting to stay on island,” Ongrung says.
As a supplement to hospitals and clinics, additional ventures have formed to fulfill specific health-related needs in the community.
“We started Health Services of the Pacific in 2004, and it was to meet a piece of health care that wasn’t quite there. You had the hospital and you had the clinics and you had the pharmacies, but you had this group of patients who would go from the hospital home and not quite bounce back without some assistance, and they couldn’t come into the clinic to be seen. So the health care had to go to them,” says Ruth Gurusamy, registered nurse and administrator of Health Services of the Pacific.
Eventually, the team of three nurses providing home care and hospice services to 10 patients grew to a company of 77 employees offering comprehensive care to more than 300 patients. HSP’s services expanded to include outpatient physical, occupational, speech and respiratory therapy; social work; counseling; a pharmacy; medical transport; diet consultation; and most recently, a clinic with a focus on geriatrics.
HSP’s main clientele are aged 65 years or older. Diabetes and complications for diabetes, such as amputations and wounds, make up a large portion of HSP’s patient conditions. HSP’s nurses and staff are able to evaluate how patients’ lifestyles, including diet, impact their condition and help them adjust to preserve their quality of life.
Magas Patriot Group, a Guam company comprised of business and medical professionals, is working to build Guam’s first assisted living facility in Mangilao, which will offer various wellness programs, medical care, activities, food and beverage services and other amenities to enhance the quality of life for seniors in a home-like environment.
The facility will feature 100 units, of which 70 will be assisting living apartments and 30 will be dedicated to memory care.
“We hope to break ground sometime in July this year, completing the building and being open for business in the latter part of 2018,” says Brian Hahn, a member of Magas Patriot Group.
The group’s research shows a potential market segment of more than 10,292 residents 65 years of age or older, as well as more than 65,000 Guamanians who have relocated off island to the U.S. mainland or other parts of the world.
The issue of access
“Are there challenges to health care? Oh,
absolutely. It costs money,” Gurusamy says. Patients who cannot afford co-payments put off seeing a doctor and, as a result, end up paying more for worsened conditions, she says.
Studies by the Department of Public Health & Social Services show that there is a significant proportion of Guam’s population that is uninsured or underinsured, David says.
“Once you don’t have [insurance], it’s very difficult to get into the health care system. So that’s an issue of access. We may have the resources, but if people can’t get access to the needed health care, then you don’t have as much as an impact,” David says.
According to David, data collected from Medicaid and MIP patients showed the direct cost of cancer-related medical services, not including loss of wages and productivity, was $20 million for five years.
Location can be an obstacle to access. David and the Department of Public Health & Social Services conducted a geomapping study of diabetes services on Guam, determining the location of diabetes services and comparing it with where the people live.
“Most of the sources of care were centrally in Tamuning or in Dededo. But when you look at the central part of the island and the southern part, there was hardly anything available. So people who may not have transport would still not be able to get to where they can get care,” David says.
Ongrung reports that in the early years of Guam Cancer Care, patients’ concerns included financial issues, transportation and access to supplies. As a result, the organization expanded to meet these needs to include a transportation program, maintaining a stock of supplies for patients and offering a financial assistance program to provide for eligible patients. The organization also collaborates with local, national and international foundations to find financial support for qualifying patients who need more assistance.
“We try to find every resource our residents on Guam are eligible for,” Ongrung says.
Suicide is one of the island’s top 10 causes of death, with a rate 50% more than the United States based on population. The U.S. suicide rate is 13 per 100,000; and Guam’s is 19 per 100,000. Data from a youth-based behavior survey shows that youth are at a high risk, with one in four high school students reporting to have made plans to commit suicide and one in five reporting that they have tried.
“Children as young as 8 or 10 years old are attempting to commit suicide. We need to have better way of capturing the data, but the data that exists seem to indicate that a lot of it has to do with family relationships and that it is the driver for suicide behavior,” David says.
Depression and alcohol and drug use contribute to the risk of considering suicide. “Those are issues that have to be dealt with simultaneously as doing the suicide intervention and prevention,” David says.
While suicide plagues the youth, the elderly face their own mental health struggles.
“In our population size [of the elderly] depression is the biggest one. Depression is because of the loss of ability do anything. Their functional ability has just deteriorated to the point of they have had to be dependent when they have been independent their whole lives and all of a sudden they become dependent. And their mind might be sharp, but they need care,” Gurusamy says.
Elderly patients could also be suffering from trauma experienced years ago during past wars, which is combined with dementia, Gurusamy says.
“Suicide is not as high [among the elderly] but depression is big. Depression is big in the care givers for the patient or the patient,” Gurusamy says.
While the completion and opening of the Guam Regional Medical City has helped, the number of hospital beds on Guam is still an issue.
“We are still not at what the World Health Organization would recommend as the ideal [capacity], which is about three beds per every 1,000 people,” David says.
“The situation is getting better, but we still have a ways to go,” David says.
Cruz reports that GRMC is making efforts to open additional rooms; however, it is victim to a national shortage of registered nurses.
“Our challenge has been staffing a hospital on a resource-strapped island where health care force is already lacking as it is, not to steal them from anyone else that is already having a hard time and to bring additional nurses in,” Cruz says.
The University of Guam graduates a limited number of nurses every year, and even so, GRMC’s services require a team with specialized knowledge.
“Our goal is to bring specialty service to Guam, but there is an understanding that specialty services require a special team. It’s not just a doctor, it’s the tech, it’s the nurses, it’s a full team that takes care of them,” Cruz says.
Gurusamy agrees that registered nurses are very much needed in Guam, and in the homecare sector finding a trustworthy and passionate nurse is an added challenge.
While GRMC has provided several much-needed specialists, still other areas are lacking. Guam has no rheumatologists, for example, to treat autoimmune diseases such as lupus and arthritis, from which many people on Guam suffer from, David points out.
The Guam Medical Referral Office reports that 3,355 Guam residents were assisted with off-island referrals in fiscal 2015, a majority going to the Philippines to for services not available on Guam.
Photo courtesy of Guam Regional Medical City