The Guam Memorial Hospital was falling apart and had lost national patient safety accreditation . The Department of Mental Health had been struggling to remain out of federal receivership due to longstanding human rights violations . Most famously , Public Health ’ s main clinic and laboratory had just been ruined by a catastrophic electrical fire due to foolishly deferred maintenance .

Covid-19 brought Guam to its knees , stranded one of America ’ s mightiest aircraft carriers in our waters , and forced churches across the planet to close their doors .

As I write this report , the virus has infected more than 123 million poor souls and killed more than 2.7 million people around the world .

Guam infamously became one of America ’ s top coronavirus hotspots with the most Covid-19 cases and deaths per capita right after the Centers for Disease Control declared our island unsafe for travel in August 2020 .

Globally , lockdown measures like the quarantine of billions of human beings and the massive closure of international borders were implemented . While too much of the American nation had been slow to fear the virus , the people of Guam wisely figured out how to mitigate the spread of Covid-19 and flatten the curve .

One year later , the lockdown did what it needed to do : starve the virus and allow Guam ’ s medical community to strengthen itself in order to save lives .

As we work to regain accreditation at GMH and build a stronger public health system , we must also acknowledge the essential role Tier 2 clinics played in our fight against Covid-19 .

The Centers for Disease Control warned that during widespread

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Covid-19 transmission , large numbers of very sick people will need medical care at the same time . Public health centers and hospitals may become overloaded with terrifying rates of critical illness and unnecessary deaths . Critical infrastructure , such as law enforcement , emergency medical services , and community transportation may be expected to be overwhelmed .

In March 2020 , as already beleaguered island hospital resources were being inundated by the rising tide of acutely ill non-Covid patients , Guam ’ s governor declared , “ We must do more … if we don ’ t cut our ( Covid ) spread rate in half to 16.5 percent , our health care system might be overwhelmed by next week .”

Gov . Lou Leon Guerrero thus issued an executive order to create the Covid-19 Unified Response Action Team . The C . U . R . E . team was empowered to make use of all medical facilities on the island to fight the spread of the coronavirus .

Tier 2 status designated FHP , the American Medical Center and the Seventh Day Adventist Clinic as Urgent Care centers for non-Covid-19 medical care and satellite emergency facilities for the Guam Memorial Hospital .

Without concern for their own comfort or safety , Tier2 clinics shared their staff resources and expertise to all who came seeking care . In the spirit of Inafamaolek , the men and women of the Tier2 clinics enthusiastically accepted the responsibility of taking care of all of Guam ’ s people . Because of prolonged material delays in the government of Guam , Tier 2 clinics patriotically invested in enhanced protective technology to quickly expand Guam ’ s very limited testing and triage capacity .

“ We prioritize if you have symptoms , all patients who are symptomatic we try to see them the same day at the Tier 2 clinics and those patients are seen at no-cost to them . They come in , they get screened for symptoms , get seen and

they walk out . Whether they have insurance or no insurance … it ’ s at no cost to them ,” said Hoa Van Nguyen , American Medical Center chief physician .

Dr . Nguyen warned that the limitation of the Tier2 clinics is the amount of patients they can realistically see every day . Nguyen said the only way they ’ ll turn a patient away is if they ’ re absolutely maxed out for the day . “ Typically , on the average day we ’ ll see 30-50 patients , sometimes much heavier , depending on how sick the population is ,” Dr . Nguyen observed .

Tier 2 clinics kept their clinic staffing levels fully operational as they were swarmed with patients who were diverted from the hospital . In order to free up the hospitals , Tier 2 clinics had to shut down their usual business operations to all other types of patients .

Based on the governor ’ s orders , Tier 2 clinics stopped their routine clinic work with established patients and took in everyone who came for treatment regardless of their ability to pay . Immediately , Tier 2 clinics were overwhelmed with Guamanians who were coughing , short of breath , and febrile .

In addition , many patients with chronic medical problems were anxiously scrambling to see a Tier 2 doctor because many outpatient medical facilities including Public Health ’ s Southern Regional Community Health Center were closed due to fear of the virus or deferred air conditioner maintenance .

The tragedy is that chronic conditions like hypertension , diabetes , kidney disease , emphysema , stroke , and obesity are treatable but will worsen when medical services are disrupted . As a result

of Guam ’ s Covid-19 chaos , a surge in deaths from non-communicable diseases like heart attacks and kidney failure is possible . Recognizing this real threat to Guam ’ s health and despite the great cost , the governor wisely forced the Tier 2 clinics to provide necessary patient services in order to save lives thus likely saving the economy .

According to a World Health Organization report released last September 2020 , when Guam ’ s worst Covid surge was occurring , the number of people dying prematurely due to poorly treated diabetes increased 5 percent worldwide during the Covid pandemic . Because of the virus , more than half the countries around the world including some of the richest nations were reporting massive disruption of medical services to treat diabetes , hypertension , cardiovascular emergencies and cancer .

On Guam , Tier2 clinics used an innovative mix of medical triage , telemedicine , and the sweat of their brows to help mitigate the impact of Covid-19 in our community . Locally grown healthcare workers quickly became expert at state-of-the-art Polymerase Chain Reaction Covid testing and epidemiologic contact tracing . High resolution virtual conferencing activities became the clinical standard for timely scientific updates within a fast-changing fluid Covid environment .

As many wise people have recently observed , Guam ’ s economy cannot thrive if its people and its private businesses are sick and dying . In navigating this pandemic , the government of Guam must first prioritize the health of our community . Tier 2 clinics and many other private sector entities have sacrificed greatly and suffered much fiscal pain while the government of Guam has refused to cut its own waste and internal corruption . The state of Guam ’ s healthcare and the health of all its people will never collectively improve until the government of Guam finally and sincerely puts service before self .

Dr . Vincent Akimoto practices Family Medicine at the American Medical Clinic . Send feedback to akimotovince @ yahoo . com