Pediatrics

The full-spectrum care of all children up to the age of 17, mainly delivered via the Nursery, Outpatient Clinic, and Inpatient Ward.

Doctor shortage fears in American Samoa

This article from Radio New Zealand point out a very serious problem but, unfortunately, the problem is much more severe than just the lack of a few medical staff. 

Read full story on RNZ

Medical sector workers in American Samoa say there is an urgent life and death situation with the hospital relying on a single pediatrician.

Two doctors from the Department of Health have been sent to help out at the Pediatric Department of the LBJ Hospital, after the sudden death of long serving pediatrician, Dr Tagilima Iatala, last week.

A replacement is due on island next week.

The chief medical officer at the LBJ, Iotamo Saleapaga, said the two public health doctors would mean they could manage until then.

But some medical staff said the situation was more serious than what the LBJ management is making it out to be.

They pointed out that the work load for the remaining pediatrician was too much and had been for a long time.

They said it had taken the hospital more than a year to recruit new pediatricians and one additional doctor was not enough.

They said some inpatients had conditions where the pediatricians had to keep an almost 24-hour watch because of seizures and other complications.

The medical staffers said this was an urgent life-and-death situation and the leaders needed to come and see for themselves and not take the management's word for it.

Concern for the Children of American Samoa

My name is Tangra Broge and I am a pediatrician. I too have been gravely concerned for the wellbeing of American Samoan children. While on-island I was privileged to work under Dr Marrone's leadership and deliver excellent medicine to the children on the island. At a time when the healthcare was/is in dire straights, I witnessed hospital administration push qualified physicians and other mid-level practitioners out for their own personal gain. Dr. Marrone was one of those individuals.

Dr. Marrone has impeccable credentials and is board-certified in pediatrics and tropical medicine. During Dr. Marrone’s 14 years of leadership the pediatric department was historically well staffed with ample local, international, and U.S trained pediatricians. A thriving rheumatic heart disease program was instituted with marked improvement in medication adherence and heart failure prevention. Dr. Marrone spearheaded biannual cardiology clinics in partnership with off-island pediatric cardiologists, providing invaluable specialized care and echocardiograms for high-risk pediatric heart patients. A “preemie program” for high-risk infants was instituted with tremendous success. Like many other qualified, trained providers, Dr Marrone eventually resigned due to the undue pressures from the CMO. 

During my time on-island I also saw the closure of the Primary Care Clinic at the LBJ Medical Center. This forced the resignation of the board-certified chief of Family Medicine, Dr. Sean Stracensky. In a territory with obvious need for preventative adult care this decision has resulted in a significant decline in services for adult patients and unprecedented wait times at the emergency department for refills and non-emergent services.

And recently I saw in Samoa News that distraught nurses were forced to use garbage bags for underpads in patient hospital beds and tearing and utilizing bedsheets for dressing changes! In a hospital that is funded by U.S. federal dollars, I think the need for action and correction of mismanagement is obvious. I still have many dear friends on the island and had hundreds of patients and families that I was privileged to care for. I hope that someone takes notice and intervenes for the people of American Samoa.

Fa'afetai Dr. Marrone

 

Having worked in the medical field for over almost 3 decades in several states on the mainland as well as in Europe, Dr. Marrone stands out as one of the most talented and dedicated physicians I have ever worked with.  While I only had the honor of working side by side with him for 8 months, he certainly left a lasting impression.  The intention of this letter is not to criticize or judge anyone but mainly to recognize an exceptional physician, human being, American, who gave his entire professional career and a good part of his young adulthood for the welfare and health of the children of American Samoa.  His contributions to your island should be recognized and not forgotten as he has saved countless of children, the island’s future.  

I met Dr. Jim Marrone at a childrens medical conference in Jacksonville Florida in the spring of 2014.  Prior to meeting him, my husband and I had several discussions about the possibility of living and working in American Samoa.  My husband highly praised the island and it was his dream to have his children experience American Samoa.  So I was really excited when I saw that there was a talk about Newborn hearing screening in island nations by Dr. Jean Johnson.  I attended this talk and it was there I introduced myself to Dr. Marrone and expressed my desire to help in anyway that I can in American Samoa.  I was beyond excited to tell my husband of the news and naturally this pleased him.  After several phone discussions with Dr. Marrone and LBJ administration (actually 9 months later) I received a letter of offer to join the pediatric team at LBJ Tropical medical Center.  I informed my current place of employment that I would be leaving to move to Samoa.  As a mother of 4 children, naturally my main concern at the time was, would they be happy, would they adjust, how would the island receive them?  So, I arranged for them to visit American Samoa during Easter break in 2015.  They were completely struck by the islands raw beauty and the openness of the people.  Unfortunately during my visit, I was informed by hospital administration that I did not have a job with LBJ and also I missed the deadline for the national health service corp (NHSC) to pay back my school loan because LBJ did not check off a box to verify my employment with them. The NHSC, funded by the US government, offers financial and other support to primary care providers and sites in underserved communities, American Samoa is considered an underserved community.  Needless to say I was heartbroken and out of a job, however Dr. Marrone was able to negotiate with the powers to be at LBJ and a new offer of employment was awarded to me albeit $13,000 less than what they previously promised and half of what I was earning in Seattle.  I prayed hard and decided the best thing to do was to be grateful for the offer and do the best job possible.  So my family and I traveled back to Seattle packed our things, rented out our home and moved to the village of Failolo.  

I quickly jumped in to my new role as a member of the pediatric team learning about the various tropical diseases that afflict the nations children.  I was especially amazed and distressed at the compelling incidence of rheumatic heart disease, a disease that has declined dramatically over the past century in the mainland.  Just so sad to see kids walking around with failing heart valves from a preventable bacteria and no pediatric cardiologist to treat them.  However, because of Dr. Marrone’s efforts, US trained practitioners have been recruited throughout his time there who have championed programs to treat this issue.  He has also helped raise tens of thousands of dollars to bring trained cardiologists to the island to treat children afflicted with this disease despite criticism from LBJ’s powers to be.  I remember attending a Wednesday morning continuing medical conference (CME) at LBJ and listening to a presentation by a Stanford trained cardiologist who spent her vacation time to travel to samoa to help with the RHD program.  She discussed her study identifying risk factors for the disease.  Her talk however was not well received in fact was dismissed by one of the powers to be at LBJ while the other power to be let out a loud yawn.  During my time at LBJ, I saw 2 trained US physicians leave because of the hospitals conditions and then the dreaded news of the failed negotiation between Dr. Marrone and LBJ admin in regards to his contract.  I too considered leaving the hospital with Dr. Marrone’s departure.  Again, I prayed hard and decided to stay and do the best job possible in a safe manner without Dr. Marrone’s guidance.  However things just weren't the same without him.  It felt as if a light went out in the hospital with his departure and furthermore that no one had the courage to do anything or even say anything about it.  As for me, I felt less than a pawn in a game of chess.  The beautiful smiles of the children and the gratefulness of their aunties and or parents gave me strength as well as Dr. Maria and the nurses.  During my time there, several rumors about the powers to be at LBJ circulated such as they wont be happy until the last palagi leaves the hospital, that they don't want or need US trained medical staff, that the palagi just wants to colonize the island.  I tried hard to ignore the rumors but they weighed heavily on me in an already severely understaffed department with very sick, sick kids.  At the same time the administration stated that they are actively trying to recruit US trained practitioners so they can bill and receive the necessary funds to run the hospital.  Does American Samoa want US trained practitioners?  Would they prefer that the US breaks away altogether?  Currently it is a US funded hospital that requires US trained practitioners to bill appropriately.  Therefore it is understandable the chief of pediatrics at the time, Dr. Marrone would advocate for healthcare standards equivalent to those on the mainland.  

Presently, my family and I have returned back to Seattle with a void in our heart and confusion in our spirit.  My children absolutely loved living there and hopefully have made lifelong friends.  My 14 year old came home from football practice excited to tell me about a kid on his team who is Samoan…I cried.  I cried for the kids who I know would benefit from Dr. Marrone’s care, the pediatric team who desperately need help, a sense of personal failure, and an end to my husbands dream.  Yet, I am grateful we had this experience.  My kids are that much richer in their world view and hopefully the island will invite them back.  I am grateful for my Seattle community welcoming me back.  Actually one of the first days back to work at Seattle children's I met a Samoan woman and her daughter….from Failolo. 

Fa’afatei tele lava.
Patricia Cleary Nurse Practitioner, Seattle