Keck Medical Center of USC recently welcomed Lourdes “Lou” Leon Guerrero, MPH, governor of the U.S. territory of Guam, and her staff, who had flown in to meet with executives, tour the facilities and look in on a patient from their home territory.

The day was a key step in the developing relationship between Keck Medicine of USC and the government of Guam and their continuing collaboration to improve the health and well-being of the territory’s citizens.

Juan Carlos Quiros, MD. (Photo/Ricardo Carrasco III)

Discovering a need in Micronesia

A U.S. territory located in the Mariana Islands in the Pacific Ocean, Guam has been medically underserved for decades.

Five years ago, Keck Medicine saw a chance to expand its presence to Guam. When the opportunity arose, members of the health system’s leadership met Juan Carlos Quiros, MD, a Southern California cardiologist who had been traveling to the island to treat local patients for over 25 years.

When Quiros told them about care gaps faced by patients in the isolated region, they invited him to send patients to Keck Medicine for any specialized care that wasn’t locally available. The USC International Health team started working closely with payers and physicians in Guam and Los Angeles to make it easier for patients to travel over 5,000 miles to the mainland for treatment.

Quiros began sending a couple of patients per year from Guam to Keck Medicine. As a result of the exceptional care provided by Keck Medicine’s physicians and a streamlined care-coordination process by its international health department, hundreds of patients from Guam are now treated at Keck Medicine.

Rene Sotelo, MD. (Photo/Ricardo Carrasco III)

Eventually, Quiros was recruited to Keck Medicine. Keck Medicine urologist René Sotelo, MD, medical director of USC International Health, became acquainted with Guerrero, a former ICU nurse, and they began to discuss how the health system could improve health care in Micronesia.

Since then, patients from Guam have been flown to Keck Medicine for tertiary care, including for urology, otolaryngology, oncology and ophthalmology cases. This spring, Keck Medicine began to provide tertiary cardiac care to Guam patients.

Closing the health care gap

Cardiovascular and renal diseases are often found in this patient population, given that the island’s most prevalent diseases are diabetes and hypertension, as well as conditions with relevant genetic components.

Earlier this year, Quiros said that in the 27 years he has been visiting Guam to treat patients, however, he has seen a significant reduction in aggressive cardiovascular disease in the population.

“I remember when I first started going to Guam, it was not uncommon for us to be sending 30- and 40-year-old females to the mainland for bypass heart surgery because heart disease was so prevalent,” Quiros said. “The trend has improved significantly, though much work still needs to be done.”

Diabetes and renal disease, however, remain problems largely due to shortages not only in care but also in public health education and outreach in the area. There are also shortages in certain types of specialists.

“In Guam, they have well-trained internists and primary care physicians, as well as some specialists,” Quiros said, “but they need support in fields such as oncological surgery, urology, hepatology and even rheumatology — and, of course, cardiology and cardiothoracic surgery.”

To address these needs, Quiros and Sotelo said they hope to get specialists from Guam trained to perform more basic and common procedures so that patients would only have to travel off-island to Keck Medicine for tertiary care — the riskier, more difficult procedures.

“We want to give patients from Guam an option to receive the best treatment in the world,” Sotelo said during Guerrero’s visit.

Plans for the future

Guerrero visits Keck Hospital of USC. (Photo/Ricardo Carrasco III)

 While access to specialized care has improved for the population of Guam, the governor anticipates a need for major steps forward in the near future, including the construction of a new hospital.

“The people at our hospital are wonderful,” Guerrero said, “but the building itself is in bad shape. We commissioned the U.S. Army Corps of Engineers to look at our current hospital. They came back and said, ‘We can renovate it for $763 million or build a new one for $743 million.’”

Considering the difference in cost, plus the difficulties of assessing the full scope of structural problems of an older building, the governor decided to build a new hospital.

“The goal is to break ground by the end of my term in 2026,” she said.

Once the hospital is complete, she hopes Keck Medicine, already a preferred provider on the territory’s government worker health plan, will take the lead in guiding its operations.

“We’re drawn to Keck Medicine for their proven reputation as a progressive leader in new techniques and technologies in patient care,” Guerrero said. “We’re also looking to expand public health efforts and community health centers. Prevention is key because it decreases the costs of health care and improves quality of life for the people.”

Sotelo agreed, saying, “It’s not just helping the patients who need specialized care today. We’re trying to see how we can improve the health care system as a whole.”

In the meantime, discussions are underway to determine how telemedicine might be employed to support Guam physicians and patients alike and significantly reduce the number of trips patients must make to the mainland for care.

In a meeting with Guerrero, Marty Sargeant, CEO of Keck Medical Center of USC, expressed optimism about future collaborations between Keck Medicine and the government of Guam, saying, “I think that we can play a substantial role for them, and we hope to see this relationship flourish and the health of everybody in Micronesia elevated.”

— Kate Faye