Guam Memorial Hospital is facing serious staff shortages in its obstetrics and gynecology department after one of its physicians had to leave due to a medical emergency, administrator and CEO Lillian Perez-Posadas said.
With a limited number of physicians, the remaining staff is tasked with managing demanding 24-hour on-call shifts.
“It’s a concern because we have limited resources in terms of physicians who would then treat the health cases, and these are patients who don’t have a primary physician that they fund with their prenatal care,” Perez-Posadas said.
When patients arrive for delivery, the gynecologist on duty is called in to arrange the delivery.
“One doctor is called every 24 hours, so they rotate,” Perez-Posadas said. “We have three of the doctors who rotate, and we also have a nurse-midwife who covers.”
This places a heavy burden on the remaining staff as the average age of midwives is around 70 years old, raising concerns about their ability to cope with the physically and mentally demanding workload, especially as on-call shifts pile up.
“It is especially tiring if you are on call 24 hours a day. That’s why they need a few days off to recover or just get some rest,” Perez-Posadas said.
She emphasized the importance of recovery time between shifts and highlighted the toll it takes on doctors.
“We have our weaknesses, our shortcomings and our circumstances. We’re just not robots. We are human,” she said.
Perez-Posadas pointed out the human side of medical professionals and emphasized that doctors are not invincible machines, but people with limitations.
“Fortunately, not that many pregnant women come in within that 24-hour period. It doesn’t happen all the time, but there may be times when three or four pregnant women all come at the same time. That does happen,” she said.
She acknowledged the unpredictability of the work, noting that while this is rare, there are cases where multiple patients arrive at the same time, further increasing pressure on staff.
Perez-Posadas, who is in the same age range as some of today’s gynecologists, admits that age can affect stamina, but the doctors’ dedication keeps them going.
“My energy is not always that great, but it is a commitment. These doctors are really commendable, admirable… they are very dedicated and committed to doing their best,” Perez-Posadas said.
She also praised the clinical and medical treatment of patients, especially those who do not receive antenatal care.
“They really did a fantastic job of making sure that the care, management and medical management of these ladies who came in to deliver their babies was just amazing,” Perez-Posadas said.
Recruitment
Despite the crisis, GMH is actively increasing recruitment efforts. The hospital expects two new midwives, including a husband-and-wife team, to join before the end of the year.
The licensing process for these doctors is already underway with the Guam Board of Medical Examiners.
“Hopefully we can get them both on board as soon as possible, if not this week, then next week,” Perez-Posadas said.
GMH is also reaching out to a former Guam doctor to help ease the burden and provide patients with better coverage. As reported by the Pacific Daily News, two additional gynecology care centers will open in February and August.
GMH is also working to bring in a neonatologist to provide additional support, especially for newborns in the neonatal intensive care unit, where specialized care is crucial.
In the meantime, the hospital is relying on telemedicine support from neonatologists to help on-site pediatricians care for newborns, especially those who require intensive care or specialized treatment.
Perez-Posadas confirmed that GMH has neonatologists available 24/7 via telemedicine to assist with neonatal care. However, she emphasized that on-site pediatricians are responsible for direct care of newborns.
“We have pediatricians who care for the babies on site, but if a baby needs more specialized care, we have neonatologists available through telemedicine to guide them,” Perez-Posadas explains.
She also said GMH is working to further strengthen its team by recruiting a neonatologist and a registered nurse with experience in the neonatal intensive care unit.
“We are also bringing in a pediatrician with a cardiology specialty in January, which will help expand newborn services,” Perez-Posadas said.
Renovations delayed
When asked about the promised renovations to the labor room and concerns about the condition of the NICU, Perez-Posadas acknowledged the importance of the care being provided despite the current state of the facility.
“The nurses and doctors provide the best care possible,” she says.
She explained that funding for the Maternal Child Health Ward renovation project had already been approved in 2009, but the process encountered a number of obstacles, including the need for upfront financing and complications with the financial institution.
“We had to put out a request for proposal, but we couldn’t because of the circumstances on the financial side,” Perez-Posadas said. “They didn’t want this to stagnate, but there were factors we had to deal with and it just didn’t work out.”
She added that the hospital has now gone back to the drawing board and has reissued an invitation to bid for the MCH project. But even after extending the deadline, no contractors have come forward to submit a bid.
“It’s not that we don’t want this to happen, but if contractors don’t step up, it’s difficult,” Perez-Posadas said.
Despite the challenges, GMH continues to provide care, recognizing that it is the only place on the island where women can deliver their babies, she said.