There’s no denying the shortage of obstetrician-gynecologists on island or that it has impacted the care of pregnant women, their babies and elderly women. But, like with all things, there are different perspectives on the extent of the crisis.
The Guam Daily Post spoke with Isa Muna, a mother who welcomed the birth of a baby boy on Tuesday at the Guam Memorial Hospital. She spent the last nine months of pregnancy and then delivering a newborn in the midst of the OB-GYN care crisis, but, she would have never known if it weren’t for recent news.
“I was able to get seen within three weeks of calling Dr. Gable. I was in my first trimester,” Muna said.
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Prior to this pregnancy, Muna suffered the loss of her newborn. When she found out she was pregnant again, she communicated with her OB-GYN to ensure the safe birth of her son, who is now a few days old.
“I was provided great care at the hospital by my doctor and the staff, especially with what happened in my last pregnancy. I wasn’t a high-risk pregnancy, but I explained to my doctor what had happened so my doctor made sure I had options of what I could do. He made me feel that he was very concerned about making sure I had a safe delivery,” Muna said. “He reassured me that I would have the best care and I did. Even the nurses there, they really updated me on what’s happening with my baby. I personally can say that I didn’t feel any impacts from the health crisis because I got the best care.”
For Muna, the 50-year-old building and 40-year-old labor room design did not negatively impact the care she or her son received.
The current delivery rooms are based on a 40-year-old model, that moves the expectant mother roughly three times as she progresses in labor. The model is still used by hospitals today.
The need for a Maternal Health Department at GMH was highlighted as word of the crisis faced by women spread Friday. But, as Dr. Annie Bordallo, an obstetrician-gynecologist, indicated, quality of care, which is at the center of the OB-GYN care crisis, is not measured by the aesthetics of a room.
“Whether you have to move three times does not make it unsafe. Quality of care is determined by your doctors and nurses, who’s paying attention, and equipment,” Bordallo said.
Mothers have been giving birth since the dawn of time, the experience is, for the most part, natural.
“It’s an almost natural kind of specialty. We need very little equipment to actually provide good care. Also, we are generally treating young healthy women, it’s the occasional patient that needs an intensive care unit,” Bordallo said.
“Every day all of us who deliver babies at the hospital feel like we provide safe care. I don’t think I ever went into the hospital and thought, ‘Oh gee, my patient has to move into this room that’s going to cause a problem for the baby or the mom.’ It’s inconvenient but it doesn’t affect the quality. It may affect the patient’s experience and yes we would like to have a nicer experience for our patients.”
But that doesn’t mean that pregnant moms can’t have a baby safely.
“We deliver 200 babies a month and, really, again, most of the OB-GYNs, we have midwives who deliver babies, we have family practice people who deliver babies. We need to support that part of the practice,” Bordallo said.
While Muna’s pregnancy and delivery was positive, doctors have agreed that in terms of expectant moms being able to see an OB-GYN, it is difficult. But, not unique to Guam, according to Bordallo.
“I think there’s a crisis everywhere. I think maternity units are closing across the country. There’s lots of areas that there’s shortages in OB-GYN. Here on Guam it’s hard to recruit doctors to stay so, yes, patients are having a hard time getting in,” Bordallo said.
The shortage of OB-GYNs does not exist for a lack of trying to recruit — across the board hiring for doctors whether private or public is difficult.
“We have tried to hire Locum tenens, we just don’t get any hits. So I think some of that is our reimbursements or wages here, certainly when we don’t get hits we try to raise the pay but I think it’s a much bigger issue than OB-GYNs itself,” Bordallo said.
Making better use of the OB-GYNs here on island is one way to stabilize care.
“So that they see the high-risk patients and certainly if you have primary care services then your family practice can see patients in the first weeks. They can order an ultrasound, they can listen to a heartbeat. I think that’s really a systems issue. People can get together and train up their employees to provide these basic services in the beginning and do risk assessment. But again this requires a discussion amongst all providers,” Bordallo said.
The OB-GYN encouraged attention to be placed on finding solutions to address the complex issue, like utilizing the manpower resources at hand.
When asked if the few obstetrician-gynecologists were handling the patient load well, Bordallo spoke candidly.
“No, there’s more patients than there are us, so who suffers? Of course, the gynecology patient suffers because really unless they are having a cancer, somebody who needs a Pap smear is the one that gets delayed because OB patients can’t wait,” Bordallo said.
It, again, boiled down to training.
“My nurse practitioners can do Pap smears. They don’t need an OB-GYN to do Pap smears. Family practice and primary care doctors can do Pap smears. A lot of contraception, intrauterine devices placements, a lot of the basic gynecological care needs to move into the primary care clinics,” Bordallo said. “These are ways we can mitigate the shortage. I don’t know how it’s going to change, we all get older,” said Bordallo.
This is not the first time Guam has faced a shortage of obstetrician-gynecologists. In fact, Bordallo recalls returning to Guam as a new OB-GYN decades ago.
“The obstetrician-gynecologist in the community were taking care of all the patients even the ones that didn’t have doctors. We were the ones delivering them at the hospital and the pervasive attitude at that time was, ‘Wow! Thank God you came home because we’re so short,’” Bordallo said.
During her earlier years practicing on island, there was a brief period that an overflow of obstetrician-gynecologists from U.S. Naval Hospital were allowed to work with the local community and at GMH.
“There was a lot more access for a few years then they downsized. They went back to Naval Hospital and weren’t allowed for quite a while, probably five to 10 years where they didn’t have enough staff to be able to come out and help the community,” Bordallo said.
At the time, GMH was busy enough with pregnant moms to have to hire hospitalists, obstetrician-gynecologists that only delivered newborns at the hospital, had no doctor or prenatal care at the Department of Public Health and Social Services.
The rotation of Guam obstetrician-gynecologists ebbs and flows.
“There’s times when we are short and currently people had an emergency, people are retiring or thinking about retiring and so it’s harder to get in to see somebody. But again, I can’t think of a specialty where that’s not true,” Bordallo said.
There are many different circumstances today that stress the system.
“I think everywhere is declaring an emergency. This is a nationwide issue. It’s always a crisis. Do we need to continuously talk about that and scare people or do we need to really rethink how we provide health care,” Bordallo said.
She said the focus needs to be on building a healthier population.
“Everybody is trying to rethink how do we get less high-risk patients that require less complex care? We have to be a healthier population. Feed our kids better food, educate them and get them out playing again,” Bordallo said. “People have to be willing to come together and talk about what can we do tomorrow, what can we do a year from now, what are the best strategies and there are many of us that talk about it. … We have to be able to share, disagree and discuss.”
With the number of high-risk pregnancies increased today, she said that a less healthy population has been one of the factors in the crisis.
“I think the big change over the 20 years is we’ve gotten less healthy. So the investment isn’t to get more of us, the investment is how do we make people more healthy,” Bordallo said.