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Op-Ed: Health Care System: ‘Free’ Ideology vs Sobering Reality


By Deeds of Cession, our forefathers ceded our islands — Tutuila and Manu’a — in 1900 and 1904 respectively. In 1902 and 1904, the President of the US formerly recognized the deeds of cession, and the Congress followed suit in 1929.

The US was not prepared to be responsible for the newly acquired territory. The delayed recognition of AS (American Samoa) reflected the delayed and slow development of health care in AS.

Despite the lack of commitment and adequate support from Washington, the Naval Governors and medical personnel were compassionate and committed to their calling. With sparse resources, they along with local leaders developed an ad-hoc health care system that helped address the needs of the people in the early 1900s. The USS Aberenda, naval auxiliary freighter that brought AS’s first governor (Governor Tilley), served as the governor’s temporary residence and housed the medical clinic for Navy personnel.

The Navy surgeon Dr. Blackwell saw the need for a dispensary for Samoans but government funds were not made available for such purpose. The good doctor nonetheless found and repaired a vacated wooden building in Fagatogo and had a falesamoa (Samoan building) built next to it and the first regular clinic for Samoans was established. The wooden building was for Navy personnel, the falesamoa housed Samoan patients. It became known as the “Government Hospital”. To the navy surgeon’s credit, governor Tilley commented “...he had given nearly all his time to the gratuitous treatment of island natives.”

In 1905, the first annual Meeting of Chiefs (Fono) was opened and convened once a year. While the Fono was not significant in administrating the territory, it was valuable in implementing public health policy. The collaboration between the navy administrators /medical personnel and the local chiefs proved effective in implementing preventive medicine and enforcing general public health policy in the territory.

In 1906, Navy funds were finally made available to build the first Naval Dispensary plus a larger Samoan Fale, and Navy Surgeon Genereal authorized regular expenditures of Naval Medical Department supplies for the Samoans.

In 1912, the Samoan Hospital at Malaloa charged a fee schedule for services. These fees and donations helped pay for the construction of the hospital as federal funds weren’t authorized to fund this project. Noteworthy is the quarantine ordered by Governor Poyer in 1918 that probably spared the AS population from extinction. The Influenza epidemic took more than 50 million lives around the world, including 9000 lives of British (or German) Samoa, one fifth of her population. The total AS population at the time was less than 9000.

The bill to approve the cessions of Tutuila and Manu’a was introduced by a friend of AS, Senator Hiram Bingham of Connecticut in 1929. Senator Bingham was a son and grandson of missionaries and was born in Hawaii. Part of the bill called for the protection of Samoan lands and provided for a fact-finding commission to visit the islands and make recommendations to Congress.

The bill was approved and the Bingham Commission deliberated in AS in the early 1930s. The Bingham Commission Report, which called for, among other issues, a Bill of Rights for Samoans and granting dual citizenship for Samoans, was defeated twice in Congress in 1931 and in 1932.

Out of the general apathetic Congressional attitude towards AS ascended Mariota Tuiasosopo as an influential local leader. He called for a “real” legislature to replace the Annual Meeting of Chiefs which he thought was useless; his efforts were rewarded in the following decade.

The rest of the 1930s was uneventful until Pearl Harbor was attacked in December 1941. The WWII brought a wartime economy for AS, and AS became a South Pacific hub overnight. The infrastructure constructed was significant and extensive.

The US Navy Mobile Hospital was built at Mesepa and Mapusaga (current location of ASCC) and it exposed the territory to a modern hospital operation. The hospital complex included 65 buildings with wards for 140 beds, an X-ray facility, 2 operating rooms, a morgue, laboratory, dental clinic, urology clinic and two urology wards, and an ENT ward. The complex was so large that streets were named to clarify the areas.

This hospital received and treated war casualties from other Pacific islands where the war was actually fought, but villages of Faleniu (which includes Mesepa and Mapusaga) and other nearby villages benefited from the “spillover” health care. The American Samoa Hospital at Malaloa benefited as well from the wartime attention the US accorded the territory.

But as quick as the economic and health care attention appeared, it disappeared when the war ended. Pago Pago and Mesespa/Mapusaga became ghost towns. Nonetheless, the Navy built a more modern and bigger American Samoa Hospital in Utulei, where the EOB is currently located, in 1946 to replace the Malaloa hospital. In 1946, Mariota Tuiasosopo initiated effort to establish the Fono once again and it was approved in 1948.

The first 10 years of the DOI administration (1950-1960) was not remarkable in terms of economic development. In early 1960, a US writer published an article in Reader’s Digest, one of the most widely read magazine in the US at the time, titled “Samoa: America’s Shame in the South Pacific” stating that “while we have been doling out billions to underdeveloped nations, we have let our only South Pacific possession sink to the level of a slum.”

In the same article, AP Lauvao, who later became AP Lutali and governor of AS, was quoted, “All we ask is to be treated as brothers, not sons or stepsons. We ask nothing but enough technical aid to help us start doing for ourselves, to prove to the world that Samoans can stand on their own feet like real Americans”.

Keniseli Lafaele was the project manager of the “Coverage for All in American Samoa Research Project”, and says he is doing this because both the Administration and the Fono pretty much ignored the report as well as previous reports done since the early 1980s. He believes that in these reports lie the foundation of viable solutions to the health care problem facing the territory today.

(See tomorrow for Part Two of Keniseli Lafaele’s Op Ed, which focuses on the development of the healthcare system in American Samoa from the building of the new hospital in Fagaalu, establishing the Department of Health, to present day healthcare developments in the territory, including Medicare and Medicaid programs.

In Part 3 of this OP-ED to be published in Thusday’s issue of Samoa News, Lafaele will discuss public policy implications and recommendations as stated in our Project Report. Further, he will express his opinion on the policymakers handling of the matter up to this point, including the Governor’s remarks regarding ASMCA on his Saturday radio program.)