Pago Pago, AMERICAN SAMOA — Testimony by members of the Board of Directors of the LBJ Tropical Medical Center during a House Health committee hearing this week revealed that the hospital believes it is well prepared to face whatever COVID-19 brings to American Samoa.

Dr. Akapusi Ledua told the House committee that once COVID arrived on our shores, the hospital management put policies and procedures in place to guide and control their service throughout these challenging times.

He said the Emergency Room (ER) has its own policies and procedures for incoming patients, the Outpatient room has also executed its own policies and procedures since last month, the COVID Ward, the infrastructure, the medicine and the equipment are all in line and ready to be used whenever needed.

Members of the LBJ board were called to give an update on the hospital’s preparation for COVID-19 and testify on the status of the hospital services for the people.

The hearing, which lasted over two hours was chaired by Rep. Logoitu’au Mark Atafua.

Tualauta faipule Larry Sanitoa took the opportunity to thank members of the LBJ board of directors for their great leadership and their service to the community while American Samoa is currently in “the most challenging and difficult time of its history”.

Sanitoa said he wanted to know the status of LBJ preparations; the situation of doctors and nurses; and the infrastructure where COVID patients are currently being treated.

“We now have COVID hospitalizations here, now we really have to put to the test all the preparation and planning you have put in place for the last two years and to see where are we standing at this most challenging time in our community,” the faipule said.

Sanitoa said while he heard that FEMA is helping LBJ a lot and they’re also adding more beds for the hospital, he wanted to know if its true that LBJ is using the Pediatric Ward to care for COVID-19 patients. He said a lot of people are concerned about this issue.

“What happens if the number of COVID-19 patients increase, does LBJ have enough beds, rooms and equipment to serve and treat these patients?” Sanitoa asked.

Dr. Ledua explained that LBJ has policies and procedures to guide them on how to deal with COVID-19 patients and also outpatients when they come in to see a doctor.

EMERGENCY ROOM (ER)

All patients who come to the hospital have to be tested before they move to the next step of their visitation.

For patients coming into the Emergency Room (ER), they have to be tested first before they enter. If they test negative, they will continue to the ER through the main door where they are seen, assessed and evaluated outside of the ER.

However, if they test positive, they will go to the streamline tent and wait there to be seen by a doctor. If they need treatment, they will be treated right away.

Patients who meet the criteria for immediate admission for COVID treatment based on the LBJ policies and procedures will be admitted at the COVID Ward immediately for further treatment, but patients who meet the criteria for home isolation will be released to go home after they are deemed fit to go home during the evaluation. These patients will also be given guidelines and instructions prepared by the Department of Health (DoH) for home quarantine.

OUTPATIENT CLINIC

For the outpatient clinic, the whole purpose and plan by LBJ is to minimize outpatients from coming together at one time in order to prevent the continuing spread of the virus in the community.

All outpatients clinic are now served by appointment only and each outpatient is given a specific time to visit the clinic.

Outpatients have a separate tent where they are tested first before they go to their clinic to be seen by a doctor. If they test negative, the patient will go directly to the clinic, however, if tested positive, the patient will be transferred to another tent to wait there for a doctor to see, assess and evaluate them, to see if he/ she meets the criteria for admission or if they can be sent home to start a 14-day home isolation.

Patients will also be given instruction and guidelines from DoH for home isolation.

COVID WARD

At this point in time, the LBJ COVID Ward can accommodate 8 patients and has 8 beds inside. If the COVID Ward becomes fully occupied, the overflow will be sent to the second location called the “Negative Pressure Tent” (NPT), located right next to the COVID Ward. The NPT has 6 beds to accommodate patients.

The next overflow option, after the NPT, is the Pediatric Ward, which has 50 beds to accommodate COVID-19 patients.

“If 50 COVID-19 patients are admitted at one time… we are preparing for that number. We are ready with everything on hand to treat, assess and evaluate our patients to make sure each patient will receive the treatment they need,” Dr. Ledua said.

The LBJ preparation was based on what other US Pacific Island territories had gone through and experienced, such as CNMI, Guam and Palau, Dr. Ledua explained. He said based on data from these territories, this is the maximum they’re prepared for right now.

He further stated that none of these territories experienced having 50 patients admitted at one time during their peak.

As of Monday morning, 7 Covid-19 patients were in the COVID Ward; zero patients in the NPT, but 21 patients were in the pediatric ward.

Dr, Ledua also explained that patients who are only showing symptoms of the virus [but not testing positive] go to the pediatric ward.

For patients who test positive, they go to the COVID Ward for treatment.

“When ever we see a patient with symptoms and the patient needs extra care, we move that patient to the COVID Ward for immediate treatment — and whoever is in the COVID Ward, who is recovering and has completed all treatment, but still needs hospitalization, will be moved to the step-down ward — which is the pediatric ward,” according to Dr, Ledua.

In the Labor and Delivery ward, Dr. Ledua explained that they have an isolation room inside the ward in case it is needed. As of Monday morning, they have one patient in premature labor who should be discharged later this week.

PERSONNEL, EQUIPMENT AND MEDICINE

With the help from FEMA, LBJ has a lot equipment and medication. They have 45 ventilators with only 11 now being used.

LBJ is working closely with FEMA personnel on island to make sure they have enough medication to care for the community. LBJ received another shipment of medication last week provided by FEMA and they are expecting another new shipment at the beginning of next month.

Eleven FEMA personnel joined the LBJ medical staff a few weeks back and they’re continuing to offer their assistance everyday, which gives LBJ staff extra support.

“I know we are all over-worked but that is what we are called to do and we are all hanging in there and everyone knows that even if we are tired, we know that this is our calling,” said Dr. Ledua.

According to Dr. Ledua, there is another group of FEMA personnel who are in Hawaii right now ready to come down on island to join them, however, the problem is that there is no room for them on the Hawaiian Airlines flight scheduled for tomorrow, Mar. 31.

The hospital is in discussion with their FEMA and Federal partners to assist in terms of transportation. There is also a request made to the Task Force and FEMA for assistance on transportation.

Discussions during the Task Force meeting last week considered the request for an extra flight for next week, Apr. 7. Based on information from the Task Force, they’re looking at a full flight this week if all tests come back negative.

An extra flight next week would bring US doctors, along with other passengers and according to the Task Force, this additional flight “would be extremely helpful.”

DoH supported the move for an extra flight.

PERSONAL PROTECTIVE EQUIPMENTS (PPE)

LBJ has enough PPE for all employees to use. They have enough face seals, gloves and the N-95 masks, which are recommended for all health care personnel in the hospital to wear.

In response to Sanitoa’s question whether doctors and nurses receive any hazard and overtime pay, Dr. Ledua said, no. He explained that discussion is still continuing on overtime and hazard pay and hopefully something will happen soon.

Sanitoa said that there was about $300 million from ARRA Funding and hopefully the LBJ finance division will look at this issue and make a quick decision.