“What are you up to this weekend?”
“Flying to Guam.”
“I promised an entire island I’d be their doctor.”
In fall 2021, Jonathon Thorp, MD, phoned a friend. A passionate internist, he was bound and determined to bring a rheumatologist to Guam. Unlike most primary care providers (PCPs), he was willing to prescribe disease-modifying anti-rheumatic drugs (DMARDs) and biologics. But he needed help.
The friend he phoned was a friend of mine. My friend said, “I’ve got two kids and a full-time private practice job. I can’t swing it. But Sam just resigned from her academic gig and loves to travel. Call her.”
The conversation that followed went something like this:
Dr. Thorp: “Hi, I’m a PCP on Guam. Our island has no rheumatologist. Those who can afford it have to fly four hours to the Philippines for care. We can’t pay you much, but we can fly you out here and give you a place to stay. Would you consider coming down to help?”
Me: “Sure. Let me just Google where Guam is.” (Answer? Far away).
Eight months and 200 handwritten forms mailed to the Guam Board of Medical Examiners later, I arrived. My clinic was booked solid for my entire four-week stay. The waiting list in case of cancellation was an additional 80 patients long.
If Guam sounds foreign to you, join the club. Guam is the westernmost territory of the U.S., located in the Micronesia subregion of the western Pacific. Spain ceded Guam to the U.S. following the Spanish-American War in the late 19th century. People born on Guam are U.S. citizens. They’re eligible for certain federal programs, such as Medicare and Medicaid, but cannot vote for president.
Island Doc Living
It’s 5 a.m. The alarm goes off, and I work out at a gym called Paradise Fitness. As I head home, the sun peaks through the clouds over the sea, and I spot a rainbow. This is not a drill.
I prepare for my morning “commute,” donning flip-flops. I tread 50 yards across a grassy hill to the clinic. I wipe the mud off my feet, put on my flats and see my first patient.
Example 1: Mr. A is a 52-year-old U.S. Navy veteran who presents for chronic joint pain. Like many Chamorro men, he has gout. Daily allopurinol at a dosage of 300 mg controlled his disease for years, but he lost access to the medication months ago. His disease flared. His PCP restarted allopurinol, without flare prophylaxis. His flares worsened. Given persistent inflammatory arthritis, an anti-nuclear antibody (ANA) was checked, which was positive at a titer of 1 to 80.