LBJ expands healthcare in the territory with Primary Care clinic

by Teri Hunkin

Samoa News staff writer

For many years, and for most of us, a visit to the hospital meant a long wait at the Emergency Room. Whether or not our case qualified as a true emergency, that was the first place we headed.

LBJ Medical Center wants you to know that those days are officially behind us. There's a better way to visit the hospital in order to be seen by a physician now.... and it doesn’t involve waiting for hours in the Emergency Room (often surrounded by people ready and able to pass on contagious ailments)

In an ongoing effort to deliver better health care to the territory, LBJ has opened a Primary Care Clinic, and as the name implies- it is- and should be- the primary source of health care for the residents of the territory, and the very first place we go for health care.

‘Primary care’ is a term used to describe the activity of a health care provider who acts as the first point of consultation for a patient. It is designed to treat patients who are not having a life-threatening emergency, and its advantages are numerous.

One of the clearest advantages of using the Primary Care clinic is a reduction in waiting time. Because patients can call ahead and schedule an appointment, they will be seen close to their scheduled time- rather than waiting an average of four to five hours to see a physician in the ER. In addition, utilizing a Primary Care clinic ensures that patients' chronic medical conditions are better managed, thus preventing multiple ER visits.

This is a savings realized in time and money, not just by the patient, but by the hospital as well. Cutting down on non-emergencies, the ER physicians have more time to spend managing and treating authentic medical emergencies. ( According to LBJ, 91% of the ER traffic does not qualify as an emergency; instead they are patients would be best served by Primary Care)

Primary Care emphasizes continuity of care and health maintenance, and involves a wide scope of health care concerns, from non-emergency acute illness to managing multiple chronic diseases. In American Samoa, the most commonly seen chronic illnesses include hypertension (high blood pressure), diabetes mellitus, asthma, gout, and chronic back pain.

Other examples of illnesses, injuries and general health concerns that can be managed in the Primary Care Clinic are: flu-like illnesses, sore throat, high cholesterol problems, knee pain, urinary tract infections, headache, rashes, problems associated with tobacco abuse, and medication refills. Yearly check-ups~ one of the best tools for maintening optimum health-~can be done in Primary Care.

A patient seen in the Primary Care clinic who needs a referral to other specialty clinics will receive the appropriate referral, again bypassing the ER and making the hospital a more efficient place for taking care of the health needs of our growing population.

Anyone 17 years old and over is welcomed at the new clinic, which is located next to the Administration offices at the "top" of the hospital compound. The clinic can be reached by calling 633-4572, and while appointments are not necessary, they are recommended, and patients will be seen according to their appointments. "Walk-ins" will be seen as they can be fit in with the regular appointment patients.

It is a truism in the health care profession that having a medical "home" for your records and health care promotes better health overall. Primary Care doctors have more time to spend with patients, more time to discuss concerns, and more time for education and imparting important knowledge-- the life-saving and health promoting information that can make a difference between a vigorous and energetic life, and one weighed down with medical problems.

Practitioners at Primary Care are under the direction of David Bouslough, MD, and include another MD, Dr. Sean Stracensky, who is the clinic manager, and three Certified Physician Assistants, or PA-Cs: Katrina Hoke, Timothy Brinker and Jamie Stevens.

Speaking to Samoa News, Dr. Bouslough noted, " the Primary Care cinic is a wonderful addtion to the health care system here in American Samoa, and provides a need that has been neglected for decades."

While both the Emergency Room and Primary Care are part of one department headed by Bouslough, the acuity of care and different needs are better addressed by separating the areas of concern. They are not competitive, but rather, they complement one another, and according to Bouslough, they are meant to assure " seamless care" for patients.

Bouslough also noted that If an ER visit is required, follow-through can be done at Primary Care to ensure that medical issues have been resolved. In many cases where ongoing treatment is necessary, Primary Care clinic fills that need.

Where the Wild Things Are

A paved road turns off the main highway at Spenser's Store in Pago Pago and leads up Vaipito Valley, across a ridge, and down to Fagasa, a village huddled beside picturesque Fagasa, or Forbidden Bay, on Tutuila's wild north shore. Legend says that porpoises long ago led a group of three men and three women to safety in Fagasa Bay, which has long been a porpoise sanctuary.


With the assistance of some local village children, we removed the kayak from the roof and placed it gently inside the reef. After a quick gear check: stove, sleeping bag, air mattress, tent, food, scuba gear, fishing spear- we located the ava and paddled out of the bay. Coral reefs usually have an ava or channel through the reef, where water ebbs and flows . Rain fell upon our shoulders as we steered westward out of fagasa bay, destination unknown.


There is scare information available regarding Tutuila's remote northwest shore. The lonely planet makes it seem as it there are only 3 sides to the island, yet in recent history villages dotted the northwest shore of the island. Unfortunately, due to modernization, warfare, and remoteness these were abandoned in the recent past.


Around the island, no one ever seemed to talk about this region of steep forests, clear rivers, and psychedelic reefs. I had been to the north a handful of times, hiking over the spine of the dragon as the central mountain range is known as. The hike down from the central ridge is very difficult, 5-6 hours, as the trail becomes overgrown and the hiker can become disoriented. From our launch we hoped to reach the campsite within an hour, although these were uncharted waters.

The rain slowed as we navigated along the rocky shoreline, as waterfalls cascaded in the background. We passed several coves until we came across the secluded Fagafue Bay. A white sand beach was interrupted by a cool flowing river off to the left. We landed the klepper and proceeded to unpack the supplies. After collecting firewood & making camp, we were treated by a full moon & a bottle of pinot noir.

The next morning we paddled over to the abandoned village of A'asu on massacre bay, site of a french genocide on local Samoans in the late 1800's. The only artifacts were an old house, vacated several years ago by the last remaining family. A waterfall can be viewed by wading 200m up through the stream. The white sand on this beach is very fine, almost powdery in texture. We paddled back through the ava and continued our surveying of the north coast.

The next cove for exploration was A'oloau Bay, where my dentist friend has a rudimentary shack for boar hunting expeditions. The water visibility was excellent, as we could see many beautiful corals directly from the side of the kayak. This seemed like the perfect opportunity to try spear fishing, it couldn't be that difficult, could it?

As soon as i jumped in the water, i sensed that the fish new what was up. They must have thought, does this palangi really think we don't notice that 4 foot spear in his right hand? The fish moved extremely quick, as i awkwardly stabbed into rock after rock. Not wanting to spear Minos for dinner, i reluctantly let go of my cave man hunger for fresh meat and rejoined the kayak. The sun was vibrant as we paddled in tandem back to the forbidden bay and said goodbye the wild coast, we shall meet again another day.

The Boar Hunt

Around 5:30AM i stumbled out of bed, grabbed a cup of java, and jumped on the scooter headed for the highest village on the island. Cloaked in full rain gear, i gently navigated through the heavy rain and potholes, as this is the day of the boar hunt. Many thoughts passed through my head during my hour long drive to the west. The only thing i was told, was to pack light and bring cleats. By 6:30am, the local dentist was waiting by the side of the road, and i followed his lead up the mountainside. His garage was lined with the skulls of fallen boar, some of the tusks measured 1-2 feet

I briefly met the crew, five local guys & four hunting dogs. We packed all of the gear: 2 shotguns, machetes, bucket of bbq chicken, rice, outboard motor, and some gas. We drove through the rain towards the westernmost village (end of the road). We unloaded and huddled in a rudimentary shack, grilled some chicken, and waited out the storm. Here in samoa, sometimes that means never, so we loaded up the small 16 foot aluminum boat and paddled out through the reef. Soon we were cruising past cascading waterfalls and sheltered coves and entering the fairytale landscapes of the northern coast. The cove we finally entered looked a bit rocky, but i figured these guys knew what they were doing. Unexpectedly, a huge wave threw us onto the rocks nearly flipping the vessel, after which they remarked with a stoic face "first crash landing ever." Phrases like this are all to common on the island of tutuila.

We organized the gear, and let loose the hounds up the steeply forested valley. I soon realized the importance of the cleats, as the mud made tracking nearly impossible. The rainforest was beautiful on the inside, a cacophony of birds and exotic plants. Many of the banyan trees must have been 200-300 years old, extending ancient, giant roots above ground much like an octopus does underwater. I learned many things during my journey through time & space- how to smell the boar, the difficulty of hearing barking dogs in a rainforest during a downpour, and about the fao tree, which is used for rope and in making the traditional fale dwelling. Although the tracks of the pigs and signs of their path of destruction were all around, they remained elusive. After several hours of ravine crossing, river wading, and mountain climbing, the scent of the boars was lost, and the hunting party returned to base camp.

All was not lost, as one of the group emerged from the forest carrying a 5 lb. coconut crab (larger than a lobster). This crustacean, collects coconut cream in its abdomen, which is considered a local delicacy. Another member of the party emerged from the sea, with a traditional spear filled with octopus and various reef fish. Before long the sense of loss from not returning with a boar was replaced by the gathering of various local fruits de mer. A beach fire was started, stories were told of past adventures and future plans to catch the elusive boar, and the bounty was grilled to perfection.

Banana leaves were laid out and the food was literally thrown to each member sitting around the smorgasboard. After lazying about under the spell of such a magnificent feast, we re-boarded the boat and traveled back to the village launch. Half the party was asleep as we returned to the mountainside village of our departure. The group slowly dispersed and went its separate ways, vowing to reclaim glory next time, and bring home the king of the samoan forests, the boar.