American Samoa Resources
An overview of telehealth resources available in American Samoa
Region Overview
The Territory of American Samoa, the only US soil below the equator, sits approximately 2,400 miles from Hawaiʻi and 4,800 miles from California.
As of April 1, 2020, the population of American Samoa was 49,710, representing a decrease of 10.5% from the 2010 Census population of 55,519. American Samoa is made up of the islands of Tutuila, Aunu’u, Ofu, Olosega, and Ta’u and two coral atolls Swain Island and Rose Island located just below the Equator. There are three districts: Eastern, Western, and Manu’a. The seven islands of American Samoa lie just below the equator and the only United States Territory in the Southern Hemisphere.
The majority of the population lives on the main island of Tutuila. Tutuila is nearly 18 miles long and just less than 3 miles wide at its widest point with a total land area of 56 square miles. Manu’a Islands are located approximately 80miles each of Tutuila. The total land area of American Samoa is 75 square miles.
Healthcare services in American Samoa are based out of the American Samoa Medical Center Authority (ASMCA) Lyndon Baines Johnson Tropical Medical Center (LBJ Tropical Medical Center) and the American Samoa Department of Health (ASDOH). American Samoa is home to ~1,000 veterans who are serviced through the VA American Samoa Community Based-Outpatient Clinic (CBOC) with many off-island referrals to Hawaiʻi and other states.
Health Ecosystem
The ASMCA, the only hospital in American Samoa, provides all acute medical services and includes outpatient clinics as well as inpatient hospital care. The ASMCA provides outpatient care at the Emergency Room, Primary Care Clinic, Pediatric Clinic, Obstetrics and Gynecology Clinic, Surgical Clinic, Medical Clinic, Ear Nose Throat Clinic, Dialysis Clinic, Psychiatry Clinic, Dental Clinic, and the Eye Clinic. The inpatient services include 150 patient beds in six wards: Labor and Delivery, Nursery, Maternity, Internal Medicine, Surgical, Intensive Care Unit, Pediatric and Psychiatry.
The ASDOH operates six Community Health Centers across American Samoa, four on the main island of Tutuila and two on the outer islands of Manu’a, Ofu and Ta’u. The ASDOH is responsible for preventive and outreach services to the community. It is also responsible for infectious and chronic disease surveillance and prevention, community nursing services, environmental health, immunization, Public Health emergency preparedness, comprehensive cancer control, HIV/STD screening, early intervention, newborn hearing, and MCH services that includes the Maternal Created Infant Early Childhood Home‐visiting (MIECHV) Program.
Health System
Mixed public + private
Health Insurance
- Subsidized (100% have Medicaid with small copay’s)
- Medicaid and Medicare
- CHIP
Hospitals
Public
- LBJ Tropical Medical Center
Health Centers
Public
- American Samoa Tafuna Family Health Center
- Rural Health Clinics and Dispensaries: Tutuila (main island) and Manu’a Islands of Ofu and Ta’u
Telehealth Readiness
In 2019 American Samoa invested $30M in the Hawaiki Submarine Cable that connects American Samoa with 200+ gbps off-island bandwidth capacity. The Hawaiki Cable is a 15,000 kilometer (9,320 miles) high-capacity underwater cable connecting Australia and New Zealand to the mainland United States, American Samoa, and Hawaiʻi. With the Hawaiki Fiber Optic Cable, American Samoa can expand telehealth services to continue to improve access to care, increased availability of services both on- and off-island, have access to healthcare professionals not locally available, reduce costs of services by reducing unnecessary travel and referral costs, and provide online educational opportunities for health care professionals. American Samoa is now well positioned with connectivity to further benefit from telehealth services.
Broadband Capabilities
In 2020, the American Samoa Department of Commerce (ASDOC) partnered with the University of Hawaiʻi Telecommunications and Social Informatics (UH TASI) Research Program and SH3 Resource Development, LLC to launch the American Samoa Territorial Broadband Strategy (ASTBS). The plan identifies nine key priorities and dozens of strategies for improving the day-to-day lives of all territorial residents through broadband-connected technology including telehealth. Read more at: Telehealth Transforming Healthcare in American Samoa.
Specific to telehealth, the plan identified these as the top three priority action items:
- Referral Process and Care Coordination: Implement a process for care coordination pre- and post- referral using telehealth. This requires the identification of off-island specialists for pre-care to determine referral and post-referral for ongoing care coordination.
- Health Information Exchange: Referral also includes the secure exchange of patient information. HIE requires connection into other systems to securely share patient health information required for the care coordination.
- Establish a Telehealth Work Group championed by physicians and other healthcare providers to lead territorial coordination for telehealth. The group can also provide guidance on workflow integration and future services.
The potential value of telehealth in American Samoa is clear in terms of improved access, quality of care, lowered cost, and increased patient satisfaction. The local healthcare system, while stressed with many challenges such as liability, lack of medical professionals, credentialing/licensure, reimbursement, workflow integration, care coordination, continues to progress in various ways with innovative technology driven solutions to meet the healthcare needs of the people of American Samoa to the best of its ability and limited resources.
Current and Emerging Telehealth Initiatives
A few existing and ongoing telehealth programs in American Samoa:
- Ongoing Shriners Telehealth Consultations and Referrals: Orthopedic cases, Physical Therapy, Occupational Therapy, Recreational Therapy.
- Pacific Emergency Medical Services for Children: Support for children referral from Pacific Islands to Hawaiʻi (Kapiʻolani and Shriners).
- Continuing Medical Education: Ongoing CMEs are being conducted between all DOH clinics including Manu’a Islands.
- Regional and national telehealth webinars and educational sessions: American Samoa is an active participant of various regional and national telehealth education groups including those on gastroenterology, geriatrics, asthma, COVID-19 and many more.
- Telepharmacy with DOH clinics: Pharmacists can receive medication orders via telephone, text and secured messaging.
- DOH Services offered via telehealth with off-island specialists: OT, Speech Therapy, Behavioral
- VA CBOC currently offers and conducts telehealth services for on island veterans.
- Teleneurology Network with Queens Medical Hospital: Currently being established between LBJ and Queens Medical Center where a specialist at Queens Medical can consult with a doctor at LBJ about stroke cases and other general neurology cases.
- Maternal Telehealth: Currently being established between LBJ and Maternal Fetal Medicine Specialists at the University of Hawaiʻi John A. Burns School of Medicine via a US Department of Agriculture grant.
Lyndon B. Johnson Tropical Medical Center and Shriners Hospital
The relationship between Lyndon B. Johnson Tropical Medical Center and Shriners Hospitals for Children has been ongoing for many years with the use of telehealth. This image from 2003 is of LBJ Hospital conducting a tele-rehab with physical therapists at the National Rehab Center; and the bottom left image shows Dr. Tuato’o (LBJ Hospital) using a Polycom and an elmo camera to show x-rays to Dr. Ono (Shriners) in Honolulu.
These telehealth sessions were delivered via a 384kbs dedicated link for health, education, disaster management donated by American Samoa Telecommunications Authority. Almost 20 years later, the relationship remains strong and now with the capacity to expand services, especially with American Samoa’s increased capacity and investment in Hawaiki Cable. Mahalo and Faafetai to all for the partnership over the years.
