IN 1284, the German town of Hamelin was suffering from a rat infestation. One day, a man claiming to be a rat-catcher approached the villagers with a solution. The man claimed to have a magical pipe and promised to remove the rats by leading them out of town with music.
The town governor and village leaders agreed to pay the piper for the removal of the rats. Dressed in colorful garb, the rat-catcher thus took his pipe and lured the rats with a song into a river where all of them drowned.
Despite his success, the Governor and his people reneged on their promise and refused to pay the rat-catcher. The man left the town angrily, but returned some time later seeking revenge. While the villagers were in church, he played his pipe again, this time luring all the children out of the town and they were never seen again.
Guam has suffered since 1983 with an acute care medical facility that fails to meet national standards for a safe, competent hospital. At the beginning of this millennium, Governor Camacho promised to achieve JCAHO accreditation for GMH by 2005. But today, as Guam faces ever increasing pressure to enhance its healthcare infrastructure, GMH remains a poorly managed institution.
An example of hospital mismanagement is the fact that the Government of Guam continues to fund unnecessary employee positions at the Guam Memorial Hospital despite routinely falling delinquent on vendor payments for critical hospital supplies such as water and blood.
Over the past four years, hospital administrators and independent auditors have identified more than 200 positions as non-critical to patient care. Despite this, more than 50 administrative staff people have been added to the hospitals’ bloated payroll over the past two years. Several years ago, a GMH spokesman responded to a query about rodent infestation in patient wards by saying, “The only rats in GMH are in the business office.”
Certainly, most GMH administrators do not deserve to be compared to rats. Most hospital leaders are merely toeing the GovGuam line which preaches that giving a hard-working, loyal constituent a government job is necessary and a good thing even if the loyal constituent doesn’t know how to do brain surgery and the only government job available is brain surgery.
While noble sentiments may serve as justification for the perpetuation of non-critical employee positions at our island’s only civilian hospital, the refusal to make timely payments to medical providers and private vendors is chasing away local healthcare personnel from Guam.
Over the past 10 years, more than 35 Guam-born physicians have chosen not to return home in the midst of the turmoil at GMH.
Over the past two years, only two Guam doctors have returned home to practice medicine and both signed contracts as off-island hires presumably so that they could leave quickly if things at GMH were as bad as their relatives had warned them.
Doctors and nurses from Guam have repeatedly been discouraged from returning home by reports of GovGuam mismanagement of the island’s limited health resources. Young physicians in training who visit the island on vacation are frightened by the lack of supplies and medicines in the hospital. Medical students see huge numbers of hospital administrative staff while one lonely doctor is assigned to work in the Emergency Room that serves an island of more than 160,000 people.
It is time to pay the Piper. GovGuam officials must hear daily the voice of concern from citizens who want better medical care at GMH. The unmandated funding of unnecessary GovGuam employee positions must stop. Unless this is done, the only music coming from GMH will be the watery hiss of brain drain.

VINCENT TAIJERON AKIMOTO, MD
Tamuning, Guam