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  • By Dr. Vincent Akimoto

India gasps

We thought we were ready. We told ourselves we were. Then we told this lie to the world. “We are open for business. We are Covid-free!”

People hailed our “visionary leadership,” as thousands attended grand sporting events and peacocky political rallies even amid warnings that infections were climbing.

By May 5, the hospitals were packed with suffocating, dying Covid patients and the crematoriums were ablaze with hundreds of dead people who could not be saved. In one single day, more than 400,000 were newly infected and 4,000 people died. The numbers are incomprehensible but the tragic images of someone’s critically ill mother gasping anxiously for air are impossible to forget.

The tragedy came at the end of the week when hospitals repeatedly ran out of oxygen. Desperate relatives were made to search the chaotic city streets for filled oxygen cylinders or available hospital beds. Hoarding, hysteria and human suffering are being witnessed daily on a vast scale.

Functional intensive care unit facilities are unavailable. Doctors and medical staff are at tearful breaking point. Hospital wards have no nurses and more dead patients than live ones. People are dying in hospital corridors, on the side of the road, and in their homes. Crematoriums in Delhi have run out of firewood.

Despite contradictory edicts from feckless government public information officers, India’s healthcare system has been shattered by Covid-19. Things became so bad that India’s Supreme Court had to order the central government to present a workable plan to meet medical oxygen requirements for devastated hospitals across the nation. According to industry experts, India has more than sufficient oxygen available but medical transport, supply coordination and logistics have been a dismal failure.

Hunting helplessly for oxygen and ICU beds, people feel abandoned by their government. Meanwhile, impotent political leaders recede into the background, bewildered by their own hopeless predicament. For now, there is a horrible democracy that caste and privilege can scarcely overcome. All are dying from lack of air. Some more slowly and with better circumstances, but in the failure which is the Covid hell of India, all who stop breathing are still dead.

With deaths mounting and healthcare infrastructure all around him crumbling, India Prime Minister Narendra Modi has thrown his people under the bus. He pushed much of the responsibility for fighting the virus onto poorly equipped and unprepared state governments and even onto patients themselves. This then is the ultimate breach of trust between the governed and their elected officials.

In India, government leadership is blaming its own citizens for the government’s operational failure to react effectively to this existential threat to humanity.

In times of crisis, public cooperation depends on trust and confidence in the healthcare system. Trust is the optimistic acceptance of the belief that public health leaders have the best intentions for the common good. Public confidence is earned by the results of recent experience.

As recently as April, India had declared victory over the virus. That declaration should have ensured strengthened hospital capacity, adequate oxygen supplies and dedicated financial resources to recruit and retain necessary medical and nursing staff. As the saying goes, dig the well before you're thirsty. But foolish government policymakers failed to prioritize funding to effectuate emergency contingency plans. Instead, they started hiring political hacks and spin doctors to lull the people into a stupor.

Despite our relative calm, Covid-19 is still heartlessly testing the ability of Guam’s health care system to withstand healthcare emergencies while maintaining routine non-communicable disease health functions.

In the midst of GovGuam’s irresponsible prioritization of nonessential employee expenditures, more than 130 Guamanians have been killed by this unforgiving virus. As ambulances wander the streets of Guam looking for an available hospital bed, the pandemic exposes the inherent weakness of Guam’s fragmented, disjointed political state that hinders efficient cooperation between the private and public health sectors.

The Guam Memorial Hospital continues to fail national patient safety standards and remains unaccredited. GMH nurses remain woefully underpaid while high-priced traveling nurses have to fly in and replace the local nurses that go to work as overpaid school nurses.

The central Public Health clinic remains a burnt-out symbol of GovGuam's deferred maintenance program and critical public health employees are forced to work themselves to the bone while clueless nonessential workers get paid to do next to nothing.


Most disturbing, the Centers for Disease Control has reported that Guam public health has failed to participate in regional influenza surveillance data collection thus putting Guam at risk for yet another poorly managed viral pandemic.

Like India, GovGuam has been kicking the can of healthcare infrastructure down the road for several election cycles. “Tomorrow we will fix the Guam Memorial Hospital. Tomorrow we will right-size government expenses. Tomorrow we will select all civil servants based on merit.”

As with the crowd who chose Barabbas, the politics of tomorrow has created the crisis of Now.

Like Guam, India must put the public back in public health. Respectful, honest community engagement will enable a sense of ownership of necessary public health interventions. Community engagement gives voice to the affected community and therefore helps the population adopt public health interventions to the values and preferences of the people.


Community-based quarantine and isolation facilities with active community participation, community policing of lockdown measures and distribution of lockdown relief materials through local leaders such as the village mayors are all potential community engagement strategies that can encourage trust and promote cooperation. Like India, Guam’s healthcare system is weak but it doesn’t have to stay weak.

We need to awaken to the possibility that we collectively have strengths upon which to build. In the end, we must evolve. Because the virus demands it, we must be the change we wish to see in the world. We must take care of our own selves. No one else is going to do it.

Dr. Vince Akimoto practices Family Medicine at the American Medical Clinic. Send feedback to

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