NHSC Clinician Sows Health Among Guam's Poorest of Poor

In the two years that Olga Emgushov, M.D., has been with the Guam Department of Public Health and Social Services, the northern district of the island has gone through world-altering improvements in its quality of life and health. This comes as no surprise, if you consider that within the heart of this NHSC Scholar are combined the formidable drive of her parents, two immigrants from the steppes of Russia.

Emgushov's mission in life started early and, like many other visionaries, was forged of personal experience. "In the summer before kindergarten, I broke my arm and my father had to take me to three emergency rooms before someone would help us because of health insurance problems," she recalls. "That was pretty much what sealed my interest in going into medicine and helping other poor people." After trying career possibilities in public health, she decided to follow her first instinct, convinced that the real power to change worlds started with healthy people.

NHSC's Scholarship Program worked well with Emgushov's vision. "I knew I wanted primary care and to serve the underserved," she explains. "I was single and enjoyed moving around. It seemed like a real match." However, when it finally came time to choose a location to serve her commitment, her circumstances had changed significantly. She had married Brian Boggs, an ER resident with a service commitment to the U.S. Navy, so it became necessary to find an NHSC clinic close to a Naval hospital. The Northern Region Community Health Center on Guam fit the bill perfectly.

The Guam clinic employs three registered nurses, two licensed practical nurses, a medical assistant, two laboratory technicians, and Emgushov, as the only physician. Most of the patients are Filipino, members of the Chamorro, or Palauan tribes, or have migrated from other islands in Micronesia. They are either on Medicaid or are noncitizens, covered under the Medically Indigent Program (MIP) that remains unfunded at this time. Their living conditions are desperately poor, beyond the imagination of the average American. On any given day, the staff sees between 40 and 70 patients, Emgushov reports. "If we could increase our capacity, we could probably see double that number."

In the face of that daunting challenge, Paula Brinkley, M.D., medical director of Guam Community Health Centers, recognizes Emgushov as "real leader in every arena." In particular, Brinkley mentions her colleague's contributions to re-engineering workflow in the clinic, taking up the reins of a separate clinic for children with special needs, and starting a breastfeeding education and support group among the poorest of Guam's citizens.

With the help of a grant from the Health Resources and Services Administration, and consultants who Brinkley was able to hire, Emgushov and her team rearranged the appointment scheduling process around the patients rather than have them wait up to four hours for a complete exam. Under Emgushov's plan, a patient stays in one place with all the providers moving in and out to address his or her needs. "With this method, we were able to bring our visit time down to one hour," she says.

At first, getting coworkers to buy into the new system was difficult, Emgushov admits, but it was gradually accepted. The scheduling efficiencies have more than proven their value, she notes, when a recent 10 percent across-the-board cut in Medicaid payments prompted reductions to a 32-hour workweek for most of the staff.

Emgushov then set out to expand an existing special needs clinic, where the social worker, a nurse from early intervention, and any other worker involved with a particular child, come to a 45-minute clinic visit to ensure that all needs of the child and family are being met. She then initiated special access during off-hours through use of her home phone. As the only pediatric specialist on the island, Emgushov eventually sees all special needs children on Medicaid or MIP both here and at the main clinic. "There is no support for them except us," she explains, "so we figure out how to get them in."

Bronchiolitis, a condition found most often among infants and toddlers living in overcrowded and poor living conditions, is a common diagnosis at Emgushov's clinic. "Studies have demonstrated that breastfed children do not have to be admitted to the hospital as much for bronchiolitis," she observes. Since albuterol was the only medicine that could have an effect on bronchiolitis, and most of her patients could never afford it, she decided to look for a more feasible solution.

"The least I could do was promote breastfeeding," Emgushov concludes. To spread the word about her "no cost" prevention method, she signed up all of her pregnant patients for a monthly class given by the Guam Department of Public Health and Social Services. Emgushov also arranged to add valuable information, and referrals to breastfeeding coalitions on the island, to the packages that new moms take home from the hospital. Finally, she started offering a weekly information session at the clinic.

In just two years, Emgushov has managed to accomplish much of her vision of creating a healthy world, among the poorest of the poor in Guam. "The future challenge is that there is no money for Medicaid or MIP," she says. But what might disillusion any other clinician only fires her creativity and resolve to make a difference. "I will have to rely more and more on teaching my patients to eat right and exercise which is why I am looking into starting a wellness clinic," Emgushov continues. As she casts her eye toward possible funding sources for her dreams, it easy to believe that Emgushov will find the support she needs, through sheer determination.

Learn about other NHSC success stories.