Health Care Delivery System

The health of the community drives productivity and quality of life for children and adults, making access to quality healthcare and information essential to the children and families of the USVI.  In the USVI, access to healthcare needs and services are addressed through Medicaid, Medicare, personal finances (uninsured) or third party healthcare insurance.  The World Health Organization (WHO) identified three goals of health systems (1) Improving the health of populations (2) Improving the responsiveness of the health system to the population it serves (3) Fairness in financial contribution i.e. the extent to which the burden of paying for health system is fairly distributed across households.  These three aspects encompass the mission and vision of the USVI healthcare system.

The USVI health care system is facing challenges on many facades.  Before the devastation of hurricanes Irma and Maria, there were major concerns about the lack of some medical providers in some specialty, a large part of the population was uninsured, and insufficient facilities and programs to aid persons suffering with mental illness.

In February 2019, a  Community Needs Assessment , a report commissioned by the Community Foundation of the Virgin Islands  and the University of the Virgin Islands (UVI) Caribbean Exploratory Research Center (CERC) post Irma Maria  published in February 2019, evaluated  health, housing, education and social services in the territory in post hurricanes Irma and Maria.  Much of the discussion revolved around the status of the territory’s health facilities.  Both hospitals and most adjunct facilities were damaged badly and were inoperable months after the storm.

Families and children of the USVI can address their health care needs through a number of different facets of the USVI healthcare system.  The selection made by families may be influenced by level of income, access to transportation, level of education and language barriers. The healthcare systems of the VI which must address the needs of the community consist of the Virgin Islands Department of Health (VIDOH), the Federally Qualified Health Centers (FQHCs), Frederiksted Health Center, Inc.  (FHC) on St. Croix and the St. Thomas East End Medical Center (STEEMCC) on the island of St. Thomas: two hospitals, the Juan F. Luis Hospital and Medical Center (JFL) and the Schneider Regional Center (SRMC), many private providers  and 382 licensed medical professionals (excluding nurses).

Federally Qualified Health Centers (FQHCs)

The Territory has two Federally Qualified Health Center, St. Thomas East End Medical Center Corporation, Inc. (STEEMCC) in the STT/STJ district and Federicksted Health Center (FHC) in the St. Croix.

STEEMCC provides comprehensive primary health care service on the Eastern end of the island on St. Thomas.  They offer primary health care services in the area of behavioral health, family planning, women’s health, men’s health, obstetrics, pediatrics, senior care, adult and pediatric dental care and nutrition services.  Screenings are also provided for blood pressure, cholesterol, glucose, TB and breast, cervical and prostate cancer.

Frederiksted Health Center operates five sites on the island of St. Croix.  Three sites offer comprehensive primary care services, Ingerborg Nesbitt Clinic, the first service site, on Strand Street, Frederiksted; North Shore site in La Grande Princesse; Christiansted; and one mid-island at Sion Farm Shopping.  One satellite clinic is based at the St. Croix Educational Complex, a public high school and the fifth site offers.  Services provided at primary care clinics include medical, behavioral health and dental care, and serve all ages, from prenatal to the elderly.

It is extremely important that the FQHCs are strategically located and accessible by public transportation and focus on providing primary care to low-income families who fall below the federal poverty level and reside in medically underserved communities.  USVI vulnerable population benefit from the wide-range of payment options offered by the FQHC’s, including offering a sliding fee scale and accepting patients covered through private insurance, Medicaid, Medicare and self-payment. 

Virgin Islands Department of Health (VIDOH)

Many services and programs provided by the VIDOH through their public health clinics are used by families and children in the territory. The VIDOH clinical services offered to the USVI community include Maternal and Child Health (MCH), Community Health, HVI/STD and the Women Infant and Children program (WIC). The inability to pay for healthcare services and inadequate support for good nutrition have been put forth as obstacles to a healthier USVI community for years and the outcome has been a population struggling to live with maintaining a healthy status (Kaiser Foundation, 2017).

In 2019, a modular version of Department of Health’s Charles Harwood Complex (CHC) opened.   Due to major damages cause by the 2017 hurricanes, the complex closed in 2018. The modular is a parred down version of the CHC and houses the entire DOH St. Croix programs, services and clinics.

Roy Lester Schneider Regional Medical Hospital (RLS)

By August 2018, just a year after the storm, then SRMC CEO, testified at the VI Legislature on the state of the territory’s hospitals & health services that the hospital in St. Thomas has been stabilize and was offering a wide range of services.  In 2019, RLS went back to regular pre-storm in patient capacity providing intensive care, neonatal intensive care, behavioral health services, emergency services, cardiology, hemodialysis, medical/surgical services, nutrition services, respiratory services, radiology, pharmacy, laboratory, endocrinology, physical and speech therapy, patient prosthetics and other auxiliary services. The only service that was not restored were   In January 2020 , RLS Hospital increased pre-storm capacity and created a 20 bed Highly Infection Disease (HID) Unit to accommodate response to the Covid-19 pandemic. 

Schneider Regional also operates the Charlotte Kilmelman Center in St. Thomas and the Myra Keating Smith Clinic in St. John.  In March of 2019, a pared down modular version of Myra Keating was opened and named the Myra Keating Smith Interim Medical Center.  Keating offers the full scope of emergency and urgent care services similar to what was offered prior to the storms. The Charlotte Kilmelman Center remains closed and cancer patient travel outside of the territory to receive cancer treatment.  The hospital is able to provide IV and chemotherapy but cannot provide radiation therapy.

Juan F. Luis Hospital and Medical Center (JFL)

The Governor Juan F. Luis Hospital and Medical center (JFL) is composed of the Governor Juan F. Luis Hospital, the only hospital on the island of St. Croix, and the Virgin Islands cardiac center.  JFL offers general inpatient and emergency care, behavioral assessment and outpatient diagnostic services (laboratory, radiology).  The Interventional Cardiology services are no longer available and inpatient capacity

In 2018 Juan Luis hospital was operating at 50 percent capacity. In 2019, JFL capacity increased to 52 and will increase to 80 by the summer of 2020. In December of 2019 JFL began accepting dialysis patients credited to the new modular dialysis trailers the hospital received.   JFL received the full modular hospital which includes a four modular operating room. 

The Health Resources and Services Administration (HRSA) designated the USVI a Geographic High Needs Professional Shortage Area before the hurricanes hit, indicating a shortage of health care providers and services in the territory. Many healthcare providers moved out of the territory in the aftermath of the 2017 hurricanes causing a significant strain on the islands healthcare system.    Although some returned and some positions were filled, a serious personnel shortage remains. The Virgin Islands Department of Health and both of the territory’s hospitals still struggles to recruit nursing staff and specialty providers.

The programs and services available to meet the health care needs of children and families two years after the passing of Hurricanes Irma and Maria continue to reflect the negative impact of the hurricanes, particularly on the local department of health and two hospitals.  There are some existing gaps relative to health care services and service delivery issues in the territory. The territory’s high rate of poverty is an underlying factor in the quality of healthcare in the USVI.

Effect of Coronavirus on the territory’s infrastructure

The coronavirus pandemic has been disruptive for all and sadly, devastating and difficult for many.  Currently, there are over 6.5 million confirmed Covid-19 cases and 749,406 deaths as a result of Covid-19 in the United States.  In the Virgin Islands, 1,221 cases were confirmed and 19 deaths.

With the health care system focused on testing and treating the coronavirus, adaptations in care delivery were made quickly with patients and  multiple avenues was provided for access to care while it was unsafe or impossible for patients to come to clinical spaces.  Telemedicine has emerged as a viable option to provide treatment while protecting the clinical staff and clients.  As

The U.S. Virgin Islands is reinforcing critical public health messaging like symptom monitoring infection prevention and ways to avoid the spread of disease into our territory.  By following the health department’s guidance, Virgin Islands residence can keep themselves and families safe if they come into contact  with someone with Covid-19  or other viral respiratory pathogens like the flu.