Overview of Guam

Guam, an organized, unincorporated territory of the United States, is strategically located in the Micronesian subregion of the Western Pacific Ocean. It is the 32nd most significant island in the United States, measuring 30.17 miles long and 4 to 12 miles wide, with an area of 212 square miles. Guam is the largest and southernmost island in the Marianas Archipelago, which includes Guam, Rota, Tinian, Saipan, and ten smaller islands. Positioned about three-quarters of the way from Hawaii to the Philippines across the International Dateline, Guam serves as a crucial hub for travel and trade in the Pacific. From Guam, many parts of the country, including Japan, Singapore, the Philippines, and China, are within a three- to five-hour flight. Guam is also the closest land mass to the Mariana Trench, the deep submarine trench that runs east of the Marianas.

Source: infoplease.com/atlas/pacific-islands

Guam is divided into 19 villages. Most of the population lives on the coralline limestone plateau of the north, with political and economic activity centered in the central and northern regions. The rugged geography of the south essentially limits settlement to rural coastal areas. The western coast is leeward of the trade winds and is the location of Apra Harbor, the capital of Hagåtña, and the tourist center of Tumon. The U.S. Department of Defense owns about 29% of the island under the management of Joint Region Marianas. On the island's northern end is Andersen Air Force Base, which houses the Navy's Helicopter Combat Support Squadron Twenty-five (HSC-25); the island’s southern end is U.S. Naval Base Guam (NBG).

Population

The civilian population of the U.S. Territory of Guam in the Western Pacific was estimated at 153,836 in 2020 (U.S. Bureau of the Census). The majority of the population is Pacific Islanders and Asians (81.5%), which includes Indigenous Chamorro (32.8%), other non-Chamorro Micronesians (13.2%), Filipinos (29.1%), and other Asians (6.4%). The remaining 8.5% comprises various ethnic groups, contributing to Guam's rich cultural diversity. Additionally, 10% of the population identifies with multiple ethnicities, further enriching the island's cultural fabric.

Among the household population aged five and over, 57.3% spoke a language other than English. Of that, 65.9% spoke English "very well" and 42.8% spoke a Philippine language. Of the population aged 5 to 17 in households, 32.3% spoke a language other than English. Of that group, 71.8% spoke English "very well" and 34.5% spoke another Pacific Island language.

Of the population aged 65 and over in households, 82.9% spoke a language other than English. Among them, 61.3% spoke English "very well" and 45.1% spoke a Philippine language.

Climate

Guam has a tropical rainforest climate. March is the driest month and almost qualifies as a tropical monsoon month. The weather is generally hot and humid throughout the year, with slight seasonal temperature variations. Guam is known for having relatively consistent temperatures year-round. Trade winds are constant throughout the year. There is often a weak monsoon influence in the summer months.

Guam has two distinct seasons: wet and dry. The dry season runs from January through May, with the wet season from June through November. The mean high temperature is 86F, and the mean low is 76F. Temperatures rarely exceed 90F or fall below 70F. The relative humidity commonly exceeds 84% at night throughout the year, but the average monthly humidity hovers near 86%.

Guam lies in the path of typhoons, and it is common for the island to be threatened by tropical storms and possible typhoons during the wet season. The highest risk of typhoons is August through November, when tropical storms and typhoons are most probable in the Western Pacific. They can, however, occur year-round. Typhoons that have caused significant damage on Guam include Typhoon Karen (1962), Pamela (1976), Paka (1997), Pongsona (2002), and Mawar (2023).

Local Government

Guam is an organized, unincorporated territory of the United States. Meaning that only select parts of the U.S. Constitution apply to its residents. Individuals born in Guam are considered citizens of the United States. Residents of Guam cannot vote in federal elections. Guam's local government is organized into three branches: executive, legislative, and judicial. The legislative branch comprises a unicameral legislature with 15 members elected for two years. The legislature is empowered and responsible for creating laws to protect the community, ensure the community's health and welfare, and promote the development of Guam. Guam's judicial branch decides issues of local statutes and interprets how these laws should be applied. The judiciary comprises the Superior Court of Guam and the Supreme Court of Guam. Finally, the island's highest elected officials, the Governor and Lieutenant Governor of Guam, manage the executive branch. These officials are tasked with implementing Guam's laws through the various departments, bureaus, agencies, and committees that comprise the Government of Guam.

Guam has a non-voting delegate in the U.S. House of Representatives. Non-voting delegates can perform many functions of a full representative, such as serving on committees, speaking on the U.S. House Floor, introducing bills, and offering amendments. However, they are not able to vote while conducting business as the Committee as a whole or on the final passage of legislation.

 

People and History

Indigenous Guamanians are the Chamorro, related to the Austronesian people of the Malay Archipelago, the Philippines, Taiwan, and Polynesia. However, unlike most neighbors, the Chamorro language is not classified as a Micronesian or Polynesian language. Instead, like Palauan, it constitutes an independent branch of the Malago-Polynesian language family.

The first European to travel to Guam was Portuguese navigator Ferdinand Magellan, sailing for the King of Spain, when he sighted the island on March 6, 1521, during his fleet circumnavigation of the globe. Despite Magellan's visit, Spain did not officially claim Guam on January 26, 1565, by Miguel Lopez de Legazpi. From 1565 to 1815, Guam and the Northern Mariana Islands, the only Spanish outposts in the Pacific Ocean east of the Philippines, were re-provisioning stops for the Manila galleons, a fleet that covered the Pacific trade route between Manila and Acapulco.

Spanish colonization commenced on June 15, 1668, with the arrival of a mission led by Diego Luis de San Vitores, who established the first Catholic Church. The islands were part of the Spanish East Indies and the Vice Royalty of New Spain. The Spanish-Chamorro Wars on Guam began in 1670 over growing tensions with the Jesuit Mission, with the last large-scale uprising in 1685. Despite these challenges, the Chamorro people have shown remarkable resilience and continue to thrive on their island.

Intermittent warfare, typhoons in 1671 and 1693, and a smallpox epidemic in 1688 reduced the Chamorro population from 50,000 to 10,000 and finally to less than 5,000. The island became a rest stop for whalers starting in 1823. A typhoon struck the island in August 1848, followed by an earthquake in 1849. In 1856, another smallpox epidemic killed over 3,600 Guamanians.

During World War II, the Empire of Japan attacked and invaded Guam in the 1941 Battle of Guam on December 8, at the same time as the attack on Pearl Harbor. The Japanese renamed Guam Omiga-jima (Great Shrine Island). The Japanese occupation of Guam lasted about 31 months. During this period, the indigenous people of Guam were subjected to beatings, forced labor, family separation, concentration camps, rape, and beheadings.

Source: https://www.history.navy.mil/                                     Pre-invasion bombardment of the Guam shore, July 1944

During the nearly 3 years of occupation, approximately 1,100 Chamorro were killed, according to later U.S. congressional Committee testimony in 2004. Some historians estimate that war violence killed 10% of Guam's then 20,000 population. The United States returned and fought the 1944 Battle of Guam from July 21 to August 10 to recapture the island.

Source: https://www.history.navy.mil/                                    

After World War II, the Guam Organic Act of 1950 established Guam as an unincorporated, organized territory of the United States, provided for the structure of the island's civilian government, and granted the people U.S. citizenship. The Governor of Guam was federally appointed until 1968, when the Guam Elective Governor Act provided for the office's popular election. Since Guam is not a U.S. State, U.S. citizens residing in Guam are not allowed to vote for president, and their congressional representative is a non-voting member.

President John F. Kennedy's 1963 removal of Guam's security clearance allowed for the development of a tourism industry. When the U.S. closed U.S. Naval Base Subic Bay and Clark Air Force Base, based in the Philippines, after the expiration of their leases in the early 1990s, many of the forces stationed there were relocated to Guam.

Guam's de facto motto, "Where America's Day Begins," refers to the island's proximity to the International Dateline.

Culture

The culture of Guam reflects a blend of traditional Chamorro customs and influences from American, Spanish, and Mexican traditions. Few Indigenous pre-Hispanic customs remained following Spanish contact, including pottery. There have been resurgences of interest among the Chamorro.

Latte Stones are the stone pillars of ancient Chamorro houses. Found nowhere else in the world, the Latte Stone has become a symbol and the signature of Guam and the Mariana Islands. Original Latte Stones were comprised of two pieces: a supporting column (Halagi) made from coral limestone and topped with a capstone (Tasa) made from coral heads. The stones were usually carried several miles from a quarry site or reef to the house's location.

By Hajime NAKANO from Tokyo, Japan - Latte stone

Unemployment/Employment

Employment and average weekly hours paid have continued recovering from the pandemic lows. The September 2024 preliminary statistics show an increase of 1,150 jobs over the year. The most significant private sector employment gains over the year were in Construction 930, Retail Trade 120, and Wholesale Trade 110. Employment, average weekly hours paid, and average weekly earnings have continued their recovery from the pandemic lows. Employment numbers began a moderate rebound in December 2020, with the recovery continuing in 2024.

Source: Guam DOL

The unemployment rate in Guam for September 2024 was 3.4 percent, a decrease of 0.6 percentage points from the June 2024 figure of 4.0 percent and a reduction of 0.7 percentage points from the September 2023 figure of 4.1 percent one year earlier. The total number of persons unemployed in September 2023 was 2,290, a decrease in the latest quarter and over the year. 

The September 2024 statistics continue the general trend of reduced numbers of unemployed people and lower unemployment rates since the pandemic's high figures occurred in December 2020. Typhoon Mawar pummeled Guam on May 25, 2023, temporarily depressing employment and the number of people looking for work.

Source: Guam DOL

Cost of Living

The cost of living, as defined by the Cambridge Dictionary, is "the amount of money that people need to spend to buy basic goods or services such as food, clothes, and a place to live."

The Consumer Price Index (CPI) measures the average price change of household goods and services over time. The Guam CPI is based on a representative "market basket," a sample of all goods and services consumers purchase, as determined by the 2005 Household Income and Expenditures Survey funded by the U.S. Department of the Interior to the U.S. Census Bureau. Guam's overall consumer prices increased from the first quarter of 2023 to 13.8% compared to the same quarter of 2022 and 4.3% from October to December.

Here are examples of Guam’s Cost of Living:

• Rent: A furnished 800 sq. ft. apartment can cost $2,200 per month, while an unfurnished apartment can cost $1,500.
• Utilities – basic utilities like power and water for two people in an 800 sq. ft. apartment can cost $350 per month
• Food – a sit-down lunch costs around $40, and a sit-down dinner can cost around $80
• Internet – cable internet service can cost around $110 per month
• Mobile phone – a monthly plan with calls and 10 GB+ of data can cost around $97 per month.

Poverty

Poverty is more than a lack of income. Poverty manifests as hunger and malnutrition, restricted access to basic services and education, isolation and exclusion, and not being invited to the table for decision-making. People living in poverty in Guam are more likely to experience poor health, be food insecure, have chronic stress, live in unsafe neighborhoods, and experience unstable housing. Those in “near poverty” are often one crisis away from falling into poverty.

The availability of data from the 2020 Guam Census allowed for Guam's poverty rate to be calculated. Unlike the 50 U.S. states, whose poverty rates are calculated annually by the U.S. Census Bureau, Guam does not have an official estimate for its poverty rate. However, a 2020 estimate calculated a rate of 29.7%, more than double the national average. The graph presents an estimate of the poverty rate for Guam for the year 2019, along with the 50 U.S. states, using data from the U.S. Census Bureau. It shows that, in 2019, 25.6% of households in Guam had incomes below the federal thresholds for a family of four. As shown, Guam's poverty rate is more than double the national average of 10.8% and is higher than that of Mississippi, which has the highest poverty rate.

Guam Poverty Rate vs. U.S. Poverty Rate 2019

Of the 25.6% of households living in poverty, 54% were individuals over 18 years of age, 4% were individuals over 65, and 4% were children under 18. When assessing families in poverty status, 41% were married-couple families, 44% were female-headed households, and 15% were male-headed households living in poverty.

 

Food Security/Insecurity

Household food security is often a consequence of poverty. The U.S. Department of Agriculture's (USDA) definition of food insecurity can be paraphrased as "a limited or uncertain availability of food. Low food security is food security without hunger."

In addition to food security trends demonstrated throughout the Pacific, the food security situation in Guam is particularly impacted by several highly context-specific factors. Among these factors is Guam's political status, which has contributed to the increase in cheap imported foods. Imports have primarily created a situation where there is enough food and sufficient food availability, but insufficient nutritional value.

 Further, adequate access and utilization components of food security are lacking in Guam. Food prices, the spread of nutritious food, the geographic location of major supermarkets, food assistance programs, diets, and widespread consumption patterns contribute to a larger picture of poor access and weak utilization of healthy food.

The Supplemental Nutrition Assistance Program (SNAP) is one of the most extensive national programs that grants food benefits based on individual and household needs. Thousands in Guam saw a slight increase in SNAP benefits starting October 1, 2023. A household of one will see SNAP benefits increase by $15 (a 3.6% increase) from $415 to $430. A household of six will see its SNAP benefits increase by $71, or from $1,973 to $2,044, or a 3.6% increase.

SNAP is the nation's most essential and effective anti-hunger program. Over one-quarter of Guam households aged 27 to 34 (37.3%) and 35-44 (28%) received SNAP benefits.

Hunger is strongly linked to health and academic achievement. Hunger negatively impacts educational performance and behavior in school, with hungry children performing worse in math, being more likely to repeat a grade, coming to school late, or missing school days entirely. Students who eat breakfast at school have better attendance and fewer behavioral problems during the day. Schools that offer free breakfast to all students through their programs improve behavior and increase focus in the classroom. In Guam, free meals are available to children attending public schools.

Homeless

Homelessness or houselessness – also known as being unhoused or unsheltered is the condition of lacking stable, safe, and functional housing. The general category encompasses diverse situations, including living on the streets, moving between temporary accommodations such as those with family or friends, residing in boarding houses with inadequate security, and individuals leaving their homes due to civil conflicts, becoming refugees within their own country.

In January 2024, the Point in Time (PIT) survey identified 1,249 homeless individuals. Of these, 405 (32.4%) were children under 18, an increase of 14.9% from 2020.

 

 

Guam Homeless Population

2018-2024

Source: Guam PIT Count

Homelessness has harmful effects on the individuals who experience it because having a home is a basic necessity to maintain health, work, school, and dignified living conditions. Lack of stable housing seriously disrupts an individual's ability to obtain or keep a job or ensure that children can attend and focus on school. Homelessness exposes individuals to serious health risks and makes it challenging to take care of one's health and access health care; therefore, homelessness can exacerbate chronic or acute health conditions. Adults experiencing homelessness often have health problems and difficulty with daily living activities that are more typical of people 20 years or older.

The stress of homelessness can also seriously harm individuals’ mental well-being. Research shows that the trauma of experiencing homelessness can cause people to develop mental health problems for the first time and can worsen existing behavioral health challenges. The longer time spent without a home is linked to higher levels of mental distress and more damage from coping behaviors like substance use.

The Compacts of Free Association

The Compacts of Free Association govern the relationships between the United States and the Republic of the Marshall Islands (RMI), the Federated States of Micronesia (FSM), and the Republic of Palau.

Source: https://gisgeography.com/micronesia-map

Citizens of the RMI, FSM, and Palau (Freely Associated States or FAS) have the right to reside and work in the United States and its territories as lawful non-immigrants or "habitual residents." More than 94,000 FAS citizens live in the United States, including children under the age of 18 who were born in the United States.

The FAS covers a maritime area larger than the continental United States, governs over 1,000 islands and atolls, and has a combined population of approximately 200,000. The FAS economy faces structural challenges similar to those of many other Pacific Island countries, including a lack of economic scale, small land areas, limited natural and human resources, and poor infrastructure in remote locations, as well as vulnerability to climate change.

In March 2024, the Department of the Interior finalized the Compacts of Free Association Amendments, which would provide 20 years of new economic assistance. The $6.5 billion in aid is critical for the financial stability and quality of life of the people of the freely associated states.

The Compact of Free Association package will provide economic assistance of $3.3 billion to the FSM, $2.3 billion to the RMI, and $889 million to Palau over 20 years through 2043. The funding will support essential public services for primary public service delivery, such as health and education, improve infrastructure, and bolster the health of the Compact trust funds previously established for each FAS.

Education

Guam's educational needs are provided by an island-wide public school system (the Guam Department of Education (GDOE)), which is comprised of seven high schools (grades 9 to 12), eight middle schools (grades 6 to 8), and 26 elementary schools (grades 1 to 5) operated by the Government of Guam.

For the School Year ("SY") 23-24, forty-one (41) public schools provided services for 24,322 students. Further breakdown by levels showed 10,699 students in grades K-5 (including Head Start and Pre-K), 5,211 students in middle school, and 8,412 students in grades 9-12, inclusive of an Alternative School.

The student population decreased significantly by 1,326 between SY 22-23 and SY 23-24. Within grade levels, there were increases in grades 2 and 11. Meanwhile, grades K, 1, 3,5,7,9, and 10 showed significant decreases.

A "dropout," as defined by the Board Policy 375, is a student who was enrolled in a GDOE high school sometime during a given school year and, after enrollment, stopped attending school without:

• Being transferred to another school or a high school equivalency educational program recognized by GDOE; or
• Being incapacitated to the extent that enrollment in school or participation in an alternative high school program was not possible or
• Having graduated from high school or completed an alternative high school program recognized by GDOE within six (6) years of the first day of enrollment in ninth grade; or
• Being expelled or removed by law enforcement authorities and confined, prohibiting the contribution to schooling.

Source: GDOE

GDOE oversees the Guam Head Start Program. Head Start programs enhance the cognitive, social, and emotional development of low-income preschool children aged three to five, preparing them for school.

Each child's perceptual, motor, and physical development is supported, enabling them to explore and function in their environment fully. All children receive developmental and health screenings, nutritious meals, and oral and mental health support. The program connects families with medical, dental, and mental health services to ensure children receive the necessary services.

Head Start enrolls children with disabilities if it is an appropriate placement for their unique needs. All children learn from their classmates through play, social interaction, activities, and role modeling. Children with disabilities need to be with their peers and to experience and have opportunities to learn in the least restrictive environment.

Source: GDOE

Department of Defense

The Department of Defense Education Activity (DoDEA) is the civilian agency that manages schools for military-connected children in the United States and overseas at American military bases worldwide. DoDEA schools serve the children of military service members and Department of Defense civilian employees worldwide. Children of enlisted military personnel represent 85% of the total enrollment in DoDEA schools. DoDEA provides for four schools in Guam: one high school, one middle school, one elementary school, and one joint elementary/middle school.

Charter Schools

The island passed its first charter school law in 2009 and opened the doors to its first charter school, Guahan Academy Charter School, in 2013. The charter movement in Guam is gaining momentum as Guahan Academy celebrated its third graduating class.

Guam's second charter school, iLearn Academy Charter School, opened in January 20156 and serves Kindergarten through fifth grade. The school emphasizes Science, Technology, Engineering, and Mathematics (STEM), with a focus on technology and robotics.

Alternative School

Under the leadership of the GDOE Superintendent, the school changed from a temporary rehabilitation center for middle and high school students with behavioral issues to a credit recovery high school. This has allowed students lacking many high school credits to make up those credits and work toward earning a high school diploma.

Asmuyao Community School was founded in April 1972 by a group of University of Guam professors, Guam public school teachers, and parents who were concerned about their children's educational welfare. Together, they established Asmuyao, a nonprofit alternative school focused on independent study.

The initial enrollment was thirty-five (35) students from various grade levels, all of whom were the children of the original incorporators and supporters of the alternative philosophy of education advocated by Asmuyao.

The name "Asmuyao" is derived from two Chamorro words: "Asmu," meaning "the coming together for a common good," and "Y'ao," which means to "wake up." Hence, Asmuyao is "where we wake up and come together for a common good."

Other Schools

The Catholic Archdiocese of Agana also operates a substantial school system with ten schools: 3 high schools, six elementary/middle schools, and one elementary school. Several other religious denominations also operate schools in Guam. They include Saint John's Episcopal School, Harvest Christian Academy, Guam Adventist Academy, Temple Baptist, and Trinity Christian School.

Additionally, two Japanese Schools, one Chinese School, and one Korean school are operating on the island.

College and University

The Guam Community College (GCC) provides vocational and technical education for high school students. GCC offers various academic and professional programs, as well as technical and vocational programs, that award Associate Degrees or Certificates of Completion. GCC collaborates with local high schools and the University of Guam and is fully accredited by the Western Association of Schools and Colleges (WASC).

The University of Guam (UOG) offers post-secondary programs through five different colleges and schools: the College of Liberal Arts and Sciences, the College of Natural and Applied Sciences, the School of Business and Public Administration, the School of Education, and the School of Nursing and Health Sciences. The University provides six Baccalaureate degrees and six Master's degree programs.

Health Care Delivery System

Guam's healthcare delivery system is pluralistic, distinguished by a public and private sector for the local civilian population, and a military system for delivering medical services to active military members, their dependents, and military retirees and veterans.

The health services customarily found in a community of similar size in the U.S. mainland are available to the island population. One unique problem that sets Guam apart from mainland communities is that specialized and tertiary medical services are located thousands of miles away, necessitating medical referrals to Japan, Hawaii, the Philippines, or the mainland United States.

Guam has been designated a Health Professional Shortage Area (HPSA) and a Medically Underserved Area (MUA). HPSA and MUA are federal designations for areas, populations, groups, or facilities with unmet healthcare needs. MUA identifies areas or populations needing medical services based on demographic data. Designations help prioritize limited federal resources to the areas that need them most.

Guam's healthcare system comprises hospitals, outpatient clinics, and home healthcare services. As a public health department, the goal is to improve the health status of every Guam resident and ensure access to quality health care. This includes helping people live free from the threat of communicable diseases, tainted food, and dangerous products. Activities to assist in this mission include regulating healthcare providers and facilities when appropriate.

Private Sector

The private sector caters to the individual needs of the community, providing one-to-one outpatient medical and dental care, laboratory, radiological, and optometric services, as well as pharmaceuticals. There are several multi-specialty medical/dental groups. In addition, there are specialty medical group practices, individual physicians, and dentists. Independent laboratories, pharmacies, and optical retailers within the community provide auxiliary services.

• Guam Regional Medical City (GRMC) – The Guam Regional Medical City (GRMC), the only private hospital in Guam, is located in one of the most populated areas of Guam. GRMC is a Joint Commission-Accredited Philippine healthcare organization. The hospitals' services include cardiology, medical oncology, endocrinology, pulmonology, neurology, and other medical and surgical subspecialties.

GRMC began phasing out its Maternal-Child Health (MCH) services on November 2, 2018. This included stopping new admissions to inpatient MCH services, such as labor and delivery, pediatrics, and intensive care units.

Private Clinics

In June 2013, Guam welcomed International Health Providers LLC, which operates as "IHP Medical Group." The American Medical Center has opened a second clinic in the central village of Mangilao. Hagåtña Med is another new development, offering primary and urgent care. The clinic enhances Guam's medical capabilities by providing urgent care services and utilizing modern technology. Hagåtña Med opened to serve the populations living in the central and southern villages of the island.

Sagua Mañagu, Guam's only birthing center, closed in December 2022. The birthing center opened in 1999. The Sagua Medical Clinic closed in February 2025 when the OB/GYN physician retired.

Guam has specialty and emergency care clinics and about 30 pharmacies for prescription drug needs. Specialized healthcare facilities include the Guam Radiology, five renal care facilities, a surgicenter for outpatient surgical procedures, and the Heart and Vascular Institute of Guam.

FHP Health Center Guam was approved as the newest affiliate of the National Cancer Institute Community Oncology Research Program (NCORP) to bring cancer clinical trials and cancer care delivery studies to people in the local communities. FHP Health Center’s affiliation with the University of Hawaii (UH) Cancer Center’s Minority/Underserved NCORP site will allow patients to participate in NCI-sponsored cancer clinical trials through the national NCI-supported network.

Home Health Services

Several companies in Guam offer integrated health services. The companies strive to deliver the most current treatments, education, and services in health promotion and disease management to the people of Guam.

Nurses and other home health assistants, such as physical therapists or licensed vocational nurses, provide certified home health care for patients in need of skilled care. Medicare typically covers home health care and consists of caregivers coming to a patient's residence over a 30 to 60-day period.

The patient's physician coordinates home health care visits. This care is given in the home under a doctor's order. It includes care similar to that in a hospital or skilled nursing facility, but is less expensive and more convenient for both the patient and their caretaker(s). Home health care covers a wide range of professional health care services given at the time of illness or injury. In hospice care, the patient typically faces a life-limiting illness.

Examples of Home Health Care Services:

• Wound care for pressure sores or a surgical wound;
• Patient and caregiver education;
• Intravenous or nutritional therapy;
• Injections; and
• Monitoring serious illness and/or unstable health status.

Military Sector

U.S. Naval Hospital Guam

The Naval Hospital offers medical care to military personnel, military dependents, veterans, and civilians in case of emergency. The military also runs small outpatient clinics at Andersen Air Force Base, the Naval Hospital, and a dental clinic.

The U.S. Naval Hospital is the regional hospital for military personnel and their families. Services provided at the hospital include family practice, OB/GYN, pediatrics, general surgery, acute care, anesthesia, internal medicine, emergency medicine, health promotion, and social services. The hospital is staffed by active-duty civilians, contractors, reservists, and volunteers. Staff at Naval Hospital not only serve military personnel stationed in Guam but also personnel who have been deployed overseas during times of conflict to provide medical support.

Although the primary population treated at Naval Hospital is military personnel and their dependents, civilians may be treated there in emergencies. Through a Mutual Aid Agreement, seriously ill or injured persons are taken to the closest emergency room if their condition is judged to be time-critical.

Guam Veterans Affairs Clinic (Guam V.A. Clinic)

The Guam community-based V.A. clinic opened in 2011. This outpatient clinic provides primary health care to eligible veterans. The V.A. Clinic also handles referrals to specialists at the Naval Hospital or private clinics in the community. If these fail, referrals may be sent to Tripler Army Medical Center in Hawaii.

Public Sector

• Guam Memorial Hospital Authority (GMHA)

Guam Memorial Hospital Authority (GMHA) is a public civilian hospital in Tamuning, Guam. It serves the island with 158 licensed acute care beds and 40 beds at its off-site long-term care Skilled Nursing Facility.

The hospital offers comprehensive medical services for adults and children. These include 24-hour emergency services, medical telemetry and progressive care, obstetrics, labor and delivery, a catheterization lab (periodically with visiting cardiologists), a nursery, orthopedic services, inpatient and outpatient surgery, intensive care (neonatal, pediatric, and adult), and laboratory and blood bank services.

In 1964, the GMHA was established as a line agency within the executive branch of the Government of Guam. This creation separated the administration of hospital services from community health services provided by the Department of Public Health and Social Services. Thirteen years later, in 1977, the Guam Memorial Hospital Authority was established as a public corporation and has since operated as a governmental, nonprofit institution serving the people of Guam under the governance of a non-member Board of Trustees.

• Guam Behavioral Health and Wellness Center (GBHWC)

Guam Behavioral Health and Wellness Center (GBHWC) is responsible for addressing behavioral health services in Guam, including mental healthcare for adults and children, drug and alcohol abuse, and treatment and rehabilitation of these issues. GBHWC has a wide range of facilities around the island, including dedicated assistance and treatment. A medication clinic caters to less severe mentally ill individuals who are unable to care for their mental condition due to the lack of resources, and individuals experiencing acute emergencies and/or crises.

For those adults who have a serious mental illness and are in long-term care at GBHWC, a day treatment service is offered to help them with social and other skills so that they can work to rehabilitate and transition to home and community living. GBHWC and its partners provide services from several facilities throughout Guam.

I Famagu'on-ta provides care coordination/wraparound and counseling services to children and adolescents admitted to the Crisis Stabilization Unit. The objective is to support, empower, and strengthen child and family ties by making mental health services accessible to children and adolescents with severe and complex mental health issues.

 

Sanctuary provides a temporary safe refuge for youth during family conflicts and abuse, a crisis hotline, supportive counseling, casework, outreach, education, and prevention programs.

 

Rays of Hope is a community-based therapeutic Intervention/behavioral management facility that provides educational instruction and personalized care. This includes assisting in the development of social skills, fostering leadership and behavioral management, and enhancing self-esteem and academic performance. The Child Adolescent Division of GBHWC oversees the children's therapeutic day treatment.

 

New Beginnings helps individuals suffering from substance abuse or addiction begin the path of rehabilitation and work towards a new start. The program offers varying levels of treatment, which vary in intensity and are based on an assessment that follows the American Society of Addiction Medicine Patient Placement Model.

 

Healing from sexual assault is never easy. The journey to recovery from trauma takes time and requires both immediate and long-term services built upon the foundation of understanding that trauma takes many forms, is often overlapping, and can be re-experienced in many ways.

 

The Healing Hearts Crisis Center (HHCC) is Guam's only rape crisis center. As a division of GBHWC, HHCC exists with the intent to provide survivors of sexual assault with discrete, immediate, and complete medical attention."

 

HHCC incorporates a holistic approach for the survivor of sexual assault or abuse. Regardless of when the assault occurred or the age, gender, ethnicity, or disability of the survivor, HHCC offers a supportive, healing atmosphere with caring professionals to assist survivors in regaining feelings of safety, control, trust, autonomy, and self-esteem. The HHCC team works together to ensure all survivors receive the services they need to begin and sustain the healing process after sexual assault or abuse. HHCC services include intake assessments and crisis intervention, forensic and multidisciplinary team interviews, short-term case management, and linkage to other necessary services, such as individual and family therapy. HHCC also provides medical services, including forensic examinations and collection of forensic evidence, as well as outreach and training for schools, service providers, and the community at large.

 

• Guam Department of Education

Each of Guam's seven high schools, eight middle schools, and 26 elementary schools has a nurse's office staffed by a full-time registered nurse (some also have a licensed practical nurse) who provides health services to students and refers children to maternal and child health services when needed.

• Department of Public Health and Social Services

The Department of Public Health and Social Services (DPHSS) is Guam's designated governmental agency responsible for providing healthcare services. DPHSS is one of the major providers of social services to the island's residents. The mission of DPHSS is "to assist the people of Guam in achieving and maintaining the highest level of independence and self-sufficiency in health and social welfare." DPHSS is comprised of seven divisions:

•         The Division of General Administration (DGA) provides department-wide administrative support functions.
•         The Division of Public Health (DPH) is DPHSS's largest division. Its mission is to ensure the provision of direct and indirect healthcare services for individuals, families, high-risk groups, and the community at public health facilities, schools, home settings, and other community locations following legal mandates and the identified collective health needs of the population.

 

Community Health Centers – DPHSS operates two Community Health Centers (Northern and Southern). The centers are federally qualified health centers and are multi-specialty primary care clinics. Three primary types of services are provided: 1) primary care and preventive services, 2) support services, and 3) social services.

•         The Division of Public Welfare (DPW )'s mission is to promote favorable social conditions to attain the highest health and social well-being for economically and socially disadvantaged populations. The division also administers payment and various social services to remove social barriers that prevent a person from obtaining/maintaining the necessities of life.
•         The Division of Environmental Health (DEH) is the branch of DPHSS responsible for ensuring public and consumer health and protection through preventive measures against unsanitary conditions. DEH's significant functions include sanitation inspections of regulated facilities, reviewing plans and specifications of regulated facilities, overseeing processing center operations, vector control, and regulating consumer commodities.
•         The Division of Children's Wellness (DCW) comprises the Bureau of Social Services, including Child Protective Services and the Bureau of Child Care Services. It addresses an urgent need to increase child care, provide financial support to existing child care providers, and expand programs that grow our child care services.

A brand new division was created in January 2025: the Division of Homelessness Assistance and Poverty Prevention, which will be tasked with:

• Coordinating with local and federal agencies, nonprofit organizations, and the private sector to deliver comprehensive resources to the homeless population; administering programs that address the root causes of poverty, including employment assistance, housing stabilization, and mental health services; and advocating for vulnerable populations and securing sustainable funding for homelessness prevention initiatives.

 

• Emergency Medical Services

 

In 1977, Guam passed legislation establishing the island's Emergency Medical Services System. The law designated the DPHSS as the lead agency and established the Emergency Medical Services Office within the DPHSS.

Guam has one public ambulance service provider, the Guam Fire Department (GFD). The military (Air Force and Navy) each has ambulance units that serve their respective jurisdictions, and a Mutual Aid Agreement is in place with each military unit for mutual aid assistance to the local ambulance service. GFD operates its ambulances at the BLS Level with two units providing ALS Service (EMT Intermediate with IV, intubations, EKG, and medication skills) (plus an ALS intercept (non-transport) unit).

Several private ambulance services are now available. These services are often provided during a medical emergency, but are not restricted to emergencies. The vehicles are equipped with lifesaving equipment and operated by medically trained personnel.

Health-Related Community Organizations

Guam has various health-related community organizations, including the American Red Cross, American Cancer Society, Lytico-Boding Association, Guam Hemophilia Program, Guam Diabetes Association, Make-a-Wish Foundation, and the Ayuda Foundation.

“Native” or Traditional Health Care Providers

Suruhanas or Suruhanas are native Chamorro healers who use natural herbs in combination with massage to cure a variety of complaints. The names are believed to come from the Spanish word "Cirujano," which refers to ship doctors who came to Guam with the Spanish galleons.

Suruhanas or Suruhanas are considered "good" people who have received their powers from God. Additionally, it is believed that powers are inherited and typically remain within a family. However, a suitable apprentice can be trained if there are no family members to continue the family tradition in health. A working knowledge of curative herbs, where and when they grow, how they are transformed into medicine, and the anatomy of the human body is taught over several years. Practicing Suruhanas or Suruhanas relies heavily on experience and success with a particular treatment. Some specialize in specific fields, such as skeletal and muscular systems, as well as pregnancy.

Hilots are traditional Filipino healers who function much the same as Suruhanas or Suruhanas. As expected, Hilot's services are used more frequently by those of Filipino descent than by any other ethnic group.

The Makåhna or Kakåhna were shamans with magical powers. They performed rituals over the skulls of Chamorro ancestors to ensure a good harvest or catch of fish, and they could cast an evil spell or revenge on a person by using the person's body waste. For this reason, Chamorro was careful about how they disposed of their body waste. No Makåhna or Kakåhna practice this magic today, as Christianity ended their practice.

The title Pattera derives from the Spanish word partera, which means midwife. Old and Middle English define a midwife as "with women" and designate a woman who assists other women in childbirth. In the past and worldwide, women have traditionally attended to and assisted other women during labor and childbirth. In Guam, lay midwives and Suruhanas or Suruhanas assisted women during labor and birth.

The Pattera links the Chamorro traditions surrounding childbirth with U.S. hospital-based birthing practices. Furthermore, they embodied the times of change when Guam experienced the transition from U.S. Navy Administration to a self-governing era and, in the 1940s, survived the ravages of World War II. They merged their roles as mothers, wives, and career women. When appropriate, they applied indigenous and U.S. healthcare practices and economics. These women became Guam's first Chamorro self-employed, licensed health practitioners.