Guam has a small population of about 200,000 residents, but it’s home to one of the highest concentrations of military veterans among U.S. states and territories. One in eight adults on the Pacific island have served in the armed forces.

by Arnaldo Rodgers

Despite those numbers, the island ranked last in the country for per capita medical spending by the Department of Veterans Affairs in 2012, with an average of $822 for each former service member. Virginia had the next lowest rate with a much greater $1,275 per veteran.

PBS recently explored whether Guam veterans are receiving the care they deserve in a documentary called “Island of Warriors,” part of an “America by the Numbers” series that examines shifting U.S. demographics and the significance to the nation.

Journalist Maria Hinojosa talked with Guam veterans about why they serve in the military and the level of treatment they receive when they return home.

The VA opened a new outpatient clinic for Guam veterans in 2011, but the island still lacks the kind of specialized treatment facilities available in other locations. The nearest intensive program for post-traumatic stress disorder (PTSD) is located more than 3,000 miles away in Hawaii.

“For me, that’s why I just stay home,” said Roland Ada, a Guamanian who was diagnosed with PTSD after serving two tours in Iraq as a combat medic. The veteran said he rarely socializes any more and thinks about ending his life several times a day.

The documentary also looked at U.S. Census data, which shows that about 8,000 former troops live in Guam. Many politicians and veterans advocates on the island suspect that the numbers are inaccurate and causing a lack of VA funding for the territory.

Hinojosa asked the VA’s Guam facility planner, Craig Oswald, whether the clinic’s two certified psychiatrists are enough to serve the territory’s veteran population.

“I think right now we’re doing quite well,” he said, adding that the clinic recently added more mental-health staff, including social workers and nurses.

Oswald agreed that Guamanians should have access to the specialized care they need, but he rejected the notion that the VA has overlooked the island.

“I think Guam is very well-known to ‘Big VA,’ to Washington, D.C.,” he said. “Our particular health-care system has actually received several million dollars … that’s being spent directly on veterans in the Pacific.”

But Guam Gov. Eddie Calvo disagreed, saying the Senate cut mental-health funding for the territory two years in a row.

“The federal government has not done their part to assist the very patriotic group of American citizens fighting in so many distant lands, in areas that have never tasted democracy,” Calvo said. “Yet these American citizens of Guam really have not felt what true democracy is all about.”

At the height of the wars in Iraq and Afghanistan last decade, four of the Army’s top recruiters were from Guam, and enlistment on the island doubled while it was falling almost everywhere else in the nation, according to the documentary.

“It’s a family tradition to do it,” said Sfc. Gonzalo Fernandez, a recruiter for the Army National Guard who won recruiter of the year awards three times in a row during that span.

Fernandez also attributed the high numbers to a sense of patriotism among Guam residents. But University of Guam history professor Michael Bevacqua said recruits may be attracted to the “shininess and the niceness” of the military, which offers economic opportunities they may not otherwise find outside the armed services.

Guam’s unemployment rate is 13.3 percent, whereas the the national average is 7.5 percent; and nearly 23 percent of residents there live in poverty, compared to about 15 percent of Americans overall, according to the documentary.

Maggie Aguon, an Iraq war veteran who was the first woman from Guam to volunteer for service in the military after 9/11, said she joined the military because she wanted to represent her island. “I want to put it on the map,” she said.

Aguon suffered a head injury in Iraq when an improvised explosive device struck her vehicle, and she said she still suffers from emotional trauma from her experiences in war. But she also said she would serve again.

“If they would have said, ‘Pack your bags,’ I would go again, in a heartbeat,” she said. “For my country, for my island. I’m not trying to prove anything. It’s called pride.”

Since the documentary was made earlier this year, the VA added one physician to its staff at the Guam clinic and applied for funding to expand its facilities.