Deputy Secretary of Veterans Affairs Donald Remy visited the Spark M. Matsunaga Department of Veterans Affairs Medical Center on Wednesday as part of a tour of VA facilities across the Pacific.

The VA’s Pacific Islands Health Care System, based on Oahu and headquartered at Tripler Army Medical Center, is unique. It is responsible for overseeing health care for veterans not just in Hawaii, but American Samoa, Guam and the Commonwealth of the Northern Marianas.

“I was so excited about the opportunity to come here to this region, where you have more than 100,000-plus veterans, and to talk about the services that they need,” Remy said at a news conference for reporters.

After completing his tour of Oahu, Remy will travel to Hilo and also will make stops in Guam, Saipan and hold a virtual meeting with officials in American Samoa. He also will stop in the Philippines where the VA operates an overseas facility to support U.S. military veterans in that country.

A major theme of the trip is looking at how to ensure access to care for veterans. In the Pacific, reaching facilities and specialists a veteran may need might require travel for another island, creating unique challenges. The Pacific Islands Health Care System has long relied on partnerships with military hospitals and community clinics.

“Our preference is (for care to be provided) in a VA facility, because I believe that they can get the best care possible in our facilities because they have the clinicians that know them the best because many of our clinicians are, in fact, veterans themselves,” said Remy, who is himself a former Army captain and the son of a Vietnam veteran.

The limited facilities across the Pacific are in high demand. During the wars in Iraq and Afghanistan, Pacific Islanders joined the military in high numbers with a study of 2003 recruiting data finding Pacific Islanders joined the Army at a rate 249% higher than that of other ethnic groups.

“You can’t provide the 21st century veteran the world-class health care they deserve in 20th century facilities,” said Remy. “And so we’re making sure that we’re modernizing our facilities, continuing our projects to build new facilities.”

Last year the VA officially broke ground for its $120 million Advanced Leeward Outpatient Healthcare Access center after years of wrangling to get permits and funding. In June, President Joe Biden signed a bill that would officially name the new facility after late U.S. Sen. Daniel Akaka.

At the news conference, the VA’s Pacific Islands System Director Dr. Adam Robinson announced a reorganization of community-based outpatient clinics, smaller facilities that the department has been relying on to better serve rural veterans. The VA sees CBOCs as central to making care more accessible to veterans across the Pacific.

“We’re starting a new initiative so that we’re going to have CBOC chiefs that are going to be selected. And we’re going to start having a governance system so we can have a more robust day-to-day activity of what they’re doing to access patients, physicians, face-to-face care, as well as virtual care,” Robinson said. “So it’s an initiative that we think is long in the making, or long needed and we’re in the short stage of getting that done.”

Remy’s tour of the Pacific marks the first visit of a top VA official to see the department’s operations in the region since before the COVID- 19 pandemic began. The pandemic has put unprecedented stress on hospitals and medical professionals as they tried to keep up with cases. The pandemic also disrupted the care of many patients who were unable to see doctors in person. But telemedicine provided a lifeline for many.

In the Pacific, VA officials say telemedicine has helped reach veterans spread across the islands or living in isolated rural enclaves that normally would be harder to travel to and from for care.

“Telemedicine is here to stay,” Remy said. “We learned a lot over the course of the last couple of years, not that we’re entirely out of the pandemic. But we learned that we can reach veterans, where they are we can provide them the care that they need, even if they are not coming into our facilities. So we can incorporate that into the care we provide into the future.”

Women’s health care was a particular emphasis during Remy’s Oahu visit. Women have become more visible in the veteran community as more and more have become combat veterans in post-9/11 conflicts. Under former President Barack Obama, the Pentagon officially lifted the last restriction on combat positions to women, opening up all military career fields to women who qualify.

“Women’s health is particularly important because that’s the largest growing cohort of veterans that we have,” Remy said. “So to be able to engage with some of our female vets that are receiving their care here at this facility was fantastic.”

Remy’s Pacific tour comes shortly after Biden signed the Honoring our Promise to Address Comprehensive Toxics Act, better known as the PACT Act, into law earlier this month. The bill includes improving health care access and funding for veterans who were exposed to toxic substances during military service along with several other new initiatives.

“It’s a tremendous piece of legislation that will grow the services provided by the VA, probably more than any other piece of legislation ever has,” Remy said.

In discussions with care providers and veterans during his Oahu visit, Remy said that he also discussed the health care challenges of U.S. military veterans in the island countries of the Compacts of Free Association — Palau, the Republic of the Marshall Islands and the Federated States of Micronesia.

Formerly administered by the U.S. after World War II, the countries have continued to have high enlistment rates in the U.S. military after attaining independence. However, unlike the Philippines they have no VA facilities of their own.

“I recognize the challenges that exist in the COFA countries, the COFA areas, and we were trying to make sure that we are providing opportunities for those vets to get health care as well,” Remy said. “That’s what I’m taking back with me, so that we can talk more about how we can position ourselves to care for those veterans.”