The insular areas are unable to provide compre-hensive health care services to their citizens, and as a result, critically ill patients are boarding planes and crossing thousands of miles of ocean for services they are literally dying to receive. With few local specialty physicians and crumbling infrastructures pushed far be-yond their limits, insular area public hospitals and clin-ics struggle to provide patient care. The dedicated, and often creative, hospital staffs work long hours with few supplies, all with the looming reality of their health care systems sinking in debt.