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The Malietoa Tanumafili Hospital, Savaii, Samoa

Hospital:

The Malietoa Tanumafili II Hospital, also known as Tuasivi Hospital, is a regional referral hospital for Savaii island and has approximately 20 beds. The hospital was named after the nation's first head of state, Malietoa Tanumafili II, who was in office since independence was achieved in 1960 and died in 1997. The hospital is a public, government funded hospital, however some medications are donated by foreign aid. There are two full time doctors working at Tuasivi Hospital, both GPs from India. There is also one local medical resident who rotates through.

Location:

Samoa comprises the two large islands of Upolu and Savaii which account for 99% of the total land area, and eight small islets. The capital of Samoa is Apia, which is located on Upolu and is the location of the nation's largest hospital. The Malietoa Tanumafili II Hospital is located on Savaii. Savaii is known for its beautiful beaches, however has fewer tourists than the main island, Upolo. The hospital and hospital accommodation is right on the coast and overlooks the beach and the stunning South Pacific Ocean. The town Tuasivi is small and rural, and the only shop is a small general store. The nearest town with a market, a bank and a few shops is 20 minutes away by car and 40 minutes away by bus.

Country:

The islands of Samoa are in the Pacific Ocean, and are home to approximately 215, 000 people. Since 1960 Samoa has been an independent state however prior to that the land has been, at various times, under the control of Germany, The United States of America and New Zealand. The national language is Samoan, however many people also speak English. The predominant religion is Christianity (approximately 98%) and the Samoan's are, in general, deeply religious people. The primary industry is agriculture, and exports include coconut products and fruit. However, development aid has been an important source of income for the nation. The Samoan's favourite sports are rugby and Samoan cricket.

Profession:

Medical Resident

Typical experience:

We spend most of our time in the Emergency Department/Outpatient Clinic. This is a room with 4 beds where patients with emergencies will present and also those who have made an outpatient appointment. There is usually approximately 60-80 patients who arrive each morning to be seen in the outpatient clinic!! Approximately 50% of these patients will speak English and for the others, the nurses are excellent interpreters. Some of these patients will require admission. One of the common presenting problems is school children who have been referred by a local screening program for rheumatic fever that is run by nurses. We also saw many children with scabies, adults with cutaneous abscesses, patients with diabetes or hypertension, and many febrile children. There were not too many emergencies and we could always call the two full time GPs for help if we needed it. This department has 1-3 doctors on site during the day , and 1 doctor on overnight. We also attended ward rounds, which were usually brief because there were so many outpatients waiting to be seen! There are 3 smaller hospitals on Savaii Island, all of which are run by nursing staff and have an outpatient clinic once per week that is attended by 1-2 doctors. So we had the opportunity to attend these clinics, which were also very crowded!

Hospital facilities:

X-rays are the only radiology available. There is a small pathology laboratory, the test available are: FBE, blood glucose, uric acid, urine pregnancy test, WCC on CSF and urine dipstick. If other tests were required these had to be sent off the main hospital on Upolo Island, in which case the patient was usually also referred.

Major duties:

Reviewing patients in ED/outpatient clinic, admitting patients, ward rounds.

Working hours:

This is fairly flexible. If you feel comfortable you can be rostered on call overnight and see any patients who present to the Emergency Department, otherwise the local staff are happy for you to work 9am-5pm, or even 9am-1pm if you ask! They are very flexible about this.

Accommodation:

The hospital accommodation was very basic. The typical house in Samoa is called an open fale. This is more like a frame of a house and some thin walls. We had a house that had a beautiful view of the beach but was very poorly equipped. The kitchen had a fridge and a sink but no over or stove so we had no way of cooking any hot food! Eventually we were allowed to share the pharmacist's stove. We had a very old flea infested mattress and no pillows. The house was very dirty and there were many insects, but we had nothing to clean with. Even though the house was open, it was very hot and very humid. We ended up buying a fan so hopefully it is still there for the next volunteers. Unfortunately we also had a few things stolen when we went away for a weekend. Overall, we found the accommodation really unpleasant.

Food:

The food was awful! But maybe this had something to do with the fact that we didn't have a stove... Basically many of the households on Savaii Island are semi-self sufficient so they grow their own vegetables and have their own livestock. There is a general store across the road from the hospital that sells very basic supplies at exorbitant prices but there is not much you can do with a big bag of flour when you don't have a stove or an oven. There is one restaurant about 200m down the road from the hospital and, out of necessity, we ate there nearly every night. We grew very tired of their menu! There is a town called Salelonga that is 40 minutes away by bus that has a market but again the options are limited. The food situation really detracted from our experience. The nurses did invite us to one barbeque where we ate mutton flaps, which is a third grade meat in Australia but a delicacy in Samoa!

Phone/Internet access:

There was no telephone or internet access at the hospital. Our mobile phones had network though. The nearest internet café was in Salelonga (40mins away by bus) but this closed at 3.30pm so it is difficult to get there when you are working.

Hospital staff:

The doctors and nursing staff at the hospital were really wonderful. They were friendly and helpful and very knowledgeable.

Language:

Approximately 50% of the patients speak some English. When patients speak Samoan, the nurses are very helpful with interpreting. We also learnt a few basic words - you would be amazed at how you can get by with a few words and body language!

Town facilities:

The nearest town, Salelonga, has internet, an ANZ Bank and a market.

Getting there:

Virgin (Pacific Blue) flies to Apia, Samoa's capital. The airport is close to the ferry terminal but you may not be able to get a ferry on the same day as your flight. We stayed the first night in Apia (1 hour from the airport). From Apia you need to take either a taxi or a bus to the ferry terminal (approximately 1 hour), and catch a 2 _ hour ferry to Savaii. The hospital is 20mins by car or 50 mins by bus from the ferry terminal on Savaii.

Travel:

Savaii is a beautiful island to explore. We needed to hire a car to get around for our travel weekend. There is a small but beautiful waterfall, a beach with black volcanic sand, some impressive blow holes and a nice resort called Le Lagoto. Le Lagoto is a costly but worthwhile escape if you need a break from a hot, dirty house!

Hospital website:

www.health.gov.ws

Hospital contact:

Dr Arun Deshpande ( If you would like to make contact, please email contact@medicineuncharted.org and we will pass your message on. ) is one of the GPs who works at the hospital and would be a good person to contact. However, you also need to contact Dr Robert Thomson ( If you would like to make contact, please email contact@medicineuncharted.org and we will pass your message on. , +685 21212) at the Ministry of Health to obtain temporary registration.

My contact details:

Alana Jane Tuxen
If you would like to make contact, please email contact@medicineuncharted.org and we will pass your message on.
Date of vist: March-April 2007

Other Comments:

I would not paticularly recommend this placement. We had a really problematic time with the government obtaining temporary registration. We contacted the Ministry of Health prior to arrival, who advised us that we would need a copy of our current CV, two references, and a copy of our medical registration in Australia, and who specifically advised us that a working visa was not necessary. However, when we arrived with out certified copies of our degrees and registration, we were told this was not sufficient and that we needed to bring our originals. It was a total nightmare trying to sort it out! Furthermore, after working for two weeks we were contacted by the Department of Immigration who advised us that we had been working illegally without visas and threatened us with a $5000 AUD fine. Apparently we should have applied and paid $300 AUD for a working visa prior to arrival. The Ministry of Health assured us that they would try and advocate for legislative changes so this does not happen in the future to volunteering doctors. My advice is make sure you contact the Samoan Embassy in Canberra before you leave (Tel: (+612 6286 5505) and make sure you have a working visa if you need one. My other advice is and if you want to work here, you will have to take the risk and bring your original documentation!!