Vaiola Hospital Tonga Program 24 years on!

In 1991, a young Tongan Anaesthetic registrar, Talia’uli Afeaki, spent 18 months training in Ballarat Health Services. He visited our club (the Rotary Club of Ballarat West), and explained a little about his country, and the difficulties he faced in lack of equipment and in a generally impoverished health care system. 

 

At one of our club meetings (November 2016), RN John Macdonald PHF, International Project Officer for St John of God Hospital Ballarat reviewed the responses of St John of God Hospital Ballarat, (and the Rotary Club of Ballarat West, the Rotary Foundation, RAWCS (then referred to as FAIM) and clubs throughout the state and internationally) over the 24 years since a visit to Vaiola by Dr John Oswald and himself in 1992

 

 

 

The Vaiola Hospital, Nuku’alofa Tonga was in crisis at the time Talia’uli worked in Ballarat. The hospital had run out of money for food and drugs, and had borrowed on the following year’s budget to keep the ship afloat. Pigs roamed the hospital grounds, and rubbish was dumped out the windows by staff. There was no facility for intensive care or coronary care in the Kingdom.  The only cardiac monitors were ancient, in fact so elderly they were no longer used.

 

There had been some 65 amputations of legs performed at the Vaiola hospital in the preceding three years for complications of diabetes.  In the face of an increasing incidence of heart disease, there was no ambulance service to take someone who had had a heart attack to hospital. Talia’uli said that he would appreciate the donation of superseded ECG equipment from the ICU at St John of God Hospital Ballarat and  of support to set up an ICU when he returned to Tonga.

 

When he departed in early 1992, our club and St.John of God Hospital sent a large supply of surplus medical equipment.  Seven cardiac monitors that had been retired from the Intensive Care Unit at St John of God Hospital in Ballarat formed the nucleus of this original shipment. 

 

In July 1992, John Macdonald and I visited Nuku’alofa for the Tongan Medical Association AGM. We took the opportunity to visit Vaiola. We confirmed the tragedy that was the Vaiola Hospital; electrical cabling was exposed and broken, roofs leaked and ceilings lay on the floor, etc., etc., and staff (often very skilled and trained in Australia and NZ) worked in a dank, primitive, regressive hospital.

 

We learnt that as well as the obvious infrastructure problems, diseases such as Diabetes were rife in the community.  Patients would not come into hospital to be treated, because the community believed that if they did, they would die. Diabetes sufferers put off their admission till they were nearly dead, then had to be admitted, died and fulfilled the prophecy. 

 

We also visited the Rotary club of Nuku'alofa. They were aware of the plight of the hospital, thanks to a damming series of articles that Talia’uli and Dr Bill Tangi (later Lord Tangi) had engineered in the local news bulletin. This was the start of the long involvement in Tonga of the Rotary Club of Ballarat West and St John of God Hospital in Ballarat.

 

The population of Tonga was determined to improve the situation, and had formed a committee, involving the Rotary Club of Nuku’alofa, the government and the hospital to raise funds and to examine ways to upgrade their hospital.  They believed there needed to be an overall plan to develop the hospital. They had raised the equivalent of Aus$50,000! An enormous amount of money in a small impoverished community.

 

 

 

 

 

 

 

 

The CEO of St. John of God Hospital, in response to our report on that visit, undertook a review of the Vaiola hospital and suggested that $50,000 (raised by the Rotary Club of Nuku’alofa to address this crisis) be used principally to establish a 5 year "Twinning Programme” between the two hospitals.

 

 St. John of God Hospital pledged $25,000 per year for the next five years to a fund that was to be set up to cover living and transport costs for staff involved in the project.  Two groups of four hospital professionals would be selected on a needs basis from Vaiola Hospital staff each year, and each group would spend four weeks at St. John of God Hospital. In turn, four to ten health professionals from St. John of God Hospital would visit Vaiola each year to teach, mentor and to support their opposite numbers.

 

In September 1993, an agreement was signed between the Ministry of Health in Tonga, and St. John of God Hospital in Ballarat, and the first teams from Ballarat went to Tonga. This agreement has been renewed several times, and in 1996 AusAID agreed to contribute to funding the exchanges.

 

The teams achieved many early successes, such as the repair of the Oxygen Concentrator. FAIM volunteer Trevor Chapman (Rotary Club of Ballarat South) got this machine working again, in the face of previous failed attempts of commercial companies to repair this equipment. This alone saved the Department of Health many, many thousands of Pa’anga (dollars) per year as all supplies of Oxygen had to be brought into the kingdom in cylinders if the Oxygen Concentrator could not supply this very basic hospital requirement.

 

The Twinning program has continued to flourish since thtat start in 1993. To this stage over 120 staff exchanges have been reciprocated each way between the two twinned hospitals, and 13 containers of pre-loved hospital equipment have been shipped. There have been dramatic improvements in the ICU, in Wound Care, Nursing, Administration, in Medical records, in Engineering, in fact in all aspects of the hospital over the course of the last 24 years. This may have been due to the contribution of the Twinning Program, but also to the hard work of the staff of the Tongan Ministry of Health.

 

 

 

 

 

 

 

 

 

 

 

 

As well as spurring this twinning programme, Rotary sent a number of FAIM teams (maintenance volunteers), to teach as they repaired solar hot water systems, installed new roofs and guttering etc. over theatre and other departments. The Rotary Club of Ballarat West also organised and shipped several consignments of goods, donated by numerous sources both inside and outside of Rotary, from a “Wish List” developed by medical staff at Vaiola. 

 

Matching grants of several hundred thousand Australian dollars were obtained from the Rotary Foundation to help fund the purchase of equipment that could not be obtained as superseded equipment. Support for these grants came from the USA, New Zealand and other clubs in Ballarat and Victoria.

 

So generally, the program spurred initially by the Rotary Club of Ballarat West in 1992 has blossomed to clinical and nonclinical acute hospital programs, a dental program, radiological program and perhaps a prosthetics program as well, with each year still bringing major advances.

 

The Twinning program has been run by RN John Macdonald (International Health Project Officer at St. John of God Hospital) for 24 years, with significant support over the last 10-15 years by RN Carolynne Murnane (Surgical Nurse) and Michelle Frank (medical records).

 

 

DIK in Geelong have been very supportive of our program over the years, facilitating it by shipping sometimes two containers a year of much needed equipment from St. John of God Hospital and other hospital sources via the Twinning Program to Vaiola Hospital. We are very grateful to Anton van Doornik, his predecessors Barry Bell and Hank Nydam, and his team.

 

 

There are three fundamental principles for the provision of international aid by compassionate agencies.

Who would have believed twenty-four years ago, that the hospital (where pigs roamed the grounds, waste lay everywhere, beds were piled in fire escapes and the rooves of theatre and other clinical areas leaked) that today they would be doing open heart surgery, or that the hospital could become the example it is to the rest of the Pacific.

 

There have been many reasons and many other supporters from Australia, NZ, Japan and other parts of the world for this improvement, but the skills and abilities of the Tongan Clinicians and support staff of the hospital have been allowed to develop and drive reform. I believe the Twinning program has provided a direction, wide support and fellowship which has allowed this development.

 

In the words of Lord Tangi (surgical registrar in 1992, and more recently Minister of Health and Deputy Prime Minister), “The Program has been a cooperation between not only the hospitals, but also the communities of Ballarat and Tonga”.

 

So, this program has ticked all the boxes. It has developed capacity, it has graduated from a Rotary supported program to a Private (AusAID / DFATsupported) program and it has, with 24 years’ experience, seen significant friendships develop between the two communities. We in the Rotary Club of Ballarat West are very proud of our involvement with this great program, and watch in awe as it develops further.

 

John Oswald PHF OAM FANZCA

Co-ordinator, Vaiola Hospital Program