President Robert Bolouri and the Rotary Club of Nuku'alofa had raised $50,000 to revitalise the Vaiola Hospital.

REPORT TO THE BOARD OF BALLARAT WEST ROTARY CLUB ON THE TONGAN PROJECT,

June 1993

 The Rotary Club of Ballarat West has joined with the Rotary Club of  Nuku'alofa, Tonga to help redevelop the Vaiola hospital, Tonga.

 
In 1990,-91, Dr Geoffery Afeaki, an anaesthetist from Tonga, spent 18 months in Australia, principally in Ballarat, developing his anaesthetic skills. He attended several meetings of our club, and explained a little about his country, and the difficulties he faced in terms of lack of equipment and facilities in general. There was no facility for intensive care or coronary care in the kingdom. The only cardiac monitors they had were ancient, in fact so elderly they were no longer used. He said that he would appreciate support from Australia when he  returned to Tonga.

 
When he departed in early 1992, we were able to ship with him 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. John Macdonald, Charge Nurse of the ICU at St. Johns, suggested, organised shipment, and undertook in-service training of these still very useful cardiac monitors. They were very rapidly put into service in Tonga, with the creation of a rudimentary  Intensive Care Unit at the Vaiola hospital.

St John of God Hospital showed a very early interest in this project, and sponsored John Macdonald's air fare.

  John and I went to Tonga in July 1992, at Geoffrey's' invitation, to, inter alia, speak on Intensive Care topics at the 50th anniversary meeting of the Tongan Medical Association. At that meeting I learned that there had been some 65 amputations of legs performed at Vaiola hospital in the preceding three years for complications of diabetes. In Australia these would have been prevented by patient education and early detection of warning signs.

 We learned that, 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. Up until Geoffery took delivery of his monitors, there was no ability to monitor and manage these patients, even if they could get access to the hospital.

We looked at the hospital, and saw that it was very dilapidated, and though staff skills were quite good and enthusiasm high, there was inadequate organisation.  The hospital had run out of money for cleaning and food in 1991-2, and had to borrow against this year's budget for food. The cleaning had simply been abandoned.

I visited the Rotary club of Nuku'alofa, and discovered that they were already aware of the plight of the hospital, thanks to a damming series of articles that Geoffery Afeaki and some others had engineered in the local news bulletin, Matangi Tonga (see photo above).  They were determined to improve the situation, and had formed a committee, involving their club, the government and the hospital to raise funds and to examine ways to upgrade their hospital. They thought that they could raise $50,000 because of public disquiet over the state of  Vaiola. This is an enormous amount of money in a country that is almost entirely dependent on foreign aid.

 In November 92, the Rotary Club of Nuku'alofa had a fund raising weekend at which more than the $50,000 was raised, and promises of significantly more were made. This reflected the community support for a project to upgrade the island's health facility,

 The committee realised that there were many problems present at the hospital. Though there were some readily achieved short term remedies (setting up a diabetes clinic, developing an intensive care unit, and training ambulance officers) there needed to be an overall plan to develop the hospital. What they needed was a review of the entire hospital. The president, Robert Bolouri, asked us to approach someone who would be suitable.

Because of St John's obvious interest in supplying the monitors, and in financing John MacDonald's trip to Tonga, and because it is one of the largest and most successful private hospitals in Victoria, I asked the CEO, Mr Daniel Slattery, whether he would be interested in reviewing the hospital's needs, with a view to how best they might spend any funds they raised.

 Daniel was immediately enthusiastic, and could see a significant role for St John's. In November 1992, the Rotary Club of Ballarat West sent Mr. Slattery to Tonga to conduct an independent review of  the hospital. He spent a week looking at the hospital from every aspect, speaking to medical, administration, nursing and maintenance staff. He talked to Rotary, to the Tongan Government, to AIDAB, and to the Australian High Commissioner.

In January 1993, he published his report, suggesting that funds raised in aid of the hospital be used to establish a 5 year "twinning" programme between the two hospitals, with initially an administrator spending an extended period in Nuku'alofa, helping with such basics as preparing a budget. Subsequent exchanges would be worked out according to a needs basis in a planned programme of total hospital development, and would include medical, nursing, pharmacy, engineering, administration, and other ancillary services. St. Johns would fund the wages of any staff that were sent to Tonga, and would train any Vaiola staff that came to Ballarat. As well, they pledged $20,000 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.

 An engineering study commissioned by the Australian Government reviewed the maintenance of equipment and buildings at the hospital, and had taken I believe some 6 months to complete. That report, delivered in May '93, suggested that  foreign aid funds be earmarked for implementation of the recommendations. The extent of physical degradation of the facility was such that it was thought that $3-4 million dollars would be necessary to upgrade the hospital. It also suggested that a "twinning" programme be set up between an Australian hospital and Vaiola. St. John of God Hospital, Ballarat,  has indicated a willingness to undertake supervision of the process of renovation as well as to be the "twinned" hospital.

      Other developments have included the establishment of a "twinning" arrangement for diabetes education and management (between Vaiola and the Prince of Wales Hospital in Sydney), and a training programme for 2 ambulance officers in Victoria. A new intensive care suite is in the planning stages.

Daniel Slattery is due to go to Tonga in August to attend a meeting of donors of overseas funds. He will put to the meeting a plan to develop the "twinning" programme, and to supervise the restoration of the hospital. He has an enormous amount of backing from the Australian Government, (via AIDAB) and Rotary in both Australia and Tonga, and is acting at the request of the Government of Tonga to pursue the redevelopment.

AIDAB  in fact hope that the protocol that is developed will serve as a model for other neighbouring countries who may need to develop their health facilities. They are encouraging the arrangement by funding the meeting in Tonga in August, and have offered other services, such as providing semi-permanent accommodation in Tonga for St. John's staff who may be seconded to Tonga.

 THE ROLE OF ROTARY IN THE PROJECT.

Now that the link between the two hospitals is being forged, the management of major future developments can be left to St John's. Funds for the project will need to be raised, and through the Foundation, Rotary is in a sound position to provide this. I am awaiting confirmation of  approval of the Rotary Foundation for a "Matching Grants" fund before asking for commitment from other Rotary Clubs. In the meantime, I will keep all interested parties as informed as possible.

The Rotary Club of Ballarat West has just sent a second consignment of  surplus medical equipment to Tonga, and is in the process of sending a body Cool room to Ha'apai. It will continue to fund the shipment of medical equipment to Tonga, and, if the Foundation is not established in time, will fund the initial costs of the "twinning" programme.