Director a man on mission

The new Director General of the Ministry of Health, Leausa Tole’afoa Dr. Take Naseri, is a man on a mission.

Becoming the first doctor to head the Ministry after nine years, the Public Health specialist is determined to put the public’s health first.

“People are expecting changes but I don’t want to make changes for the sake of change,” he said.

“However we want to make appropriate change that has an impact on our people and our patients and deliver the best quality care deliver, the best information, the most accurate information.”

A day into his new role, Leausa admits that the job may never have eventuated if it wasn’t for the urging of his colleagues who wanted him to apply. He did and now the health of the nation is in his hands. “When I got the news I felt so humbled,” he said.

“I was thinking about my dad (who was also a doctor). He never aspired to this kind of position.

“He loved his work out in the villages with the patients. He never wanted to be a politician, he never wanted to hold a big post. “Some people would tell him to run for Parliament and he would say ‘no I don’t know what I am going to do there, I am much needed here’. “So you would never see him sitting in this position, but it (the appointment) did make me think about him.”

He said the process of his appointment was mindboggling – that simply by putting your name in the hat you had to be mentally tough. “I felt that this might be the only time I can do this,” he said.

“If I don’t get it now then I don’t think I will do it again because I will be over 50 and I will do something else.” He also felt if the former Director General, Palanitina Toelupe, was not re-appointed, then having someone from the Ministry would make for a smooth transition.

“We wouldn’t want anyone from the outside to come in and make drastic changes of the things we have worked towards over the last three to four years,” he said.

“That was the perspective I was thinking. I could just go from where Tina left off, maybe a few modifications, but the bulk and the perspective is there.”

In his 24-year career as a physician, Leausa brings much experience to his new role from hands on one-on-one patient care to the area of Public Health, which looks at the prevention of disease and prolonging of life within the community. But his knowledge of the medical industry extends beyond these years. “I grew up in a medical environment," he said.

“My father was a physician and I grew up around the district hospitals.

“Wherever my father went he would take the whole family and we would stay there. I am the eighth in a family of ten. My eldest sister was born in Savai’i and then the others in the different areas where my dad went. “So medicine was the talk of the day as we grew up. “I have three sisters who are nurses and so there was a big influence on how we were brought up.”

Despite the number of medical practitioners in his family, Leausa said his father never encouraged any of them to follow in his footsteps. “He just made sure we had a good education,” he said.

“I made the decision to become a doctor when I was in high school and I felt it would be a good thing to do.”

However, it wasn’t a straight path to medical school, with Leausa attempting a Bachelor of Science before he found himself first, at the Fiji’s School of Medicine, then at Papua New Guinea’s School of Medicine and Health Sciences.

“P.N.G. was very good for me,” he said. “It was where I became serious about studying medicine.

You have got all these (medical) cases there – the school was very well equipped with a good library and labs that were open 24 hours a day. “Also there were not many students, so the professors spent a lot of time with you. It was a very good atmosphere to study medicine and when I was there they had a very good programme. “So from then on there was no looking back for me.”

Upon graduation in 1990, Leausa returned home and worked in the Outpatient ward and the Anaesthesia department at the National hospital. He said he was lucky enough to be under the tutelage of a former head of the National Health Services, Dr. Stanley Dean.

“I think I was the only graduate at the time who returned to Samoa, although there may have been two of us,” he said. “When I returned to Samoa, staff at the hospital was so sparse so we had to cover up for the severe shortage.

“But it was a very challenging time because we were short staffed. You really had to come out and use your clinical judgement.

“The experience was that the people were very nice and it felt right to serve the country.

“They really respected what it was I was doing – I felt I was in a noble profession, I felt respected.” It was in 1992 that he was called up and offered a position in American Samoa.

They were looking for someone with his experience, he had spent six to eight months furthering his anaesthesia training at Waikato Hospital in New Zealand, so he packed up and moved to the island where his wife was from.

“I did a lot of work in their ICU because my background in anaesthesia goes with intensive care and internal medicine,” he said. “I spent a lot of time there and it was very good, I was exposed to all these US standards and what they expected.

They are very strict on their standards and clinical procedures.” It was during his 18 years stateside, that he was given the opportunity to further his skills in the area of Public Health. So in 2006, he travelled to Brisbane on a World Health Organisation Fellowship to study towards a Masters in Public Health.

“That is when I did a 180 degree turn from clinical medicine to public health,” he said. He said it was when his mother got sick that he made the decision to return to his home country. “My dad passed away in 1995 so it was just my mother,” he said.

“I was still in American Samoa in 2008 when my mum got sick and so I came home. “She had a very serious illness so we had to take her to New Zealand for an operation so I let go of my job for six weeks and we stayed there to help.

“My mum said to me at the time ‘I don’t think you will ever come back’ but I told her I would.” But after six weeks, he returned to his job in American Samoa and it wasn’t until he came back for a fa’alavelave that his mother reminded him of what he said in 2008.

“My mother said ‘I thought you said you would come back, but you have forgotten’,” he said. “I was just lying out in one of our fales and then I found an old copy of the Samoa Observer and I was going through it and I saw they were looking for a doctor here.” So he put his application in and got the position and during his three years with the Ministry he has worked as its A.C.E.O. for National Disease Surveillance and International Health Regulations Division and also as a Consultant Specialist Public Health Physician.

“I just told my wife I think there will be a change of plans,” he said.

“She supported me and said I think it is time to go because we always wanted to bring my children to be with my mum because she was getting old. “I was very excited to come back and I felt that when I came back at least I came back with some experience and some knowledge.

“I felt that I came at the right time I came back and I was not old. “It was always my intention to return home to work and help but the timing, I do not want to go there retired.

“I want to go there at the peak of my career where I can help people and make an impact and do something for our country and our people.” Leausa said while his career as a doctor has not always been easy – the rewards were well worth the work overcoming the challenges.

“Working as a doctor makes me feel responsible for something - you are more a public figure because I know there are not that many doctors here in Samoa. You know the ratio of doctors to people is quite wide,” he said. “Don’t get me wrong. The responsibility is enormous because you carry it 24 for hours a day – you are a doctor for life.

“However, I feel that being brought up with the Christian belief - that it is a major part of working in medicine you really have to believe in God, it gives you reassurance in what you do.

“This is how I have been carrying myself all these years from when I was doing acute medicine attending at the Intensive Care Unit to today.” He used past cases to highlight this point. “I had one 19-year-old boy, it was amazing, who was presented with Guillain-Barre Syndrome (a disease that paralyses the body) – a text book case.

“He was referred to us and while he was waiting for us he started collapsing and with the muscle weakness he couldn’t breath, so we had to put him on the ventilator and gradually the paralysis started to take over. “We keep him on the ventilator and after about 10 to 12 days he started to feel pain in the tips of his toes.

“A lot of muscle wasting even though we were feeding him. “It was amazing that he was able to stand and walk because he lost a lot of muscle despite the supplements you are giving him - it was not enough. “Two weeks later I saw him out with his sports shoes.

“It is cases like these that make being a doctor more than worthwhile, it makes you realise it is your calling.”

His appointment also reminded him of the time when he was escorting a patient from American Samoa to Hawaii. He said while he was on the plane another man, also travelling to Hawaii for medical attention, had lost consciousness.

“I heard someone crying and it was the wife of this patient – he has lost consciousness – it was another patient but at the time they told me that the guy was okay, he was stable.

“However, he was just unresponsive so we put up a monitor for oxygen and it was very low. “So from that awkward position from where you sit, I had to put a tube in his throat and bag him with oxygen. “I really don’t know how I did it – I just thanked God for helping me do this while everyone slept. “I could feel that his hands were cold so I kept on bagging him.

“At the time, I had only come prepared to deal with the patient I was transporting. “At the time I only had one medication vial for my patient to help with the heart rate. “So I had to dilute and give small increments for my patient and save some in case my patient needed it. “When the plane started going down the gentleman started to recover.

“I found out later that when he left for Hawaii he was anaemic and that is why he was knocked out in the air because of the altitude.

“But we were able to maintain that heart rate and I took him straight to the hospital with the ambulance.” So from the health of individual patients to the health of a whole nation, Leausa says this appointment was a pretty special way to cap off his career in medicine.

“It hasn’t been held by a doctor for quite a while, nine years, so it is a big task” he said. “People are expecting changes but I don’t want to make changes for the sake of change.

“However we want to make appropriate change that has an impact on our people and our patients and deliver the best quality care, deliver the best information, the most accurate information.

“Samoan people now have a good literacy level rate, which I feel enough information will now help them to make good decisions.”

He said there are also challenges with the increase of tourism and trade the world over. These have allowed diseases to spread more easily. “We have to up our level also to meet these challenges,” he said.

“We are also looking at the emerging and re-emerging diseases so these are also challenges.

“And then we have our N.C.D. (Non- Communicable Disease) problem.

“People are looking to us, these people are coming because we have good interventions.”

However, he did acknowledge that in addition to the challenges the Health Ministry, like other Ministries, was not without its problems. Problems such as issues having to reach breaking point before change occurs.

“I think the weaknesses are that most of us take things very complacently or casually until it is serious,” he said.

“So I am looking at policies and reviews.

“I think sometimes the work is overwhelming that we might be too ambitious of what we want and then when we start implementation we don’t have enough staff, or we don’t have enough time.

“So it exposes the weaknesses.”

Another issue he raised in regards to these reviews was that the N.H.S staff sometimes feel they are being policed. “The only thing I know for a fact is that we have a lot of policies that have not been implemented or not been reviewed,” he said.

“And I think reviewing those will help redirect or help to strengthen some of those things.

“Then look at our staffing – doctors and nurses.

“The Ministry heads up the health sector so we need corporation from the medical staff.

“I think some of the people felt that we are policing, it shouldn’t be a policing thing - the regulating and monitoring. “We don’t want them to feel like that – but they need to understand that we need to monitor to better the system.”

Leausa says he is ready to meet these challenges and move the Ministry forward, something he says is possible because of the calibre of his staff. “Most of the Ministry staff are well trained,” he said.

“They have very good training, particularly the short term trainings they have been to. “Most are very well trained right up to the A.C.E.O level, the Principal level - they have enough of the capacity to carry the work.

“Most understand the policies and they have experience. “It is just that we are not utilising them, giving them a task to perform because that is when you see the experience and the knowledge coming out.”

“So I feel the Ministry has the staff to do it. Leausa says Samoa has seen some positive impacts through its health system in the past few years. “But we don’t want to be too overjoyed, we don’t want to take these for granted,” he said.

“We really need to monitor and see whether it is the true picture that we see.

“We really need to talk to the people to make sure that when we review there is an outcome base, and put timeframes on these things to make sure they work.

“With health it is different, you know, the people come first approach and then we try and predict the behaviour of the people to see how things are going.

“And I feel that with every policy or every intervention we do the impact should be felt at patient level, the population level.

“We don’t need policies that just affect the higher ups but we need policies where the people can feel the impact - the beneficial impact.”

When asked what he wanted to accomplish over the next three years, he said he had not had the time to absorb getting the job yet.

“I haven’t thought of that yet since I am just trying to absorb everything the first day,” he said. “It will be a challenge – every aspect of health.

“I feel that we need to strengthen areas to ensure people have good access and if people have good access we have to have good doctors to help them.

“We really need to redefine our approach to the people “I believe we have to change ourselves to meet the people half way.

Despite being offered jobs further abroad than American Samoa, Leausa said he could never be so far away from his family – that his aiga and village were his home.

“There is no better place for me than here,” he said. “I am being appointed to stay in Samoa and serve the people.”