Tongan adventures
Kate Brown*, Jessica Madden B Med Sci; MBBS (Hon)* |

*Medical student, The Australian National University

In January 2012 we travelled to Tonga for a four week elective. Tonga is a collection of beautiful islands in the Pacific Ocean just a four hour plane trip from Sydney.  We chose Tonga because we wanted to experience medicine in a developing country and also have a holiday.  Also, Tonga is a cheap place to travel.

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)

Figure1. Snorkelling at ‘Ene’io beach on Vava’u

We spent the first two weeks in the Vaiola Hospital on the main island, Tongatapu.  In the hospital we spent a week on the paediatric ward and a week on the general medical ward.  There is also the opportunity to spend time in theatre, maternity and outpatients/emergency department.

The paediatric ward encompassed the special care nursery and so we got a broad paediatric experience. A normal day would consist of paediatric rounds, neonatal rounds, and then any procedures (eg. bone marrow biopsy under ketamine).  The paediatricians did three day baby checks in the maternity ward and outpatient clinics.  They also got called to neonatal resuscitations, and so we were able to see a triplet delivery and then the care of the triplets in the special care nursery.  We saw many interesting cases including Tetralogy of Fallot, rheumatic heart disease, cleft palate, epilepsy and a few cases of acute lymphoblastic leukaemia.  Tonga has very basic imaging and pathology facilities and so there is lots of opportunity to make diagnoses with limited information.

The second week we spent on the general ward.  Most patients had complications of diabetes mellitus (chronic renal failure, diabetic foot ulcers etc.).  Almost all the doctors in the hospital were Tongan and had trained in Fiji.  English was the primary language in the hospital; however communication with patients was usually in native Tongan.

We then spent two weeks in the Prince Ngu Hospital in Vava’u.  Vava’u is a small collection of islands north of the main island.  It is a very beautiful place and we would highly recommend spending some time there.

The Prince Ngu Hospital was a lot smaller and staffed by two junior doctors.  The ward rounds in the morning cover all the wards (paediatric, maternity, general and surgical) so you get to meet all the patients.  We were able to scribe on ward rounds, write scripts (on scraps of paper, Tongan style!) and then take blood after the rounds.  After rounds there were sometimes clinics (antenatal or diabetes/hypertension), procedures and theatre (mostly caesarean sections and diabetic foot debridement) where we were able to scrub in and assist. On Thursdays there was an outreach clinic which we attended and it was a great way to see more of the island. 

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)

Figure2. The Prince Ngu Hospital in Vava’u

We took some basic medical supplies with us (such as clean and sterile gloves, handrub, dressing packs, stethoscopes, otoscopes), and we also recommend taking your own scrubs.  If you could afford it they would really appreciate things like glucometers, sphygmomanometers and otoscopes.

In terms of a cultural experience Tonga was amazing.  It was our first time visiting a developing country but we felt very safe and welcome in Tonga.  We went to a few feasts and were invited to the hospital kava club to serve kava (only males usually drink it) .  Religion is very important in Tonga and although we never made it to church many people found it to be a worthwhile experience.

In terms of a holiday Tonga was an awesome place to visit.  The hospitals could get very quiet in the afternoons so we took the opportunity to go to the beach, snorkel, visit the botanical gardens, learnt to weave baskets, climb mountains and visit other islands (we visited ten in total).  We also met and spent time with other medical students, volunteer workers and travellers.