The challenges of GP work in Samoa
Dr Melanie Webster and her husband Dr Jake Pearson (Sports and Exercise Physician) had always wanted to do some volunteer work in the South Pacific – not only for their own experiences, but also to give their three primary school aged boys an experience of culture and way of life, very different to suburban Wellington.
Melanie set off on a mission to organise a 14-week placement for herself and her family after discovering Volunteer Service Abroad weren’t set up to place families, let alone trying to fit the timing within school terms.
“I got in contact with Dr Nola Gidlow, the only GP on the island of Savai’i (pop. 40,000), who is a fellow Otago University Graduate. Nola helped organise my Samoan Medical Council registration, schooling, and our accommodation.”
Melanie’s family are staying in Tapuele’ele, a rural village of around 200 people who welcomed them with open arms.
“We're definitely getting as much out of this experience as we are giving and feel very lucky with how things have worked out. The island is beautiful and the people are the friendliest you could meet.”
Melanie has been splitting her time between the main hospital and Nola’s GP clinic which has been a highlight of the trip.
I’ve been really impressed with Nola’s dedication to the community here. They’re very lucky to have her as she provides the only continuity of healthcare on Savai’i. Her GP clinic is serving to make differences in the management of long-term conditions, which there is less time to do in the hospital system.”
When asked about the challenges Melanie had picked up on, she replied “health literacy, late presentation, refusal of treatment and the cost barrier.”
Melanie says health literacy in Samoa on the whole is very limited and that patients typically can’t say what medications they’re taking or what the medication is for.
“Checking inhaler techniques has led to some interesting demonstrations including patients spraying the inhaler on their neck. I’ve been educating the nurses and pharmacists about the importance of patients understanding what their medications are for and how to take them – I’m hopeful that this has been some of my most helpful work.”
Dr Api Talemaitoga, Chair of the College Pacific Chapter, says Melanie’s work in Samoa to educate health professionals around health literacy is essential and that GPs working in New Zealand also need to be mindful when treating Pasifika patients.
“Just because someone has moved to Aotearoa, doesn’t mean their health literacy levels have raised automatically. As GPs in New Zealand, we need to be very aware when talking about all aspects of health, particularly screening programmes and explain why it’s so important.”
While Melanie expected late presentation to be a challenge due to geographical access to clinics, refusal of treatment came as a surprise.
There is widespread use of traditional healers in the community and unfortunately, still a level of distrust in mainstream medicine. It’s particularly heart-breaking to see people have poor outcomes from conditions that could be cured if they (or the head of the family) would consent to it.”
Similarly to New Zealand, there is a cost barrier for people to get medical treatment in Samoa. A hospital outpatient visit costs $10ST (approx $6NZD), a GP visit is $15-25ST (there is no government funding for Primary Care) and a blood test is $5ST.
“To put that into perspective, minimum wage is $2.50ST per hour but 70-80% of the population are not in formal employment and live off the land so these relatively small amounts present a large barrier for many.”
With four weeks left of her Samoan adventure, Melanie says she’d recommend it to College members wanting a change of scenery, “it’s been one of the most rewarding things I’ve ever done.”
Volunteers and Locums are welcome in Savai’I, if you’re interested please email Dr Nola (ndrgidlow@yahoo.com).
