Cook Islands Mangaia Loses Doctor; Nurse Practitioner To Replace Physician

Lack of doctors on outer islands draws heavy criticism

By Cameron Scott 

RAROTONGA, Cook Islands (Cook Islands News, Jan. 23, 2017) – The Ministry of Health’s doctor on Mangaia has resigned and will not be replaced.

Instead, the island will be given the services of a “nurse practitioner,” who will be responsible for health care on the island.

Nurse practitioners are also stationed on Mauke, Atiu, Mitiaro, Manihiki, Rakahanga, Penrhyn and Pukapuka, while another on Aitutaki plays a support role to the islands two doctors and nursing staff.

On Nassau and Palmerston islands, nurses, rather than practitioner nurses, are responsible for health care.

Health secretary Elizabeth Iro said she couldn’t say why the Mangaia doctor had resigned as she had yet to receive the full details and the situation was “unclear.” However, the doctor’s contract was due to expire in June. There was a vacancy for a doctor on the northern island of Pukapuka, but that no regular transport was available to the island, and flying there involved an expensive four-hour charter flight, Iro added.

It’s a different situation on Aitutaki where there are two doctors. due mostly to the fact that the island has high numbers of tourists who boost the small resident population.

Aitutaki also has a dentist, but there are no dental specialists on any of the other outer islands. Iro said the nurse practitioners who had replaced doctors on seven islands were being supported “on the ground” by doctors at Rarotonga hospital through computer technology (“telehealth”), early medical intervention and medical evacuation flights.

“The Health ministry has been considering the best skill mix of professionals that would best support the people on the Pa Enua in view of improved technology and patient management information systems that have been rolled out to the outer islands. We have also been considering transportation challenges for each island.”

She described nurse practitioners as “advanced trained registered nurses with midwifery qualifications”.

“The last group of CI nurse practitioners graduated in 2008 with a commitment to work in the outer islands as part of their contract at the time.

“Very positive reports were received from patients, island governments, visiting specialists and local specialists about the excellent healthcare that was provided by the nurse practitioners.

“Their scope of work is wide and the hands on nursing care complements the advanced medical training they have received.”

To maintain their skills and knowledge, each of the nurse practitioners would be brought back to Rarotonga for upskilling and training for one to three months, every two or three years, Iro said.

 “This upskilling involves working with the doctors on Rarotonga, dentists, nurses and public health officers with more time in areas of special needs as they are identified by the Chief Medical Officer and Chief Nursing Officer and the individual nurse practitioners”

The lack of doctors on the outer islands has drawn heavy criticism from some quarters, with one source, who asked not to be named, claiming that since the advent of self-government, a succession of governments has ignored the outer islands’ health needs. 

“One of New Zealand’s great achievements, when it was the colonial power in the Cook Islands was that by 1955 permanent medical staff were stationed on all inhabited islands of the Cook Islands,” the source said.

“By 1960 medical services in the Cook Islands had been entirely localised. These medical practitioners were trained at the Fiji Medical School. A nationwide medical service was developed, served by several generations of legendary Cook Island doctors – a proud record that has been squandered under self-government.

“While we are told there is no money for doctors in the outer islands, there is always money for politician’s travel and beauty pageants.”

Cook Islands News
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