The disparities in Samoa’s health system were the driving force behind a 28-year-old woman taking up medicine to train to become a doctor.

Dr. Mosana Evagelia grew up in American Samoa but her villages are Satalo, Lalomanu, Vailoa i Palauli on her father's side and Sapapali'i, Saipipi, Fagalii and Falevao on her mother's side. 

She completed primary and secondary education in American Samoa, and did three degrees in university over 10 years with her recent one being a medical degree from the University of Otago in New Zealand.

She now works at the Middlemore Hospital in Auckland as a first-year house officer and is currently doing rotations in psychiatry. 

Speaking to the Samoa Observer, Dr. Evagelia said that it was her exposure to health disparities in both Samoa and American Samoa that compelled her to train to become a doctor.

She witnessed first-hand the rising number of non-communicable diseases with cases even present in children. Diabetes and its complications, in combination with heart disease and high blood pressure, are the leading cause of both morbidity and premature mortality for Samoans.

"To put it simply, we don't have enough resources to cater for the rising numbers of the disease burden that looms ahead of us," she said. "We don't have enough health professionals [doctors, nurses, lab technicians, nurse aids] to be able to provide the care for our people. We don't have a system that flows and communicates with each other effectively and efficiently."

As a result of this, Dr. Evagelia says there are patients who may wait for hours to get seen by a doctor, days before their lab results are out. This might be weeks before they're able to find time to follow up, and months prior to the commencement of appropriate treatment, they understand the importance of sticking with their medication.

"This lack of human resources and medical supplies at the health facility, as well as lack of financial resources, are challenges that need to be met in order to have a high quality and functioning health system," she added.

Existing health disparities will always exist in American Samoa, according to the Auckland-based doctor, and will mostly affect those living in low socioeconomic areas and target low-income families. 

"Unless more resources are put into place within the system to address these disparities, it will remain, and COVID-19 accentuated these issues," she added. "For one, it made it difficult for a lot of our Pacific and indigenous communities to access healthcare, and it is no secret that we have the worst health status compared to other ethnic groups in New Zealand."

In Samoa, it is access to healthcare and the accessibility of the rural communities to the country’s leading referral hospital Tupua Tamasese Meaole National Hospital [TTM] that is an issue.

Dr Evagelia is of the view that the Government should increase the capacity of district hospitals in order to free up resources at the main hospital.

"I would love for district hospitals to get the help that they need, as the downstream effect will be beneficial towards the main hospital," she added. "This will enable the district hospitals to manage chronic and less acute issues so the main hospital isn't getting a high number of cases coming through their outpatient and emergency department services.

"This will not only allow the district hospitals to spend more time in improving the health literacy of those who attend their services, but it also frees up the acute services to attend to those who are severely unwell." 

In light of Samoa's response to the measles outbreak and COVID-19, Dr Evagelia said the country learnt from it and was able to respond effectively to the coronavirus global pandemic.

"Samoa's response in closing the borders earlier, calling for a state of emergency earlier, having strict criteria upon entering the country, and closely monitoring those who do arrive has been a success. Well done to all those whose tireless efforts have allowed Samoa to continue to be COVID-19 free," she added.

Working in Samoa is her ultimate goal but she wants to gain experience and learn more about medicine in order to prepare her to move to Samoa.

"I need as much experience under my wings. I will do more harm than good if I was to go back any earlier, and the people of Samoa deserve better," she added. "They deserve a doctor who is well equipped in all forms: mentally, spiritually, and professionally and I aim to be just that for them, for my village, for my family, and most especially for my parents."

Dr. Evagelia's parents, Reverend Elder Ioane and Ina Evagelia, are currently the pastors of the Congregational Christian Church of Samoa [C.C.C.S.] in Utulei, American Samoa for the last 25 years now. She has four siblings who are back home in American Samoa with her parents.