Responding to COVID-19 in the West of Fiji

 I have just returned from Fiji, where I had the opportunity to work alongside and support my Fijian colleagues in their fight against COVID-19. Fiji is a place very dear to me, as I lived there for nearly 4 years (2013-2016), building formal training in emergency medicine and assisting with emergency care system development.

In April 2021, after a whole year without community transmission, the delta strain of COVID-19 escaped from hotel quarantine and has caused a second wave that has devastated the main island, Viti Levu. Fiji is a place with vulnerable populations: socioeconomic hardship due to the impact of COVID-19 on tourism, people living in crowded informal settlements, a high prevalence of (often undiagnosed, hence untreated) diabetes, ischaemic heart disease, hypertension, chronic renal failure, and asthma. Outside of Viti Levu, communities are still recovering from tropical cyclone Yasa and Ana and providing comprehensive healthcare to remote island communities with scarce resources presents an ever-present challenge.

Amid crises there are always stories of hope: Inspiring stories of innovation and resilience, and this is what I’d like to share with you. Let me introduce you to Dr Mafa Lokega. Mafa undertook her training in emergency medicine in Fiji and is currently the acting head of the emergency department in Lautoka. Mafa leads a team of four brilliant inspiring women who currently run a pre-hospital and retrieval system for the west of Fiji which was set up during the second wave.  Consider the challenge: no formal national ambulance system, no trained call takers, no guidelines, no trained pre-hospital care providers, and no equipped ambulances. With support from the district commissioner, Lautoka hospital incident management team, NGOs, the business community, and colleagues from the central division, the pre-hospital emergency coordination cell (PHECC) for the west of Fiji was born.

Working alongside Mafa, providing pre-hospital care and undertaking retrievals, and directing operations, are two emergency nurse leaders: Shanistika Shivalni and Sheetal Nand and Dr Kelera Tabuaniqili. This dynamic quartet have recruited, trained, fed, and managed a diverse group that includes those from the armed forces, fire authority, police, teachers, dentists, hospital drivers and volunteers who have become call takers and responders. They have sourced vehicles, equipment, and PPE, drawn up standard operating procedures and call scripts and set up a dataset for reporting and budgeting. They work closely with the public health teams who supervise home care of those with COVID-19, the other hospitals in the western division to arrange retrieval of the critically ill and the police to facilitate death certification and ensure the dignity of those dying at home is preserved. Sadly, more than half of the deaths from COVID-19 in Fiji have been those dying at home.

The pre-hospital sphere is a male dominated one. This is all the more reason to highlight the great work done by these incredible women, all in the middle of a devastating pandemic.

• Dr Anne Creaton

Dr Mafa Lokega, Emergency Physician and director of the Western PHECCC teaching BLS to first responders and call takers.

The team at the PHECC Western Division, Fiji, from left to right:

Suliano Nayacalevu JNR (National Fire Authority) Dr Kelera Tabuaniqili (Lautoka ED, Sheetal Nand (lautoka ED,) Fredrick Bulivou (Lautoka hospital driver,) Dr Apensia Waqatabu (Lautoka ED) Inspector Sakiusa Jitoko (Fiji Police,) Shanistika Shivalni (Lautoka ED,) Private Koroi (Fiji armed forces), Akuila Nawaqabuli (Lautoka Hospital Operating room technician) and Dr Mafa Lokega (acting head, Lautoka Emergency department.)