“Who we are in the present includes who we were in the past.” (Fred Rogers)

Returning to Tonga as a young medical intern in 2001, I was one of only four new additions to a professional group of around 30 doctors serving the estimated 100,000 people of the Kingdom of Tonga. At the time, the majority of the consultants were wearing multiple hats, such as Lord Tangi 'o Vaonukonuka, who was the Chief Surgeon and Minister for Health. Dr Taniela Palu was the Head Physician, the Royal Physician and the Medical Superintendent. This meant, that one must learn fast, take on more load than was usual for interns, and literally live in Vaiola Hospital. Medical Internship is a young doctor’s baptism of fire and the flames are extra scorching in Tonga!

Whenever you feel the urge to vent, complain or about near your breaking point, the senior doctors and nurses would encourage you with stories of your medical predecessors, their legendary commitment, skills and love for King and country. Stories that I had always thought were overly exaggerated and fictional rather than truth only to discover that there was a time when doctors were highly esteemed and respected in Tonga such as my great uncle Dr ‘Alokihakau ‘Eva, a renowned surgeon, who was extraordinarily gifted. Years later after he has passed and I started my career, I had patients of his proudly showing me their surgical scars recounting their amazing experiences with Dr ‘Alo whom they proudly referred to as their saviour.  Long-serving staff at the Ministry of Health would tell of how Dr Supileo Foliaki, the Medical Superintendent at the time, would pull shift after shift at the Outpatient Department because they were permanently short-staffed. His humility was a key aspect of his successful leadership and a quality by which he is still remembered fondly by many. These larger-than-life characters established, developed and invested in the TMA since its inception on 13 July 1942. I would find myself enthralled by these stories of medical titans and heroes of the past, fascinated that somehow, I too, was connected to them, through our shared profession and belonging to the cool club that is TMA.

Only recently did I fully comprehend the power and impact of these stories on my professional and personal life. These stories were the threads that kept me going throughout my 22 years of serving as a doctor in Tonga. Despite the challenges of being overworked, and underpaid in a resource constraint environment, two things kept me going: the faith (and hope) that things will get better and that the good Lord would not have put me through anything that He would not equip me for. And the determination to continue the legacy of love and service that my medical predecessors and mentors had instilled in me over the years. For God, King and country.

When I took up office as President of TMA in 2020, our numbers had tripled, with our female colleagues almost equalling the male in quantity. The majority of the mentors and seniors whom I had worked under had retired or, passed on. The interest in TMA has waned over the years with its purpose reduced to annual medical conferences. The lack of engagement was reflected in poor payment of membership subscriptions, attendance of TMA functions and lukewarm support for the association.

The volcanic eruption that happened in January 2021, followed by the COVID-19 pandemic put tremendous pressure on the health system, including the doctors who were physically, mentally and emotionally stretched like never before. It was obvious that there should be better support in place for the welfare of our doctors. They also bring to the surface the important roles doctors play which was beyond their health space. These unprecedented events were instrumental in bringing to focus the need for a voice and presence like TMA. The vision of the medical forefathers for TMA included an association that looks after the welfare of its members, to provide advice to the government on health issues and advocate for the health of the people.

The 80^th milestone anniversary of TMA presented the perfect opportunity to implement the mission of injecting much-needed life into the association. Tongans are known to accomplish mighty feats when their hearts “loto” and souls are truly engaged. My strategy was simple. Create a connection between the members and association through the sharing of its rich history and legacy, while providing inspiring stories of accomplished doctors of Tongan descent in their fields, that the mostly young membership can relate to. Through connections, we anticipate a desire to better engage and naturally, an increase in commitment will follow. The theme of “Investing in the Future of TMA. Learning, developing, cultivating, 80 years on” evolved organically. With nothing much in the TMA’s bank account, the relevance of the association in question, and by now I had moved to Auckland and was remotely operating from there, it was challenging to execute the mission. So, we do what we do best when presented with the impossible. We prayed. Hard. And then, we acted on faith.

Preparation for the 80^th celebration served as a team-building and bond-strengthening exercise, with members coming together for choir and dance practice, fulfilling cultural protocols for the Patron HRH Crown Prince Tupouto’a ‘Ulukalala and doing whatever was needed to make the conference a reality. It was the catalyst needed to further reveal leadership capacity and highlight the different superpowers of TMA members outside the operating theatres and clinics. Through the process, we learned that we need to be kinder to ourselves, our colleagues and to extend patience and understanding to each other. We learned to harness the power of the collective and in the process discovered the joy in belonging to the TMA.

The support from the Pasifika Medical Association, SPC, DFAT and local businesses not only enabled us to pull off a conference and celebration worthy of the significant milestone, but it demonstrated to the TMA members how much they are valued by the wider community and the region. It emphasised the need to stay connected and maintain relationships with partners for no association or individual can operate in isolation.

The 80^th celebration and conference was a success if judged by the feedback and accounts from the speakers, participants, members and public. The likes of Dr. Lupe Taumoepeau, Simione Lolohea, Siale Foliaki, Etuini Ma’u, Kalo Lalahi, Michael Burling and others, share not only their knowledge and expertise but also their personal medical journeys, their connection to Tonga and TMA was invaluable. The impact on the lives of the TMA members especially the young doctors, was profound and powerful. The academic and clinical aspects of the conference were equally thrilling, injecting the right dose of inspiration to the overworked, undervalued local medical doctors. Being reminded that they are not alone and that there are many resources and much support at their disposal was exactly what the TMA needed.

Recognising the special need to provide a supportive platform and space for our women doctors, we launched a Women’s Breakfast funded by DFAT. PMAG CEO Mrs Debbie Sorensen was the keynote speaker in the presence of HRH Crown Princess Sinaitakala, as well as women in and, outside of health who together can further enable the work of TMA and its members. The sharing of experiences, tears, laughter, encouragement and hope was both uplifting, inspiring and beautiful with everyone leaving the meeting empowered. The evenings were just as busy as the days providing more opportunities for networking and catching up between old friends and family.

Success for me was seeing the young doctors show up in numbers, staying on throughout the day, participating in the social activities and volunteering their service throughout the conference. Seeing new bonds and relationships formed and no doubt will be maintained for many, many years was too gratifying. The trip down TMA memory lane and history lessons were well worth it as it yielded new-found pride in the members as they become more aware of the legacy, they are a part of. The support network of specialists abroad and partners including PMAG, SPC and the University of Auckland showed that they are ready and available to assist and invest in TMA and its future. The faith and support shown by the government, communities and Tonga’s Royal Family was equally overwhelming as it was humbling.

The challenge will be maintaining the warmth, interest and engagement of the TMA members and the TMA partners, locally and abroad. Moving forward, a research workshop is planned with Sir Collin Tukuitoga and interested partners for TMA members. There are opportunities for mentorship, clinical support and building of a stronger, safer and more resilient health system through investing in members and the future of TMA. If we want to create sustainable positive changes, we have to invest in the people who will affect those changes.

I reflect and echo the sentiments shared on the TMA 50^th anniversary by the President at the time, the late Dr Sateki Tu’itavake. “It is our duty to contribute, to the utmost of our ability, to building up the TMA, for it not only just to survive, but to thrive vigorously and fruitfully so that our future colleagues and members may appreciate the value of our efforts when commemorating the 100^th Anniversary of the TMA in 2043.” If in some small way, I have contributed to keeping this vision alive, to re-igniting the commitment, passion and dedication in our doctors during my watch, then the sacrifices of the past, are truly being kept alive today through us and re-invested into the future of Tonga’s medical profession.

The cycle continues, the legacy lives on.