American Amelia Borofsky has been on Pukapuka since last year, and has been providing regular reports to Cook Islands News. Here she writes of Dr Thein’s arrival to the remote northern group island.
A doctor has not been in Pukapuka since 2005.
For the last 20 years, Manongi Tiro, a nurse practitioner, has served her people. For the last five years, she oversaw the ten hospital and health affiliated staff. The hard-working staff delivers babies, dresses wounds and administers medication.
They also provide health education at Niua School and listen to people’s needs. Any urgent or high-risk cases they send on a Ministry of Health flight to Rarotonga, a necessary and valued service for the atoll.
When the doctor arrived the island buzzed “the doctor has arrived,” “have you met the doctor yet?”
Dr Hla Thein grew up in Burma and lived in Fiji for the last 18 years with his wife Florence, a theologian, and his son Ederil, a professional golfer.
Dr Thein has lived in 18 different countries. He worked for the United Nations and in a refugee camp along the Thai-Burmese border. He last worked as a principal medical officer overseeing seven hospitals and has a special interest in non-communicable diseases.
Dr Thein wanted a new challenge and chose the Cook Islands because of the high rates of non-communicable diseases and the chance to have an impact.
While working at the Rarotonga Hospital, he heard about the vacant position in Pukapuka. No one wanted to take the position and other doctors discouraged him.
“You will come running back here,” they said.
The negative prejudices about Pukapuka offer a partial explanation for why a doctor has not been posted here for such a long time.
Dr Thein says: “I love a challenge and I knew that my skills would be most useful in a remote location.”
Pukapuka and Dr Thein have met their match.
“Last night, my dear,” he says, “I thought this is paradise. I just need to catch a chicken and then it will be paradise.”
The next day the island secretary’s son delivered him a chicken.
“We will get this whole island eating vegetables,” he says, “and I will eat all the chicken.” Dr Thein already planted cucumbers, radishes, chilli, garlic and cabbages to serve as a model. He and his staff planted the edible rukau and plumeria and hibiscus around the hospital.
“Non-communicable disease management and the upgrade of the hospital are my priorities,” he says.
In the first few days, Dr Thein walked around the atoll introducing himself to people, chatting and joking. Upon meeting Mama Vai on her front porch he kissed her and rubbed her sore legs.
“Ea koi ite akalili,” says Mama Vai laughing. The nurse practitioner and Mama Vai’s daughter-in-law, Letai, translates.
“I am not cheeky my dear,” says Dr Thein, “I am super cheeky.”
He delivers a few more hilarious not-for-print jokes.
“Actually,” he says, “you are super cheeky and I am super, super cheeky.”
“Oh the old mamas are going to love you,” says Letai.
Everyone hopes that Dr Thein stays at least for the two-year contract, or for longer. In the past, some doctors broke their contract early because of boredom, isolation or an inability to pass the language barrier.
Because of these issues, the coconut wireless said a long-term Pukapukan doctor would arrive.
Pukapuka has a relatively healthy population thanks to a diet of fish, taro, and coconuts and a lifestyle of fishing, taro farming and playing sport.
Pukapuka also has invaluable local remedies including medicinal plants, lomi lomi massage and a local chiropractor healer.
Still, there’s additional public health work needed. There’s home visits to the elderly, health education at the school, medication compliance, management of and education on non-communicable diseases, a diet low in fruits and vegetables, nicotine dependence, alcoholism, domestic violence prevention, sex education, breast feeding promotion, public sanitation and encouraging people to seek medical attention early rather than waiting until something becomes serious.
There are also transportation challenges making it difficult to send blood samples or receive needed supplies.
“We have toothbrushes but no toothpaste to do the tooth brushing drills at the school,” says Noloto Williams the dentist. Dr Thein rises to the challenge stating “just wait, we will have the healthiest island.”
In the next few weeks, Dr Thein and the nursing staff plan to visit each house on the atoll to survey the prevalence and management of non-communicable diseases.
Dr Thein is a welcome, chicken-eating, jovial, “super, super cheeky” presence in Pukapuka.