Cook Islands Health Department in 1965. SUPPLIED/22032515
With very few resources and little official encouragement, the Cook Islands first local doctors tackled epidemics and eliminated diseases, laying the foundations for the modern Cook Islands medical service.
A century ago, the Cook Islands Medical Service
comprised two European doctors in Rarotonga supported by a handful of nurses.
The outer islands were visited occasionally but between rare visits, were left without
In 1926, Dr
Sylvester Lambert, of the U.S. Rockefeller Foundation wrote – “With
the best of intentions on the part of the (Cook Islands) Government, occasional
visits from a European doctor are unsatisfactory for the dreadful emergencies that occasionally
arise and for current severe sickness. Then, too, these (European doctors) do not
understand the language nor the native mind.”
solution was to train “Native
Medical Practitioners (NMPs) … native doctors, well trained in Western medicine, and
understanding the native mind”.
Lambert’s encouragement and funding from the Rockefeller Foundation, a Central
Medical School was established in Suva in 1929, to provide medical training for
students from a range of Pacific countries, including the Cook Islands.
mission, according to its first Director Dr David Hoodless, was to “train
natives to be better and still better natives and not to train natives to be
even perfect imitations of Europeans”. This was in part a response to a widespread
distrust of European doctors but also to ensure that graduating doctors would
be willing to return to work in their villages, rather than clustering in
European compounds in the main settlements.
As part of this policy, “Students were expected to wear standard ‘traditional’ lavalava; shirts were acceptable, but other overt indicators of ‘Europeanisation’ discouraged” (Stuart, 2006; 133).
Islands medical students, however, were generally the sons of chiefs or of
wealthy part-Europeans and having spent three years at Te Aute College for
Maori Boys in Hawkes Bay they were, sartorially at least “almost completely
Europeanised”, their trousers, shoes and other European clothing regarded with
envy by fellow medical students restricted to the ‘short loin cloth and bare
feet’” (Stuart, 2006; 133).
lavalavas and bare feet, Cook Islands students were usually to be found “at the
Grand Pacific Hotel’s dances, in tail-coats and stiff shirts” (Lambert; 367).
at Te Aute and fluency in English also meant the Cook Islanders “knew so much
already that they saw no necessity to work for what they got.” None of this was conducive to the school’s
efforts to build a collective islander ethos. But over time, the Cook Islanders
made up for it with their prowess in the classroom and on the sporting field.
On their return to the Cook Islands as newly graduated NMPs, they found themselves
“not trusted (by NZ colonial authorities) and given no real
responsibility or incentive”. Their training and skills were devalued and under-paid.
“Since the average salary of the practitioners was around one hundred and fifty
pounds a year,” wrote Tom Davis, “they were obliged to supplement their
earnings by farming …” In 1947, the salary of a New Zealand recruited papa’a Assistant
Medical Officer was six times higher at £900.
historian Annie Stuart believes the NMP concept was itself to blame for the
subsequent demoralisation of the young doctors. Colonial administrations refused
to train islanders to become fully qualified doctors, for fear they “desert
their people and seek fortune abroad among the whites”. Accordingly, they
settled on a scheme that produced local practitioners skilled enough to deliver
unsupervised medical care but always subject to the overall guidance of fully
qualified European medical officers.
“(This) entrenched a hierarchical system of
medical education and employment in which race (or at least whiteness or
non-whiteness) determined options, career prospects and income. NMPs were only
eligible for government employment, mostly in primary care, while European
Medical Officers took on specialist clinical work at central hospitals”
(Stuart, 132, 143).
To avoid such an outcome, Tom Davis undertook privately funded medical training at the Otago Medical School. In his autobiography, he writes that he wanted to avoid being “always at the beck and call of a fully qualified doctor from elsewhere” and believed an NMP qualification would be “a life sentence to the limited medical scene of the Pacific Islands” (Island Boy, 15).
earlier the doctor politician Sir Maui Pomare had foreseen the latter dilemma
and, as Minister of Health, made provision for doctors serving in the Cook
Islands to be on a rotation of three years, followed by four months furlough and
a fourth year of practice in New Zealand. In 1948, Davis took advantage of both
furlough and study leave to complete a year’s postgraduate training at Sydney
University’s School of Tropical Medicine. In 1952, he was offered but declined
an opportunity to study in London in preference to a scholarship awarded by Harvard.
Both offers suggest that Pacific Islands’ tropical medicine was not a ‘limited
scene’ or ‘life sentence’ after all.
Graduating from Otago, Davis returned to the Cook Islands
in 1945, first as a medical officer, then as Chief Medical Officer (1948-52). In
both roles, he developed a high regard for his Fiji trained colleagues. While
the Administration considered NMPs in the outer islands ‘useful’, they regarded
those working in Rarotonga as “not worth a damn” and treated them as ‘hospital
chore men’. “I could not quite see,” said
Davis, “how they would be useful in one place and not in another” (Islands
encountered the NMPs at morning surgery, “sitting on the (old Tupapa hospital) verandah-rail
laughing and talking with the crowd (of patients) joking back and forth and
roaring with laughter at some remark, as only Polynesians can. I smiled to
myself at the thought that they had better laugh while they can, because I was
planning to put them to full use” (Island Boy, 38).
for the NMPs to undertake post graduate training overseas in specialist areas such
as TB, leprosy and filariasis. On their return Davis made full use of their
skills and lobbied to improve their salaries. He supervised Dr Tere Williams in
general medical practice and Dr Tekao Tinirau in surgery. NMP’s were also put
to work tutoring Cook Islands student nurses studying for the NZ Trained Nurses
Dr Tinirau whom Davis encouraged into surgery was, with Tau Cowan, the first Cook Islander to graduate from the Central Medical School in 1931. He was the third son of William Parau Browne and Tuva’ine Elizabeth Tamarua and adopted by Makea Ariki-nui Tinirau. On graduating, he served as doctor to Penrhyn Island. In 1937, he married Noeline Titaua Brander of the Pomare family and the couple moved to practice in Mangaia. Tom Davis recalls that “When he met you, (Tinirau) bowed from the waist, clicked his heels together and shook hands. He seemed taller than he was, so straight did he carry himself; he was handsome, always courteous with a gentility I have found in no other …. He was the Prince Charming of our circle” (Doctor to the Islands, 85-6). After 16 years of official neglect, Tinirau’s abilities were finally recognised in 1947 when he was posted to Pukapuka, in the dual role of Resident Agent and medical practitioner (subsequently in 1953 to Manihiki/Rakahanga). As a Resident Agent his salary tripled.
Dr Tau Puruariki Cowan was the son of Charlie Cowan and Nuku Parapa Kainuku. The Central Medical School regarded him as “one of our outstanding graduates” (Lambert; 369). In 1937 he married the future Makea Nui Teremoana Ariki. The following year the couple moved to Atiu where, as local NMP, Cowan tackled an outbreak of typhoid that had killed 40 of the islanders (PIM, 25 May 1938). During the war, Dr Cowan, was responsible for the health of 2200 Aitutakians, benefitting from advice in surgical cases from American medical officers, stationed there. He served as a doctor for 40 years and was awarded the MBE in 1983.
In 1935, John Adam Numa became the third Cook Islander
to graduate from the Central Medical School. John Numa was from the Numangatini
and Parima families of Mangaia. “John’s purity of Polynesian ancestry,” wrote
Tom Davis, was manifest in “classical features” and “gentleness in handling his
patients” (Doctor to the Islands; 262). His bedside manner was so
natural that “European mothers of young children … would usher him to the door after
his examination of their child was complete, with perfect confidence that he
had just worked a miracle”.
In Suva, he
had been given specialist leprosy training including attachment to the Makogai Leprosarium.
From 1937 –
1940, as NMP at Penrhyn, he was responsible for the Leper isolation station at
Te Sauma motu. Leprosy cases from other islands in the group were concentrated there
for later transport to Makogai.
In mid-1937, Dr Numa
made the first of many surveys on the prevalence of leprosy in the Cook Islands. Lambert, who had intended to carry out the survey
himself, described it as “outstanding” (Lange, 238). Dick Scott tells the
story of “a world expert brought in by the South Pacific Commission to conduct
a leprosy survey (who) found 42 new cases on Aitutaki, only one more than John
Numa had already diagnosed”. Dr Numa’s ability to identify and diagnose early
cases, meant Cook Islanders spent much shorter treatment times at the Fiji
In 1952, he completed a further six months of post-graduate work
in leprosy and medicine in Suva and Makogai. The senior doctor with whom he worked reported that Numa “revealed a splendid practical knowledge
of leprosy. This was expected of him, for the Cook Islands patients sent by him
to Makogai are always early cases, in better condition than those from any
other of the Pacific Territories”.
He was an “outstanding” practitioner, “possessed of initiative,
clinical judgement and reliability far beyond most of his fellows” (Lange, 244).
also author of an article
on leprosy in the Cook Islands, published in the International Journal of Leprosy, 1953 – making him the first Cook Islander to be
published in an international medical
In a second
co-authored article for the New Zealand Medical Journal (61:77-85) in 1962, he was able to announce that leprosy in the Cook
Islands was “no longer a major problem” “It may well be that leprosy in the group will soon be a matter of history”, he wrote. The last new case of leprosy was diagnosed in
1995 and in 2005, leprosy was declared eliminated from the Cook Islands by WHO (Lange,
247). Described as a man with “an insatiable thirst for knowledge”, John Numa
was twice denied official support to further his medical studies at Otago. He continued in medical service until his death in 1967 at the
young age of 54. In
addition to medicine, he was an accomplished pianist, historian, dictionary maker and writer.
Nia Rua who graduated as NMP in 1938 took over from Dr Numa at Penrhyn, as
physician in charge of the Te Sauma facility from 1940.
Williams also graduated in 1938. Tom Davis recounts how, in 1946, he and Dr
Williams endured three days and nights at sea on the towing launch Takuvaine
to reach Atiu where an outbreak of cerebro-spinal meningitis had killed 18
children. The launch had been hastily converted to a sailing craft by Ron
Powell using sails borrowed from the Muri Sailing Club.
Dr James Rennie was the sixth Cook Islander to graduate from CSM having distinguished himself both academically and in rugby, tennis and cricket, playing against the touring Maori All Blacks in August 1938. At his graduation in Suva in 1939, the British Governor Sir Harry Luke presented him with the British Medical Association’s gold medal in surgery, the Dr A. H. B. Pearce gold medal in Obstetrics and the Sydney Pacific Islands Club prize for the School’s most advanced medical work.
At the outbreak of the Second World
War, Dr Rennie, enlisted as a founding member of the 28th Maori
Battalion, later transferring to the 2nd NZ General Hospital (2NZGH) corps serving in North
Africa, as a medic on numerous battlefields including El Alamein. Dr Rennie was awarded the United Kingdom’s 1939-45 Star,
the UK’s Africa Star with 8th Army Clasp, the UK War Medal 1939 – 45 and the NZ
War Service Medal.
In 1943 Dr Rennie was
granted a war concession bursary for medical studies at Otago Medical School
and in May 1949, travelled
Ireland for further studies,
graduating in 1952 as Licentiate of the Royal College of Physicians and
Licentiate of the Royal College of Surgeons in Ireland. He was chronologically
the second fully licensed Cook Islands doctor after Tom Davis.
Dr Rennie was formally
registered as a New Zealand medical practitioner in
November, 1952. He continued in general practice
in New Zealand for the rest of his working life, further distinguishing
himself as first
responder to New Zealand’s worst bus crash in February, 1963, saving many lives.
Ngaeikura Tou graduated as a NMP in 1942. During the war he served at Penrhyn
and, like Dr Cowan on Aitutaki, benefitted from medical and surgical advice
provided by US Army doctors stationed on the atoll. He later specialised in
obstetrics, gaining a positive reputation among the “most conservative of New
Zealand ladies” (the wives of the NZ colonial administrators). Dr Tou served as a doctor for 37 years,
becoming Deputy Director, then Secretary, of the Department of Health. He died
in 1980 aged 63.
graduated in the same year as Dr Manea Tamarua. Dr Tamarua spent the first four
years of medical practice, 1942-5, on Mangaia with responsibility for the
health of 1600 people. There,
under radio direction, he was one of the first NMPs to successfully undertake
remote surgery on an outer island, in this case for a strangulated hernia.
He subsequently undertook post-graduate specialisation in tuberculosis in Fiji. On his return in 1951 he took charge of the TB sanitorium on Hospital Hill and helped lead the country’s fight against the disease. Against objections from colonial administrators, his wife Pari Taniera, a Rarotonga trained nurse, replaced the European qualified sister-in-charge at the sanitorium. Together, they are credited with a leading role in the ultimate elimination of TB from the Cook Islands.
a fellow CSM graduate, Dr Pupuke Robati, Dr Tamarua became one of the many Cook
Islands doctor/politicians, and first Deputy Premier of the Cook Islands. His medical
partner and wife, Charge Nurse Pari Tamarua was awarded the British Empire
Medal in 1985 for services to medicine.
In 1946 it was estimated that these eight men and the
teams they led, had collectively saved hundreds of Cook Islands lives (Otago
Daily Times, 22 January 1946).They had
also contributed significantly to the eventual elimination of the islands’ more
serious diseases – leprosy, TB, yaws and filariasis; fought measles, typhoid
and other epidemics; made perilous boat journeys to save lives and attended the
birth of a new generation of Cook Islanders.
Davis left Rarotonga in 1952, he reported that there were a further 25 Cook
Islanders in training at the Fiji CMS as doctors, pharmacists, technicians, etc.
These included three future prime ministers, Dr Sir Pupuke Robati, Dr Robert
Woonton, Dr Sir Terepai Maoate and a cabinet Minister, Dr Teariki Matenga.
By the late
1950s, with 16 NMPs (now called Assistant Medical Officers), four public health
inspectors, 24 trained nurses, 23 trainee nurses, six male nurses, 20 mosquito
inspectors, 12 dressers and nurse aides, seven technicians and seven district
nurses, and a complement of dentists and dental assistants, the Cook Islands
had a full-scale national health service with doctors rotating on fixed-terms
around the northern and southern group islands.
island in the Cooks could boast its own local doctor (with two on Aitutaki) except
Mitiaro, Rakahanga and Palmerston, which had resident male nurses.
one outer island can make this claim.
and Lydia Davis, 1955, Doctor to the Islands, Michael Joseph, London
Davis, 1992, Island Boy, IPS, USP, Suva.
1941, A Yankee Doctor in Paradise, Little Brown, Boston
Raebum Lange, 2013, Exile And
Compassion: The Management of
Leprosy in the Cook Islands, 1925-95 Pacific
Vol. 36, No. 3, December
Stuart, 2006, Contradictions and Complexities in an Indigenous Medical Service,
JPH, Vol. 41, No.2, September