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• 16th January 2009

Tokelau Mission

Wellington Hospital nurse consultant Bronwen Markham is back on dry land after agreeing to be part of a Ministry of Health response to a suspected influenza outbreak threatened to overwhelm health services on the isolated atolls.

A swift response was required with nearly 150 people reported sick out of a population of 1500 people on the three atolls, more than 500km north of Samoa, separated by 60km of open ocean, which make up New Zealand's last remaining dependent territory.

With about 10% of the population reported ill, Tokelau's acting Director-General of Health, Lee Pearce (on leave from her job as Capital and Coast's Pacific health services manager), sought urgent assistance from the New Zealand Health Ministry on March 29. Bronwen took her partner Carl Reller, an environmental manager at the NZ Transport Authority who is also a medical technologist, along for support and to help educate local nurses on using the rapid test kits.

After a flight to the Samoan capital of Apia, where they met Lee Pearce and World Health Organisation doctor Jacob Kool, they caught the fortnightly sailing to Tokelau. “Everyone spreads their mattresses on deck like in a marae and looks after each other as best they can.” After 45 hours in horrific sea swells they finally arrived at Fakaofo late on April 1.

After reaching Atafu they met with the Taupulega who granted permission at a formal meeting to proceed with the work of vaccinating and screening. The team then headed to the hospital to set up a base. Nurses were trained in vaccination technique then, accompanied by members of the team proceeded to vaccinate the community going from house-to-house. Approximately 200 of the 350 doses were administered on the first day, which was a majority of the population on Atafu.

Local health services had acted swiftly to limit the spread of the disease. The school had been closed, public gatherings banned, sick people advised to stay home and the message of hand washing reinforced.

"We were feted like heroes - people were so touched that New Zealand was at last acknowledging they existed. They are incredibly generous people; we were overfed like there was no tomorrow."

The team spent nine days in Tokelau, testing and treating the sick, vaccinating the population and training nurses. The nature of the illness remains a mystery. Tests showed negative results for influenza Type A and B and instead results show it to be an 'influenza-like illness' with similar symptoms to the flu but of shorter duration and not as dangerous.

Pictures from Tokelau

(Click images to see a larger version.)

Bronwen and Carl's temporary home.	Life on board.	The welcoming party.
The health centre on Atafu.	A disused hospital ward in Nukunonu.	Jacob Kool (WHO) collecting patient information.
RN on Atafu.	Vaccinating on the beach.	Helping hands...
No one escaped attention.	An older style house on Atafu.	Tupaulaga on Atafu.
Working from 'home'.	Debriefing in Apia.	Ministry of Health headquarters in Apia.