A conversation with WHO’s new Chief Nursing Officer, Dr Amelia Afuhaʻamango Tuʻipulotu

Our guest this week is Dr Amelia Afuhaʻamango Tuʻipulotu, the World Health Organization’s new Chief Nursing Officer.  

Dr Amelia was the Kingdom of Tonga’s first female Minister for Health and the first Tongan to receive a Ph.D. in Nursing. Her previous roles also include Chief Nursing Officer of Tonga and Director of Nursing at Vaiola Hospital. Dr Amelia took up her role at the WHO earlier this year.

In this episode we discuss:

• Dr Amelia’s initial priorities in her new role.
• Pivotal moments in Dr Amelia’s career.
• How her Tongan values shape her leadership approach.
• The actions health ministries should take to support nurses against the backdrop of a declining workforce.

You can read more about the Emergency Care campaign here. We encourage you to join the conversation on Twitter at @CentreHealthSec. You can follow Dr Amelia at @AfuhaAmelia

Transcript

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The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government. 

Dr Stephanie Williams 00:35

Hello, and welcome to Contain This. I'm Dr Stephanie Williams, Australia's Ambassador for Regional Health Security. I acknowledge the Traditional Owners and Custodians of Country throughout Australia and the Indo Pacific region. I recognise the continuing connection to land, waters, and community and pay my respects to Elders past, present, and emerging. 

Today I'm thrilled to be joined by Dr Amelia Afuhaʻamango Tuʻipulotu, the World Health Organization's new Chief Nursing Officer. Dr Amelia was the Kingdom of Tonga’s first female Minister for Health, and the first Tongan to receive a PhD in nursing. She has also been the Chief Nursing Officer of Tonga, and Director of Nursing at Vaiola Hospital, the main hospital. In this episode, we discuss Dr Amelia’s initial priorities in her new role, including what actions health ministries could take to support nurses and the workforce, against the many challenges the pandemic has thrown up. Dr. Amelia also reflects on some pivotal moments in her own career, how her Tongan values shape her leadership approach and the importance of speaking up. I hope you enjoy the conversation. 

Thank you for joining us today. Dr Amelia, can you describe your role at WHO and some of your priorities in the first few months of this important job?

Dr Amelia Afuhaʻamango Tuʻipulotu 02:05

Thank you, Ambassador, Dr Stephanie Williams, and Malo e lelei. And thank you for inviting me and to have a conversation, which is very important for me, to have this dialogue. Right now, I'm only about two months, plus into my new job. And, of course, it's a huge step from Kingdom of Tonga, a small island to the global stage. What I'm trying to do right now is to build relationships. As I grew up in Tonga, relationships are very fundamental to success. So that is, what I'm doing right now is meeting, listening and learning from directors and team leaders and getting their perspectives. And then, of course, getting a sense of the culture and the environment here. And priorities for the first was, you know, a key priorities. I have a drafted, you know, given conversations and of course, this is still early stage. But two of the key priorities that were already on the chief nurse agenda is around future leadership programme, which I fully support as I have supported future leaders programme, which is supporting early career nurses towards building leadership skills, as we understand that the future will be more challenging. And given my experience, I would like to better support future leaders to stand on a stronger ground moving forward. And the other priority is a basic emergency care campaign that was launched by the Director General, together with the 75th anniversary of the World Health Organization last week, and that aims to try to train 25% of nurses and midwives in 25 countries by 2025. And of course, that programme aims to save lives given climate emergencies outbreaks and as we prepare for future global pandemics.

Dr Stephanie Williams 04:57

They’re interesting first couple of priorities and I was interested in the future leadership programme and the need to support early career nurses. I had one follow up question from that and which was, is there something in your career that you can remember being able to use or be mentored to enable your own leadership development, you have a personal experience of, of a leadership programme when you were a junior nurse?

Dr Amelia Afuhaʻamango Tuʻipulotu 05:38

When I was a junior nurse, I was supported by the senior nurses at the time. I was put straight to become a manager of the ward of the busiest ward in Tonga Main Hospital, after I graduated from Australia, I was only 21 years old. And the matron and the Chief Nurse at the time always engaged me. And they always asked for my ideas as a young graduate. And of course, the age difference gap was, you know, they were in their 50s, or 60s, and I was only 21. So that was very empowering. And they have asked me also to lead some of the young youth programmes for nurses and midwives.

Dr Stephanie Williams 06:31

And you're also the former Minister for Health from the Kingdom of Tonga, and also former Chief Nursing Officer of Tonga, I'm interested in how your Pacific perspective can or is shaping your new role and your ideas that on the global stage. 

Dr Amelia Afuhaʻamango Tuʻipulotu 06:51

Absolutely, you know, my childhood, I was brought up with the concept of equality, tatau be in Tongan. So, you know, my grandparents were very influential in my upbringing. And they have taught me while I was very young, and I couldn't understand what it means, you know, that, reminding me that, despite whoever you may become, in the future, whoever you may be, you are just equal to the people of okoa, you know, a people of a small island in Tonga where my grandfathers grew up. So, I later went to the small island when I was minister, and actually get off the vehicle and just walk on the ground, a very small community, yeah, but it made you to be really grounded. And of course, when I did my PhD, it even re-emphasised the importance of equality in the way you know, within the nursing profession, with engagement with people in society, coming in different classes and hierarchy, but also with patients, or you know, treating everyone the same, with respect, inclusiveness, recognition, and empowerment equal treatment. So, because my thesis has reemphasised the importance of equality, I try my, I try my very best during my leadership to live by those key principles. But of course, also taught by my mother, who is very religious, the importance of love and compassion, you know, and, you know, understanding it later, you know, during my career, that compassion is the true north of the compass, you know, in Tonga, we were raised to, to love and, you know, have compassion to our family, our extended family, to people in the society and to all humanity, you know, I was even encouraged to have compassion to people who oppose your ideas, when you lead. So, yeah, so those things, you know, you were brought up with, and, you know, in Tonga we have, we have as a nation the Tongan golden garland and, you know, the kafi goula. And I want to talk about two, which is one is respect. And you respect everyone and value everyone's contribution to the success of, of the community and the nation. So, respect and, you know, valuing everyone's contribution and having freedom to robustly respectfully debate at the same time, and even when we disagree, that you still respect and do not dismiss other's ideas or undervalue other people. So that is fakaʻapaʻapa in Tongan. And the other one that I want to talk about is keeping good relationships, you know, coming here, you know, I have to do my best to be able to navigate and build strong relationships here in the headquarter with the regional office, and then with the 194 member states of the World Health Organization, and that is a balancing work that one would need to work hard on. 

Dr Stephanie Williams 11:25

There is absolutely a dizzying array of stakeholders when you think about being in a senior leadership position at WHO as you are, and the stakeholders, not just in Geneva, but in the regions and the countries. And I trust that you have a good support from the big divisions and areas of WHO to make that slightly less daunting than I'm sure it is. I wonder if I can ask a little bit about how we support nurses as key cadres in health professions, and the pandemic highlighted the value of nurses, how dependent every health system is on them. But we have also seen reduction in numbers of nurses through burnout, retirement, migration, and even less people moving through in some places of the world through their degrees. So in your view, from all the different hats you've worn in in your career, what do you see is some of the most important short-term actions that health ministries can take today or tomorrow to support the nurses that they still have, and the nurses that they will need into the future? 

Dr Amelia Afuhaʻamango Tuʻipulotu 12:45

Thank you, this is a very important question. And from my perspective, this is an issue for all of us, the whole world, the regions, and also the sub regional areas. Let's take for instance within the Pacific region, the way I see moving forward with this, as I see it, it will be long term moving forward, that, you know, high income countries and developed countries must come together with the low middle income countries and the Pacific to robustly discuss, you know, innovative solutions, and of course, ethical solutions for this matter, as I think that we will be challenged tomorrow on the ethical and equity standards that we abide with, with decisions regarding, you know, international recruitment and migration of healthcare workforce, given on one side, that the potential benefits that they bring to a country, but then also we must understand the impact the potential impact on the vulnerable population. And when I look at low middle income countries and small island developing states, when, you know, you look at the staff situation roll out to the whole island at some national, rural remote and outer islands. When this happened, you know, it shocks the system. And most likely staff are moved to the referral main hospital at the national level, leaving a very weak because there's already weak healthcare systems at rural and sub national level. So we that further perpetuates, you know, challenge for the vulnerable population living in rural and remote areas. So I think the best way forward is that, that all countries within a sub-regional area can come together and clearly understand the situation. You know, there are professors in Australia that would be able to assist with regards to nursing and midwifery, who will be able to look deeply into the situation so we can better forecast on a longer lens, the future. But of course, short term solutions, there has to be right now a recalibration, a redesign a reconfiguration of staffing within the small island developing states, so that we can ensure equity with the vulnerable population and the remote. So, that needs to be done by and led by the health systems and the government, as it protects and seek to be accountable to the vulnerable population, and of course, ensuring that staff renumerated adequately, and that they are supportive with resources and referral mechanisms are in place. This is what I call that, you know, the, there was a group who came from the Royal Melbourne Hospital, they were here last week in our forum, and they talk about the importance of caring for the carers, you know, we also need to look into the working conditions for nurses and midwives, their pay and working conditions. So that we can retain, and, of course, for the future, attract talents to the profession, because that's the one that I'm more concerned about is the future attraction to the profession to serve the population, but, of course, and there is a need for some bilateral, you know, discussions with regards to support for world class education and research at small island developing states, as they are now preparing nurses, not only for their islands, but they're preparing nurses for Australia, New Zealand and the world. So I was thinking around that and, and I also would like to acknowledge Australia’s support. Australia have been the, you know, strong support throughout my time in Tonga and building capabilities for world class nursing education in Tonga. And, of course, and I was also thinking of, what about a transformative reverse innovation whereby, you know, nurses trained  Australian nurses, but the, you know, they are from Tonga can come back with the support of Australia can come back to Tonga and give back to the country and I mean, by that, you know, Tonga, Tonga nurses who are Australians, you know, citizen, you know, because we've had nurses in the past who come and do volunteers in Tonga, but the they work in Australia. So, there are there are many short terms policy directions, the member states need to consider a policy directions for newly graduate and direction so that they can retain safe staffing situations, you know, I was thinking about what if there is a major outbreak? What if there is a global pandemic and you know, given the situation right now, and of course, the need for a redesign of service delivery. So that, you know, there is empowerment of nurses and midwives to empower the population, and in particular, those in rural and remote and the very last one, maybe a rethink around a policy for recently retired nurses, you know, for engagement as a backup and a pool. Should there be any, you know, escalation of future shocks into the future You know, should there be an outbreak of pandemics in the coming years we have a backup plan. 

Dr Stephanie Williams 20:28

Thanks for those thoughts. And I think your answer just highlights that we just don't have the luxury of choosing one or two short term actions that transform a nursing workforce and in education pathway, what you've outlined in terms of the migration, education, distribution, safe workplaces, referral processes, all of that just really highlights the challenges for leaders, both ministers and bureaucrats working in stretched health ministries, about what is the most important levers to pull now and how can we do short term with keeping an eye on to the future, it's just that was a really interesting overview that you just presented. So thanks for that. I wonder if we can turn to your own journey. You talked a little bit about it before when I asked about your early career support as a young nurse, and the Tonga hospital which I have also had the great pleasure of visiting, but many of our listeners are clinical practitioners, including from the Pacific, and we'd be really interested to know your journey from junior nurse in Tonga to Chief Nurse of WHO, I wonder if you can give us a sense of some of the important moments in your career that have led you to where you are today.

Dr Amelia Afuhaʻamango Tuʻipulotu 22:01

As I said, I started as in charge of the surgical ward, then I moved on and was in charge of the psychiatric ward where I you know, I learned so much, you know, looking at vulnerable people at the psychiatric ward, before I was asked to go to the School of Nursing, and I was at the School of Nursing for the longest period of time, during my career and was acting principal, but I was intrigued through engagement with the young potentials for the future and there, I develop the, you know, my passion to support future young leaders in leadership, but also in research. So, that was very important at the time, then, I then move on and become director of nursing and then continued and did my PhD, and then come back and become the Chief Nurse of Tonga. So, yeah, throughout my career as a as a nurse, you know, it was very important for me to, to speak up all the time, because I would most of the time, I would be the only female and was younger than the rest of the executives. So, it was very important that I speak up all the times in meetings and be able to defend, you know, my plan, defend huge promotion that I delivered on in Tonga for senior nurses to be able to rise within the hierarchy within the career pathways. So, after, you know, becoming Chief Nurse and have delivered on so many key thematic areas like, review of the regulation of the law, which I passed when I was in, in parliament in 2021, which is sorry, I proposed to the Legislative Assembly and was passed and was given Royal Assent but also worked on professional standards, code of ethics and performance management system, patient satisfaction, nurses grow wellness and nurses satisfaction survey. So a lot of work must be delivered along the pathways. As you know, I was, I was, you know, told when I was young that, you know, I will not be judged by my intelligence or my ability to speak publicly, or the impressiveness of my policies. But I, but I will be judged as per my consistent delivery, or implementations or actions to benefit the voiceless, and, and, and the population. So, those were key within nursing. And then when I was asked to become Minister for Health, that was a very important time during the pandemic, to be able to lead with compassion, lead with humility, and also lead with courage to be able to make courageous decisions, even with strong opposition's but to be able to have clarity and, and to lead with justice for the population. So, those were the developments of my career up to when I was minister.

Dr Stephanie Williams 26:59

Can I ask, you said it as you were the director of nursing, you realise you just had to speak up? Did that come naturally and easily to you? Or did you have to work on that? Can you recall how you felt in those times about realising when needed to speak up? 

Dr Amelia Afuhaʻamango Tuʻipulotu 27:19

Well, I am, you know, I grew up speaking up. As I, as far as I know, when I, when I was in primary school, when I was in high school. Yeah, and when I was at university, and I was, you know, I was supported at university to share my to have freedom, to share my ideas and my perspectives. And when I right from the day one, when I started as in charge of the surgical ward I, I spoke up for the patients, for the base for the patients, and I also spoke up for, for the nurses and midwives that I worked with. And that was a very important because if you do not speak up, and also in executive meetings, you know, no one will speak up for the nurses and midwives. And, you know, they will, you know, decisions will be made. Otherwise, if you do not speak up and defend what is right, and just for the nurses and midwives because they are the backbone, and they deliver care throughout the whole islands for the population.

Dr Stephanie Williams 28:50

I’ve so enjoyed talking with you, Amelia this morning. And just, I think that's a great point to end because your description of your family and cultural values of compassion, your ability to speak up and find yourselves and create supportive environments throughout your career, and to have your inner sort of inner compass, knowing that to be judged by the delivery of good policy. It's been such an interesting opportunity to hear your perspectives right from early days and junior nursing and now into Chief Nurse of WHO we really wish you well in this endeavour. And I think we are in terrific hands, with you guiding our efforts to bolster nurses and nursing workforces into the future. So thank you so much for your time this morning.

Dr Amelia Afuhaʻamango Tuʻipulotu 29:50

Thank you so much, Ambassador, and I look forward to continual work and support from Australia so that we can better support nurses and midwives to transform health systems to better serve the population of the world. Thank you very much.

Dr Stephanie Williams 30:12

You've been listening to Dr Amelia Afuhaʻamango Tuʻipulotu, the World Health Organization's chief nursing officer. Dr. Amelia spoke about her initial priorities in her new role, including supporting future leaders and the emergency care campaign to train 25% of nurses and midwives in 25 countries by 2025. We talked about actions health ministries might consider to support nurses today and into the future. And finally, Dr Amelia reflected on her own career, and the Tongan values of equality, compassion, and respect that continue to inform her work. I hope you have enjoyed the conversation. I certainly did. 

I'm Dr Stephanie Williams, Australia's Ambassador for Regional Health Security. Our podcast, Contain This, aims to bring you fresh insights and updates on what is shaping our region in health. We look forward to having your company on the next episode. 

Contain This is produced by the Indo Pacific Centre for Health Security. We acknowledge the Traditional Owners and Custodians of Country throughout Australia and the Indo Pacific region. We recognise their continuing connection to land, waters, and community and pay our respects to elders past and present. You can follow us on Twitter @centrehealthsec.