The market in Nuku'alofa, Tonga was crowded that Saturday morning as ten BYU Nursing students set up a pop-up clinic. Hundreds eagerly queued up to get tested for hypertension and diabetes. People brought their mothers, fathers, aunties, and anyone in their family to get their blood glucose level taken. After four intense hours under the Tongan sun, 319 people were screened and had their information recorded to streamline follow-up appointments. The students realized on their walk home that they had broken a BYU Tonga practicum record for most people screened in one sitting.
The Global Population Health Nursing clinical practicum in Tonga was launched in 2010 through a partnership between Brigham Young University’s College of Nursing and the Queen Salote School of Nursing, now part of Tonga National University’s School of Nursing. Dr. Shelly Reed and Dr. Jane Lassetter, now the Dean of BYU College of Nursing, established a successful collaboration with Tilema Cama, the school's principal. Over the past 14 years, this partnership has provided students with valuable and impactful experiences in Tonga.
As part of their training, students had to clock 84 clinical lab hours in a variety of settings: hospitals, villages, stake centers, fish markets, even homes. These clinical experiences varied depending on the students’ career interests and the opportunities available to them.
The Healer’s Art: Caring for the One
Dr. Reed has been impressed by the dedication of the Tongan nurses, who ensure that no patient falls through the cracks. They truly embody the Healer’s art, going beyond simple practice to seek out and care for their patients. This dedication was vividly demonstrated during a postpartum check when a Tongan nurse, accompanied by Dr. Reed and nursing student Halle Huber, could not locate the mother and child at the expected address. Unwilling to leave the task incomplete, the nurse ventured beyond her assigned district, visiting three different homes to ensure the patients' needs were met promptly. Upon finally locating the mother and child, the nurse, Dr. Reed, and Halle checked the baby’s weight and the mother’s vitals, demonstrating their willingness to care for the one.
“The nurses in Tonga go to the people,” said Professor Sarah Davis. She realized that because it is a tight knit community that “literally everyone is counted.”
Students, inspired by the Tongan nurses’ example, also went in search of every patient they could help. Professor Davis said that the team “became more earnest at getting to everyone that we could.” Consequently, three students returned to the flea market at the end of the trip to test the merchants who were busy during the first pop-up clinic. These students altruistically gave up their pre-scheduled assignments in the hospital because they wanted to serve. Recognizing the opportunity, numerous vendors eagerly invited students to their stalls, including the manager of a nearby fish packaging plant who invited the students to her facility where they conducted medical screenings for her staff free-of-charge. She was eager to arrange these screenings for some time, but scheduling with the Ministry of Health nurses was challenging. The students performed check-ups and identified several workers with hypertension. The plant owner immediately contacted the non-communicable disease clinic (NCD) for follow-up appointments for her employees. The students began the trip with 700 glucose strips and returned with just 35.
The nurses in Tonga go to the people and literally everyone is counted.
Remote islands often receive fewer check-ups throughout the year because renting a boat to travel to outer islands can be too expensive for some hospitals. Therefore, the BYU students accompanied a dentist and other health professionals to these distant communities. The students had the opportunity to teach primary-aged school children about good health habits, like brushing teeth. They also taught older children about vaccinations, like the HPV vaccine that was recently introduced in Tonga.
Another thing students observed is Tongan nurses are far better at using limited resources since few supply shipments regularly reach the island nation. For instance, on one island, nurses knew that three children needed the MMR vaccine, but will wait to administer the vaccine until more children require the shot to avoid wasting the dose. “They're thinking about the whole group and getting everybody immunized by using their resources wisely,” said Dr. Reed.
Kate Blaine, one of the students on the trip, had an opportunity to work in labor and delivery in Tongan hospitals. Tonga’s system is unique because student nurses often lead in the delivery room. Due to limited resources, women in labor do not receive an epidural or have any pain management during delivery, so nurses learn to provide relief with counter pressure non-medicine pain relief measures as contractions come. Kate worked alongside these nurses to provide care for a woman in delivery, Kate didn’t leave the woman’s side for six hours. “It’s such an intimate thing,” she said. “You’re helping someone in pain, and it feels fulfilling as a nurse and as a disciple. Trying to relieve suffering is what the Savior would do. He would be right by someone’s side the whole time.”
Another student, Savanah Cripps, had an experience helping during a home visit to care for an elderly man with diabetes. “In our healthcare system, people barely go to your home to see if things are okay,” said Savanah. “I used to be an at-home CNA, and the physical therapist would sometimes just not show up. It was sweet to see how the Tongan nurse went out of their way to help their patient.” The nurse bound the wounds and abscess, and even cleaned the patient’s brief, a responsibility usually reserved for the at-home caretaker. “Other nurses would say, that’s not my responsibility, that’s the CNA’s,” Savanah said. “These nurses took it upon themselves to go and take care of it.” She loved how connected the Tongan nurses were to their patient and community.
Cultural and Spiritual Experiences
Students embraced the Tongan culture throughout their trip. One experience that stands out for Kate is learning about tapa cloth, known as "ngatu" in Tonga. Ngatu is a traditional fabric made from the inner bark of the mulberry tree (Broussonetia papyrifera). The process of making ngatu is labor-intensive and involves several meticulous steps, starting with the inner bark of mulberry trees being soaked and beaten into thin sheets, which are joined together using a natural starch adhesive. These sheets are overlapped to create a seamless finish. After this, the cloth is sun-dried, decorated with natural dyes, and sometimes beaten again to enhance softness and ensure deep dye penetration.
During their stay, Professor Davis had heard the tapping associated with ngatu production coming from a home close to the hospital. On the way home from clinical one day, Dr. Reed stopped at the home and asked through motions and gestures, about the fresh ngatu hanging to dry in the home’s front yard. The BYU nurses and their professors were invited into the home by a tiny and happy older Tongan woman who was eager to show them how to participate in creating ngatu. This hands-on experience allowed them to immerse themselves in the traditional Tongan craft, deepening their appreciation for the culture.
Savanah was able to participate in Tongan dancing throughout the trip. As a cultural dance minor, she had previously learned many of the dance moves and wanted a chance to practice. During a cultural exchange night between the BYU students and the Salote school students, she made strong connections with the students by participating in a Tau'olunga dance. She followed the movements and felt immersed in the dance.
In addition to performing the traditional Tongan dance, Savanah showcased her skills in a K-pop dance, discovering common ground with a Tongan student who shared her passion for the genre. "That's all thanks to Dr. Reed. I'm grateful she encouraged me to participate," Savannah reflected. This cross-cultural exchange not only deepened Savanah's appreciation for Tongan culture but also fostered a strong connection between the two students.
The students and faculty were happy to witness the Tongan nurses and doctors singing and holding devotionals with scripture reading and prayer before starting their workday at the hospital and before beginning any operation. The emphasis on a strong spiritual start to the day reinforced the student’s own spiritual growth. “There's nothing more heavenly than to hear a Tongan sing acapella at church, in the operating room, or wherever they're singing,” said Dr. Reed. “It is like you have a piece of heaven.”
Dr. Reed loved how adventurous and adaptable the students were to take in every experience possible. Even when they needed to pivot, like when torrential rains prohibited boat travel to more outlying islands, the students immediately tried to find more opportunities to serve. Due to limited Wi-Fi, Dr. Reed feels that the students were able to bond and soak in the experience.
From bustling market stalls to remote island communities, BYU nursing students learned invaluable lessons from the Tongan nurses and community members, lessons that will shape their professional and personal lives. Their experiences in Tonga were not just about providing medical care; they were about building bridges of understanding and friendship. As they return home, these future nurses carry with them the spirit of the Healer’s Art. “It’s really gratifying to know that the work that we do won't be forgotten,” said Professor Davis. Their time in Tonga, filled with cultural immersion and heartfelt service, will forever remind them of the profound impact one nurse can make when they truly care for the one.