Mamatuki Sosefo is returning to Suva to take up the role of Nurse Unit Manager at the Emergency Department at Colonial War Memorial Hospital. Having spent the last 18 months at Sydney University undertaking a Masters in Emergency Nursing, he now feels far more confident to lead his team in critical decision making and capacity building in Emergency and Disaster Nursing, just as Fiji prepares for the 2nd wave of COVID-19 to reach their shores.
What did he learn from his Masters degree? The importance of open dialogue and listening to patients’ stories – a key part in critical decision making and triaging patients. As well Mamatuki learnt how to apply the best evidence to practice. The course improved his clinical capabilities as well as his leadership skills. Through the program he was able to improve his understanding of his workplace, from the Ministry of Health, to the hospital and department level.
Mamatuki is no stranger to emergency nursing. In his 12 years of nursing he has experienced three major disasters and learnt a lot from each of them. In 2015 Category 5 Cyclone Winston charged through Suva, it partly ripped off the roof of the Lautoka hospital (where he was working at the time) and left the patients exposed.
We were working 12-hour shifts over 5 days. But we didn’t have any fatigue because of the adrenaline coursing through body. We all learnt a lot about how to prepare and plan for the next disaster
Two years later in 2017, a fire started at midnight at Lautoka hospital. Mamatuki explained that training is so important in these situations and he especially is grateful for the Emergency Disaster Training that he undertook in at the National Critical Care and Trauma Response Centre (NCCTRC) in Darwin (MIMMS and HMIMMS, explained below).
The NCCTRC is the Australian Governments’ Health Emergency Response Centre funded by the Commonwealth Department of Health (DoH). The Department of Foreign Affairs and Trade (DFAT) provides some additional funds to support the NCCTRC Regional Engagement Program which teaches disaster management through the Major Incident Medical Management Approach (MIMMS) and Hospital Major Incident Medical Management System (HMIMMS) across the region.
The leadership and confidence I have gained from the NCCCT and DFAT supported Masters will aid me in my challenges ahead as I return back to Fiji.
MIMMS is a course created and supported through the Advanced Life Support Group (ALSG) in the UK, it teaches a systematic approach to disaster medical management based on practical skills that are applicable and adaptable to the health systems worldwide and encourages cooperation and coordination across all agencies involved in managing disasters. HMIMMS focuses on the delivery of care in the hospital environment. It explores the priorities and responsibilities of clinical and administrative responders facing a mass casualty incident in their hospital.
In particular, the HMIMMS expertise of key Lautoka Hospital Clinical Leaders provided a structured approach to the response of the hospital to the fire. In a very short space of time they were able to evacuate 200 patients from the 4-storey building. This time the response went smoothly – Gold command, clear decision-making, and with each nursing team leader they were able to evacuate the patients to the car park, then they ran out of space in the car park. They liaised with the fire, police and military and fortunately had no casualties and also no patients that deteriorated during the ordeal.
The communication process was excellent. The tiers of command were excellent and it was evident how important understanding the command structure was. We all learnt a lot from the Lautoka hospital fire and these learnings were passed onto the other 2 hospitals in Suva.
The importance of open dialogue with patient families the lesson that Tuki took from the other mass casualty event that he attended. A large group of youth were on their way to watch a rugby game and were involved in a horrific car accident. Twelve critically injured patients – 14 to 18-year old young men - presented to casualty. Luckily Mamatuki’s team were able to respond to this one much more effectively from what they had learnt from the cyclone and the fire. One of the biggest challenges of this disaster was the number of casualties’ distraught families and friends who descended on the hospital. They were able to quickly designate a space for families – where their privacy and dignity could be protected and be updated on their loved one’s progress.
Mamatuki says that you can’t underestimate the importance of training in disaster situations. While once they had to go to the NCCTRC in Darwin (training is accredited through Advanced Life Support Group in the UK) to update their training every 5 years for advanced life support, now they now have a full faculty of 10 practitioners in Fiji and run their training from there for nurses and doctors. In terms of local capacity building, Mamatuki emphasizes how important it is that the training is ongoing and located in Fiji. One of the biggest challenges is not only the lack of nurses in Fiji but also the lack of succession planning. While the University of Fiji has invited Mamatuki to join their nursing faculty, he thinks that it’s vital that this kind of training occurs in the clinical environment because
that’s where students learn best and where the processes need to be developed.
Former Chief Nurse for Fiji, Margaret Leuong, has been an important mentor for Mamatuki.
Margaret’s been our champion and our go-to person who keeps reminding us about the importance of continuing education and training.
Margaret supported Mamatuki’s application for DFAT funding to attend his Masters at Sydney University and she also championed the triaging system that Mamatuki spearheaded.
Prior to 2017, Fijian hospitals suffered from a lack of triaging systems in their emergency departments – it was achieved on a ‘first come, first serve basis’. Mamatuki spent 7 years sacrificing his Saturdays to work with a group of nurses to adapt a South African Triaging package to implement at Lautoka hospital. Now it’s been implemented across another 2 hospitals – one in Nandi and the Colonial War Memorial Hospital in Suva.
Mamatuki returns to Fiji as his country prepares for the 2nd wave of COVID-19. He says that during the first wave where Fiji had 19 cases, and they contained the outbreak through isolation and through the application of the HMIMMS program. Despite this, everyone was extremely anxious attending to patients because they did not know what to expect and didn’t have adequate PPE. This time they’ll be much better prepared and be able to support and educate nurses to feel safe. They’ve established a buddying system, team leaders and also have managed to synchronize working together – this is the critical backbone of the response team to contribute through conversation.
Once he returns home but before he gets back to the clinical environment, he’ll have to be quarantined in a hotel for 14 days. I ask him if he’s anxious about that,
No I’m going to use the time to work on Action Plans and Guidelines, get lots of reflection and writing done and start working on writing Emergency Disaster Standards. If you don’t have very detailed standards of care then you can’t act or communicate effectively.
He’s looking forward to strengthening Fiji’s public health policy, advocating for infection control to help avoid community transmission of COVID-19 and spearheading the development of emergency nursing in Fiji.