Tonga's Dr Afuha'amango Tuipulotu making a difference as the world’s chief nurse

By Hugo Hodge, ABC

As a young girl growing up in Tonga, Dr Amelia Latu Afuha'amango Tuipulotu lived only two minutes' walk from the hospital she would eventually lead.

Her relatives from Tonga's outer islands would travel to the capital Nuku'alofa and stay with her family to access specialist healthcare at Vaiola Hospital, the only tertiary hospital in the country.

"In our small, poor home, they came to live with us because it's very expensive to go to and from where they live and it was very far," Afuha'amango Tuipulotu said.

It was on those early hospital visits where Tonga's future health minister became "intrigued".

"I used to see people in pain and suffering, and children crying, and I used to say to myself - 'I need to do something about that in the future'."

The world's No 1 nurse

Afuha'amango Tuipulotu is now the most senior nurse in the world at age 51.

She became the chief nursing officer of the World Health Organisation in late 2022, a role which saw Afuha'amango Tuipulotu move with her husband and two children from tropical Tonga to Geneva, Switzerland, over 17,000km away.

"Coming here in January, I was shocked with the cold. I was almost frozen," she said.

Afuha'amango Tuipulotu admits her teenagers are adapting to their new lives in the Geneva, a global hub for diplomacy, faster than she is. They have already joined the local rugby team and have made friends in the Pasifika and African communities.

While the alpine conditions may take some time getting used to, Afuha'amango Tuipulotu has a track record of perseverance.

Her rise to the upper echelons of international leadership is just the latest peak in a remarkable career spanning clinical nursing, hospital management and politics, with several pioneering moments dotted in between.

First Tongan to receive a PhD in nursing

After studying nursing in Australia, at 21 years old, Afuha'amango Tuipulotu was placed in charge of the surgical ward at Vaiola Hospital. She also led the psychiatric ward and was appointed director of nursing before becoming the first person from her country to receive a PhD in nursing in 2012 from the University of Sydney.

She described it as a "euphoric moment", going where no countryman or woman had gone before.

"It felt so great that I was breaking a new ground, but also huge responsibility at the same time."

Seven years later she became Tonga's first female health minister between 2019-2021, successfully steering the country through the Covid-19 pandemic and a measles outbreak, with zero deaths during both crises.

Leader from an early age

Afuha'amango Tuipulotu's predisposition for leadership was evident from primary school age.

"The teacher would ask me to look after the class while she'd go out to the main headquarters to meetings and I'm doing spelling tests, multiplication tests for the class and getting the tests recorded, so that the teacher comes back and everything is already done," she said.

Other students might have viewed Afuha'amango Tuipulotu as a teacher's pet, but she viewed these early leadership opportunities as an "immense reasonability".

Afuha'amango Tuipulotu takes a pragmatic approach to leadership, with the practical knowledge gained at each step of her life informing her actions in leadership positions.

As health minister, tasked with the Covid-19 vaccine rollout, a top priority was ensuring the vaccines reached the outer-most islands.

"As I saw when I was director of nursing and chief nurse [of Tonga], when I visited those contexts, it's extremely challenging and the people shared to me how they have often been left behind with regards to developments. So, when I became minister, I said, 'vaccines must reach the context of the remotest islands in Tonga'."

Tonga weathered the pandemic better than most with just 12 deaths and 91 percent of the population over 12 years old fully vaccinated, according to Minister of Health data.

"Do your best and make sure you deliver, that is something very important for me that as a leader that I'm able to deliver on key priorities to make a difference in people's lives. If I don't do that, there is no reason for me to become a leader."

The second chief nursing officer from the Pacific

Surprisingly, Afuha'amango Tuipulotu isn't the first Pacific woman appointed to chief nursing officer of WHO.

She was beaten to it by Elizabeth Iro from the Cook Islands. Together they are the only two women to hold the position which was created in 2017.

There are fewer than five WHO staff members from the Pacific, by Afuha'amango Tuipulotu's count, but she thanks the Director-General Tedros Adhanom Ghebreyesus for back-to-back Pacific chief nursing officers.

"I feel it's very important that someone from the Pacific, from small island developing states, is engaged at the global stage and to be able to contribute to global health and support nursing and midwifery."

While Afuha'amango Tuipulotu's focus is now global, healthcare workers and patients in the Pacific still stand to benefit from her key initiatives.

She wants nursing and midwifery experiences from the world's remotest contexts, such as Tonga's, informing WHO policy in all areas.

"So that we would have policies and norms and standards that are well informed by the realities of practice, realities within the far, remotest context, where often it's only a nurse or midwife working, delivering care to a small population," Afuha'amango Tuipulotu said.

A major campaign led by her office is aiming to give emergency care training to 25 percent of nurses in 25 countries by the end of 2025. More effective emergency care could reduce deaths by an estimated 50 percent in low- and middle-income countries, with injuries accounting for 8 percent of all deaths globally.

Afuha'amango Tuipulotu is yet to finalise the 25 countries participating in the programme but she said a number of Pacific countries had expressed interest.

Women lead with 'compassion'

Afuha'amango Tuipulotu comes from a long line of politicians, but she is the first woman in the family to be a member of Tonga's Legislative Assembly.

The Pacific region has some of the lowest rates of female participation in politics in the world and Tonga had zero female candidates elected to office in the 2021 national election.

Despite this, Afuha'amango Tuipulotu thinks the dynamic is changing.

"It's a very tough environment but women have capabilities to be able to negotiate and debate in parliament … and the compassion to be able to balance things out as well, which is very important whilst we make sometimes difficult decisions," she said.

Afuha'amango Tuipulotu believes women can prove themselves to the voters through their grit and determination.

"The population will listen and they will make judgement on the quality of women's contribution to debates and formulation of laws for the country," she said.

While Afuha'amango Tuipulotu's time in office was short, she was productive, passing a key piece of legislation - the Nurse Practitioners and Midwives Act 2021 - governing nursing education and practice. She proudly keeps copies of the various nursing codes of conduct introduced under her leadership in her new office at the WHO.

"We developed it while I was chief nurse (of Tonga), but it didn't go through and pass Parliament until I became minister. I really asked the attorney general, 'please, this is also a priority during my time', even though we are busy with the Covid-19," she said.

Advice for aspiring leaders

Afuha'amango Tuipulotu says "everything is possible" for young Pacific women dreaming of a career in international leadership.

She is still friends with a group of nurses from her university days and these networks remain important in her life.

"I have my best friends who we can talk about anything and they can criticise me on any of these decisions that I make," Afuha'amango Tuipulotu said.

However, her most important piece of advice: "make sure you deliver."

This story was first published by the ABC.