Talofa! My name is Bita Minaravesh and I am in my final semester of the global health leadership track of the Master of Public Health program at USC. After eight short weeks in Apia, Samoa, I have completed my practicum at the Ministry of Health and can now add working in a government organization overseas and conducting a policy gap analysis to my resume.
Samoa is a remarkable Oceanic nation that lies halfway between Hawaii and New Zealand in the South Pacific and is home to roughly 190,000 people, the majority of whom live in the capital city of Apia. Even in the wet season, Samoans enjoy a warm climate, remarkable waterfalls and a protective reef that keeps crystal-clear warm turquoise water in and predatory fish away.
Line where the sky meets the sea
In Samoa, you are greeted with a friendly “Malo” (“Hello”) and smile from every person who crosses your path. Samoan culture is based on respect and can be a bit conservative but there were only a few customs that I needed to get used to, such as bowing your head and saying “tulou” (“excuse me”) if you must walk through a conversation, remembering to cover my knees and shoulders in the villages regardless of the heat, or sitting through a prayer at the start of most meetings. Samoa relies heavily on imported vegetables and meat but what the island lacks in produce variety it makes up for in fresh young coconuts (niu) and bowls of fresh fish marinated in coconut milk (oka).
From the start, my supervisors and I knew that completing a gap analysis, producing a first draft of the next non-communicable disease policy, and providing technical assistance to relevant projects as needed was a daunting amount of work to accomplish in eight weeks. Nevertheless, the manager and assistant CEO working with me made one thing very clear from the beginning—if I wanted to truly understand the country, I needed to see as much of it as I could, and enjoy it. This was definitely not something I would argue with!
Getting from the north side side of Upolu, where Apia lies, to the south side takes a mere 30-minute car drive. While the city is where all the offices and agencies are stationed, almost of the natural gems are located on the opposite side of the island. Sometimes, I was able to go with the team to visit villages for the World Health Organization’s Package of Essential NCD interventions (PEN) Fa’a Samoa program, a NCD prevention and health promotion initiative that use women’s committees from the villages to educate the community. Otherwise, I dedicated my weekends to exploring all the beautiful sites Samoa had to offer. From black sand beaches to marine reserves and the To-Sua ocean trench, the island does not disappoint. By far one of the most beautiful experiences I have had traveling was going on a waterfall hike that took us along and through the Liua le Vai O Sina River. It required jumping, climbing, crossing and skirting more than a dozen waterfalls, each more picturesque than the last.
The expat community is strong in Apia and has seen many volunteers come and go, and quite a few make Samoa their new home! I lived in a house with a volunteer from New Zealand working for the United Nations, a Chilean woman working for UNDP, an Australian volunteer working in earthquake preparedness, a Fulbright scholar researching human rights and climate change, and a Samoan Matai Orator (a position in the chief system) who moved out of his family’s village to be in the city. I have my housemates to thank for showing me the gorgeous sites on the island and introducing me to other expats, Samoans, and even a running group that met every Monday night. Work hours throughout the organizations stuck to 9-5 and never interfered with weekends, which are set aside to be spent with family. For us, that meant Saturdays and Sundays were dedicated to exploring and staying at fales on the beach, where you can snorkel all day, get a hearty home-cooked meal before sleeping under your mosquito net, and wake up to waves and pink sun rays.
The Gap Analysis
In order to meet all my goals for my practicum, I had to be very proactive. In essence, my main goal was to take a long overdue look at the 2010-2015 National NCD Policy to see what areas needed further attention, which topics need to be incorporated in the future, and where they had successes. The first three weeks took a great deal of adjusting and no amount of warning regarding “island time” prepared me for the truth of the matter.
While normal work hours are 9-5, it is completely normal to take a lengthy lunch break. In addition, every Monday, Wednesday and Friday there is office-wide Zumba from 4:30-5:00 p.m. in the office parking lot. Since everyone began changing clothes and preparing for the exercise at 4:00 p.m., Zumba was essentially three hours of the work week. However, once the policy team was ready for me, my work began! This form of audit did not have a standard procedure at the MOH and that allowed me to be creative and apply my own knowledge. I gathered that the 2010-2015 policy was created by a foreign volunteer who came in, barely interacted with the staff, and left the document without fully explaining it to everyone. This definitely presented a problem for me as occasionally, even when I asked for clarification on a specific goal, no one could provide an answer.
I broke the policy down into measurable deliverables, conducted interviews with the assistant CEOs in charge of the relevant programs, brought in NCD priorities from the WHO’s Sustainable Development Goals, and incorporated issues such as climate change preparedness as it relates to natural disasters and rising rates of CVD, mental health and more.
In my interviews, I tried to let conversations flow naturally and get everyone’s personal takes on the public health situation in Samoa. The end result was priceless—honest opinions and suggestions on strengthening youth health promotion programs, encouraging e-health, and supporting transparency. All of these suggestions were considered and almost all were incorporated into the policy draft to ensure stakeholder opinions would not be overlooked.
The end result became a 45-page document with a full analysis of the 66 policy objectives, 16 interviews conducted and a rough draft of the next policy. To finish off my experience, I presented all my work to the bimonthly meeting of the assistant CEOs!
The findings, though mainly negative and focusing on the shortcomings, was very well-received and appreciated. At my goodbye lunch, I exchanged email addresses with many members of the NCD department and was able to express my gratitude for their assistance throughout my time.
At many times, I doubted whether or not I would make my deadline—for instance, requesting a copy of a recent report took three weeks, setting me considerably off my tight-schedule. Nevertheless, I was only able to complete my project because of their willingness to spend time discussing their work with me, so I truly meant fa’afetai tele lava for all their help. I am still in contact with the NCD coordinator, Mareta, and she, along with a few others, have asked why I had not bought a one-way ticket so I could stay and conduct further analysis. In truth, it was often difficult to reconcile the gorgeous scenery and opportunities for physical activity with the knowledge I had gathered regarding obesity and diabetes, and I imagined multiple research possibilities exploring this disparity. As happy as I am to be back home, my head is already swimming with ideas of how I could explore other public health topics and my stomach is growling for a bowl of oka!