Pacific spotlight: building emergency care in Tonga with Dr Pafilio Tangitau

18 Mar 2025

When Tongan Dr Pafilio Tangitau began his internship at Papua New Guinea’s Port Moresby General Hospital, he was young and impressionable, witnessing firsthand the difference emergency care made – especially in resource-limited settings. "Witnessing how doctors provide emergency care with limited resources and the difference they made in relieving pain and suffering inspired me to pursue a career in emergency medicine," he recalls.

Today, Dr Tangitau heads the Emergency Department (ED) of Vaiola Hospital, the only ED in Tonga. Though not formally trained as an emergency medicine specialist, he is deeply committed to improving emergency care in his country. Like many healthcare systems worldwide, Tonga faces staff shortages, increasing the risk of burnout and job dissatisfaction while adding pressure to patient care. Despite these challenges, Dr Tangitau remains focused on solutions, working to build a resilient and well-supported emergency care workforce.

For Dr Tangitau, strengthening emergency medicine in Tonga requires a deep understanding of the local context. "An understanding of our context, our strengths, weaknesses, and unique challenges, helps guide us on where and how to go forward," he explains.

Exposure to what happens in other Pacific countries and in developed countries around the world inspires me to be a better doctor, but it's equally important to stay grounded in our own clinical reality, to understand what is applicable in our setting and what is possibly not.

This awareness shapes his approach to improving emergency care, ensuring that solutions are both aspirational and practical. His experience across the Pacific has reinforced the importance of flexibility, recognising that while international best practices provide valuable insights, each country must tailor its emergency response to its own healthcare system and resources.

Dr Tangitau’s connection with the National Critical Care and Trauma Response Centre (NCCTRC) began in 2015 when he undertook the Major Incident Medical Management and Support (MIMMS) training. Developed by the Advanced Life Support Group (ALSG), MIMMS teaches a systematic approach to disaster medical management at the scene of mass casualty incidents.

“The MIMMS training has provided our staff with the skills to manage major incidents effectively, even in resource-limited settings. By emphasising strategic resource allocation, prioritisation of patient care, and effective communication across teams, MIMMS offers practical tools that apply not only to large-scale disasters but also to the daily challenges of emergency medicine. A key takeaway from MIMMS has been learning to maximise existing resources rather than focusing on what’s lacking – a mindset shift that has been a game-changer in Tonga’s emergency response,” he notes.

But Dr Tangitau didn’t stop at learning – he became a MIMMS instructor in 2018, helping train other Pacific healthcare professionals in emergency response. For him, MIMMS is more than just a course; it’s a structured, systematic approach to handling major incidents—a crucial need for a country ranked among the most disaster-prone in the world.

One of the most impactful aspects of MIMMS, he notes is the involvement of Pacific-based instructors. "Having Pacific-based instructors deliver the course adds unique value," he explains. "Their understanding of local cultures, beliefs, and the regional healthcare context – its strengths and challenges – makes the training more relevant, practical, and effective."

By ensuring that emergency is grounded in regional experience, the MIMMS courses go beyond theory. They provide real-world, actionable solutions that healthcare professionals can immediately apply.

Emergency medicine and rugby – a unique intersection

While Dr Tangitau is committed to strengthening Tonga’s emergency care system, his expertise extends beyond the hospital. His passion for emergency medicine intersects with another important part of his life – rugby. As the team doctor for the Tongan Rugby team, he is responsible for keeping players healthy and managing injuries on the field. The role presents a stark contrast to his work in ED – from treating patients to making rapid assessments on the sidelines of international matches, with thousands of spectators watching.

It’s challenging being the head of ED and travelling for rugby, but each role brings valuable experiences that inform the other.

Despite the challenges of balancing leadership in the ED and commitments to rugby, Dr Tangitau remains focused on a bigger goal: building a stronger, more resilient emergency care system in Tonga. His vision is simple yet powerful: to leave the ED in a better place than when he started. “Touching one life at a time, letting them know they matter, that’s what’s important. And it doesn’t cost anything. We just have to stay connected to our humanity and be kind to one another.”

Through his leadership, advocacy for emergency medicine, and commitment to disaster preparedness, Dr Tangitau is not only shaping the future of emergency care in Tonga – he’s strengthening healthcare resilience across the Pacific.