When the state of emergency expires today, the nation's hospitals are slowly returning to normal operations for the first time since the measles epidemic took hold. 

Since the epidemic's declaration in mid-October, the hospitals have faced an unprecedented surge of patients and the overwhelming of their wards and systems.

Tupua Tamasese Meaole (T.T.M.) Hospital and Leulumoega and Faleolo District Hospitals were all forced to reconfigure their operations.

Faleolo District Hospital became a 24-hour ward exclusively devoted to patients without measles to isolate the sick or pregnant from the highly infectious virus. Nearby Leulumoega became an entirely measles ward.

But on Friday Leulumoega reverted back to its role as the district's 24-hour hospital and Faleolo returned to its operating hours of 9am till 5pm.

From today, T.T.M. Hospital’s general outpatient ward, the Acute Primary Care Clinic, which had been converted into a measles ward, will resume regular services. 

Many of the international emergency medical teams who have come to the country to help fight the epidemic are beginning to depart this week and next. 

The Australian mission, among others, will remain in Samoa to help the hospital transition back to its regular activities, continue treating new patients and support ongoing work planning future health emergencies.

Dr. Brian Spain, the mission leader of the Australian Medical Assistance Team Mission said no one in their mission had seen anything of the scale of the epidemic in Samoa, and said there will still be several more critically ill children in the weeks to come.

“Everyone sees severely ill children occasionally but not in the numbers that were occurring here,” he said.

As for exactly how long the impact of the epidemic will last, that is harder to predict, the doctor said. 

But he is confident that when the last Emergency Medical Team leaves Samoa, local hospitals will have returned to normal operations and patient loads. 

“One of our key things at this time of year is we could allow [local medical staff] to have a bit of a break because they’ve been working incredibly hard for more than 12 weeks now," Dr. Spain said. 

“But the time the international teams leave, they will have had a little rest over the holiday period and the work load will be diminished. They have got a great recovery plan to restore things to normal so the overflow areas are closed down.”

Dr. Brian Spain, of the Australian Medical Assistance Team Mission, said they had been tracking numbers of new cases and assessing each day whether the rate of new infections had dropped enough to disassemble the tents.

“Once we could see there was enough there, and that the number of critically ill children coming in were one or two a day rather than the larger numbers that were seen earlier, we felt it was safe.”

Dr. Spain, an intensivist and anaesthetist, who is leading the fifth rotation of Australian medical staff on island, said his team will be the last of Australia's clinical deployments. The Australian mission is now half the size of its previous rotation, which is a sign of the waning epidemic.

Their clinical work will continue until January 4. But a team focused specifically on disassembling the emergency mission before the advent of cyclone season.

Ministry of Health senior staff have also been invited to check if there is anything among the Australian deployment's resources that may be left behind.

“We don’t want to leave things that might be used in Australia but are not useful for people in Samoa,” Dr. Spain said.

“We are mindful from health responses in the past that it can be problematic disposing of things you don’t use or are not appropriate. It just creates a problem of storing it or disposing of it and we don’t want to leave behind a problem".

As of December 28, there are 46 in-patients with measles in Samoa: 40 at T.T.M, two in Leulumoega, one in Poutasi, one in Lalomanu and two in Malietoa Tanumafili II in Tuasivi.

According to Government figures released on Saturday, nine children remain in the Intensive Care Unit after 22 new cases of measles were reported on Friday.

Samoan authorities had benefited from an Australian programme designed to build its capability to respond to emergencies, which has included visiting Australian trainers and local staff attending training in Australia. 

Dr. Spain said the successful reconfiguring of the hospital for the surge of highly infectious patients showed that training had paid off. 

“While we’re still here we’re meeting with the [Ministry of Health] Director General [Leausa Dr. Take Naseri] to help formulate a plan to really enhance that over the next weeks and months,” he said.

“Part of the recovery is going to be public health, and part of that is enhancing emergency response and there is an opportunity to also review how things happen in the hospital and what things can be improved upon.”

Dr. Spain said he is encouraged by signs that the mass vaccination campaign working, and of the epidemic slowing down, not least of all for the reducing burden on hospital staff. 

“They have just worked incredibly hard for week after week after week to bring this under control. It has been our privilege and pleasure to work alongside them," he said. 

“We know many of the local staff have worked for eight weeks without a whole day break and it’s great to see the end is near.

“The commitment of the Samoan medical and nursing staff and the senior hospital leaders has been incredible. They work seven days a week, and the hospital executive meetings happen every day even Christmas and Boxing Day.”