Professor of Medicine at the National University of Samoa (NUS), Professor Asiata Dr Satupaitea Viali received correspondence dated 23 May 2023 advising of his appointment as Professor Adjunct of Epidemiology in the Department of Chronic Disease Epidemiology within the Yale School of Public Health, which marked a major milestone among his various medical achievements. Below is an edited version of an interview between Prof. Satu and Samoa Observer editor Alexander Rheeney.

1. With your other roles with the N.U.S. [National University of Samoa] and the O.U.M. [Oceania University of Medicine], which are also significant in terms of your contribution to Samoa's human resource upskilling, how are you able to juggle the new responsibilities at Yale University?

I have worked with Yale University since 2010, collaborating in Research. I started collaborating with US Universities when I was the Dean and Professor of Medicine for the Oceania University of Medicine Samoa in 2002, which started with Brown University (Prof S McGarvey) in 2003. The Yale University collaboration started in 2010 (Ass Prof Nicola Hawley & Team), plus the Pittsburg University (Prof Dan Weeks, Ryan Minster and Team). We have a number of research going on at the moment in Alzheimer’s Disease, Diabetes, Non-Communicable Diseases, etc. I have attached the Brochure of our Collaboration with these US Universities, MOH, SOM and OUM.

Fortunately, this Yale University Professorial role pivots around research and research supervision, which is something I like. Research answers some of the health questions and solves some of the issues in health and disease. Over the years, our Research team which includes the three Universities (Yale, Brown, and Pittsburg) meets on Zoom every 2 weeks (5 am or 6 am Samoan time) to discuss the various issues in the research carried out and discuss the various publications. So, my day starts at 5 am some days. Though time zones are sometimes difficult to synchronize, I have to make time as often as possible to meet, also paying attention to my other roles in the School of Medicine and the Oceania University of Medicine now. If I have a class that starts at 8 am, then I have to juggle my availability, and maybe catch up with the team later. I also do Cardiology Clinics for our National Hospital which usually start at 8 am and till 5 pm, on some days we have Zoom meetings. It’s a juggling act, but, one can only fit in 12–14 hours of work a day. I have done this for many many years. For teaching, as the Professor of Medicine, I teach for two days for the School of Medicine, from 8 am-5 pm, covering Basic Science and Clinical Science in Lectures, Tutorials and Bedside clinical teaching on patients, in Cardiovascular Medicine (200 level), Neurology Medicine (200 level), and Internal Medicine (400 & 600 level). For the Oceania University of Medicine, I do two days, as I am currently the Interim Dean until a permanent Dean is found, and also the Professor of Medicine teaching Cardiology to final year OUM students and Internal Medicine to 3rd and 4th-year students. For the one day that is left, I do Cardiology Clinics as the Visiting Cardiologist at the Ministry of Health. My contract in the Ministry of Health finished in January 2023, and I am waiting for renewal, before starting again. The research that I do, is done in between these works, or before work starts. On the weekend (Saturday and Sunday) I am the Senior Pastor of Cornerstone Church Samoa.

2. What are some of the potential benefits to Samoa that would flow from your recent appointment by the Yale University School of Public Health?

The benefits to Samoa are huge. Yale University has a Research Centre here in Samoa, and many colleagues are employed by this centre (Olaga Brochure attached), paid by the research grants that we apply for. We make applications for research grants regularly to fund this research and staff. The rent they pay for using the local facilities is another benefit to the Ministry of Health. Yale brings in much expensive research equipment (eg DEXA scan, etc) that is used here in Samoa. The association and the collaboration between Yale University and the NUS School of Medicine and the Oceania University of Medicine Samoa will boost our local reputation because we are doing work with one of the Ivy League Universities in the USA. We also publish many papers with colleagues from Yale and other universities. It boosts our academic reputation. For myself, I want to show our local academics here in Samoa and overseas, that we can reach the heights of academia if we work hard and have faith in our God so that we develop Samoa and its reputation. E le na o le tautaua I le lakapi ma sports, ae tautaua I le tele o le iloa ma le malamalama o le mafaufau.

3. With your long history in teaching medicine in Samoa, through the NUS and OUM, what is the current status of training the next generation of Samoan doctors, and if the country is getting enough doctors?

The country is still short of doctors, even though we have 131 doctors working here in Samoa. I cannot give you the amount of doctors needed, but, my guess will be about 250-300 doctors in total needed so that we cover the whole of Samoa. We need doctors at these levels - Interns, House surgeons, junior registrars, senior registrars, Consultants, and Specialists. We need to train them to these levels. We have many young and newly graduated doctors between 1-3 years (called Interns & House surgeons), we do not have many registrars, especially senior registrars, and we do not have many consultants or senior level doctors or specialists.

I came back to Samoa 24 years ago as a Specialist Physician and Cardiologist, and have continued to work and fight in Samoa, leaving the country from time to time to sit exams and to do more training in cardiology and other fields of medicine.  When I came back 24 years ago, I only had the qualifications of BHB (Bachelor of Human Biology), MBChB (Bachelor of Medicine and Bachelor of Surgery), FRACP (Fellow of the Royal Australasian College of Physicians). I did all the other qualifications while working in Samoa, and was absent for short periods of time, to acquire a Master of Public Health (MPH) (UNSW Sydney) via Research Thesis, FCSANZ (Fellow of the Cardiac Society of Australia and New Zealand), FESC (Fellow of the European Society of Cardiology), and recently FACC (Fellow of the American College of Cardiology).

We need to train more younger doctors, to make up the numbers, while we focus on doing post-graduate training and specialist training of the senior registrars to achieve the Consultant status and eventually the Specialist Status. We need specialists and consultants in all areas of medicine, so that, we are self-reliant on our local doctors to have the knowledge and the skills to manage our own people.

The New Zealand and Australian level, to qualify to be a specialist level in a field of medicine, is the “Fellow” level (eg FRACP, FRACS, FRACOG, etc). I trained at Auckland Medical School for 6 years to get a basic medical degree (MBChB). I did a one-year Internship at Palmerston North Hospital to register. After that, I did 1 year as a House Surgeon at Palmerston North Hospital, then migrated to Auckland to do junior medical registrar for 3 years while studying to sit the Part 1 Fellow exam in written exams followed by 2 days of clinical, oral and viva exams. This is once a year exam for all the New Zealand and Australian junior registrar trainees (about 300). Only 10% pass this exam, as they take the top 10%, even if your total score is over 50%. I then enter the 4 years of  Fellow training, which is full of work and academic stuff. Part 2 consists of 4 years of consistent hard work and assessment by the specialists on the job skills and knowledge, and you sit the exams nearly every day of that 4 years. In total, it took me 16 years of supervised training to get my first Fellow awarded by the RACP. The problem has been, we have our Samoan doctors with “Fellow” qualifications in New Zealand and Australia, and they have decided, for one reason or another, to stay and work overseas, because they are able to. Whatever the reasons they are staying overseas, all of them are contributing to our well-being in Samoa, by visiting and doing clinics in Samoa, all send money over to their families, and many help our local SMA association. The decision to come back to Samoa is a personal one, and God has called me back to serve Samoa in the medical area, as well as the spiritual area. Hence, because our Fellows are staying back, creating specialist training in Samoa, and utilising their knowledge and skills to visit regularly to train our local staff at the specialists level, will be the best way, to utilise them. I am sure they will be, more than happy to do this and to help our colleagues here.

The Fiji National University (FNU) is training our doctors to the Master of Medicine (MMed) level, to begin the path to Consultant status. I used to teach for FNU MMed program in Internal medicine, as I was involved from 2004 with the Fiji School of Medicine, Master of Medicines Program. I have supervised 2x MMed doctors (Drs Rosanna Tofaeono-Pifileti & Dr Folototo Leavai) in Samoa in Internal Medicine. About 10 of our local doctors are doing post-graduate MMed through the FNU at the moment, in various disciplines.

The NUS School of Medicine is starting to do training in the Master’s Program, starting with the Master of Public Health, to train our local doctors to the post-graduate level. The School of Medicine is also preparing an MMed in Obstetrics and Gynaecology, an MMed in Internal Medicine, and other disciplines. Once we develop our local capacity and are able to the MMed through the NUS School of Medicine, then we do not need the FNU pathway to get MMed.

4. What would be the advice that you can give to aspiring medical doctors based on the pathways you've taken in life as well as the choices that you've made?

I came back at the end of Medical School at the end of 1989 to serve our Nation. When I looked around at that time, no one had a Fellow qualification. So, I ran away to New Zealand to do another 9 years of difficult and hard training to get the Fellow, at the beginning of 1990. I was always going to come back to serve the nation that had sent me overseas. God had opened up the training pathway, and I was determined to keep my promise to Samoa. Before I came back at the beginning of 1999, a doctor told me a vision about my calling to come back to Samoa. My wife also wanted to come back to Samoa, to serve this nation. We both got the revelation to come back to Samoa. When our Government called in 1998 that Samoa needed senior doctors, I responded. Hence not only I kept my promise to the country, but I also obeyed God to come to serve Samoa. I want colleagues, to know, that we serve here in Samoa, as God’s calling on our lives. We serve at God’s pleasure.

The riches in other countries that our medical talent can secure, can also be secured in Samoa. “E miliona tala Iesu o lo’o i inei I Samoa, e tutusa foi ma le Iesu o loo i fafo i Niu Sila ma isi atunuu”. We serve the same Jesus here, or overseas. Working, working, and working, hard is the way to achieve all this. This is God’s gift to us all – is working hard. Nothing comes easy.

For the new medical student – let me say this - if this kid, that was born in Satupaitea, brought up in Vaimoso, came to Apia and went through our local school system, went on NZ MFAT scholarship and got to the top of medicine overseas in New Zealand and Australia, and was able to achieve all these qualifications, and returned to service, and continues to assist Samoa in its development, you can do it too. What it needs – it needs a strong faith in our God, and it needs old fashion hard work, to achieve the best to help our nation. Do not, let anyone tell you, you can not achieve your dreams.

Lastly - I now serve as the Senior Pastor of Cornerstone Church Samoa for the last 9 years, and it has been a great journey with God, and how God has opened many doors for His servant to serve. I have had the favour of God in my life for all these years. The famous hymn “All to Jesus, I surrender….for all, he has done for me, I gladly serve where he has placed me”. Never forget our faith in God, and never forget who you are in God, and that our God fulfils the dreams that you have. My last dream is to see as many as possible, come into the Kingdom of our God. Ia manuia.