Global good partners in profile: Lenara Tupa'i-Fui, Samoa Ministry of Health
Each quarter, Digital Square shines the spotlight on global goods and innovators in our community through our Global Goods Community Newsletter. Lenara Tupa'i-Fui is the Acting CEO of Health Information Technology & Communications at the Ministry of Health, Government of Samoa.
Tell us about your background and how your career has evolved to bring you into the global digital health sector.
My two favorite things in my college years were studying biology and watching CSI (Crime Scene Investigation). So naturally, I joined university with a dream to become a doctor in a digital forensic field or any career that would integrate the use of biology and computing.
Unfortunately, back then neither of the two universities in Samoa offered medical courses that included computing, so I ended up studying and graduating with a bachelor’s in computer science and a double minor in biology and chemistry. With high scores in computing, an advisor at the university encouraged me to pursue my dream and apply for a scholarship to study Artificial Intelligence, Data Mining, or one of the other cool computing courses available in Japan. A few months later, I was in Tokyo studying for a Post-Secondary Diploma in System Engineering.
After this, I returned home where I worked at the Ministry of Education for close to four years as a Senior System Support Officer. It was fun and challenging, and during this time, I found that I was more interested in synergizing network infrastructure and system discussions than working specifically in a database or networking field. I returned to Japan and did a Masters in International Relations with a major in ICT for Development in health and education sectors. This has become very handy for handling ICT project discussions in the ministry and generating ideas for the utilization of ICT in these core sectors.
The experiences and challenges of living as a foreigner in Japan for seven years, a country more technically advanced than Samoa, impacted how I advise on ICT projects in Samoa, especially working for the Ministry of Health.
What excites you most about the digital health space?
Encouraging and building the confidence of staff to use technology can be challenging. For example, it can be hard to persuade a 60-year-old nurse in the community to register vaccinations on a digital platform rather than document it in a book. Interpersonal skills are very critical, as well as patience and perseverance as you may have to go back more than five times before they accept your ideas.
I get excited when our users adopt the digital platforms in their everyday duties. It is always exciting when you send out an urgent email and the community hospital facilities respond in minutes without having to call them to follow up on matters. During a cyclone, a busy nurse can send in photos of their current situation—whether it is a shattered window from a fallen tree, a leaking roof, or a downed electricity line—to better inform the Ministry of Health emergency response. Given the shortage of clinical workforce, a doctor can tune in live from a district hospital facility computer for capacity building trainings or online degrees.
It is also fulfilling when members of the public appreciate these efforts, such as when they commend shorter waiting times that result from digital systems being used by a hospital for its processes.
What role have digital technologies played in response efforts?
I am the technical lead for Communication in the Health Emergency Operation Centre and the Health Focal Person in the National Emergency Operation Centre in Samoa. Digital technologies make it possible to make decisions regardless of time and location as well as to keep everyone better informed. Drones can be used to see the impact of a cyclone, damage caused by a fire, or identify the safest route to take to avoid floods and damaged bridges. The use of mobile phones (using apps like WhatsApp, Viber, and Telegram) allow us to gather visual evidence from facilities to give them advice or allocate resources. The ability of technology to forecast and predict weather patterns allows us to advise whether schools need to close, or work canceled and for everyone to shop and prepare for the worst.
How is Samoa using Tamanu to roll-out COVID-19 Vaccinations?
Tamanu is used nationally for collecting and managing data of the vaccination roll-out campaign in Samoa. Our COVID-19 vaccination process is that each vaccination team (made up of Senior and Junior vaccinators and a data administrator) heads out from district to district to administer the vaccine to communities. Currently, Tamanu can be downloaded on a tablet or mobile phone and is taken out to the field by each vaccination team where they administer and record the administration of Samoa’s AstraZeneca vaccine. Each record on the tablet is then synced back to the main Tamanu servers which update and send the updated information back out to all other connecting tablets and mobile devices as well as the main office.
This allows those of us in the main office to quickly know the number of people vaccinated by each mobile team and use this information for decision-making processes to better utilize and allocate our resources.
From the arrival of the vaccine to the expiry date, we are given a window of less than 3 months to use them. Tamanu has greatly assisted with managing our collected data. It has helped eliminate the need to manually write down information on tally books and submit for data entry later or entering in Excel spreadsheets which from experience usually results in a lot of data entry errors.
The mobile version is very compact and requires fewer resources to carry around, thus helping the mobile teams to move quickly through their vaccination process in the communities without worrying about carrying bags or boxes of physical books or heavy laptops and worry about charging them.
Data collected via Tamanu is then visualized using Tupaia. This tool is very handy in allowing us to see which areas have the highest and lowest vaccinated population on a map of Samoa. This is extremely useful information for those who are not too tech savvy but need real-time data to make critical decisions. The data collected is then analyzed by our data team and used for planning and response efforts of Samoa’s National Emergency Operation Centre as well as updating the public on social media and other media platforms.
We have been online since 2020 with the support of the Beyond Essentials team which set up and contextualized Tamanu to Samoa’s needs. They have been an immense pillar of support throughout our rollout, always there when we email, zoom or WhatsApp them even during odd hours of the night or early hours of the morning given our time differences. We acknowledge their commitment and patience with us.
How has your work evolved during the COVID-19 pandemic?
COVID-19 has sped up the development of most initiatives, and I feel like it has been a race against time with all developments. Samoa currently does not have any COVID-19 cases, but we have repatriation flights. So, all our efforts are put into ensuring we are digitally capable of detecting a COVID-19 case and managing its spread as much as possible.
With the worldwide effect of COVID-19, there was a rush to have everything available and accessible online to minimize coming into contact with others. This meant that we had to make our processes available online. The number of online meetings and trainings has increased drastically, particularly with Samoa’s border lockdown, and this has increased demand on Internet bandwidth. It has also increased the importance of ensuring backup and information security is maintained and prioritized.
We also need the proper resources to implement our health services. Given the border lockdown, we have had to forecast and make decisions on whether we need to procure certain items and when to order them as it could take two to eight months before delivery of the items.
Negotiation skills have also become very important in better allocating budget and funds. An increase in technical resources, in turn, places a demand for an increase in the technical workforce. What used to take us months to justify is now fully realized as the demand for technical project implementation grows across the different areas of health.
How will COVID-19 impact the digital health sector over the next five years?
Advocating for technology can be challenging, especially when the system is intended to change the way people do certain things that they have been doing for more than a decade. COVID-19 has helped push forward the use of technology.
We do not see COVID-19 going away anytime soon, so technology is helping us with online education and trainings. People have realized they can still get a degree remotely and do not need to travel. Teleconsultations are now common online, and we foresee that we will slowly move into diagnosing in real time. Virtual Autopsy is also being discussed with the challenges in lack of forensic pathologists locally. As most of these online services are welcomed and encouraged, there is also a need to put policies and laws in place with regards to patient information confidentiality and security from unauthorized access.
What are some of your other interest areas?
I am also interested in the use of ICT for development in the Education and Environment Sectors. I also love gardening and beach days with my family.