Samoans Seek Medical Care Abroad

Due to the rising cost of healthcare in New Zealand, the government of Samoa has decided to shift the destination of its Overseas Medical Referral Program (OMRP) away from its South Pacific neighbor and send patients to India instead. Because of the country’s limited medical resources, Samoan citizens who require complex medical procedures have traditionally been flown to New Zealand for treatment under the country’s universal healthcare system.

Although India is much further away from Samoa, the cheaper cost of medical care makes it a more attractive destination for a state that has limited financial resources. Samoan Prime Minister Tuilaepa Sailele Malielegaoi explained that the advantage of this shift was not just financial; it also will allow patients to be accompanied by family members: “We know it’s far, but it is cheaper. Whenever we need to send a patient to India for treatment, they will have money for their fares, not only for the patient, but also their family members.”

Malielegaoi stressed that the quality of the care given to Samoan citizens would not be diminished by the new program, praising the quality of the Indian doctors. “If you go to New Zealand, you will see that a lot of doctors there are Indians. Even when we have specialists from overseas visiting our hospital, most of them are Indians.” Malielegaoi also indicated that he hoped that Overseas Medical Referral Program could lead to more contact with Indian medical professionals who might be able to travel to Samoa for training. “If we can bring in doctors from India to work at our hospitals,” the prime minister said, “our doctors can then learn from them by observing how they [Indian doctors] carry out operations.”

While the increased cost of medical care in New Zealand is one factor driving the shift in policy, a further contributing factor is the increased number of Samoan citizens requiring complex medical procedures.

According to World Health Organization statistics from 2015 43.3 percent of Samoans are obese. Obesity, and the significant health problems that stem from it, has become a pronounced problem throughout the Polynesian, Melanesian, and Micronesian regions of the south Pacific. About 40 percent of the almost 10 million people throughout these regions have been diagnosed with a noncommunicable disease, notably cardiovascular disease, diabetes, and hypertension. These diseases account for three-quarters of all deaths throughout the Pacific islands and 40 to 60 percent of total health-care expenditure.

As has happened around the world, obesity has followed in the footsteps of globalization. Throughout this region, traditional diets based primarily on fish and tropical fruits have been replaced by imported processed foods, Western fast food, and sugary drinks. While such imported processed foods originally came from Australia and New Zealand, in recent years there has been a significant increase in processed foods arriving from countries like China, Malaysia, and the Philippines. Often these imported foodstuffs do not contain nutrition labels in English – which is the language of education throughout most of the south Pacific – inhibiting people’s ability to make informed choices. These processed foods are generally cheaper than both imported and locally grown fresh produce, further compounding the problem.

Scientists who have studied the the genetic makeup of people throughout the south Pacific have developed a hypothesis known as the “Thrifty Gene.” The theory suggests that populations who would need to go long periods without food, due to long sea voyages, would need to store fat more quickly to compensate. This was a traditional evolutionary advantage, but as this genetic trait has come into contact with the sugars within modern processed foods, it has created a predisposition toward obesity and diabetes.

So while it is positive that the Samoan prime minister is forging new links for his country with India, the impetus to do so is less positive. Due to the current health problems in his country, the cheaper cost of medical care in India will need to be pursued for now, and hopefully Malielegaoi’s desire for a knowledge-exchange between Indian and Samoan medical professionals comes to fruition. But in the long term it would be far more prudent for the Samoan government to invest in educating the public on the adverse health effects of processed foods, and seek ways to lower the cost of traditional foods that are more suitable to the metabolisms of the Samoan people.