Jasmin Dodge was a 24 year-old junior pharmacist back in 2012 when she saw an advertisement for her dream job: Village Mission Pharmacy, an NGO-owned community pharmacy in Nuku’alofa, the capital of Tonga, was looking for an overseas pharmacist.
Jasmin, who had graduated from the University of Otago in her native New Zealand and completed her pharmacy internship, could hardly believe it. “From when I was about 12 years old, I knew I wanted to do something outside of New Zealand to help people less fortunate than myself. But I had no idea what that would be,” says Jasmin, a committed Christian.
“After high school, I studied to be a pharmacist because I thought it would be a good job if I ended up staying in New Zealand. I didn’t see any connection between the two things. Most developing countries don’t have pharmacists; a doctor or nurse does everything.”
Pharmacy laws introduced in Tonga in 2001 separated the roles of prescribing and dispensing medicine, however, creating a need for pharmacists. Still, the Village Mission Pharmacy ad seemed to have come too soon for Jasmin, who was in her first year working as a pharmacist and also doing more study.
“I emailed and said: ‘This is my dream job, I’d like to do this in the future. What experience or study should I do to reach that point?’ And they replied: ‘The previous pharmacist left three months ago. Please come as soon as you can.’”
Jasmin, who had never been to Tonga, answered the call. She expected to stay six months before moving on to other overseas work; more than 12 years later, she is the heart and soul of Village Mission Pharmacy, which opened in 2004. It sits alongside Village Mission Clinic, which was set up in 1984 by New Zealand doctor Glennis Mafi and her husband Manu.
“Due to the legal requirements, the pharmacy would have had to close down if they didn’t have a pharmacist,” Jasmin reflects. “The local staff were just holding onto their jobs, hoping that someone would arrive soon. When I said I could come – and pretty much just didn’t leave – they were happy.”
Of her first impressions of Tonga, she simply says: “I was finally doing what I felt like I’ve been born to do. It was definitely challenging – but they were the right kind of challenges.”
For a developing country, Tonga has a good level of government-funded basic healthcare although state pharmacies don’t sell over-the-counter medications and don’t have a patient communication role. The local healthcare issues include chronic illnesses such as heart disease and diabetes, as well as complications from mosquito bites and fungal infections.
“The tropical environment means that infections grow very quickly,” says Jasmin. It’s all relative, though: a pharmacist colleague worked in Togo in West Africa and had malaria 28 times, she says. “I’m just thankful Tonga doesn’t have malaria. No rabies. We have dengue fever only sporadically.”
Jasmin describes Tonga as the opposite to most developed countries, where people can “get a pill for everything” and many people are on too much medication. “Here, we could do with a lot more medicine and preventative healthcare to reduce the risk of strokes and heart attacks,” she says.
She was welcomed by the local community and threw herself into learning Tongan as her “first second language”, progressing from writing medicine labels in Tongan to addressing customer queries. “A lot of people in Tonga have good basic English but when you’re talking about your health, it’s really helpful to hear it in your own language,” she says.
“The most rewarding – and most needed – part of being a pharmacist in Tonga is the communication, just being able to explain to people what the medicine is for, how to use it correctly, what to expect in their recovery. I’ve really enjoyed learning the language and getting deeper into the culture.”
Village Mission Pharmacy is the second-busiest non-government pharmacy in Tonga, which has a population of about 107,000 people across many islands. Jasmin’s role spans everything from dispensing prescriptions and advice to procuring stock, which comes the 2,500km from New Zealand by air freight once a month and sea freight every six months.
“We try to have everything that people rely on, which is quite difficult when we’re at the very end of the supply chain,” says Jasmin. “Tonga is the kind of place that, if you see something you want in the shop, you buy it straight away and you buy enough for six months. Because if you go back to that shop in two days’ time, there will probably be none left and they’ll never have it again.”
Like the rest of the world, Tonga closed its borders in March 2022 because of Covid-19. Unlike most of the world, it stayed virus-free for almost two years. The eventual arrival of the virus in February 2022 came just after the violent eruption of the Hunga Tonga-Hunga Ha’apai undersea volcano, which sparked a 15-metre tall tsunami that hammered coastal communities.
“It was a difficult time. There were people from whole villages that had been wiped out by the tsunami and were all living together in church halls,” says Jasmin. “Then our Covid lockdown finally happened about two weeks after that and no one could visit them.”
By then, however, Tonga was well prepared. About 98% of adults were fully vaccinated for Covid-19, using vaccines distributed through the Covax scheme for developing countries, and the health service was set up for testing and emergency care. “The nurses doing the vaccines had 10-dose vials and they were very proud of the fact that they wouldn’t waste a single dose,” Jasmin says. The reported statistics say the country had 12 coronavirus-related deaths in total.
Natural disasters are a fact of life in Tonga, says Jasmin, who is familiar with earthquakes from her upbringing in Christchurch. In fact, when a magnitude 6.6 earthquake hit Tonga on May 26th this year, she didn’t even feel it. “I got a call from work to say the tsunami sirens had gone off and they had to evacuate. There was no damage done but it was good practice for a real emergency.”
Alongside her pharmacy expertise, Jasmin has picked up a range of business and technology skills in running Village Mission Pharmacy. The practice has been computerised since it was set up and uses Clanwilliam’s Toniq dispensary and retail software on two laptops.
“The Toniq program is given to us for free, which is incredibly generous as I know we wouldn’t be able to pay for it,” says Jasmin, who is the pharmacy’s de facto IT person. “We do have challenges with our internet and our hardware is quite old but the Toniq helpdesk are always helpful.”
“We have other key people around us that make a big difference. Our supplier at the wholesaler in New Zealand goes above and beyond. Our customs broker here in Tonga is very helpful in getting the stock through all the red tape that it takes to import medicines.”
With the help of local workers and other overseas pharmacists, Jasmin has been able to scale back her workload from her original six days a week. Training local pharmacy assistants is one of the most enjoyable aspects of her role. “It’s usually the first job they’ve ever had and it’s really rewarding to see them progress and get more responsibility,” she says.
While the long-term goal would be for a Tongan pharmacist to take over running Village Mission Pharmacy, there are challenges associated with that, she explains. “When people are qualified in a good job in Tonga, there is a lot of pressure to move overseas to earn much better money and send some back to their family. The economy relies on remittances but we’re thankful for the people who stay because the country needs skilled people in order to develop.”
She typically works one month a year in New Zealand to keep her pharmacist registration there up to date and sees the contrasts between the locations. A New Zealand pharmacist might be expected to do 100 prescriptions a day but they are generally prepared by someone else before a final check by the pharmacist. “I think I’d be bored,” says Jasmin.
“I like the challenge of working this environment, not just the language but the cultural understanding of what people expect. Even something that you would consider very easy to tick off your to-do list can be very, very challenging. Everything in Tonga is done relationally; it’s about who you know and keeping a good connection with them, so that you trust each other.”
Her overseas excursion has lasted much longer than the average ‘OE’ – overseas experience – of a typical Kiwi but Jasmin has no regrets. Her family are very supportive and visit her in Tonga and she is content to stay as long as she feels her skills are valuable and she is not needed elsewhere.
Any doubts were put to rest some time ago when she talked on Skype to another pharmacist who was interested in coming to work at Village Mission Pharmacy. “When I was talking to him, I was thinking, ‘No, he won’t be able to do it, he can’t come’. Afterwards, I realised that the problem wasn’t him; the problem was that I wanted to stay. It’s just that overall sense that I’m here and I’m in the right place.”
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