Prior to becoming a British Protectorate in 1888, the medical care of Cook Islanders were dependant on customary herbal remedies, massage therapies or supernatural intervention offered by Ta’unga. The Ta’unga held a culturally significant place in the community and were the first point of contact for local people who were sick.
In 1901, the Cook Islands were annexed to New Zealand. During this time, medical services were provided free of charge to all Cook Islanders by one medical officer from New Zealand appointed as Chief Medical Officer. In 1912, there was a second medical officer appointed as assistant medical officer to give attention to Outer Islands Health.
In 1929, the first two Cook Islands doctors Takau Tinirau and Tau Cowan were trained in Central Medical School in Fiki and graduated in 1931 as one of the first Native medical practitioners.
Special campaigns to combat diseases were conducted with the support and resources of the New Zealand government in the early 1900’s. In 1926, Lepers were transferred to the central leprosy hospital at Makogai in Fiji, which New Zealand had assisted in its establishment and operations.
By the early 1930’s an annual Tutaka (village and household inspections) program was instigated and carried out by the “…Resident Commissioner, Medical Officer, local leaders and women’s committee’s in each district on Rarotonga during December” (Futter-Puati, 2010). The aim of the program was to improve living conditions and also to focus on vector and intestinal parasites and micro-organisms of gastroenteritis and proper disposal of sewage, referred to as ‘refuse’. This began on a competition basis to encourage the community to participate and adhere to the objectives of the program, however later this was looked upon as to place extra pressure on families that experienced difficulties conforming. This program continues today with three (3) Tutaka visits conducted per annum as compared to one.
It was also during this time that the Chief Medical Officer (CMO) Ellison, supported by the Au Vaine, helped to establish the baby and children’s welfare clinics through the Cook Islands (referred to today as the Maternal Child Health Clinic). The aim was to enable education, monitoring and support in screening and wellness monitoring of families as well as identifying illnesses.
The public health programs which included the village health inspections, baby and child welfare clinics, vaccinations and inoculations, identification of tuberculosis and leprosy, proper water and sanitation, sewage and waste disposal amongst many other programs continued over the decades, even as the Cook Islands became independent from New Zealand in 1965.
The return of Dr. Thomas Davis to the Cook Islands as a trained clinician saw the introduction of the public health department by mid-1950’s, which was commissioned to address the issues that were considered non-clinical, such as home visitations, destroying vector breeding sites, vaccinations and inoculations, proper water sanitation and sewage disposal with a focus on the prevention of diseases, so as to reduce the burden on the hospitals staff and resources.
The progressive shift from Communicable diseases to Non-Communicable diseases
Up until the late 1960’s, the Cook Islands were experiencing the deathly effects of communicable diseases such as tuberculosis or leprosy. The hospital (referred to as the ‘Sanatorium’) being located on a mountain in Arorangi was in response to the tuberculosis disease during this period. An extensive campaign to identify and treat TB cases included a directly observed medication program and screening programs which included chest x-ray and mantoux (skin test).
The vaccination and inoculation campaign (in the late 1970’s was referred as just ‘immunization’) which was conducted by the hospital staff up until the late 1960’s, was transferred to the public health department and partnerships were forged with the Cook Islands Child Welfare Association to assist in the development of the Mother and Child Health Clinics (MCH) around Rarotonga and into the Outer Islands.
As standards of life improved and development became apparent in the country, the control of communicable diseases had improved drastically by the 1980’s, to the point where low incidences of TB, leprosy and other communicable disease were realized, however, an increased awareness of the effects of non-communicable diseases such as diabetes, hypertension etc was experienced by the late 1980’s, early 1990’s.
During the 1980’s, the establishment of Health education provided for a permanent facility to develop adapt and produce local mass media health education material in the priority areas of health. These priority areas were, NCD’s – alcohol, smoking & nutrition, maternal child health, school health, HIV Aids and STD’s (now referred to as STI’s – Sexually Transmitted Infections). Campaign messaging included for MCH (Maternal Child Health) “I’m a lucky baby I’ve got the best”, HIV and AIDS focused pamphlets and posters were produced in both English and Maori, NCD’s focused television and radio advert were under the slogan “Are you overweight?”, translated “Kua matu koe?.
Mrs. Frances Topa-Fariu became the first locally qualified Health Educator in 1988 after achieving a Graduate Diploma in Health Education from Victoria University in Melbourne, Australia. Mr. Repaio Taia, in 1997 became the first Cook Islander to graduate with a Bachelor’s Degree in Environmental Health at the University of West Sydney, Hawkesbury, Australia. Many other Cook Islanders have become people of influence in ensuring that the Health of the general public was monitored and supported since 1965.