Laboratory
We have one clinical laboratory in the Cook Islands based at Rarotonga Hospital. Our laboratory has not been accredited yet but we are working towards this.
Core laboratory services include:
- Haematology
- Clinical biochemistry
- Microbiology
- Blood bank services (immune-haematology)
- Specimen collection and phlebotomy (blood) services
There are two specific tests for SARS-CoV-2, the virus that causes COVID-19:
- Nucleic acid testing (commonly known as PCR tests)
- Serology
The PCR test is the main method for testing in the Cook Islands and worldwide, as it indicates if someone is currently infected with the virus. The second type of test, serology, is a useful indicator of past infection and surveillance. It indicates if someone was infected with the virus in the last 10-14 days.
The PCR test is the method of choice for the detection of SARS-CoV-2 as it will identify if the virus is current present in the body. We do not have the full infrastructure required to conduct PCR tests in country.
We have two methods for testing:
- We send nasal and oral swabs collected to LabPlus in Auckland, New Zealand for analysis. It can take approximately one week for test results to return to the Cook Islands. It is also a costly process as each swab costs over $100.
- We use our cartridges on the GeneXpert machine to conduct testing in-country. It can take approximately 24 hours to analyse the test results. While this process is more cost-effective, we have limited cartridges and an older machine that can only conduct 2-4 tests per cycle.
As at 18 June 2020, over 1930 COVID-19 swabs have been taken and sent to New Zealand for analysis. This accounts for 15% of the population on Rarotonga. No test results have returned positive at this stage. Furthermore, 19 in-country COVID-19 tests have been conducted using our existing GeneXpert machine.
We have submitted proposals to obtain a PCR laboratory in country which will be more cost-effective and enable us to conduct up to 1000 tests per day. As part of this work, we are working towards accreditation for our laboratory that involves investing in quality infrastructure and upskilling our workforce.
Pharmacy
Te Marae Ora provide pharmacy services on Rarotonga at the hospital and Tupapa Clinic, as well as on Aitutaki. Additionally pharmacy services are delivered through nurses on Rarotonga and the Pa Enua. Other pharmacy services are provided through community pharmacies on Rarotonga.
Regulation and registration
The Pharmacy Board is responsible for the registration and licensing of pharmacy assistants, technicians and pharmacists, including the establishment and regulation of pharmacies. The Board is enacted through the Ministry of Health (Pharmacy and Therapeutic Products) Regulations 2013. Membership of the Board includes:
- Head of Ministry (Chairperson)
- Chief Pharmacist
- Registrar
- Medical Practitioner nominated by the Cook Islands Medical Association
- Representative of the private pharmacy profession appointed by the Minister
- Representative of the community appointed by the Minister
Accessing medicine during COVID-19
There is still no vaccine or antiviral treatment available for COVID-19, however patients should still be able to receive the medicines they need. While it is important to get medical help if you need it, we are currently limiting face to face contact.
Paperless prescription process
- Patient calls the Healthline for a medical consultation
- The doctor writes a prescription onto the health information system and this will show up on the pharmacy system
- The pharmacy receives the information and dispenses the medicine
- If the patient is at the clinic, the medicine is provided to them there along with advice on how to take their medicine properly
- If the patient is not at the clinic, the medicine is delivered to their Puna and they may collect it from their Puna office or have it dropped off at their home by a nurse
Radiology
Radiology is an important service that assists clinicians in their ability to diagnose and manage conditions, as well as to make appropriate referrals overseas.
Services include:
- General radiography services – x-rays
- Ultrasound services – includes general abdominal scans, musculoskeletal, echocardiogram
- Special x-ray examinations
Te Marae Ora is working to secure a CT scan in country to improve diagnostic capability in country, and inform clinical management and appropriate referrals overseas.
Rehabilitative services
We currently offer physiotherapy services for the treatment of injuries, and to assist patients post-surgery or who have had a stroke. Physiotherapy services assist with pain management, improving joint mobility and movement, and strength and coordination.
Biomedical
Biomedical services relate to the servicing and repairs of medical equipment. Our biomedical technicians are responsible for overseeing equipment, and ensuring it is safe to use and health professionals use this equipment correctly.
Patient Referrals
The Patient Referrals Policy applies to resident Cook Islanders and permanent residents who have been assessed by Te Marae Ora clinicians for medical transfer. All patient referrals from Te Marae Ora must be approved by the Secretary of Health and the Patient Referrals Committee.
Domestic referrals
All referrals from the Pa Enua are sent to Rarotonga for care. Most conditions requiring urgent medical transfer include complicated pregnancies, accidents and emergencies. All resident Cook Islanders and permanent residents will be eligible to receive a medical transfer.
International referrals
All urgent medical transfer from Rarotonga are sent to New Zealand. However, the process to refer a patient to New Zealand requires clinicians from Rarotonga contacting clinicians in New Zealand. A patient can only be referred internationally if there is a hospital or specialist to receive the patient.
Health Specialist Visits
The Health Specialist Visits (HSV) programme enables Cook Islanders and residents to access quality specialist services and for Cook Islands based health professionals to build their capability. The HSV programme is funded by the New Zealand Government and started in 1994. This programme has helped Te Marae Ora fill critical gaps in service delivery, and build the capability of our workforce.
A range of services are offered under the HSV programme including:
- Specialist oral health services
- Laparoscopy
- Psychiatry
- Diabetes management
- Dermatology
- Ophthalmology
- Ears, nose, throat (ENT)
- Radiology
- Audiology
- Cardiology
- Neurology
- Paediatrics
- Obstetrics and gynaecology
- Urology
- Orthopaedics
- Breast cancer screening
- Rehabilitative services (such as speech language therapy)
The HSV programme occurs every year and the calendar for the year is organised six months in advance pending the availability of visiting specialist teams.
Anyone wishing to access visiting specialists’ services must be screened by a clinician at Te Marae Ora. You will be referred to the specialist team based on severity of your condition. Most HSV services are for complex health problems which cannot be provided for in the current health system.
