When New Zealand orthopaedic surgeon Dr John van Dalen first came to Tonga in 2018, he paid his own way and planned to have a look around. He ended up operating for the whole visit.
Lord Tangi, a senior Tongan surgeon, told the story at this week's opening of the renovated sterilisation department at Vaiola Hospital. A visiting surgeon from Hamilton who worked regularly in Tonga had mentioned that his brother, an orthopaedic surgeon, wanted to visit.
"I said, 'Oh, bring him the next time you come.' So they came," Lord Tangi said. "John paid his own way on that first visit, and it was supposed to be just sightseeing and looking at the place. We actually had a lot of cases here for him to do. We arranged his registration immediately, and he operated the whole time."
Children no longer sent overseas
Dr van Dalen found sponsorship and kept coming back. One of the first gaps he filled was treatment for slipped upper femoral epiphysis, a condition in children where the top of the thigh bone slips out of place. Tongan children with it had been sent to the Shriners Children's hospital in Hawaii for surgery.
"John is familiar with this procedure, so he ended up doing the whole waiting list for this condition," Lord Tangi said. "For a number of years now, we haven't sent any more patients to Shriners. John is doing all the cases."
Tears in the clinic
The next problem was arthritis. At his clinics in Tonga, Dr van Dalen kept seeing patients whose lives had been taken over by hip and knee pain.
"I was doing clinics here and having to deal with patients who had arthritic pain and were crippled, and we could say, 'Look, we can change your lives by giving you a knee or hip replacement,'" he said. "At the end of the consultation, they were in tears, because we couldn't say we can do this operation here. If we took them to New Zealand or Australia, the cost would be prohibitive."
"That was really the impetus to say: we've got these theatres here, but we need to take them up to another level to be able to offer joint replacement surgery."
Step by step
With the backing of Lord Tangi and Rotary, the project moved forward in stages. First came a trauma table, then new trauma equipment, then telemedicine support during the Covid lockdowns. After that came the upgrade of the operating theatres, finished in May 2025, and now the renovation of the sterilisation department.
Dr van Dalen remembers the Zoom call with Indian contractors that made the theatre upgrade affordable. They offered the work for around 20 to 25 percent of what New Zealand or Australian companies would have charged. "After that meeting," he said, "we said: let's go for it."
He credits the Church of Jesus Christ of Latter-day Saints for much of the funding, and the church's elders in Tonga for their personal support. "I can't speak highly enough of what they've actually done," he said. "Through that support I've been able to have amazing friendships with them, and it's been an incredible partnership. I could write a book about it."
Handing over to the next generation
Lord Tangi said the project was a good example of what Pacific health services need: safe, affordable procedures available when patients need them. He also said it would be his last project, and that his team was now "ready and capable" of carrying the work forward.
"It is all because a citizen was not happy just to continue doing that," Lord Tangi said of Dr van Dalen. "Even though he was very busy, he wanted to move to the next step."
A speaker for Tonga's Ministry of Health paid tribute to Dr van Dalen at the ceremony. "For many years you have worked alongside Vaiola Hospital as a colleague, mentor and friend," the speaker said. "Through your surgical expertise and your willingness to share knowledge with our local teams, you have left a lasting contribution that reaches far beyond the operating theatre."