Hip and knee replacement surgery begins at Vaiola Hospital in Nuku'alofa on Monday. It follows the official opening of the hospital's renovated central sterile supply department (CSSD), the last piece needed to make these operations possible in Tonga.
The CSSD is where surgical instruments are cleaned, disinfected and sterilised between operations. Its renovation follows the upgrade of Vaiola's operating theatres to near international standards in May 2025. Together, these two projects mean Tongan patients no longer need to travel overseas for joint replacements.
A volunteer surgical team from New Zealand, led by orthopaedic surgeon Dr John van Dalen, will spend the week performing ten to twelve joint replacements. Seven patients are having knee replacements and three are having hip replacements. The team members are not paid, and patients will receive their surgery free of charge.
Closing the last link in the chain
Speaking at the opening ceremony, Dr van Dalen explained why the sterilisation department mattered so much.
"Any operation that we do as surgeons, the concern that we have is infection, and more so with the high-tech surgery that we're doing now: joint replacement surgery, but also trauma, putting in hardware, screws, plates, rods," he said. "If you get an infection, I tell you, it's a sorry state."
"There's this chain that we had to close, and that was the CSSD. Not many surgeons, or even nurses, go into that area. It's not an area that you think is important, but it's actually a very important part of the whole chain."
The representative of the Church of Jesus Christ of Latter-day Saints, which funded much of both upgrades, said the project was ultimately about people rather than facilities.
"This project is not about a room. It's not about a piece of equipment. It is about family," he said. "It is about a patient who needs surgery. It is about a mother or a father who's waiting for a loved one to receive his or her treatment. It is about a family who have greater confidence that their loved one is receiving safe and appropriate care."
He noted that some patients had been waiting for months for the work to be finished, and said the new facilities would allow them to "receive specialised care closer to home and surrounded by their families and communities."
Care at home instead of overseas
Until now, Tongans with severe arthritis in their hips or knees had to travel to New Zealand or Australia for a joint replacement. For most families, that was impossible.
"Doing the surgery here in Tonga will make a big difference," Dr van Dalen said. "We believe it will change people's lives, enhance families, and also allow people to be independent."
Senior Tongan surgeon Lord Tangi, who has supported the project from the beginning, said it was about access to care. "All these patients who have painful hips and knees now have access, and they will have the procedures here in Tonga, free," he said. "John and his team are here, sitting next to these nurses and physios, and they are not getting paid for this."
A partnership across countries and churches
The project has been led by Rotary New Zealand through the Rotary Club of Whanganui North, working with the Rotary Club of Nuku'alofa, Tonga's Ministry of Health and the staff of Vaiola Hospital. The Church of Jesus Christ of Latter-day Saints and the Plymouth Brethren Christian Church have provided major funding.
By working with contractors from India, the team was able to upgrade the theatres for around 20 to 25 percent of the cost quoted by New Zealand and Australian companies. The stainless steel benches came from Quantum Surgicals in India, and the washer-disinfector for the CSSD came from Finland.
The surgical team and what happens next
Alongside Dr van Dalen, the team includes anaesthetist Dr Geoff Spenser, registered nurses Lynette Sweetman and Lydia Sargent, and logistics coordinator Steve Flaunty. Local physiotherapists will guide patients through rehabilitation. After the New Zealand team leaves at the end of the week, Tongan orthopaedic surgeon Dr Tevita Tu'ungafasi, who trained at Whanganui Hospital, will take over the patients' care. Dr van Dalen will review each patient at a virtual clinic about a month later.
The team is also training local surgeons on new trauma equipment from India. With it, surgeons in Tonga can fix fractures of the thigh and shin bones with internal rods, treat open fractures with external fixators, and treat wrist fractures with state-of-the-art equipment.
This visit is a pilot. "Next week we're looking at doing ten joint replacements, and the hope is that in the future we'll be able to continue that on an annual basis," Dr van Dalen said. Depending on funding, the team hopes to return next year, possibly twice.
The project relies on donations to fund future visits, implants and equipment. Details for New Zealand and international donations are on this website.
