Tongan eruption spurs research on kids’ PTSD

Dr Patelisio Na’a Patelisio own post-traumatic stress following the large eruption of Hunga Tonga-Hunga Ha’apai inspired his masters research on PTSD in Pacific children.

Two years later Patelisio is graduating on 7 May 2024 with a Masters degree from the School of Population Health at Waipapa Taumata Rau, University of Auckland and a fire in his belly to improve mental health support in the Pacific, especially for children, following natural disasters.

When Hunga Tonga-Hunga Ha’apai exploded massively, Dr Patelisio was running an outpatient clinic at Tonga’s Vaiola Hospital.

“The first explosion occurred and I assumed construction work was being done  in the hospital ,” he says.

“It was after the second, I realised. I saw, out in the parking lot, everyone was gathering there, looking up towards the area where the volcano had been erupting during the week.

“And once I got outside to the side where the volcanic eruption was happening. You can see the dark smoke coming up from there.

“The third explosion occurred and then I felt a shockwave. From the shockwave, we had to make sure that the patients in the outpatient clinic were sent home.”

Patelisio then went with his sister, who also was also working at the hospital, in disease surveillance, to join his family members and drive through the raining volcanic ash to the airport, where they spent the night.

In the following weeks, Patelisio and his colleagues working in the health promotion unit for the Ministry of Health formed a public health team to assist people who most needed help, especially those who had been forced to leave their homes, often on smaller islands, and live in halls on Tongatapu.

“Most of the help they requested related to mental health. They wanted talks about stress, anxiety and coping strategies.

While there had historically been stigma around mental health, that changed during the Covid-19 pandemic and people were open to support, Patelisio says.

Patelisio wanted to have a good evidence base for the advice he was giving, which is when he discovered a paucity of evidence relating to the Pacific.

“The research was mostly done in developed countries, places where they have enough resources to conduct the work. It wasn’t contextualised to places that have low resources where they just make use of whatever they have.”

While he was thinking this over and giving talks, a few weeks after the eruption, the rain came and with it came thunderstorms.

“I was feeling like it was traumatic, it was like PTSD. I was thinking back to the eruptions, and people were posting on Facebook about how they were feeling. It made me think, ‘as an adult, if I’m feeling this way, imagine what the kids are feeling. Would they be able to voice their concern to their parents of their friends?

“We’re adults, we’ve experienced a lot of things and we know how to cope. But the kids have just started life and their coping hasn’t really been developed well. That was the main reason I focused on PTSD in children in my thesis.

“That rainy night triggered me to think, if this is me, imagine the younger ones."

So, at the University of Auckland, Patelisio set out to do a systematic review of existing scientific literature on PTSD in children in the Asia-Pacific region.

His early degrees in surgery and family medicine were undertaken at Fiji National University. Coming from the village of Kolonga, there were no role models for doctors, but Patelisio wanted to set the bar high for his four younger siblings.

His parents and family sacrificed to pay for his university undergraduate education, Patelisio says.

What he found doing his masters research was a lack of Pacific research, with
studies about PTSD following natural disasters mainly taking place in Asia.

The incidence of PTSD in children was between 1.9 and 69.9 percent, depending on factors such as the severity of the natural disaster, type of assessment and time elapsed, but also raising questions about the burden of undiagnosed PTSD.

Risk factors included being female, older children and witnessing the death of a friend or family member or being injured themselves.

The protective factors, which could be contextualised for the Pacific, include social support and coping strategies.

“The recommendations I made start with conducting research in each Pacific island country to assess the current state of PTSD in their children.”

Public health efforts have been focused on non-communicable diseases in the Pacific, but mental health is a good addition, he says.

Other recommendations included educating clinicians on the common symptoms they should look for, because, if PTSD is not treated early in children, they will have issues in the future.

Another recommendation was for a Pacific representative on the Asia-Pacific Disaster Mental Health Network, which didn’t have one. However, Patelisio has now been appointed to the network, so can tick that one off.

When he was in Auckland writing his dissertation, Patelisio picked up some teaching work, then found he still had time to tutor Pacific students, winning a Residential Excellence Award for Service in halls in the process.

“I felt like I needed something to keep me on my toes. It would also help me
relax. I didn’t have to look at my thesis. I would turn to the work for comfort.”

Patelisio is back in Tonga working as a doctor and in health promotion, but he has his sights on a doctorate at the University of Auckland in a few years’ time.