In late June – July Sharon had the privilege of following up our talanoa earlier this year. She met with and interviewed twelve Fijian health leaders and workers, exploring how the health system responded to and recovered from the COVID-19 pandemic. These interviews with healthcare workers, administrators, and frontline responders across the archipelago – from remote maritime islands to urban hospitals – uncovered stories of remarkable resilience, alongside profound grief and ongoing trauma that continues to shape Fiji’s recovery.
The Hidden Cost of Crisis Leadership
The motivation for this research was the crisis faced by Fiji during 2021, when the health system was overwhelmed. This was confirmed through the stories shared in this round of interviews –the most poignant theme of these being the psychological toll on healthcare leaders and frontline workers. Multiple interviewees described a unique form of exhaustion that was not physical tiredness, but mental and emotional depletion from constantly making life-and-death decisions with incomplete information.
Senior health officials spoke of sleepless nights wondering, “Did we make the right decision?” and the weight of balancing competing priorities, including saving lives versus protecting livelihoods, and repatriating citizens versus preventing virus spread. This created what one leader described as feeling “pulled apart”. In these interviews we found a critical gap: despite the gravity of the work, little consideration was given to the mental health and support needs of those making strategic decisions.
Unresolved Grief and Ongoing Struggles
The trauma extends far beyond leadership and health statistics. Healthcare workers told stories of hospitals locked down with nurses trapped inside for days, sharing facilities with COVID-positive patients, inadequate PPE, long working hours, stigmatisation, and family separation.
Four years later, the trauma of those months in 2021 persists. The grief is palpable in conversations with those who lived and worked through Fiji’s darkest pandemic period, when daily death tolls dominated headlines and communities struggled to maintain traditions including funeral rites. Many health workers left Fiji for better opportunities abroad, creating workforce shortages that persist today.
Innovation Born from Crisis
From this crisis emerged innovative responses. Healthcare workers developed local solutions when guidance proved inadequate or delayed. Laboratory staff worked around the clock to process thousands of tests, while rural health workers used community networks to deliver medications and monitor patients when formal transport systems broke down.
The “boots on the ground” approach, which included health workers walking through communities, taking temperatures, and providing direct care, proved more effective than many high-tech solutions. This personal touch helped counter social media misinformation and built trust, although it often came it came at enormous personal cost to those delivering care whilst managing their own trauma and loss.
The pandemic also accelerated improvements in Fiji’s health system infrastructure, including the establishment of molecular laboratories and expanded testing capabilities that previously required sending samples overseas.
The Power of Traditional Networks
One of the support mechanisms that became very important to health leaders was Fiji’s traditional governance structures. Rather than seeing customary systems as obstacles to modern public health measures, Fiji’s leadership recognised them as vital assets. This allowed health officials to reach communities through trusted, respected voices rather than relying solely on government messaging. Village chiefs became an important strand in COVID-19 communication, whilst in urban and semi-urban areas, religious leaders – ministers, pastors, and priests – stepped into similar roles as trusted community voices. When official channels were overwhelmed and misinformation spread rapidly, these traditional networks provided the trust and reach that government messaging alone could not achieve.
Looking Forward
The research continues, but already it’s clear that these insights from a Fiji remind us that the most sophisticated pandemic plans mean little without the trust of communities, the wisdom of local leaders, and the dedication of healthcare workers willing to serve under the most challenging circumstances. Perhaps most importantly, the interviews revealed that resilience isn’t just about having resources – it’s about how communities adapt, innovate, and support each other during crises.
Exploring Fijian Health System Resilience 