Comparing apples to oranges: LBJ Nursing situation

Dear Editor,

LBJ’s CEO Mr. Emmsley recently quoted, upon the first release of LBJ’s Taulasea newsletter on 11/26/2022, that “A House Divided Against Itself Cannot Stand” – by the Great Abraham Lincoln. He couldn’t have been more correct, in theory. In practice, and less than a week later on 12/2/2022, he unfortunately contradicted his own quote, by degrading the Bachelor of Nursing program at the National University of Samoa (NUS) in Upolu without presenting any evidence of the curriculum that was reviewed by ASCC’s Program Director/Administrator; if said reviewer was qualified to undertake curriculum reviews comparing a 2+ year college (ASCC) against a 4+ year university (NUS) system, or whether it was a complete curriculum from NUS at all that was reviewed.

Comparing a 2-years junior college curriculum (with one BA non-medical program), against a 3-6 years university medical curriculum is akin to comparing apples to oranges. It’s not a common sense approach, and by all accounts the 3-4 years nursing program at NUS is a well-funded program compared to ASCC’s 2-years program; meaning NUS’ nursing program is not struggling to fill their seats with indigenous Samoans, instead they’re struggling to keep their talent locally. LBJ’s CEO Mr. Emmsley stated, on 12/8/2022, that he stood by the “statement of facts” given on 12/2/2022, but there were no facts (no citations or sources) referenced for the people of American Samoa to research for the people’s confirmation. If facts are cited, please give the website address or URL from where the curriculum was queried for Samoa, Fiji and the Philippines. American Samoans are truly smart enough to compare apples to apples, instead of comparing oranges to apples.

Nurses from independent Samoa are currently working at LBJ, and as the President of the Samoa Nurses Association pointed out, some of the current nurses on staff at LBJ also completed their training at NUS. Even before LBJ’s CEO Mr. Emmsley called out this nursing issue, nurses schooled and trained in Upolu (beginning at Papauta in 1917) have been faithfully working at LBJ for decades, going back to the three founding Nurses of LBJ – whom were from Manu’a. Back in the early 1900s, it was common for future theologians, including Manua’s very own King Tui’Manu’a Elisara, to undergo academic training in Upolu at Malua. However, their wives were then schooled in nursing practices at Papauta. That was the founding curriculum of nursing anywhere in Samoa. Upon their return to Manu’a, some of them came over to be some of the very first nurses and founding members of nursing cohorts at LBJ. Knowing our history will allow us to avoid repeating the costly mistakes of a divided house. It does cost millions of dollars, not including the years and the lives wasted, to repeat the same mistakes over and over.

LBJ’s CEO Mr. Emmsley stated that the “nursing curriculum for Samoa was not comparable to US standards which would present a challenge for nurses from there to get US certification,” was divisive. Is the curriculum from the Philippines, Fiji or any other nation comparable to US standards? Absolutely not. The closest the top universities in the Philippines rank is within the top 300-400th, then 8000-1,500th placement; it’s a big drop-off. To be fair, rankings are based of many factors including student body size, funding and other factors that are not entirely clear. None of their curricula are comparable to US Standards, and that’s why ALL nurses, from any country not part of the continental US, are required to go through US certification (NCLEX); even nurses educated at ASCC need to pass NCLEX. To be certified.

The existing LBJ setup is to bring in nurses from Fiji and the Philippines etc., either by contract through a 3rd party contractor or individually, then they work under a NCLEX licensed LBJ nurse, while physically attending classes at ASCC for up to 6-months in order to prepare for the NCLEX US certification test offered twice a year. For payment, they also have to clear PTAN because of “federal dollars / public money”, via direct grants to LBJ (a CMS certified facility) or receive pass-through funds through our local government, that are being used to pay the nurses and services at LBJ. When federal dollars / public money are dispensed for any project or program, federal requirements have to be met. The point of all this, why then are “American Samoans” with Bachelor of Nursing degrees from American Samoa, or any other jurisdiction, are being denied a job at LBJ due to being educated at NUS?

For example my niece, who is an American Samoan, with a Bachelor of Nursing from NUS along with over 2-years of hands-on RN experience, and is legally able to work in the US with her social security number, has been overlooked multiple times while LBJ continue to hire dozens of non-social security owning nurses from other foreign jurisdictions. While LBJ’s imported nurses are being paid to attend classes in preparation for the NCLEX, and continue to work at LBJ, American Samoans with Bachelor of Nursing degrees from NUS are being denied this same equal treatment, despite being U.S Nationals.

I’m not attacking any nurses at LBJ (from Fiji, the Philippines, Tonga or otherwise), I’m attacking the principle, that an American Samoan whom was educated at NUS, or another university outside American academic jurisdiction, is denied a nursing job merely because of the perception, instead of the facts at hand, the lessons learned and best practices of our Samoas working together – a house united. American Samoans’ children are born internationally, for many reasons, to include being stationed in Samoa for theological duties and other countries globally for military duties as well. I humbly call upon Mr. Emmsley to give preference to hiring American Samoans, with a Bachelor of Nursing from NUS, given the severe lack of Samoan nurses at LBJ. It is a preference that is also protected by the Native American Act for indigenous Americans. American Indians (tribal nations of America), and Pacific Islanders (Polynesians, Melanesians and Micronesians) are the only recognized indigenous people of the United States of America.

Solutions and the Case for American Samoan High Schoolers:
On 10/14/2022, LBJ posted a notice for, “Medical School Scholarship Announcement”, for applicants to be schooled in Fiji under the Bachelor of Medicine / Bachelor of Surgery degree (probably at USP in Suva), paid in FULL by LBJ and the Governor’s Initiative. What a FANTASTIC opportunity!!! The biggest hurdle is that the “minimum” education requirement is a Bachelor degree. Education in both Fiji, and independent Samoa, are based on the British system and both are comparable to each other. Meaning, all high school graduates in Fiji and independent Samoa, go straight from high school to this Bachelor of Medicine/Surgery program in both countries. Fiji’s program is the oldest and the most respected medical program in all of Polynesia (excluding Aotearoa and Australia) with many Samoan medical students completing their training there in Fiji, since many decades ago. However, independent Samoa also has the same Bachelor of Medicine/Surgery program now. It’s been around for over a decade, albeit at a more affordable cost due to several factors, including the ability of Samoan medical students to stay with families, near NUS in Apia, as opposed to renting in Suva.

Offer this “Medical School Scholarship” to the top 20% of high school graduates from each of our public high schools in American Samoa. Offer it not as a percentage of the entire graduating high schoolers of American Samoa, but as a percentage of each individual high school. This will allow LBJ, and the Governor’s Initiative, innovation in creating and maintaining a pipeline of nurses and doctors to each regional area of American Samoa (i.e. Fagaitua, Leone and Manu’a).

For further innovation, expand the program to include FULL scholarships for the Bachelor of Nursing in both independent Samoa and Fiji. Your team can secure it further by requiring applicants to complete their first 2yrs at our local ASCC, then the final 2-4 years at either NUS or USP in Suva. This will revitalize our local high schoolers, our ASCC medical students, staff, educators, parents and the local economy. I’m advocating for public high schools specifically, because our public high schools have been gutted so much that they need rejuvenation. Students who enter the program can be required to commit to a requisite number of years (pro bono) in lieu of the FULL scholarship years. As evidenced by the number of ASG workers, and other sectors on island, our public high school graduates represent the highest percentage of workers for American Samoa. Those public high schoolers deserve that investment in their future. If our young people are truly the future of American Samoa, than please make this investment in their education. Even if it’s a small sample size to begin with, at least you’ve lit the flames of HOPE. Hope that American Samoa is blazing a path, and empowering our youth with more academic tools to help resolve our local issues well into the future.

Discussion on blowback, hot topics, and open issues:
1. Preferences for American Samoans. It absolutely needs to be part of LBJ’s hiring practice, every public sector or at the least any sector that involves federal dollars/public money. Why do some ask? Because American Samoans are a federally recognized indigenous population, with cultural practices protected by federal laws including the Native American Act. It was our indigenous Samoan ancestors (from both Samoa) who bled on those battlefields, during the colonial era in the south Pacific. American Samoans were under the yoke of military martial law for over 50yrs (the longest in American history). It was our ancestors, whose foresight and words of wisdom, negotiated the terms of our treaty with the US, and then guided our decades long transition from military rule to having our very own American Samoan-blood elected by our American Samoan people.

Our ancestors worked tirelessly for decades to give us this greatest of situations, to govern ourselves as a sovereign territory recognized by our US government and Congress. We did that, our indigenous Samoan ancestors did that. Therefore, it is the GOD GIVEN right of our American Samoan children to be FIRST in line, preferred over everyone else, for those jobs in American Samoa. That is a preference we do not get anywhere else in this world! No other country or nation, anywhere in the Pacific or the world, will reciprocate or give American Samoans that same reciprocity treatment. It will not be racist, nor will it be prejudice. It is the American way, and a right, as set forth in federal, state and local hiring and contractual practices. Preferences are standard for minority companies, veterans and veteran owned businesses, women owned business, tribal affiliations etc. It is our GOD GIVEN right as American Samoans, and it is protected by federal law including the Native American Act.

2. Hiring from Samoa, Fiji, and Tonga have been decades long practices in American Samoa. Our ties with those nations run deep, thousands of years deep to the origins of our ancestors. Talent comes from all over the world though, but costs also increase as you widen the geographic recruiting area. Cost in terms of national security, of safety, logistics, medical, environmental and economic among many other direct and indirect costs. Locals spend money locally, period. However, just as Samoans work overseas and send money back to Samoa, so too do foreign workers in Samoa. It’s human nature to support families, no matter where one works. Your American Samoans cannot compete against foreign labor without government intervention, hiring preferences, and safeguards for our indigenous Samoan people in place. Most of our foreign workers come from well-funded, complex societies with sectors that are more developed than our own, and populations in the hundreds of millions of people.

American Samoa belongs to the Pacific Island group of people (Melanesians, Polynesians, Micronesians), and all the population of our islanders combined does not even come close to competing with the populous nations itching to get a piece of the pie in American Samoa. The numbers don’t lie, American Samoans spending locally (i.e. church contributions, fa’alave’laves, goods and services etc.) help stabilize and rebuild our local economies. The cost savings are passed onto our American Samoan students, parents, extra money for off island medical visits and so much more. It puts money back into the pockets of American Samoans. It’s a common sense approach, and it’s also data driven.

The Great Abraham Lincoln gave us many lessons and best practices to ponder. Including, “to sin by silence when they should protest makes cowards of men.” Therefore, I did not want to be a coward due to my silence, especially not during the holiday season while my fellow indigenous Samoans can’t get hired as nurses on their own island. I’ll end with this quote, “I am not bound to win, but I am bound to be true.” It is our collective effort, directly or indirectly, that will help us maintain our American Samoan sovereignty. This humble protest to LBJ’s CEO Mr. Emmsley, with proposed solutions, trade-offs within, is my effort to better our American Samoa. I do not wish to be a hero, nor do I want to be a villain, but if I am deemed either because of this note, then so be it, for the tree of liberty is watered by both.

Semper Fi,

Ioane – a proud American Samoan