Tonga recently marked a historic moment in its public health journey with the arrival of 10 brand-new dialysis machines, moving the country closer to opening its first-ever free dialysis clinic. While this development is commendable and brings much-needed hope to those suffering from kidney failure, it also highlights a long-standing issue: Tonga continues to address its health crises from the bottom of the cliff, rather than investing seriously in prevention.

The dialysis machines—valued at over AUD $2 million—were officially handed over in Nukuʻalofa last week. The equipment was secured through international partnerships by the Siaosi Brown Dialysis Board, based in Utah, USA, and supported by the Ministry of Health. Hon. Dr. Ana ‘Akauola, Minister of Health, expressed heartfelt gratitude at the handover, acknowledging the efforts of her predecessors and the donors.

“This work was started by ministers before me… and finally I come into the picture… we have the first dialysis machines in Tonga,” Dr ‘Akauola said in an interview with Radio Nukuʻalofa. “I’m in awe… and very grateful that there are people who are willing to donate their time, their efforts, and their money.”

Rodnia Emam, Chairman of the Siaosi Brown Dialysis Board, described the moment as emotional after an eight-year journey to bring the machines to Tonga. “It felt like a dream,” he said.

Two machines will serve acute cases at Vaiola Hospital, six are allocated for chronic dialysis patients, and the remaining two are being held for emergencies and future capacity. Training for local staff is underway, with full clinic operations expected to begin in July. The machines come with a generous package of supplies and ongoing technical support.

This critical step forward began with the groundbreaking ceremony for the Dialysis Centre in August 2023, led by His Royal Highness, Crown Prince Tupoutoʻa ʻUlukalala. The project was the vision of the late Queen Mother, Her Majesty Queen Halaevalu Mataʻaho, who personally requested Dr. Emam to support the development of dialysis services for the Tongan people. Subsequent visits to Utah by former Minister of Health Dr. Saia Piukala and Prime Minister Hon. Huʻakavameiliku helped to fast-track the partnership.

The establishment of the Veitongo Dialysis Centre is expected to reduce the burden on families who previously had to send loved ones overseas for expensive and long-term treatment. It will also repatriate some patients currently receiving care abroad, although this will happen gradually as local staff build capacity.

A Solution at the End of the Road

While the arrival of these machines is a major win, the core issue remains: Tonga is still reacting to a health crisis that could—and should—be mitigated through effective prevention policies.

Chronic kidney disease in Tonga is largely driven by poor diet, obesity, diabetes, and hypertension—all of which are preventable. Studies and medical records consistently point to high consumption of sugary drinks and cheap, fatty imports such as lamb flaps, turkey tails, and canned corned beef as contributing factors. Yet successive governments, including the current Ministry of Health, have hesitated to implement serious regulatory or fiscal measures to curb these risks.

It is alarming that the very diseases contributing to skyrocketing dialysis needs are being met with limited public health campaigns and no comprehensive tax policies on unhealthy foods. The Minister of Health, like her predecessors, has made statements on these matters—but talk is not enough. The window for effective prevention is closing fast.