1. Could you begin by introducing Aspen Medical's role in Fiji's healthcare sector? Through your partnership to operate and upgrade hospital services, how does Aspen Medical contribute to the health of Fijians and the country's development?
Aspen Medical is our brand and trading name here in Fiji. We are a global medical company headquartered in Canberra, Australia, and we operate across 10 countries.
In Fiji, the story goes back one step further, to the public-private partnership with the Government of Fiji. Our registered business is Health Care (Fiji) Pte Ltd, which has two shareholders: the Fiji National Provident Fund (FNPF), which holds 80%, and Aspen Medical Pty Ltd, the 20% minority shareholder, whose trading name is Aspen Medical. We have operated across the Pacific, in Solomon Islands, Vanuatu, Timor-Leste, Papua New Guinea and Nauru, and that brand awareness, that trust and connection within the region, is why Health Care (Fiji) Pte Ltd trades as Aspen Medical.
Under the PPP we manage two government-owned hospitals under a 23-year concession agreement. Fiji is organized into four administrative divisions. In the Western Division, the divisional hospital at Lautoka is the second-largest hospital in the country after Colonial War Memorial (CWM) Hospital in Suva, and it supports five sub-divisional hospitals. Lautoka has 305 beds, and Ba Sub-divisional Hospital, about 30 kilometers away, has 70 beds.
Lautoka is a much larger undertaking in infrastructure, modernization and development, because the existing hospital is over 50 years old. Ba is a much newer build: it was built and lay dormant for several years until April 2022, when Aspen Medical was entrusted by the Government of Fiji to operationalize what was a shell of a hospital. It was a very busy 12 months to staff it, equip it and get it ready to see patients in the Ba catchment.
Ba is one of the highlights we have achieved and sustained, and that comes down to the workforce. Our people are our greatest asset. In Fiji, Aspen Medical has a workforce of just under 1,500 staff, and only 10 are expatriates, all in strategic roles. All have a clear mission: to raise our capability within the health system, supporting the government's and the Ministry of Health and Medical Services Strategic Plan 2026 – 2031, which is renewed every five years.
Ba became the first sub-divisional hospital in Fiji ever to have a CT scanner installed. Ba is quite isolated, and the drive back to Suva, Nadi or Lautoka for diagnostics of that level can be very lengthy. To continue the Ba journey, Ba Hospital became the first hospital in the Pacific to achieve Joint Commission International accreditation, the internationally recognized gold standard for patient safety and quality of care. It took the team two and a half years, and we are extremely proud of the achievement and what it means for Fiji.
Now the work really begins, because we have to maintain it. There is a renewal cycle every three years and a touch point with the JCI team from the US every six months; we had our second touch point just last week. That model is about continuous improvement, something we are very aligned with.
Lautoka is a tertiary-level facility. Five smaller hospitals refer their more complex patients to us, we support the other two divisional hospitals, and in some instances our neighboring brothers and sisters across the Pacific. In October 2022, Lautoka Hospital, in partnership with MIOT International, established the first permanent, ongoing open-heart surgery program in the Fijian public health system. I'm especially pleased to report that we have just ticked over our 500th open-heart surgery this month. With the addition of our cardiac catheterization laboratory, we will reach 2,500 cardiac patients in March next year. That means far fewer Fijians need to travel abroad for that level of care; it is much closer to home.
Lautoka is now our major focus: infrastructure modernization and upgrades, a combination of old and new. Some infrastructure is very well built and needs modernizing; some must be taken down and replaced. That program will proceed in step with the Government of Fiji. We are working very productively with the Government of Fiji on the systems, processes and equipment that will bolster the health system across the whole country, not just two hospitals.
2. Aspen Medical's work in Fiji centers on a landmark public-private partnership to manage and modernize hospitals, including Lautoka and Ba. What does this partnership involve, and what has it set out to achieve?
It involves several things. First, the workforce: we are only as strong as our people. By investing in our workforce and upgrading their skills, they can share those lessons with colleagues across the Ministry and raise healthcare capability not just at Lautoka and Ba but across the wider health community in Fiji.
Second, infrastructure: raising what Lautoka Hospital will be able to do, with new systems, processes and services updated to today's practice rather than that of ten years ago.
Third, longevity and sustainability. One of the largest contributors to Fiji's economy is tourism, and tourists want to feel safe when they visit. But importantly, my mission is to make sure that Fijians get access, first and foremost, to the healthcare they should have today. A stronger health system for Fijians also gives visitors confidence, which is a win-win for Fiji.
3. Public-private partnerships in healthcare are still relatively new in the Pacific. Why is this model well suited to Fiji's needs, and how does it help strengthen the healthcare system for patients and communities?
It is very new, absolutely, and we have a lot of interest from our Pacific neighbors, who are watching how this PPP progresses. Several countries have followed up to ask how it started, where our challenges are and what we have learned over the last four years; we are now in our fifth with many more to come.
We work hand in glove with government to identify needs from the trends we see at the hospitals, such as patient presentations and caseloads, and act ahead of time. This is a 23-year PPP with an option to extend for another 20 years, so we are not just looking at the next two or three years; it is a couple of decades, if not more. The infrastructure and systems we are building is to last many decades.
We need to plan for population growth. We have a huge problem with non-communicable diseases (NCDs), not only in Fiji but across the Pacific, so education about what is preventable starts with our kids. And there is a growing focus on pre-hospital care: why wait until we are in the hospital? The PPP is a very broad instrument for working with government to raise capability, support health infrastructure and deliver its vision for the people of Fiji.
4. Upgrading hospitals and raising standards of care is a significant undertaking. What are the biggest opportunities and challenges in improving infrastructure, services and patient outcomes across the facilities you operate?
That's a really good question, and the challenge is not unique to Fiji. If we have to build a new maternity wing, we can't just tell everybody in the old one to come back in a year's time. So the planning that goes into our infrastructure upgrades is key, working with government and, most importantly, with the community about what is about to happen on site. There will be traffic disruption, equipment coming in and staff moving around, but what everybody cares about is: what happens to me while I'm being treated at the hospital?
The challenge is to plan a model we can roll out over time: fast enough that we're not disrupting our community, but not so fast that we fall over, while ensuring that our key services are never switched off. We work with a number of partners to make sure that plan is robust and has redundancy throughout.
We have done this before. When we installed our new Cath Lab and upgraded our cardiothoracic operating room and the intensive care unit, we couldn't stop hospital operations. We moved treatment spaces and kept supporting the community while introducing a new service; we will simply be doing it on a much larger scale.
The ultimate goal is Joint Commission International accreditation for Lautoka as well. When we've gone through this journey, Fiji will be the custodian of two internationally accredited hospitals.
5. Access to quality care can be a challenge in an island nation, with patients sometimes traveling abroad for treatment. How is Aspen Medical working to bring more advanced care closer to home for Fijians?
The example I always fall back on is our cardiothoracic program. Fijian public patients used to have to find the funds themselves, or explore employer and insurance policies, and go to private providers or travel abroad to get a stent. Now a Fijian can go through the referral pathway at Lautoka Hospital, get their stenting procedure, recover, and never leave our shores.
Many Fijians don't have passports, so the challenge is not only the health piece but the documentation needed to travel abroad. In many of the areas covered by our cardiothoracic program, they no longer have to do that, and we have started to roll out vascular services to complement that program too.
In kind, our Pacific brothers and sisters in neighboring nations, who may have had to travel further abroad, may, in time and in line with Government policy, be able to access that service in Fiji. But first and foremost, it is about raising capability for Fijians, and then, as an add-on, for our neighbors.
6. Attracting, training and retaining skilled medical professionals is critical everywhere. How does Aspen Medical invest in the local healthcare workforce, its doctors, nurses and specialists, and help build local capacity?
The workforce drain on particular skill sets is very evident globally, and in healthcare we see it every single day. Going back to my original point, our people are our greatest asset, so we invest in them: training, equipment, time, energy and funds. Sometimes we send leaders offshore to pick up a skill set they bring back and teach to the existing workforce; sometimes we bring the education to Fiji and teach on site.
Retention is a challenge in health everywhere. What we strive to do is build an environment that staff don't want to leave: a safe workplace with a real investment in its people, where they keep learning and growing as we do. When people can see a pathway for promotion and education, and have the tools to do their jobs well, they want to stay. At Lautoka and Ba, we are building a workplace where people feel they contribute, feel valued and don't want to leave.
I can't thank our staff enough. They are pioneers, and they champion exactly what we want to do for the people of Fiji. They can go home and tell their families: we've just rolled out a new piece of life-saving equipment, so people no longer have to go abroad; or I'm doing a course next week that will take my skill set to the next level. It takes time, money and effort from both the employer and the individual.
It is a journey we are all on together, and we are blessed with a wonderful, committed workforce. The smiles and the Bula spirit you mentioned when we first met, we have that in the hospitals. When someone smiles and welcomes you with a genuine “Bula,” you start to feel better. That's an energy we are going to continue to build on.
7. Technology is transforming healthcare worldwide, from diagnostics to digital health systems. How is Aspen Medical using technology and modern practices to improve the quality, efficiency and reach of care?
It is an extremely important part of what we are doing at both hospitals. Patients used to carry around a manila folder that was their medical record, and if you didn't bring it, you started again with all the investigations and diagnostics needed. I don't know anyone who carries their medical records around 24/7.
The hospitals are owned by the Government of Fiji. When we took on their management, we introduced an electronic medical records platform as an interim solution, and it has served us well. Twelve months ago, we began building a complete hospital information system: a large investment, but a necessary one, that will set us up for greater success well into the future.
The system is called Meditech, another global brand that is tried and tested in our region and beyond, and we are 12 months into a 19-month build. At the bedside, a doctor will have the patient's X-rays and blood work on file. Today those records are electronic but spread across three platforms; we are building a turnkey solution, one source of truth, that takes patient-centered care up to another level.
The Ministry of Health is also looking at upgrading its systems, and we are sharing the lessons from our rollout. Next year will be exciting, as we work towards go-live, another significant milestone.
8. Fiji has potential as a regional healthcare hub in the Pacific. What opportunities do you see in strengthening Fiji's healthcare capacity, and what role can partnerships and investment play in realizing that?
There are investment opportunities everywhere here, and you see it wherever you drive, up and down the Coral Coast, around Nadi or around Suva: there are infrastructure projects, things are happening. In healthcare, more private providers are now entering the market at various levels, from general practice to specialist hospitals under construction.
There is no single answer to where the opportunity lies; the pages would exceed eight to ten if I tried to list them all. My suggestion to investors looking at healthcare is to approach the Ministry of Health and have that conversation, and to talk to the private providers operating here. There is always something that is needed. The opportunities are there. The best first step for investors is a conversation with the Ministry about what is needed now. The Strategic Plan 2026 – 2031 the Ministry is rolling out over the next five years is comprehensive, and it gives partners a clear framework for where they can contribute.
9. International expertise and investment can accelerate healthcare development. What opportunities do you see for collaboration with partners from the US, particularly from the West Coast and California, a global leader in medicine and health innovation?
I can link this example back to our Joint Commission International accreditation. That should resonate with potential investors. If a small sub-divisional hospital in the islands of Fiji can achieve an internationally recognized gold standard accreditation, then imagine what investors, with a concerted effort and the support of government, could do on a larger scale.
For me, the next step is Lautoka Hospital and rolling out its infrastructure and service-delivery improvements. There are opportunities in that health precinct, and its future direction is for the Government of Fiji to set. Again, it would simply be a matter of having a conversation with the Ministry about its priorities.
What Aspen Medical is doing as part of this PPP to raise capability and the health profile is well progressed, but there are definitely opportunities, certainly on the West Coast, for people to explore. Equipment is one of them, but it needs to be equipment supported by education on how to maintain it. Donated equipment makes the greatest difference when it comes with training for the people who will operate it, and a plan for maintenance and consumables.
So the conversation is key, and so is understanding what the investor opportunity gap is. We are focusing on Lautoka right now, and when that is complete and we are ready for the next step, we would welcome the chance to share what comes next.
10. Looking ahead, what is your vision for Aspen Medical in Fiji over the next five to ten years? And finally, what message would you like to share with Los Angeles Times readers about healthcare in Fiji and the opportunities for collaboration, investment and partnership?
Within five years, our goal is for Lautoka Hospital to be internationally accredited by Joint Commission International, and for Ba Hospital to have been re-accredited. We will have introduced new services to the communities we currently serve, grown a larger workforce and invested in it. Ultimately, the long-term plan is for any international expertise we have brought in to hand over to a local counterpart.
The Aspen Medical model is about embedding yourself in a community, getting someone alongside you to take them on that journey, and reaching a point where you can give them the keys to take the next step. In five to ten years, I see Fiji's healthcare infrastructure well progressed from where it is today.
And my message to the wonderful readers of the LA Times, and the wonderful people of California and across the States, is this: Fiji is an exceptional place to visit. You will fall in love with the place, and you will find a country that is investing seriously in the health of its people.
We have health infrastructure here now, and a strong desire and mission to raise capability and the profile not only at Lautoka and Ba but across the whole health infrastructure network. Fijians come first, and every improvement we make for them is one that visitors benefit from too.
