“Iá e mataala”: Perioperative nurses stand watch and help save lives in Samoa

The operating theatre is a world apart from other places, with its bright lights, sterile surfaces and instruments, and humming machines, all conveying a quiet intensity that signifies the lifesaving work going on inside. Here at the operating theatre at Tupua Tamasese Meaole (TTM) Hospital, we follow Daru Heaven Faanimo Isaia, known as Heaven to colleagues and loved ones, as we observe a day in her life as a perioperative nurse and Nurse in Charge.

Heaven’s day, including those of the whole operating theatre team, starts at 9:00am as they gather for a morning briefing. They review the expected cases for the day, share updates, and pause for lotu, a prayer for guidance and safety.

^{A morning briefing at the operating theatre. ©WHO / Faizza Tanggol}

As patients arrive, Heaven steps into her role as a patient advocate. She checks every detail, including identity, consent, allergies, and risks, acknowledging that for many people, the operating theatre can be an intimidating and scary place.

“This work is very humbling. Patients come to us putting their full trust in our hands. Sometimes they are scared and sometimes they don't even remember us after. But knowing that we played a part in keeping them safe, that is enough,” explained Heaven.

^{Heaven (standing second from right) helps prepare the patient for the surgical procedure. ©WHO / Faizza Tanggol}

Heaven’s responsibilities as a perioperative nurse span the entire surgical journey. Before each operation, she helps prepare patients, ensuring they are comfortable and all necessary checks are completed. Once the patient is ready, Heaven scrubs in as part of the surgical team, assisting the surgeon throughout the procedure and monitoring the patient’s condition. After the surgical procedure, she remains involved in post-operative care, overseeing the patient’s recovery and making sure the operating theatre is thoroughly sterilized and ready for the next case.

Science guiding care

Science is at the core of every action here at the operating theatre. The team follows strict evidence-based protocols, confirming patient details, reviewing notes, and conducting a “timeout” before surgery begins. Heaven acknowledges that these routines, though repetitive, are vital.

“I believe they remind us that every patient is important, and we cannot afford to miss even the smallest details,” she said.

Throughout the operation, science guides every step. From hand hygiene to the preparation of sterile instruments, Heaven and her colleagues rely on evidence-based practices to keep patients safe.

^{Heaven washes her hands before scrubbing in to assist in the surgery. Above the handwashing station, a poster on WHO’s 5 moments of hand hygiene guidance can be seen. ©WHO / Faizza Tanggol}

“Science is in everything we do. Even the smallest actions are guided by evidence. It’s not just routine. There is a reason behind every step. And that’s what keeps our patients safe,” Heaven shared.

In their day-to-day work, infection prevention and control is a constant focus. Heaven is especially vigilant for signs of sepsis, a life-threatening complication.

"We follow strict sterile techniques, proper hand hygiene, and make sure the environment is clean at all times. With sepsis awareness, I can say we are always, always watching closely for early signs. Every small change in a patient can mean something serious, so we act quickly. In our culture, we say, ‘Iá e mataala’, meaning always be watchful. And I shall say that mindset helps us protect our patients,” she said.

^{Heaven (right) assists in the surgical procedure led by orthopaedic surgeon Dr Areta Samuelu (left). ©WHO / Faizza Tanggol}

Working together for science and health

The teamwork of all health workers is key to the successful procedures in the operating theatre. Surgeons lead the operation, and nurses like Heaven provide steady support and ensure everything runs smoothly. Heaven believes that working together is essential.

“’Together for health, stand for science,’ to me, it means we are not working alone. It's teamwork guided by science to give the best care possible. So in the operating theatre, every person has a role. And when we come together and follow evidence-based practice, we protect our patients,” explained Heaven.

“I would want the public to know that behind every surgery, there is a lot of careful planning, a lot of knowledge, and a lot of teamwork happening quietly,” she added. “So it's not just a surgeon, it's a whole team making sure everything is safe. And most importantly, every step we take is to protect life.”

^{Heaven and other perioperative nurses work together to clean up the operating theatre, ready for the next case. ©WHO / Faizza Tanggol}

For Heaven, who has provided 12 years of service as a nurse and 11 years as a perioperative nurse, her behind-the-scenes work continues to be an inspiring career which she considers a calling.

“I always believe that this is not just a job. It’s a calling from God to serve others,” she said.

On World Health Day and every day, Heaven Isaia and nurses like her serve as ambassadors of science, always watchful and ready to work together to save the lives of patients who enter the operating theatre.