NUKU’ALOFA, Tonga – Cmdr. Christina Carter, a public health nurse currently serving as Director for Public Health at Naval Hospital Twentynine Palms and Navy Medicine Readiness and Training Command (NMRTC) Twentynine Palms, recently returned from a temporary assignment to the Kingdom of Tonga in June, where she served as part of Pacific Partnership 2025, the U.S. Navy’s largest annual humanitarian assistance and disaster relief mission in the Indo-Pacific region.

“Pacific Partnership is a U.S. Navy-led annual mission that focuses on humanitarian assistance and disaster preparedness in the Indo-Pacific region,” Carter explained. “It brings together partner nations to conduct medical, dental, engineering, and community projects, with the goal of strengthening local capabilities, enhancing interoperability, and fostering lasting global relationships.”

Carter, a public health nurse with a long-standing passion for prevention and health education, said the mission’s core values closely aligned with her own professional goals.

“As a public health nurse, I am extremely passionate about empowering people to take control of their own health through education, advocating for ways to address health disparities, and fostering a healthcare culture of prevention that helps to mitigate the risk and progression of disease,” she said. “I was inspired to participate in the Pacific Partnership 2025 because its core principles mirrored my dedication to public health.”

Her initial expectations going into the mission included learning about the public health priorities in Tonga and collaborating with nursing staff to address areas of need. She shared that the medical professionals at Vaiola Hospital in Nuku’alofa, along with those at community health centers throughout the islands, were warm, collaborative, and eager to share insights about their healthcare system’s strengths and challenges.

Enhancing Public Health Education

Throughout the mission, Carter played a central role in organizing and delivering a series of educational engagements aimed at bolstering clinical knowledge and promoting public health best practices.

“In a significant collaborative effort, I worked alongside Cmdr. Annissa Cromer, Cmdr. Shirline Marie Sulatan, Lt. Cmdr. Margaret Mitzkewich, Lt. j.g. Brittny Debow, and the Tonga nursing leadership to successfully host three nursing training events,” Carter said. “These immersive sessions, which engaged approximately 16–20 nurses and nursing students each day, provided in-depth education and hands-on practical skills in areas such as infection control, fostering resiliency, precise medication administration, and fundamental basic life support.”

Additionally, Carter partnered with Dr. Lisa Bauer, Dr. Andrew Kaplan, and Ens. Kelly Kobliska to lead an information-sharing session focused on non-communicable diseases such as diabetes, heart disease, and chronic wound care — conditions of growing concern across the Pacific Islands.

She also contributed to a tabletop exercise with Lt. William Douthitt, Lt. j.g. William Chipmon, Lt. Iyanna Alexander, and Hospital Corpsman 3rd Class Camille Erespe, which simulated a response to a potential Salmonella outbreak, providing host nation healthcare workers an opportunity to refine their emergency preparedness protocols.


Improving Emergency Response Capabilities

One of Carter’s most impactful efforts involved leading five basic life support (BLS) classes. The sessions were met with enthusiasm by local medical personnel.

“The basic life support classes were a lot of fun, with participants fully engaged in the hands-on training,” Carter said. “Furthermore, the joint quality assurance testing of existing AED equipment by Pacific Partnership biomedical staff and host nation partners was a resounding success. These tested AEDs were then distributed throughout the hospital and community health clinics, significantly enhancing local basic life support capabilities.”

Building Relationships Through Cultural Exchange

Beyond the technical training and clinical collaboration, Carter described several personal and unique cultural experiences in Tonga that left a lasting impression on her.

“There is a strong Christian presence in Tonga, and religion is a very important aspect of everyday life,” she said. “At the start of the workday and prior to every educational event, the staff would open with spiritual songs and prayer. This was so encouraging and set a positive tone for the day ahead. I was really impressed and inspired by the spiritual commitment and community connectedness demonstrated throughout the island.”

She emphasized the importance of cultural understanding and relationship-building when conducting international public health work.

“Effective public health requires deep understanding of local customs, beliefs, and social structures, fostering better cross-cultural communication and partnership,” Carter said. “The Pacific Partnership mission in Tonga created an opportunity for U.S. military participants to learn more about the culture, social structures, and healthcare capabilities on the island.”

She added that while cultural differences were present, the mission also revealed many common goals between U.S. and Tongan healthcare providers that strongly unite the two nations.

“My biggest takeaway is that despite our cultural differences, we share many similarities — including our desire to reduce the burden of disease, improve the quality of life for community members, and contribute to optimal population health,” Carter said. “There is no perfect solution to achieve these goals, but sharing best practices, conducting joint exercises, and building community trust is a great starting point.”

A Lasting Impact

Reflecting on the overall experience, Carter praised the hospitality and openness of her Tongan counterparts.

“I thoroughly enjoyed my time in Tonga and the opportunity to work alongside our host nation partners,” she said. “Everyone I met was incredibly kind, welcoming, and eager to exchange public health ideas. I believe the mission successfully achieved its objective of strengthening host nation relations and enhancing the collective ability to respond to potential global health crises.”

Pacific Partnership 2025 underscores the essential role public health plays in strengthening regional cooperation, improving medical readiness, and building trust among partner nations.