It is a privilege to contribute to the conversation of how the physiotherapy profession could, and should, embark on critically evaluating its relationship with the natural environment. In doing this, I draw on the knowledge of my forbears, particularly in Samoa, to highlight the importance of this discussion on the Pacific islands; to frame the tethered relationship of a person to her natural environment and finally to suggest how the Samoan indigenous reference points us towards more fulfilling roles for the profession, particularly for those practicing in the Pacific and potentially across the world.

At the time that Filip invited me to share some thoughts from a Samoan indigineous perspective, I was learning to weave harakeke (New Zealand flax) with my wife. In a similar vein, I will present three conceptual strands drawn from the Samoan indiginous reference and aim to weave them together so that they may serve the global physiotherapy community. These three concepts are: Tulagavae, Lagimalie, and Taulāsea/Fofō.

The Pacific region covers a third of the earths surface, making it the most important site for the impact of climate change on human habitation. With rising sea levels, changes in water salinity, volatile weather patterns and the impacts on coral systems, some of these island nations may soon become uninhabitable. Climate change has and will continue to have dramatic consequences on the island nation states in the Pacific Ocean. Although these nations are home to only one percent of the global population, they are also home to over a thousand languages, making the Pacific region the most linguistically diverse region in the world. Therefore, climate change not only presents an urgent threat to the natural environment in the Pacific, but also a direct threat to the survival of languages, cultures and the very identities of these island nation states. Pacific identity, as described below from the Samoan perspective, is innately bound to the natural environment.

Oka Sanerivi

Oka Sanerivi

Oka is a Physiotherapist of Samoan and Tongan heritage. He has worked across public and private sectors and has recently established the Samoan Physiotherapists Network that deployed three PTs to serve in Samoa in response to the recent Measles epidemic. He has been gifted the chiefly title of ‘Lilo’ from his village of Matautu-Uta, Lefaga, in Samoa and lives in Turanga-nui-a-Kiwa/Gisborne (NZ) with his wife and three children.

Strand I: Tulagavae

Foundational to the Samoan indigenous reference is the concept of Tulagavae, meaning ‘the place of standing’. Tulagavae encompasses one’s identity from their villages of ancestry and enables swift connection of a person to their family, village and chiefly lineage. This grounding relationship between the Samoan person and the land of their heritage provides the setting to introduce the Samoan sense of self and belonging, best captured by the former Head of State of Samoa, Tui Atua Tupua Tamasese Meaole Ta’isi Efi (Efi, 2003):

“I am not an individual; I am an integral part of the cosmos.

I share divinity with my ancestors, the land, the seas and the skies. 

I am not an individual, because I share a tofi (inheritance) with my family, my village and my nation. 

I belong to my family and my family belongs to me. 

I belong to my village and my village belongs to me.

 I belong to my nation and my nation belongs to me. 

This is the essence of my sense of belonging”. 

The Samoan self is a relational self that exists within connections to others; family, village and nation. Foundational to this sense of self is the awareness of our kinship relationship with the natural world and that the land not only sustains us but is part of us. This awareness is expressed in the Samoan vernacular in that the word eleele meaning earth and palapala meaning dirt, are the same words used for blood. The word fatu, meaning rock, is the same word used for heart; and the word fanua, meaning land, is the same word used for placenta – the life sustaining organ of the fetus. This relationship is further secured through the ritual practice of burying the placenta, thus returning the fanua to the fanua. Tui Atua declares that this is “more than symbolism, there is spiritual continuity, a spiritual continuity that ensures harmony and respect for the environment.”

Strand II: Lagimalie

Lagi, means the heavens and Malie, means harmony and so the combination of these two words, Lagimalie, means the heavenly harmonies. In ancient Samoan traditions there are four heavenly harmonies that when equivocally held in balance, ensures the peace and wellbeing of the Samoan. The heavenly harmonies are described in detail by Tui Atua (Efi, 2005) and summarised here:

Harmony between man/woman and the cosmos: This refers to the reverent acknowledgement of mankind’s sacred relationship with the heavens. The acknowledgement of the heavens and environment has long been respected by Samoans and other sea-faring people, as our livelihood often depended on astronomy-based navigational knowledges. The appearance of the moon and stars also guided planting and harvesting practices for crops and building materials.

Harmony between man/woman and the environment: This refers to the sacred relationship between the Samoan and his or her natural environment. As mentioned earlier, the ritual of burying the fanua reminds the Samoan of the spiritual continuity between mankind and the land. This ritual draws the connection of the common birthing between the human female and mother earth. What this illuminates is recognition that the environment lives, shares pain, grows and dies in a manner and form similar to mankind. In this relationship, the Samoan acts as student, guardian and caretaker of the environment, which in ancient Samoa was seen in the development of protocols and tapu (taboo) in order to preserve the physical and spiritual elements of natural environments. These protocols dictated what and how much was harvested with the stipulation that resources were never to go beyond what nature could not sustain in terms of natural re-growth.

Harmony between man/woman and fellow man/woman: This refers to the relationship between the Samoan and his or her fellow human beings. This relationship is founded on alofa (love), fa’aaloalo (respect) and tautua (service) and is constantly maintained through an active process known as teu le vā (maintaining or honoring the relational space).

Harmony between man/woman and him or herself: This refers to the harmony in which a person has with him or herself, through the balance of the three key parts of the Samoan: tino (body), mafaufau (mind) and agaga (soul). Harmony in oneself requires harmony of the body, mind and soul.

Of immediate interest to Physiotherapists is the search for harmony in the body. Tui Atua asserts that “The body and all its movements and/or performances reflect at all times God’s divinity, from the most physical and ceremonial to the most mundane, hence the Samoan saying: ‘O le faiva o le Tamaalii o le gasese’ meaning, ‘it is the mark of the chief and the progeny of chief to perform or serve well’.“ Thus it can be suggested that in our clinical practice of facilitating healing to the body, physiotherapists are engaging in divine restorative work. This is particularly true when aligned with Samoan traditional healers, known as Taulāsea or Fofō.

Strand III: Taulāsea/Fofō

Taulāsea are Samoan traditional healers who are known more colloquially as Fofō. These Fofō are trusted members of the community who are specialised in bringing healing and a calming sense of peace. The Fofō continue a legacy of intergenerational connection that represents the epitome of trust, care and shared values. The Fofō are the embodiment of the fulness of being Samoan, through holding the pinnacle responsibility of healing in a community. In ancient Samoa, the Taulāsea or Fofō were healers on par with the highest chief title holders. Additionally, Taulāsea were also responsible for establishing and maintaining the tapu protocols that ensured the conservation of the environment, as described earlier. They were the traditional ‘faafeagaiga’ (brokers of sacred covenant), facilitating healing by being the intermediary between the human and the divine.

Weaving the strands together

As extensively described elsewhere, the history of the physiotherapy profession has led to a reduction of the body to ‘body as machine’ and has largely ignored indigenous knowledges in non-European contexts. In the process, it has isolated the body from the relationships and environmental contexts that sustains ones identity. The concept of Tulagavae illustrates this inherent connection between mankind and the environment and how this connection cultivates a strong sense of belonging. This sense of belonging forms the foundation for the search for harmony in ones life. The concept of Lagimalie further illuminates the sacred relationship between man and environment and signals to the sacred work that each physiotherapist is tasked with in facilitating the restoration of harmony to ones body. This sacred work is paralleled with the ancient role of Taulāsea in being the intermediary between the divine and the natural and ensuring that protocols for environmental conservation are established and actively maintained. 

My hope is that the global Physiotherapy profession can turn to indigenous knowledges to enrich the critical conversation of how we achieve harmony in our clinical practices, reasearch approaches and personal lives. If we can, there is the potential that the profession, at least within the Pacific, can recognise its role in restoring harmony at a personal, community and environmental level. This role may be more closely aligned with that of the Taulāsea than with our legacy of conventional physiotherapy practitioners and it is certainly at the precipice of the human and the divine.

This weaving is purposefully left open-ended, to invite further strands into the conversation.

Ma le fa’aaloalo lava (With sincere humility),

Lilo Oka Sanerivi


Efi, T. A. (2003). In Search of Meaning, Nuance and Metaphor in Social Policy. Social Policy Journal of New Zealand 20 , 49-63.

Efi, T. A. (2005). In Search of Harmony: Peace in the Samoan Indigenous Religion. Vatican City, Rome, Italy.