Expanding end-of-life education in American Samoa: A communal approach

By Maria Otero, director of priority populations at Compassion & Choices

On a small island in the Samoan archipelago, a movement for healing and empowerment has been taking root. 

Local leaders and advocates Ipu Lefiti and Chief Leuga Leiataua have been working for years to address community concerns related to justice and health, guided by a commitment to the well-being of their people. 

Recognizing that navigating serious illness, death, and grief are part of life and well-being, Compassion & Choices was recently invited to the Territory of American Samoa to share end-of-life resources and education.

A week-long, multidisciplinary conference brought together community members, government officials, Samoan traditional leaders, faith leaders, and law enforcement. The conference provided practical training sessions as well as spaces for reflection and artistic expression to help people heal and connect on a deeper level.

Communal, culturally-grounded education

During a training for community health workers, faith leaders, and trusted community partners, I shared motivational interviewing skills and introduced culturally-relevant tools to guide end-of-life conversations. Together, we explored ways to honor family values, faith, and the wisdom of elders while helping people make informed decisions about care at life’s end.

The most impactful part was the time spent in conversation. Sitting in circles and hearing the stories of lay workers who accompany families in times of need, I witnessed courage, love, and a profound respect for life and transition.

These moments reminded me why being in community matters: people must feel seen and safe before they can open their hearts to conversations that are both personal and sacred. Many participants shared that this was the first time they had reflected on their own experiences with loss or grief in a collective way. 

Through trust and shared learning, they began to see that end-of-life planning is not something to fear, but rather an act of love that brings peace and clarity to future generations.

Internationally-recognized Siapo artist Reggie Meredith Fitiao and Dr. Trina Nahm-Mijo, a member of the Compassion & Choices Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Leadership Council, also led a moving workshop on navigating the end-of-life through the lens of Samoan art and culture.

During the workshop, we reflected on the Samoan principle of teu le va — the sacred duty to nurture the space between people, between life and death, and between generations. This idea beautifully reflects a core belief of Compassion & Choices: that preparing for the end of life is a continuation of caring for one another.

Nurturing trust, courage, and embodied transformation

On the last day, we gathered and celebrated with food, laughter, and dance. Many women who participated cried as they moved, and I later learned that this sharing of dance represented more than celebration — it was also a way of expressing gratitude, releasing long-held emotion, and demonstrating trust and solidarity.

In Samoan culture, the act of coming together in movement opens space for healing and relational connection. 

Dancing together became a symbolic moment of bridging, acknowledging pain, bearing witness, and welcoming hope.

A ripple effect across American Samoa

In addition to the impact experienced at the conference itself, our efforts are leading to other concrete outcomes in American Samoa.

The Governor’s office has requested that Compassion & Choices’ end-of-life resources be shared in all public-facing government offices. The LBJ Medical Center, the primary healthcare provider in the territory, has also identified multiple spaces for end-of-life resources to be displayed and made available. Additionally, community and non-profit leaders are interested in facilitating future trainings in collaboration with Compassion & Choices. 

These are signs that the groundwork we laid together is expanding beyond the training room — into systems and daily life.

My time in American Samoa reaffirmed what I have learned throughout my years of community work: transformation begins with relationships. By listening, sharing stories, honoring cultural traditions, and spending time together, we help communities find the courage to talk about death and dying as part of what it means to live fully.

Learn more about Compassion & Choices’ work to ensure AANHPI communities and others are prepared to navigate the end-of-life, for themselves and their loved ones.