Pacific Dispatch: Lessons

It’s amazing what you can learn about a new place in one week.

I work at the public health branch of the Ministry of Health of Tuvalu, located inside the only hospital in the country.

The waiting room of the Princess Margaret Hospital
The waiting room of the Princess Margaret Hospital

This week, I began my research. Well, I started on Tuesday afternoon. The pacific is a very slow place. Even though I asked for the outpatient records last Friday, Tuesday was when the nurses got around to getting them to me.

Last Saturday, we were provided with nearly three hours of entertainment by sitting on a dock watching schools of fish ride the currents back and forth.

You get the point. Life is slow.

For my project, I am looking through outpatient and inpatient records from 2010, 2011, and 2012 to extract those patients that had diarrhea. The goal is to describe the outbreak in 2011, and compare the demographics of that outbreak to the demographics of the expected cases of diarrhea in other years.

The only problem is that the records before July 25th, 2011, between February and July 2012, and after August 2012 are missing with apparently no knowledge of their whereabouts. I am hoping to rectify this problem on Monday but let’s just say even Effie Trinket wouldn’t tell me the odds are in my favor.

That’s a second lesson about Tuvalu: resources are limited. I had a first hand experience with this on Wednesday when I was made very aware that I am the most qualified epidemiologist and infectious disease specialist on this island. There is currently an ongoing outbreak of Dengue virus in Funafuti, the island that I am on. With nearly 130 cases out of a population of only 5000, this presents a concerning new threat to the population of Tuvalu.

On Wednesday, I was urgently approached by the environmental health officer of the Ministry of Health. She proceeded to give me an overview of the planned activities to stop the outbreak of Dengue, and then asked for my suggestions for improvements. “I really need your expertise”, is word for word what she continually repeated to me. It was the first time in my life I had been deemed an expert on a topic.

In Tuvalu, this lack of qualified human resources is simultaneously a beautiful and an unfortunate problem. It is beautiful in that Tuvalu operates without the heavy weight of bureaucracy and red tape. If you can demonstrate the knowledge and skills to do a job, you do that job. There is very little concern with licensing, necessary years of experience, or other burdens that prevent otherwise intelligent and hardworking people from doing good work in other parts of the world.

However, red tape burdens like these do serve a purpose. They ensure quality services are delivered. Therein lies the unfortunate facet of Tuvalu’s human resources problem. Every day I walk into work only to be greeted by one to two hundred people waiting, sometimes all day, to be seen by a doctor or a nurse. In looking at the outpatient registers for my own work, I see that sometimes these individuals face issues as mild as a cough or some diarrhea. But others have debilitating, sometimes life-threatening conditions. Tuvalu does not have a choice when it comes to who delivers care to all of these people. Quantity has to come before quality. So whether a 64 year old MD, PhD with 30 years of experience working with Dengue or a 22 year old Master’s student in infectious disease epidemiology with a big smile waltzes through the front door, they both have the same utility for Tuvalu.

That being said, it was very fun to offer up my knowledge and to teach the staff at the Ministry what I have learned about Dengue and epidemiological methods so far in my program. This coming Wednesday, the Ministry will be giving a health education class to a community on one of the northern islands of Funafuti. I was honored that they asked me to give a talk about Dengue and the importance of drinking plenty of water.

Outside of work, I have moved this week from a guesthouse next to the airport to an apartment owned by the same owner. The new apartment is very nice, the nicest in Tuvalu I’ve been told, although I definitely think my standards for apartments have gone down slightly. There are some termites that like to swarm right around 6pm every night, accompanied by a couple of cute geckos that try to eat them. One of these geckos decided that my leg would be a fun place to jump onto yesterday morning while I was in the bathroom.

The first room I stayed in
The first room I stayed in
New apartment room
New apartment room





The nice thing about moving to the new apartment is that I can now cook my own meals. Here’s the third lesson: once you start having to buy food for yourself, it is very easy to see why chronic disease rates are skyrocketing in the pacific islands. In the small convenience stores (there are no super markets) all that is available is canned food, rice, instant noodles, and some frozen, imported chicken. Basically, imagine an entire island food desert. I’ll talk a little more about food in a later post.

I was able to get my hands on some vegetables, though not as simply as you might think. The people I’ve been spending the most time with are Pauline and Jerry, two Taiwanese co-workers at the hospital. Pauline is a nurse and a midwife and Jerry is an IT engineer. Tuvalu is one of the countries that recognize Taiwan. As Taiwan likes to hold onto its few friends in the world, it is the only country to have an embassy in Tuvalu. In addition, Pauline and Jerry, among other Taiwanese people here, are part of a “peace-corps” type program for one or two years here in Tuvalu. Among the projects included in this service is a garden where they grow various vegetables and sell them every Tuesday and Friday morning. Believe it or not, this is the only opportunity to buy vegetables on the entire island.

Pauline and Jerry at work one day said to me “We have a housewarming gift for you. But you can’t tell anyone about it.” They then grabbed a bag of vegetables out of their bag, looked around to make sure nobody was watching, then handed it to me and told me to hide it. Cucumbers and spinach are the marijuana and cocaine of Tuvalu.

Pauline and Jerry have been very friendly by inviting me on several trips to some other islands. Yesterday we went to Funafala, a southern island in Funafuti. Imagine an image of a deserted pacific island. Now add about five houses to it. That is Funafala. We planted mangrove trees there in a process to try to curb the erosion of the sand. We then went to another island where I had the best snorkeling experience of my life. The biggest mistake of my life was not bringing a waterproof camera to this country.

Snorkeling on the way back to Fongafale
Snorkeling on the way back to Fongafale

I have never seen coral reefs so healthy, colorful, and teeming with life.  It was a relaxing day that encompassed everything that is incredible about Tuvalu.

Every day that I am here, the more I love it. If not for a life outside of Tuvalu with which I have to communicate, I could live here for a very long time. For now, I will continue to take showers in the rain, walk around barefoot, and jog on the international airport runway. Listening to Kanye West on Spotify offline mode is one of the few reminders that I have a whole world back in the US to return to. I think I’ve listened enough times now to be certain that Kanye and Beyonce are in fact NOT only talking about Kanye’s “Ego”.

Thank you all for reading and I hope you are all enjoying the posts and the photos. I realized that most of you could not place Tuvalu on map, much less know anything about it.  As I am in a unique opportunity to share this incredible country with you all, my next few posts will be devoted towards giving a “portrait” of the country. I’ll try to describe different elements of the life and culture here. If there is anything you’re wondering about please comment below! I hope to inspire at least one of you to experience this beautiful and peaceful place for yourself in the future.


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