Where on earth is Tuvalu? My year as a Health Information Manager in a developing country Kaye Borgelt
What does an experienced Health Information Manager (HIM) do when they leave the Victorian public health sector after thirty years? I packed up my knowledge and suitcase and relocated to Tuvalu, one of the smallest and least visited countries in the world, to work for 12 months as a volunteer HIM with Australian Volunteers International, an aid program funded by the Australian Government. Tuvalu, which comprises nine small tropical islands, has a total population of just under 11,000 and only one hospital located on the island of Funafuti. My role as HIM was designed to assist in improving medical record documentation and building capacity and knowledge for local staff. It proved to be so much more.
The Nation of Tuvalu Tuvalu is one of the poorest and least developed of the Pacific Island countries. Diseases that are almost unheard of here in Australia – tuberculosis, leprosy, rheumatic heart disease and dengue fever – are real and ongoing health issues. The infant and under five mortality rates are very high, and life expectancy is estimated at 67.2 years (Central Intelligence Agency [CIA] 2020), more than 15 years less than our life expectancy in Australia, although with no accurate mortality and morbidity data that is a best guess, but more of that later. Tuvalu has the fifth highest obesity rate in the world at 51.6% (CIA 2020). Living on a coral atoll with no soil means that access to healthy food is extremely limited and the diet consumed by the population is largely processed food, very high in salt and sugar, brought to the island from Fiji every six weeks.
The Tuvalu healthcare system There is one hospital which is located on the main island of Funafuti, with health clinics on each of the outer islands. These clinics are staffed by nurses only, which given the furthest island is a 22-hour boat ride away, makes acute health care extremely difficult. The reality is that most people on one of the outer islands with an emergency condition will die. There is one General Surgeon, one specialist locum Anaesthetist and one specialist locum Obstetrician, who rotate from other Pacific Island countries. All other medical care is provided by General Practitioners (GPs) who are local Tuvaluans who travel to either Cuba or Taiwan for medical undergraduate training and then have one-year intern training before coming back to Tuvalu to literally run the entire health care system. In the seven years they are overseas the medical students may get to return to Tuvalu once to see family and friends. The hospital has 50 beds and one theatre. There is no access to intensive care, with the ward designated as high dependency different from the normal wards by having an air conditioner and at least some effort made in regard to infection control. Basic radiography and pathology services are available at the hospital although there is no access to Radiologists and Pathologists, leaving all diagnosing to be done either by the technicians or GPs. The hospital pharmacy is the only provider of drugs and medications in the country, with paracetamol only being sold in the ‘supermarkets’ from 2019 onwards. Previous to that citizens would have to come for a GP consult to even have paracetamol prescribed.
13 HIM-INTERCHANGE • Vol 10 No 3 2020 • ISSN 1838-8620 (PRINT) ISSN 1838-8639 (ONLINE)
