helen weld public health

Saturday, March 1, 2008







“Hi-bye, hi-bye” Tuvalu. . .

“Hi-Bye” is what all the small children say in their sing-songy voices as we walked to work every morning. The 12 days flew by when we were in Tuvalu, so it felt like…”hi-bye”, even though in some ways it felt as though we were there for a long duration since we did so much.










Now I am preparing to depart for the USA tonight…just enough time at home to have a bit of a catch up with Robert and friends, clear off the desk, tend to some business, have a few swims in Lake Eacham and mow!

The time in Tuvalu was a fantastic and new experience for me. It was a wonderful opportunity to get a good perspective on the research side of public health, as well as soak in a bit of the glorious South Pacific.

For those who are interested in more of the scientific and technical aspects of the project…read on…otherwise skip ahead…




Our team from James Cook University was in Tuvalu under the auspices of the Gates Foundation and the Task Force for Child Survival and Development, Emory University in Atlanta, Georgia who are coordinating the multi-centre, multi-country evaluation of lymphatic filariasis diagnostics. The mission had two objectives:

#1 To collect blood and urine samples and trap mosquitoes to compare detection methods for lymphatic filariasis in a low transmission setting.

#2 To help the Ministry of Health with a whole-population survey for lymphatic filariasis on Funafuti Island. The samples for objective 1 were collected from within this survey.

The community survey for the Gates Project comprised individuals from age 3 to 80 – totaling 1000 , as well as a survey of school children from age 6 to10 – totaling 350 children. Data was to be collected with the use of Personal Digital Assistants and training of locals to assist was all part of the project.

The diagnostic tests included:
Preparation of a “three line” blood slide for microfilaria.
ICT rapid filarial antigen test.
BMR1 rapid antibody test.
Filter paper samples prepared and stored for BM14 antibody and Og4C3 ELISA at JCU, and PCR in the USA.

Urine was collected from many participants and preserved for antibody testing in Japan.
Mosquitoes were collected using gravid and BG traps and sorted, stored, and transported. Mosquitoes were only being used as “de-facto blood collectors” or “flying syringes” and both the Aedes vector and the Culex non-vectors were suitable for analysis

Upon arrival our team of seven soon realized that those higher in the ranks than us had apparently had a few gaps in communication resulting in an overall lack of attention to details concerning the project and also enlisting the support from the people in Tuvala. We successfully met the challenge of pulling off the task at hand without alienating anyone in Tuvalu and potentially jeopardizing future collaborative projects. The whole situation was further complicated by two other projects requiring data collection being piggybacked onto the Gates Global Filariasis Project and the Tuvalu national survey. By the end of the 12 days it was apparent that we had been successful in laying the groundwork for the projects and progressing very well in the field and in the lab. Locally trained people became integral to the whole scheme and will be able to complete the work. It was a Herculean task requiring all of us to put in a succession of 14-18 hour days. Our team was very professional- competent, efficient, hardworking and good humoured throughout.

The best analogy I can conjure up is that it was like an enormous jigsaw puzzle which was dumped on the floor and we had to just hunker down and tackle it, but without having the edge pieces/framework available until the end.

We did manage a Sunday morning getaway to an islet, Tepuka, on the other side of the lagoon for a bit of R and R. Such a treat! I also managed to get in daily dawn and moonlit swims which definitely increased my level of productivity.

Our group all together.

Cultural anecdotes/observations about Tuvalu:

Global warming and the rising ocean are issues in the spotlight for Tuvalu, eventually making the people of Tuvalu environmental refugees (the island of Funafuti is only 800 meters wide at the widest point and 1+meters at the highest elevation). We were there during the highest tides of the year, king tides, and the water was coming up onto the runway.

Garbage issues are huge. They are running out of space to dump rubbish and the amount of plastic waste is horrendous. Very sad to see, as it seems that mostly the people have a tendency to be quite tidy…sweeping the breadfruit leaves assiduously every morning in front of their houses.

Owning land is a precious commodity. The houses are all very close together.
The people are generally all very overweight. Minimal exercise and high fat/sugar diet major contributing factors. Diabetes and hypertension must be huge problems. The people don’t squat, they lie down or just lean on one arm and rest.
Goods are never carried on heads, as in many other countries and babies are carried in the arms, not on backs.



4WD vehicles are prominent, despite the flat roads (only 8 km). Motorbikes/cycles too. Some ride bikes and few seem to walk.
It’s against the law to work or play on Sundays. They are a highly religious culture. Walking back from the lab at the hospital every night, we could hear the lovely singing in the churches.


The people are all very friendly, giggly and laid back, not appearing to have too many worldly worries. Despite being isolated they seem very happy and don’t appear to have conflicts amongst themselves.


The naming system is very complex. The first name of the father is generally the last name of the child. Wives keep their names, but then there seems to be other name switching too. This made data entry very challenging. Common names were along the lines of Fanoanoaga Patolo and Penielu Penitala…occasionally there was a “regular” name like Lolita or Honolulu and even a Snow White!



Extended families prevail. If one family member has an infertility issue, another family member will give a child over to that individual to be the parent. This can have serious health consequences as the child could miss out on being breast fed.
The dead are buried immediately as there is no refrigeration. Leo, the lab head at the hospital from the Philippines, has been asked to embalm people. He had to learn how to do it on the internet! The dead are buried in the front yards with elaborate graves.


The airport strip built during WWII by the US remains the central focus on the island. The incoming planes on Tuesdays and Fridays are major events. Otherwise the strip is the site for family picnics, walking, romantic rendezvous and sports.
The cargo ship arrives with goods about every 4-6 weeks


When a citizen is hospitalized they get a government subsidy of $15/day
In 2000 there was an agreement to lease the country’s national internet suffix “.tv” to a US company which generated enough funds for Tuvalu to join the UN. As a result of this agreement , the $45 million has been placed in a trust fund for the country and has been used for secondary school education, street lights and paving of roads.
The incredible turquoise colour of the ocean/lagoon is also the colour of their passports and school uniforms.


The jail doesn’t have walls or locks. There is a man who murdered someone on another island in the jail, he works during the day and goes to the jail at night. Lesser criminals are allowed to go home on weekends.

I hope that I can return someday. It would be a pleasure to work amongst these lovely people and try to assist them with some of their public health issues.

Blood samples on disks and strips (with ants checking them out).