A tiny nation with only one obstetrician is now a cervical cancer screening leader

There are unique challenges that come with living in one of the smallest countries in the world, one at risk of being swallowed by the ocean as sea levels rise.

Tuvalu, a collection of nine small islands or coral atolls in the South Pacific with a population of just over 11,000 people, has a single hospital. Residents can be forced to travel thousands of kilometres away, to a different hemisphere, for standard medical treatments.

Funafuti, the capital of the island nation of Tuvalu, consists of strips of land encircled by a lagoon and the vast ocean.Credit: Alamy

“If they need to go for chemo [or] radiation, a lot of the women go to India,” said Family Planning Australia’s international program director Anne Stuart.

It’s despite this remoteness and other significant challenges that the nation has recently become the first in the Pacific to reach the World Health Organisation’s global screening goal for cervical cancer screening of 70 per cent.

The achievement was made with the aid of Family Planning Australia, whose nurses trained and helped develop resources for a tiny team of local staff, who set about knocking on doors and making hairy boat trips to remote islands.

Tuvalu Family Health Association talk to a mother about cervical screening.

The screening effort was managed by two local nurses. Tuvalu has only one obstetrician-gynaecologist, who is able to remove any precancerous lesions identified by the cervical tests in a process called thermal ablation.

Most people in Tuvalu do not have a home address or, in some cases, a phone, said Shannon Rasmussen, a senior international nurse educator. She visited Tuvalu last year from Australia to help the program.

“A lot of people live in very basic surroundings … Maybe even an open-air kind of shelter of sorts, so they don’t have addresses like we would in Australia, so they [the nurses] actually do a lot of door knocking.

“So it’s very, very community-focused.”

The nurses also embarked on weeks-long outreach trips involving long boat journeys to Tuvalu’s remotest islands.

Fenuatapu Mesako, program officer with the Tuvalu Family Health Association, explained there was a risk the boats could capsize in rough seas.

Some of the remote islands could take two or three days to reach, then staff might end up stranded for weeks, waiting for a return ride because of a shortage of boats, which sometimes have to be sent away for repairs or diverted for medical evacuations.

“Those are some of the things that can happen but it’s happening quite often nowadays,” Mesako said.

Stuart said the screening program came about after Family Planning Australia was approached by the Tuvalu Family Health Association about whether they could help build their local cervical screening capacity.

Fenuatapu Mesako, program officer with the Tuvalu Family Health Association.

Key to the success was technological advances allowing cervical screening to be routinely conducted via self-testing swabs. The tests can be processed on Funafuti, the main island of Tuvalu, within less than an hour.

Previously, screening of women in Tuvalu was via a Pap smear, involving a health worker collecting cells from the surface of the cervix. It was ad hoc, no accurate data was available on the levels of coverage, and samples had to be sent to Fiji for testing. It could take months for results to be returned, and many specimens went missing.

The new system is much more accepted by residents, Mesako said.

“You do your own swab, no one has to see you down there.”

Tuvalu is among the 10 smallest countries in the world, based on both land mass and population. It is at grave risk from climate-change-related rises to the sea levels and wild weather, according to recent research.

Last year Australia signed a deal with Tuvalu that would allow 280 of its residents to migrate here each year in exchange for giving Australia effective veto power over any future security pact between China and Tuvalu, though Tuvalu’s new government has announced plans to revise it.

It’s estimated that 76 per cent of Tuvaluan women aged 30 to 49 have now been screened for cervical cancer. This is higher than Australia in this age group, where screening rates are between 68.2 per cent and 73 per cent.

Tuvalu’s cervical screening program was also supported by the Tuvalu Ministry of Health, the Australian government, the World Health Organisation, American molecular diagnostics company Cepheid and the Australian Centre for the Prevention of Cervical Cancer.