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Tackling TB in Tuvalu

Reaching the ‘missing’ cases by boat and by bike

By United Nations Development Programme

September 20^th, 2018

No-one should be left behind in the fight to end tuberculosis (TB), which is now the world’s most infectious and deadly disease. Yet in 2017, 3.6 million people with TB were ‘missed’ by health systems and remained undiagnosed, or detected but not reported. With the first-ever UN High-Level Meeting on TB on the horizon, patients and healthcare workers from Tuvalu, a remote Pacific island, explain how diagnosis and treatment is being scaled-up across the Pacific and reaching directly into people’s homes and communities.

Tackling TB in Tuvalu

PISISAMI KALAMELU, LABORATORY TECHNICIAN

Tracking TB in the outer islands

“Before, we used to have to bring patients to the main island if we needed to get a full diagnosis for TB,” explains Pisisami Kalamelu, a laboratory technician at Tuvalu’s only hospital, on the main island of Funafuti.

For those living in the smaller outer islands, travel to the hospital is difficult due to limited and often expensive transport options. The journey also presents further risks as TB is airborne and highly contagious.

“They would have to travel to the main island with a lot of people on a boat, and we know TB can spread very fast, especially where it’s crowded,” he continued.

To prevent the spread of the disease and to enhance diagnostic capacity in remote and hard to reach locations, UNDP and the Global Fund have provided the Government of Tuvalu with GeneXpert machines, along with portable X-ray machines and training for health teams.

Tackling TB in Tuvalu

On the small island of Amatuku, a short boat ride from Funafuti, the mobile health team is hosting a TB awareness session for the local community and carrying out chest X-rays for those presenting with TB symptoms.

“It’s very easy for us to reach people now, because the X-ray machine is portable,” Pisisami explained.

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Back at Funafuti hospital, the state-of-the-art GeneXpert machine has also drastically reduced the time it takes to test for TB while also allowing health workers to diagnose drug-resistant strains of the disease.

“It only takes two hours to get a result,” said Pisisami. “So now we can quickly inform the patient if they have TB or not.”

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Salote, housewife and TB patient

Gaining strength

“I could see in my eyes that I was sick. When I did my work, when I took a breath, I could tell it hurt,” explained Salote, a 25-year old woman recently diagnosed with TB.

Salote initially found her treatment difficult to manage and felt isolated and alone. But daily visits from community-based health promoters have provided a vital lifeline.

“If it wasn’t for them, I would not have gotten better and started feeling strong again. If they were not here, I guess I would have died already,” she said.

Fearful of facing stigma related to TB, and although she ceased to be contagious after a few weeks on treatment, Salote distanced herself from her neighbours. “I spend most of my time with my family. I don’t feel comfortable around others because they treat me differently,” she said.

Tackling TB in Tuvalu

Leaving no one behind in the fight to end TB means ensuring access to TB treatment and care for the most vulnerable and at-risk people. Stigma and discrimination can be barriers to people accessing and staying on TB treatment. By bringing Salote’s TB medication directly to her home, community-based health promoters have ensured she gets the medication she needs, while also providing much needed emotional support.

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Foma, community-based health promoter

Home-based care

“Sometimes patients won’t fully access their treatment because they are ashamed to go out in public,” explained Foma, 28, a Tuvalu Red Cross community-based health promoter.

“That is why I think it’s better that we collect the medicines and treat them at home,” she said.

Local communities and volunteers play a vital role in supporting patients to stay on treatment. UNDP and the Global Fund, through the Ministry of Health, are partnering with volunteers from the Tuvalu Red Cross to ensure people are supported during the often gruelling, but life-saving, treatment regime.

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Having received training on TB treatment for her volunteer role, Foma knows what is at stake.

“People can die from the disease if they refuse to take the pills, or if they won’t let us come to see them. But if they allow us to come, they can be cured and stay safe and happy with their family,” she explained.

With multiple patients to support and a job far from her village, Foma relies on her motorbike to get her where she needs to be.

“Every day I go by motorbike to the patient’s house and deliver the pills. I ask them to make sure they drink enough water when taking the medication.”

Foma visits her last patients at 9 p.m. every evening, but despite the long hours, she enjoys her role and the people she meets.

“I chose to do this because I care about people’s health. I love to help people.”

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Doctor Christine Lifuka, junior doctor

Changing perceptions, saving lives

In the two years that Dr. Christine Lifuka has been working at the Tuvalu hospital, the numbers of people diagnosed with TB have increased.

“Ten years ago it was eight cases a year, but last year there were 23 cases, and this year we are already at 21 cases, and it is still only September,” she said.

According to Dr. Lifuka, the increase can be attributed to the arrival of the new diagnostic technology, namely the portable X-ray machines and the GeneXpert machines.

“We can now actively find cases in the outer islands where there are no facilities, and we can assess everyone, even those who previously faced difficulties coming to the hospital,” she explained.

Tackling TB in Tuvalu

Tackling TB in Tuvalu

But there remains another major hurdle in the fight against the spread of TB.

"If you ask most people how is TB spread, they think it's spread by touching or by using the same utensils. Within communities there is confusion about what TB is, "she said. To address this, your team is using radio to broadcast information on TB to the local community. Community health workers are also trained in TB awareness and education and help share information while observing their patients and ensuring they take their medication each day.

“We used to have a lot of people stop treatment, and we didn’t know where they went or if they finished their treatment or not. We wanted to change this system, so now health care workers go to patients’ homes and monitor them every day.”

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Doctor Ronald Achidri, UN Volunteer

Sharing skills to build healthier communities

The islands of Tuvalu are a long way from Uganda, where Ronald Achidri was born and received his medical training.

Having served as a doctor in Uganda for two years and in South Sudan for four years, specializing in health system strengthening and the implementation of HIV and TB programmes, Dr. Achidri is now supporting the Ministry of Health of Tuvalu as a United Nations Volunteer (UNV).

“I support the Ministry of Health in the control of TB and HIV by working with and training community health workers, initiating and implementing preventive approaches, and treating patients,” he explained.

Through volunteerism, Dr. Achidri has used his knowledge and skills to help people affected by TB in Tuvalu have access to care, support and proper treatment.

Tackling TB in Tuvalu

“Professionally, I am learning skills to manage TB programmes in a different context,” he said. “For example, one of the highest risk factors for TB in Africa is HIV. Here in Tuvalu, HIV prevalence is low, but diabetes prevalence is high, so I am learning how to control TB in this environment.”

The Pacific is the region hardest hit by non-communicable diseases, and death and impoverishment from them disproportionately affect poor and vulnerable populations. Many people affected by non-communicable diseases are among the same ‘missing cases’ of TB, as people continue to go unreached, undiagnosed and untreated. UNDP is working in partnership with the Government of Tuvalu, the Global Fund and others to address TB and non-communicable diseases, ensuring people can live healthier, more productive lives.

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Tackling TB in Tuvalu

Tackling TB in Tuvalu

2018: The year for action against TB

TB is one of the top 10 causes of death worldwide. In 2017, an estimated 10 million people developed TB, and 1.6 million died from the disease. Finding and treating people with TB who are currently missed by health systems is a priority. As reported by the World Health Organization, only 6.4 million TB cases were detected and officially notified, leaving a gap of 3.6 million people undiagnosed, or detected but not reported.

The upcoming UN High-Level Meeting on TB will be held on 26 September 2018 at the United Nations General Assembly. The meeting is an opportunity to move TB to the forefront of the global health agenda and secure the commitments and resources needed to meet the goal of ending TB as an epidemic by 2030.

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In line with its HIV, Health and Development Strategy, and as outlined in the UNDP Strategic Plan 2018-2021, UNDP partners with the Global Fund and governments to support and strengthen multi-sectoral national responses to TB in 22 countries, by providing integrated policy, programme and capacity development support. To date, this has resulted in 888,398 cases of TB being successfully treated.

This includes the Multi-Country Western Pacific Integrated HIV/TB Programme, where UNDP and the Global Fund work in supporting the government to improve the coverage and quality of TB prevention, treatment and care in: Cook Islands, Federated States of Micronesia, Kiribati, Marshall Islands, Nauru, Niue, Palau, Samoa, Tonga, Tuvalu and Vanuatu.

Photos: UNDP/Aurelia Rusek

Tackling TB in Tuvalu

© 2026 United Nations Development Programme

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