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Tuvalu, composed of nine islands, is a nation located in the South Pacific Ocean. The population is 10,645 (Tuvalu Population and Housing Mini-census, 2017), and almost half of the population stays in the capital, Funafuti. As a matter of fact, the traffic between the main island and outer islands only relies on two transport vessels, which operate one to two times a month and are often rescheduled or cancelled due to poor weather conditions or mechanical failure of the vessels, not to mention that two vessels could be out of function at the same time. Geographically, there are no mountains and rivers in Tuvalu. For sanitary, every family has a private tank to collect rainwater or buy desalinated water. Because of climate change, the higher temperature results in insufficient water supply, making personal and environmentally-related hygiene worse with potential vector-borne or skin diseases. Moreover, due to the lack of natural resources, people in Tuvalu catch fishes and collect coconuts for living and rely on imports for food and daily necessities. These imported goods of high-calorie foods and sugary beverages have a significant impact on their health. The prevalence of obesity is 39.6% (Tuvalu Ministry of Health, 2016) and has been increased annually.
In Tuvalu, Princess Margaret Hospital (PMH), located on Funafuti, is the only hospital in the country and offers outpatient and inpatient care. The healthcare team of PMH includes professionals recruited from friendly or neighboring countries and provides basic health care and surgical delivery if equipment and resources are available. In the outer islands, there are no doctors but nurses and midwives to provide health services for the residents, such as primary assessment and health promotion. If there is a specific or urgent case, the nurses and midwives will reach out to those professionals at PMH for further referral of the patient or arrangement of doctor’s visit. In case of patients with severe complications that cannot be treated in Tuvalu, the doctors will then consider international referrals, which is a great burden on health budgets. Therefore, the healthcare system in Tuvalu has faced major challenges because of scarce medical resources.
In view of the hardship, Chung Shan Medical University Hospital (CSMUH) in Taiwan and Princess Margaret Hospital in Tuvalu has established a sister hospital relationship to send medical teams and provide medical services in Tuvalu annually since 2006. In 2011, CSMUH launched the Tuvalu Medical Program to further set up an office in Tuvalu, which consisted of a coordinator, doctors and nurses, for providing medical services and health education and implementing public health programs, improving health awareness of the local people.
Chung Shan Medical University Hospital has conducted various public health programs between 2012 and 2021. For example, health information system program (2012-2017), Pap smear screening program (2013-2014), non-communicable disease prevention program (2015), nationwide health examination program for primary school children (2016), nationwide health examination program for adults (2017), weight loss program for adults (2018), obstructive sleep apnea screening program (2019), nationwide oral health program for primary school children (2019-2021) and dengue screening program (2021). Particularly, the results from these health examinations for children and adults between 2016 and 2017 were published on both Taiwan’s and international journals. Through these programs, it provides people in Tuvalu an opportunity to understand their own health status and raise their health awareness. In addition, CSMUH has colleted the results and statistics of each program for the Ministry of Health in Tuvalu to develop health policies for facilitating public health improvement. Chung Shan Medical University Hospital does not leave the Tuvaluan people behind even during the COVID-19 pandemic. CSMUH has assisted in the assessment of medical resources needed as well as promotion of the prevention and control of COVID-19 in cooperation with health departments in Tuvalu. According to the requirement for medical education by PMH, CSMUH has created distance courses for health professionals in Tuvalu to keep up their learning and practices. Regarding patient needs, CSMUH has also provided telemedicine consultations for Tuvaluan physicians to get a second opinion easily and enhance the quality of care. Chung Shan Medical University Hospital has made an effort to provide professional exchanges and services and assist in strengthening healthcare capacity in Tuvalu for many years. Most importantly, CSMUH has made a collaborative partnership with Tuvalu as well as contributions to global health.