Country Snap Shot & Eyecare Profile
	Country Tuvalu Region Western Pacific Capital Funafuti Area (sq/km) 26 Geography 9 Atolls Provinces / Districts *Population 11810 *Population Below Poverty Line NA % *Infant Mortality/1000 Births 19.47 *GDP Per Capita ($US) $1,100 Schools of Optometry 0 Optometrists 0 Optician 0 Ophthalmologists 0 Eye Health Workers 18 Optometric Association No Vision 2020 Signatory No Vision 2020 National Plan No National Eye Health Plan No

Project Personnel

Project Aim
To eliminate refractive error blindness by establishing sustainable eye care delivery systems.

Project Commencement
2001

Project Background/History
Tuvalu is a small Western Pacific island nation located north of Fiji. The population of approximately 11,800 is distributed across nine islands, with some islands inhabited by as few as 50 people and with around 5,000 on the main island of Funafuti. The only link between the outer islands and the main island is a boat service, and the trip from the most distant islands can take 24 hours.

Eyecare in such an area is a great challenge. There are no optometrists or ophthalmologists residing in Tuvalu and so nurses are the sole permanent providers of eye health care on all islands.

The main causes of vision impairment in Tuvalu are refractive error (the need for glasses) and cataracts. Since 1996, the Pacific Island Project (PIP) organised by the Royal Australasian College of Surgeons (RACS) has been sending a small ophthalmological team to Tuvalu to provide cataract and other eye surgery. ICEE has worked alongside the surgical team in 2001, 2002 and 2003 to provide pre-screening of surgical patients and glasses to those in need.

ICEE is also working towards more permanent eye care services in Tuvalu. Primary eye care services available to individuals in their communities on an ongoing basis, are needed to address common eye and vision problems.  ICEE has been working with the Ministry of Health to identify an appropriate strategy to make these a reality.

Project Activities
In 2004, the first step to enhancing primary eye care services was a Primary Eye Care and Presbyopic Spectacles training course conducted by ICEE. The nurses learnt to identify and manage eye conditions commonly occurring in Tuvalu, including learning how to measure visual acuity, conduct an eye examination and take a case history. They also learnt how to prescribe presbyopic spectacles (near spectacles for people over 40 years of age). Each nurse was given a copy of the Primary Eye Care Manual and additional materials and resources to consult during the training and to use as a reference after the course. Laminated distance and near eye charts in Tuvaluan were provided to enable nurses to perform visual acuity measurements and presbyopic spectacle testing on their return to their islands.

As a result of the training, the nurses were able to fit up to 70% of people requiring spectacles on their islands. This is a more cost-effective and faster than referring patients to Funafuti for the annual visit by the Pacific Island Project eye team. It is important that this initial training was supported by the provision of accessible, affordable spectacles for all Tuvaluans. With this in mind, ICEE provided a seed donation of ready-made spectacles, and income from spectacles sales contributed to future spectacles purchases as well as further nurse training, eye care awareness programs and school screening programs.

In 2005, these nurses and an additional group of nurses were trained in Children’s Eyes, Primary Eye Care and Presbyopic Spectacles. This meant that every island in Tuvalu would now have a senior nurse that was trained to provide eye care for their community. In addition to the reinforcement of training previously received, the inclusion of training in Children’s Eyes was intended to broaden the scope of eye care. The Children’s Eyes component of the course was focused on the detection, prevention and treatment of the major causes of childhood blindness, with emphasis on those conditions more likely to be encountered in the context of Tuvalu (eg corneal scarring, new-born conjunctivitis).

School screening was treated as a crucial inclusion to the Children’s Eyes training during the planning of course content, due to its fundamental role in the identification of children with poor vision and eye health abnormalities that need to be referred for further eye testing.

In 2006, a local senior nurse was trained in a Train the Trainer’s workshop. The workshop provided prospective eye nurse trainers with the knowledge, skills and attitudes needed to train others, based on learner-centred, participatory training techniques. This nurse and an ICEE trainer then provided Primary Eye Care training to a group of nine Tuvaluan nurses. The trained junior nurses are now able to provide support to the existing trained senior nurses on the outer islands.

Project Achievements
Tuvalu is well on their way to establishing ongoing local primary eye care services and spectacle supplies. To date, 28 nurses have participated in eye care training provided by ICEE. The impact of trained nurses to provide primary eye care and near vision spectacle services on the outer islands was well indicated by the decrease in the number of minor eye conditions and patients that presented to the ophthalmology team in 2004, 2005 and 2006.

ICEE is continuing to work with the Tuvalu Ministry of Health to provide support for local programs to prevent and treat many of the leading causes of avoidable blindness and visual impairment. The evaluation and follow-up of eye care training, ongoing support for nurses in the delivery of eye care to their community, and implementation of continuing education are cornerstones for the foundation of a sustainable program for the provision of eye care in Tuvalu.

2004     Primary Eye Care & Presbyopic Spectacles - 13 Senior Nurses
2005     Primary Eye Care, Presbyopic Spectacles & Children's Eyes - 15 Senior Nurses
2006     Train the Trainer & Primary Eye Care - 1 Trainer & 9 Junior Nurses

Project Partners
Ministry of Health, Tuvalu

Project Sponsors
OptiWear, Australia

	Personal Story
	Nurses are learning about the structure of the eye in Tuvalu. Perhaps the story is best told by some comments from the nurse trainees: “I used this information very well for my peoples in my community in testing their eyes about their vision and also teaching the peoples in how to care to their eyes.” “I will share my knowledge and skills with my colleagues at work and I will always refer to the ICEE manual if I have any doubts.” “I think the notes in the manual is very clear and very good to understand, so I would like to thank you for this workshop which really helps me and give me a clear picture of how to recognise or to diagnose what type of eye problem the person, and also how to detect those with poor vision and good vision.”