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To request permissions please use the Feedback form on our webpage. http://researchspace.auckland.ac.nz/feedback General copyright and disclaimer In addition to the above conditions, authors give their consent for the digital copy of their work to be used subject to the conditions specified on the Library Thesis Consent Form and Deposit Licence. OLA LEI: DEVELOPING HEALTHY COMMUNITIES IN TUVALU Tufoua Panapa A thesis submitted in fulfilment of the requirements for the degree of a PhD in Development Studies, The University of Auckland, 2014. i ii ABSTRACT My research examines the relationships between the formal health and education sectors, schools, external donors, non-government organisations (NGOs) and communities with regard to health in Tuvalu. A significant contribution of my research is the development of a Tuvaluan conceptual framework for health and wellbeing, which I have called the Ola Lei Conceptual Framework. My thesis takes seriously the embeddedness of culture in health (Dixon, Banwell & Ulijaszek, 2013). Throughout my thesis I raise the issue of the autonomy of Tuvalu as a recipient of aid, and the necessity of developing cooperative partnerships between donor and recipient through which can be forged mutually agreed goals and practices. Indeed the concept of caring for relationships or partnerships (tausi te vasia) pervades the thesis, because relationships at all levels are central to all aspects of health. But even when there is equality in specific partnerships, Tuvalu is faced with a major challenge to its society and culture, which was introduced with colonialism and continued through the post- colonial period: that of a sharing-based economy which used mainly local products now being progressively integrated into a market-driven globalised economy with very different values and practices. My research was based on a series of three fieldwork periods between 2010 and 2014 in Tuvalu on the contrasting islands of Funafuti and Vaitupu. Funafuti is urbanised, while Vaitupu is rural and the site of the national state secondary school. I employed qualitative methodologies including document analysis, interviews, participant observation, and focus groups, and I supplemented this material with available health and population statistics. My particular focus is to examine the ‘gaps between’ (vasia) health policies, what people say and do about health, what happens in everyday life, and the needs and desires of communities and schools in relation to health. As a result, I argue that an approach to health and wellbeing development, which is built on frameworks drawn from contemporary health promotion and ola lei, can assist the health and education sector to work together with NGOs, communities, and external agencies to promote health and wellbeing in Tuvalu. Keywords: Pacific, Tuvalu, development, health, education, ethnography, indigenous iii ACKNOWLEDGEMENTS There is a saying in Tuvalu: Moi isi se mea e maluga atu i te ‘fakafetai’, e avatu loa ne au. ‘If there is anything more precious and priceless than “thanks”, I will give it’. And this is what I am feeling right now – I wish I could repay now all the people and institutions who have helped me with something that is more than a fakafetai. Firstly, I would like to acknowledge the ‘Transnational Health in the Pacific through the lens of TB’ Project, funded by the New Zealand Health Research Council, and the University of Auckland for the financial support. You were the entrance doors of my journey – fakafetai lasi. I am also indebted to the members of the project, mainly Professor Julie Park, Associate Professor Judith Littleton, Professor Anne Chambers, Dr Keith Chambers, Associate Professor Yvonne Underhill-Sem, Dr Jennifer Hand, Mrs Sagaa Malua, and Mrs Evelyn Marsters, for all the academic contributions and words of encouragement, during our reading sessions and other gatherings. Fakafetai lasi. Fakafetai lasi to my five supervisors, who have gigantic hearts and managed to put up with such a simple guy from an island. Fakafetai lasi Associate Professor Yvonne Underhill-Sem, my main supervisor, for the endless support you gave me, the guidance and advice for me to be more critical, and the smile when I was around. Professor Julie Park and Associate Professor Judith Littleton are unique individuals; I am so lucky to have them. Their expertise and intelligence have guided me through all these years. Their ‘motherly’ personalities – the care and faiga-alofa – have given me hope during the bad days and saved me from many stressful moments. Fakafetai lasi. My fakafetai lasi also goes to Dr Keith Chambers and Professor Anne Chambers for their deep understanding of Tuvalu, which guided me well through this programme.Though they live and work in Oregon, USA, they found time to supervise me, through Skype and in person. Fakafetai lasi. Thirdly, I thank you my Development Studies Ph.D. colleagues – Akiko Horita and Evelyn Marsters – for your friendship. What a lovely bunch of people to learn and get help from. I would also like to acknowledge the great assistance that I got from Sagaa Malua, who transcribed some interviews for me. I am also thankful for Briar Sefton, the illustrator in Anthropology, for drawing a perfect octopus for me, and Pauline Herbst and Ally Palmer for proofreading and doing the layout of my thesis. Fakafetai lasi to you all. Dr Steven Homasi (Director of Health), Dr. Nese Conway, Dr Puakena Boreham, Dr Maliesi Toakai, and Nurse Temilo Laitailiu from the Department of Health have been iv helpful in my research. The Secretary and Director of Education, Paulson Panapa and Katalina Patiale, supported me all the time. Thank you for believing in me. To the principal and deputy principal of Motufoua Secondary School (Leti Pelesala and Siautele Lito), senior teachers at Motufoua Secondary School (Kapuaua Eli, Neaki Letia and Fineaso Tehulu), the principal of Fetuvalu High School (Penehuro Hauma), and all principals of Nauti Primary School, Seventh Day Adventist School, and Tolise Primary School – thank you so much for your time and help. To all my research participants from the Departments of Education and Health, schools, various government departments, NGOs (mainly TANGO, TuFHA, and TRCS), Funafuti and Vaitupu Islands kaupule (local government), churches, and various communities: without you, this research project would not have been possible. Fakafetai lasi. To my family and friends in Tuvalu and in NZ, I have struggled, but thank you for your prayers. Thank you Sam Panapa, my brother, and all other siblings, and my mother, Loloma Panapa, for your words of encouragement, and financial assistance. To my PAPESU family in Auckland, NZ – you contributed so much to this journey. You always give me warmth care, happiness and financial assistance when I need them. Fakafetai lasi to the Nui Community, Nukulaelae Community, my dear Vaitupu Community, Te Kaunibiti Family, and my church Malie Tasi in Auckland – you all made me feel at home. To my brother and guardian, Iupeli Taufilo, and wife Fataliga Iupeli, thank you so much for bearing with me for four years. Thank you for the accommodation, food, and financial support. Fakafetai lasi e taina! Last but not least, fakafetai to my wife, Asogali Faavae Panapa, for struggling with me in this life, and in my Ph.D. programme. Your ideas and contributions are priceless. To my two daughters – Tiale Mele Panapa and Liutala Elisefou Littlehillparkers Panapa – though you interrupted me many times, you gave me strength in my journey. What we have gone through strengthened my faith in God even more. To my father – the late Panapa Panapa – you are the reason that I have come this far. E puli pefea a koe ia au nei? Me ia koe ko te kaualai-aagai o taku kete-malaga. In spirit, this thesis is dedicated to you. I aso matagi taatilitili, a te Aliki e ana tausia au. Fakafetai te Atua. v TABLE OF CONTENTS ABSTRACT iii ACKNOWLEDGEMENTS iv CHAPTER 1: INTRODUCTION 1 1.1 Introduction to the Research 1 1.2 Health Promotion & Ola lei Conceptual Framework 3 1.3 Research Aims and Significance 5 1.4 Tuvalu Context 7 1.4.1 Geography and Population 7 1.4.2 Historical Background 9 1.4.3 Development of Tuvalu 12 1.4.4 Education and health 16 1.5 Research Design and Methods 20 1.5.1 Research Context and Stages of Fieldwork 20 1.5.2 Stages of Field Research and Research Participants 21 1.5.3 Methodology 25 1.6 Structure of the Thesis 333 CHAPTER 2: COMPETING CONCEPTS AND APPROACHES TO ‘HEALTH’ AND ‘EDUCATION’ 35 2.1 Introduction 35 2.2 Health 35 2.2.1 Ola Lei Conceptual Framework 37 2.2.2 World Health Organization’s (WHO) Concept 37 2.2.3 Communities’ Conceptions 40 2.3 Development Context – Education and Health 46 2.3.1 Education and Development 49 2.3.2 Health and Development 52 2.3.3 Challenges to Education and Development 53 2.3.4 Challenges to Health and Development 54 2.3.5 Development? 56 2.3.6 Education and Health: Making the Link 57 2.3.7 Development Links to Education and Health 59 2.4 Conclusion 60 vi CHAPTER 3: OLA LEI – TRADITIONAL CONTEXT OF ‘LIVING WELL’ 63 3.1 Introduction 63 3.2 What is Ola Lei? 64 3.2.1 Filemuu (Harmoniousness and Peacefulness) 65 3.2.2 Fiafia (Happiness and Contentment) 68 3.2.3 Malosi (Fitness) 74 3.2.4 Ola Leva (Longevity) 76 3.3.