DOCSLIB.ORG

Leprosy in Kiribati: the Lived Experience

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Leprosy in Kiribati: the Lived Experience Lepr Rev (2020) 91, 353–366 doi:10.47276/lr.91.4.353 Leprosy in Kiribati: the lived experience Lee Thompsona, Nabura Iotebab & Steve Chambersc aAssociate Professor, Department of Population Health, University of Otago, Christchurch, New Zealand bDoctor, Public Health Registrar, Christchurch, New Zealand cProfessor, Department of Pathology, University for Otago, Christchurch, New Zealand Submitted 9 July 2020; Accepted 20 August 2020 Summary Objectives: In spite of much progress around the world in eradicating leprosy, it continues to be a significant problem in the Pacific Island nation of Kiribati. Inorder to better understand elements that may contribute to leprosy’s continuing threat, the research reported in this paper set out to address the following research question: what is the lived experience of leprosy amongst Kiribati people? The research had a qualitative design and used in-depth interviews with seven people with leprosy and one parent who accompanied one of the participants. While there have been small survey projects, there has been no previous in-depth investigation of this topic in Kiribati to our knowledge. Results: Studies in other countries have found that traditional healers played a significant role in how people managed leprosy. There was little evidence that tra- ditional healers played such a role for the participants in this study. Two key themes that did emerge from the data were recognising leprosy and the ongoing role of stigma. Participants did not seem to have a high level of awareness and sometimes misrecognised it. Though some authors have found that stigma is not evident until after people are diagnosed with leprosy, some of the participants in this study anticipated stigma prior to diagnosis, in spite of what appeared to be low levels of awareness of the disease. Stigma, both anticipated and enacted, was evident in a range of settings for participants. Conclusions: There is an ongoing need to understand local context when delivering leprosy awareness programmes to try to avoid reinforcing, rather than mitigating stigmatisation surrounding leprosy. Keywords: Community stigma, social distance, leprosy, Kiribati Correspondence to: Lee Thompson, Associate Professor, Department of Population Health, University of Otago, Christchurch, New Zealand (e-mail: [email protected]) The work reported in this paper was carried out in Kiribati and New Zealand. © The author(s). This article is Open Access under CC BY 4.0 353 354 L. Thompson et al. Introduction The objective of this study was to explore the experiences of those living with leprosy in Kiribati. Leprosy is caused by the bacillus, Mycobacterium leprae (M. leprae) and is amenable to treatment using a prolonged multi-drug treatment (MDT) regime with three antibiotics. Leprosy causes damage to the skin and peripheral nerves and can be severely disfiguring and may manifest itself with a range of dermatological presentations, the most common of which are pale or white lesions.1 In the advanced stages, people can present with very obvious open wounds, ulcerations and physical deformities.2 People with leprosy carry a heavier burden of mental illness,3,4 and therefore psycho-social disability. Even though leprosy is curable, and non-ulcerated skin lesions heal, permanent disfigurement and disability from tissue destruction and nerve damage can give the impression that a cure for leprosy in the fullest sense is not possible.5 Early diagnosis and treatment can prevent disabling complications although they may still have a complicated clinical course. While this disease has been eradicated in many parts of the world, in 2016, over 214,000 new cases of leprosy were reported globally.6 Recent figures indicate that more than 80% of newly detected cases reside in the subtropical regions of India, Brazil, Ethiopia, Bangladesh, and Indonesia.7 Many of the reported cases within the last decade have come from the Pacific Islands, including Kiribati.8,9 It is thought that leprosy was introduced to the Pacific Islands as recently as the 19th century via migration and traders,10 but not absolutely clear when it arrived in Kiribati. Contact between Europeans and Islanders accelerated from about 1830.11 Records show that in 1925 there were 28 known cases of leprosy.12,13 Leprosy has been and remains endemic in Kiribati, with an annualised rate of 15 new cases per 10,000 population during the 2013–2017 period, and higher rates in more populous parts of the islands.13 Kiribati became a republic in 1979. It had been part of the Gilbert and Ellice Islands, which became a British protectorate in 1892 and a Colony in 1916.11,14 The small island nation, with a population of 110,00015,16 consists of 33 coral atolls in three separate island groups.17 The main island of Tarawa is geographically and politically structured into three areas known as North Tarawa, South Tarawa (where most of the government administration and departments are located) and Betio, an islet at the southern end of the main island. Over half the total population (72.9%) lives on the main island of Tarawa with 15.7% of those in Betio. Betio has a land area of less than two square kilometres,16 is very densely populated at 10,377 people per square kilometre and has the highest rates of leprosy.18 Unemployment and overcrowding are major issues for the country.19 Health problems persist in the form of non-communicable diseases, tuberculosis, maternal and childhood morbidity. In the health sector, there are issues with appropriate buildings and facilities, and sub-optimal numbers of clinical and technical health services.20 Inconsistent transportation and the huge spread of the islands and people over a vast ocean area pose major difficulties in the delivery of services.15 Despite these socio-economic and infrastructural challenges, the Ministry of Health and Medical Services administers a publicly funded health system that includes a national referral hospital in South Tarawa (126-bed Nawerewere Hospital), two district hospitals in outer islands, and another small hospital providing basic medical services in Betio. Primary health care is provided through a network of close to 100 health centres and outreach village clinics throughout the islands, staffed by medical assistants who are experienced nurses with advanced training.15 The Kiribati National Leprosy Programme has local staff and an administration building located at the Skin Clinic and National Leprosy Centre. In close partnership with the Ministry of Health and Medical Services, and the World Health Organisation (WHO), the Pacific Leprosy in Kiribati: the lived experience 355 Leprosy Foundation (PLF), which has headquarters in New Zealand, has been the major driver of funding, planning and implementation of initiatives in ongoing leprosy control programmes. In line with the WHO global strategy for the elimination of leprosy, the government of Kiribati, in partnership with the WHO and the PLF implemented a campaign that involved population screening and mass chemo-prophylaxis in the late 1990s, following which the prevalence apparently dropped.21,22 However, between 2003 and 2010, prevalence began to rise above the WHO elimination target, fluctuating between 0.9 and 16.9 per 10,000 population, withnew case detection rates between 22.3 and 179.9 per 100,000 population.23 These large fluctuations likely reflect varying intensities of leprosy surveillance programmes in Kiribati, with high rates in recent years coinciding with increased activities that include contact tracing by the National Leprosy Programme and Skin Clinics organised by the Pacific Leprosy Foundation.18 The need to find ways to halt and control the endemicity of leprosy in Kiribati is becoming more urgent from a public health perspective. People whose diagnosis has been delayed or who remain undiagnosed not only become sources of transmission of the disease, but they are also at real risk of developing severe and disfiguring complications.8,24–28 People with leprosy have such a wide range of symptoms and manifestations of the disease that confusion regarding diagnosis exists amongst both health workers and sufferers alike.29,30 Leprosy symptoms and manifestations vary because of the characteristics of M. leprae and an individual’s immune response to the disease.31,32 Furthermore, the long incubation period for leprosy, ranging from one to 20 years or more, and averaging five years,33,34 adds difficulty to its detection and management. This prolonged phase means that people exposed to and carrying M. leprae may be asymptomatic but be carriers for many years.34 In addition to delayed diagnosis related to the long incubation period, there are a range of other factors that may contribute to delayed diagnosis. Awareness of the disease and its management, stigma and the role of traditional healers have all been identified as potentially important in understanding delayed diagnosis. Raising awareness about the signs and symptoms of leprosy can be challenging. Croft and Croft’s study35 in Bangladesh, for example, comparing knowledge from communities that had received intensive community health education and those that had not, found alarmingly high proportions of people who did not know the cause of leprosy in both communities (84% and 96% respectively). A recent project by Batio,36 looking at factors that contribute to late presentation among i-Kiribati people with leprosy, reported that a significant number of participants (23/29) claimed they were not aware of leprosy. Stigma
Load more

Recommended publications
  • The Dynamic Gravity Dataset: Technical Documentation
    The Dynamic Gravity Dataset: Technical Documentation Lead Authors:∗ Tamara Gurevich and Peter Herman Contributing Authors: Nabil Abbyad, Meryem Demirkaya, Austin Drenski, Jeffrey Horowitz, and Grace Kenneally Version 1.00 Abstract This document provides technical documentation for the Dynamic Gravity dataset. The Dynamic Gravity dataset provides extensive country and country pair information for a total of 285 countries and territories, annually, between the years 1948 to 2016. This documentation extensively describes the methodology used for the creation of each variable and the information sources they are based on. Additionally, it provides a large collection of summary statistics to aid in the understanding of the resulting Dynamic Gravity dataset. This documentation is the result of ongoing professional research of USITC Staff and is solely meant to represent the opinions and professional research of individual authors. It is not meant to represent in any way the views of the U.S. International Trade Commission or any of its individual Commissioners. It is circulated to promote the active exchange of ideas between USITC Staff and recognized experts outside the USITC, professional devel- opment of Office Staff and increase data transparency by encouraging outside professional critique of staff research. Please address all correspondence to [email protected] or [email protected]. ∗We thank Renato Barreda, Fernando Gracia, Nuhami Mandefro, and Richard Nugent for research assistance in completion of this project. 1 Contents 1 Introduction 3 1.1 Nomenclature . .3 1.2 Variables Included in the Dataset . .3 1.3 Contents of the Documentation . .6 2 Country or Territory and Year Identifiers 6 2.1 Record Identifiers .
    [Show full text]
  • Sustained Prehistoric Exploitation of a Marshall Islands Fishery
    Sustained prehistoric exploitation of a Marshall Islands fishery: ichthyoarchaeological approaches, marine resource use, and human- environment interactions on Ebon Atoll Ariana Blaney Joan Lambrides BA (Hons) A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in 2017 School of Social Science Abstract Atolls are often characterised in terms of the environmental constraints and challenges these landscapes impose on sustained habitation, including: nutrient-poor soils and salt laden winds that impede plant growth, lack of perennial surface fresh water, limited terrestrial biodiversity, and vulnerability to extreme weather events and inundation since most atolls are only 2-3 m above sea level. Yet, on Ebon Atoll, Republic of the Marshall Islands in eastern Micronesia, the oceanside and lagoonside intertidal marine environments are expansive, with the reef area four times larger than the land area, supporting a diverse range of taxa. Given the importance of finfish resources in the Pacific, and specifically Ebon, this provided an ideal context for evaluating methods and methodological approaches for conducting Pacific ichthyoarchaeological analyses, and based on this assessment, implement high resolution and globally recognised approaches to investigate the spatial and temporal variation in the Ebon marine fishery. Variability in landscape use, alterations in the range of taxa captured, archaeological proxies of past climate stability, and the comparability of archaeological and ecological datasets were considered. Utilising a historical ecology approach, this thesis provides an analysis of the exploitation of the Ebon marine fishery from initial settlement to the historic period—two millennia of continuous occupation. The thesis demonstrated the importance of implementing high resolution methods and methodologies when considering long-term human interactions with marine fisheries.
    [Show full text]
  • Marshall Islands
    Country Guide to Gamefishing in the Western and Central Pacific by Wade Whitelaw Oceanic Fisheries Programme Secretariat of the Pacific Community 2001 © Copyright Secretariat of the Pacific Community 2001 All rights for commercial / for profit reproduction or translation, in any form, reserved. The SPC authorises the partial reproduction or translation of this mate- rial for scientific, educational or research purposes, provided the SPC and the source document are properly acknowledged. Permission to reproduce the docu- ment and/or translate in whole, in any form, whether for commercial / for profit or non-profit purposes, must be requested in writing. Original SPC artwork may not be altered or separately published without permission. Original text: English Secretariat of the Pacific Community Cataloguing-in-publication data Whitelaw, Wade Country guide to gamefishing in the Western and Central Pacific: by Wade Whitelaw 1. Fishing - Oceania. 1. Title 2. Secretariat of the Pacific Community 799.1665 AACR2 ISBN 982–203–817–8 Secretariat of the Pacific Community BP D5 98848 Noumea Cedex New Caledonia Telephone: + 687 26 20 00 Facsimile: + 687 26 38 18 E-mail: [email protected] http://www.spc.int/ Funded by AusAID Layout: Muriel Borderie Prepared for publication and printed at Secretariat of the Pacific Community headquarters Noumea, New Caledonia, 2001 CONTENTS INTRODUCTION . .1 BACKGROUND . .2 SOURCES OF INFORMATION . .4 RESULTS . .4 WORLD RECORDS . .5 SEASONALITY OF GAMEFISH SPECIES . .5 SEASONALITY OF TOURISM . .5 SUMMARY OF INFORMATION BY COUNTRY . .6 American Samoa . .7 Cook Islands . .11 Federated States of Micronesia . .15 Fiji Islands . .19 French Polynesia . .23 Guam . .27 Kiribati . .31 Marshall Islands .
    [Show full text]
  • ATOLL RESEARCH Bulletln
    ATOLL RESEARCH BULLETlN NO. 235 Issued by E SMTPISONIAIV INSTITUTION Washington, D.C., U.S.A. November 1979 CONTENTS Abstract Introduction Environment and Natural History Situation and Climate People Soils and Vegetation Invertebrate Animals Vertebrate Animals Material and Methods Systematics of the Land Crabs Coenobitidae Coenobi ta Coenobi ta brevimana Coenobi ta per1 a ta Coenobi ta rugosa Birgus Birgus latro Grapsidae Geogxapsus Geograpsus crinipes Geograpsus grayi Metopograpsus Metopograpsus thukuhar Sesarma Sesarma (Labuaniurn) ?gardineri ii Gecarcinidae page 23 Cardisoma 2 4 Cardisoma carnif ex 2 5 Cardisoma rotundum 2 7 Tokelau Names for Land Crabs 30 Notes on the Ecology of the Land Crabs 37 Summary 4 3 Acknowledgements 44 Literature Cited 4 5 iii LIST OF FIGURES (following page 53) 1. Map of Atafu Atoll, based on N.Z. Lands and Survey Department Aerial Plan No. 1036/7~(1974) . 2. Map of Nukunonu Atoll, based on N.Z. Lands and Survey Department Aerial Plan No. 1036/7~sheets 1 and 2 (1974). 3. Map of Fakaofo Atoll, based on N.Z. Lands and Survey Department Aerial Plan No. 1036/7C (1974). 4. Sesarma (Labuanium) ?gardineri. Dorsal view of male, carapace length 28 rnm from Nautua, Atafu. (Photo T.R. Ulyatt, National Museum of N. Z.) 5. Cardisoma carnifex. Dorsal view of female, carapace length 64 mm from Atafu. (Photo T.R. Ulyatt) 6. Cardisoma rotundurn. Dorsal view of male, carapace length 41.5 mm from Village Motu, Nukunonu. (Photo T.R. Ulyatt) LIST OF TABLES 0 I. Surface temperature in the Tokelau Islands ( C) Page 5 11. Mean rainfall in the Tokelau Islands (mm) 6 111, Comparative list of crab names from the Tokelau Islands, Samoa, Niue and the Cook islands, 3 5 IV.
    [Show full text]
  • Hold Fast to the Treasures of Tokelau; Navigating Tokelauan Agency in the Homeland and Diaspora
    1 Ke Mau Ki Pale O Tokelau: Hold Fast To The Treasures of Tokelau; Navigating Tokelauan Agency In The Homeland And Diaspora A PORTFOLIO SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAI’I IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN PACIFIC ISLANDS STUDIES AUGUST 2014 BY Lesley Kehaunani Iaukea PORTFOLIO COMMITTEE: Terence Wesley-Smith, Chairperson David Hanlon John Rosa 2 © 2014 Lesley Kehaunani Iaukea 3 We certify that we have read this portfolio and that, in our opinion, it is satisfactory in scope and quality as a portfolio for the degree of Master of Arts in Pacific Islands Studies. _____________________________ Terence Wesley-Smith Chairperson ______________________________ David Hanlon ______________________________ John Rosa 4 Table of Contents Table of Contents 4 Acknowledgements 6 Chapter One: Introduction 8 1. Introduction 8 2. Positionality 11 3. Theoretical Framework 13 4. Significance 14 5. Chapter outline 15 Chapter Two: Understanding Tokelau and Her People 18 1. Tokelau and her Atolls 20 2. Story of Creation from abstract elements 21 3. Na Aho O Te Pohiha (The days of darkness) 21 4. Peopling of the Tokelau Atolls 23 5. Path of Origin 24 6. Fakaofo 25 7. Nukunonu 26 8. Atafu 26 9. Olohega 26 10. Olohega meets another fate 27 11. Western contact 30 12. Myth as Practice 31 Chapter Three: Cultural Sustainability Through an Educational Platform 33 1. Education in Tokelau 34 2. The Various Methods Used 37 3. Results and impacts achieved from this study 38 4. Learning from this experience 38 5. Moving forward 43 6.
    [Show full text]
  • Håfa Adai Everyday
    SharingHåfa the Håfa AdaiAdai Spirit with EverydayOur Visitors and Each Other February 2016, Volume 4, Issue No. 12 HÅFA ADAI PLEDGE CEREMONY LIVING THE HÅFA ADAI PLEDGE Service with Håfa Adai is our business Guahan Insurance’s team from left: Brent Butler, Yuka Oguma, Shyla Santiago, Erica Gumataotao, Lorna Malbog, Dee Camacho, Naidene Rios and Kyoko Nakanishi. A HÅFA ADAI PLEDGE CEREMONY WAS HELD JANUARY 26 AT TERRY’S LOCAL COMFORT FOOD IN TUMON. From left: Edrienne Hernandez, family Guahan Insurance Services, Inc.’s (GIS) main focus and approach every day is member, Terry's Local Comfort Food; Kotwal Singh, owner, Singh's Cafe - to provide the highest level of service. It is important that we emphasize the Kabab Curry; Anthony J.G. Tornito, sole proprietor, Minahgong; Shalyn Allen, Håfa Adai Spirit as we welcome our customers and make them feel right at principal broker, Welcome Home Realty; Nadja Rillamas, realtor, Welcome home. Our licensed insurance associates will help individuals, families and Home Realty; Allison Sollenberg, realtor, Welcome Home Realty and Bianca businesses with customizable coverage that fits their needs and oer savings Cloud, realtor, Welcome Home Realty, proudly display their newly signed Håfa on combined packages. Adai Pledge certificates. Insurance transactions are unique and unlike any other line of business, because the product you purchase is an intangible item. Unlike trying on KAO UN TUNGO’? (Did you know?) clothes or test-driving a vehicle, insurance is dicult to sample. It is important that we eectively communicate and build customer confidence during this Agad’na: Canoe Builders transaction. Our insurance associates can help you map out the best coverage and thoroughly explain the sometimes intricate policy wordings.
    [Show full text]
  • Unlocking the Secrets of Swains Island: a Maritime Heritage Resources Survey
    “Unlocking the Secrets of Swains Island:” a Maritime Heritage Resources Survey September 2013 Hans K. Van Tilburg, David J. Herdrich, Rhonda Suka, Matthew Lawrence, Christopher Filimoehala, Stephanie Gandulla National Marine Sanctuaries National Oceanic and Atmospheric Administration Maritime Heritage Program Series: Number 6 The Maritime Heritage Program works cooperatively and in collaboration within the Sanctuary System and with partners outside of NOAA. We work to better understand, assess and protect America’s maritime heritage and to share what we learn with the public as well as other scholars and resource managers. This is the first volume in a series of technical reports that document the work of the Maritime Heritage Program within and outside of the National Marine Sanctuaries. These reports will examine the maritime cultural landscape of America in all of its aspects, from overviews, historical studies, excavation and survey reports to genealogical studies. No. 1: The Search for Planter: The Ship That Escaped Charleston and Carried Robert Smalls to Destiny. No. 2: Archaeological Excavation of the Forepeak of the Civil War Blockade Runner Mary Celestia, Southampton, Bermuda No. 3: Maritime Cultural Landscape Overview: The Redwood Coast No. 4: Maritime Cultural Landscape Overview: The Outer Banks No. 5: Survey and Assessment of the U.S. Coast Survey Steamship Robert J. Walker, Atlantic City, New Jersey. These reports will be available online as downloadable PDFs and in some cases will also be printed and bound. Additional titles will become available as work on the series progresses. Cover Image - Figure 1: Swains Island satellite image: Image Science & Analysis Laboratory, NASA Johnson Space Center.
    [Show full text]
  • Turtlephilia in the Pacific: an Integrated Comparative
    TURTLEPHILIA IN THE PACIFIC: AN INTEGRATED COMPARATIVE ANALYSIS FROM THE PERSPECTIVES OF BIOLOGICAL, CULTURAL, AND SPIRITUAL ECOLOGY IN A PARTICULAR CASE OF BIOPHILIA A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAIʻI AT MĀNOA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN ANTHROPOLOGY MAY 2013 By Regina Woodrom Luna Dissertation Committee: Leslie Sponsel, Chairperson Charles Birkeland Alice Dewey Sherwood Maynard Heather Young-Leslie Keywords: Sea Turtle, Traditional Laws, Cultural Take, Consumption, Tapu, Tabu, Kapu, Taboo, Oceania, Polynesia, Myth, Legend, Ritual, Creation Story Acknowledgments First and foremost, I would like to thank my wonderful husband, Jason Rudrud, without whose support -- both physically by picking up sea turtles with all their weight, and mentally by picking me up when it seemed as if my health issues would not allow me to finish – this dissertation would never have been completed. He is my hero and this is his accomplishment as much as it is mine. Next, I would be remiss without acknowledging the tremendous and never-ending support of my mother and chief editor, Mary Anne Woodrom; my dad and step-mother, Harold and Marilyn Woodrom; and my sister and assistant editor, Rebecca Reid and my brother-in-law, Lynn. My brother Roy Woodrom, whose generosity with his frequent flier miles sent me to ECOnference 2000, which set me on my path to study sea turtles as an undergraduate at Texas A&M. The rest of my extended family, especially my aunt Dr. Sandra Luna McCune for her editing assistance, also deserve acknowledgement for always being there for me regardless of the paths I choose to take.
    [Show full text]
  • SPC Climate Change and Disaster Risk Management Support Activities in Pacific Island Countries and Territories
    SPC climate change and disaster risk management support activities in Pacific Island countries and territories 2013 Compiled by the Secretariat of the Pacific Community (SPC) © Copyright Secretariat of the Pacific Community (SPC), 2013 All rights for commercial / for profit reproduction or translation, in any form, reserved. SPC authorises the partial reproduction or translation of this material for scientific, educational or research purposes, provided that SPC and the source document are properly acknowledged. Permission to reproduce the document and/or translate in whole, in any form, whether for commercial / for profit or non-profit purposes, must be requested in writing. Original SPC artwork may not be altered or separately published without permission. Original text: English Secretariat of the Pacific Community Cataloguing-in-publication data SPC climate change and disaster risk management support activities in Pacific Island countries and territories: 2013 / compiled by the Secretariat of the Pacific Community (SPC) 1. Climatic changes — Oceania. 2. Environment — Management — Oceania. 3. Climatic changes — Management — Oceania. 4. Risk management — Oceania. I. Title II. Secretariat of the Pacific Community 577.22 AACR2 ISBN: 978-982-00-0646-1 Contents Purpose of document .................................................................................................................... 1 SPC national climate change support activities in Pacific Island countries and territories ............ 2 American Samoa......................................................................................................................
    [Show full text]
  • Pacific Islands by the University of the South Pacific Suva, Fiji ©H.E
    imfcm fehk, 1 b . ,.' " * l Sm, , -.< äflj -Ff r.*^ ¥ ^ m / h i ^ r w ljt ■ ft' ■ ■ p 8fi > “*% A \ iß^jÄ . 1 "jSSm V * ■P* f 4 md ‘ 'Jt W W f l I ^ ■ V 6 ' j p w ~ i I V A U . GROUP - 10“ - 3 Q 0 o q ' Sunäav I. rPLBASS RETURN 7 _ . _......._ ■ K.ERMADEC • ' GROUP I EDiiOVJAL DEPARTMENT , Santiago y l / CHILE ( / »iM tiä yilOtiM yNiV£fiS!TV[i i Auckland i*** -I - * * »■% If* _40° \ / n e w ) 40»- RECOMMENDED RETi f l D S O ' /ZEA LA N D f PUBLICATION DATE ■H d M 180° 160° 140° 120° KK)0 80° I__ I | % Main Routes Gomez (2); Urmeneta y Ramos; Barbara 10 Guillermo: from Rapa. Notes Gomez (repatriation voyage). 11 lose Castro: from Rapa. 1 Northern Route from Callao to or through Southern route from Easter Island to Rapa, 12 Rosa Patricia: from Rapa. 1 Routes within island groups are not shown the Marquesas and Northern Cook Groups, taken by Cora (via Mangareva); Guillermo; 13 Rosa y Carmen: from Rapa. but are detailed in Table 2. taken by Adelante (1|; Jorge Zahaza; Jost Castro; Rosa Patricia; Rosa y Carmen 14 Micaela Miranda: from Rapa. 2 Voyages (route numbers) in an easterly Manualita Costas; Trujillo; Apuiimac; (via Mangareva); Micaela Miranda; Misti; 15 Ellen Elizabeth: from Tongareva. direction are underlined. Eliza Mason; Adelante (2); Genara; Barbara Gomez 16 Dolores Carolina; Polinesia; Honorio; from 3 The return route is only shown to the last Empresa; Dolores Carolina; Polinesia; (repatriation voyage). Pukapuka. island visited, from which ships are Adelante (3); General Prim (2|; Diamant Other Routes 17 La Concepcion.
    [Show full text]
  • Healthy Islands: Best Practices in Health Promotion in the Pacific
    Healthy Islands: Best Practices in Health Promotion in the Pacific Healthy Islands: Best Practices in Health Promotion in the Pacific a a Healthy Islands: Best Practices in Health Promotion in the Pacific © World Health Organization 2017 ISBN-13 978 92 9061 827 0 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules). Suggested citation. Healthy islands: best practices in health promotion in the Pacific. 2017. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data.
    [Show full text]
  • Wayfinding in Pacific Linguascapes: Negotiating Tokelau Linguistic Identities in Hawai‘I
    WAYFINDING IN PACIFIC LINGUASCAPES: NEGOTIATING TOKELAU LINGUISTIC IDENTITIES IN HAWAI‘I A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAI‘I AT MĀNOA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN LINGUISTICS AUGUST 2012 By Akiemi Glenn Dissertation Committee: Yuko Otsuka, Chairperson Michael Forman Katie Drager William O’Grady Richard Schmidt TABLE OF CONTENTS Dedication and acknowledgments i Abstract iv List of tables and figures v Epigraph vi 1. Introduction and research questions 1 1.1 Introduction 1 1.2 Research questions 2 1.3 Tokelau linguistic identity in a transnational space 4 1.3.1 The Tokelauan language in the diaspora 9 1.3.2 Olohega in Tokelau 12 1.4 Tokelauans in Hawai'i 16 1.4.2 Te Lumanaki o Tokelau i Amelika School 18 1.4.3 Tokelau identities in Hawai'i 23 1.5 Overview of the study 25 2. Theoretical frameworks 26 2.1 Introduction 26 2.2 Theories of community 26 2.2.1 Speech communities and communities of practice 27 2.2.2 Imagined communities 29 2.3 Language and place 31 2.3.1 Multilocality and multivocality 31 2.3.2 Linguistic ecologies 33 2.4 Social meaning and metalinguistic knowledge 35 2.4.1 Performance and performativity 35 2.4.2 Indexicality 36 2.4.3 Enregisterment 37 2.4.4 Stancetaking in discourse 38 2.4.5 Crossing 40 2.4.6 Language ideology 41 2.5 Ideologies of language maintenance and endangerment 41 2.5.1 Heritage language 42 2.5.2 Language revitalization and endangerment 44 3.
    [Show full text]