This article first appeared in The Lancet on 06 May 2023 .
In December, 2022, Joanne Clarke flew home to the UK for the Christmas holidays. She had been working in Australia where she was in the final stages of training as a paediatrician. One morning, during her break, she awoke to a multitude of texts and missed calls from a Médecins Sans Frontières (MSF) staffer who manages doctors' postings. The staffer informed her that there was an urgent need for a specialist paediatrician in the island nation of Kiribati, located in the Pacific Ocean, as the current one was leaving the country for another job.
“The first messages were ‘are you interested?’” Clarke remembers. “An hour later, the next message said: ‘I've put you forward.’” Clarke was bemused but intrigued. She had already spent time working with MSF in South Sudan and Afghanistan, and agreed to take the Kiribati post, thinking it would be an interesting change. However, once she arrived at Tungaru Central Hospital to begin her 5-month assignment there, she realised that the reality was much more complex.
Kiribati, made up of 32 atolls and one raised coral island situated between Australia and Hawaii, is one of the poorest countries in the Pacific region. Around half of the 120,000 population live in the overcrowded capital South Tarawa, where unsanitary conditions are common and tuberculosis is rife. Fertility rates in Kiribati are high, but it has one of the highest rates of neonatal mortality in the Pacific region (ie, 39 deaths per 1,000 livebirths, compared with 3 deaths per 1000 livebirths in Australia) and under 5 mortality (48 deaths per 1,000 children). Covering an immense area, mainly ocean, it also has one of the lowest rates of access to primary care in the world.