The extreme mortality due to measles on Rotuma typifies the experiences of isolated populations after first encounters with measles; it suggests that prior exposures to a narrow range of microbes and genetic homogeneity predispose isolated populations to lethal outcomes when they are first exposed to highly contagious and pathogenic viruses e.
The first known recorded contact with Western explorers occurred in , when the HMS Pandora arrived in search of the Bounty mutineers. Rotuma was inhabited by a Polynesian people whose subsistence economy was based on root crops and coconuts, while protein was supplied by pigs and fish.
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In the latter half of the 19th century, French priests and English Wesleyan ministers arrived and competed for converts. Antagonisms between the newly converted Wesleyans and Catholics mounted until , when they culminated in a skirmish in which the Catholics were defeated by the numerically superior Wesleyans. The unrest that followed this conflict led the chiefs of Rotuma to cede the island to Great Britain to preclude French intervention. Cession was formalized in , after which Rotuma was governed by the British as part of the Colony of Fiji, despite being nearly km distant 1.
The colonial administration closed Rotuma as a port of entry, thus requiring all visitors to the island to come from or go through Fiji. Because of the island's extreme isolation, the assigned Resident Commissioner was usually also a medical officer. The Rotuman population was predominately of Polynesian ancestry, although interbreeding with other Pacific Islanders and a limited number of Caucasian seamen who had abandoned their voyaging life to live on Rotuma added to the composition of the gene pool 1.
In discussions with J. Stanley Gardiner in , Chief Marafu described a highly lethal infectious epidemic that had occurred on Rotuma when he was a child i. The description was inexact as to the nature of the disease, and there are no corroborating accounts by visitors to the island. As in Fiji, there was great official concern regarding the decreasing native population, which when enumerated appeared to be related more to high infant and childhood mortality rates than to a falling birth rate 3 , 4.
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When measles is introduced into an isolated population, it often causes high mortality in all age groups. The extreme mortality from epidemic measles on Pacific islands is not easily explained, since there is no direct evidence of hypervirulent strains of measles virus or genetic predispositions to fatal outcomes after measles infection.
In the late 19th century, transoceanic steamship travel brought measles virus to most Pacific islands. Because population censuses and mortality registrations were not yet institutionalized on many islands, the numbers, natures, and timing of deaths occurring during measles epidemics were generally not systematically documented 6. The measles epidemic on the island of Rotuma in is a notable exception. A strict quarantine was established on Rotuma in response to the disastrous measles epidemic that occurred on Fiji in The quarantine and the geographic remoteness of Rotuma protected it from measles until late January , when a ship bearing 2 sick women landed on the island; the island's medical officer was absent at the time 7 , 8.
For other purposes, one of the authors recovered the detailed population and mortality registers kept by Hugh McDonald, the medical officer of Rotuma in , as well as records of all births, marriages, and deaths of Rotumans that took place through These records enabled a detailed examination of mortality after a point-source introduction of measles virus into an immunologically naive population with a very narrow genetic base due to geographic isolation and founder effect 7 , 8 , The findings suggest that prior exposure to a narrow range of microbes and the genetic homogeneity of the closed Rotuman population contributed to the extreme measles-related mortality in The primary data used for analyses were obtained from original documents located on Rotuma in the s and from archives located in Suva, Fiji of birth, marriage, and death records pertaining to Rotumans.
Mortality registers documented the following information regarding each death that occurred on Rotuma from to date of death, place of death, name, age, sex, cause s of death 1 or 2 diagnoses , names of parents, burial place and date, birthplace, and name of informant For this analysis, the names of Rotumans who were alive anytime in were identified by aggregating and reviewing birth and death records from years prior to and during Because some Rotumans lived on Fiji or worked at sea, the locations of all Rotumans during the measles epidemic could not be determined with certainty; however, the presence of approximately 2, persons on the island during the epidemic is well documented.
One of the authors reviewed the unedited mortality register entries. Based on his review, 21 mortality categories were defined; these were further aggregated into 6 major mortality categories which were used for most analyses. The major mortality categories were measles-related, tuberculosis, gastrointestinal diarrhea, dysentery, gastroenteritis , pneumonia and influenza, other infectious, and noninfectious. All other death records were categorized on the basis of the first listed cause.
No morbidity records other than annual Fijian medical reports were available for review 8. The endpoints of the analyses were deaths overall and in major mortality categories occurring among members of a cohort that included all persons who had resided on Rotuma anytime during For mortality rate calculations, person-time at risk for each cohort member was calculated as the number of days from the beginning of the follow-up period January 1, or the date of birth if after January 1, to the death of the cohort member or the end of the follow-up period December 31, Survival experiences in relation to age group, geographic district, and birth cohort were summarized using the Kaplan-Meier and classical life-table 2-year intervals methods.
In , although the only contact between Rotuma and the rest of the world was by sea, there were no dedicated port facilities i. During , Rotumans died from all causes; the cumulative mortality incidence during the year was Measles-related deaths began in February, peaked in April, sharply decreased in May, and continued sporadically through the rest of Figure 2.
Measles mortality on Rotuma in following the introduction of the measles virus in late January A and all tuberculosis B and gastrointestinal C deaths occurring during the same time period. During , among Rotumans of both sexes and all age groups except those older than 55 years , measles accounted for more deaths by far than any other category of mortality causes Table 2.
Sex was unknown for some persons mortality rate for persons of unknown sex: 3. In contrast, only 1 measles-related death was associated with pneumonia, influenza, or other respiratory infection data not shown. Deaths that were attributed to tuberculosis or gastrointestinal causes without mention of measles occurred sporadically through Figure 2. Notably, there were more tuberculosis-related deaths among study cohort members in than in any other year through Figure 4.
Because tuberculosis and gastrointestinal pathogens were endemic on Rotuma in , they probably co-circulated with measles throughout the epidemic period; if so, some deaths attributed to tuberculosis or gastrointestinal illnesses alone in may have been precipitated or complicated by measles.
Annual numbers of deaths left y -axis and incidence rates of death right y -axis due to tuberculosis and gastrointestinal illnesses among persons who resided on Rotuma in , by calendar year, — The timing and intensity of measles-related mortality sharply varied across age groups. Measles-related deaths affected adults aged 16—35 years and aged 36—55 years concurrently; however, a much higher proportion of adults aged 16—35 years than Rotumans of any other age except children under 6 years were affected overall Figure 5A. Similar proportions of Rotumans aged 6—15 years and aged 36—55 years, but relatively few older than age 55 years, died of measles during the epidemic period Figure 5A.
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During the epidemic period, Rotumans as old as 80 years died of measles; the finding supports the historical evidence that the epidemic involved the first exposure of Rotumans, regardless of age, to the measles virus. Kaplan-Meier curve for survival following the measles epidemic on Rotuma, by A age group and B geographic district. For districts, refer to the map in Figure 1. The timing, intensity, and overall mortality effects of measles also markedly varied across the 7 geographic districts of Rotuma Table 3 , Figure 5B.
The dynamics of measles-related mortality did not precisely reflect—but probably indicate—the spread of measles virus throughout the island. The dates of index measles-related deaths across districts suggest that the virus spread throughout the island in approximately 5 weeks: from the likely point of introduction in the south, along the southern coast, and eventually to the northern coastal districts.
Although residents of each district were probably affected by the same strain of measles virus, there was more than a 3-fold difference in measles-related mortality across the districts cumulative incidence of measles-related mortality by district was 7. Hereniko had some heavyweight help in getting this film from dream to reality. Atkins and his Emmy Award-winning sound-recordist wife, Grace Niska Atkins are known throughout the world for their films on cultures and wildlife. In the end, the films that satisfy us most have at their heart a wonderful story, beautifully told.
His current professional work is primarily in commercials. Brad is a self-confessed "motion picture addict. Truth, Justice, and the Rotuman Way; This is a winner! It tells the story of a young girl growing up in a poor but loving family on a remote island in the South Pacific. And while the narrative seems on the surface to be a fairly straightforward coming-of-age film, as you peel back the layers you discover a complicated tale of hopes, dreams and just plain survival within a culture ruled by colonial occupation and preyed upon by political corruption.
This is not a simple movie and cannot be summed up in a few well-chosen words. First of all, award-winning National Geographic cinematographer Paul Atkins has captured the vivid beauty of this hidden world that few of us will ever get the chance to see. The footage of the mythical Warrior Woman of Rotuma has a mysterious soft-focus quality, making the ancient tale seem enigmatic and slightly out-of-reach.
It is a lovely contrast with the modern scenes that are crisp with saturated color and beauty. They work really hard. They never cry or show any emotion or difficulty or even dare to talk about it. If something is painful or difficult, their coping mechanism is to laugh. The other day I was in the kitchen with Mua and another Auntie, when Mua told us that the old lady from across the road was very sick and they had called the doctor to come over.
To that, the Auntie let out a big laugh. Minutes later someone came around and said that she had died. They use this to call for prayer times at the church, but as I just found out, they also use it to announce that something has happened in the village. I watched Rechelli bang the thing with all her might for ages, and tears filled my eyes. She was going nuts on it, and I thought- what a great outlet of feelings.
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To bang the guts out of a big log. It was the day that Mua was leaving to go back to Fiji. When someone dies they lay the body on a bed of mats, with the white ceremonial mat underneath them and another one hanging on top of them. People come around to pay their respects and bring gifts, usually a mat, sarong or money.
I went with Mua and other relatives and placed a mat next to the body. It seemed like such a natural and uneventful thing to the rest of the people there. In the meantime the men go and dig the hole for the grave. Carl helped with doing that. When would any of us, unless we work in a cemetery or are trying to hide a dead body, get the opportunity to dig a grave? They make a bottomless coffin lined with some colorful silk fabric in which they place the body, wrapped in a traditional woven mat.
They all hung out in the graveyard, laughing and making fun, the kids playing around in between the graves and waiting till they brought the body. While the men did that the women and the chiefs sat at the house and sang songs. They were sounds with which I would like to rise to heaven.
I was really curious to see how they bring the body over to the graveyard and bury it, but unfortunately I fell asleep Then we waited a while, until the earth ovens were opened one of which was right outside my bedroom window. The day before, I came outside to find a dead pig lying feet up and tongue hanging out, ready to be gutted and chucked in the burning rocks.
Obviously I was totally grossed out and tried to stay away until it was deep underground, but as usual, Noah was really curious and examined it from all directions And the feast begins What an experience!
‘A REMARKABLE ROTUMAN WOMAN’ BY JACINTA TONGA
We have no idea what it was or why it happened, but he came up with this really weird rash all over his body which, within a couple of days, got worse and spread and looked quite violent. If we were anywhere else in the world we probably would have gone straight to the doctor or hospital to get it checked out, but here I asked the elderly ladies what it was, and what to do. In Rotuman culture each family 'owns' a massage for different ailments, so if you get sick with something you go to the family who 'owns' the massage and they massage you for a few days or however long is necessary.
Very non-descript, but if you have a sore tummy you come over here and get it massaged.
So off we went for five days in a row to a lady in a different village for Noah to be massaged if you can call it that. It was very 'witchety-poo' if I might say so myself, and even I was very skeptical about it.