Dr Wendy Page's research is tackling a neglected tropical disease
"Let her death not be in vain."
Those words, shared by the sister of a revered Aboriginal Health Worker, have fuelled Dr Wendy Page's decades-long fight against one of Australia's most neglected tropical diseases.
It’s a commitment that has culminated in a PhD for the CQUniversity researcher and medical practitioner, whose work has demonstrated that strongyloidiasis, a preventable and treatable chronic infectious disease, can be significantly reduced through a sustainable primary healthcare approach.
Her thesis, Towards a National Strongyloidiasis Control Program: Closing the Gap on Strongyloidiasis in Endemic Indigenous Communities in Australia, provides a practical framework for reducing the disease burden in remote Indigenous communities and contributing to national and global elimination efforts.
Strongyloidiasis is caused by the microscopic roundworm Strongyloides stercoralis. Despite being preventable and treatable if diagnosed early, it remains endemic in many remote Indigenous communities in northern Australia and can lead to severe complications including septicaemia, meningitis, organ failure and death.
Conducted across four Aboriginal community-controlled health services in north-east Arnhem Land, Dr Page’s research demonstrated that integrating strongyloidiasis testing into existing Indigenous adult health assessments reduced prevalence from 44 per cent to less than 10 per cent of those who were tested (2012-2020). Coverage reached 84 per cent of the resident adult population.
Dr Page said her journey began in 1995 while working as a GP for Miwatj Health Aboriginal Corporation.
“Like most Australian medical practitioners at the time, I knew very little about Strongyloides,” she said.
“Professor Rick Speare came to Nhulunbuy to conduct a parasitology workshop. We identified many soil-transmitted helminths, but the most clinically significant was Strongyloides stercoralis.”
Strongyloides stercoralis is distinguished by its unique autoinfective lifecycle. The parthenogenetic parasitic female does not need a male, and her embryonated eggs hatch quickly into rhabditiform (baby) larvae, which have an internal or external pathway. The internal pathway involves autoinfective filariform (teenage) larvae re-entering the host, enabling an indefinite life-long infection. This ongoing autoinfective lifecycle of S.stercoralis can be accelerated decades after the initial infection, with unpredictable life-threatening complications. The external pathway is time-limited, with larvae, not eggs, being passed in the faeces.
In 1996, her understanding deepened after treating a young man who was diagnosed with his second episode of life-threatening septicaemia.
“You can learn about something in theory, but it becomes real when you’re looking after a patient. Our patients are our teachers,” Dr Page said.
“I remembered Rick telling us that recurrent septicaemia could be associated with Strongyloides. When the test came back positive, it was a lightbulb moment.”
The experience prompted her to test patients who were unwell and to further investigate the disease's hidden impacts, as well as strategies for prevention and control.
“People don't necessarily die with a diagnosis of strongyloidiasis,” Dr Page said.
“They may die from septicaemia, haemoptysis, meningitis or multiple organ failure. If clinicians aren't thinking about strongyloides, they may never identify the underlying cause. If you don’t look, you won’t find.”
A defining moment came in 1999 when her colleague, an Aboriginal health worker, community leader and mentor to Dr Page, died from disseminated strongyloidiasis in Adelaide.
“For me, that was the evidence that Strongyloides really does kill,” she said.
“It was a huge loss for community and a huge loss for those of us at Miwatj Health Aboriginal Corporation.”
The following year, while travelling to a public health course, Dr Page sat beside the woman's sister and explained the efforts underway to improve testing and treatment.
“She said to me, ‘Let her death not be in vain’.
“Those words sit on my shoulders and have been a driving force behind my research and advocacy.”
In 2001, the first National Workshop on Strongyloidiasis was held in Nhulunbuy. At the end of the workshop, an Aboriginal elder asked, “We’ve had this Strongyloides for so long, why hasn’t something been done?’ Each workshop since has been dedicated to our Aboriginal Health Worker. Soon after, the Yolngu Women’s Conference at Gulkula passed recommendations – one for education and the other for screening.
A founding member of Strongyloides Australia, now Strongyloides Australasia, Dr Page has spent decades advocating for greater awareness of the disease and challenging misconceptions that have hindered prevention efforts. Her research resulted in the correction of a widely used international lifecycle diagram and provided evidence that serology can be used to measure treatment outcomes in chronic strongyloidiasis.
The research also supports calls for strongyloidiasis to be included on Australia’s National Notifiable Disease List.
“We would like to see strongyloidiasis made notifiable so we can identify hotspot locations and where One Health strategies are needed,” Dr Page said.
“If we can make a difference in those hotspots, we're not only making a difference for Strongyloides but for a range of other health conditions as well.”
CQUniversity supervisor Professor Jenni Judd said the research demonstrated the power of community-driven, practice-based evidence.
“Dr Wendy Page's work is an outstanding example of research translating directly into improved health outcomes for communities,” Professor Judd said.
“What makes this research particularly significant is that it demonstrates a practical, sustainable solution that can be embedded within existing primary healthcare systems.
“Wendy has combined decades of clinical experience, community partnership and academic rigour to produce evidence that strongyloidiasis control is both achievable and sustainable. Her findings provide an important roadmap for reducing the burden of this neglected disease and advancing health equity for Indigenous Australians.”
Recognised in 2021 as Northern Territory Australian of the Year, Dr Page said her advocacy would continue through Strongyloides Australasia and the broader public health community. Strongyloidiasis is now included in the WHO Neglected Tropical Disease Roadmap 2021-2030.
“My passion is still very much our commitment to closing the gap on strongyloidiasis in endemic First Nations communities in Australia,” she said.
“By 2030, we can do it and end the neglect.”
Dr Page received her doctorate at CQUniversity’s Brisbane graduation ceremony on Friday,14 August.
