
topnav new topnav new topnav new topnav new

... Program 6: A Healthy Outlook...

Dr Wame Baravilala:

Health and development are two sides of the same coin. I do not think it's possible for a society to be able to develop unless the people within it are healthy and they're happy. And likewise one of the goals of development is for a country to obtain good health.

Heather Jarvis:

Dr Wame Baravilala, Dean of the Fiji School of Medicine.

Hello, and welcome to another edition of "Carving Out - Development in the Pacific", I'm Heather Jarvis.

Well as the doctor said, good health is not just essential to a happy and productive life, it's also a cornerstone of sustainable development.

So in today's programme we'll be looking at the major health issues in the Pacific, and finding out about some of the most effective ways of dealing with them.

(baby crying)

This young baby has been brought to the maternal and child health clinic at the Nausori Health centre in Fiji.

Each day, about 80 mothers and their babies attend the clinic for general advice, health checks, family planning, and infant vaccinations against diseases like measles and polio.

But while clinics like these help to ensure that more of these children than ever before will make it through those critical first months and years of life, the bad news is that in some countries, improvements in infant survival are being balanced or matched by a rise in adult mortality.

In fact across the Pacific islands there's been an alarming rise in the number of young adults dying from so-called 'lifestyle diseases' caused by poor nutrition, less exercise, more stress, and increased drinking and smoking.

And to medical professionals like Dr Wame Baravilala, it's a worrying and challenging trend.

Dr Wame Baravilala:

We're basically caught between a stone and a hard place in the Pacific because we're sort of evolving from the types of societies where deaths and illnesses were predominantly due to infections, to those where deathsand illnesses now are more and more due to what we call "lifestyle illnesses" such as obesity, high blood pressure, strokes and a lot of the conditions which can be attributed to obesity and cigarette smoking and so on.

And the problem is that we are now caught in a double whammy where on the one hand we're still having to take care of the problems to do with infection, and on the other hand we're trying to fight off those illnesses which the more developed countries like Australia and New Zealand are well equipped to tackle because of their much higher health budgets. But of course we here in the Pacific don't have access to that kind of money.

So I think this calls for a lot of innovative approaches, not only from our health department and from the doctors who work in them, but I think also from the public at large and from our educational system.

Heather Jarvis:

The smallness, isolation and fragmentation of Pacific Island nations makes the provision of health care very expensive.

And it also presents a lot of problems for delivery and access to services.

People with serious illnesses often have to travel long distances by foot, car, motor bike or boat in order to get to a hospital.

And in many places, even the local health clinic can be difficult for people to get to, with the result that many commonplace and treatable illnesses like colds and flu for example turn into life-threatening conditions like pneumonia.

Take the situation in Kiribati.

This small island republic of 83 thousand people is spread out over 33 low-lying coral atolls and islands spanning the central Pacific ocean.

The country's only hospital is on the main island of Tarawa. And for people living on the outer islands, basic health care clinics are provided by the government.

The island of Abaiang is the closest outer island to Tarawa - about an hour an a half's ride in a motor boat.

It's health centre in the village of Taburao consists of a clinic, a birthing room, kitchen and six open-air wards made of local materials.

Renika Matita is the medical assistant at the centre, and on the day I dropped in to visit, she told me about the patients she was caring for in the wards.

Renika Matita:

At the moment we have five patients and two are adults and three are children. One is having asthma, the other one has diarrhoea and the three children have chest infections, pneumonia, they are getting better now.

Heather Jarvis:

So is pneumonia a common health complaint for children in this area?

Renika Matita:

Yes it's just that every time when there's flu they might come down with pneumonia most of the children. Maybe because they are a bit far away from the hospital and they come late for treatment. That's why when they came in they caught pneumonia, and the transport is a bit difficult for them to come to the clinic early.

Heather Jarvis:

So it starts with just a cough or a cold and because they can't, or they don't get treatment soon enough it develops into something worse?

Renika Matita:

Yes that's right. They start with cough and they can get pneumonia while they're in their rooms because they didn't get any treatment early.

Heather Jarvis:

Respiratory infections are the leading cause of death across the Pacific region. In most cases these deaths can be prevented, if a patient seeks medical help in time. But as we've just heard, this doesn't always happen - especially when clinics are difficult to get to.

The second most common cause of death, and the leading cause in children, is diarrhoea - another largely preventable and treatable disease.

On Abiang, as in other parts of the Pacific, adult education is helping to reduce the incidence of diarrhoea, and the number of deaths, although many children and adults continue to get sick, because they don't always boil their drinking water.

Renika Matita:

It's a bit common too, diarrhoea, but every time when the patient came for treatment that time we give education to every patient individually about the disease. We give information about diarrhoea and say we can give treatment and at the same time we can teach the mother what to do to prevent diarrhoea.

Heather Jarvis:

And what about getting to people before they actually get diarrhoea. Do you hold meetings or workshops or that sort of thing in the community?

Renika Matita:

There's a group in the village, called the VWG - Village Welfare Group. With that group we used to meet with them, teach them about some diseases, how to prevent them, the signs and symptoms of the disease. And then those in the VWG will teach to the community in their village about that disease.

Heather Jarvis:

Renika Matita, and she's the health assistant at the health clinic on Abiang in Kiribati.

Infectious diseases including pneumonia and diarrhoea, remain the number one killer of people in the Pacific. And in Papua New Guinea, Vanuatu and the Solomons islands, the two big mosquito borne diseases, malaria and dengue fever, remain a major cause of illness and death.

But as we heard earlier, it's the newer "lifestyle" diseases such as diabetes, obesity, and high blood pressure, that are beginning to take a huge toll on health systems already stretched to the limit.

In Nauru, for example, nearly a third of people over the age of 20 have diabetes. And in Fiji, diabetes cases occupy 15 to 20 per cent of all hospital beds.

At Nausori health clinic, an hour and a half's drive from the Fiji capital Suva, educational tools like posters and leaflets are used to warn people of the dangers of diets high in refined oils, fats, and sugar.

Kenya Kala's speaking here with nursing sister Erini Sakilea.

Kenya Kala:

You know the poster outside the outpatients, it's written in Fiji, can you just translate that for us?

Erini Sakilea:

In Fijian it says Mate ni Suka is translated as how to prevent diabetes. And in the picture we have a man who is running because that is one way of preventing diabetes is to have a lot of exercise. And there's a lady who is planting because we always believe in women planting their own vegetables. And there's a woman who's carrying the vegetables from the garden to the house to cook and we believe that we shouldn't buy anything which is, you know we should grow whatever we should eat. And we plant and we grow.

Kenya Kala:

Yeah, because the word "suka" is on it, that's sugar isn't it?

Erini Sakilea:

Yes suka means sugar. It's translated as the illness that arises from sugar, and it is diabetes in English.

Heather Jarvis:

Nursing sister Erini Sakilea.

The rise of these lifestyle diseases, along with the continuing problems caused by infectious diseases, means that governments and other health care providers are having to find innovative ways of making the health dollar stretch further.

And as Dr. Wame Baravilala points out, it seems that preventative medicine and education is the only viable long-term strategy, in an economic climate where health budgets are almost certainly not going to grow.

Dr Wame Baravilala:

All in all you're faced with the situation where it is unlikely that Pacific economies are going to expand in any way. A lot of them are contracting, there is increasing population numbers, so there's increased demand per head of population for the amount of money that's already available. Because it's unlikely that more money is going to be made available for health care or for health services.

And so people at medical schools, hospitals, nursing stations, all of us need to look at innovative ways in which we can make the money address the problem before it reaches us in the hospitals, because experience from overseas has shown time and time again if you give limitless amounts of money to hospitals, it will be spent in the hospitals and very little of it will go back into the community.

But I think there is a sea change and it's certainly something we'd like to get across here to the undergraduate and the postgraduate students at the Fiji School of Medicine, including those who are taking clinical subjects that where there is an opportunity it's best to spend your money on prevention. In other words in supporting public health programmes, health promotion programmes that prevent people from arriving at the health centre or the hospital in the first place.

Heather Jarvis:

Dr Wame Baravilala.

And on Radio Australia and Radio National, you're listening to Carving Out: Development in the Pacific.

While governments may need to invest a greater proportion of their health budgets in preventative education and medicine, they also need to be mindful of the many other factors that impact on public health.

Many Pacific Islands are currently in the process of economic reform and restructuring. And while these reforms might help to balance the books, experience from around the world shows that if they're not properly managed, they can also have negative impacts on health and nutrition, as less food is produced for domestic consumption, and local currency devaluations make imports such as medicines and other medical supplies substantially more expensive.

In the Pacific, as in other parts of the world, economic change is happening hand in hand with social change.

As the cash economy takes hold, Pacific societies are becoming more urbanised.

Traditional foods such as fresh fish, root crops, coconuts and leafy vegetables are being replaced by imported rice, tinned beef and tinned fish. And the knowledge and use of traditional medicines is also slipping away.

In Kiribati the effects of all these factors are easily seen.

Toniti Irata is the Assistant Director of the Foundation for the Peoples of the South Pacific or FSP, in Kiribati.

Toniti Irata:

The i-Kiribati way of life, shows that we are more or less eating a lot of this imported stuff from overseas and we are forgetting our own local foods which are better than what we eat from overseas. So it is very important for us as community workers to serve our people in the communities and to try to encourage them to go back to their own local food which is very nutritious to them, than to depend on this imported stuff from overseas.

Heather Jarvis:

So what sort of health problems are caused by people eating as you say less local food and substituting it with more imported, I suppose, high salt, high fat kind of foods from overseas?

Toniti Irata:

A lot of people have hypertension, high blood pressure, malnutrition, in cases of children iron deficiency, the vitamin A deficiency, night blindness and all those diseases....

Heather Jarvis:

How well do children in Kiribati eat?

Toniti Irata:

Looking at our quantity of food I think yes they're ok with that, but then the quality of food is not up to standard because they're depending on fried rice, flour, sugar, excluding all the green leafy vegetables and proteins that we get from the sea like seashells and fish and most of them they're depending on tinned meat and tinned fish, all those sort of things.

Heather Jarvis:

Why aren't they eating vegetables? As you say the green leafy vegetables for example? Why not?

Toniti Irata:

In Kiribati it's not really ourway of life to eat leafy green vegetables. However we were given when we were young by our elders in a form of medicine, that's when we have the roots crops or the shoots of the plants and this is a sort of medicine. And that's how we got those vitamins and minerals. But now, especially on Tarawa people have tended to get away from that sort of thing, so what they're depending on, the food now is rice and fish and that's it.

Heather Jarvis:

Part of the problem in Kiribati, and particularly on the main island of Tarawa, is that there's little room for gardens on what's a very crowded island. As well as that, many households are large - whoever's doing the cooking might have to cook for up to 20 people at a time, and it's much easier to boil up a pot of rice, than spend hours preparing and cooking labour-intensive traditional foods.

Many imported or foreign foods have also become prestige foods, and apart from that, people just like the taste of them.

So it takes a lot of perseverance, and a very well thought out strategy, to convince people of the benefits of making the effort to change their diet.

Toniti Irata:

To get the message across we have these weekly workshops with the communities and this is a sort of integrated programme between nutrition, agriculture and environment within our organisation. And so what we do is we go as a team to the maneaba (meeting house), or meeting places in the villages and we call upon all the communities in that area and then we give our talks or we present our topics on nutrition and agriculture and environment. And by doing this we also have the drama with us, which are plays, dramatised like environmental issues that we think are important for the people. And we also have demonstration cooking where by people can see how to cook green leaves and vegetables and not over-cooking them, and then we have this brainstorming and role plays and show and tell.

So by these methods and we use also posters and videos, by these methods I think we really get across to these people.

Heather Jarvis:

Toniti Irata from FSP in Kiribati.

(sound effects of people chanting a play on diabetes)

These young people are rehearsing a short play on diabetes, as part of a training programme run by the the Wan Smal Bag theatre company, in Port Vila, Vanuatu. When they're finished their training, they'll go back to their home island of Malakula, and work with community programmes to promote health issues across the island.

Community theatre is being used in a number of Pacific island countries to get the health message, and other social messages across. And Wan Smal Bag is one of the more famous and established groups. From humble beginnings back in 1989, they've gone from strength to strength. They now boast a regional training programme, and produce videos of their work, a great deal of which concentrates on health, often with a focus on reproductive health. Peter Walker is the Director of Wan Smal Bag.

Peter Walker:

We deal a lot with reproductive health issues. We do a lot of work about STDs and AIDS and family planning. A whole range of stuff, not just plays, we do sort of participatory workshop stuff. We've developed a lot of what we call moving biological diagrams in which the actors run around as sort of sperms in mockup penises and vaginas and then they stop the action and say ok, so what's happened here? What should this person do now?

So we do that and at other times we try to do plays that are quite powerful, you know I think emotion itself if you can present a memorable experience on the stage that does stay with people perhaps longer than a talk.

(women talking in Bislamah)

Heather Jarvis:

This play about the risks and reality of teenage pregnancy is one way in which Wan Smal Bag gets an important health message across to young people. And to make sure that it really hits the mark, it's actually performed by the Wan Smal Bag Kids - the youth branch of the company.

Reproductive health covers everything from reproduction and fertility, including birth spacing, contraceptive use and other aspects of family planning, through to sexually transmitted diseases and reproductive tract infections.

And these are not topics that are easily discussed in Pacific island communities - in fact they're still somewhat taboo.

But there's a growing acceptance that people (including men and adolescents) need to have more information on reproductive health in order to improve their own health, and that of the community.

And Wan Smal Bag is at the cutting edge of getting that information out as far and wide as possible - and encouraging people to discuss the issues despite the traditional taboos.

Peter Walker:

I find myself that a lot of people are willing to face those taboos now. I mean most people know that rates of STDs are very high. I mean I was hearing reports from a particular island saying seven out of 10 pregnant mothers of late had been showing positive tests to STD. I mean I'm not saying it's like that throughout the country, but it is high.

And we get resistance in one or two islands perhaps more than others, but even amongst some chiefs, I mean we have found a great willingness to tackle it. Partly our actors often when the chief is a bit worried they'll say something like well ok if we don't teach people are you going to? And they'll say no, no, it's a taboo, we can't talk to our families about it. And they say well why not let us then? Because they're going to need this information to survive.

And I think for the group too we were at the first regional STD-HIV-AIDS conference and it really brought home to us, I mean it was the first time for many of us to have met HIV-positive Pacific islanders, and we brought home photographs of ourselves with some of the participants who'd been HIV-positive. We asked their permission if we could use these photos after our performances in discussion. And the effect is phenomenal because people are still at the stage in this country of saying well we must find a separate island for people when the disease comes or you know we must kill them or whatever. I mean that's still quite prevalent.

But these photos and the group had just done a play which is simply they improvise, there's the stories that they heard at the conference, and they're taking that round the islands at the moment. And those two things together the realisation that Smal Bag members have sat down and shared food with and eaten off the same plate as people who are HIV-positive has had a very positive effect, I'm sorry to use the pun. But I think it really has made people question those beliefs. And that's all you can do. I think you must confront those taboos sometimes.

I mean we find a lot of support for doing that. The taboo as the HIV conference pointed out, the taboo can become an excuse just for not facing something. And I guess having worked in Zimbabwe and I went back for the first time in 10 years a year ago, and you know not one family that we knew had not had someone die of AIDS. So if we just say here oh it's taboo, we can't tackle it, then I think we go the same way over the next 10 or 15 years would be my guess.

Heather Jarvis:

As Peter Walker, said, HIV-AIDS is looming as a major threat to health in the Pacific.

Although the numbers of people infected with the virus are still small compared to Africa and Asia, HIV is on the rise in the Pacific. The problem's most serious in Papua New Guinea and Kiribati, and the rates are rising in all the other Pacific nations, particularly of late in Tonga and Fiji.

An HIV-AIDS epidemic would place huge stresses on the provision of basic, and other health services in the Pacific. So just like with other diseases, the emphasis must be on prevention.

And the bottom line in prevention is education and community participation.

Dr Wame Baravilala:

The Pacific is now the repository of enough educated people who should I think in terms of leadership and example show other people that health is not the responsibility of health department, it's not the responsibilities of doctors and nurses, but it's the responsibility of everybody. And that is why I think education is so important. No population is able to take on the ideas of health promotion and the ideas of taking responsibility for their own health unless the people within that society are themselves educated to be able to receive the information and to be able to digest it and to be able to make decisions for themselves.

And so I don't think it's going to be possible for a proper health promotion initiative to work unless the population reaches a certain threshold of literacy and understanding. But I think that's occurring throughout the Pacific. If you look at the statistics and the rate of education in the Pacific is increasing and especially the rate of education of women and I think that's the key factor. Educating the women often gives you more than just one potential benefit, it's not only the woman but it's the children at home and it's the people who come into contact with that woman who might get the benefit.

Heather Jarvis:

Dr Wame Baravilala, Dean of the Fiji School of Medicine.

That's all for this week's Carving Out.

I'm Heather Jarvis, see you next time.

Carving Out is a production of Radio Australia with support from Community Aid Abroad and Save The Children Australia. Series producers are Heather Jarvis, Kenya Kala and Carolyn Court.

Let us know what you think of the radio series