Poverty and the Pacific — two words you wouldn't think normally go together.
When it comes to our glorious back yard, other words beginning with P spring to mind. Paradise, pleasant people and pina coladas by the pool are some of my favourites.
As a proud citizen of this region, I was resistant to the idea that there would be poverty somewhere in our shared paradise.
I wrestled with this as I sat in the middle of a tiny plane rumbling its way to Tanna, the third-most-populated of Vanuatu's 83 islands with about 40,000 people. It's famous for having one of the world's longest-running active volcanoes, Mt Yasur. Captain James Cook was the first European to set foot on the island, drawn by the glow of the volcano.
I was headed to the southwest of the island, where World Vision and the New Zealand Government's aid programme have been working with 12 remote communities to raise maternal and child healthcare.
As we flew from Port Vila and over the ocean, I scanned data from the beginning of 2011, just before one of World Vision's programmes began.
It was remarkable to learn from this baseline survey that children in Vanuatu suffer from such highly preventable diseases and conditions as diarrhoea, measles, pneumonia and low birthweight. The diarrhoea issue is especially disconcerting — it is the second most common cause of death in infants worldwide.
For all its natural beauty, Vanuatu is one of the poorest countries in the Pacific. It ranked 124th out of 187 countries on the Human Development Index last year and 40 per cent of the population lives on less than $1 a day. Child health is a big issue here, in particular malnutrition.
Most communities lead a traditional and isolated way of life, still ruled by their traditional customs, with limited exposure to the modern world and Western health information. Health knowledge lies in the hands of the traditional birth attendants and traditional healers, who often don't know the causes and symptoms of diseases. Local knowledge on basic ante-natal and post-natal care is poor.
My two-day visit to Tanna began with a trip to the single-storey, three-room base of World Vision. The highly motivated Kiwi-Vanuatu team reports a marked improvement in health outcomes since they started work three years ago.
Take colostrum — that all-important form of milk in early breastfeeding that contains antibodies that protect the newborn baby from disease. It delivers its nutrients in a particularly low-density form so that a newborn's immature digestive system can process it.
Its yellowy appearance led the traditional healers to think that it was dirty and tainted, so they warned mothers not to feed it to their babies.
The baseline survey figures show only 17 per cent of mothers used to give their babies colostrum — after two years of the programme that is now up to 98 per cent.
We pile into a rugged-looking pick-up truck and make our way to the first community we will visit. It's not long before I realise one of the issues affecting the communities' ability to access healthcare is that no one can get to them. - not unless you have a very sturdy four-wheel-drive vehicle and are prepared to walk for hours through dense bush with someone continuously chipping away a trail with a large bush knife.
We head off the coastal "road" and head inland, climbing up and through the island's lush vegetation.
These villages are remote. The world would not even be able to visit them if the people themselves hadn't cut a road with the same bush knives they need for walking.
Finally, we arrive at Ianepkasu, where the chief and few of the villagers have gathered to welcome us. When you are given something in welcome, it's a nice feeling. When it's from people who actually don't have much to give, it's a truly humbling experience.
I speak to Fenna, a nurse who works at the local aid post. In 20 years of working on Tanna, she has seen a lot of illness in her community. She says that, prior to World Vision working with her, children were always sick, particularly with diarrhoea, worms and acute respiratory infections. She would get 50 sick children a month at her clinic. Many walked for hours with their mothers to get there.
Fenna is positively beaming with joy as she reports that in the past year that number has dropped to about five or 10 a month.
The chief is joyful as well. In fact, his first name is Joy. Joy Nakou tells me, "When we heard about this new information, we didn't understand it and were afraid of change. There was a lot of disease and deaths."
Now they look forward to adopting the changes and ideas that are keeping their kids healthy.
He would like to thank the people of New Zealand very much for investing in the health of his people and is surprised that people from so far away would even care about them.
The community's adults and children stare out at us, shy smiles never far their faces, but there are also a few children with the distended bellies that are a sign of malnutrition.
The next day, we visit another remote community, Yelkis. If I thought the rugged road to Ianepkasu was tough, the "road" to Yalkis would have terrified even Crumpy and Barry from the classic Toyota television ad.
Our truck gets stuck halfway up, before an exhausting hike up the hill. Thankfully, another vehicle is waiting, having worked in Yelkis the day before.
Here the locals have prepared a lunch using the nutritional lessons they have learned from the programme. There are no food shortages as such in the region but meals are not varied enough to provide a balanced diet. The staple foods are taro, island cabbage and coconut milk. Meat is reserved for ceremonies, so most people do not get enough protein.
Today we see evidence of how this is slowly changing. The meal is a sumptuous feast of local vegetables and chicken.
It's also a chance to meet many local mothers and babies who have had the benefit of the programmes.
Community malnutrition officer Marcelyn Mau is one of the workers employed by World Vision who live in the communities so they can help monitor the programmes' development and effectiveness.
She says that before the programmes, children were always sick with skin infections, diarrhoea and stunted growth. "Their age was increasing, but their weight and height wasn't."
Though some of the children who stare at us curiously are rather skinny, some of the babies I meet have the bonny bounce that you expect. Not all, though. I pick up one and put him on my knee. He seems to weigh as much as one of my sneakers.
I meet Mary Touata, whose daughter Matela was part of the baseline survey.
She tells me that Matela was very thin and at 2 years old was not crawling or walking. She always had fever and breathing difficulties.
Mary had no idea why this was happening.
"I knew she wasn't well, but I didn't have the courage to take her to the hospital, because I didn't know what was wrong with her."
Mary put into practice what she was taught on the programmes about nutrition, hygiene and appropriate care. Matela is now a healthy, strong 4-year-old looking forward to her fifth birthday next month. During the interview, she doesn't stop eating from the pile of food on her plate.
Ellen Iaham introduces me to her third child, Lerina. Though Lerina is healthy, Ellen regrets not having this information available when her other two children were born and she says there's a big difference between them and Lerina.
"It would be very helpful for all women to know this, especially so that women don't have to walk far to hospital all the time. I had to do this a lot."
Ellen can accurately report that Lerina is 2 years old. She thinks she herself is in her early 20s but can't be sure, as births were never accurately recorded in these remote communities. Without a birth certificate, people have no official identity and are therefore unable to apply for Government support. It's a widespread problem here. When I ask a lot of adults for their ages, they have to make an educated guess.
Yelkis chief Tom Naih has been a staunch advocate for the programmes, encouraging his people to embrace them and apply the knowledge they are learning. He says the real benefit won't be felt properly for 10 to 20 years when this generation of babies grows up to be the strongest and healthiest people the communities have produced.
Back at Port Vila, I have a short visit at the Maternity Ward of Central Vila Hospital. I want to get a picture of what healthcare the Government is able to provide.
The ward is staffed by 12 midwives, four nurses and two doctors. There are only 28 beds in the ward and it's not enough to cope with the 70 births a week, which usually require new mothers to stay for one or two days. Staff say the country's health budget has remained the same for the past five years and the country only has 40 doctors for the entire population of about 250,000.
With a national health system so severely under-resourced, it's not hard to see how remote communities can fall off the map and have to rely on overseas development programmes.
The stories from the people I met on Tanna show me that the programmes are working, the people are responding and profound change is possible in maternal and child healthcare. But we have a long way to go. Alongside sub-Saharan Africa, Pacific countries are making the least amount of progress in meeting the United Nations' Millenium Development Goals for 2015, especially when it comes to reducing child mortality rates and improving maternal health.
New Zealand is a small player on the world stage but a big player in the Pacific. Because of the close historical, cultural and people to people links with Pacific Island countries, New Zealand puts more than 50 per cent of its aid into the region.
But the percentage that goes into maternal and child healthcare could be boosted.
Part of the problem is that in 2009, the previously semi-autonomous aid agency NZAID was re-integrated into the Ministry of Foreign Affairs and Trade. This shifted the mandate of its aid programme away from poverty reduction to a core focus on economic development and trade — which makes no sense to me.
How can you foster economic development and trade when the poorest of the poor are suffering through not having the most basic start to life?
In the few days, I was on Tanna I learned more about maternal and child healthcare than I ever thought I would. I'm hardly an expert now but it was enough to realise how important it is and why it's one area that could do an incredible amount in terms of development. It could also go a long way to reducing poverty in paradise. It exists I've seen it. I've also seen it's possible to change that.
Poverty in the Pacific
• One in three people in the Pacific live below the poverty line.
• In Timor Leste (formerly East Timor), 58 per cent of children under 5 are physically and/or mentally stunted.
• Women in Timor Leste have a one-in-55 chance of dying in childbirth.
• In Vanuatu, more than 64 per cent of women give birth at home with no medical assistance.
• Across the Pacific, 40 children die every day from preventable causes.
• With a population nearing 7 million, PNG only has 400 doctors, 292 midwives and 16 obstetricians.
• In PNG, at least five women die each day of preventable childbirth-related causes.
• In pockets of Vanuatu, child malnutrition rates are higher than Niger, Chad and the DRC.
• Access to clean drinking water across the Pacific is only 53 per cent, lower than any region in the world.
- Sources: Unicef, WHO, World Vision