The tiny island nation of Tuvalu is the lowest lying nation on Earth and is struggling with the effects of rising sea levels and frequent storm surges. But there are plenty of other problems facing its inhabitants, whose home could be seen as the canary of the Pacific.
Pule O'Brien returned to Tuvalu after 10 years away and was shocked by how many more people are now living on his home island of Funafuti.
Alongside the island's airfield, where there used to be just a couple of dozen houses, "now there are houses all the way down to the end".
The 23-year-old, who moved to New Zealand when he was a teenager, was the first Tuvaluan to enlist in the New Zealand Army. He returned as part of the Defence Force's Operation Tropic Twilight this month.
Returning to his home island was an exciting feeling but at the same time something of a shock as he sees his people still struggling.
"Especially knowing that there's a lot of money coming from overseas and nothing is being done to improve the welfare of the country."
Tuvalu is laden not only with the high profile fact it is so low lying - the highest point is about 5m above sea level - it is also grappling with the problems of rubbish, environmental contamination, high unemployment, isolation, and an increasingly unhealthy population, now very reliant on imported food.
The small archipelago of nine islands, north of Fiji and about 3700km from New Zealand, has a population of about 11,000 - the only country with fewer people is the Vatican.
Most live on the main island of Funafuti, which is the seat of government and where Tuvalu's only airstrip and main port are located.
Only about 1500 people are formally employed and the average per capita income is about $1410 a year.
Most people, if they don't study further after leaving school, look for quick money in seafaring jobs, and that option is a popular one. Seafarers send a lot of money back to their families.
With very little land area - 26 sq km - Tuvalu cannot produce crops to export, and relies largely on aid to feed its people and keep them going on many western staples - transport, government, communications and contact with the outside world.
There are no springs, streams or rivers, and people rely on captured rainwater. There are just 8km of paved roads and most people get about on scooters.
In 1978 the population of the main island Funafuti was about 1500, but that has now risen to nearly 5000, leading to water, sanitation and health problems.
Many coastal homes are swamped in high seas, salt water intrusion ruins crops and causes coastal soil erosion.
The southern end of Funafuti suffers during very high "king tides" in March and April each year.
"It's not really in terms of becoming totally inundated and being under water, but the change in frequency of hurricanes, storm surges and other related risky situations that result from climate change," said Department of Environment director, Mataio Tekinene.
Mr Tekinene said the country was frustrated with Copenhagen climate change talks last year, where Tuvalu called for a legally binding outcome and a tough cap on temperature rises.
Prime Minister Apisai Ielemia said he would not sign an agreement at the end of the Copenhagen talks that supported just a 2degC cap on a global average temperature rise, saying this would doom his country.
Earlier this year a study published in the journal Global and Planetary Change said Tuvalu was one of a number of islands actually growing because of coral debris and sediment.
But Mr Tekinene disagrees, saying the waves were still coming up and over the beach.
BORROWING A RUBBISH PROBLEM
One of the striking aspects of Tuvalu, and especially the main island of Funafuti, is the rubbish, which is strewn along the beaches and roadsides. On such a low-lying sliver of an island, there is no way it can be buried in landfills.
Unsorted plastic, metal and other waste pours into the tip at the northern end of the island - a spit less than 100m wide.
Home Affairs Minister Willy Telavi said the European Union was providing between A$3m ($3.71m) and A$4m in assistance, due by early next year, to help with water sanitation and waste treatment.
Officials are looking at getting wood chippers so the organic material can be recycled, and plastic shredders which means the plastic can be compacted and used to fill the "borrow pits" - the large holes excavated by the Americans in World War 2 to build the island's runway.
The pits are a headache because they attract rubbish, but they are full of sea water, and so don't harbour bugs and mosquitoes.
PIGS VERSUS HEALTH
Pigs are an important part of Tuvaluan culture, as they are a staple fare in feasts, but they are also part of a pressing health issue - the island's pig pens are being put in places that threaten to contaminate soil and water supplies, including the lagoon.
In the outer islands the local council, or kapule, had embraced the idea that pig pens were not desirable in a village setting and they had set aside in one area, where ground water could not be contaminated.
However, that had not happened on Funafuti, director of health Dr Stephen Homasi said.
"We are still struggling with this island. This is a big challenge for us, it's home to close to 5000 people, half the population of Tuvalu, so it's really important for us to do something."
Nevertheless, he said the lagoon was safe to swim in.
Overall, the main causes of death are diabetes and cardiac diseases, which have been rising in the last decade or so. More people were now dying of those problems in their 30s and 40s, as opposed to their 50s and 60s previously.
"Physical inactivity as well as dietary come in to play, it's the full package, not just the one component," Dr Homasi said.
The Pacific Islands have long been a dumping ground for cheap, fatty cuts of meat, by a number of countries, including New Zealand.
Earlier this year it was claimed that Tuvalu faced an epidemic in HIV cases, but Dr Homasi said that was a case of media misreporting.
Tuvalu has 11 recorded cases of HIV since 1995, eight are still alive and the last new cases were reported in 2008, after six were reported in 2002.
"The trend is downward, not upward as reported."
The fear over HIV arose after a survey showed chlamydia in 17.5 per cent of those tested, but the same survey showed no cases of HIV, he said.
The government is hoping education and promoting condom use will help address problems with sexually transmitted diseases.
GLOBAL ECONOMIC WOES
Tuvalu recently became a member of both the World Bank and the International Monetary Fund.
Lotoala Metia, the minister of finance, economic and planning, perhaps the only finance minister in the world with a small chevron tattooed between his eyebrows, is honest about the immediate benefit for Tuvalu, which has US$2.5 ($3.5) million in the bank from the IMF.
Financial reserves are being depleted as the Tuvalu Trust Fund suffers from the global financial crisis.
The fund was established in 1987, with contributions from New Zealand, Britain, Australia, Japan, South Korea and Tuvalu itself. It is worth nearly US$110 million.
The government has outgoings of A$32m ($39.55m) and the 2010 budget had a deficit of A$10m.
"Our challenge is to try and cut the budget so we can survive for another one or two years. If we continue down this path, all our reserves will be depleted, it's as simple as that," Mr Metia said.
Tuvalu is also trying to screw down a better deal from its arrangement with Verisign, the US company it leased its "dot.tv" internet domain name to in 1999.
Tuvalu gets about $2m annually, or about 10 per cent of its income, from its sale and investment in dot.tv until 2016, but Mr Metia said it was not enough. However, the company was playing hardball in negotiations. "We have to stick to our guns. They are giving us peanuts and they are getting more."