"They don't have enough knowledge about diabetes and they come up with all sorts of thoughts - oh, I was punished by something, or I was poisoned." Video / Chris Tarpey
This Christmas, the Herald and The Fred Hollows Foundation NZ are working together to bring the Gift of Sight to the Pacific, where four out of five people who are blind don't need to be. Alarmingly, an increasing number of these are young people, suffering from diabetes-related eye disease. This week, we bring you stories of just a handful of these people and invite you to help us raise money for a sight-saving machine that can improve the lives of people like them.
The best part of the job of an eye nurse in Vanuatu is witnessing someone who thought they were blind forever suddenly seeing again.
"These are amazing stories for people to hear because people here still believe that if you have a cataract and become blind then that is it," says David Silapo, the sole eye nurse on Tanna Island.
Success stories help with the hardest part of his job - convincing villagers of the benefits of modern eye care.
"On Tanna there is a common belief in traditional medicines and eye operations are scary for them.
"We all know that eyes are very fragile so I go slowly," say Silapo. "I tell them the operation is not removing the eyeball but a small incision, that the lens is calcified and is replaced with another one and that will help their vision."
The benefits of laser surgery to combat damage done by diabetes to the retina is a harder story to sell.
For diabetics the most common cause of blindness is diabetic retinopathy where uncontrolled blood sugar can lead to retinal blood vessels leaking.
"It's about giving the right message," says Silapo. "I explain that even though it doesn't improve vision it stops bleeding that can make you lose your sight forever."
In a country where almost a quarter of the population has diabetes, eye nurses must also be educators, explain about insulin and diet.
"It is very challenging when talking to people with diabetes," says Silapo. He explains the damage done by uncontrolled blood sugar levels, that they must take insulin to do the job their pancreas no longer can.
"I tell them if you don't you might end up having amputations and going blind. That's the best way to convince them to take their medication faithfully."
Basil Aitip, an eye nurse trained by the Fred Hollows Foundation NZ. Photo / Chris Tarpey
The key, says Port Vila-based eye nurse Basil Aitip, is to win trust.
"It is likely that the patient will refuse treatment in the first place," says Aitip, who worked in a bakery to put himself through nursing school. "He wouldn't like to hear that he has got diabetes. He wouldn't like to come to appointments. And the first place he would like to go is to the witchdoctor."
"They don't have enough knowledge about diabetes and they come up with all sorts of thoughts - oh, I was punished by something, or I was poisoned."
Sometimes they stop coming to appointments. "When they come back they might have complications already, they might have foot sepsis and eye damage and all these things."
The job carries a heavy emotional load, such as when infection caused the third cancellation of badly needed surgery for 21-year-old Clerence Natnaur whose story the Herald featured on Monday.
The delay risks further eye damage from complications of Clerence's Type 1 diabetes that has also resulted in her toes being amputated.
"Having this diabetes, especially when you are very young and you know that this is your life and you are not sure someone will ever want to marry you and yet she can still put on a smile and talk nicely to people and sing so nicely. To me Clerence is really a hero."
There are happy tears too, such as patients who see their grandchildren for the first time when bandages after cataract surgery are removed.
"I tell you," says Aitip, "that's when you see the real meaning of a family reunion."
It is increasing most rapidly in low- and middle-income countries.
7 of the 10 countries with the highest incidence of diabetes are in the Pacific.
The causes are complex, but the rise is linked to obesity, diet and insufficient exercise.
Diabetes of all types can lead to complications in many parts of the body and increase the risk of premature death.
A large proportion of diabetes and its complications can be prevented by a healthy diet, regular exercise, maintaining a normal body weight and avoiding tobacco use.
