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.
Diabetes has been described as "a tsunami" that is overwhelming healthcare systems in the Pacific Islands.
Seven of the 10 countries with the highest rates of the disease are in the Pacific.
The highest is the Marshall Islands where 33 per cent of people aged between 20 and 79 have diabetes.
In October, the Herald spent a week with the Fred Hollows Foundation in Vanuatu where 21 per cent of the population have been diagnosed with the disease.
The rates in other Pacific countries in which the charity works are Kiribati, 28 per cent; Samoa, 24 per cent; Tonga, 19 per cent; Fiji, 16 per cent; Papua New Guinea, 14 per cent; Solomon Islands, 13 per cent.
Diabetes is part of the broader problem of non-communicable diseases - heart disease, stroke, diabetes, cancer and chronic respiratory diseases - that cause about 70 per cent of all deaths, says public health specialist Robert Beaglehole.
Diabetes increases the risk of dying from heart disease, stroke and kidney failure.
In New Zealand, more than 240,000 people have been diagnosed with diabetes while the Ministry of Health estimates another 100,000 have the disease. Taken together that is about 7 per cent of the population.
Olympic shot put champion Valerie Adams recently revealed that her late mother, a Tongan, had type 2 diabetes, as do half of the family from her mother's generation.
The rate in the Māori and Pasifika communities is about three times higher than other New Zealanders but much lower than in Pacific Island countries.
Beaglehole, an Auckland University emeritus professor, puts that down to greater ability and encouragement in New Zealand to eat healthier foods.
"It's diet but that suggests an individual responsibility and it is much more than that."
The opportunity, particularly in the Pacific to eat a healthy diet, was now low.
"If the local supermarket is bringing in cheap stuff - mutton flaps, turkey tails, chicken wings - then of course you go for that," Beaglehole says.
"In Samoa a fresh coconut is more expensive than a can of coke. That epitomises the problem, and of course the coke is sweet and we do have a predilection for sweet and tasty drinks."
Beaglehole says there are still isolated atolls in the Pacific that have low rates of obesity and diabetes because the traditional diet had not changed.
"Apart from the costs [to healthcare], the most tragic aspect for me is the fact that diabetes is preventable. We didn't used to have these high rates of diabetes anywhere, least of all in the Pacific," he says.
"I hate to use this word but it is [driven by] the modernisation of access to poor quality food in the context of a tradition in which eating large amounts of food is important."
Dr Malakai Ofanoa, a Tongan who lectures in pacific health at Auckland University, adds cultural factors to the mix.
"Have you been to a Tongan feast?" he asks. "Fifty suckling pigs! Food is a big part of the culture. If you explore that further you will see the issues around that."
He makes a list: the types of food, inactivity, poverty, poor knowledge, lifestyle as well as cultural aspects.
"In some of the islands, half of the people are affected by diabetes-related blindness. It has huge implications for them and for health services."
The rise of diabetes has opened a new frontier for the foundation set up by Dunedin-born eye surgeon Fred Hollows. Hollows began by treating trachoma in Australia's indigenous population and moved onto other preventable and treatable diseases, particularly cataract.
While cataract is still the leading cause of blindness worldwide, diabetic retinopathy is close behind and has become a main focus for the foundation.
"There is a big and growing need to fill the gaps in healthcare systems in these countries," said Komal Ram, manager of the foundation's Pacific diabetic eye disease programme.
The foundation's goal is for each country they work in to have its own national eye-care system headed by an opthamologist.
"The diabetes problem in the Pacific has been referred to as a time bomb that has gone off. People are presenting too late, with chronic conditions, right across the region," Ram says.
"When a person has diabetes the job becomes trying to prevent them getting the complications; amputations, going blind, renal failure."
Another charity focussed on reducing preventable blindness is the Queen Elizabeth Diamond Jubilee Trust, set up on the Queen's 60th jubilee in 2012 and focussed on Commonwealth countries.
The trust's director of programmes, Andrew Cooper, who was on a visit to Vanuatu, told the Herald that a lot of education was needed about diabetes, diet and exercise.
"To see the number of people who have diabetes, the numbers having amputations and the numbers who might go blind has been quite shocking."
The goal was to help each country provide annual eye checks and laser operations where needed.
"We know that with the right screening and treatment we can reduce 95% of the worst sight-threatening diabetic retinopathy."
The number of people in the world with diabetes has nearly quadrupled since 1980.
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 dying prematurely.
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.
Source: World Health Organisation
Diabetes and blindness
Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults.
Diabetic retinopathy involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision.
Other diabetic eye diseases include diabetic macular edema (swelling to an area of the retina), cataract, and glaucoma.
• The Herald visited Vanuatu courtesy of the Fred Hollows Foundation NZ.