Caring for villagers in Vanuatu: two New Zealand public health nurses spent a month on Malekula Island in Vanuatu in November last year, working with New Zealand doctor Derek Allan at a local health centre. Here they share some of their experiences of caring for villagers.

Smiling children calling "hello" and reaching out to touch our white skin; the gift of fruit and vegetables from hard working women; and the concern for their families shown by the men folk. These are some of the strongest memories of our visit to Lamap.

Lamap is on Malekula Island, the second largest island of Vanuatu. The health centre serves the communities around the island's south-eastern coast. It is from here that we spend our time getting to know the people in the surrounding villages.

How did we come to be working in this remote Pacific community? In September 2002, TV1 produced a documentary "The Good Doctor", on Derek Allan's work in Vanuatu. This showed some of the deficiencies in Vanuatu's health system and also brought the case of Beatrice to our attention. Beatrice was a Vanuatu patient who Allan gained help for in New Zealand. He has since changed the lives of others by getting them access to New Zealand health care and many New Zealanders have donated medical goods and toys. Some have even taken time out to help in person.

Last year Allan was again in the news, bringing six-week-old twins Karen and Margaret Mandan to Auckland from Vanuatu. Margaret needed lifesaving heart surgery and Karen was also found to be seriously ill. Some may remember the controversy around the twins' operations in Auckland Hospital, the subsequent return of these babies to Malekula Island and the death of Karen some months later in her village.

Since that time, many New Zealanders have volunteered to go to Vanuatu to work with Allan, including nurses, doctors and groups such as Youth with a Mission, working on special projects such as re-roofing, animal husbandry, and building water tanks. Volunteers have also come from Switzerland, Sweden and America. Our interest in volunteering came from reading a letter in Kai Tiaki Nursing New Zealand from Joan Brown, who had visited Vanuatu. We set off for Lamap with little knowledge of what to expect, although we had read the Lonely Planet guide to Vanuatu, sourced Allan's "troppodoc" web site and Terri had met him on two occasions in New Zealand.

Lamap is the closest land to Ambrym Island, where smoke from the active volcano is clearly visible. Our flight from Vila took the long route, via the island of Espiritu Santo and Norsup in northern Malekula, before landing on the grass strip at Lamap. The local and only transport is a Toyota ute, which bounds along the track between coconut plantations, villages and the mangrove-edged sea, to deliver us to the health centre. We have arrived!

A tour of the facilities

"Dr Derek", as he is known locally, takes us on a tour of the facilities. The remnants of a once thriving hospital, staffed by two full-time French doctors, are evident in the rusting beds, sad and dirty mattresses, a room where locals arrive for dressings most mornings, a consultation room, an obstetric room, which includes two cots, and an operating room with no light and a very short operating table. There is an empty radiology room and a dispensary with a Limited range of drugs. A laboratory technician analyses blood but only for malaria, as there is no opportunity for further training.

Our accommodation is rough and ready and we share it with a collection of boxes containing clothes, dressings, equipment and drugs which have been donated from New Zealand. They await out attention to unpack, sort and distribute. Our first task is to walk to a nearby village to fix a washer on a dripping tap, which is the village's water supply. Water here is precious. As we walked, we met the rest of the team, all from New Zealand: nutritionist, Deborah Wilson; anaesthetic technician, Nick Fischer; community health worker, Angela Ewen and rural practice nurse Margaret Thorne from Gisborne, who had also featured in the television documentary and who has worked on Malekula Island many times.

"Dr Derek" has only recently arrived in Lamap and is still in the process of meeting and being recognised by the local people. We are able to help this process, as our introduction to a village is via the chief and then by those who are "handicapped", and then by women parenting on their own. Gradually more villagers present themselves to our team for help with wider health issues.

To visit these people often involves hours of walking in temperatures of 30-35 degrees. Water bottles are essential, especially when we learn that the next village is "just around the corner"! We travel by dug out canoe, aluminium dinghy, helicopter or 'Sandal power" and also visit other small islands.

The plan for our nursing day is to divide into pairs, depending on the tasks ahead.

We have brought with us a pushchair for an 11-year-old girl, who is only the size of a three-year-old, possibly because of maternal rubella. Estelle is only able to walk a short distance, with support, and has limited intellectual ability. The sheer excitement of her village family and the delight on her face as she is lifted into the pushchair and wheeled between the coconut trees, is a warm memory. A simple pushchair raised the quality of life for a small girl.

Crude equipment

We return to the health centre from a hot tiring walk to a village clinic to find a young mother at the health centre, who has had a miscarriage at 15 weeks. We struggle to get a haemoglobin reading with the crude equipment and are shocked to see a dark-skinned woman so pale. Finally we get a reading--an Hb of 4.2! Then there is the challenge of organising a transfer to Norsup Hospital for the blood transfusion. First a boat trip to Sandy Bay and from there a ute takes her on the three-and-a-half hour journey over a corrugated, pot-holed road to Norsup Hospital.

Public health issues

As public health nurses (PHNs) we are interested in public health issues: the source and quality of the water supply; mosquito breeding sites; immunisation programmes; child health and safety; communicable and tropical diseases; nutrition; education; and social and economic issues in the village communities. "Dr Derek" says PHNs, with their community focus, are welt suited to this work.

In the village clinics we see children with tuberculosis, infected scabies, malaria, protein deficiency, evidenced by various degrees of blonding of the hair; yaws with ulcerating sores, gastric diseases and tropical ulcers.

The quick response of many of these diseases to antibiotics is amazing but there are issues about completing the course. An 11-year-old boy is stung by a stonefish and this causes severe swelling and pain. After 48 hours of antibiotics and pain relief, he is back in his village, running around and bathing his foot daily in the sea. The family has stopped the medicine as "not need, number one boy gud, gud", family members tell us in the local dialect, Bislama.

We do health profiles on each village, talking with the chiefs, elders and mature women. It is these people who bring those needing attention to us. They are intelligent, friendly people and very welcoming to nurse volunteers--"Oh, New Zealand nurses, welcome, welcome."

Sewing to fund grandchildren's education

We meet Sabine, an "elderly" woman of around 50, who pulls herself along on her bottom or who, for short distances, lifts and manually braces her leg. She was crippled by an immunisation into the sciatic nerve. Sabine has a hand-driven sewing machine given to her by an Italian Catholic nun. She sews clothes for villagers and, with the money she makes, pays for her grandchildren to attend the mission school. "Dr Derek" is trying to purchase a small solar panel to supply power to a fluorescent light in her hut, which is quite dark, even during the day. We are able to give Sabine donated material and cotton to continue her work.

Sabine's daughter Rechel is a beautiful intelligent young woman, keen to learn more English and to teach us Bislama. She has a three-year-old son Jordan and decides to start a kindergarten for 12-15 children, aged up to six or seven. She is overjoyed when we give her exercise books and pencils! She shows us some excellent work by the children, who write on their hands with their fingers or write in the sand, until they have written it correctly. Only then do they write in their precious books.

In another village, we meet Isabel and her small daughter Suzette. We visit Isabel who suffers from epilepsy, which has been uncontrolled for a long time, and she now has an intellectual disability. Suzette has infected scabies. We visit them every day to treat the sores and talk with mother and daughter. This contact increases their status in the village. Over our time visiting, we see Suzette smiling and running to greet us, and Isabel cleaning her neglected teeth with a toothbrush and toothpaste, wearing clean clothes and proudly showing us improvements in her hut and her life.

We attend church on Sunday and those who don't, are allocated cleaning duties around our compound. Church is a spectacular experience--special colourful Sunday clothes, the bright eyes of the children and the beautiful singing in Bislama. Each evening we Listen to children practising around the village fires "Jesus luv Little pikanini, all pikanini of the world" and find ourselves singing this as we walk along tracks from village to village.

In church, men sit on one side, women the other. The children sit quietly and shyly, and proudly show us their new clothes and the stickers or soft toys we have given them for being brave when we treated them.

It is good to see the chief's father, Eugene from Penup, who has been house bound for years with unknown leg problems, perhaps a stroke. He has been pushed three or four kilometres to church in a wheelchair which "Dr Derek" brought from the Island of Ambrym by helicopter. It is a great opportunity for Eugene to be out with other villagers.

Then there is Felix, an elderly man, almost blind. To save us another visit to his home, he has come to us after church. We dress his leg ulcer with honey donated by the "bee man" from Taneatua and are pleased to see gradual healing taking place.

Our evening meals are mostly vegetarian, with beans from Felix's garden, kumala (kumara) from Rechel's garden, and tomatoes, minock and taro, coconuts, small sweet bananas and pineapples. The Ni Vanuatu are very generous but we are aware they have little money and have to pay for their children to attend school. We learn when something is truly a gift or when we should pay some vatu for the goods--it is all a learning experience.

Daylight goes quickly. There is no electricity and running water is unpredictable. "Dr Derek" and Nick have rigged up a fluorescent light to an old intravenous drip stand and, with power from the solar panel and car battery, we have light to cook our dinner quickly over the single gas cooker.

Nights are hot and we make good use of our mosquito nets. The quietness of a tropical night is a complete fallacy--they are punctuated by the loud acclaim of village dogs, roosters crowing (one of which sounded like a pubescent boy, his voice breaking and not quite in tune) and the distant bellow of a cow. The animal kingdom reigns supreme during the hours of darkness.

Far too soon, dawn light wakes us and we rise at 5am to enjoy a cold shower. We breakfast on lovely local bread, an unexpected luxury, soft with crunchy crusts and spread with the remains of the large jar of vegemite we brought with us. Water bottles are filled from the outside water butts. Rainwater supplies are low and an oily sheen hovers on top, so we squeeze lemon or lime juice to give it a fresh tang. We apply the necessary layers of sunscreen lotion and check dressing supplies in our small backpacks and are ready to leave. The hospital campus displays a large sign in Bislama, which states that women must wear skirts on the hospital site or face a fine of 5000 vatu (about $95). We are wearing trousers, so wrap our lava lavas around until we leave the grounds.

This day we manage to be out walking by 6.30am so it is lovely and cool as we set off, just the two of us. We tramp past the village where children are already calling out cheeky "hellos", which they repeat until we answer individually. Sometimes it is difficult to see where these lively little people are calling from, as they peek from their huts and swing around trees. Breakfast consists of green mangoes and pieces of coconut, which the children gnaw on as they wander off to school, if they are lucky enough to be able to attend. Through the open ground we walk, past cows munching on straggly tough grass or short bushes, and pigs snuffling among the weeds. Each sow has an entourage of six to eight piglets of various colours, which play tag as they rush from one hiding place to another. We walk on past the mission school, the Catholic Church and our favourite frangipani tree. We gather some blooms with their perfect white petals and bright yellow centre and enjoy the perfume of pure Pacifica as we walk on to the next village. Just another working day in Malekula--how hard can it get!

Terri Webby, RN, BHSc, ADN is a public health nurse in the eastern Bay of Plenty, with the Bay of Plenty District Health Board. Judy Barnett, RN, BN, is a public health nurse with the Waikato District Health Board. For more information on Derek Allan and his work: [e-mail].