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Australian volunteers are helping to reduce Fiji's high rate of diabetes, heart disease and stoke.

Lunchtime has changed a bit for five-year-old Isabella. Not only have fried noodles vanished from her kindergarten's menu, but now there are songs about fruit and pop quizzes on her favourite vegetables. Nutritionists and dentists drop in to visit regularly.

This isn't a token attempt to please health-conscious parents. It's a nation's desperate effort to save its children.

Fijians are dying far too early: death rates from heart disease, cancer and stroke are highest among those aged 39-59, with recorded deaths among in people in their 20s. Foot amputations from diabetes-related complications are now common. Among children, rates of malnutrition and obesity are climbing steadily.

Dr Isimeli Tukana is the Fijian Government's senior adviser on non-communicable diseases. "The challenge for our Ministry of Health is that we are trying to respond to a social problem medically," he says. "If Fijians are dying at 40, they must be sick at 20. If they are sick at 20, the lifestyle factors that made them sick started much earlier. We have an opportunity to delay the onset and complications of these diseases by addressing the social determinants of health."

Australian health professionals have joined the Ministry of Health in its efforts to stem the crisis, through the AusAID-funded Australian Volunteers for International Development program.

In Suva, Brigid Buick is training community nurses to diagnose and treat diabetes-related foot complications, a major step towards reducing the number of amputations each year. In Lautoka, Shelley Thompson is supporting project officers to plan a range of healthy eating, exercise, alcohol and tobacco control initiatives, and analyse data gathered at community health screenings. In Levuka, nutritionist Jessie Pullar is assisting local dieticians to reintroduce traditional recipes based on fresh produce. In Labasa, Emily Meyers has been involved in the development of a stress management centre for people experiencing mental illness.

These diverse yet connected assignments reflect the Ministry's recent shift from a disease-focussed approach to one that encourages people to make healthier choices earlier in their lives. This new approach takes into account the physical, emotional, social, economical, environmental and spiritual aspects of wellness.

Major efforts are underway across the country. Anti-tobacco legislation is being enacted and workplaces are encouraged to become smoke-free. Health messages appear regularly in newspapers, television and community radio. Health services are using mobile technology to send health tips to their clients via SMS.

Interventions are being trialled at the community level: from young mothers learning about early childhood nutrition, to kindergartens signing up to regular dental and dietician visits, high schools developing wellness policies and village groups participating in cooking, gardening and physical activity programs.

In essence, it's about rediscovering the benefits of a more traditional way of life. As volunteer Jessie Pullar explains: "The transition to a more modern society brought in convenience foods such as noodles, sweets and soft drinks. So a lot of the work we do is around promoting traditional habits - going back to growing your own garden, sharing with your neighbours, using local foods."

Isabella and her friends have the advantage of starting early. Hopefully they will lead the push for change within their families and communities.

Significant challenges remain: analysing the vast amounts of health data collected at the community level, identifying success stories, developing region-wide behaviour change programs, and addressing the socio-economic factors that restrict many Fijians' ability to afford healthy food. But as volunteer Shelley Thompson observes, Fiji has reached a pivotal point in its approach to public health. "They've identified that there is a problem and are very open to ideas from all over the world about how to tackle it. It's exciting because there's a lot of possibility and I think it will become actuality very soon."



Photo: Australian Red Cross/Louise Cooper

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