When you think of Fiji, you probably think about an island paradise full of luxury resorts, cool cocktails and tropical fruits. Or, you might think about the devastation of the recent Cyclone Winston. However, you may not realise that this beautiful island, like many western countries, is in a health crisis.
I recently spent two weeks volunteering at a community health clinic in Fiji, helping with a mix of health education on community outreach and individual consultations during the weekly NCD clinics. These clinics were busy ones, attended mostly by those with high blood pressure, heart disease, diabetes or all three. In Fiji, 80% of deaths will be from non-communicable diseases, one in seven people between 25-64 have diabetes and 17% of people with diabetes will be disabled by the condition either through blindness or high rates of amputation. Furthermore, it is estimated that around 50% of children and 40% of women of child bearing age have iron deficiency anaemia. Now, like many cultures leaving traditional diets for a Western one, Fiji is seeing huge rates of non-communicable disease both due to over and under nutrition, putting pressure on an already over-strained and under-funded health system.
Fijians lived for hundreds of years eating a traditional diet of fresh meat, fish, veg and fruit. British colonists arrived in the 1800’s and ruled Fiji up until the year 1970. They brought their love of tea, white flour, the establishment of sugar plantations and subsequently a Westernisation of the traditional Fijian diet. These days, highly processed imported food is making up an increasing portion of the Fijian plate – partly due to Western influences, but also food insecurity linked with living in an isolated location and the limited incomes of so many families. Salty fried snacks, packaged crisps, instant noodles, breakfast biscuits (like a sweet Jatz biscuit), sugar sweetened beverages and white bread are all available conveniently and very cheaply. Imported meat is also popular – usually third grade cuts or processed choices such as sausages and offal, or more commonly, corned mutton in a tin. Locally grown chicken or pork is a luxury item for many. What I found most striking was that most people on the main island don’t eat fresh fish. Instead, fishermen will sell off their day’s catch then come home to eat a can of fish imported from China – simply because it is more profitable.
One strength of the food system is that many people out of the cities grow their own fruit and veg, selling what extra they have on the markets, meaning a local fresh fruit and veg supply. However one of the devastating effects of cyclone Winston has been that many local crops had been uprooted or ruined by the cyclone, abolishing the food supply of many families and ruining livelihoods. Now in Fiji’s west, fruit and veg is increasingly difficult to find and much of what is available has been imported from the other side of the island, thus doubling the prices and putting fresh produce out of reach for much of the population.
One man told me of how all the thousand banana trees on his farm were ruined in the cyclone, so he couldn’t afford to buy other fruit to eat.
This became apparent talking to patients in my first NCD clinic. One man told me of how all the thousand banana trees on his farm were ruined in the cyclone, so he couldn’t afford to buy other fruit to eat. Another patient recalled how her blood sugar levels were rising because the only vegetables she could get for her curry were potatoes. The implications of Winston and decreased food security were echoed by many others who could not get vegetables on the days they went shopping in town, or simply could not afford the huge prices being asked.
So what can be done? The clinic where I was volunteering with had a comprehensive community program to address food security and the rising health crisis. One part of this is the clinic’s community garden program, where communities are provided seeds and training to establish community vegetable gardens. The produce from these gardens gets divided up amongst the community, helping to provide food security and improve health. Last year 110 gardens were established and maintained despite a relatively long drought. This program was being renewed post cyclone with communities provided with fast growing seeds so that fresh vegetables could be accessed as soon as possible.
One of the strengths of the program is the community health workers, people who have been recruited from local villages and settlements, who are empowered to be health leaders in their village by receiving basic health promotion, first aid training and help to promote the clinic’s services. Linking in with this, the clinic operates an outreach program, where the specially fitted bus drives to villages/settlements in the health district to conduct free health screening tests, as well as deliver public health education talks based on the SNAP guidelines. The key messages from these programs are simple – cut back on salt, sugar and added oils, eat plenty of local fruit and veg (grow your own!) and limit packaged food.
We often forget how lucky we are in Australia to have such a wide food choice and availability. Volunteering in Fiji, especially right after a cyclone has really helped to put this all in perspective and made me realise the need to sometimes get back to basics when it comes to health education.
If you would like to know more about the Viseisei Sai Health Clinic you can find their website here
To find out more about volunteering in Fiji go to the IVI website.