"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.
Waiting for the Herald on the ferry that has just docked in Port Vila, Vanuatu, after its overnight voyage are three Tanna Islanders who fear diabetes is taking their sight.
The oldest is Morris Niliuan, 55, who hasn't let the amputation of a leg - a complication of the disease - stop him growing flowers. He vigorously digs his garden from his wheelchair.
The youngest is Zipora Niam, 15, who has type 1 diabetes, an autoimmune disease that damages the pancreas and stops it making insulin. Zipora has tribal tattoos on her cheeks, and a voice so soft it could blow away on the breeze.
She had never travelled on the sea, never seen "a city". "Yes," says Zipora, glancing at the busy little port, "it is scary".
Ida Iesul, 54, who worked as a nurse, knows best what diabetes can do to the body in a developing nation such as Vanuatu.
She and Morris have type 2 diabetes, a disease that causes their bodies not to respond well to insulin or to make enough of it. Both are chronic diseases that need careful management.
They are here to be checked by a visiting Fred Hollows Foundation NZ Outreach team.
Ida Iesul, 54, from Tanna Island, has Type 2 diabetes. Photo / Chris Tarpey
When the Herald asks what she hopes to get from the trip, Ida begins to cry.
"She wants to know what is happening with her eyes," says David Silapo, the sole eye nurse on Tanna, "and what can be done because she believes that if she loses her sight then, for her, that's it."
Embarrassed, Ida wipes her eyes with the palms of her hands and says, "sorry".
"I find that I can't look properly," she says. "When I stand on the side of the road and a truck passes, I can't see the people who are sitting on the truck.
"It is very hard for me to read any newspaper or books or the Bible. Very hard.
"My parents, they had sugar [diabetes] and high blood pressure. I come from a small island off Tanna and most people they got sugar."
She is trying. She takes her tea now without sugar. "To me, it is nice," she says.
Next morning the Tanna patients are among two dozen people assessed by the Outreach team of two doctors and four nurses who squeeze into a small room at Vila Central Hospital along with two eye examination machines and one that can do simple laser operations.
Morris Niliuan, 55, from Tanna Island, had his leg amputated due to complications of his Type 2 diabetes. Photo / Chris Tarpey
Morris enters on crutches wearing a Wallabies cap and red shirt and sits on a blue plastic chair. Quickly he crosses himself. Later, he appears to be mouthing a prayer.
Ida wears the same worried expression of the day before.
Zipora is like a young bird out of the nest. She is from the remote west of Tanna Island, an area that follows traditional ways. Her diabetes was diagnosed a few years ago after she complained of "foggy" vision.
She stopped going to school after diabetes was diagnosed. The reason is unclear but it may be the cost. It was explained to the Herald that it is common for only the boys of families with little money to continue past primary school because they were thought to have the best chance of a getting a job.
The news could be worse.
Zipora's eyes show no sign of diabetic retinopathy - to be expected for one so young - but there are already early-stage cataracts in both eyes. The eye doctor tells her she needs to control her blood sugar level and come back in a year.
It is unclear how much she understands. She forgot to bring her insulin on the trip.
Zipora Niam, 15, from Tanna Island, has Type 1 diabetes. Photo / Chris Tarpey
Ida, likewise has no retinal damage but has cataracts. She is asked to come back for surgery after the new eye clinic that will have the latest diagnostic and laser equipment opens at Vila Central Hospital in February.
It means another expensive boat trip but Ida can look forward to being able to read again.
Morris has only minimal diabetic retinopathy in one eye and will be checked again in one year. He laughs with relief. Perhaps his prayers were answered.
And there's good news for all Tanna Islanders. After a representative visited recently, the Queen Elizabeth Diamond Jubilee Trust, a British charity, is giving $110,000 to the Fred Hollows Foundation to spend on equipment for the small eye clinics on Tanna and Santos Island.
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.
