Emergency care in the most disaster prone country in the world

Delivering supplies to Vanuatu

“All I do is sit and cry with my children. I want family planning so bad. I’ve known about it, but I have never managed to get it,” says Esther, 31, sitting in the tiny village on the island of Ambae, in Vanuatu. On her lap is her youngest child, Elijah. Next to her on the mat is her two-year-old child, Stewart. Running around outside her modest house are her four other children - George, 12, James, 10, Steven, 8, and Judith, 6.

Esther lives on the Manaro Voui volcano in Vanuatu - where sudden recent seismic activity causes it to belch toxic fumes. Esther’s husband is barely home. Her second youngest, Stewart, has a disability and cannot walk. Her youngest, Elijah, was born one week before the family were forced to evacuate to another island. On her own, Esther packed up their home and safely brought her children to the evacuation centre. This was the first time that an entire island population had been evacuated in the Pacific Region.

Once the threat level was decreased and the population returned, the Vanuatu Family Health Association, through the International Planned Parenthood Federation, commenced a humanitarian response with mobile health clinics and awareness sessions. The services available through the clinics included pregnancy and delivery support, contraceptives such as condoms, injectables, implants and emergency contraceptives, and screening and management of sexually transmitted infections.

 

Humanitarian response team ensures safe delivery of emergency supplies following volcanic eruptions, Vanuatu

  • Our humanitarian team bring urgent medical supplies by boat including vaccinations, antibiotics and contraceptives to remote communities living on Manaro Voui Volcano on Ambae Island.
    Our humanitarian team bring urgent medical supplies by boat including vaccinations, antibiotics and contraceptives to remote communities living on Manaro Voui Volcano on Ambae Island.
  • The team hiked for hours along the volcano's mountainside to reach remote communities.
    The team hiked for hours along the volcano's mountainside to reach remote communities.
  • The team prepare for the day ahead as they set up the mobile clinic.
    The team prepare for the day ahead as they set up the mobile clinic.
  • The community of Lovutialau is high up the steep sides of the Manaro Voui vlcano on the island of Ambae in Vanuatu. IPPF teams have set up a mobile clinic in the community, providing family planning and pre- and ante-natal services to women and girls.
    The community of Lovutialau is high up the steep sides of the Manaro Voui vlcano on the island of Ambae in Vanuatu. IPPF teams have set up a mobile clinic in the community, providing family planning and pre- and ante-natal services to women and girls.
  • The mobile clinic is busy with people attending from the local villages. The clinic is a welcome opportunity for many locals who usually have to travel for hours to reach the nearest health centres.
    The mobile clinic is busy with people attending from the local villages. The clinic is a welcome opportunity for many locals who usually have to travel for hours to reach the nearest health centres.
  • The mobile clinic in Lovutialau, West Ambae.
    The mobile clinic in Lovutialau, West Ambae.
  • "After the eruption we slept in this church for those two nights. We were the last group to evacuate," says Donneth. "Island women are afraid to talk about family planning because we are shy. Some people have as many as ten children here, it’s too much. I always planned to have four kids myself. Women who have as many as ten tell me it was by mistake, they often use the ‘calendar’ method as their only form of contraception.”
    "After the eruption we slept in this church for those two nights. We were the last group to evacuate," says Donneth. "Island women are afraid to talk about family planning because we are shy. Some people have as many as ten children here, it’s too much. I always planned to have four kids myself. Women who have as many as ten tell me it was by mistake, they often use the ‘calendar’ method as their only form of contraception.”
  • Gabriella has decided to have the implant, Jadelle, fitted at a mobile health clinic in Lovutialau, West Ambae.
    Gabriella has decided to have the implant, Jadelle, fitted at a mobile health clinic in Lovutialau, West Ambae.
  • "I came to this mobile health clinic today for my own needs, but as soon as I found out about family planning I rushed back to my house to tell my wife. I encouraged her to get it; she decided on the 'five-year stick' (Jadelle implant). We were actually looking for family planning options but didn’t realize there was this new method!" Isaac and Gabrielle already have four children.
    "I came to this mobile health clinic today for my own needs, but as soon as I found out about family planning I rushed back to my house to tell my wife. I encouraged her to get it; she decided on the 'five-year stick' (Jadelle implant). We were actually looking for family planning options but didn’t realize there was this new method!" Isaac and Gabrielle already have four children.
  • Kwevire came to the mobile clinic in Lovutialau, West Ambae to get an antenatal check-up. This is her eighth pregnancy. “Today at this clinic I received medicine for my pregnancy, including iron tablets. Normally to access health care I have to travel far, it costs Vt2,000 for one trip in a truck, or a two-hour walk. Plus, I have to buy lunch for myself and my children as it’s a full day travel. Today has saved me that long walk. I am happy.”
    Kwevire came to the mobile clinic in Lovutialau, West Ambae to get an antenatal check-up. This is her eighth pregnancy. “Today at this clinic I received medicine for my pregnancy, including iron tablets. Normally to access health care I have to travel far, it costs Vt2,000 for one trip in a truck, or a two-hour walk. Plus, I have to buy lunch for myself and my children as it’s a full day travel. Today has saved me that long walk. I am happy.”
  • Staff talk to the local community about reproductive health and contraceptive choices.
    Staff talk to the local community about reproductive health and contraceptive choices.
  • Natalie is seven months pregnant. She lives with her son Johnson high up on the volcano's steep sides. The mobile outreach team visited her village and give vaccinations to her son. "When the volcano started to become active, we could hear the noise of the volcano erupting and see the smoke in the sky. We had to walk down the mountain to Lone, it took many hours," says Natalie. "After I deliver this child I want to get the ‘five-year stick’ [Jadelle]. It will make life easier.”
    Natalie is seven months pregnant. She lives with her son Johnson high up on the volcano's steep sides. The mobile outreach team visited her village and give vaccinations to her son. "When the volcano started to become active, we could hear the noise of the volcano erupting and see the smoke in the sky. We had to walk down the mountain to Lone, it took many hours," says Natalie. "After I deliver this child I want to get the ‘five-year stick’ [Jadelle]. It will make life easier.”
  • Esther, 31, and her six children live in Naqua, West Ambae. Their village is one of the closest to Manaro Voui Volcano. The family were evacuated after the volcano threatened to erupt. "When we returned yesterday from Santo, our home was covered in ash, even all our beds. It’s so dangerous for the children. My two-year-old son Stewart is disabled. It’s very hard with six children. I want the family planning so bad. I’ve known about it but I have never managed to get it."
    Esther, 31, and her six children live in Naqua, West Ambae. Their village is one of the closest to Manaro Voui Volcano. The family were evacuated after the volcano threatened to erupt. "When we returned yesterday from Santo, our home was covered in ash, even all our beds. It’s so dangerous for the children. My two-year-old son Stewart is disabled. It’s very hard with six children. I want the family planning so bad. I’ve known about it but I have never managed to get it."
  •    "I’ve never been taught about comprehensive sexuality in school", says Rosiane. "My mama told me a few things when I was about 12 years old – to stay away from boys during my period and about condoms. Even if I wanted to get them I would have to drive one hour to the nearest health clinic to get them. I want to work when I grow up, and move to Port Villa. I have decided I only want one child, it’s too hard to look after more.”
    "I’ve never been taught about comprehensive sexuality in school", says Rosiane. "My mama told me a few things when I was about 12 years old – to stay away from boys during my period and about condoms. Even if I wanted to get them I would have to drive one hour to the nearest health clinic to get them. I want to work when I grow up, and move to Port Villa. I have decided I only want one child, it’s too hard to look after more.”
  • The mobile clinic runs family planning and sexual health awareness sessions.
    The mobile clinic runs family planning and sexual health awareness sessions.
  • At a mobile clinic Jason, who is married with two sons, attended a family planning and sexual health awareness session. Afterwards, Jason chose to a take an HIV test and collected condoms. Jason says "the problem is people here don’t feel free to ask for condoms, we don’t get enough sexuality education in Vanuatu. Our parents tell us its taboo and don’t teach their kids how to protect themselves."
    At a mobile clinic Jason, who is married with two sons, attended a family planning and sexual health awareness session. Afterwards, Jason chose to a take an HIV test and collected condoms. Jason says "the problem is people here don’t feel free to ask for condoms, we don’t get enough sexuality education in Vanuatu. Our parents tell us its taboo and don’t teach their kids how to protect themselves."
  • "Rape is a big problem in Vanuatu in general, including on Ambae. If a young man likes a woman, he can feel like it’s his right to have sex with her and can force her. In rape cases, the chief is required to refer the case to the police. There are some cases of young girls walking to and from school and getting raped. Sometimes they keep it a secret due to shame. We have to teach young people about safe sex in school", says Pastor Solmon Aru.
    "Rape is a big problem in Vanuatu in general, including on Ambae. If a young man likes a woman, he can feel like it’s his right to have sex with her and can force her. In rape cases, the chief is required to refer the case to the police. There are some cases of young girls walking to and from school and getting raped. Sometimes they keep it a secret due to shame. We have to teach young people about safe sex in school", says Pastor Solmon Aru.
  • After the threat level of Manaro Voui volcano was downgraded, evacuated residents returned after one month in evacuation centres on nearby islands. However, their homes are covered in ash and the air is filled with smoke. The volcano rumbles, having not been active like this in the islanders' lifetimes, leaving many frightened.
    After the threat level of Manaro Voui volcano was downgraded, evacuated residents returned after one month in evacuation centres on nearby islands. However, their homes are covered in ash and the air is filled with smoke. The volcano rumbles, having not been active like this in the islanders' lifetimes, leaving many frightened.
  • Many families are rebuilding their homes and planting new crops after many were destroyed by the volcanic ash.
    Many families are rebuilding their homes and planting new crops after many were destroyed by the volcanic ash.

Often the communities were in areas that were impassable by road, so the VHFA response team - which included nurses and midwives - travelled by boat and foot with their medical supplies to reach those closest to the crater. Esther lived in one of those villages, evident by the smoke constantly billowing out of the crater in the near distance.

Raising six children alone was already difficult for Esther but her life was made even harder during and after the evacuation. Emergency situations are particularly unsafe for women and children, who are more likely to die during an emergency than men. Transmission rates of sexually transmitted infections - including HIV - increase during an emergency, as does sexual violence and maternal deaths.

Esther desperately wanted access to long term contraceptives. The nearest clinic for her is a two-hour way away, almost impossible with six children in tow. When the Vanuatu Family Health Association arrived at her village they were able to counsel her about her contraceptive options, and return the following week to give Esther a five-year contraceptive implant.

‘Mothers do everything in Vanuatu, so having a smaller family makes it easier to move around in emergencies,’ says Julie Aru, a nurse working with VHFA during their humanitarian response. This is particularly important in Vanuatu, which according to the World Risk Index, is the most disaster-prone country in the world.

‘But the biggest issue is isolation. Mothers do not have access to family planning even in stable times,” says Julie. “The second issue is ‘kastom’ - religious and cultural beliefs – which sometimes don’t allow women access to family planning. We are working to change this.”

Whilst emergencies create immense challenges, they also provide opportunities for organisations like the Vanuatu Family Health Association to reach remote communities such as Esther’s, to increase sexual literary rates, and to provide women with reproductive choices. By the end of the response, VHFA had reached over 1,600 people across the southern part of Ambae Island with sexual and reproductive health care and information, and 480 dignity kits were distributed on North and East Ambae.