Port Vila, Vanuatu

'They have a really important role to play in bridging the health literacy gap.'

When QAS Intensive Care Paramedic Ben Elliott stepped in to cover for a close friend who was working with ProMedical in Vanuatu as part of the Australian Volunteers Program, he didn’t realise it would evolve into a full-time career in the small island nation.

And while joining the Australian Volunteer Program (AVP) had been on his mind since completing his master’s degree, it wasn’t until his friend, who had lost a family member, needed to travel back to Australia that he signed on as a volunteer, initially for a one-month relief period.

Returning to Queensland, he worked on road for another 18 months before re-joining the program and heading back to Vanuatu for the next two years, from 2019 to 2021.

“Essentially, we had 30 Australian volunteers in country in Vanuatu prior to COVID, and then when COVID hit, everyone was repatriated back to Australia except for myself, an emergency physician and a few other key health volunteers who were here on the Volunteer Program as well. We stayed on.”

He then headed home again and worked on road for another year when a full-time position with ProMedical as Clinical Manager opened up. He applied, was successful, and has been there ever since. He and his Ni-Vanuatu partner have recently welcomed their first child and have put down roots in the capital, Port Vila.

“My tentacles got stuck in Vanuatu and I haven't really left. I do go back to Australia, but my heart and home is here. I’m here for the foreseeable future and am enjoying the work. For me, it's a good mix of everything.”

ProMedical is a non-governmental organisation and a locally registered charity providing pre-hospital ambulance services in the capital on the island of Efate and Espiritu Santo island, the largest island in the Vanuatu archipelago. The country has 83 islands, 65 of which are inhabited.

“So it's quite complex. At the moment we have we have six qualified advanced life-support EMTs. These ALS EMTs work at the standard of an Australia paramedic, however with registration, a bachelor's degree is needed to be recognised as a paramedic. We are working hard to provide further education opportunities to study a bachelor’s degree.

“At present there are six ALS EMTs who have completed a diploma in paramedicine, 1 BLS EMT and four first responder trainees. We have been lucky enough to recruit two new first responder interns this year to boost our clinical team to 11 staff. We have developed an education and training pathway to develop local paramedics and EMTs. Traditionally, ProMedical recruited nurses and employed them as paramedics, however this has many challenges.

“In Vanuatu, it’s a little bit different to nurses in Australia; they don't really work autonomously. They really only follow instructions from doctors, so we're finding that our nurses do need a lot of help with autonomous decision-making, so that's why we want them to do the diploma as well. There's a bit of a transition process needed.”

The long-term goal is bachelor-level paramedics, longer-term sustainability, and a locally led service. Ben’s biggest challenge at present is how to make that a reality. He is already in discussion with Australian universities that offer mixed modal online and practical paramedicine undergraduate degrees and the support of some donors that expressed interest in funding the initiative. But there’s still a long way to go and many mountains to climb.

“At the moment we rely on Australian volunteers and people like myself to facilitate training and development. But we would like to have completely locally led development and training. That's the long term goal of the organisation.”

Ben said the geographical challenges of working servicing an archipelago meant ProMedical were largely localised to the two islands with the largest populations. However, it does have a memorandum of understanding with Vanuatu’s Ministry of Health to provide aeromedical retrieval to all 83 islands in the archipelago.

On those islands without access to land retrieval and transport, people present to their local health facility, which, depending on how the size of the population, is staffed by doctors, nurses, nurse’s aides, and midwives. Referrals are via the Ministry of Health which then contacts ProMedical to facilitate the retrievals using chartered nine-seater planes.

“We don't own the plane; essentially we just put our people and equipment on the plane and they can go anywhere in Vanuatu and pick people up and bring them back to high-level care. Sometimes we can do three in a week and sometimes there’s two weeks without a aeromedical retrieval.

“We fly on these tiny little two-propeller, nine-seater planes. What we do is very mixed, but the majority of the cases we do are obstetric cases, women that are having trouble with their deliveries.”

They are also helping to build health literacy in communities and break down the barriers resulting from a long-standing distrust of Western medicine. This is particularly vital given the sharp spike in non-communicable diseases such as heart disease, hypertension and diabetes that has been driven by changes in diets and lifestyles and the ready availability of red meat and processed foods that were never a part of the traditional diet.

The ProMedical team is at the forefront of raising community awareness about healthy lifestyles and providing guidance on what people need to do when they are unwell.

“When you hear one of our local paramedics explain heart disease to someone in the local Bislama language using metaphors from the ocean or from the garden, it's a way of breaking down those barriers and improving health literacy.

“We go to cases in the community, in the villages, and our paramedics are treating one person, but they're educating a whole community at the same time. Recently we had a patient with a seizure and one of our paramedics was explaining to about 50 people what to do when someone's having a seizure, rolling them on their side, clearing their airway, so they have a really important role to play in bridging the health literacy gap.”

Ben said the biggest areas of potential growth for paramedics in Vanuatu were community paramedicine, health education and awareness, and the integration of hospital systems within communities.

“Rather than just transporting patients to hospital, how can we bring these services and referrals into communities to treat people at home? These would be the areas that we can work on as a long-term goals for us.”