In the first week of September, 2014, a Chinese hospital ship visited Port Vila, Vanuatu.

Demand for services was immense....

This man traveled from his home island of Tongoa to get treatment.

The wait was confusing and frustrating for many. They crowded around the triage centers at the public wharf, the Chinese club and Port Vila hospital.

One the first day alone, Chinese medical staff from the ship reportedly attended to 900 people. A public relations official stated that the preliminary estimate of the number of people seen during the week-long visit was nearly 5,000.

In a town numbering only slightly more than 40,000, that's an astonishing level of demand.

"You're waiting to see the doctor?"

"Yes, I've been waiting all morning."

"What's the matter?"

"My legs are sore. They've been sore for years."

"But you've been to the local hospital?"

"Yes."

"And what did they do for you?"

"Panadol," she said, and rolled her eyes.

"What time did you get here?"

"Before 7:00 a.m. I've been standing here for 3 hours. I came yesterday, too, but I gave up. There were too many people."

"What's the matter?"

"I have a boil that became ulcerated. They lanced it a week ago at the hospital, but it didn't heal, so they cleaned it again, but it still won't heal. I can't use my hand, and the pain keeps me awake at night."

"Aren't you going to go back to the hospital?"

"They told me to go see them again next week, but I don't want to wait any longer."

The ship itself is impressive.

According to Chinese PLA Navy public relations, its capabilities are equivalent to a mid-size to large hospital in Beijing.

It contains equipment and facilities that are otherwise unavailable in the country. This CAT scanner is just one notable example.

The staff were without exception courteous, firm and professional.

It was frankly impressive to see how well they handled the numbers, and how people from all walks of life were treated with equal respect and dignity.

Many people seemed to treat the visit as an outing or a day trip....

But the visit of the Peace Ark, as it's known, did in fact save lives. I was told by staff about one situation, coordinated with doctors at Vila Central Hospital, where they were able to save the life of a young mother who had experienced complications following the delivery of her child.

Had she only had local facilities available, her prognosis was negative, but aboard the PLA Navy ship, her chances of survival were near certain.

The Chinese I spoke with were impressed with the dedication and professionalism of senior medical staff in Vanuatu. Their concerns, however, were nothing new: Primitive facilities, under-staffing, a lack of state of the art equipment and services, and most importantly, a lack of capacity to provide longer-term treatment and prevention of non-communicable diseases and other inevitable aspects of living longer.

Per capita spending on health in Vanuatu differs so much from that of developed countries, they can't usefully be put on the same chart. Likewise, it's almost pointless to talk about health service delivery here in Vanuatu in the same terms as we would use in Sydney, for example. Health spending represents between 11% and 13% of annual budgeted spending, which is in line with most other countries, and although Vanuatu is in the lower rank among Pacific island countries where per capita spending is concerned, it's not out of scale with them.

As we see below, China's per capita spending is quite similar, but the nature and scale of their economy make resources like the state of the art Peace Ark possible. It's quite likely, though, that they understand the possibilities and the limitations of delivering health services in a place like Vanuatu better than many other donor partners, whose experience might leave them somewhat distanced from Vanuatu's.

But the story goes far deeper than just money.

Health has not been a national political priority for years, and it shows. Management issues abound. Staffing levels are low, with many remote nursing and aid stations remaining empty for much of the year. One Australian nurse on a voluntary secondment from a Queensland hospital, told me that nurse-to-bed ratios were four to six times lower in Port Vila than where she worked.

What can we say, then, to the next generation of patients? What hope can we reasonably offer?

The prospects of this changing in any meaningful way are disturbingly poor.

While the amount we spend per person is nowhere near enough, we have to come to terms with the fact that the system itself is in trouble. Some experts have said that even if we had more money now, we wouldn't be able usefully to spend it.

"Is the money being spent efficiently?

"The answer to this question is probably no. It is 'probably' no because the lack of data on the impact of health services makes it tricky to give a definitive answer."

Source: Vanuatu Department of Finance and Treasury - Health Sector Public Expenditure Review

Attitudes toward the health care system need to be repaired as well. Many people have simply lost faith in Vanuatu's health services.

"I came because I was worried about cervical cancer. They gave me a PAP smear and scanned me."

"But you could have got a PAP smear at a clinic or the hospital...."

"No, I don't trust them. I wanted to be sure."

Periodic access to facilities such as those provided by the Chinese is unquestionably a good thing, but as the crew of the ship themselves told me, they are powerless to address chronic illnesses, public health... indeed, any long-term issues.

The responsibility, ultimately, belongs to Vanuatu alone. But until public faith is restored and expectations raised, until political will is brought to bear, it's hard to imagine how Vanuatu's health services can be improved.

THE WAIT

Recent events have highlighted just how weak Vanuatu's health services really are.

Find out more...

The issue of how to improve our health services —and how to build a functioning health system— in Vanuatu is complex and difficult. There is no silver bullet, no one thing that will magically fix the many problems that result in so much unnecessary suffering and loss.

Written by Dan McGarry for the Pacific Institute of Public Policy.

The Pacific Institute of Public Policy (PiPP) is the leading independent think tank serving the Pacific islands community. We exist to stimulate and support informed policy debate in the Pacific.