In general, Vanuatu is a pretty healthy place to visit, but:
This is a biggy, no matter what the tourist authorities tell you. Virtually all ni-Vanuatu have malaria, which flares up whenever they get sick from something else. At the least, malaria will cause a week of your vacation to be miserable, at worse it will kill you - In early 1992, a New Zealand volunteer died from malaria a few days after returning home. I ran into lots of people who scorned those of us who took anti-malarials (claiming that the drugs were harmful or that they just masked the symptoms); each to their own, I guess. I am not qualified to say which anti-malarials to take (usually in the form of weekly or daily pills), but there is a lot of chloroquine-resistant malaria in Vanuatu. Our entire family took anti-malarials, even when we lived in Port Vila. Only the kids got malaria, because they could only take chloroquine on Malekula due to their young age. I think that attempting to avoid mosquitoes by staying in at night or wearing long pants and sleeves all the time is unrealistic; use lots of mosquito repellent and carry a mosquito net to sleep under (box-shaped net with hexagonal weave allows better ventilation than the old conical cheese-cloth style). My wife (renown within the family, at least, for having dramatically cut Malekula's reported malaria incidence by getting after the local lab technicians to stop reporting every slide positive after a casual glance - see the January, 1988 and later government stats) has reminded me to add that getting malaria is "dose-related". Even a person who takes anti-malarials is liable to come down with malaria if he get lots of bites from infected mosquitoes.
Checking malaria slides at the Norsup Hospital Laboratory. Photo ©S. Combs, 1988.
This other mosquito-borne disease killed a few score ni-Vanuatu when we lived in Port Vila. There is no prophylaxis or treatment for this virus, so avoid mosquito bites. My parents caught this one while working in the Caribbean, and it laid them low for a month.
Hepatitis A, B, C, etc.
These are rampant in rural Vanuatu and are often found in wells in densely populated areas (like small islands). Get vaccinations for A and B and whatever else you can before you go. Treat water that comes from wells or streams before you drink it. Think about this one and TB, etc. before you drink kava that has been ground by chewing (usually only on Tanna - ask at the nakamals there before you buy).
Other Water-Borne Diseases
Tap water in villages, which comes from far up the hill, is usually OK. I have to admit that I never treated water, and I never got sick from it (well, maybe once or twice). Nevertheless, it is common for things like salmonella to sweep through a community after a communal feast. Be aware that most rural ni-Vanuatu use the bush for a toilet, and the rainy season's floods sweep the forest floor clean and into wells and streams. Look out for small, heavily-populated islands where the wells are near the beach to access the fresh-water lens that floats above the salt-water table, and the pit latrines are up the hill behind the buildings. My wife tells me not to mention giardia (actually, we only knew of one case, in Port Vila) because it is just as, if not more, prevalent in Canada.
Parasites, Internal and External
Our kids got lice and pin worms, just like they would have in Canada, but perhaps more frequently. These types of parasites are very wide-spread in Vanuatu. I don't know if I ever got any, because we always treated the entire family when we noticed them on or in the kids.
Venereal Disease, Including HIV/AIDS
Non-AIDS VD is very widespread in Vanuatu (the missionaries weren't quite as successful with chastity as they were with clothing). My wife assisted with AIDS testing in the Vila Hospital Lab, and never found a confirmed case up to 1992. I have trouble believing that is isn't present, though, knowing the habits of the many ni-Vanuatu that travel abroad, including fishermen to Thailand. There is also a fair bit of cross-cultural sexual activity in Vanuatu, so some fairly exotic VDs are present (perhaps introduced by reputed competitions among visiting cruise ship crews to see who can get laid first upon arrival). I would assume heterosexual/homosexual HIV/AIDS (sometimes referred to by the French acronym "SIDA") is present in Vanuatu and behave accordingly.
This is one the guide books neglect to mention. Melanesians do not have the Rh Negative blood type, so any injury or emergency surgery requiring Rh Negative blood transfusions sets off a search for matching blood in Vanuatu's small European community. The absence of Rh negative blood will become an increasing problem as more and more Europeans visit Vanuatu, and is a factor to be kept in mind by potential tourists. When we lived in Vanuatu, there were a couple of resident European women who had permanent difficulties carrying pregnancies to term because of past emergency transfusions of blood with the wrong Rh factor. On the subject of blood transfusions, see above re: the likelihood of blood-borne diseases such as hepatitis and/or HIV/AIDS in the general population of blood donors.
Ciguatera, or "Fish Poisoning"
This kills about one person a year in Vanuatu, but makes many more very sick. It is caused by a toxin produced by a coral reef algae that is eaten by fish and concentrated up the food chain in carnivore fish. Its presence is variable from one place to another and from season to season, but it seems to be associated with trauma to the reef (storm, blasting, etc.). I was told that it is a neurological toxin with symptoms including the sense of warm and cold being switched and water on the skin causing pain. Symptoms last for months and once sensitized, a person is vulnerable to much smaller doses. Ciguatera is avoided by not eating fish that live or are caught on the reef or their predators, such as barracuda. Deep water species, such as most of the fish sold by government Fisheries Department (FD) shops on the islands or in FD shops in Luganville and Vila are safe, as they do not graze on coral or eat fish that do. Just be aware that even FD shops often sell parrot fish (a reef "grazer") and that "Tahitian Salad" sold in restaurants is traditionally made from marinated parrot fish. Personally, I never ate fish caught on the reef (well, Tahitian Salad a couple of times; I admit that I survived), and I noticed that Fisheries Department advisers out on the islands never did either. Many people advise that you go with local advice regarding the safety of specific fish, but I think that just makes your odds of staying well a bit better; it is no guarantee of safety.
This is a problem for expats everywhere in the tropics. Don't try to match your ni-Vanuatu guide at doing without water. Drink lots and often. Always check the colour of your urine (I know this is easier for men than women); if it is dark, you are not drinking enough water. The least you will get from not drinking enough water is an urinary tract infection; acute dehydration can be very serious.
"Crotch Rot", etc.
I recommend loose 100% cotton boxer shorts for men for good air circulation. My wife recommends women wear cotton underwear and carry yeast infection medication.
There is lot of TB in Vanuatu, as well as a bit of exotics like elephantiasis and leprosy, but these are not usually a problem for expatriates, who tend to be better fed (for cultural reasons, not unavailability of food) and live in less crowded conditions than ni-Vanuatu. Also, expats are usually not run down from constant malaria.
What If You Become Seriously Ill?
Curative health care in rural Vanuatu is not up to western standards. There is a network of Aid Stations, where you can get a superficial wound dressed, but that is about it. There are a few rural Hospitals, (Norsup, Malekula; Lolowai, Ambae; Lenekel, Tanna) that sometimes have a physician on staff. His primary priority, though, is the health of ni-Vanuatu, not travelers. If you go through the regular channels at a hospital, you will see a ni-Vanuatu "Dresser" who may have some nursing training, not a Doctor. Most complaints are diagnosed as malaria, stomach upset, or skin infection. If you think you have a sickness that is more than just inconvenient, I advise a quick plane trip to Luganville, where there are physicians at the Luganville Hospital, or Port Vila, where there is the main national Hospital and a couple of private physicians. Again, the main priority of the few Doctors at the hospitals is ni-Vanuatu health. There is always a lineup, and there are stories about babies, ni-Vanuatu and expatriate, dying while their mothers wait in line. You will get personal attention from a private physician in Port Vila.
If you become seriously ill, I (and probably the physicians) recommend that you get on the first available airline seat to Noumea, New Caledonia; Auckland, New Zealand; or Sydney or Brisbane, Australia. Vanuatu's curative health system is not meant to be up to Western standards, although all of the physicians are very good. Indeed, some are specialists of a caliber you wouldn't get in to see at home, but they don't have the same facilities and backup available. For what it's worth, we had minor oral surgery performed on my daughter in the Port Vila Hospital. We also know expatriates who bore children in Vanuatu, but I wouldn't recommend that; my wife was once part of a team that hand-pumped a ni-Vanuatu baby's respirator around the clock for three weeks until it could breath on its own.
Summary: Vanuatu is part of the third world, and people die there of things they wouldn't die of in the West.
When You Return Home
Your family doctor is probably not going to recognize that fever as malaria (or other tropical illness) unless you make a point of telling her that you recently were in the tropics. On malaria - after returning to Canada after nearly six years in Vanuatu, we finished off our prophylaxis with a course of an especially strong anti-malarial to completely cleanse our bodies of any form of the parasite.
It is not unusual for adjacent villages in Vanuatu to have completely separate languages that are spoken only by members of each village. Nevertheless, most ni-Vanuatu, especially under the age of say, forty, have attended elementary school in either English or French. There is usually someone around who has at least a smattering of either, but usually not both, languages. In fact, there are probably more people around rural Vanuatu that speak fluent English than I am aware of, because everyone spoke Bislama in my presence. Bislama, an English/French/Indigenous pidgin, is the lingua franca amongst ni-Vanuatu from different villages. It is very easy to pick up a few phases, such as "tankyu tumas" (thank you) and "plis" (please), but please, please don't try the old loud baby-talk approach. Allow the language some respect. I know it has a "cute" name, but "Evri samting yu wantem save long Bislama be yu fraet tumas blong askem" is for sale all over Port Vila and worth reading as a quick introduction to the language.
Our hotel 48 hours after our initial arrival in Vanuatu. During the height of Cyclone Uma (7-8 February, 1987), with our quarters disintegrating around us, we vacated through the upper window on the extreme right and spent the night in the white car. Photo by Alan & Jackie McPhail.
May to October, the cooler dry season, is probably the best time to visit rural Vanuatu. If, however, you must go during the hot, wet, cyclone season, expect to get rained on, and keep an ear to a portable shortwave radio for cyclone warnings. The locations of cyclones are given as coordinates on a small map that is widely distributed throughout Vanuatu. We went through 6 or 7 cyclones during 5 cyclone seasons (none in some years, 2-3 in others) in Vanuatu, but always in a concrete building (except the first one; see photo above). I really don't know what measures people in villages take during cyclones, but I do know that few people are killed or seriously injured in Vanuatu's cyclones. The primary dangers are falling trees and flying roofing iron, flash floods, and ships sinking (about 50 people were lost in February, 1987 when two ships ignored the Cyclone Uma warnings and set sail). My advice is to take shelter in a concrete building if possible (close windows on the side the wind comes from and open windows on the opposite side, making adjustments as the wind shifts direction; the bathroom is a popular shelter because it has lots of wall for the amount of floor area, making it the strongest room), don't be near a river, stream, or gully, and don't get on a ship when a cyclone is in the area. Inter-island planes all head for Port Vila before a cyclone and stay there for the duration; international planes vacate the region. If caught by a cyclone in a village, I would do as the villagers did; cyclones are normal weather to them and they have been surviving them for centuries. I have heard that villagers sometimes sit in the centre of a road during a cyclone so that they are away from trees that might fall; I know that they and everything in their houses always get soaked because the walls are woven bamboo that is not at all watertight, and cyclonic rains are always heavy and horizontal. I recently read Margaret Mead's description of her first cyclone on a remote island in Samoa; when things started to look bad, her American host cut a hole in the concrete water tank to let the water out and them in to take shelter.
In Vanuatu, the best rain gear in a normal vertical rain storm is an umbrella, shorts or skirt, and thongs; that way you just let everything from the knees down get wet and your upper body and head stay relatively dry. I also used a cheap poncho on occasion, especially when walking through the bush. When it is not raining in the wet season, it can get very hot during mid-day. Stay out of the sun and take it easy: I overheated once just pushing a lawn mower, and even a cold shower took a long time to get my temperature back to normal. All year long, hats should be worn, and sun-screen is a must.
The main advantage to being in Vanuatu during the wet season is that the sea is warmer, especially in the south. On the other hand, more silt is washed down the rivers, so visibility underwater can be poor.
During the dry season, it can get very cold at night (like 18 Celsius; well it seems cold there), especially around August or at higher elevations. I carried a wool watch cap, at least a flannel shirt and light nylon windbreaker (most ni-Vanuatu wear track suits on cool evenings), and a blanket when traveling in the dry season, and was glad to have all of this at night even at sea level. Some parts of Vanuatu, especially the western lee sides of islands get very arid at this time of the year. Places such as north-west Ambrym go completely waterless, and people live on green coconut water, cooking and bathing with sea water.
Urban Budget Accommodation
This is a page on travel in rural Vanuatu, but since you have to get there through Port Vila, a few words on affordable accommodation in town. Both Port Vila and Luganville were short on affordable accommodation when I left in 1992, but Port Vila had a new hotel called the Talimoru at the south end of the road in front of the Hospital. People told me it was inexpensive (bathroom down hall), was clean, and had good food at the attached restaurant. Less expensive than the fanciest hotels were the Rossi/Olympic, the Kaiviti, and the Marina. We've stayed at all three and liked the Kaiviti the best, although they are all good.
Luganville has the New Look Hotel above the store of the same name on the main street, where I stayed several times. The Unity Park Motel, with common bathrooms, has a good reputation, and is located on the west end of main street across from the Public Market and Unity Park. My wife and I also stayed at the reasonably-priced Natapoa Studio kitchenette units while I dived the Coolidge one week. If you don't mind the half-hour walk into town, the Espiritu Santo Local Government Council used to run the inexpensive Jeranmoli Bungalows out towards the airport. I've stayed there a few times; they were basic but clean. The New Look, Unity Park, and Jeranmoli have common cooking facilities. Some friends once stayed at the budget Church of Christ Transit Hostel; they were satisfied. The Hotel Santo was the fanciest place in town, and much cheaper than Vila's best. One of my guidebooks lists the Asia Motel as Luganville's "friendliest budget hotel", but that place and its disco had the worst reputation in Vanuatu for violence. Our family once stayed at the Bougainville Resort (priced on a par with the Hotel Santo) just west of town; nice private bungalows, great restaurant.
The only hotel in rural Vanuatu that I am aware of is on Tanna, but in order of luxury (see the last paragraph of the "Rural vs. Official Tourist Vanuatu" section for some of the local fauna you can expect to share your accommodation with):
Several of the regional governments ran guesthouses when I lived in Vanuatu at places like Norsup and Lakatoro on Malekula and Isangel, Tanna, among other places. These were clean and inexpensive western-style buildings with youth-hostel style accommodation. Phone ahead to the regional government for reservations and to ensure the door is unlocked when you arrive.
A smattering of ni-Vanuatu-run tourist bungalows are starting to spring up in places like Champagne Beach, Espiritu Santo and Port Resolution, Tanna. These are bush materials housing with what can be very good food. Check with Tour Vanuatu in Port Vila for a current list.
Most villages have a "haus blong ol woman" (women's club house) or similar community centre that casual visitors can bed down in return for a small donation to the women's club or whatever. Bring a sheet and blanket and expect to sleep on a pandanus mat on the ground. Expect to be the focus of public attention; one afternoon when we had dozens of eyes peering at us through the woven bamboo walls, my wife and I closed our eyes to nap. When I opened them a few minutes later, the entire audience had silently stolen away.
Most custom land owners will give permission to set up a tent for a night or two.
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©Stan Combs, 1996.