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Starting her career in health in the mid 1970s, Carmel worked as a radiographer in New Zealand, Darwin and Britain before moving into medical technical writing in the British and New Zealand media.

Taking advantage of a gap in the health publishing market, Carmel established New Zealand Doctor magazine, a newspaper for GPs, which she edited for seven years.

It was during this time that she became interested in local and international health policy and politics. With her undergraduate degree in social sciences and interest in developing countries, she became increasingly drawn to examine international health policy and recognised the important links between health and economics in impoverished nations.

"Often people don't see the connection between health and economics. You can't separate poor health from the poverty that causes it in developing nations. By eliminating poverty we can eliminate the appalling health statistics that exist so close to home. Starting with advocacy from New Zealand seemed like a good place to engage with the international health sector," says Carmel, who is also the Treasurer of the Council for International Development New Zealand.

Just as Carmel completed her Masters thesis in development studies and public health, The Fred Hollows Foundation NZ was looking for someone to set up its Pacific programs.

"What appealed to me about working for Hollows was the entrepreneurial and practical approach to solving issues of financial sustainability within the health systems of developing countries. Hollows' work contributes to more than just health, it builds industry and local enterprise. I think that's an important contribution."

Making education a focus of The Fred Hollows Foundation NZ adds an extra dimension to the way the organisation builds capacity and sustainability, says Carmel.

"By developing programs such as those offered by the Pacific Eye Institute (the new regional training centre recently established in Fiji by The Fred Hollows Foundation NZ), we are training local people, contributing to the economy through construction and bringing in students, ultimately providing better health outcomes delivered by local people to the benefit of local people. That's what's interesting about health, it's a sector that cuts across many levels of society," says Carmel.

Researching how to shape successful health programs that fit into under-funded health systems without further draining the resources is part of Carmel's next mission as she undertakes a PhD.

"One of the challenges in the Pacific is the lack of people: there are small populations and high attrition of nurses and doctors from the region. That is hugely damaging on the health infrastructure when you're talking about small numbers of health care workers; one well-trained person can really make a big difference, but if you lose that person, you've lost your investment.

"The other big challenge is the incapacity of health ministries to fund staff or services to meet the needs of their people. If we don't look at what's working and what isn't, we can't figure out how to change it for the better. Research and education are vital to this changing."