By Pacific for Pacific
The health needs of Pacific peoples appear to be best met through services that are provided parallel to mainstream services. And, the concept of ‘by Pacific for Pacific’ is integral to this, according to Ministry of Health Director
of Public Health, Colin Tukuitonga.
‘It is about the development of a group of people. It’s about moving from
being passive recipients to active participants in care.’
Here are the stories of some of the many providers of health services for Pacific people in New Zealand.
West Auckland - Pasifika Healthcare
West Auckland Pacific Island Health Fono – also known as Pasifika Healthcare – was set up in 1989 by a group of Pacific peoples in West Auckland.
Now an incorporated society, it provides a seven-day-a-week general practice and nursing servicefor more than 10,000 people. In addition, it provides community health promotion programmes, mental health services and a nursing outreach service, as well as population-based programmes such as cervical screening, Hepatitis B, asthma and immunisation services.
James Prescott, who currently heads Pasifika Healthcare, says ‘Mainstream services do not, as a rule, work as well as they could for Pacific people. The family, the community and the church are a huge part of life for Pacific people which is integral to the delivery of services for Pacific people.
‘Our mission is to develop and provide an affordable, accessibleand culturally
appropriate service that improves and contributes to best health outcomes
for Pacific people. Our strength is Pacific people making decisions for Pacific people.’
James says this philosophy has helped the fono become one of the best primary health care providers in Waitakere City. The goal now is to become one of the best providers in the region.
Mary Watts, who is Samoan, was one of those who worked to set up the fono in the 1980s. Mary says ‘It was really a West Auckland Pacific community initiative, with links to the Waitemata City Council who were working with the wider community to address health issues at different levels.
‘The Pacific Island community identified their own needs and felt the best way to provide health services for our people was from a “by Pacific for Pacific” perspective.
‘My role at that time was to set up a Pacific forum [fono] so that we could address our own needs and also look at our own cultural diversities. It was a hard struggle in those days as everything was done on a voluntary basis; for example, we were having our fono at different venues every time, depending on which agencies were kind enough to let us use their premises for free.
‘We did not have any money or resources for this. However, I believe the community was clear in the focus and work on these values.
‘In 1989 we progressed our work to become a legal entity and from there we managed to have an agreement with West Auckland District Health Committee to have a community nurse based at our clinic in Hindmarsh. This was important for us to start building strong relationships with other agencies.
‘For me it was exciting as we were now talking about working in partnership and collaboration with local and central government, I believe the Pacific Island community in West Auckland was the catalyst in putting this into reality.
The Pacific Touch
‘It [has] struck me that there is an incredible amount of work, dedication and commitment in our Pacific community that largely goes unacknowledged. …They are the Pacific Island cultural support workers making themselves available 24 hours a day in our hospital; the community worker filling out WINZ forms for a family; the nurse who ensures that a family has money to buy food.
‘A Samoan nurse once explained to me about “the Pacific touch.”
What is the Pacific touch?
It is taking the time to stop and pray with a family. It is taking the
time to teach a young mother how to cook. It is being committed and dedicated and passionate about our people. The Pacific touch is that quality that sets a special few of our nurses and health workers apart.’
Dr Teuila Percival
Paediatrician
Counties Manukau District Health Board |
Southseas Healthcare
Southseas Healthcare provides health services to more than 7,000 people from the South Auckland Pacific community.
Set up in February 1999, the service’s mission is ‘to improve the health status of Pacific families and communities by increasing access to comprehensive primary and preventive health care and effectively integrating these services with secondary and tertiary care’.
‘We want good health and wellbeing for Pacific people – 100 percent, with
no disparities,’ Dr Debbie Ryan of Southseas Healthcare says.
Central to the centre’s service is acknowledging the family as the heart of the Pacific community. With 35 employees, the service is able to offer dental health education, chronic disease management services, treatment for diabetes and well child programmes, intensive home visiting services, child and youth health care services, cervical screening, facilitation with other services and support services for parents.
‘In the three years we’ve been operating, we have experienced rapid growth – especially in the last six months – and this has meant we have had to reorganise our management structure. Part of the review involved auditing our organisation to assess our strengths and weaknesses,’ says Debbie.
Debbie Ryan says the review highlighted some of the things that were working well, and which were helping to deliver better outcomes.
‘We’re also focusing strongly on workforce development, working with Manukau Institute of Technology Health Studies department to develop accredited qualifications for community health workers and a primary health care practitioner programme for registered nurses.’
Dr Siro Fuata’i
I went into general practice in 1986 after a year of working as a locum. I set up Royal Oak Health with Dr Leone Dillon at the Royal Oak RoundAbout. We started from scratch – that is we had no patients, we simply set our sign up and advertised our services. I suppose the main obstacle then was finance and we organised this through our bank: to buy the property that housed the clinic and equipment.
We advertised our services to all and everyone including the Pacific community. We both practiced obstetrics and it took about three years to get up to a level of patient numbers that would sustain ongoing costs. We had a wide mix of patients of which 30–40 percent were Pacific people, the rest were palagis and other groups. Once our services became widely known amongst the Pacific people the numbers of people seeing us increased quickly.
To cater for the large numbers of Pacific people coming over from Mangere to see us, I set up a second set of rooms in Mangere Town Center in 1988.
This was the start of Health Pacifica Doctors. This practice took off like a balloon.
I divided my time between the two practices and employed locums when I was not there during the week.
I was involved in health education with many church groups who requested such activities as well as a health programme on radio.
The main difficulties we encountered then was having finance to start a practice, having time for continuing education and peer reviews, Pacific health workers and the lack of contact with other Pacific medical practitioners. There were only four of us then but the numbers have increased a lot since.
One of the other difficulties was to try and run a ‘business’. This was not helped by the expectation of some of our people that they would not pay or pay very little. I had to learn most of the needed skills with help from appropriate professionals.
The changes in the health sector have been very trying and at times confusing. But they have brought about changes that have seen a lot of progress in Pacific providers as well services to the community. This has seen an overall benefit for us.
One of the great things that has evolved through the years has been the support and utilisation of our services by the Pacific community. We have tried to evolve services to meet their needs and though we have not got this completely spot on, I think we are moving very close to addressing needs we know best.
Tongan Health Society – Langimalie
Langimalie is New Zealand’s first ‘ethnic-specific’ health care provider. Set up in 1998, it serves the Tongan community in the central Auckland region.
Ata Ata Sitaleki Finau, Professor of Public Health at the Fiji School of Medicine, helped to set Langimalie up. He describes the service as ‘the product of the Tongan community and Tongan health workers talking about the problems Tongan people in New Zealand were facing in terms of health care’.
‘Discussions centred around all kinds of things – from the need for more professional services that were culturally appropriate for Tongan people right through to the fact that we felt there were simply too many funerals.’
Sitaleki describes health as intrinsically ethnic specific, ‘so it follows that health care services must also be ethnic-specific’.
‘Langimalie is about empowerment and community coherence, and we must remember that the Pacific community is multi-ethnic and multi-lingual. We have a large Tongan population here, and that is our focus,’ he says.
With over 10,000 registered clients, the service also provides home visits and house calls in addition to extensive public education programmes.
‘It’s important to us to be able to employ Tongan workers who can
speak Tongan to clients, and to offer longer consultation times at lower costs.
Our consultation rooms are also designed to be family-sized. Our focus is on health rather than medical service.”
Sitaleki says the Tongan community has played a significant role in contributing to the service’s success, through monetary donations, providing voluntary services and equipment such as furntiture, as well as strong church support. The Tongan Nurses Association has also provided voluntary labour, equipment and assistance with marketing.
‘Langimalie is about having community-based control and self-determination. The issues for us as we move forward are attracting permanent funding, continuing to be able to provide low cost services and looking at expanding the kinds of services we offer.’
Healthstar Pacific
‘Prevention is better than cure’ is the motto of Pacific health organisation Healthstar Pacific.
Set up in 1994, Healthstar Pacific offers a range of public awareness and health promotion programmes – aimed mainly at the health of children under five – for the Pacific community in the Auckland region.
‘Our three main programmes are based around pregnancy support
services, the promotion of immunisation programmes and breast screening,’
Anna Bailey of Healthstar Pacific says.
‘We don’t offer personal health services as such; rather our focus is on health education. This is such a vital part of the whole health care picture. As a country, we can continue to build hospitals and treat people who are sick, but the real way to go is to prevent these things happening in the first place, and that is what we are about.’
Healthstar Pacific, a charitable trust, acts as a facilitator of services – ‘We don’t aim to replace services that already exist, but rather put our people in touch with the right services, make sure they’re getting what they need and help them find their feet’, Anna says.
‘Our point of difference is that we have a Pacific focus. It is one thing to know about the nuances and intricacies of another culture, but another thing to understand those values and protocols. It’s amazing how powerful it can be to even just be able to speak the same language. For us the edge is cultural competency, it’s about being able to communicate information in a way that actually makes a connection. In terms of health services, a lot of barriers seem to be ones of language and cultural differences so our focus is on reducing the numbers who fall through the gaps.’
Anna says Healthstar Pacific will always try to match nationalities when it comes to service provision. ‘For example, we’ll aim to put a Tongan with a Tongan. If we can’t do that, the next best thing is making sure there is a brown face for the family to work with.’
Healthstar Pacific also promotes other health topics locally, getting involved when and where the opportunities arise.
‘We just did a door-to-door campaign trying to get information on meningococcal disease to parents, for example. We provided information on what the signs were and what to watch for. We also get involved in local events and hold education talks wherever possible through local groups.’
Anna describes Healthstar Pacific’s work in making sure the community gets the care it needs as ‘largely common sense’.
‘It’s not rocket science, it’s simply encouraging the community and service providers to get in touch with each other. Our population is very mobile, so for example we try to encourage health professionals to always fill in the Well Child book whenever they see a child, and to talk to the parent about when the child next needs to be seen. It’s this kind of thing that makes all the difference in ensuring fewer people fall through the gaps.’
K’aute Pasifika
A ‘not for sale op shop’ is one of the many services Hamilton-based K’aute Pasifika provides to its Pacific communities.
K’aute Pasifika was set up in 1999 by representatives from Hamilton’s seven Pacific groups – Tonga, Samoa, Cook Islands, Kiribati, Fiji, Tokelau and Niue.
‘It is a known fact that Pacific peoples face considerable problems with
accessing existing health care services due to costs, lack of knowledge
about the diversity of Pacific Island languages and cultures, and being
poorly informed about their own health issues. We set up K’aute Pasifika
to help address some of these problems,’ K’aute Pasifika chief executive
officer Peta Karalus says.
Peta says that as a ‘by Pacific for Pacific’ organisation, ‘we can contribute significantly to reducing Pacific health disparities.
‘Currently, we offer services in the areas of child and adolescent mental health, well child, asthma, diabetes and smoking cessation.’
In addition, K’aute Pasifika provides community social services such as supporting family members during crisis, assisting families to access other social services, and assisting new immigrants to settle into life in Hamilton by providing free clothes, blankets, shoes, tinned food, cutlery and dishes (donated by the community) through their ‘op shop’.
With 997 Pacific peoples registered with the service, Peta believes K’aute Pasifika is definitely meeting a need.
‘For example, in a recent review of our well child contract, we were pleased to find out that we have 190 children on our register below the age of five. One hundred percent of them are registered with a GP, we’ve improved our immunisation uptake by 20 percent, and 98 percent of well child books are up to date.’
Peta says the long-term sustainability of K’aute Pasifika relies heavily on a significant increase in the number of trained Pacific Island health professionals. As a result, they have started providing staff with appropriate training.
Pacific Health Hutt Valley
Keeping the cost down for Pacific health consumers is a big driver for Pacific community health provider Pacific Health Hutt Valley.
Set up in 1999, Pacific Health Hutt Valley is a not-for-profit organisation based in Naenae, just east of Lower Hutt. Manager Nanai Muaau says the centre’s approach is more holistic than that taken by mainstream providers.
‘This approach appears to be working, as we started out with 100 people on our books, and now have more than 3,000. We’re definitely filling a gap.’
Nanai says in taking a Pacific approach to providing health services, the centre considers the whole picture – including cost and cultural needs – when working with Pacific clients.
‘One of the things that stops many Pacific people from seeking care is the
cost. But often what they need care for is something a nurse could help with,
so we are getting out there and making sure our Pacific community knows they
can get these services for free.’
The centre has a close working relationship with Hutt Valley Hospital. One of its key objectives is to reduce the hospital’s Pacific admission rates.
‘A lot of people leave things until the last minute, until they’re on death’s door – but this doesn’t need to happen now we have services like this.’
In line with the saying that ‘prevention is better than cure,’ Nanai says the centre spends a lot of time working with families and considering the big picture – not just one particular problem.
‘If a nurse spends half a day with one family, that’s great. In mainstream services appointments are often rushed, but if we can spend more time over a cup of tea, our care workers can give a family time to relax and talk about issues.’
Nanai says this approach means more problems – and therefore solutions – can be identified. One example is overcrowding.
‘We have found cases where overcrowding is causing asthma. We wouldn’t necessarily know this if we weren’t going out there and taking the time to get to know our clients.
‘And this in turn means the centre can take on a wider advocacy role, working with agencies like Housing New Zealand to sort out better housing.
‘Other big issues for the centre are high rates of diabetes and obesity in the Pacific community,’ Nanai says.
‘We have been running exercise programmes in conjunction with Sports Wellington. Our first programme was so successful that people turned up in droves and we had to shift halls to fit everyone in. We incorporate lots of singing and cultural factors into the exercise to make it work as well as we can.’
The South Island
When looking at the history of Pacific health services in the South Island it is the women who stand out as the pioneers.
People like Gwenivere Newport, Tufuga Lagatule, Maria Godinet Watts, Louisa Crawley, Rangi Oberg and Edith Iremia are all long time servants of the Pacific health sector in the South Island, in particular women’s health.
An early pioneer in youth and sexual health Gwenivere Newport arrived in Christchurch in 1967, although she had been living in New Zealand since the 1950s when she arrived from Samoa. She was one of the country’s first community health workers, appointed by the Canterbury Hospital Board in 1986.
‘I got involved in this work partly because I didn’t want to stay home and
do nothing. I needed to find a way to work with my community and to stay busy.’
In 1990 Gwenivere was appointed as an administrator for South Health Programme for the Canterbury Hospital and Health Service where she still works, for the Canterbury District Health Board although her role is now as a health promoter.
Gwennie has strong memories of the first Pacific women’s health meeting held in the early 1980s.
‘The Samoan Catholic Women’s Group and the Presbyterian Women’s Group
hosted the first cervical education meeting. This was the first initiative of its
kind and more than 80 Pacific women came. It was a subject that wasn’t
discussed publicly in those days ... so for it to be piloted by these women was great.’
These meetings progressed to talking about sexual health issues for the youth, cervical smear taking and screening. Mamea Bubsy Eletino, one of the region’s leading sexual health educators, describes the early days as being difficult.
‘Many families found it difficult to talk about many sexual health issues
and it wasn’t until the young people themselves starting seeking advice
that more formal sexual health education and promotion became
available for the community.’
Mamea recalls working the community for families where both parents were working and children often had no child care. ‘In those times we did everything – health promotion, education, social services, baby sitting ... you name it. We were everywhere.’
Maria Godinet Watts, another founder of P.A.C.I.F.I.C.A., recalls the first women’s session as being ground breaking for the South Island.
She says that it only worked because the meetings were scheduled
after 12 noon on Saturdays ‘after their men had finished their golf games’.
These women were also all instrumental in helping set up Pacific Trust Canterbury, which today provides health services to the Pacific community in the Canterbury region.
Pacific Trust Canterbury
A not-for-profit organisation, Pacific Trust Canterbury was set up in 1999, and is managed by a board comprising Pacific health professionals, social workers and other Pacific leaders.
Chairperson Mr Teariki Maoate says the trust’s ‘Pacific-specific’ approach is already helping improve health outcomes for the community.
‘Pacific people have a similar set of values and beliefs and by offering a
service that understands their needs – whether this be cultural, language or
family – we are better able to identify their needs and mould our service to suit.’
Pacific Trust Canterbury employs 14 people, and expects this to expand within the next 12 months when it offers an extended range of services.
Currently, the trust’s employees are split into two main teams – a mental health team and a child health team. The mental health team’s objective is to deliver ‘culturally safe’ services for Pacific peoples.
‘We always identify cultural influences when we work with someone who has a mental illness – and this includes how we treat the illness. It also means establishing a rapport with clients and their families and using a model of intensive community support for high needs,’ Kiki says.
The child health team provides support for communities and families through education programmes that identify options for child-rearing and discipline, and which help people understand family violence.
‘We want to help Pacific people make their homes and family units a better and safer place,’ Kiki says.
Pacific Trust Canterbury believes it needs to take a wider approach than just health to ensure the wellbeing of its communities. It offers other services such as exercise and injury prevention programmes, asthma education services, car seat rental and purchase schemes and even learner driver’s license courses.
‘Each year we find that the health needs of the Pacific community in
Christchurch become more varied, and as this happens, we plan to
expand the areas we provide support in,’ Kiki says.
‘At the end of the day, it is about helping our clients take control of their lives and achieve their personal goals, and we’re proud of the part we play in this process.’
Pasifika Medical Association
The ‘marginal health’ of Pacific peoples living in New Zealand was one of the factors behind the setting up of the Pasifika Medical Association in 1996.
Dr Alec Eckeroma, a founding member says there are 95 Pacific doctors registered in New Zealand, and that the association’s objective is to promote learning and work opportunities for Pacific doctors and medical students, in turn helping to improve health outcomes for Pacific peoples in New Zealand.
‘It is important that a professional body of Pacific doctors advocates for the health of Pacific peoples in various forums whether they be in the development of guidelines or advice to the Ministry and other agencies, or as representatives in various meetings and committees,’ he says.
‘The association also advocates and supports the training of Pacific health personnel, especially at tertiary institutions. Developing the Pacific workforce to meet the needs of our Pacific population has been our priority.
‘We have also been proactive in promoting Pacific research by Pacific researchers, which we have done in conjunction with the Department of Maori and Pacific Health at the University of Auckland.’
Dr Eckeroma says a key success for the association has been the Pasifika
Medical Association Conference, held every year with support from sponsors.
‘These conferences have been hugely successful in that they provide a platform for Pacific researchers to present their findings on Pacific-related research. They have also provided an opportunity for Pacific health workers from throughout New Zealand and the Pacific to network and to share ideas about health care services, especially those which have worked well in Pacific communities.’
Our future workforce
Encouraging more Pacific peoples to enter the health workforce – and keep them there – has been a strong focus in the drive to boost the Pacific health sector.
The Maori and Pacific Admissions Scheme (MAPAS) is an scheme aimed at doing just this. Established in 1972, MAPAS is an affirmative-action programme that reflects an obligation by Auckland University to increase the number of Maori and Pacific entrants to medical school. The admission scheme is available for entry to medicine, health science, nursing and pharmacy.
‘MAPAS is an opportunity for young Maori and Pacific people to study
medicine in a supportive environment where students, their families
and staff accept a commitment to academic achievement and cultural
integrity,’ Malakai Ofanoa of MAPAS says.
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Pacific Health Research
Underpinning the ability of the Pacific health sector to optimise its workforce and health services to Pacific peoples is research. The Auckland University-based Pacific Health Research Centre was set up in 1996 to undertake culturally appropriate and scientific research and training for this purpose.
With a focus on training Pacific researchers, information dissemination and the delivery of improved health services to Pacific peoples, the centre’s goal has been to become a recognised centre of excellence in the field.
‘We also teach undergraduate and postgraduate students about health research and aim to raise awareness of health issues affecting Pacific people, and encouraging students to take an active interest in research,’ Malakai Ofonoa says.
The centre offers two postgraduate research fellowships, one focusing on social science methodology and the other on clinical practice.
Whitireia Community Polytechnic in Porirua, set up in 1989, is another research-based centre offering training in a range of Pacific-focused community health care and social work areas.
Getting visible about study is a big part of the battle for Pacific
students wanting to succeed, according to Margaret
Southwick of Whitireia Polytechnic.
‘We need parallel programmes that can equip Pacific students to stand with confidence in mainstream culture and also have the same level of confidence in their own culture. Part of this is making Pacific learning more visible to the mainstream,’ Margaret says.
Scholarship programmes have also been developed to help Pacific peoples within the health workforce.
The Health Research Council administers two scholarship programmes on the Ministry of Health’s behalf. The Dr John McLeod scholarships, each worth $3,000, are awarded to up to 10 undergraduate students each year. This programme was set up in remembrance of John McLeod, who worked in health for many years before his life was taken tragically in a car accident. John’s vision was to advance Pacific health outcomes through strengthening the Pacific health workforce, and his contribution and commitment to the Pacific community was significant.
The Health Research Council also administers the Pacific Provider scholarships for postgraduate students. Scholarship recipients can study thesis topics ranging from Pacific health policy, Pacific cultural competencies, nutrition and psychological resiliency through to Pacific peoples with disabilities.
The Ministry of Health’s Pacific Health Leadership programme aims to develop Pacific health leadership and to work towards better health status for Pacific peoples.
It helps leaders to be more useful in serving communities and of greater support to other health workers – ‘putting into reality what many people talk about’, Ministry of Health Chief Advisor, Pacific Health, Audrey Aumua says.
‘It is recognised that many Pacific health workers who are in key positions and roles do not have all the foundations essential for leading Pacific health. This programme aims to clarify the role of ascribed leadership, develop more experience in working with the community, and extend knowledge and skills in leadership practice,’ Audrey says.
The programme is for people who are currently in senior leadership roles in the health and disability sector or who are in community leadership roles.
Next:
Reflections
Looking to the future
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