This story has been reproduced from the Gisborne Herald. GISBORNE-TAIRAWHITI health and education professionals have come together to develop a community action plan for whanau affected by Foetal Alcohol Spectrum Disorder (FASD).
FASD is a brain-based disability that is the result of alcohol consumption during pregnancy.
The hui discussed prevention, assessment and diagnosis, workforce development, support for families and the removal of the stigma associated with FASD.
Gisborne/Tairawhiti social worker, Tania Rauna, and clinical psychologist, Sarah Goldsbury, have been leading local efforts to spread awareness and information on FASD.
They are both passionate about exploring the need to set up local assessment and support services, but are also well aware this is no easy task.
Ms Rauna said FASD is a much bigger problem than people are aware of.
“We always talk about it as being the one thing no one wants to talk about, and I think if we talked about it more and we admitted it was a bigger problem than P and meth, then maybe the investment in it would be bigger,” said Ms Rauna.
Ms Goldsbury said there was clear evidence alcohol is the most damaging of all recreational substances for a foetus.
“Most people would be shocked to know that despite the damaging effects of cocaine, heroin, methamphetamine and marijuana, the damage that alcohol does to a developing foetus is far greater than any of those” she said.
“Those other substances go into the mother’s lungs or blood stream, whereas alcohol freely crosses the placenta, just as food does. The blood alcohol level of the baby in utero is the same as the blood alcohol level of the mother.” Ms Goldsbury said.
Alcohol is also recognised as a teratogen, which is a substance that is particularly toxic to a developing baby’s brain and body.
She said alcohol is a huge problem for New Zealand pregnancies, as alcohol consumption was such a big part of how New Zealanders live their daily lives.
“New Zealand research has found that 40 to 50 percent of New Zealand pregnancies are unplanned. When you put that together with other New Zealand research that tells us around 70 percent of women in New Zealand drink alcohol prior to pregnancy recognition, the combination is a ticking time bomb for all parts of New Zealand society”.
Around 25 percent of New Zealand women have been found to continue to consume small amounts of alcohol after pregnancy recognition, and around 10 percent continue to binge drink”.
“There are a number of lucky individuals out there, who have been exposed to alcohol in utero, and grow up apparently the same as everyone else around them. These individuals are blessed — we do not know why some people escape unscathed. But we do know there are more than 4000 research studies proving the link between prenatal alcohol exposure and brain damage.”
The women said most of their clients who drank during their pregnancies didn’t know they were pregnant, didn’t know the damage alcohol in pregnancy could cause, or were experiencing high stress situations, mental health difficulties or addiction.
“A number of people know it is not recommended to drink in pregnancy, but they may not know that alcohol in pregnancy can cause permanent brain damage for their baby,” Ms Goldsbury said.
There is a huge stigma around talking about alcohol use in pregnancy publicly. Women often feel ashamed, embarrassed, and guilty. This is made worse by the judgement that members of the public often espouse, Ms Goldsbury said.
“I have so often heard people calling it child abuse and saying that mothers should be charged for drinking in pregnancy. However, the harshest critics are usually the mother’s themselves, when they eventually realise the harm that was inadvertently caused.
“We know punitive measures do not stop addictions, we need a rehabilitative approach, and one that takes all blame and judgement away, or mothers will not open-up and share honestly with professionals.
“We need to take collective responsibility as a nation for a problem that is a result of our drinking culture, our high mental health and addiction rates, and our high levels of domestic violence, and ask ourselves what we can do differently as a society.”
Turanga Health nurse Janneen Kinney said the message given to whanau about alcohol needed to be the same from everyone — midwives, teachers, kaiawhina, doctors, nurses.
“Different messages about what is ok causes confusion. All whanau want the very best for their baby. Our community can help whanau to achieve this if the same correct information is given at every opportunity.”
Turanga Health’s community action on youth and drugs co-ordinator Courtney Stubbins said children in this district live with the harm from the drinking culture.
“A recent study in NZ showed children are exposed to alcohol marketing on average 4-5 times a day.
“The rate is five times higher for Maori children and three times higher for Pacifica children. This highlights not only inequity and a lack of regulations but the incredible amount of resources that go into messages aimed at increasing alcohol sales. Estimates show that around $400,000 a day is spent marketing alcohol as fundamental to our lives.
Experts say there is no safe level of alcohol consumption during pregnancy.
Ms Stubbins said people need to be made aware of the harms of drinking during pregnancy, and that community action is important because we have a shared responsibility.
“Stop drinking alcohol if you could be pregnant, are pregnant or are trying to get pregnant,” said Ms Stubbins.
THEY are too late to save the community member who died in his driveway after a day's work, but could well be in time to save others who suffer a heart event near marae around Turanganui-a-Kiwa.
Maori health organisation Turanga Health has paid for defibrillators to be installed at 20 marae in a move chief executive Reweti Ropiha says is about making sure all whanau have access to the life-saving equipment.
For Turanga Health long-term staffer and kaumatua Libby (Uncle Lib) Kerr, it's personal . . . many of his siblings have hearts weakened by rheumatic fever and after their youngest son caught rheumatic fever as a teen in the late 1980s, Uncle Lib and wife Mere were told their boy would be unlikely to live beyond the age of 30.
He's defied the odds -- now aged 42, their son is still going strong, even after having major heart surgery -- but the Kerrs say it's reassuring to know that, should anything happen, help is not too far away.
St John New Zealand had gifted 59 defibrillators to marae around the country, but with the focus on remote areas, those closer to cities like Gisborne missed out.
“Reweti saw that some had gone up the East Coast and thought, 'hey, what about closer to home',” says St John national adviser (Maori health), Stephen Dennett. “So the contribution from Turanga Health is a great way to continue this journey.”
There had been talk of the possibility of getting defibrillators to Turanganui-a-Kiwa marae, but according to Reweti, it was Uncle Lib who made it happen.
“We call him Speedy because when he sets his mind to something, he makes sure it gets done.”
Getting the defibrillators purchased, installed, maintained and whanau trained in their use is a joint project between Turanga Health, St John, the NZ Fire Service and marae committees.
There is not much training to do: the hand-held devices come with easy instructions on how to get them to deliver a dose of electric current to the heart in the event of a cardiac emergency.
But even so, Turanga Health in December hosted three sessions to ensure marae representatives were up to speed.
Opotiki first responder Rebecca Jones was on annual leave when the training team visited Turanga Health but says she didn't hesitate to come back on board to help share her knowledge about defibrillators and their operation.
“That is just the St John way.”
Among the whanau at the training sessions was Ohako Marae chair Dave Pardoe, who says the chance to have a potentially life-saving device installed in their Manutuke community was “fantastic”.
“That's an offer from Turanga Health we just couldn't turn down and our committee will support St John in making sure the community knows it is there for them to use. We have all lost people so anything that could help prevent that in the future is wonderful.”
According to Stephen Dennett, Maori have high incidences of heart conditions and low rates of survival after an event, so installing thedefibrillators at marae is a way of taking help to where it is needed.
For that reason, the devices be will available externally so they can be used by the community, not just when there is a marae event on.
“While that brings some extra challenges, we believe that each community will seek to protect the safety and integrity of the devices,” Reweti Ropiha says.
“For us, it’s all about access to potentially life-saving equipment. If an incident occurred -- whether it be at Matawai or Muriwai – then we have something on hand that could make a difference and potentially change the outcome.”
THEY might be all about healthy living but they don't mind a bit of healthy competition as well!
Staff from Tūranga Health and Three Rivers Medical in November donned aprons and took up spatulas to take part in their semi-annual Cook-Off.
This year, the challenge was to cook tasty skewered kebabs on the barbecue, using ingredients from chicken, beef and vegetables to tofu or haloumi cheese, and (uncooked) fruits.
The playing field may, at times, have been a little uneven . . . Tūranga Health unleashed an early advantage with their appetiser of fresh kinaand oysters served with homemade rēwena bread.
However, Three Rivers' succulent Whangara Farms flagship beef was eventually too good for Turanga Health's seafood bonanza, and the medical team took away the win.
“We wouldn't say they cheated . . . but their appetisers were a force to be reckoned with,” laughed Three Rivers co-owner and education co-ordinator Dr Fergus Aitcheson.
Dr Aitcheson and Turanga Health events and programmes co-ordinator Dallas Poi agreed that, while the healthy competition between both organisations is well received by staff members, the atmosphere and message on the day is what sings true: “Healthy kai and nutrition can be fun and whanau can get a lot of enjoyment out of cooking together.”
And as Tūranga Health events and programmes co-ordinator Dallas Poi pointed out, “nobody can cheat anyway because there aren't any rules!”
Three Rivers chief executive and co-owner Ingrid Collins says that as well as encouraging healthy eating among whānau and service users, the cook-off is a chance for the two organisations to celebrate their ongoing relationship.
“We've worked well together since we launched in 2012 and to this day Tūranga Health is represented at our doctors' peer review meetings where they share input and ideas,” she said. “It's an important way to encourage healthy living beyond the doctors' rooms.”
For the service users who went along for the big Cook-Off, their involvement went further than simply getting a tasty, healthy feed.
As well as being able to vote for the grand winners of the 2018 Cook-Off between the two organisations, they also went into the draw to win the day's prize of a Gascraft barbeque (taken home by Eddie Evans).
And service users were questioned about their own secret food tricks, which may come into play for next year's competition.
STELLA Rihari was busy studying towards a planned career as a social worker when everything changed.
“As I got closer to completing my degree I had two placements with Tūranga Health's mental health team,” she says.
“It wasn't an area of practice I’d considered but I found the opportunity to help give disadvantaged people a voice to be deeply rewarding. When a position came up I jumped at it.”
Stella still gets to use her degree.
“There's a lot of crossover from social work and the focus on biculturalism has been really useful. I'd long felt passionate about Māori health and this is such an important part of that.”
As a kaiāwhina in Tūranga Health's busy mental health team, the former teacher gets out and about helping whānau according to needs identified in their specially-tailored support plan.
“We're there for support if they need to be hospitalised, but it’s mainly about helping in their day-to-day lives, whether that be getting to a doctor's appointment or doing their shopping.”
“Some of our whānau are more independent than others but all seem to value just knowing that we care,” she says.
“They know that we are there, that we’ll work alongside them doing everything we can to help them lead independent, meaningful lives.”
Turanga Health is hitting the great outdoors with it’s rohe-wide physical activity and health programme Tū Pakari.
For the city-based sessions the Tūranga Health team has devised activities that can be done at stunning locations around town.
“We love getting out there but if it's raining we just do the session at the Tūranga Health gym,” says physical activity kaiawhina Shane Luke.
Town-based session locations include Titirangi Kaiti Hill, Waiweherua (the meeting of the three rivers), Elgin’s Blackpool Park, and Oneroa (Midway Beach).
And since the sessions are suitable for all, Luke hopes whānau will bring their young ones along for the ride.
Tū Pakari sessions in rural areas continue 6pm on Tuesdays at Patutahi Hall (with Bernie Semau), Muriwai Marae (with Daiminn Kemp) and Mangatu Marae (with Luke Bradley); Wednesdays (Te Karaka Sports Ground with Hotorene Brown); and Thursdays (Patutahi Hall with Daiminn Kemp).
Turanga Health service delivery manager Dwayne Tamatea says it's great to whanau getting out and about to exercise .
“We were stoked to see the numbers of people at the Te Karaka and Muriwai sessions increasing earlier this year, and we’re hoping everyone returns and brings a friend or whānau member for the summer sessions.”
THE team at Tūranga Health know they are making a difference – they see good results every day – but now they’re drilling deep to provide evidence that what they do works, and why.
Tūranga Health was this year one of six primary health providers from around the country chosen to be a part of the Health Quality and Safety Commission's best practice initiative, Whakakotahi.
The only iwi health provider in the bunch, Tūranga Health is using the opportunity to zoom in on its Tū Mahi programme, where on-the-job health checks are offered to workplaces to improve and prevent health issues.
“For us, Whakakotahi is not about introducing something new, it is about achieving quality assurance by really looking close and understanding the essence of what we are here to do,” says Tūranga Health chief executive Reweti Ropiha.
“What we're using is a powerful tool of discipline that not only ensures our clients are getting the best of the best, but also future-proofs Tūranga a Health as a high-quality provider of primary care.”
With support from Commission Advisor Jane Cullen, the Gisborne initiative has been driven by the Tūranga Health team and their Tūranga Mahi Workplace Wellness programme for the research phase of Whakakotahi.
The Tū Mahi Workplace Wellness programme offers a range of services including heart checks, flu vaccinations, smoking cessation and other wrap around services all year round to primary industry workers.
“What we saw, was that some whānau could be better served if we extended our consults into the home,” says team member Dallas Poi.
“So, during a workplace visit our team might identify employees, for example, with a potential heart problem. Following up by visiting the person at home means we can also offer wrap-around services they may not have had access to had we not taken that extra step.”
It might include services like a Healthy Homes assessment, or registration with a lifestyle programme or, if there are young ones in the home, support from the Tamariki Ora Well Child programme.
“What we have identified is that getting the whānau involved means there is a better chance of success in achieving a good health outcome,” says Dallas Poi.
As an integral part of the Whakakotahi project team, Ms Poi works closely with the nurses doing follow ups on each home visit to assess its effect and ensure that the kaupapa is applied and is based on robust evidence.
“But at this stage we are already optimistic that home visits will become standard, so we can improve on what is already a successful workplace programme,” she says.
The Health Quality and Safety Commission has invited Tūranga Health along as its co-presenter at next year's National Rural Health Conference.
And that dovetails nicely with Mr Ropiha's ambition to see Tūranga Health excel in providing services that can be adapted by health providers nationwide.
“Our aim is to make sure that there is real, evidence-based rigour to all of our programmes to ensure they are sustainable,” he says.
“We are in this for the long term, and that's why it was important for us to really zoom in and look closely at the what, the why and the how of everything we do.”
In te reo Maori the word “whakakotahi” literally means unity and under the initiative of that name Turanga Health has combined with the Health Quality and Safety Commission to ensure there is rigorous, evidence-based backing to all of its programmes.
Image caption: Tūranga Health’s Dwayne Tamatea and Dallas Poi, and Gisborne Fisheries chief executive Salve Zame discuss the potential of Whakakotahi to help improve and prevent health issues for staff at Gisborne Fisheries.
The hotter months of the year are a prime period for events in the great outdoors, physical activity under the sun and fitness within the wonderful rohe we live in! To do these things that we at times take for granted, it means we need good quality sports shoes. But for many of our VLC whanau who love to partake in physical activity, sports shoes are something that they have gone without – many not even having owned a pair of sports shoes before.
Luckily, the VLC team for the past 5 weeks have been running a Sports Shoes Co-op allowing the whanau to finally be able to purchase their own pair of shoes from Rebel Sports! Now, we don’t know about you – but by the looks on these guys’ faces, we think this has been an awesome initiative! The Vanessa Lowndes Centre is about building confidence and preparing people with mental, physical or intellectual disabilities for employment.
Well done, whanau! We are incredibly proud of your achievements and can’t wait to see you wearing your new shoes at every opportunity! The VLC whanau have been hitting the Kaiti Hill Challenge – so make sure you stop and say “Kia ora!” on your way up the maunga…
PART of being a Tūranga Health team member is about being a great role model.
Waldo Horomia knew that being a sturdy prop helped him on the rugby field, but it wasn't doing him a lot of good in other areas of his life.
“When I finished playing rugby about three years ago I weighed 120kg so I was a sitting duck for health problems like chronic gout or high blood pressure.”
This year Waldo joined Tūranga Health as a member of the CAYAD (Community Action on Youth and Drugs) team.
“I was already working with youth and was mindful that they were in need of role models, and so I was going to have to live up to that.”
Now, having already lost a quarter of his body weight, Waldo (Te Aitanga-a-Hauiti) says he’s “walking the talk” and in better shape for the demands of the Tūranga Health job.
“Much of our work involves running programmes to help young people make better choices around the use of drugs or alcohol so it's pretty demanding,” he says.
“We work in this space because we're all committed to helping make change for our rangatahi.”
While physical activity is known to be good for youth, Waldo says the old-school rugby culture he was involved in has a lot to answer for. “There was just too much alcohol and unsafe behaviour like drink-driving and that caused a lot of grief for whānau. That's really how I came to this work. Our people deserve better.”
LUKE Bradley has devoted his life to physical activity playing sport, studying it, and acting as a sports agent.
Now as a Tūranga Health kaiāwhina he gets to share those same opportunities with young people.
“My role is life skills coach which means I get to spend time with rangatahi at kōhunga and kura and help them develop things like fine motor skills and confidence around physical activity,” he says.
“It's a really great opportunity to help the young ones with skills they can take forward into their lives.”
Luke comes to Tūranga Health after a decade in Japan where, as well as teaching English, he ran a sports agency, helping New Zealand rugby players succeed in a foreign environment.
It was in Japan that his interest in physical activity for young people back home started to grow.
“I was looking at studies about how sport tended to drop off in young people after they left school and that's what really got me interested,” he says.
“There’s so much benefit to be gained in everything from physical fitness to developing leadership skills so supporting that is really rewarding work.”
On any given day Luke (Ngāti Porou/Ngāi Tahu) can be doing anything from working with pre-schoolers to organising the popular 4x4 Basketball League. And he still runs the sports agency.
“Being home means that as well as sharing some of the things I learned in Japan, I can get back in touch with my own culture, language, and people.”
Half of the region’s new babies have their growth and development checked by a Māori health organisation nurse. Just seven years ago it was only 22 percent. The shift reflects ways iwi health providers are reaching out to mums and the extensive wraparound support they offer.
Eight-week-old moko Gypsy Lee Anderson has grown two centimetres in two weeks and mum Kassandra Anderson (Tuhoe, Ngati Porou) is thrilled.
“I’m an experienced mum but I’m a bit of a worrier and it’s nice to have someone here to tell me those kinds of things.”
The busy mother of four looks on proudly as her Tūranga Health Well Child Tamariki Ora nurse Christine Kemp lifts Gypsy off the length chart and on to the baby scales to check her weight. “They’re both doing really well,” says Christine.
Baby Gypsy is just one of 152 babies born between January and June this year receiving Well Child Tamariki Ora nurse care from Tūranga Health. Yearly, around 700 babies are born in the region and if current numbers are anything to go by iwi providers will be supplying the Well Child service to half of them by year end.
Well Child Tamariki Ora is a free service funded by the Ministry of Health for all New Zealand children from birth to five years. The service traces its origins back to when Karitane nurses first specialised in infant care. Since the early 1920s most New Zealanders can claim they had their growth recorded in an official baby book. These days it happens in the Well Child Tamariki Ora book.
Over Gypsy’s next four years of life Christine will make seven to 10 visits – and Christine and Kassandra will record every milestone in Gypsy’s book.
Most of the nurse visits will happen in Gypsy’s first 365 days. Christine will monitor her growth and development as well as Kassandra and the family’s health and wellbeing. She’ll advise about immunisation, oral health, early childhood education, vision and hearing.
In a recent visit Christine brought beanies, booties and a woollen jersey for Gypsy. The gifts weren’t unusual. Many Tūranga Health mums are lucky enough to receive baby clothes and quilted blankets created by local craftswomen who want to give back to the organisation and whānau.
Kassandra says she looks forward to the visits. “I always have questions. ‘Is this okay? Is this normal?” laughs the 34-year-old, who worked at Te Wiremu House as a caregiver before Gypsy was born.
“When Gyspy once cried for what seemed like the entire day, that’s when it was awesome to contact Christine and ask for advice.”
All up there are 2800 zero-to- four-year-olds in the district. Over the past seven years Tūranga Health has gone from looking after 357 zero to four-year-olds to 900. When combined with the 300 pre-schoolers being cared for by Ngati Porou Hauora nurses, Tūranga Health’s Well Child Tamariki Ora coordinator Janneen Kinney says iwi health providers are now seeing 43 percent of the district’s youngsters.
“At Tūranga Health, it’s a privilege that more mums and their families are choosing us to support them. Families are looking for a provider they can connect with, and that’s what we’ve been working hard to make happen at Tūranga Health.”
}Tūranga Health has increased its nurse numbers from two to three to manage demand. The team includes nurses Christine Kemp, Tausilia Letufuga and Akesa Kavai, kaiāwhina Sarah Brown and Leslie Puketapu, and Whānau Ora kaimahi Rhonda Pohatu and Tangiwai Milner-Madden.
Tūranga Health’s services for new mums and their babies includes antenatal classes and breastfeeding advice, and it can help with car seats, driver licensing and home insulation.
Janneen says Tūranga Health staff work where people live, work and play, and that’s been an attraction for families. “Having a baby is an exciting but often challenging time of life for mum and the rest of the whānau. We’re offering mums and their families’ choice, and that’s to be celebrated. Furthermore, what we offer here fits with today’s family life.”
}An example of that is when the nurses use Facebook and its Messenger app to connect with mums no longer actively using the service.
“We find lots of mums using Messenger,” says Christine. “Maybe they’ve moved or don’t have a phone. Often they don’t have credit for calls but they do have access to free wi-fi, and so we’ve become tech friendly and it’s helped us reconnect with mums.”
Kassandra regularly talks to Christine that way. “Messenger is easiest for me because I don’t always have credit on my phone. I’ve wanted to know about sleeping and feeding and even though I’ve been here before with my other children I can’t always remember this type of stuff.”
Janneen thinks Tūranga Health’s communication with families is one reason it’s baby numbers continue to rise. “We want to be relevant and useful to whānau. Between feeding and sleeping and everything else life can throw at you, the support we offer to parents and tamariki adjusting to the new arrival can be crucial.”
Kassandra agrees. She keeps Gypsy’s Well Child Tamariki Ora book in the cot (Gypsy sleeps in a bassinet) and every time Christine turns up she grabs it knowing she’s about to learn a little bit more about her baby’s progress.
“I’ve used other providers before but this time I chose Tūranga Health because friends suggested it. They’ve been awesome and I get all the information I need.”
When Kassandra learns Gypsy has blossomed to a healthy 10 pounds 5 ounces her smile and sense of relief couldn’t be greater.
“That’s another one of my questions ticked off!”
Jo Ware Imagery
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