FOR years Courtney Stubbins has worked in the disability sector because she has a passion for challenging barriers that block people from being their best.
And that's a passion she brings to CAYAD (Community Action on Youth and Drugs), Tūranga Health.
“If we want to minimise harm we need to take an honest look at the environments young people are in, from home, school and the community to the broader structures of society,” she says.
Courtney’s grateful for the chance to learn from the grassroots actions and initiatives taking place in Tairāwhiti. Since moving here in 2017 Courtney has immersed herself in the community, connecting with schools and youth organisations. “Working with CAYAD’s a new area for me, there’s heaps to learn. Because I’m new here there’s a lot to take in about the people, land, culture and history.”
The CAYAD team supports community-led programmes or projects that address alcohol or drug harm, or promote youth wellbeing in general. Schools, marae and sporting groups are the types of organisations that might access its resources and expertise.
AFTER years of raising her four children, Ema Jones (left) is now sharing her wealth of knowledge with whānau at the Vanessa Lowndes Centre.
VLC helps whānau with mental, physical or intellectual disabilities build confidence, perhaps to the point where they are job-ready. And for “Aunty Em” that means tackling the basics.
While VLC offers programmes from creativity to cooking, horticulture to health, her job as kaiāwhina involves delivering modules around personal hygiene and running a home. “It is all things we do in our everyday lives – having regular showers, keeping the house clean – and we tend to take it for granted that everybody else does the same,” she says.
“But some of our whānau require a bit of help in learning the skills needed to live independently. We know what their strengths are, we know they can live well, it's just a matter of providing the necessary support and guidance.”
Born in Tokomaru Bay, Ema Jones (Ngati Porou) brings a broad range of experience to her role at VLC, which has nearly 40 whānau on its books. ”
She's a big fan of hunting, fishing and camping; an experienced netball player; and, when she gets the chance, loves to read. She goes to great lengths to do her job driving more than 70 kms each way daily from Matawai, where her husband manages a farm. “This work is perfect for me,” she says. “It means I can be 'Aunty Em', not just to my own whānau, but to the whānau here at VLC.
TURANGA Health has again earned a big “tick” for the work it does as a leading primary health provider.
Like a voluntary, four-yearly warrant of fitness, EQuIP (Evaluation and Quality Improvement Programme) accreditation is awarded after an intense process of auditing that sees quality manager Shirley Keown – and the rest of the team – come under the microscope.
The Gisborne organisation first went for accreditation in 2007: a decade after its 1997 opening, when it had a kitty of just $300 and a client list of only 10 whanau.
Now, at the age of 21, it has come of age and chief executive Reweti Ropiha says that is reflected in the accreditation process.
“When we first went down this road it was all about the minutiae of working in primary health . . . there was a lot of dotting of 'Is' and crossing of 'Ts',” he says.
“For the last two programmes, though, there has been a definite shift to looking closely at things like strategic planning and examining relationships. They're saying 'we know you can do the day-to-day stuff, now let's go a little deeper'.”
Auditors from Australasian agency DAA spent three days assessing Turanga Health across clinical, support and corporate functions – not just looking at how it looks after whanau today, but also how it is ensuring a strong and sustainable tomorrow.
“It's not just about the services being provided right now,” Mr Ropiha says. “When you are working with Crown dollars you need to show that what you are doing makes your organisation strong going into the future.”
For her part, Ms Keown says that after a near 30-year career in measuring health outcomes, the process is getting easier at Turanga Health, even as the assessment criteria get harder.
“As an organisation we are now doing a lot of this work as we go along so it is more a matter of pulling it together to capture a point in time,” she says. “That is kind of the whole point. It's about validating our systems and processes to reinforce the way Turanga Health goes about fulfiling its purpose.”
And though she is at the sharp end of the assessment process, she likes the auditors' focus on a constant need for organisations to evaluate, evolve and improve.
“So it's not just about doing a great job . . . it's about always looking for ways to make things better for whanau,” she says.
“I think it offers assurance that we are a quality provider that is always striving to give the best quality service.”
– EQuIP (Evaluation and Quality Improvement Programme) is an accreditation programme that addresses the essential elements of quality care.
– Turanga Health first earned accreditation in 2007 and has been successfully assessed every four years since.
ALL Annette Ransley (far right) wanted was for the pain to go away - but she got more than that!
The osteoarthiritis sufferer has now thrown away her walking stick and the prospect of hip surgery is increasingly remote thanks to a Hauora Tairawhiti programme at Turanga Health.
Annette is one of more than 140 people to have so far taken part in a Tūranga Health-hosted outreach programme to do just what Annette has achieved: manage their osteoarthritis to the point where hip or knee surgery may be avoided.
Funded by the Ministry of Health and run by Hauora Tairāwhiti, the two-year pilot programme – started in January, 2017 -- saw physiotherapist Samantha Henderson-Genefaas run classes at both Gisborne Hospital and Tūranga Health for clients referred by their GPs.
And this year it all continues with senior therapist Paula Bruce taking the reins while Sam is on maternity leave.
“The programme is aimed at people with mild/moderate hip or knee osteoarthritis with the intent of reducing pain and improving function and to prevent or delay the need for surgery,” Paula says.
“Though many clients are reluctant to go to the doctor, letting the GP know about pain or stiffness in your hip or knee means we can get started with treatment early.
The programme runs in six weeks blocks and consists of weekly exercise classes, sessions about how best to manage osteoarthritis, and an education component with input from a dietitian, pharmacist, and a diabetes and gout educator.
“Times are flexible with options during the day and after hours and Tūranga Health kaiāwhina can offer transport to and from classes,” saus Paula.
Once the six-week period is over clients are often referred to other Tūranga Health programmes or given green prescriptions so they can build on the good work they’ve done.
“The goal is to find the types of activity people enjoy so they can make long-term lifestyle changes.”
The pilot programme will continue until the end of 2018 with the aim of seeing 288 people.
For her part, Annette says that after putting up with a painful hip for years, the six-week programme gave her an exercise regime tailored just for her . . . and it's working.
“Six weeks is a big commitment but I managed to stick to it because I thought it was important,” she says. “Before, if my hip gave out I would fall but now I have the strength in my legs to avoid that. The help we have had is awesome and I’m so grateful for that.”
And her classmate and line-dancing buddy, Dawn Wihongi, has made similar progress, ditching the walking frame she used when an osteoarthritic hip stole her mobility.
Dawn loves being in an environment with so much support and encouragement and is stoked to have delayed a planned hip operation.
“My family thinks I am doing wonders so I'm really proud of myself,” she says.
ELISABETH Tākao, Tūhoe, is one of hundreds of women Tūranga Health supports each year to breastfeed their moko. Here Elisabeth shares her story alongside Tūranga Health nurses and kaiawhina who say they are starting to see a rise in the number of exclusively breastfed Maori babies.
Twenty-eight-year-old Elisabeth Tākao is revelling in her ability to exclusively breastfeed baby Tamaikoha Tākao-Smith, and credits Tūranga Health for their support.
“This time I wanted to breastfeed fully and wanted to express, and I when I told my nurse she was amazing.”
Elisabeth’s Tamariki Ora Nurse Celia Letufuga helped Elisabeth acquire a breast pump and gave her advice on the best way to express and store milk. Freezing breastmilk for later use was a revelation for Elisabeth.
“I thought that was the greatest lifehack ever! There’s no wastage. It’s all been amazing,” says the motivated mother of three.
Support from Tūranga Health
Tūranga Health staff working with mums like Elisabeth, say breastfeeding is the single most important thing they can help a mum and a family with, once a child is born.
As well as Celia, Tūranga Health’s Tamariki Ora team includes nurse Akesa Kavai, kaiāwhina Sarah Brown and Leslie Puketapu, and manager Janneen Kinney.
“It’s the best start for baby, mum and whānau,” says Janneen. “Breastfeeding has been shown to improve the short and long term health of baby and their whānau,”
The Tūranga Health staff, say breastfeeding is more widely spread in the community compared with four years ago, and that’s a huge victory.
“We know that breastfeeding is hard work and takes commitment however the benefits that baby and mother will reap are truly incredible,” says Sarah. “We’re here to help make that commitment to breastfeeding easier for both mum and baby.”
Elisabeth, who intends to exclusively breastfeed Tamaikoha until he is at least six months old, couldn’t agree more.
With the support nurse Celia, and her partner Hemi Smith, Elisabeth’s been able to remain in her Te Wānanga O Aotearoa programme of study, taking baby with her to class, weekend noho, and marae.
“For me it’s been amazing to be able to keep studying. I thought I would have to stop with baby but it’s been so easy to make it part of my life.”
Elisabeth’s study has reignited her interest in her Māoritanga and she has woven her experiences of pregnancy, birth, and breastfeeding into her creative and written work.
“A lot of my past year’s work has been about Tamaikoha my baby, and Tamaikoha the pou tokomanawa.”
Breastfeeding pilot programme increases rates
Four years ago Tūranga Health launched pilot breastfeeding support programme Kiri ki te Kiri Innovation (Skin to Skin) which aimed to increase the breastfeeding rates for first time Māori mothers.
Now, with the combination of kaiāwhina support, and Kiri ki te Kiri, breastfeeding rates have risen across the rohe.
The New Zealand target is 75% of Māori babies be exclusively or fully breastfed at six weeks, and 65% at six months. In 2016, 58% of Māori babies under the care of Tūranga Health were exclusively or fully breastfed at six weeks and six months.
“We haven’t reached our target yet, however it is fantastic increasing numbers of babies are being breastfed.” says Janneen. Four years ago about 35% of babies were exclusively or fully breastfed.
Increasing the awareness and knowledge of breastfeeding, involving partners and whānau as much as possible, and maximising community support, all helps.
“There can be a raft of reasons why a new baby doesn’t breastfeed,” says Janneen. “In a small number of cases, mothers experience lactation problems and other health issues.”
“Along with the Tamariki Ora Well Child Service, whānau can access the expert skills and knowledge of midwives and lactation consultants in the community.”
“We’re all here to help.”
Meanwhile, Elisabeth is thrilled with the balance she has in her life being a mum, a partner, and a student.
“I’ve been able to do all of this at the same time and I have connected even more with my Maori side. I’m proud. Really proud of what I’ve been able to achieve.”
Tū Mokopuna is the new kohanga reo physical activity programme for the under-fives, taking our kohanga by storm.
Established at seven kohanga in the eastern and western rural districts, Tūranga Health’s Tū Mokopuna program is made up of activities and exercises to help tamariki grow confidence, while building their skills in balance, co-ordination and the use of motor skills.
“Right from the word go, the tamariki loved it, and so the staff loved it,” says Tūranga Health lifestyle coach Daiminn Kemp.
As a member of Turanga Health’s population health team, Daiminn is used to setting challenges for others. He, along with other Tūranga Health staff, are enjoying the newfound venture of getting small children moving.
“It is absolutely fundamental to their development,” Daiminn says. “Even just participating gives them confidence and for many it is a new experience, but once the little ones see their friends getting into it, they all want a go.”
Tū Mokopuna encourages and motivates children from kohanga reo age, to a point where they have the confidence to fully participate in physical activity.
Tū Mokopuna can be tailored to suit each kohanga and fulfils Tūranga Health's aim of increasing physical
activity in Māori and community spaces, and reducing childhood obesity.
“Even if they are a bit shy, they quickly learn that when ‘Matua Daiminn’ turns up, it is time to get moving.” says kaiako of Te Waihirere Kohanga Reo, Louise Kingi.
As well as strengthening their bodies, the classes help tamariki build confidence, “something we work on a lot”, Louise says.
“It's always exciting watching the progress of each and every child we work with. By the time they get to school they will have the confidence to participate in physical activity, and that can really enrich their lives.”
MORE than 70 years ago Jo Kapene's mother presented her with a pair of four-inch nails and taught her to knit, and that’s the skill she’s using to warm the babies of a new millennium.
A participant in Turanga Health's popular Kaumatua Programme, Jo is among a group of nannies talented with knitting needles making a difference in the lives of whanau.
Every winter many Gisborne babies and children can get respiratory illnesses. But babies attached to Turanga Health’s Tamariki Ora programme have been helped to stay warm with hand-knitted beanies created by these nannies.
The talented nannies, who want to stay connected with their whanau and community, recognise that being a good mum is one of the toughest jobs in the world, and can be made harder if there’s not much money to go around.
Jo Kapene, Norma Peck, April Tololi, Mary Staley and Maata Tuturangi are some of the regular contributors, and say knitting the beanies is a chance for them to give back.
“Knitting the beanies is a lot of fun and you know they are going to a good cause.” says grandmother and great-grandmother Maata.
Since they began knitting the nannies have created hundreds of sweet little beanies for newborns.
“We all hate waste so it's a wonderful way to use up those little bits of leftover wool,” say the hardcore knitters, who are now adding booties and blanket squares to their list of knitting for the babies.
Turanga Health’s Operations Manager Dwayne Tamatea says “staying warm during winter is not a luxury that everyone can afford.”
“Turanga Health is incredibly appreciative to these nannies for their aroha and skills, and we’re always grateful for anyone that wants to donate their time and abilities to whanau in our community.”
TURANGA Health isn’t giving up on wahine who’ve missed their regular cervical smears.
That’s the message from the Turanganui-a-Kiwa Maori health organisation as it throws itself in behind a very personal approach helping ensure women at high risk have the best chance of preventing cervical cancer.
“Cervical cancer is one of the easiest cancers to prevent – as long as we detect the cell changes that cause it, early,” says Turanga Health Community Nursing Coordinator Renee Stewart.
In the six months to June 2017, Renee and her team have assisted and supported 92 wahine whose health records showed they were at high risk of developing cervical cancer or were behind in their regular smears.
Of those 92 women: 71 were more than five years overdue for a smear (and of those, 6 were ten years overdue and 1 was 15 years overdue); 17 were not on the national cervical smear register; 3 women were overdue for a call-back smear following an earlier abnormal result; and 1 was supported for a colposcopy.
“I really do feel that this is such a worthy programme and wahine by wahine we are making some sort of difference,” says Renee. “While there could be hundreds still out there I think getting four to five more people a week to their general practice to be screened by a nurse is a positive outcome and a great start.”
The two kaiawhina involved in the programme are making contact with women in conjunction with partner general practices Three Rivers Medical, Te Karaka General Practice and City Medical.
The criteria for contact is women who are considered high-risk, says Renee “This is Maori, Pacific or Asian women aged 20-69; women who are not on the national cervical screening register, and or women who are five or more years overdue for a screening.”
Renee says the age range of women contacted has been broad. “There are a quite a lot of young women who have never taken advantage of the screening, that is, they weren’t even on the register.” Anecdotal evidence suggests many of these younger women didn’t know about the programme or are whakama or shy about attending.
At the other end of the spectrum there are older wahine who we appreciate are scared, says Renee. “Perhaps they have known someone with cancer, or just don’t have enough information to feel comfortable enough to attend.”
“Across all ages there are challenges and barriers. Some women are busy with children, others lack transport, and other times it’s just the normal trials of a busy life that prevent a woman looking after her own health.”
Kaiawhina Leslie Puketapu says encouraging wahine to have their smear isn’t always easy. “It’s especially hard when you are talking to someone you have never met before, and talking to them about something so private. The reaction can often be negative.”
But Leslie and fellow kaiawhina Sarah Brown are not dissuaded. They spend time with women, learn about their daily challenges, and support them to visit their general practice for a smear. Leslie and Sarah will even sit in the waiting room with them.
“We know having a smear can be stressful, so we want it to be as quick and easy as possible, and if that means being a shoulder to lean on, then that’s what we do.”
Leslie adds: “I have sat with at least three women in the waiting room. And they come out and they tell me ‘oh is that all it was!’”
The Turanga Health cervical screening programme will continue for the rest of the year. Renee says if you, or someone you know has been contacted about a smear, please take advantage of the service.
“Since the national screening programme started, the number of women who die of cervical cancer has dropped by nearly two thirds. And if every woman you know got tested regularly, the number could drop even lower.”
Funding for the Turanga Health service has come from Te Pou Matakana, the Whanau Ora commissioning agency for the North Island. As part of the same contract Ngati Porou Hauora is also supporting women to have regular cervical smears, while Te Whare Hauora o Te Aitanga a Hauiti is supporting women in breastscreening.
LAMERE Edmonds pulls into her driveway, enters her warm, dry unit and takes her eight-month-old twins with her as she has a quick shower to wash off the day's work.
A vehicle, a job, and a home for her babies . . . all things she could never have dreamed of just six months ago.
After a “horrible” 12 months plagued by legal problems and family breakdown, Lamere was living in a refuge with her baby twins. Her two older sons (aged 3 and 4) were with whanau, she had no job, and no drivers' licence.
The 28-year-old knew she had to turn things around and that’s where they long arms of Turanga Health come in.
“It seems crazy now, but it's like I had to get to the point where I had no other options before I could ask for that help.”
Lamere had already connected with Turanga Health last year by taking part in its antenatal classes in the lead-up to Justyce and Harmony's birth.
“I had already had the boys but I'd never had twins and I knew Janelle (Turanga Health's Mama and Pepi kaiawhina Janelle Te Rauna-Lamont) had triplets, so I thought it was a chance to learn about multiples,” she says.
While the babies turned out to be “cruisy as” Lamere herself needed extra help.
Turanga Health linked Lamere into programmes including Mama And Pepi (for pregnant mothers); Tamariki Ora (for healthy babies); Mums And Bubs (fitness for mums); and Driver Learner Licence (to get her on the road – legally).
Her Turanga Health Whanau Ora navigator, Tangiwai Milner, helped get Lamere and the twins into a cosy, two-bedroom Housing New Zealand unit and got to work on accessing funds for vitals like car seats and furnishings.
And at the beginning of July, Lamere started back in the workforce.
“When you consider that I started from nothing, Turanga Health has had a huge impact on our lives,” she says.
Meet the staff:
Tangiwai Milner has worked at Turanga Health since graduating with a social work degree in 2015. She works with up to 30 whanau. Below she shares how she and the other kaiawhina can help.
“When I visit whanau we talk about putting together a plan that will help them take control of their lives. It might be something as simple as doing a literacy course or getting a driver's licence. Or I might refer them on to another service to achieve a certain aim.
Even the seemingly little things can have a big impact. If you don't have a driver's licence you can have trouble with employment, you can't take your babies to the doctor, it can be very limiting.
Our ultimate goal is to empower whanau to take charge themselves. I like to think I can support whanau in achieving their goals, while ensuring they do 95 percent of the work.
They know the support is there and we walk alongside so they can make a difference in their own lives.”
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