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
A Whatatutu girl who can’t breathe and eat on her own has broken through her physical barriers and started school. Turanga Health has wrapped a number of services around Marita McLaren and discovers that out of a daughter’s illness…a mother has found a career in health.
Five-year old Marita was born with esophageal atresia which means she can’t eat normally. For the past two years she’s also had a compromised airway which means she breathes through a tube in her neck.
Unlucky to be living with these extremely serious conditions, the plucky precious daughter of Bessie and Reid McLaren is lucky enough to be wrapped up in the loving arms of an extraordinary whānau who rarely leave her side.
Marita’s most powerful advocate is her formidable mum Bessie who’s fought for Marita’s life every step of the way and now has her own challenges ahead as she trains to be a nurse. “It’s been an experience,
I’ll tell you that, I didn’t see that coming! But if wasn’t for her I wouldn’t be doing it.”
Marita, Te Aitanga-ā-Mahaki, started school at Te Kura Kaupapa Māori o Whatatutu this year weighing just 17kg, and having survived dozens of life threatening surgeries.
Marita’s esophageal atresia means the tube that carries food from her mouth to her stomach never fully developed. It’s in two segments, one part connected to the throat, and the other part connected to the stomach. Since the two segments didn’t connect Marita needed lifesaving surgery at a day old.
Bessie says while handing her newborn over for surgery was hard, “nothing was as difficult as learning at 32 weeks that the life of my baby hung in the balance”. Rushed to Wellington Hospital and on bed rest for two weeks, the post-birth surgery was just the one of many to come.
Marita’s first operation gave her a way to eat, albeit a complex one. Doctors created an artificial opening just under her neck so that anything she ate could trickle out of the hole into an external bag. The bag’s contents were then fed into Marita’s stomach via a tube. “It would go in, and then out, and then from out to in,” says Bessie, who has grown used to describing complex surgery in everyday language over the years.
During this time Bessie persevered with breastfeeding thereby teaching Marita the important art of swallowing. But it was always fraught with danger as any liquid spilling into Marita’s lungs would have led to a chest infection.
“Breathe, swallow, breathe, swallow. She couldn’t do that initially, and at the start she went all blue. It took a while, but I didn’t carry any fear. You can’t afford to. There’s no room for it – my head was filled up with all the important stuff I had to do.”
At three-years-old Marita had surgery that lifted her stomach to sit above her diaphragm thereby removing the need for the tube and external bag. While she can now eat some food through her mouth, she suffered damage to her windpipe and now Marita breathes with a tracheostomy: a small hole that’s been surgically made into her windpipe through her neck. A tracheostomy (trachy) tube sits in the hole and air goes in and out of her lungs. Just one accidental knock and Marita could be deprived of oxygen....
“She’s a battler,” sighs mum Bessie, who’s also bringing up four older children along with shearer husband Reid. “That’s what helps her get through any surgery. Mentally she’s a tough cookie. She bounces back pretty fast.”
While life in the McLaren house is just like any other family juggling work, school and sport, the difference is that everyone around Marita is skilled in her care and emergency procedures. Marita’s watched 24/7 at home and school, and at night she sleeps right alongside her mum hooked up to a breathing and intravenous food machine. “We’re so aware of her trachy. As long as that’s in the right place we’re not concerned. I’ve tried to make sure the kids don’t feel like they have to overcrowd her…just as long as we are all within shouting distance.”
Marita’s older brother and sisters have learned the skills to help Marita breathe safely. “We can do all the practical stuff that mum does,” explains Aroha (18).
Aroha and the twins Errol and Kirangi (12) live at home. Older sister Ashleigh lives in Gisborne. Each of them can help with the delicate and life-threatening job of changing Marita’s trachy once a week.
“At first what we have to do can be frightening but we’ve all learnt how,” says Aroha.
They also help with suctioning multiple times a day; when mucus in Marita’s airway becomes thick and she can’t get rid of the secretions herself. When they hear the telltale sounds of bubbling they grab the ever present emergency pack, place a small plastic tube through Marita’s trachy, and vacuum the secretions out.
The long term goal is that Marita won’t need the trachy. Recent surgery to help hold her windpipe open hasn’t worked, but Bessie’s quietly confident it’ll be gone by 2019. “There’s always a bigger picture, we’re always going back to the drawing board and mentally we’ve prepared her for what’s coming up.”
Bessie says Marita’s fixated on being able to duck under the water when swimming. “I want to put my head under,” replies Marita in her husky voice.
Since Marita was born Bessie and Reid have received untold kindness, help, and love from whānau and friends . Shearers, teachers, aunties, grandparents and siblings have helped the bilingual family, and Bessie and Reid can’t thank them enough.
“It’s all about family,” says Bessie. “I come from a big family myself and they’re awesome. My sister Pauline Brown has been amazing, always our go-to person. In those early days Reid and I and the twins could be with Marita in Starship and the big kids could stay here with Aunty Pau.”
Bessie also pays tribute to her parents Paul and Wini Brown. “My parents are so cool, they were cool back in the days when I was growing up, and they are still cool now. We never experienced the same kinds of hardship they did. We’ve really got nothing to worry about.”
Because of this unified support Marita has travelled to every family occasion be it school camp, the circus, the marae. She rides a bike, does gymnastics, plays with her dog, mucks about with hockey, and now goes to school. At the same time, Marita’s siblings have also been able to pursue their own childhood dreams, and Bessie and Reid have remained a formidable team.
Bessie: “Because of all of them, the whole extended whānau, we’ve lived as normally as possible. We’ve been able to stay together even when we were with Marita at appointments, surgeries, and clinics all around the North Island. We feel very blessed.”
Turanga Health kaiāwhina Tangiwai Milner says the McLaren and Brown whānau are “awesome”. Turanga Health has supported the family with numerous services including Tamariki Ora, Whānau Ora, marae-based exercise programmes and throat swabs for Rheumatic fever prevention. Turanga Health also recently helped Marita access an i-pad for use at school.
“School has opened up a new world for Marita, and the rest of her family, including Bessie, who’s an amazing mum and is now on her own exciting journey,” says Tangiwai.
After providing much of the high level care needed to keep Marita alive, Bessie, 44, is training to be a nurse. She praises the New Zealand health system, particularly the care received at Starship, but there’s times when she’s been frustrated.
After a particularly harrowing visit to the emergency department, a general practice, and then Starship via an emergency plane all in one day, Bessie decided she needed to do something. “I wanted to get in there on the public’s side and be able to help families that were going through what we were.”
Bessie’s completed her certificate in health science and begins a nursing degree in February. Eventually she’d like to work with neonatal babies. Just as they did during her last period of study, Bessie’s family will set up a desk and chair for her in the living room and do more of the household chores and practical care of Marita.
“They all came to the party when I started studying. I guess we’ve all got that long term goal that Marita won’t have the trachy. If I can achieve these next three years of study, then one day I’ll be working as a nurse!”
Tangiwai and the rest of the Turanga Health staff wish Bessie and Marita all the best as they dive into their new challenges.
OPENING its arms to the nurses of the future has earned a special award for Tūranga Health.
The health provider was named winner of the Support for Undergraduate Nurses (Team) prize at the Nurses and Midwives of Tairawhiti Awards for 2018.
And selector Adrianna Grogan (pictured at left) says the impact of its work will be felt long into the future.
As a senior lecturer at EIT's School of Nursing, Adrianna is charged with placing up to 80 students a year with health providers around Te Tairāwhiti.
She said Tūranga Health had been given the award because of the way it welcomes students with open arms, mentors and encourages them, and ensures they have lots of learning opportunities during their placements.
Tūranga Health is built on a vision of “Kia whai oranga-a-whanau mo nga whakatipuranga' . . . building family wellness for future generations,” she said at the awards ceremony in Gisborne.
It offers EIT third-year nursing students comprehsive primary healthcare placements that encompass values such as tinana (physical), wairua (spiritual), whānau (relationships), and hinengaro (mental health).
According to Adrianna a good number of the 22 students who graduated from EIT with a Bachelor of Nursing in 2018 had enjoyed clinical placements at Tūranga Health. Of those graduates, 20 had employment secured, three of them with a Māori health provider in Auckland,” she says.
The support they received through the course of their training was vital to that, and to the contribution they will make to the health sector going forward.
THE influenza vaccine is a big part of Tūranga Health's Tū Mahi Workplace Wellness programme and when nurses Kimi Biddle and Swanitha Brown visited the Coxco packhouse recently workers were keen to see them.
Twenty-seven-year-old machine operator/stock hand Sandra Tombleson only started at Coxco this year but she'd got the vaccine through her former employer so decided to do it again.
“It's great that it's free,” she says. She adds that she’s determined not to take bugs to her home, which she shares with her one-year-old niece and 95-year-old grandfather.
Meanwhile Coxco administration manager Lisa Loader lined up for the first time. “I hadn't booked, but a space became available so I jumped in,” she says. “I'd always thought about having a flu vaccine but having it here at work made it really easy.”
Tūranga Health has long worked at educating whānau about the benefits of being protected against influenza but 2016 was the first year it started offering the vaccine through its workplace programme.
“Last year our nurses gave more than 310 vaccines,” says events and programmes co-ordinator Dallas Poi. “So we found it was a great service to offer, especially for primary industry workers who are often unable to get to the GP during the course of their working day.”
The importance of helping workers to stay well is just one reason why agencies like Tūranga Health are being proactive about immunisation.
Another reason is the risk posed by dangerous strains like the ultra-powerful ‘Aussie’ flu (H3N2), which is covered in the new four-strain vaccine being used in New Zealand for 2018.
“Since we launched the service there's been a great response to the vaccine initiative both in our Tū Mahi programme, and also among our own workforce,” Dallas Poi says.
“We offer it to staff, not just because they are often in contact with whānau as part of their working day, but also as a way of supporting them to stay well in themselves.”
IT'S a sunny autumn morning and at Tūranga Health's city-centre gym questions about medication are coming thick and fast.
“What do I do if I have side effects?” How do I manage my medication when I go overseas?” Why am I getting nose bleeds?”
Nurse Kimi Biddle is up front fielding the questions triggered by her presentation, but this – along with talks on issues like nutrition – is just the first part of the Eke Tū sessions run by Tūranga Health.
Kaiāwhina Bernie Semau has a part to play, too . . . talking about diet and leading whānau through specially-tailored exercise programmes to help those with chronic conditions manage their health.
Participants are referred by their GPs and to make sure everyone can get along there’s a choice of location, timing, and settings in Gisborne and Te Karaka.
And while up to 30 people are gathered in the gym for this particular session, not all of them have health issues like diabetes or heart disease: some are whānau there in support. Tūranga Health chief executive Reweti Ropiha says that's as it should be.
“There needs to be a certain amount of compliance around things like diet and medication, how involved the whānau is, it’s the litmus test for us,” he says.
“Traditionally, the process of supporting those with chronic conditions has only involved the individual but with Eke Tū we say ‘why not widen that approach to make sure the whānau are at the centre of it’.”
Mr Rophia likens the programme to Green Prescription “but on steroids”.
“We had to come up with a really rigorous programme that provides tools for individuals and whānau to achieve better health outcomes,” he says.
“And that's something that is usually easy to measure. For example, if someone has been averaging 10 nights in hospital a month and we can help them get that down to six, then that's a big win.”
For Bernie, the programme's strength is how it gives people the tools to manage their own health.
“Eke Tū gives patients an opportunity to increase fitness, lose weight and improve their overall health,” he says.
“By giving our patients the knowledge, skills and motivation to make good decisions in daily life we’re empowering them to take a leading role in their own care.”
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.
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