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.
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.”
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