AS a young father, Avenir Maurirere took a “whatever it takes” approach to supporting his growing family and that's what he brings to his work life.

As a navigator for Turanga Health, Avenir works with whānau targeted for support under Manaaki Tairāwhiti's 50 Families scheme.

And he knows all about the challenges whānau can face.

Raised in Mangatuna and Kaiti, Avenir and his “soulmate” started their family very young so he had to make the choice between staying at school or going into the workforce . . . the workforce won.

From there the roll-out of challenges continued until, while living and working in Hastings, Avenir and his partner faced multiple deaths in the whānau that brought them back home to Gisborne, and led to some tension in their family unit.

“All sorts of things can have an impact on your life and it is that understanding, that 'lived experience', that I bring to our 50 Families whānau,” he says.

“For my own whānau finding a nice home was a real turning point so I see how just addressing one thing can make a huge difference.”

Housing might be something Avenir (Ngati Iranui, Te Aitanga-a-Hauiti/Ngati Porou) talks about with whānau. Or it they might need help to navigate social development systems, justice, education . . . whatever it takes.

“Many whānau have a preconceived idea of what social services means but my approach is just 'this is me, and I'm here to help',” says the proud father of three.

“One of the most rewarding things is that, between us, we can help bring about systemic change in encouraging agencies to help whānau achieve their goals, not get in their way.”

Avenir's unusual name is derived on the French word for “the future”, and he says that's what he's firmly focused on.

“We listen to whānau, we help them work out a plan, and then help them work towards their goals.

“But though everyone is different, the one constant is that our relationships are entirely built on trust. If whānau trust us, they can be open with us, and then the real work can begin.”
 

 
 

AFTER more than 30 years as a hairdresser, Marnie Evans went for a career change that’s not quite as radical as it seems.

As a navigator for Turanga Health, Marnie works with whānau targeted for support under Manaaki Tairāwhiti's 50 Families scheme.

“Any hairdresser will tell you that the job is just as much counselling as it is working with hair so I've had a lot of experience in that area,” she says.

“And in any case, throughout my life I've always taken in kids in trouble, those who have needed a bit of help, so this is a natural fit for me.”

With Under 50 Families, the approach is “whatever it takes” to help targeted whānau -- both for their own good, and for the good of generations to come.

And “navigator” is a good term for Marnie's role as her job is not only to support whānau in good decision-making, but to help them untangle the systems they may need to work through.

For Marnie (Te Aitanga-a-Māhaki), “whatever it takes” means she and her colleague Avenir Maurirere listen to whānau before working out a plan.

“It is not our place to tell them what they need, it is for them to tell us what they need,” she says. “Our role is to build trust, to hear what they are saying, and to do whatever it takes to get it done.”

So on any one day she might be helping a whānau member get to the doctor, supporting them in court, teeing up counselling or just taking the time to talk through what is affecting them.
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“There's a lot involved but it never feels like work,” says Marnie. “Being able to help whānau achieve their goals is the most rewarding thing you could ever do. It just makes me happy.”

Years ago while working as a caregiver for the elderly Shannon Maats-Niwa decided she wanted to be a nurse and offer exemplary care.
 
“I wanted to be the kind of nurse that a person deserved to have,” she says.
And now she is!

Shannon has been a nurse for seven years and is loving her new role at Turanga Health as a tamariki ora nurse supporting new māmā and their pēpi.

She started with the iwi health provider just before New Zealand went into lockdown in response to the COVID-19 pandemic, and so for the first few weeks in her job she provided virtual care to whānau over the phone.

It was vastly different to her previous nursing jobs including stints on various wards at Gisborne Hospital and four years on the frontline at the Rhythm and Vines music festival.

“I wanted a job in primary care to help shape me and I have discovered I love being on this side of caring for people.”

“It’s humbling” visiting whānau in their own home. She says some of the strong wahine she supports live with very little in the way of life’s luxuries and it makes her appreciate her own family and extended Dutch and Māori whānau.

With an insatiable thirst for learning Shannon, 34, has her sights set on expanding her nursing career. Since graduating she has already added a post-graduate certificate and post-graduate diploma in nursing. Becoming a nurse practitioner, one of the country’s most qualified nurses, is her long term goal.

“I like to keep on learning. I get stale if I stay in the same thing for too long” says Shannon, who along with husband Adam is bringing up their four children.

There’s a chance her curiosity and motivation comes from her unique and stimulating childhood. Shannon and her two siblings grew up in a house truck for nearly five years traveling around much of New Zealand. They had a childhood surrounded by a range of unique and worldly people with the added bonus of being home schooled to a high standard.

“It was an adventure,” remembers Shannon, who finished her education at Lytton High School.
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Turanga Health welcomes Shannon Maats-Niwa. 

​Eligible Three Rivers Medical patients are being vaccinated against influenza by Turanga Health nurses as the region’s two biggest primary health providers unite against the deadly disease.
 
Three Rivers Medical co-owner and chief executive Ingrid Collins says Turanga Health’s offer of help to ensure patients over the age of 65 are vaccinated against influenza has come just at the right time.
 
Local figures from the National Immunisation Register show 64 percent of people aged over 65 in the district have been immunised as of 29 May – up by 11 percent on last year’s figures. 

The figures also show 1350 over-65-year-olds who identify as Māori have been immunised – 56 percent of those who are eligible. 

But that means 1060 over-65-year-olds who identify as Maori around the district haven’t been immunised.
“We want to make sure the eligible patients enrolled with our practice don’t miss the chance at protection,” says Mrs Collins. 

Mrs Collins says nurses and kaiāwhina from Turanga Health already have a relationship with many Three Rivers patients as part of the iwi provider’s work.

“Turanga Health staff are already out in the community. It’s what they are good at so the partnership means we can use them to help get to our patients that qualify for the free vaccination.”

Influenza, commonly known as the flu, is an infectious respiratory illness, caused by strains of the influenza virus. 

Each year it has a large impact on the community with 10-20 percent of New Zealanders infected. Some of these people become so ill they need hospital care, and a small number die.

As part of the Ministry of Health's preparation for the potential impact of Covid-19 on the health sector, the 2020 influenza immunisation programme began early, from 18 March, for eligible patients, as they are at greatest risk of serious illness from influenza. 

Turanga Health now has five, two-person vaccinating teams working around the rohe. A kaiāwhina makes contact with the eligible person and lets them know when they will next be in their area.  The kaiāwhina then books the person in for vaccination and a Turanga Health nurse administers the flu jab in the person’s home.
Turanga Health adds the vaccination details to the National Immunisation Register, a computerised system that holds immunisation information of New Zealanders.

Turanga Health chief executive Reweti Ropiha says there’s a couple of very good reasons why the large iwi health provider wanted to help.

He says influenza is incredibly easy to catch and following New Zealand’s move through the lower alert levels, interactions between people are increasing.

Alongside the onset of winter, it’s human nature for people to spend more time inside, Mr Ropiha says. 
If someone has the virus then there is a risk of giving it to anyone you are sharing air with indoors. “Our pakeke are vulnerable and so we want to get to them if we can.”

By Monday 8 June Turanga Health staff had managed to track down 50 hard to reach pakeke who otherwise would have gone unvaccinated.

Mr Ropiha says it’s important for whānau to remember the flu vaccine does not protect them against Covid-19 but it will help to “flatten the curve” of demand on Gisborne Hospital this winter.

The shared influenza vaccination campaign is not the first time the two health organisations have worked together. Four years ago, Turanga Health’s flexible hours and community-based staffing were used to help more eligible Three Rivers Medical patients into smoking cessation programmes. Last year Turanga Health helped encourage more Three Rivers female patients to come in for their regular smear.
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“Some of our patients are hard to reach,” says Mrs Collins. “But that’s the kind of work that Turanga Health is so good at. It’s a great relationship that’s helping look after the health and wellbeing of this community.”

ON placement at Turanga Health in her last term of training, Well Child Tamariki Ora nurse Brigitt Fielder knew she was in the right place.

“We'd done all sorts of placements and while I enjoyed the theatre environment, it was Turanga Health that really inspired me,” she says.

“The moment I walked in I thought 'this feels like home' and the day after I sat my last exam, in November 2019, I started work.”

That seems quick, but Brigitt had taken a long road to get there.

A self-confessed “Jack of all trades”, between parenting her children she had worked in areas from upholstery to horticulture, to the stained glass work she still does today.

“I had often thought about going into nursing but, with three kids to raise, I couldn't really afford to be a poor student,” she says.

“But it was them that pushed me into it. My youngest was still at school when they said 'Mum, it's time, just do it!'.”

If Turanga Health feels like “home”, Brigitt sees a lot of other homes in the course of her working day.

As one of a team of three, she has hundreds of pēpi on her books, starting home visits from when baby is just five weeks old and continuing – though in reducing frequency – until the age of five.

“We look at lots of things to do with a baby's health and development and also to see if mum has everything she needs, and how we can help if she doesn't,” Brigitt says.

And working at Turanga Health means Brigitt has support for things outside her immediate brief.

“Just recently I visited a rental home where there were eight kids, and no working heating -- it was freezing! – so that was a situation the team here at Turanga Health could do something about. If a home isn't warm, or the tamariki don't have enough clothing, those are issues we can refer on for further support.”

But sometimes it is not only the babies that need the care of the Tamariki Ora team.
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“Everyone has different degrees of whānau support and sometimes the māmās just need to talk, and for you to say “you're doing the right thing, you're doing great . . . you've got this”.
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As COVID-19 threatened the rohe this month Tūranga Health staff mobilised a swift and unprecedented campaign to protect whānau from influenza.

“We’ve never done anything like this before or to this scale,” says Tūranga Health manager Dallas Poi, who’s helped oversee the all-of-staff crusade to keep whānau safe from influenza and its complications. 

In just one month, Tūranga Health has vaccinated 250 people in their homes and another 300 people in their workplace.

“In a regular year we’d spread the vaccinations out over a two-or-three-month period but with the COVID-19 situation we knew we had to vaccinate as many as we could as soon as we could.”

Ms Poi says it is normal practice for the iwi health provider to vaccinate primary industry workers as part of its workplace wellness Tū Mahi programme offered to local companies.

The workplace vaccinations happened with speed this month at Cedenco Foods, Leaderbrand, Coxco, Riverland Fruit Company, Thompson’s Horticulture, Gisborne Fisheries, and Illawarra Orchard.

“They are often two-day jobs but this month we decided to throw a lot of nurses and kaiāwhina at it in one go and have safely vaccinated dozens of primary industry staff in just a couple of hours at each workplace.”

Individuals who use Tūranga Health services are usually educated about influenza and encouraged to get their jabs with their GP. But not this year.

A fast, home-based roll out of influenza vaccinations, was aimed at keeping the district’s vulnerable and elderly healthy, and as a result, hospital beds free for people with COVID-19. There’s another 150 to go.

“We needed to prevent a bad flu season from stressing out a health system that was preparing to cope with the virus.”

Tūranga Health’s vaccinations of individuals started ahead of lockdown. The organisation’s nurses and kaiāwhina travelled through the city and into rural areas in the crazy days before lockdown encouraging as many over 65-year-olds and people with long term conditions to come to various meeting points with their sleeves rolled up.

Once lockdown was in place two-person teams including a nurse and a kaiāwhina have continued to move around people’s homes offering the vaccination and checking how whānau are.

They do as many of the vaccinations as possible outside of the home and limit their physical contact with the person- apart from the actual moment of vaccination.

Verbal rather than written consent is sought so there’s no sharing of pens and paper. And this year the recommended post-vaccination observation time was dropped from 20 to 10 minutes where appropriate to help speed up the process and reduce participant’s exposure to potential infectious disease.

Registered nurse Kimiora Biddle says it’s an unusual way to deliver health care. It feels a little more rushed than normal but people they visit are grateful to have been vaccinated at all, and in their own homes.

“We are seeing sometimes 20 people a day. We are entering a lot of people’s bubbles but we are all well-trained in the appropriate infection control processes and we are able to keep ourselves and our clients safe.”

Kaiāwhina Rhonda Pohatu says this kind of support work alongside nurses is unusual for her. She’s enjoying the chance to work with whānau and help resolve any anxieties.

She says her own family is very supportive of the work “mum is doing” and know to wait until she has showered and changed before giving her a welcome home hug.

As well as the influenza vaccinations Tūranga Health staff have delivered over 1100 hygiene buckets to families who use Tūranga Health services – with another 400-plus to go, says Ms Poi.

​“As well as the delivery of some practical items like wipes,  disinfectant, and tissues, it’s a way of catching up with whanau to see if they need any help.”

BY all accounts the opening of Ihipera Mahuika's first solo exhibition was a resounding success. There were speeches, there were friends and whānau out in droves, and there was kai. Lots and lots of kai.

The feedback and aroha were awesome, says Ihipera, and she's earned it. To get to opening night, Ihipera first had to take control of the voices, shouting from the pulpit of a long-term mental illness (paranoid schizophrenia), that were dominating her life.

“I'd always heard the 'good' voices – ones that connect me to who I am – that I refer to as my 'gift',” says Ihipera who is Ngati Hamoa/Ngāti Porou. “But then the negative ones got too loud.”

To help her drown out those voices, Ihipera was admitted into psychiatric in-patient unit Te Whare Awhiora after her first psychotic episode at the end of 2007. In 2011 she was referred to Kenepuru Rehabilitation in Wellington, where she spent a couple of years addressing her addictions to marijuana and alcohol. Then from 2014 she finally dealt with her addiction to cigarettes when she accepted help from Tūranga Health's community-based Whānau Ora Mental Health Team.

Depressed, unmotivated and sick of having her life derailed by negative voices, Ihipera worked hard to get back on track with both her support team and whānau working together to help her manage medication, keep clinical appointments, live a healthy lifestyle, and work her way back to her independence . . . and her art.

“When she came to us in 2014 the voices were still dominating to the point where she couldn't really live independently and could not follow her life's passion,” says then Tūranga Health community support worker, Kay Walker, who together with colleague, Stella Rihari, worked closely with Ihipera and her whānau.

“So before her discharge four years later it was our role to help her get back in charge. Ihipera's strength was that she was determined to get out of – and stay out of – the dark places she had been so worked hard on every aspect of her care, including developing her own strategies to cope.”

After discharge there is always a plan to make sure whānau have wrap-around support so they can flourish in the community while knowing that, if anything goes wrong, Tūranga Health is always there, Kay says.

“With the support of both Tūranga Health and whānau, Ihipera managed her own journey back to wellness and to her art. I think she is amazing.”

Coincidentally, Ihipera's mum Maria Samoa also works with the Tūranga Health mental health team. As her mother, it was not appropriate that they work together but Maria was close by as her daughter developed, both as a person and as an artist. “We are so proud of our girl,” Maria says, “and so privileged to have the support of Kay and Stella, who still make special time for her, even though she has been formally discharged. The team has supported me as much as my daughter.”

Ihipera's solo exhibition My Journey: Gifted Voices, was in two parts; the earlier pieces she did while working in the studio at the Toihoukura school of Māori art (where she had previously studied); the newer ones were created in her own studio at Tautua Village, a new creative space to support Māori and Pacific youth.

“When I was at Toihoukura, (Associate Professor) Steve Gibbs taught me how to put my life on canvas, and (then tutor) Mike Tupaea helped me develop my contemporary Māori/Pasifika style,” she says. “So these works represent my life up until now.”

And Steve says the Toihoukura whānau welcomed seeing Ihipera's return – even though she had completed her certificate.

“This was a good example of how engagement in art, in particular painting, creates an important aspect of healing,” he says. “The tragedy is that, for artists, real life can get in the way and disrupt that engagement, but Ihipera showed the commitment, sacrifice and discipline crucial to being a working artist.”

Ihipera says she draws strength from both her father's Ngāti Porou (Māori) heritage and her mother's Ngati Hamoa (Samoan), but while she has spent plenty of time at her father's Tūrangawaewae at Whakawhitirā (East Coast), she is yet to have travelled to Samoa.

“Especially because I use a lot of those Samoan patterns in my art, it is a big goal for me to get there,” she says.
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“Working with Kay and Stella, and the Tūranga Health team showed me how I can reach my goals, and even today I know they will always have my back.”

When Henry Lamont started as the Tūranga Health kaiāwhina helping whānau find jobs it was tough work. He was looking for jobs for whānau managing mental health problems, as well as Vanessa Lowndes Centre whānau. The challenge was getting employers to take a punt on someone who might have been out of the workforce. Henry discovered there were very few jobs available… so he created some of them himself!

“We looked at what resources we had and how we could use them and thought ‘why don't we help whānau set up their own car valeting business right here at Tūranga Health?’”

“They use the site to carry out their mahi and we are right here to offer support and pastoral care if they need it.”

“We have some wonderful champions that have come on board,” he says. “Businesses like East Coast Farm Vets, Sport Gisborne Tairāwhiti, Property Brokers . . . they bring their vehicles along for a spruce up.”

That, according to Henry, is a win-win. “The businesses get a service they require, and whānau get what they want and need, which is to have the empowerment and dignity of employment. It’s amazing to see how people who may have struggled now have this strength in the face of adversity and that makes for some pretty great workers.”

Henry Lamont (Ngāti Porou/Te Whānau-a-Ruataupare) is used to a busy work life balance. He and wife Janelle have five children – including triplets – making for some demanding whānau and sporting commitments.

He's also used to being an advocate: in his former role as development officer for Poverty Bay Rugby Union he had a special passion for supporting youth in the sport. Those are strengths he takes into his position at Tūranga Health.

As a community kaiāwhina and whānau ora co-ordinator, Henry is charged with working with whānau to ensure they have the support and access to resources they need.

“An example might be we'd visit a new mother and identify if she needs any support with, for example, getting a new car seat, or having help to get to the doctor's,” he says.

“But you often find in those situations that there is a man in the household who might need some support, too. They might need a plan, some help in achieving their goals, and it helps to have another bloke to talk to about things like that.”

Having worked with all sorts of people throughout his life, Henry hopes that makes him approachable and easy to talk to.

“It's a bit of a cliché but most people don't want a hand-out, they just want a hand-up and that's where we can help,” he says.

“Our approach is to treat people the way we would ourselves like to be treated. It's all about respect.”

He loves how at Tūranga Health, whānau can pop in and self-refer. “That's the amazing thing about Tūranga Health . . . if someone wants to talk about anything that might help improve their lives or lifestyle, the door is always open,” he says.
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“Getting access to services can be a real barrier for whānau, and we are here to help break down those barriers.”

WHEN diagnosed with prostate cancer at the end of 2009, Ron Heemi was told to get himself to Palmerston North for treatment – and make it quick.

But when he pulled out of his Te Karaka home, instead of heading for Palmy he turned left to Gisborne and got on a plane to visit his children and moko in Australia.

“I knew I had to have treatment but this was not news I was prepared to give them over the phone,” he says. “I wanted to tell them face to face.”

It’s that care for others that has been a defining feature of Ron's journey to health, and something he says he gets back in spades from the team at Turanga Health.

First, though, Ron (68) – a handy hooker in his day -- helped Turanga Health by getting the message out to men.

“I just happened to see Tama (Turanga Health population health manager Dwayne Tamatea) at the Waikohu Health Centre and he asked if I'd go talk to the local rugby team about getting checked,” he says.

Continuing with that work saw Ron previously nominated for a Tairāwhiti Man of the Year Award but he still managed to accumulate a range of health problems, from the arthritis that keeps him on crutches to pre-diabetes and the high blood pressure he manages on a daily basis.

To help, he accesses an equally wide range of Turanga Health services including attending twice-weekly Eke Tū sessions in Te Karaka, where he and other whānau get both educational support and a good physical work-out to boot.

Ever the doer, Ron has also taken part in Turanga Health's DIY workshops, which he says are invaluable for those needed to do jobs around the house.

For those tasks that are too big, however, he's had an assessment through Turanga Health's Health

Homes initiative that will see the repair work done to help make his home dry and warm.

It's all good, practical stuff but Ron says he especially likes Turanga Health's focus on the whole whānau.

“When you get crook it is not just you that suffers . . . it is all those who love you,” he says. “I had to go through 13 weeks of radiation and it breaks my heart to think that my wife had to go through it, too, so that support is really important.”

A former farmer, Ron (Ngāi Tūhoe) believes life on the land can be hard on people like him who have had physically-taxing jobs.

“But it's not just the physical things Turanga Health helps with . . . being unwell can be really isolating and a bit depressing, and they help with that as well.”

Turanga Health rural nurse Amanda Humphris says she loves working with Ron, who she describes as “a real community man”.

“He'll do anything for anyone,” she says. “You'll never hear a bad word about him.”

That's not to say she won't get tough when required – Ron has already lost more than 10 kilograms in preparation for surgery to help fix his arthritic hips and she is right behind him in helping get rid of that last five kilograms.

“And I really appreciate it!” Ron laughs. `“We might be part of the Turanga Health whānau, but she is part of ours, too.”