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.”
 

THE aroma of bacon hock and vegetable soup mingles with the heady scent of baking bread as Thomas Mokomoko tends his steaming saucepans.
“I like to use whatever is in season,” says Thomas of the meals he creates. “You have to work out what’s fresh and make sure you don't go over budget.”
It has been six months since Thomas and fellow Vanessa Lowndes Centre (VLC) user Rachelle Gardner founded the V Club healthy food initiative.
Every Wednesday the pair plan, shop for, and prepare $5 lunches for up to 32 staffers at VLC umbrella organisation, Tūranga Health.
VLC kaiāwhina Christine Nepia (employment) and Kendy Riki (living with diabetes) say there is more to the club than providing healthy meals.
The idea was to use the commercial kitchen at VLC to teach healthy eating habits to Thomas, who admits that an affection for burgers and pies wasn't doing his diabetes any good.
At the same time the V Club could help the formerly-reserved Rachelle develop skills and build confidence.
We started small, says Thomas who, with some cooking and food hygiene training already under his belt, takes most responsibility for menu planning and shopping.
“Our plan was just to start making a few healthy sandwiches for staff but it built up and up from there.”
Vanessa Lowndes manager Laura Biddle says the V Club is just one solution for helping guide a person towards independent living, and the results have been beyond their expectations.
“We knew it would help but we can't believe how much. In terms of coming out of her shell and taking charge of her life, Rachelle has just blossomed”.
And as well as feeling physically better, Thomas' confidence has de-veloped to the point that, rather than being a worker in the kitchen, he is running the show. “What was a way of managing his diabetes has turned into a potential career path.”
Tūranga Health chief executive Reweti Ropiha says the organisa-tion's flexibility meant it could look across its programmes and find so-lutions to help build resilience and independence.
Meanwhile, Thomas has also re-cently joined Tūranga Health's health and fitness programme, Eke Tū, meaning his diabetes now faces the dual threat of a healthy diet plus regular exercise.
“I’m really impressed by how both he and Rachelle have taken the bull by the horns,” says Reweti (a regu-lar lunch time customer despite be-ing refused a discount by legendary “tight bugger” Thomas).
“They have taken charge of this project so all I can do is stand back and applaud their awesome efforts.”

Turanga Health’s Eke Tū fitness programme is Te Karaka is getting Ruby Broadhurst mobile.

“I definitely need a new hip but when I saw the specialist in Gisborne he said he wouldn't touch me until I had given up smoking cigarettes and lost 20 kilograms in weight.”

Kicking the fags was no problem, and Ruby says she’s saved a heap of money, but she’s always been “a big lady”.
 
Getting down from 128kg was going to be a challenge. “Some people can feel a bit shy about coming along but as soon as they meet [kaiūwhina] Bernie Semau, that all changes. He’s amazing and he keeps such a close eye on us that we don't want to disappoint him.”

GPs refer clients with long-term or chronic health conditions to the Te Karaka or Gisborne Eke Tū programme so they can learn about nutrition and lifestyle choices, and participate in activities like circuit sessions, yoga, swimming and gym workouts.
 
Eke Tū Kaiāwhina Bernie says for the foreseeable future chronic diseases will be responsible for the greatest number of deaths and disability in this region.
 
“But it is by no means a future without hope,” he says.  “Eke Tū gives referred patients an opportunity to increase fitness, lose weight and improve their overall health.”
 
Bernie has developed a fun but safe programme, and clients' progress is followed by a nurse offering extra security for those wrestling with chronic health conditions.
 
"We want to teach our patients, empower them, to take a leading role in their own care,” he says. “It’s about giving them the knowledge, skills and motivation to make good
decisions in daily life.”
 
 “It's great to see someone like Ruby put in the effort and achieve such great results,” adds Bernie.
 
 After just a few months of attending twice-weekly sessions at Te Karaka's Rangatira Scout Community Hall, Ruby, who used to work in mental health, is already halfway towards her weight loss goal.
 
 She’s optimistic of being hip-ready by summer because at just 65 years of age she’s got more to give she says. She can't wait to get off the crutches and back into what she loves doing.
 
 “I’ve come so far that I know I can lose the rest of the weight and get this hip sorted out.”
 
 “Achieving that would mean the world to me. It would be amazing to get back to the point where I can share my skills in the mental health field and, with Bernie's help, I will definitely get there.”