​TAWHITI hasn't had one for a year; it's been seven years since Juanita got covered; and Solomone has never had one. But now all three – and many of their colleagues – are vaccinated against influenza.
 
That's thanks to a Tū Mahi Workplace Wellness partnership between Tūranga Health and employers like Gisborne's Riverland Fruit Company.
 
As part of their Tū Mahi programme, Tūranga Health nurses arrive at workplaces all over the district and offer flu vaccinations.
 
Their visit to Riverland, located on the outskirts of Gisborne, saw a crew of just over 20 permanent staff and 20 casuals keen to board the Pikiteora mobile clinic.
 
“There is absolutely no pressure and it is totally up to them,” says Tūranga Health kaiāwhina, Hinehou Smiler. “We're finding most whānau are keen to protect themselves and those around them as we move into the colder winter months.”
 
Riverland worker Solomone Paongo had never been vaccinated against the flu but when his employer said Tūranga Health would be offering them as part of their workplace programme, he was one of the first to step up.
 
“I've worked here for seven years and if it wasn't offered on-site I don't know if I would have had the time to get it done,” says the senior orchard worker. “It's a good way to help me stay healthy and also to protect my wife and two children (eight-year-old and 10-month-old).”
 
Juanita Taute also received the shot to protect her from getting unwell. “I haven't had the vaccine since I was at intermediate school so getting it at work was pretty great,” she says. “I live with my mum and neither of us want to get sick.”
 
Growing up with his grandparents in the Manawatu, Tawhiri Brandon-Davies used to get an annual flu vaccine but hasn't had one since he moved to Gisborne.
 
“I was always told it was important when I was with Nan and Pop but I missed out last year,” says the 19-year-old orchard worker. “It's really great to be back on board by having it at work . . . it feels good to be covered.”
 
Last year the primary health organisation gave more than 350 flu vaccinations in workplaces and Tūranga Health’s Dallas Poi says protecting even more whānau through newly signed-up employers like Riverland is a great result.
 
“Keeping on top of a dangerous infectious disease like influenza is a constant challenge as people move among their workmates, their whānau, and the general community,” she says.
 
“One person can have a lot of contacts throughout the course of a day and this is one way of keeping them all safe.”
 
Riverland’s human resources manager Carl Hamlin says not only does the Tū Mahi Workplace Wellness programme, including the flu vaccine, encourage healthy lifestyles for his employees, but it also shows the family company’s commitment to offering good support.
 
“It’s good business in that it keeps workers in work where otherwise they may be ill with the flu,” he says.
“These Tū Mahi Workplace services are also a vehicle for us, as an employer, to show our workers they are valued.
 
“We’ve dealt with Tūranga Health before and think they do a wonderful job.”

A HOME insulation scheme that appears “too good to be true” is helping Tūranga Health whanau stay warm and that's a big plus for those managing chronic illnesses, says Healthy Homes kaiāwhina Memory Taylor.

Under the government scheme, $142.5 million has been allocated nationally over four years to fund grants covering two-thirds of the cost of ceiling and underfloor insulation.

But Gisborne has gone one better . . . Eastland Community Trust (ECT) has chipped in $1.6 million over that period to offer 100 percent funding to homeowners in the Gisborne/Tairāwhiti region.

Tūranga Health is serving as a vital link in getting that offer to the community.
“It's an opportunity many of our whānau think is too good to be true so they can be hesitant in taking it up,” says Tūranga Health chief executive Reweti Rophia.

“So we knew we'd need a real mover and shaker in the community who whānau could trust to take them through the process, and that's where Memory comes in.”

To qualify for the 100 percent funding, applicants must own their own home (built before 2008). They also need to have a Community Services or SuperGold card; or be living in a lower-income area; or be referred by a Healthy Homes provider like Tūranga Health.

“And that's it,” says Memory, who has already referred hundreds of homeowners for the scheme and, if required, is on call to help them through the process.

“We know that living in a warm home is much healthier for everyone, and especially for those managing chronic illnesses so this is something we can do to really make a difference.”

A cancer survivor herself, Memory knows how important a healthy home is to vulnerable whānau.

“If you are in a situation where you are sitting around a lot you feel the cold a lot more than if you are active.”

She cites the example of one member of Tūranga Health's Pasifika whānau, who has already accessed the scheme to top-and-tail his home in warmth-holding insulation.

“As well as managing diabetes himself, his daughter and moko were living with him so it was important they have a warm home,” she says.

“We were able to help them through the process of applying and having the home inspected and the insulation installed, and now they are all feeling the benefits.”

Reweti says it's a great way to ensure whānau are getting good results for the work they put into fostering a healthy lifestyle.

“It's frustrating to see whānau come to us for help in managing their conditions, getting great support around their health, diet and exercise, then going home to cold, drafty houses,” he says.

“That's just not going to work for them and that's why we have whole-heartedly embraced the Warmer Kiwi Homes scheme.”

Homeowners will be better off financially, too: It is estimated that an $1800 home insulation project could save that household up to $2857 each year in energy costs.

And Reweti says there's more good news to come. Once a house is adequately-insulated the homeowner can then apply for funding for a heating appliance (heat pump, or pellet or wood burner) for the main area of their home. Details of that part of the scheme will be announced soon.

“Many of our whānau live rurally in older properties that can no longer be considered to be warm, healthy homes,” he says.

“Through this scheme we can help them with that, and at the same time we're supporting them through our lifestyle programmes so they be the healthiest they can be.”
​
 

This story has been reproduced from the Gisborne Herald. GISBORNE-TAIRAWHITI health and education professionals have come together to develop a community action plan for whanau affected by Foetal Alcohol Spectrum Disorder (FASD).
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FASD is a brain-based disability that is the result of alcohol consumption during pregnancy.
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The hui discussed prevention, assessment and diagnosis, workforce development, support for families and the removal of the stigma associated with FASD.

Gisborne/Tairawhiti social worker, Tania Rauna, and clinical psychologist, Sarah Goldsbury, have been leading local efforts to spread awareness and information on FASD.

They are both passionate about exploring the need to set up local assessment and support services, but are also well aware this is no easy task.

Ms Rauna said FASD is a much bigger problem than people are aware of.
“We always talk about it as being the one thing no one wants to talk about, and I think if we talked about it more and we admitted it was a bigger problem than P and meth, then maybe the investment in it would be bigger,” said Ms Rauna.

Ms Goldsbury said there was clear evidence alcohol is the most damaging of all recreational substances for a foetus.

“Most people would be shocked to know that despite the damaging effects of cocaine, heroin, methamphetamine and marijuana, the damage that alcohol does to a developing foetus is far greater than any of those” she said.

“Those other substances go into the mother’s lungs or blood stream, whereas alcohol freely crosses the placenta, just as food does. The blood alcohol level of the baby in utero is the same as the blood alcohol level of the mother.” Ms Goldsbury said.

Alcohol is also recognised as a teratogen, which is a substance that is particularly toxic to a developing baby’s brain and body.

She said alcohol is a huge problem for New Zealand pregnancies, as alcohol consumption was such a big part of how New Zealanders live their daily lives.

“New Zealand research has found that 40 to 50 percent of New Zealand pregnancies are unplanned. When you put that together with other New Zealand research that tells us around 70 percent of women in New Zealand drink alcohol prior to pregnancy recognition, the combination is a ticking time bomb for all parts of New Zealand society”.

Around 25 percent of New Zealand women have been found to continue to consume small amounts of alcohol after pregnancy recognition, and around 10 percent continue to binge drink”.

“There are a number of lucky individuals out there, who have been exposed to alcohol in utero, and grow up apparently the same as everyone else around them. These individuals are blessed — we do not know why some people escape unscathed. But we do know there are more than 4000 research studies proving the link between prenatal alcohol exposure and brain damage.”

The women said most of their clients who drank during their pregnancies didn’t know they were pregnant, didn’t know the damage alcohol in pregnancy could cause, or were experiencing high stress situations, mental health difficulties or addiction.

“A number of people know it is not recommended to drink in pregnancy, but they may not know that alcohol in pregnancy can cause permanent brain damage for their baby,” Ms Goldsbury said.

There is a huge stigma around talking about alcohol use in pregnancy publicly. Women often feel ashamed, embarrassed, and guilty. This is made worse by the judgement that members of the public often espouse, Ms Goldsbury said.

“I have so often heard people calling it child abuse and saying that mothers should be charged for drinking in pregnancy. However, the harshest critics are usually the mother’s themselves, when they eventually realise the harm that was inadvertently caused.

“We know punitive measures do not stop addictions, we need a rehabilitative approach, and one that takes all blame and judgement away, or mothers will not open-up and share honestly with professionals.

“We need to take collective responsibility as a nation for a problem that is a result of our drinking culture, our high mental health and addiction rates, and our high levels of domestic violence, and ask ourselves what we can do differently as a society.”

Turanga Health nurse Janneen Kinney said the message given to whanau about alcohol needed to be the same from everyone — midwives, teachers, kaiawhina, doctors, nurses.

“Different messages about what is ok causes confusion. All whanau want the very best for their baby. Our community can help whanau to achieve this if the same correct information is given at every opportunity.”

Turanga Health’s community action on youth and drugs co-ordinator Courtney Stubbins said children in this district live with the harm from the drinking culture.

“A recent study in NZ showed children are exposed to alcohol marketing on average 4-5 times a day.

“The rate is five times higher for Maori children and three times higher for Pacifica children. This highlights not only inequity and a lack of regulations but the incredible amount of resources that go into messages aimed at increasing alcohol sales. Estimates show that around $400,000 a day is spent marketing alcohol as fundamental to our lives.

Experts say there is no safe level of alcohol consumption during pregnancy.
Ms Stubbins said people need to be made aware of the harms of drinking during pregnancy, and that community action is important because we have a shared responsibility.
​
“Stop drinking alcohol if you could be pregnant, are pregnant or are trying to get pregnant,” said Ms Stubbins.

THEY are too late to save the community member who died in his driveway after a day's work, but could well be in time to save others who suffer a heart event near marae around Turanganui-a-Kiwa.

Maori health organisation Turanga Health has paid for defibrillators to be installed at 20 marae in a move chief executive Reweti Ropiha says is about making sure all whanau have access to the life-saving equipment.

For Turanga Health long-term staffer and kaumatua Libby (Uncle Lib) Kerr, it's personal . . . many of his siblings have hearts weakened by rheumatic fever and after their youngest son caught rheumatic fever as a teen in the late 1980s, Uncle Lib and wife Mere were told their boy would be unlikely to live beyond the age of 30.

He's defied the odds -- now aged 42, their son is still going strong, even after having major heart surgery -- but the Kerrs say it's reassuring to know that, should anything happen, help is not too far away.

St John New Zealand had gifted 59 defibrillators to marae around the country, but with the focus on remote areas, those closer to cities like Gisborne missed out.

“Reweti saw that some had gone up the East Coast and thought, 'hey, what about closer to home',” says St John national adviser (Maori health), Stephen Dennett. “So the contribution from Turanga Health is a great way to continue this journey.”

There had been talk of the possibility of getting defibrillators to Turanganui-a-Kiwa marae, but according to Reweti, it was Uncle Lib who made it happen.

“We call him Speedy because when he sets his mind to something, he makes sure it gets done.”

Getting the defibrillators purchased, installed, maintained and whanau trained in their use is a joint project between Turanga Health, St John, the NZ Fire Service and marae committees.

There is not much training to do: the hand-held devices come with easy instructions on how to get them to deliver a dose of electric current to the heart in the event of a cardiac emergency.

But even so, Turanga Health in December hosted three sessions to ensure marae representatives were up to speed.

Opotiki first responder Rebecca Jones was on annual leave when the training team visited Turanga Health but says she didn't hesitate to come back on board to help share her knowledge about defibrillators and their operation.

“That is just the St John way.”

Among the whanau at the training sessions was Ohako Marae chair Dave Pardoe, who says the chance to have a potentially life-saving device installed in their Manutuke community was “fantastic”.

“That's an offer from Turanga Health we just couldn't turn down and our committee will support St John in making sure the community knows it is there for them to use. We have all lost people so anything that could help prevent that in the future is wonderful.”

According to Stephen Dennett, Maori have high incidences of heart conditions and low rates of survival after an event, so installing thedefibrillators at marae is a way of taking help to where it is needed.

For that reason, the devices be will available externally so they can be used by the community, not just when there is a marae event on.

“While that brings some extra challenges, we believe that each community will seek to protect the safety and integrity of the devices,” Reweti Ropiha says.

“For us, it’s all about access to potentially life-saving equipment. If an incident occurred -- whether it be at Matawai or Muriwai – then we have something on hand that could make a difference and potentially change the outcome.”

​

​THEY might be all about healthy living but they don't mind a bit of healthy competition as well!

Staff from Tūranga Health and Three Rivers Medical in November donned aprons and took up spatulas to take part in their semi-annual Cook-Off.

This year, the challenge was to cook tasty skewered kebabs on the barbecue, using ingredients from chicken, beef and vegetables to tofu or haloumi cheese, and (uncooked) fruits.

The playing field may, at times, have been a little uneven . . . Tūranga Health unleashed an early advantage with their appetiser of fresh kinaand oysters served with homemade rēwena bread.

However, Three Rivers' succulent Whangara Farms flagship beef was eventually too good for Turanga Health's seafood bonanza, and the medical team took away the win.

“We wouldn't say they cheated . . . but their appetisers were a force to be reckoned with,” laughed Three Rivers co-owner and education co-ordinator Dr Fergus Aitcheson.

Dr Aitcheson and Turanga Health events and programmes co-ordinator Dallas Poi agreed that, while the healthy competition between both organisations is well received by staff members, the atmosphere and message on the day is what sings true: “Healthy kai and nutrition can be fun and whanau can get a lot of enjoyment out of cooking together.”

And as Tūranga Health events and programmes co-ordinator Dallas Poi pointed out, “nobody can cheat anyway because there aren't any rules!”

Three Rivers chief executive and co-owner Ingrid Collins says that as well as encouraging healthy eating among whānau and service users, the cook-off is a chance for the two organisations to celebrate their ongoing relationship.

“We've worked well together since we launched in 2012 and to this day Tūranga Health is represented at our doctors' peer review meetings where they share input and ideas,” she said. “It's an important way to encourage healthy living beyond the doctors' rooms.”

For the service users who went along for the big Cook-Off, their involvement went further than simply getting a tasty, healthy feed.

As well as being able to vote for the grand winners of the 2018 Cook-Off between the two organisations, they also went into the draw to win the day's prize of a Gascraft barbeque (taken home by Eddie Evans).
​
And service users were questioned about their own secret food tricks, which may come into play for next year's competition.

Turanga Health is hitting the great outdoors with it’s rohe-wide physical activity and health programme Tū Pakari.

For the city-based sessions the Tūranga Health team has devised activities that can be done at stunning locations around town.
​
“We love getting out there but if it's raining we just do the session at the Tūranga Health gym,” says physical activity kaiawhina Shane Luke.

Town-based session locations include Titirangi Kaiti Hill, Waiweherua (the meeting of the three rivers), Elgin’s Blackpool Park, and Oneroa (Midway Beach).

And since the sessions are suitable for all, Luke hopes whānau will bring their young ones along for the ride.

Tū Pakari sessions in rural areas continue 6pm on Tuesdays at Patutahi Hall (with Bernie Semau), Muriwai Marae (with Daiminn Kemp) and Mangatu Marae (with Luke Bradley); Wednesdays (Te Karaka Sports Ground with Hotorene Brown); and Thursdays (Patutahi Hall with Daiminn Kemp).

Turanga Health service delivery manager Dwayne Tamatea says it's great to whanau getting out and about to exercise .

​“We were stoked to see the numbers of people at the Te Karaka and Muriwai sessions increasing earlier this year, and we’re hoping everyone returns and brings a friend or whānau member for the summer sessions.”

THE team at Tūranga Health know they are making a difference – they see good results every day – but now they’re drilling deep to provide evidence that what they do works, and why.

Tūranga Health was this year one of six primary health providers from around the country chosen to be a part of the Health Quality and Safety Commission's best practice initiative, Whakakotahi.

The only iwi health provider in the bunch, Tūranga Health is using the opportunity to zoom in on its Tū Mahi programme, where on-the-job health checks are offered to workplaces to improve and prevent health issues.

“For us, Whakakotahi is not about introducing something new, it is about achieving quality assurance by really looking close and understanding the essence of what we are here to do,” says Tūranga Health chief executive Reweti Ropiha.

“What we're using is a powerful tool of discipline that not only ensures our clients are getting the best of the best, but also future-proofs Tūranga a Health as a high-quality provider of primary care.”

With support from Commission Advisor Jane Cullen, the Gisborne initiative has been driven by the Tūranga Health team and their Tūranga Mahi Workplace Wellness programme for the research phase of Whakakotahi.

The Tū Mahi Workplace Wellness programme offers a range of services including heart checks, flu vaccinations, smoking cessation and other wrap around services all year round to primary industry workers.

“What we saw, was that some whānau could be better served if we extended our consults into the home,” says team member Dallas Poi.

“So, during a workplace visit our team might identify employees, for example, with a potential heart problem. Following up by visiting the person at home means we can also offer wrap-around services they may not have had access to had we not taken that extra step.”

It might include services like a Healthy Homes assessment, or registration with a lifestyle programme or, if there are young ones in the home, support from the Tamariki Ora Well Child programme.

“What we have identified is that getting the whānau involved means there is a better chance of success in achieving a good health outcome,” says Dallas Poi.

As an integral part of the Whakakotahi project team, Ms Poi works closely with the nurses doing follow ups on each home visit to assess its effect and ensure that the kaupapa is applied and is based on robust evidence.

“But at this stage we are already optimistic that home visits will become standard, so we can improve on what is already a successful workplace programme,” she says.

The Health Quality and Safety Commission has invited Tūranga Health along as its co-presenter at next year's National Rural Health Conference.

And that dovetails nicely with Mr Ropiha's ambition to see Tūranga Health excel in providing services that can be adapted by health providers nationwide.

“Our aim is to make sure that there is real, evidence-based rigour to all of our programmes to ensure they are sustainable,” he says.

“We are in this for the long term, and that's why it was important for us to really zoom in and look closely at the what, the why and the how of everything we do.”

In te reo Maori the word “whakakotahi” literally means unity and under the initiative of that name Turanga Health has combined with the Health Quality and Safety Commission to ensure there is rigorous, evidence-based backing to all of its programmes.
 
Image caption: Tūranga Health’s Dwayne Tamatea and Dallas Poi, and Gisborne Fisheries chief executive Salve Zame discuss the potential of Whakakotahi to help improve and prevent health issues for staff at Gisborne Fisheries. 

The hotter months of the year are a prime period for events in the great outdoors, physical activity under the sun and fitness within the wonderful rohe we live in! To do these things that we at times take for granted, it means we need good quality sports shoes. But for many of our VLC whanau who love to partake in physical activity, sports shoes are something that they have gone without – many not even having owned a pair of sports shoes before.

Luckily, the VLC team for the past 5 weeks have been running a Sports Shoes Co-op allowing the whanau to finally be able to purchase their own pair of shoes from Rebel Sports! Now, we don’t know about you – but by the looks on these guys’ faces, we think this has been an awesome initiative! The Vanessa Lowndes Centre is about building confidence and preparing people with mental, physical or intellectual disabilities for employment.
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Well done, whanau! We are incredibly proud of your achievements and can’t wait to see you wearing your new shoes at every opportunity! The VLC whanau have been hitting the Kaiti Hill Challenge – so make sure you stop and say “Kia ora!” on your way up the maunga…
Mauri ora!