Delivering effective services to pacific peoples: helping break the cycle of pacific peoples' ill health is what motivates one Pacific nursing leader at Hutt Valley District Health Board.
Subject: Automobile industry (Study and teaching)
Author: Manchester, Anne
Pub Date: 08/01/2010
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2010 Source Volume: 16 Source Issue: 7
Topic: Computer Subject: Automobile Industry
Product: SIC Code: 3711 Motor vehicles and car bodies
Organization: Company Name: Motors Liquidation Co. Ticker Symbol: GM
Geographic: Geographic Scope: United States
Accession Number: 236247993

For Pacific Peoples health adviser at Hurt alley District Health Board (DHB), Siloma Masina, the contrast between this and her first job in New Zealand could not be greater.

"When I first arrived in New Zealand as a young married mother, I worked at General Motors in Petone, inserting elements into oven tops. Unfortunately, I was very slow and often the line of ovens would pile up and stop, making the foreman very angry with me. I would go home in tears, very disillusioned with my new life. I had to work to support my husband who was studying at Victoria University and to support my baby who was fostered out during the week. It was a tough time. This experience motivated me to go back to nursing."

Initially Masina worked as an enrolled nurse (EN) at St Helen's maternity hospital in Newtown, as her three-year training in Samoa was only recognised as EN-equivalent. In 1979, she enrolled for the three-year registered nurse programme at Wellington Hospital, working in oncology for a year, then transferring to the Hurt Hospital. She later worked for seven years as a practice nurse with Petone Union Health Service, helping set up other union and Pacific health services in the Wellington region. In 2004, she moved from being clinical co-ordinator with Hurt Valley's Pacific Heath Services to her present role with the Hurt Valley DHB and is the second person to hold the role.

"The role grew out of an identified need for better health care for Pacific peoples living in the Hurt Valley," said Masina. "Wellington has the second highest Pacific population in New Zealand, with around 11,300 Pacific people living in the Hurt Valley. It was clear the DHB needed to understand the health needs and perspectives of Pacific people, who present, proportionately to other population groups, in large numbers in our emergency department, (ED) and outpatient services."

Masina describes the rote as many-faceted. She is an adviser to the board, a voice for the Pacific community and part of the senior management team. It's a strategic role but one operating at the grassroots. As Pacific peoples' adviser, she must ensure the DHB's annual and strategic plans have Pacific input. She works with DHB staff to help them gain a better understanding of Pacific peoples' worldview and with Pacific health providers in the region.

"The DHB must find ways to deliver services more appropriately to Pacific people," she said. "All too often they delay seeking medical help or fail to pick up prescriptions due to the cost. When their conditions become acute, they present at ED with complex health needs. There are many reasons for this. In the islands, people go to a hospital to access health services; primary health care does not exist as a separate service. Hospital, therefore, equals health care. Going to ED is convenient because you don't need an appointment, it's free, and you don't' have to go during work hours. Attending an after-hours clinic is much too expensive for most Pacific people."

Contact with patients

Masina is proud of the work being done by the two nurses in the DHB's Pacific unit. Using their clinical and social skills, they visit every Pacific person admitted to the hospital and refer them to a primary health provider on discharge. Numbers of Pacific patients vary from week to week, though average about eight percent overall, with the highest numbers coming from the poorest areas of the community. The nurses attend family meetings alongside doctors and other health professionals, and provide interpreting services as required. Last year, Masina and the nurses planned cultural workshops for DHB staff, but the tsunami that wreaked havoc in Samoa last September put paid to that plan. However, cultural workshops are back on the agenda, with the aim of running them in different units later this year.

"We want to give staff an overview of how Pacific people think and why. This knowledge will give mainstream health workers a better understanding about how to care for these patients more appropriately and more successfully. This knowledge should be part of everyone's work. It shouldn't be seen as too challenging or threatening. We just want people to be more confident about how to meet the needs of Pacific patients, and to accept and understand their differences.

"We encourage staff to use the resources available. This includes ourselves, and the handbooks we have produced. These provide guidance to health professionals caring for Pacific people in hospital, and include communication tips, simple phrases and assessment questions translated into the four main Pacific languages--Samoan, Cook Island, Tokelauan and Tongan.

"There are also brochures, similarly translated, for patients having cancer treatment, these cover topics such as caring for your skin following radiotherapy, coping with chemotherapy and what palliative care can offer."

Masina believes upskilling health professionals working in mainstream health services is vital, as that's where the majority of Pacific people receive health care. Only a small component of services is delivered by Pacific providers.

Recently the Pacific unit conducted a six-month survey of Pacific patients presenting in ED and Pacific "did not attend" (DNA) rates in the outpatient departments. Masina and the unit nurses presented the results in a grand round Last month and will submit a format report on their findings to the Ministry of Health, which funded the project.

"During that six-month period, about 800 Pacific people came through ED and there were at Least 100 DNAs," said Masina. "We discovered that at Least 60 percent of those using ED services had ACC-related injuries, with ages ranging from 12 to 25 years. Many teenagers said they did not want to go to the family doctor because of confidentiality issues--they feared the doctor would pass on information to their parents. Of those presenting with illnesses, the most common was respiratory-related. When you are on a tow income, as most Pacific people are, you can't afford to buy heaters and, even if you have one, you can't afford to turn it on. Housing is often poor and overcrowded. Among children, bronchiolitis was common, with high rates of pneumonia and cellulitis in other age groups."

Masina hopes recommendations from the survey will be included in the DHB's next annual plan. "We don't want this to be yet another report that gathers dust on a shelf." Her major recommendation is for the hospital model to be replicated in the community, within primary health organisations. If the Government's new model of "better, sooner, more convenient" health care is adopted, this should be achievable, she says.

"Pacific people want a one-stop shop system of health delivery, a place where they can see the doctor, nurse, radiologist, occupational therapist, nutritionist, physiotherapist. This is what the hospital provides and the model they are culturally most comfortable with. We also need to develop services in the poorest areas of our region--Wainuiomata, Naenae and Taita --because this is where the bulk of our patients come from. If we could do this, it would be a great achievement."

Frustrations of a small budget

Despite some real achievements over the past six years, Masina still finds the rote frustrating at times. "Funding constraints and the small budget the Pacific unit receives mean progress is never as fast as I would Eke it to be. It's hard to make big decisions when you only have access to a small amount of money. It's also hard when you are the tone voice on the management team, though generally my colleagues are supportive. A real strength is the regular contact I have with other public sector Pacific advisers. However, recent cost cutting has seen our annual face-to-face meetings reduce."

Masina would Love to see the service the Pacific unit offers expand. "If we had five nurses, for example, we could do a tot more follow-up in the community. Most patients who come through the hospital don't go back to see their GP. They just want a quick fix. Much more education is needed to increase their awareness of the importance of follow-up care, be that physiotherapy or attending outpatient appointments."

Despite the obvious problems, Masina believes there are huge opportunites for Pacific people to develop further, to become economically sustainable and to develop their human capital in the workforce. A Pacific student cadet programme she helps run at the DHB over the summer holidays has seen a number of students moving into health professional roles at the end of their study.

More needs to be done, too, to recognise the multi-ethnicity of Pacific people. "There are at Least 22 Pacific nations and we are all a bit different. This needs better recognition. For convenience, we are Lumped together, to make it easier for funders and planners."

Masina has had a tong and distinguished nursing career in New Zealand. However, she tongs to take her skills back to Samoa one day to help her own people. Late this month, she will spend two weeks doing general nursing in one of the villages in Upolu most affected by the earthquake and tsunami nearly a year ago. Thanks to funding through NZAID, two nurses from New Zealand are still going to Samoa every two weeks to assist local nursing efforts and to help rebuild the weakened health sector.

And if her Long-term dream comes true, one day Masina will return home permanently to set up a nursing service providing preventative health care and health promotion. "Samoa's hospital services atone cannot deliver the health services the people need. There is an enormous gap in services run by non-government organisations and I would Eke to play a part in helping fill that gap one day.

By co-editor Anne Manchester
Gale Copyright: Copyright 2010 Gale, Cengage Learning. All rights reserved.