Voyages magazine Pacific Heart | Pacific Heart | | Print | |
ProCare Health, which represents 500 independent GPs in greater Auckland and manages three primary health organisations (PHOs), has set up its own Pacific Health team. Voyages met the people who are mobilising Pacific communities to access health services and following up those in high need who don’t. Mac Leauanae There’s no denying the reach of ProCare’s work. ProCare caters for the primary health care needs of 650,000 Aucklanders, many of whom are Pacific. “We service a large proportion of Auckland and have the largest enrolled Pacific population – around 70,000 of the 150,000 Pacific people in Auckland. So, we are a mainstream provider, but we are a mainstream provider that has a major influence on Pacific health,” says Mac. “To do our job well and reduce inequalities, we really need to focus on the needs of Pacific people. My role as Pacific advisor is to ensure that the policies and strategies we develop improve access and health outcomes for Pacific people.” Kim Buchanan, Clinical Programme Manager, says targeting areas of highest need means doing more to connect with Pacific peoples. “We want to ensure our programmes are used as well as they can be. That means targeting high needs Pacific patients. Our knowledge of our people means we can tailor efforts to improve their health.” To this end, ProCare has established dedicated Pacific Health Promotion and Community Health teams to work with local communities. 
The role is a challenging one involving home visits to high needs Pacific patients who are not currently accessing available health services. The barriers are both practical and cultural and the team’s responses range from arranging transport and budgeting advice to translating and explaining information about the health system. “We back up the work of the doctors, reinforce their health messages and help patients manage chronic conditions,” says Malama Atutolu. “For example, it’s easy for GPs and nurses to tell patients to watch their diet but our people will still go back home and eat what they can afford and cook it how they know. When we visit we can say ‘you don’t have to drop lamb flaps or corn beef, but you can change the way you cook and prepare it.’ That can have a huge impact on their wellbeing. We’re taking the health system to these people at their level.” The team is convinced that culture plays a very strong role in addressing health inequalities among Pacific people. “That why it’s a unique service,” says Lottie Sisepi. “You’ve got to know how to talk to your community. You’ve got to earn their respect. It works because we live the life they live. Our people often don’t know how the health system works. That’s why they need us. Many Pacific Islanders are simply not accessing the services provided for them. We’re the link between the GP and that community. That’s why the team’s been set up and that’s why it’s working.” Limaono Kingi sums up the need for the team’s work. “If you don’t provide this level of service, you won’t see these people. They just won’t be there in the health system.”  This type of practical support can be a great help for busy practices, especially those serving large numbers of Pacific patients. Kingsland GPs Dr Peter King and Dr James Lowe see plenty of potential in the new model. “The difference it makes is huge because without this type of support some people are lost,” says Peter King. “As doctors we pick up on people’s needs opportunistically, whereas this way you can actively arrange to meet their needs. It’s much more proactive. Because the ProCare team can reach out into the community, it makes things easier for us.” James Lowe agrees: “There needs to be better communication between primary, secondary and tertiary care. There’s a real bridging role explaining the complexities of the health system and its sub-specialities to people. Having people who can act as the link between the client and the layers of the system helps things run smoothly.” Practice nurse Barbara Lowe has been impressed with the efforts of ProCare Community Health Coordinator Valita Partsch.  Dr Peter King adds, “The potential of this initiative is huge. The Auckland Pacific Island population is big and their health problems are a major issue so you need Pacific people working in this role.” Meanwhile, ProCare’s Health Promotion team focuses on community engagement – raising community awareness about healthy living, cardiovascular disease, diabetes and obesity. Health Promotion Advisors Melissa Lelo and Elaine Prince say their work is about supporting Pacific communities and focusing on the actions that will improve access to and quality of services delivered to Pacific communities. It’s also about collaborating with other agencies, providers and churches to improve uptake of current programmes. The Healthy Village Action Zone initiative is a good example. ProCare is working closely with a range of other health providers to mobilise Pacific communities to improve their health based on communities of interest modelled on Pacific villages. Melissa Lelo says the team is also developing community lifestyle coordinators. “These are movers and shakers in the community who can help advance our goals in improving nutrition and increasing physical activity. We are giving them first aid training and nutrition courses because health promotion is all about community development and community action so that when we’re not there, the work carries on. Sustainability is a huge part of developing programmes that work.”  The Health Promotion team is also involved in the Green Prescription programme which was launched in October 2006 to help people who suffer from health conditions which would benefit from exercise. The programme offers a range of exercise classes in Mangere, Manurewa, Pukekohe, Papakura, Otahuhu, Mt Roskill, Mt Albert and Glen Innes.
Evaluating the effectiveness of these programmes for Pacific people is vital, says Mac Leauanae. “For example, under our Green Prescription programme doctors will refer patients to do physical exercise. Now we’ve noticed that Pacific numbers aren’t as high as we’d like on one exercise programme, so we are finding out why they aren’t turning up – is it the venue, is it the way it’s being delivered? That’s our role. Providing a Pacific heart and conscience for ProCare.” All concerned believe the establishment of the Pacific team is helping to keep Pacific issues top of mind. “Our general practices were doing well before ProCare set up this team, but we know we can do better. It’s about shifting mindsets and making our impact on the Pacific community a lot bigger,” says Mac Leauanae. “There is now a better understanding of the needs of Pacific people and that makes a big difference when clinical programmes are rolled out. ProCare needs to have that impact because we’ve got 50 percent of Auckland’s Pacific population enrolled. So if we are making an impact on that 50 percent we are making an impact nationally. We need to make ProCare work for Pacific.” • ProCare At a GlanceREPRESENTS:
PHOs and Pacific peoplesThere are 81 PHOs throughout the country. By 2006, 95 percent of the New Zealand population had enrolled with a PHO including nearly all Pacific people. The majority of Pacific peoples (216,766 or 83 percent) are served by 16 PHOs in seven DHBs with the biggest Pacific populations. There are three Pacific PHOs – AuckPAC and Langimalie Clinic (Tongan Health Society) in Auckland DHB and Ta Pasefika Health Trust in the Counties Manukau DHB region with 31,051 Pacific enrolments combined. Enrolled Pacific Population in Pacific PHOS (2007)
Source: Ministry of Health 2007. The majority of Pacific people, 88 percent, are enrolled with mainstream PHOs, such as ProCare. Mainstream PHOs with over 10,000 Pacific People Enrolled in 2007
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