Māngere Integrated Community Health

Costs are a Burden

Costs are a burden to people and their families

People sometimes leave the decision to seek help until too late because of the cost of treatment. In some communities the issue of cost is a vexed one. Some Pasifika families and communities pool costs for individuals to get medication. People sometimes leave the decision to seek help until too late because of the cost of treatment. And families can struggle to pay for treatment and care when a condition becomes very serious. Over the past 20 years political parties have tried to drive down the cost of the health system. But these strategies have not empowered communities to manage health more effectively. When economic drivers dominate, the systems act powerfully on people’s confidence to take control of their own situation. This is why in some communities the priority for things other than health is in evidence. For example, some Samoan communities place a priority on funding basic needs, the church, weddings and funerals. This makes sense from a relationships perspective as the people remain integrated. The alternative is to engage in a health and related agency system from which people feel disconnected.

This leads to an interesting question from a relationships perspective.

If people were acknowledged, engaged and supported within the professional and agency network for who they are, would their view of funding priorities change?

Comfort of Facilities

Facilities being as comfortable as home

Many people said that when visiting a doctor to discuss their health they need to go to a place where they felt comfortable. In some cases people would travel considerable distances to do that. This issue related to the relationship with the doctor and was often described in terms of trust. Others said health facilities needed to have a look and feel of ‘home’. The concept of home or being at home is connected with the acknowledgement of the person in the context of an engaged relationship.

Colour is comforting for many

There are also issues related to colour schemes in surgeries and agency offices. The eyes and emotions of a number of Pasifika communities are used to seeing more colour than is to be found in the ‘corporate office’ type colour schemes of many general practices, for example.

Clinics should have longer opening hours

There are issues relating to the hours of work for clinics. People cannot afford to take time off work to go to the doctor.

There is also a need for more flexible hours of work so that family members do not need to take time off work to accompany family members to visit the doctor for language or cultural reasons. Parents also find it difficult to take time off work when their children need to see the doctor.

Clinicians to the people

Our community came up with the idea of ‘clinicians to the people’. It is important to have a range of facilities near each other. But facilities themselves do not drive development from a community perspective.

We recommend that health providers take services to where people are, once there is a relationship to support that. This is particularly important because there are not enough clinics to cover the need for primary care services in Māngere. People are also often distressed by overcrowded surgeries and long queues.

Providing Muslim prayer facilities

We talked about what happens for Muslims waiting to consult a doctor (often at a hospital) given the Muslim prayer schedule. People need to pray 4 to 5 times a day at particular times. Hospitals and other health facilities need a place to pray together with a place for people to wash as part of the prayer process.

Traditional Medicine

Traditional medicine is a real force for health

Within our communities there are a range of effective traditional approaches to health and wellness. Past attempts within secondary care to acknowledge rongoā Māori have been managed on the basis of risk. This means the patient must provide a list of rongoā and the hospital assesses whether these will have an adverse affect on western treatments. Anything they consider risky is stopped. In effect the western treatment becomes the norm and traditional medicines are ‘other’. This powerful approach is a long way from patient ownership of health.

Across our communities today there are examples where the first preferred route is traditional medicine. The doctor will be consulted later. Many Pasifika people use a range of options such as prayer for healing within the family, prayer with the pastor or elders of the church, (particularly in serious cases) and anointing with oil. Traditional fofō involves the use of selected plant leaves to massage the body. People also drink the juice from selected leaves, when available, to cleanse the body and promote healing.

Our reflection on traditional practice was not about who is right and who is wrong. But we think people would benefit from a mix of traditional and western healing. This would happen if health service provision was informed and guided by a different kind of relationship between the various parties.

Cultural Practices

Cultural practices relating to food and cleanliness

A Muslim value around cleanliness relates primarily to ablutions and to food. Toilet facilities need to be designed in such a way that there is easy access to clean water for washing within the toilet cubicle. The design would be similar to a disabled toilet.

Halāl restrictions on food and the need for medicines to be free of alcohol and animal ingredients suggest that Halāl and its place in the health of people needs to be better understood.

Tongan groups would like to talk to health professionals about the strengths and weaknesses of traditional foods that are part of the cultures of Māngere. Both the health professionals and the groups would learn from this.

Tailored Services

Services tailored for particular groups

People liked participating in the activities of local swimming pools and gyms. But there is a need to provide separate areas/times for men and women in some Muslim communities. If men and women can’t take part separately, then they can’t take part at all. Current arrangements prevent them participating.