Building a kaupapa Maori service.

In 2002, at the request of Local Maori, various hui were held throughout Tauranga Moana and Te Puke, with target groups identified through a scoping project. This project was not funded by any agency, as it arose from the genuine interest and needs of the community. Hui were held at different venues and were kept informal to allow free flowing discussions for all those wanting to participate.

Our community told us they needed help to keep themselves well and out of hospital They wanted support to understand their illnesses and medications, and to learn how to serf manage their illnesses. A group of Maori nurses met to discuss how they could help the people achieve this wellness.

With support from local kuia and kaumatua, a charitable trust was formed with a governing board of trustees. A contract was secured through the Western Bay of Plenty (WBOP) Primary Health Organisation (PHO), to provide a primary health care (PHC) whanau nursing service. So Te Hunga Manaaki Services (THMS) began operating as a clinical team.

We work alongside hauora providers, general practice and other health service providers. Our nurses provide services for hauora GP clinics where there is no nurse. To date, this includes clinics at Te Awanui Hauora (Matakana Island and Rangiwaea Island), Waipu Hauora, Ngati Pukenga Hauora and Motiti Island.

Matakana Island is a highlight for our nurses working with the Ngati Kahu Hauora satellite clinic. Access is by barge, so with the GP and practice manager, we pile into the 4WD and set off. This trip provides certain hazards, like the 4WD being squashed between the barge sides and the huge milk tanker overshadowing us. There is also the risk of hitting a sand bar at Low tide. This could keep us stuck for quite some time. Depending on the tide, the trip can take between 15 minutes and one hour 15 minutes.

Now and again we venture over to Rangiwaea, a smaller island alongside Matakana. This is accessed either by 4WD at tow tide or by boat. The 4WD must return before the tide comes in, so there is no time for chit chat.

It is exciting visiting Motiti Island, in our gumboots. Transport is via a four- or six-seater plane and the landing strip is a paddock. A tractor collects us and art our gear from there. The clinics are basic, no fancy facilities, but the whanau are so welcoming, and between Motiti and Matakana Islands, the nurses have someone else to blame for any weight increase!

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For the Motiti Islanders, being seen by the GP with support from the nurses, on their own island, is a service that is welt overdue and would otherwise be very costly for the whanau. Nga mihinui ki a Ngati Kahu Hauora and Te Awanui Hauora for making this service a reality.

THMS also provides hauora or marae-based nurse-led clinics to Huria Management Trust, Ngai te Ahi Ngati He Hauora, Kimihauora and Te Kura Kokiri at fortnightly, monthly or as required intervals, as well as clinical support to clients/whanau in the community. This service assists whanau to serf manage their illnesses, and provides support during acute exacerbations. Health education and health promotion, as weft as social service work, are part of most consultations.

A positive outcome of this service is the collaborative networks established between secondary and primary services, with referrals between the two services requesting follow-up visits for whanau.

Referrals are received from any PHC provider, whanau or via serf referral We are also available to any other service requesting clinical support to assist clients and whanau to manage their health within the community. We respond to urgent referrals/requests from whanau whenever they arise. We also offer support to hauora providers aligned to the WBOP PHO, to assist them build their clinical capacity and capability.

Requests over and above contractual work are often expected of us, eg to provide first aid support to hui-a-Maori and clinical support for kuia/kaumatua trips away. This is a point of difference from other more mainstream nursing services.

It is difficult to be a fully kaupapa Maori service while stakeholders do not understand what such a service should took like. This can cause conflict between what the client/whanau expects and what the PHO contract requires. For example, reconciling PHO geographical coverage with hapu/iwi boundaries is not always easy.

Acknowledging cultural work

Under a mainstream funder, contractual expectations often conflict with recognition or adequate acknowledgement of cultural work. Funder reporting expectations are also often difficult to reconcile with the reality of providing a kaupapa service. Whakawhanaungatanga takes time--the challenge is to include this when reporting numbers and other quantitative data. These contractual reporting requirements often create barriers to delivering services in both geographical iwi/PHO areas.

Current evaluation and/or audit methods often do not capture or truly reflect the cultural awareness needed in client consultations, nor are there any nationally recognised nursing indicators to measure success accurately.

Possible solutions include:

* educating funders and other stakeholders about the cultural appropriateness of providing a kaupapa Maori service and funding this aspect appropriately;

* building a reporting process that captures the cultural component of the service;

* developing outcome measures that capture the quality of kaupapa Maori service delivery reflected in the collation of qualitative as well as quantitative data; and

* building extended collaborative networks with other providers and health organisations to enhance outcomes for whanau, hapu and iwi.

Report by Mairi Lucas, RN, who works with Te Hungo Manaaki Services, Bay of Plenty.