The rise and rise of Pacific healthcare

• Pacific providers’ COVID-19 vaccination push this year was jet-fuelled by $26.3 million of Pacific-specific funding from the Government.
• Pacific health leaders say they have struggled to have their views heard and communities’ needs understood.
• By 30 November, 29 per cent of COVID-19 cases to date were in Pacific peoples, along with the highest rate of hospitalisations, at 38 per cent.

It has been exciting and incredibly moving, actually, to see the things that have been achieved

Everyone stops what they’re doing to learn a dance, and you almost forget why you are there.

I’ve seen dance routines at health events several times now, most recently as The Fono’s mobile vaccination team learned a Tokelauan fishing dance in a Henderson car park. This was, presumably, a metaphor for pulling people in for their shots, but I’m no expert. Everyone was up, including the vaccination nurses, giggling as they went through the moves that got faster as the song went on.

Children leaned out of car windows waving their arms as they waited while mum sat out the regulation 15 minutes.

The street-side cheerleaders, who spend all day singing, dancing, and waving flags and signs to attract toots and unvaccinated passers-by, paused to yell out: “Turn it up! We can’t hear!”

But getting it right, right now, isn’t all that necessary, because the dance will be repeated over and over today as the crew celebrates every 100th vaccination milestone. Not that everyone driving through will notice; the music and banter are constant.

I’m having serious kōrero in the welfare assessment tent as Tuvaluan singer Johnny “No Cash” is being introduced. The woman next to the guy I’m talking to turns away to bellow: “Call the police, he’s an overstayer!”

Our interview continues once the laughter stops.

I don’t know about you, but I got my shots at mainstream facilities. They were polite, efficient and, I guess, a textbook example of a one-size-fits-all national healthcare response.

Sure, there was music. My first dose was accompanied by some family-friendly hip hop, my second by boomer-friendly Elton John, but at levels that would not have roused complaints in a library.

When you get to the simply massive Malu’i Ma’a Tonga vax events, dropping by to get a needle in your arm is bit like going on a theme-park ride.

With entry-to-exit noise, dancing, prizes, flags, costumes, food and the constant flow of the MC’s commentary, getting a vaccination becomes a celebration of helping to protect your community.

These events perfectly illustrate how far Pacific healthcare providers have evolved.

For all their hubbub, the events are the pointy end of a coordinated, community-driven response and, says healthcare researcher and former GP Debbie Ryan, showcase a sector that came of age under COVID-19.

The process was jet-fuelled by $26.3 million of Pacific-specific vaccination funding announced by associate health minister Aupito William Sio on 19 March.

But still, says Dr Ryan, the sector has reached a level “a million light-years from where we thought we would be 10 years ago”.

“It has been exciting and incredibly moving, actually, to see the things that have been achieved and that are now being recognised.”

If that funding was based on modelling that showed New Zealand was likely to repeat the US experience of high rates of COVID-19 infection within the Pacific community, the “needs must” response has been relatively hands-off.

The implied recognition was a welcome boost to healthcare workers who have been in emergency mode since the 2019 measles epidemic. Both here and in the islands.

It had not been straightforward earning that recognition.

Leading Pacific health advocate and specialist GP Api Talemaitoga has talked of walking away in frustration from negotiations with the Northern Region Health Coordination Centre. And at Whānau Ora agency Pasifika Futures, chief executive Debbie Sorenson spoke of losing her temper with Ministry of Health officials.

New Zealand Doctor Rata Aotearoa has also been told of Pacific health providers’ battling to be allowed a greater role in the COVID-19 response. One lead player described it as exhausting, adding: “You have no idea.”

Speaking to New Zealand Doctor in April last year, South Seas Healthcare chief executive Lemalu Silao Vaisola-Sefo spoke of the preconceptions he faced when he first began talking about funding for expanded models of care.

“When you mention the words Pacific, NGO and community trust in one sentence, there is a perception that they’re a bit dodgy, they’re not really that good,” Mr Vaisola-Sefo said.

But there is no denying the symbolism of five Government ministers choosing to align themselves with the Ōtarabased South Seas during one week in November.

Health minister Andrew Little was even live-streamed surrounded by South Seas signage when giving a briefing to those gathered.

Dr Ryan says the Pacific model of care can be traced back to how the practices were created; not so much as small, primary care businesses, but as a response to community need.

“Which means they remain very close to their communities,” she says. “The workforce often comes from the community, the governance comes from the community, and they were often formed as a response to community activism.

“For the past 20 years, they have gone about developing services in a way more aligned with primary care in the broadest sense, with that social welfare component and willingness to employ people from other workforces, such as community health and allied health workers.

“But this means they are often responding to quite different needs from mainstream practices. It’s not just the GP services you find outlined in PHO contracts or [protocol] agreements. These practices were offering services like child home visits by district nurses from their beginnings.”

Dr Ryan says most Pacific people are, however, enrolled with mainstream practices, which means the Pacific practice response has been about leveraging community resources and networks rather than a known pool of patients.

This has seen the major Auckland players, The Fono, Tongan Health Society, South Seas and Pasifika Family Health Group integrating directly with churches, sports clubs, community trusts, youth groups and new online entities such as Cause Collective and youth initiative Bubblegum.

The providers also had to get access to community halls and the logistical infrastructure for major vaccination events.

“We know how to do this engagement – it’s like a big funeral,” Dr Ryan says. “We take food, fine mats, it is a cultural response that brings people together, but none of that work is recognised in the funding. It is covered by the practices themselves.”

All this has also set in motion the Pacific Consortium, a collective of south Auckland practices that have abandoned the competitive model to share staff, resources and even patients. The group has now been bolstered by housing, welfare and mental health organisations.

Even then, pan-Pacific strategies are made difficult by fierce parochialism among the many Pacific communities, as Dr Ryan found when she co-purchased the late Joe Williams’ Glen Innes practice. As a Cook Islander, Dr Williams had attracted compatriots from throughout New Zealand. Then, when a Samoan took his seat, they moved on.

“That was my lesson about how cultural competence really matters for a GP, but it also showed me how ethnic-specific services are not geographically specific,” she says.

“There are Cook Islanders everywhere and that becomes an obvious challenge.”

So, while at first glance, it doesn’t make sense that the big Pacific providers ended up creating their own infrastructures for food banks, phone centres and community outreach, they are each targeting different ethnic mixes.

This approach appears to be effective, and Dr Ryan says it’s now important to figure out whether all the effort has made a tangible difference to health outcomes and, if so, whether the processes bringing about that difference are transferable.

Change is always difficult, and the system always defaults to what it knows, she points out. But now, Māori and Pacific providers have shown they know the community levers to pull to make things happen.

Good data and evaluations will be needed to see the full story and work out what, in particular, enabled successful actions to occur. Dr Ryan says these then should be embedded in the reforms to come – “and not just holus-bolus applied to different contexts without understanding how those drivers interact”.

The risk, says Dr Ryan, is that an unfocused shift towards the widespread adoption of wraparound “holistic” healthcare will come at the cost of traditional general practice values.

A few decades ago, the doctor lived above the surgery and the relationships built with families over generations were central to continuity of care, especially in rural practices. “Life has moved on, we are seeing more complexity, but I would be cautious of any narrative that says we should give up what is best about New Zealand general practice.”

For now, though, Pacific providers are working on supporting their workforce through an all-singing, all-dancing, pandemic response, especially as they look to take on responsibility for COVID-19 cases in Pacific households.

The Fono chief executive Tevita Funaki makes no bones of the difficulty they have in ensuring staff get a break, especially when shifts stretch into the following day.. The first weekend of December saw their mobile vaccination team conduct four events around west Auckland.

Which makes the dancing at the Henderson event as much about the staff as it is about the atmosphere. Pacific practitioners make up only 2 to 3 per cent of health workforce but, by 30 November, 29 per cent of COVID-19 cases to date were Pacific peoples, along with the highest rate of hospitalisations, at 38 per cent.

After hosting Mr Little at South Seas Healthcare on 20 November, Mr Vaisola-Sefo told reporters the sector had wanted a greater say in caring for self-isolating Pacific peoples – even though the prospect of what lay ahead had him thinking, “be careful what you wish for”.

But then, as he says, emergency mode is the new normal for Pacific providers.

When he stepped up to the lectern to introduce Mr Little for an announcement, Mr Vaisola-Sefo couldn’t help himself, pointing out: “Gosh, you all look so serious!”