Trailblazer’s 40 years of healthy connections

The cogs turn slowly, and change was not catching up with young people

Nurse practitioner Maria Kekus’ career in health has always been about making connections. It is what she does with patients and colleagues, and it probably explains why the service she co-founded is named Health Connections.

Speaking of which, Ms Kekus thinks she may have been the midwife who delivered this reporter in Yorkshire 20-something years ago.

Sharing stories and making connections has been a theme of her 40-odd -year health career, from nursing to midwifery and back again, with always one goal in mind: better health outcomes for children and youth.

Ms Kekus was named College of Nurses Aotearoa NZ Nurse Practitioner of the Year at the New Zealand Primary Healthcare Awards | He Tohu Mauri Ora 2021.

Auckland nurse practitioner Karen Hoare, of Greenstone Family Clinic, was also a finalist.

The judges praised Ms Kekus for sharing her skills and expertise with others as well as providing leadership at both local and national levels.

“You have trailblazed as one of the first child and youth nurse practitioners, but have gone on to establish a nurse-led service for youth.”

Hearing her name called out that night in May, at the Cordis Hotel in central Auckland, was an amazing but surreal moment, she says.

She tells a story of recently working alongside a couple of GP registrars in the Counties Manukau district: “They were like, ‘You’re the Nurse Practitioner of the Year’!

“It’s a nice acknowledgement at this stage of my career: I feel very privileged. But it’s also for all the people who have journeyed with me.” Ms Kekus says it was exciting but scary to found Health Connections, a primary healthcare service dedicated to providing free healthcare and social services to young people aged 10 to 25.

She and her business partner, nurse Pat Mitchell, had crossed paths several times, including at the Youth Health Hub in west Auckland.

Motivated by the level of unmet need for youth in the health system, they decided, in 2013, to do something different: “The cogs turn slowly, and change was not catching up with young people,” she says.

It was a “nice marrying” of their skills, with Ms Kekus as the service’s clinical director, and Ms Mitchell as chief executive and executive director.

“Everything in healthcare is in silos, but young people are across all of those silos. We use all the resources available; [for example], not many services will ask for a child’s school report.”

Starting a business with little prior business experience certainly was a huge step: “[We] were taking a leap, we had a vision, but were unsure of the trajectory,” she says.

That vision was to ensure a young person who presented at a general practice would find that the staff were trained to work with them.

The idea received great support from Rawiri Wharemate, another advocate of child and youth wellbeing, who went on to become kaumatua for the service. Ms Kekus sadly reports that Mr Wharemate passed away in June.

The needs of the Health Connections cohort are constantly changing, while the COVID-19 pandemic has hindered practice growth. But Ms Kekus says she’s happy with the path the service is on with its two nurse-led clinics, one in south Auckland, and one in the central city, both opened in 2020.

“Our model doesn’t lend itself to a large practice; it’s all about that proactive wellness approach,” she says.

“We look at what they’re doing in the next year, and will schedule appointments before their exams.

“We did a ‘query build’ recently and in one quarter, a single Māori male had four contacts with our service – a statistic that is just unheard of.” For Ms Kekus, to get this kind of response shows they are doing something right.

After training and registering as a nurse in the UK, Ms Kekus spent 1982 volunteering at the Mother Teresa Home for Abandoned Babies in India.

“You literally didn’t know what was coming through the door,” she says. “Babies were picked up in the night; we had donated equipment, and were heavily reliant on donations for food. It was very basic. We had oxygen, but no monitor to check the levels or flow.”

Back in the UK, she trained as a midwife, before starting a family in the late 1980s. Returning to work after time out with children, she transitioned again, training as a health visitor; an advanced nurse with additional postgraduate training in community public health nursing.

It was a beautiful role, she says.

“I was GP-attached and held the population from the new babies, the under-fives, the children with disabilities, and I looked after the well elderly. I did a lot of home visiting, ran quit-smoking groups – early interventions to keep those populations healthy.”

Then, based in Huddersfield, she found herself negotiating the cultural aspects of delivering care with a population mainly from Pakistan. Her work in India had given her some insight.

“Often, these women were brought over to be married, and their first experience of the UK was Huddersfield, which is poles apart from the life they left behind.”

The women couldn’t speak English, so Ms Kekus worked closely with “link workers”, interpreters who were also members of the community with a health promotion role.

After moving to New Zealand in the late 1990s, she carried on with her most recent career diversion into sexual health, working with young people who had HIV/AIDS at Auckland’s Herne Bay House. “It was the early days, so there weren’t a lot of treatments. It was hard, but rewarding. The theme was tailoring the care to the population – not one size fits all,” she recalls.

After a brief foray into public health, Ms Kekus began her nurse practitioner training and moved into primary care.

As a nurse, she says, “Someone would come to see you and you’d have to send them to the doctor to get a script – they would never get there.”

So her priority became to qualify as a nurse practitioner and make a difference by improving young people’s access to treatment. And to create stronger health connections.