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Tairawhiti Māori Health Plan 2015/16 0
Te Tairawhiti - He Urupare Rangapu Hauora Maori
2015/16
Tairawhiti Maori Health Plan 2015/16
Tairawhiti Māori Health Plan 2015/16 1
He Whakawhetai
Ka tuku Whakawhetai ki te Atua Mo te mahana o te ra
te kohimuhimu o te hau te waiora o te marangai.
Mo te rere takaro o te awa Mo te mana oreore o te moana. Mo te tu totika a te kahikatea.
Mo te waiata tioriori a te korimako A tae atu ra
Ki te aroha o te tangata mo te tangata, whanau mo te whanau Te tino putake o te Ao
Mauri ora!
We give thanks to the Lord for the warmth of the sun The whisper of the wind
The purity of the rain For the playful flow of the river
For the restless power of the sea To the majestic stance of the Kahikatea tree
To the sweet morning song of the bellbird Last but not least
The love of people for people, family for family The way the world should be
Let it be!
Tairawhiti Māori Health Plan 2015/16 2
He Rarangi Upoko /Table of Contents He Whakawhetai ................................................................................................................... 1
Mihi/He Korero Whakataki - Foreword ................................................................................ 3
Anga Taupore Tupu/ Tairawhiti Population Profile ........................................................... 5
Take Tupono Hei Huri/ Modifiable Risk Factors ................................................................ 6
Tairawhiti Maori Health Plan Indicators 2015/16 .............................................................. 9
1. Whakaaturanga Huanga / Data Quality ................................................................ 11
2. Putanga ki te Oranga / Access to Care ................................................................ 12
3. Hauora Taitamariki / Child Health .......................................................................... 13
4. Mate Iaiamanawa / Cardiovascular and Diabetes .............................................. 14
5. Mate Pukupuku / Cancer .......................................................................................... 15
6. Tupeka / Tobacco ....................................................................................................... 16
7. Whakato Kano Arai Mate / Immunisation ............................................................ 17
8. Kai Honokoiwi / Rheumatic Fever ......................................................................... 18
9. Hauora Niho / Oral Health ........................................................................................ 19
10. Hauora Hinengaro / Mental Health ...................................................................... 20
11. Tutohu A Rohe / Local Indicators ....................................................................... 21
Tapiritanga / Appendix: The Day I Turned Purple – (A patients account) .................. 22
Acknowledgements for front page photographs, sourced from www.flickr.com/photos/tourismeastland
Main picture - Kutia, Te Aotaihi, My Beautiful Uawa, 2011, Tourism Eastland, Gisborne
Outside Left – Takurua, Hinemaia, A Beautiful Moment, 2010, Tourism Eastland, Gisborne
Middle Left – Ngawhare, Trudi, Kohi Kina, Dats how we roll, 2012, Tourism Eastland, Gisborne
Middle Right – Donnelly, Mikayla, Touching Statues, 2013, Tourism Eastland, Gisborne
Outside Right – Richter, Paige, Aroha, 2013, Tourism Eastland, Gisborne
Tairawhiti Māori Health Plan 2015/16
Tairawhiti District Health Board Published June 2015 by the
Tairawhiti District Health Board Private Bag 7001, Gisborne, 4010
This document is available on the Tairawhiti District Health Board website:
www.tairawhitidhb.health.nz
Tairawhiti Māori Health Plan 2015/16 3
Tihei Mauriora! Ki nga uri o nga maunga kamehameha o te rohe o Te Tairawhiti
Ara Ko Hikurangi, te toka whakairo, te maunga pupu tangata, te Iringa waka o Maui Tikitiki a Taranga ko Nukutaimemeha
Ara Ko Maungahaumia, ka rapa haumi ka rapa punake, ka kitea haumi ka kitea punake, Ara Ko Manawaru, te waahi tuatahi I onokia ai te kumara e Hinehakirirangi,
Ara Ko Te Kuri a Paoa, nga pari ma e mamae ra Tena Koutou Tena Koutou Tena Koutou katoa
Tena hoki koutou i te maharatanga o ratou ma kua riro ki te Po Kua riro ki te kapunipunitanga o te Wairua
Kua takahia atu ra e ratou te huanui I papatauria ai e te tapuae kauika tangata Kua mihia kua tangihia no reira ko te whakatau noa atu
Ko ratou te hunga mate ki a ratou, ko tatou te hunga ora ki a tatou No reira tena tatou katoa.
Anei te purongo mahere e karangatia nei Ko Te Urupare Rangapu Hauora Maori o Te Tairawhiti Hei kaupapa hei whakaawe mai I a tatou ki te whai oranga
Mo o tatou hapori katoa, mo o tatou whanau katoa mo o tatou mokopuna hoki Kia purea ke ai tatou e nga hau tamata e pupuhi mai nei I roto I o tatou wharua
Kia painaina ke ai tatou I raro I te ihi o te uranga o Tamanuitera Kia whangaia ke ai tatou na te pataka kai o o tatou whenua momona me o tatou rawa moana Kia whakaaio ai o tatou whakaaro me a tatou korero me te mahurutanga o to tatou noho tahi
Kia horahia ai nga manaakitanga a te Arikinui ki runga ki a tatou Kia whakahuia mai enei rei katoa ko te whakapuawaitanga o nga moemoea me te
whakatinanatanga o nga whakaaro a Kui ma a Koro ma ka hua mai Koiara te Whanau Ora!
Mihi/He Korero Whakataki - Foreword
He Urupare Rangapu Hauora is a plan for Māori health in Te Tairawhiti and a catalyst to achieve greater “Wellness” among our Whanau and communities. It provides Tairawhiti District Health (TDH) and our local health services with priority action areas for the next twelve months and specifies accountabilities for the activities. A key statutory function is to reduce disparities in health status by improving the health outcomes for Māori. This requires “Mahi Tahi” collective action across the health sector keeping Māori at the very front of planning, funding and service delivery activities. Whanau Ora will be a key platform on which will be based activities to improve health outcomes and reduce health inequities for Māori through quality prevention, assessment and treatment services. Sir Mason Durie provided in his “Pae Ora – Māori Health Horizons” broad aims in relation to “Mauri Ora (Healthy Lives), Whanau Ora (Healthy Whanau) and Waiora (Healthy Environments).” He stressed that the goals sought would be to:
increase the protective factors and
reduce the risk factors.
Tairawhiti Māori Health Plan 2015/16 4
He said a fresh strategy would be required to shift emphasis from old paradigm to new such as: a) Crisis and Disease Management Building Capability/addressing the
causes of Illness (Determinants) b) Healthcare (Providers) Health literacy/knowledge to Whanau c) Sector Orientation Sector – Iwi – Community Collaboration d) Disadvantage and Adversity Potential and Achievement e) Māori models for Treatment and Care Whanau Kawa for Health and
Wellbeing.
Underpinning this Pae ora Strategy are nine Principles:
1) Whanau Centred approach 2) Affirmation of Culture 3) Inter-sector collaboration 4) Telehealth and health literacy 5) Environmental scanning 6) Matauranga Māori 7) Alleviating Poverty 8) Tertiary Education 9) Alignment of Policies, Projects and Practices.
Change Agents will be required to start weaving the Pae Ora framework into today’s practice so that tomorrow’s health teams will integrate treatment and care with health promotion and disease prevention, they will be ready to collaborate and will include a “holistic” approach of community, health and cultural leadership and expertise.
He Urupare Rangapu Hauora o Te Tairawhiti recognises the “Pae Ora” framework and the call to navigate a new direction based on the prevention of whanau illness and the ability of whanau to take self- responsibility for their Wellness. The evolving journey needs to start today, so Tairawhiti’s public resources and energy can be harnessed to help whanau transition to a better future that they ultimately control. Orienting the health sector to respond effectively to Māori health needs will require a commitment of the wider health workforce and advanced competencies for health practitioners. Such an approach will also contribute positively to opportunities of potential that a Māori-led health focus brings. It will also inherently require a shift in thinking and practice. By 2020, we want to see Māori in Tairawhiti living longer and enjoying a better quality of life. We want to see a hauora system that is responsive, integrated, well- resourced and sustainable so that gains we make today can be built upon by future generations. Our ambitions are certainly achievable and will be one of the key ways in which our success as a District Health Board and as health professionals will be measured in years to come. Our primary health organisations and Māori health providers will collaboratively help us to succeed in this critical role and enable transformation to a future “Pae Ora – Māori Health Horizons” reality.
Toitu te Whenua Toitu te Tangata.
Picture source: Te Aturangi Clamp, Private collection
Tairawhiti Māori Health Plan 2015/16 5
Anga Taupore Tupu/ Tairawhiti Population Profile Tairawhiti, New Zealand’s most eastern district has a land area of roughly 3% of the country and a population base of 1% of New Zealand’s population, with a population density of 5.6 people per km2. Tairawhiti has a significantly higher than national average with 48.9% (23,155) of the 47,075 residents in Tairawhiti identifying as Māori1 compared to 14.9% nationally2. Tairawhiti’s Māori population is mostly young with around 48% under the age of 25 years. The local population is expected to remain steady over the next 10 years. Census data indicates that some 77% of Māori within the Tairawhiti district live in areas classed as the 3 most deprived areas.
Iwi within Tairawhiti The principal Iwi tribal groups within the Tairawhiti district are Ngàti Porou of the East Coast (the 2nd largest Iwi in New Zealand), and
Te Aitanga-a-Mahaki, Rongowhakaata and Ngai Tamanuhiri whose tribal boundaries are situated within the Turanganui-a-Kiwa rohe. Representatives from Ngàti Porou (East Coast) and the Iwi residing in Gisborne City (Ngai Tamanuhiri, Rongowhakaata and Te Aitanga a Mahaki) make up Te Waiora o Nukutaimemeha (our Iwi Relationship Board) which has a seat on the District Health Board strengthening the linkages between the District Health Board and our community.
Health Service Providers
Key health service providers in Tairawhiti include:
Two public hospital sites; Gisborne Hospital and Te Puia Springs Hospital
3 Primary Health Organisations (Ngati Porou Hauora3, Midlands Health Network4 and National Hauora Coalition5)
1 mental health inpatient facility
8 aged related residential care facilities (rest home, hospital and dementia level care)
8 pharmacies
12 primary care facilities
3 Māori providers
1 NZ Department of Statistics, 2013 Census usually resident population,
http://www.stats.govt.nz/browse_for_stats/population/census_counts/2013CensusUsuallyResidentPopulationCountsHOTP2013Census.aspx 2 NZ Department of Statistics, 2013 Population Projections by DHB produced for the Ministry of Health
3 Ngati Porou Hauora: http://www.nph.org.nz 4 Midlands Health Network: https://www.midlandshn.health.nz/
5 National Hauora Coalition: http://www.nhc.maori.nz/
Picture source: Ministry of Health NZ. http://www.health.govt.nz/new-zealand-health-system/my-dhb/tairawhiti-dhb
Tairawhiti Māori Health Plan 2015/16 6
Māori Participation and leadership There are a number of mechanisms for Māori to participate in the governance and delivery of health services in Tairawhiti. There are a range of Māori providers who deliver a variety of health care services within a Kaupapa Māori framework. Māori are involved in the governance of Tairawhiti DHB through our Treaty relationships with Iwi and our Iwi Relationship Board Te Waiora o Nukutaimemeha (TWON) which provides advice to the Board on Māori health issues and Māori make up 25% of all staff at Tairawhiti DHB compared with 6% nationally6.
Take Tupono Hei Huri/ Modifiable Risk Factors A healthy Tairawhiti is the outcome Tairawhiti District Health and its Primary Care Partners are working towards. Each of the modifiable risk areas below have been shown to impact on the health outcomes of Māori and those living in high deprivation areas. Any reduction in these areas will result in improved outcomes for Māori in Tairawhiti. The 2013/14 New Zealand health survey results show people living in more deprived areas have poorer health and report greater unmet need for health care: adults living in the most socioeconomically deprived areas have significantly higher levels of all health risks, including smoking, hazardous drinking, inadequate fruit and vegetable intake, low physical activity and obesity. They also have higher rates of psychological distress, diabetes, asthma and chronic pain. Children living in socioeconomically deprived areas also have higher levels of most health risks. For example, they are more likely to watch two or more hours of television each day, and are more likely to be obese. Although adults and children living in the most deprived areas report similar accss to General Practices as those living in the least deprived areas, they have much higher levels of unmet need for health care with cost being the main barrier. Adults and children living in the most deprived areas are more than three times as to have not filled a prescription due to cost in the past year. These types of unmet need for health care are of particular concern for the Tairawhiti region with our large amount of lower socioeconomic areas.
6 DHB Shared Services, Health Workforce Information as at 30 September 2014:
http://www.dhbsharedservices.health.nz/Site/Future_Workforce/HWIP/DHB_Base_Data_Reports.aspx
Age Group Breakdown Maori/Non Maori
Pepi (0-4)
Tamariki (5-19)
Rangatahi (20-39)
Pakeke (40-64)
Kaumatua/Kuia (65+)
Tane Wahine Tane Wahine Tane Wahine Tane Wahine Tane Wahine
Maori 1,077 1,047 3,114 2,943 2,055 2,625 2,649 2,913 585 771
Non Maori
672 675 2,223 2,034 2,445 2,487 4,095 4,476 2,175 2,595
Total 1,749 1,722 5,337 4,977 4,500 5,112 6,744 7,389 2,760 3,366
Data source: Census 2013. Statistics NZ, http://www.stats.govt.nz/
Data Source: DHB Shared Services Workforce Reports. http://www.dhbsharedservices.health.nz/Site/Future_Workforce/HWIP/DHB_Base_Data_Reports.aspx
Tairawhiti Māori Health Plan 2015/16 7
He mate hei karo / Avoidable (amenable) Mortality Rates Avoidable (amenable) mortality includes deaths of those less than 75 years old that could potentially have been avoided through preventive and curative interventions at an individual level. 47% of deaths each year in New Zealand are considered avoidable with Māori rates twice that of non-Māori rates. These rates are also shown to increase with deprivation levels. Tairawhiti’s rates for both Māori and Total populations are higher than national rates. A reduction in both these rates would lead towards a healthier Tairawhiti as it would indicate an increased level of access to both primary and secondary care.
He kai hikareti / Smoking Smoking is a major contributor to preventable illness and long term conditions, such as cancer, respiratory disease, heart disease and strokes. Cancer is the leading cause of death in New Zealand (29.8%), and is a major cause of hospitalisation and driver of cost. Cancer also highlights continuing inequities, with Māori experiencing a higher incidence (20%+), higher mortality and higher stage at presentation.
In some communities in Tairawhiti, a sizeable portion of household income is spent on tobacco, resulting in less money being available for necessities such as nutrition, education and health. Supporting our population to say “no” to tobacco smoking is our foremost opportunity to target improvements in the health of our population and to reduce health inequities for Māori.
Tino Momona/Obesity Maintaining a healthy lifestyle is vital to preventing obesity. This needs to include regular exercise and healthy eating. Obesity can cause diabetes, high blood pressure, cancers, arthritis, stroke and heart disease. The 2013/14 New Zealand Health Survey reports that: almost 1 in 3 adults nationally (aged 15 years and over) are obese (30%) and 1 in 10 children nationally (aged 2–14 years) were obese (10%) with children living in the most deprived areas 2.7 times as likely to be obese as children living in the least deprived areas7.
7 http://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-data-and-stats
Data Source: Data supplied by Ministry of Health Analytical Services
Data Source: Ministry of Health, New Zealand Health Survey results 2013/14
Data Source: Ministry of Health, New Zealand Health Survey results 2013/14
Tairawhiti Māori Health Plan 2015/16 8
TAIRAWHITI INTER-PROFESSIONAL EDUCATION PROGRAMME Ko Matakerepo is the base for the Tairawhiti Inter-professional Programme (TIPE), funded by Health Workforce New Zealand. The TIPE programme was initiated recognising that inter-professional education improves teamwork, access to and coordination of services, health outcomes, patient care and patient safety. Also students who train in rural areas are more likely to return to those areas after graduation. Through living, working and learning together students learn about the roles of other health professionals and how they can collaborate. The focus of the programme is on rural health care, chronic conditions management and the principles of hauora Māori as well as inter-professional education. A new discipline, occupational therapy, was added in 2014. Students are now from seven disciplines (dentistry, medicine, nursing, pharmacy, physiotherapy, dietetics and occupational therapy). In 2014, 158 students attended the programme. Of these, 15 graduates from the following disciplines have already returned to Tairawhiti: nurses (TDH and practice), doctors (house officers at TDH), pharmacists (TDH and a community pharmacy) and a dietician (Turanga Health). Community projects undertaken by students for Tairawhiti health organisations have been a feature of the TIPE programme. Students enjoy working together on these projects, which often produce health promotion resources for local people. Health providers find the end products of the community projects very useful and a worthwhile contribution by the students to the communities hosting them. Ko Matakerepo - Tairawhiti Health Learning Centre Annual Report 2014
He Mea Tuatahi me Nga Tutohu / Priorities and Indicators The following section presents Māori health priorities and aligned indicators that have been selected nationally. They are presented to summarize the following aspects:
The outcome we desire
where we are at now (the current gap between Māori and Non Māori)
what we are going to do and why
what we will focus on
Reporting on these indicators is provided monthly to our Iwi Relationship Board and the District Health Board as required. The actions referred to in this section are a subset of the activities Tairawhiti District Health is undertaking to improve some of the most important areas of Māori Health. He Urupare Rangapu Hauora is a companion document to Tairawhiti District Health’s Annual Plan which can be found at: www.tairawhitidhb.health.nz
The following symbols are used to report progress on inequities indicators:
Symbol Key
Progressing well
℗ Some progress
No progress, or worsening
Ţ Not sufficient time to judge
? Further information or work required
↑ Increasing gap
↓ Decreasing gap
Tairawhiti Māori Health Plan 2015/16 9
Tairawhiti Māori Health Plan Indicators 2015/16
Priorities Indicator Baseline 2013/14
8 2014/159
2015/16Target
Māori Non Māori Māori Non Māori
Whakaaturanga Huanga/ Data Quality
percentage of Māori enrolled in PHOs 98% 98% 100% 93% >99%
Putanga ki te Oranga / Access to Care
10
ASH rates percentage relative to National Result
0-04 yrs. 166% 151% 156% 147% <125%
45-64 yrs. 194% 121% 196%% 122% <116%
Hauora Taitamariki / Child Health
percentage of children breastfed
11
6 Weeks (fully or exclusively breastfed)
73% 73% 73% 77% >75%
3 Months (fully or exclusively breastfed)
44% 52% 49% 53% >60%
6 Months (receiving breast milk at 6 months)
58% 65% 57% 57% >65%
Mate Iaiamanawa / Cardiovascular and
Diabetes
percentage of eligible Māori males aged 35-44 having CVD risk assessment in the past five years
83% 89% 85% 90% >90%
Tertiary Cardiac Intervention waiting times
percentage of High Risk Angiograms performed within 3 days
60% 33% >70%
% of Acute Coronary Syndrome patients with ANZAZS QI ACS and Cath/PCI registry data collection completion within 30 days12
97% 100% 100% 50% >95%
Mate Pukupuku / Cancer
Breast Screening Rate, 50-69 Age Group 66% 73% 67% 71% ≥70%
Cervical Screening Rate, 25-69 Age Group 70% 79% 66% 80% ≥80%
Tupeka / Tobacco percentage of Māori mothers smokefree at 2 weeks
postnatal13
56% 68% 56% 70% >95%
8 2013/14 Baseline rates are as at 30 June 2014
9 2014/15 results are as at 31 December 2014
10 ASH Rates for 2014/15 are as at 30 September 2014
11 2014/15 breastfeeding data taken from Well Child Tamariki Ora Quality Improvement Framework reporting as at 30 September 2014, 6 Month breastfeeding rates include exclusively, fully or partially
breastfed children. http://www.health.govt.nz/publication/indicators-well-child-tamariki-ora-quality-improvement-framework-september-2014 12
New indicator for 2013/14 as per Policy Priority 20 (PP20) 13
Smoking rates at 2 weeks post natal are as at 30 September 2013 for the 2013/14 year and as at 30 September 2014 for the 2014/15 year.
Tairawhiti Māori Health Plan 2015/16 10
Priorities Indicator Baseline 2013/14
8 2014/159
2015/16Target
Māori Non Māori Māori Non Māori
Whakato Kano Arai Mate / Immunisation
percentage of 8 Month babies fully immunised 87% 91% 90% 92% >95%
percentage of population 65 and over who are immunised against influenza
59% 63% 63% 66% >75%
Kai Honokoiwi / Rheumatic Fever
Reduction in 3 year average of Rheumatic Fever Hospitalisations14
9.3 per 100,000 (rate is for total population)
9.0 per 100,000 (rate is for total population as at 31 Dec 2014)
4.2 per 100,000
Hauora Niho / Oral Health
Increase in preschool children enrolled in DHB funded dental services
92% 92% 90% 99% >95%
Hauora Hinengaro / Mental Health
Mental Health Act: Section 29: Community treatment orders
121 per 100,000
33 per 100,000
198 per 100,000
58 per 100,000
Reduce disparity
Tutohu A Rohe / Local Indicators
WCTO Contacts Infants receive all WCTO core contacts due in their first year
15
71% 73% 82% 80% 95%
Immunisation 2 year olds fully immunised 91% 92% 94% 93% >95%
Failure to Treat (Did not Attend rates)
Reduce the disparity between Māori and Non Māori rates 13% 5% 15% 9% Reduce
disparity
ASH Rates Reduction in the Ambulatory Sensitive Hospitalisations (ASH) 00-74 age group
181% 136% 175% 132% <118% of
National rate
14
Rheumatic Fever target for 2015/16 is a 55% reduction in hospitalisations from the 3 year average, our 3 year average is 4 cases per year 15 2013/14 baseline data is as at 31 March 2014, 2014/15 data is at 30 September 2014. Both datasets available at: http://www.health.govt.nz/our-work/life-stages/child-health/child-health-publications
Tairawhiti Māori Health Plan 2015/16 11
1. Whakaaturanga Huanga / Data Quality & PHO Enrolments What is our desired outcome? That care is delivered to a patient and their whanau is appropriate to their level of need. Improve the quality of ethnicity data to ensure that accurate data is available for informing the public and the health sector, identifying health need, service planning, and monitoring activities.
Where we are at now?
PHO Enrolments16
Māori 100%
Non-Māori 93%
Progress ℗
Target 99%
Why is this priority? There are known issues with ethnicity data quality in the New Zealand health sector. Although there is an ethnicity data protocol issued by the Ministry of Health (MoH), there is evidence of inconsistent data policies and practices and an overall undercounting of Māori in primary care. Through the monitoring of the coverage of enrolment for our population by ethnicity we can ensure that everyone across Tairawhiti is engaged with primary care. Changes how services are integrated across Tairawhiti and with the implementation of Health Care Home connectedness to primary will be more and more vital to ensure that the patient and their whanua are at the centre of the provision of health care.
To achieve this we will focus on During 2015/16 we will continue to monitor and review Maori enrolment in to the PHOs operating within the district. We will continue to consult with PHO partner over variations in their enrolled populations. The outreach work performed by the PHOs to engage with our communities will continue and the provision of services to those who have issues access the traditional model of primary care will remain a focus of attention.
16
As at Quarter 1 2015
What are we going to do By When
Investigate the implementation of the Ethnicity Data Audit Tool in General Practices across Tairawhiti
By the end of 2015/16
Maintain the current levels of Māori enrolled in PHOs in our region by continuing to support lead maternity carers to push new-born enrolment with GP’s within 2 weeks of birth. Outreach work performed by Kaiawhina, PHOs and Maori Health Providers is vital to improving the levels of Maori enrolled. By continuing to support this work we can ensure rates are maintained.
Maintain current levels throughout 2015/16 by continuing to support work underway in this area.
Through the use of quarterly dashboard monitoring to Te Waiora o Nukutaimemeha (TWON) and the Tairawhiti Integration Forum (TIF) which is our alliance team made up of the three PHOs and DHB. This continued quarterly monitoring of PHO and practice enrolments in our district will ensure that Maori rates of enrolment within our PHOs does not fall
Ongoing as at March 2015 Maori enrolment across Tairawhiti was 103% of the 2013 Census population compared to 92% nationally.
Data source: Ministry of Health NZ, PHO enrolment demographics. http://www.health.govt.nz/our-work/primary-health-care/about-primary-health-organisations/enrolment-primary-health-organisation
Tairawhiti Māori Health Plan 2015/16 12
Ranking Maori Non Maori
1Upper respiratory and
ENT infections
Upper respiratory and
ENT infections
2 Dental ConditionsGastroenteritis /
dehydration
3Gastroenteritis /
dehydration
Respiratory infections -
pneumonia
4Dermatitis and
EczemaConstipation
5 Asthma Cellulitis
1 Cellulitis Cellulitis
2 Dental conditionsRespiratory infections -
pneumonia
3Upper respiratory and
ENT infections
Gastroenteritis /
dehydration
4Respiratory infections -
pneumoniaMyocardial infarction
5 AsthmaUpper respiratory and
ENT infections
1 Diabetes Myocardial infarction
2Respiratory infections -
pneumoniaAngina and chest pain
3 Angina and chest pain Cellulitis
4 Myocardial infarctionRespiratory infections -
pneumonia
5 Congestive heart failure Diabetes
00-04
00-74
Top 5 Avoidable Admission Conditions
45-64
2. Putanga ki te Oranga / Access to Care What is our desired outcome? Our goal for 2015/16 is to continue to build on the gains made during 2014/15 in reducing our Ambulatory Sensitive Hospitalisation (ASH) rates further towards the national rates. The key factor in reducing avoidable hospital admissions is an improved interface between primary and secondary services by improving access to and the effectiveness of primary care will facilitate early interventions, particularly among Māori.
Where we are at now?
0-4 ASH rate17
45-64 ASH rate
Māori 156% 196%
Non-Māori 147% 122%
Progress ℗ ℗
Target 125% 116%
Why is this priority?
Evidence shows that an integrated approach across the health care system is vital for better management of long term conditions, responding to the pressure of an ageing population and in managing acute demand. Hospital demand is growing at a rapid rate, and as we face an aging population with higher complexity and increased comorbidities, we need to examine who we deliver our services to face the future demand.
To achieve this we will focus on
Our ASH rates are currently significantly higher than
the national rates. To reduce our ASH rates we need to
improve the linkages between Primary and Secondary care.
What are we going to do By When
Reduce avoidable admissions from Aged Related Residential Care Facilities by
Expansion of the role of the nurse practitioner Aged Care across all facilities who is employed by all General Practices
increasing the use of Telehealth facilities to reduce the number of referrals to ED.
Increase usage during 2015/16
The long term conditions SLAT will have a focus on reducing or better managing the number of Maori aged between 45-64 years admitted to hospital for the conditions in the table above.
SLAT agreed and established during 2015/16
The E Tipu E Rea work programme focusing on sector wide service improvement will implement the following during 2015/16:
Realign Mama & Pepi Whanau Ora Services provided by 3 local iwi providers to focus on addressing social issues of families
Establish a community options putea to address immediate barriers to well-being, such as heating and insulation of homes.
Establish a coordination hub providing a single referral point to refer families with social needs that are affecting their health.
Coordination Hub established 1 July 2015 Community Options Putea established 1 July 2015 Implement local NCHIP by Dec 2015
Continue to maintain the level of green prescriptions at least 22% above the MoH funded levels for 2015/16
Ongoing
The Whanau Ora Pakeke will help reduce Maori failure to treat rates by ensuring appointments accommodate the needs of the patient and their whanau.
Ongoing
Increase the support to primary care practices from secondary specialists to provide patient care closer to home
Mental Health by Dec 2015 Medicine by Dec 2015
17
ASH results are presented as a percentage of the national result and are current to 30 September 2014
Data source: Ministry of Health NZ, Quarterly reporting SI1 results
Tairawhiti Māori Health Plan 2015/16 13
3. Hauora Taitamariki / Child Health What is our desired outcome? Every child in Tairawhiti is given the best start in life. Where we are at now18?
Breastfeeding Rates19
6 Weeks 3 Months 6 Months20
Māori 73% 41% 65%
Non-Māori 74% 44% 66%
Progress ↑ Target 75% 60% 65%
Why is this priority? Breast milk is considered the most complete food for infants, by encouraging the ‘breast is best’ message; our children will have a healthy start in life. The World Health Organisation recommends exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.21 For those babies who are not breastfed there is an increased risk of childhood obesity, type two diabetes later in life and its associated co-morbidities. To achieve this we will focus on We will continue investment in lactation consults and support services for mama and pepi, programmes targeting the at risk population. In addition, a pathway for tongue ties is being developed and will be implemented early in the 2015/16 year. Breastfeeding is promoted by all health care services as the safest, most appropriate infant feeding from birth. What are we going to do By When
Continue the implementation of the Well Child Tamariki Ora quality improvement framework across all providers
By the end of 2015/16
Through the E Tipu E Rea services redesign we will improve service coordination and provision for mama and pepi/tamariki
Establish Community Hub by Sept 2015 Implement local NCHIP by Dec 2015
Continue to build and maintain relationships with all Well Child Tamariki Ora providers in our region through quarterly meetings of the WCTO steering group
Strengthen linkages between all providers during 2015/16
Maintain Baby Friendly Hospital accreditation for Gisborne Hospital and Te Whare Hauora o Ngati Porou
Ongoing
Integration of Children’s team activities with Health care provision and the E Tipu E Rea service Redesign
Throughout 2015/16
18
As at 30 September 2014: http://www.health.govt.nz/publication/indicators-well-child-tamariki-ora-quality-improvement-framework-september-2014 19
Currently only Plunket data reported in the Well Child Tamariki Ora quality improvement framework reports produced by the Ministry of Health due to data limitations nationally. 20
6 week and 3 month status are exclusive or fully breast feeding rates, 6 month status includes exclusive, fully or partial
breastfeeding status. 21
World Health Organisation breastfeeding resources: http://www.who.int/topics/breastfeeding/en
Tairawhiti Māori Health Plan 2015/16 14
4. Mate Iaiamanawa / Cardiovascular and Diabetes What is our desired outcome? Heart disease is the leading cause of death in New Zealand with Māori disproportionately represented. A Cardiovascular and diabetes (CVD) risk assessments every five years on ‘at risk’ people ensures they receive timely help and support, to enjoy longer, healthier and more independent lives.
Where are we now?
CVD Risk Assessment
Percentage of High Risk Angiograms performed within 3 days
% of Acute Coronary Syndrome patients have completion of ANZAZS QI ACS Cath/PCI registry within 30 days
Māori 85% All – 33% All - 100%
Non-Māori 90%
Progress ℗ ℗ Target 90% >70% 95%
Why is this priority? Diabetes is a major and increasing cause of disability and premature death. CVD risk assessments (CVDRAs) are a good indicator of the responsiveness of health services. By ensuring people receive heart and diabetes assessments at early stages, activities to manage these conditions can be developed.
What we will focus on? The focus for the 2015/16 year is to enhance the service provision across our district. We will measure current services against the 20 Quality Standards for Diabetes Care, with the help of the Diabetes Atlas of Variation, to identify gaps and develop a plan to implement changes to address those gaps. What are we going to do By When
Continue to ensure equity of access between Māori and non-Māori to tertiary cardiac services. Specialist Cardiac pre-admit clinics are held locally across the district reducing the burden of travel on our rural population to tertiary investigations.
Currently occurring
Assist PHOs in supporting primary care practices achieve the Health Target and ensure equitable outcomes
Throughout 2015/16
Maintain national waiting times for cardiac services. Throughout 2015/16
Extend post-acute cardiac- pulmonary services to rural areas. By the end of 2015/16
Implement the Acute Chest Pain Pathway by working with regional partners. Throughout 2015/16
National Hauora Coalition has introduced weekly reporting of patients eligible for CVDRA’s via Mohio which is helping increase coverage rates.
Ongoing
Midland Health Network is enhancing information flows including continuous improvement of their risk stratification tool, to increase performance and opportunities to provide CVDRA’s to its population.
Ongoing
Turanga Health will continue providing work place and Marae based health checks which include CVDRA’s across the district.
Ongoing
The DHB and PHOs will continue to provide support to and promote Map of Medicine and local clinical care pathways for diabetes, stroke, heart failure and other long term conditions.
Ongoing
Data source: More Heart and Diabetes Health Target Results, http://www.health.govt.nz/new-zealand-health-system/health-targets/how-my-dhb-performing/how-my-dhb-performing-2014-15
Tairawhiti Māori Health Plan 2015/16 15
5. Mate Pukupuku / Cancer What is our desired outcome? Reduce the impact of breast cancer and cervical cancers on women in Tairawhiti by increasing screening coverage rates for both breast cancer and cervical cancer.
Where are we now?
Breast Screens22 Cervical Screens23
Māori 67% 66%
Non-Māori 71% 80%
Progress ↓ Target 70% 80%
Why is this priority? Early detection is the key to managing these conditions. Tairawhiti has a large number of priority group women. By helping our PHOs and practices identify and contact these women and ensure they attend screens, we can ensure our coverage rates are maintained, pick up these cancers at an earlier stage and the 5 year survival rate of cancer patients is improved.
What we will focus on? We will work to increase linkages between our contracted breast screen provider BreastScreen Aotearoa Coast to Coast (BSA), The National Cervical Screening Programme – Tairawhiti (NCSP-T) and PHO’s; this will provide improved screening coverage information for women in our area allowing for more focussed activities.
What are we going to do By When Ensure funding for free cervical screening is appropriately allocated to reduce
barriers to cervical screening for Maori women. Ongoing
Support practices by identifying/targeting priority group women by data matching and providing quarterly reports on progress.
Quarterly results provided to practices during 2015/16
Establish a key stakeholder group consisting of DHB, PHO, provider and Community representatives to work collaboratively to guide future planning and improve access for all women to breast and cervical screening.
Group established by December 2015
National Cervical Screening Programme – Tairawhiti (NCSP-T), Turanga Health, and BSA will look to form closer working relations with a view to conducting/supporting joint screening programmes across Tairawhiti, where possible.
Ongoing
BSA’s Gisborne based kaiawhina in will continue to work closely with General Practices and community groups to raise the importance of breast screens.
Ongoing
Hauiti Hauora will continue to offer transport and kaiawhina to support Māori women living along the East Coast to access breast screening appointments.
Ongoing
NCSP-T and BSA will continue to offer support services such as transport options to priority group women in our region to attend mammogram and colposcopy appointments in a timely manner.
Ongoing
Tairawhiti will continue to push increased integration in screening activities, with the DHB providing PHOs and general practices across the district with support in identifying Māori women who are new to the programme or due/overdue their regular screen.
Ongoing
22
Breast Screening Coverage Rates as at 31 Dec 2014 for women aged 50-69 years who have had a breast screen in the last
2 years. Breast Screen Aotearoa quarterly reports https://www.nsu.govt.nz/health-professionals/breastscreen-aotearoa/breast-screening-coverage/dhb-quarterly-reports/december 23
Cervical Screening Coverage Rates as at 31 Dec 2014 for women aged 25-69 years who have had a cervical screen in the
past 3 years. National Cervical Screening quarterly reports: https://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/cervical-screening-coverage/dhb-quarterly
Tairawhiti Māori Health Plan 2015/16 16
6. Tupeka / Tobacco What is our desired outcome? To help achieve Smokefree Tairawhiti 2025 we will focus on improving smoking cessation for hapu (pregnant) mothers, whanau and Smokefree Environment.
Where are we now?
Mothers smokefree at 2 weeks postnatal24
Māori 56%
Non-Māori 70%
Progress ℗
Target 95%
One in 10 women in New Zealand smoke during pregnancy, with this figure significantly higher among Māori and women living in lower socioeconomic areas (one in three). The post-natal period is characterised by a high level of smoking relapse, especially among women who live in households with other people who smoke. Measuring the smoking status of women at 2 weeks post natal will provide indications as to the successfulness of our smoking cessation services. Smoking rates collected at Gisborne Hospital Maternity department show 44.4% of Māori women admitted to maternity are current smokers as opposed to 8.8% of non-Māori women.
Why is this priority? Providing advice to smokers around quitting is shown to increase the chance of a quit attempt and by providing support for this quit attempt improves the likelihood of it being successful. Reducing the opportunity for people to smoke reduces the likelihood of smoking
initiation in younger generations. Tairawhiti has a large population of Māori women of child bearing age as well as a large number living in low socio economic areas who smoke.
What we will focus on? The focus for 2015/16 is to build closer working relationships for smoking cessation services with Lead Maternity Carers (LMCs), hospital midwife, GPs and Radiologists. With all services working together and sharing the same message we can move closer towards achieving Smokefree 2025.
What are we going to do By When Support LMCs and primary care practices to provide active support to pregnant women who smoke to quit as early as possible in pregnancy
Throughout 2015/16
Increased alignment of cessation services through the Tairawhiti Tobacco Control plan will see our Maori and Non Maori smoking rates during and post pregnancy decrease
Throughout 2015/16
Te Aka Ora – a Māori health provider - will lead whanau cessation support activities targeted hapu young women who want to go Smokefree
By the end of 2015/16
Support the implementation of Smokefree ABC in early pregnancy, including training, referral pathways, monitoring and support.
By the end of 2015/16
Hospital sonographers will be trained to provide brief advice to pregnant women who smoke and refer them onto smoking cessation services.
During 2015/16
24
Data for this indicator has been taken from the Well Child Tamariki Ora Quality Improvement Framework report as at
September 2014. http://www.health.govt.nz/publication/indicators-well-child-tamariki-ora-quality-improvement-framework-september-2014
Tairawhiti Māori Health Plan 2015/16 17
7. Whakato Kano Arai Mate / Immunisation What is our desired outcome? We will ensure at least 95% of infants have completed their primary course of immunisations at 8 months of age and at least 75% of our 65+ population are vaccinated against Influenza.
Where are we now? Why is this priority? Immunisation can protect people against harmful infections, which can cause serious complications, including death. Immunisation provides both individual and population-wide protection by reducing the incidence of infectious diseases and preventing spread to vulnerable people.
What we will focus on? Older people, young children, pregnant women, and people with certain medical conditions are at a higher risk of developing serious complications from vaccine preventable diseases than other population groups.
The introduction of E Tipu E Rea (Conception to 5 Years) and NCHIP (National Child Health Platform) projects in 2015 will allow us to further monitor our most vulnerable 5 and younger population and allow more opportunities to increase our immunisation rates.
What are we going to do By When
The DHB led immunisation team will continue to monitor and report on childhood immunisation coverage across the district at PHO and practice level.
Ongoing
Continue to promote the importance of the 6 month immunisation reports to ensure the 8 month target is met
Ongoing
Ensure the immunisation status of children seen by secondary care is recorded and opportunistic immunisations are provided where applicable.
Ongoing
Support Iwi Health providers to deliver and promote influenza vaccination programmes at Marae’s and other at other Kaumātua activities.
Ongoing
Implement the National Child Health Platform (NCHIP) as a way of integrating child health service delivery in Tairawhiti.
It is aimed to have this platform implemented by December 2015.
Continued participation on local, regional and national immunisation forums.
Ongoing
8 Month 65+
Māori 90% 63%
Non-Māori 92% 66%
Progress ℗ Target 95% 75%
Data source: More Heart and Diabetes Health Target Results, http://www.health.govt.nz/new-zealand-health-system/health-targets/how-my-dhb-performing/how-my-dhb-performing-2014-15
Tairawhiti Māori Health Plan 2015/16 18
8. Kai Honokoiwi / Rheumatic Fever What is our desired outcome? In June 2012, Cabinet agreed targets for the Better Public Services key result areas. The national target for rheumatic fever is to reduce national incidence rates to 1.4 cases per 100,000 by June 2017. Where are we now?
Māori 9.0 cases per 100,000 (Total population rate as at 31 Dec 2014) Non-Māori
Progress
Target 4.2 cases per 100,00
Why is this priority? Rheumatic fever rates are highest amongst Māori and areas of high deprivation, Tairawhiti’s rates reflect its high Māori and high deprivation population. Early detection and management are vital elements in eliminating rheumatic fever and if left untreated it can lead to rheumatic heart disease leading to lifelong problems What we will focus on? There are a number of child and youth specific health services and programmes already underway or planned. Ensuring integration of the 2015/16 Tairawhiti Rheumatic Fever Action Plan with these existing initiatives is very important. The reduction and ultimately prevention of rheumatic fever in the future is a priority area in the Tairawhiti and the Public Health Annual Plans. An example of this is the E Tipu E Rea, a child health initiative, which focuses on the health and well-being of children from conception to 5 years.
What are we going to do By When
Continue to support the rheumatic fever clinical coordinator as an on the ground rheumatic fever champion.
Ongoing
Continue to support the Rapid Response program, a nurse led throat swabbing clinics, in all primary care practices.
Ongoing
Support the development of community ownership and management for local programmes to prevent rheumatic fever.
Ongoing
Continue to support the community based Kaiawhina position. Ongoing
Support the rheumatic fever governance group in its role to improved integration between primary and secondary care. This group will evaluate and monitor rates and initiatives across the district on a regular basis.
Ongoing
Tairawhiti Māori Health Plan 2015/16 19
9. Hauora Niho / Oral Health What is our desired outcome? Currently our rates for preschool children for both Māori and Non-Māori enrolled in community oral health services are very close to our target rates allowing for our focus to be on firstly on achieving the national target and secondly reducing the number of children overdue for their scheduled examinations. Where are we now?
Māori 90%
Non-Māori 93%
Progress
Target 95%
Why is this priority? Enrolling children at a young age with community dental services establishes a habit of dentist visits for life and ensure their teeth last a lifetime. Oral health rates have improved within Tairawhiti in the past 3 years in part due to working with the schools/ kōhanga reo across our community.
What we will focus on?
In conjunction with Māori Health partners across the district we will continue to increase access to those areas currently with low rates. Our services are mobile and provide service on school grounds throughout the East Coast and the Western rural areas. Oral health services are included in the E Tipu E Rea project and through this coordinated approach at risk children will be targeted for a range of services. What are we going to do By When
Reduce the current arrears rate of 10% of children overdue for their scheduled examinations.
Reduce to 7% by December 2015 and 5% by June 2016
Continue the “Brush In” programme in all interested primary schools across the district for the next 3 years
Ongoing for at least the next 3 years
Continue to identify and address identified gaps in our current service. Ongoing
Continue the use of light illuminated dental mirrors delivering fluoride at kōhanga reo on the East Coast
Ongoing during 2015/16
Monitor enrolments rates and provide referral outcomes to referrers at the end of each month.
Monthly during 2015/16
Data source: Ministry of Health Oral Health reporting
Tairawhiti Māori Health Plan 2015/16 20
10. Hauora Hinengaro / Mental Health What is our desired outcome?
When a person experiences mental illness they usually get to make their own decisions about their treatment. The Mental Health (Compulsory Assessment and Treatment) Act 1992 covers situations when it is considered a person needs treatment for their mental illness, but they do not agree to this. In Tairawhiti we want to see reduce the number of patients who are compulsory treated.
Where are we now?25
Māori 198 per 100,000
Non-Māori 30 per 100,000
Progress Ţ
Target Reduce Disparity
Māori are currently 2.9 times more likely to be subject to a court ordered compulsory treatment order under section 29 of the Mental Health Act 1992 than non-Māori26.
Why is this priority?
The New Zealand Mental Health Survey found that 46% of the population will suffer some sort of mental health issue in their lives. There is an ongoing focus within the mental health and addiction sector to understand the needs of Māori with serious mental illness and their whanau, as past models of care have not reduced the burden of serious mental illness.
What we will focus on?
Our approach has been the development of the Recovery Action Plan booklet by and for people with serious mental illness. We also have strengthened and are growing a Whanau Ora approach across in Tairawhiti services when working with Māori. Tairawhiti has a Whanau Advisor employed by Turanga Health who works across the sector to reflect and represent the needs and concerns of whanau/family.
What are we going to do By When
Ensure all people with serious mental illness and/or addiction write and use their own Recovery Action Plan which provides them and their whanau with a relapse prevention plan.
By the end of 2015/16
Strengthen the Whanau Ora approach when working with Māori with serious mental illness.
By the end of 2015/16
Ensure the Whanau Advisor has a voice in mental health and addiction service planning, sentinel event follow-up, recruitment and service evaluation.
By the end of 2015/16
Increase the support offered by the Indigenous Psychiatrist employed by TDH. Ongoing during 2015/16
Service users have access to more cultural support staff through a realignment of roles. Ongoing during 2015/16
All acute mental health staff undergo cultural training During 2015/16
The equity framework is to be embedded into practice for service reviews and redesign. During 2015/16
25
Section 29 Patient numbers as at 31 Dec 2014 26
Ministry of Health. 2014. Office of the Director of Mental Health Annual Report 2013. Wellington: Ministry of Health http://www.health.govt.nz/system/files/documents/publications/office-of-director-of-mental-health-annual-report-2013.pdf
Data Source: Office of the Director of Mental Health Annual Report 2013
Tairawhiti Māori Health Plan 2015/16 21
11. Tutohu A Rohe / Local Indicators What is our desired outcome? Tairawhiti Health Board mission statement is Whaia te Hauora I roto I te Kotahitanga (A Healthier Tairawhiti by Working Together). The indicators in this section focus our approach on how we get there and are included in addition to the nationally prescribed areas. Different factors affect people at different life stages and some of the most common are presented in the table below. By reducing the disparity between Māori and Non-Māori rates we can ensure we provide the people of Tairawhiti with the best opportunity to life longer healthier lives.
Where are we now?
Life Stage Indicator Target Maori Non Maori
Pepi (0-4)
Well Child/Tamariki Ora Contacts
95% of all Infants receive all WCTO core contacts due in their first year27
82% 80%
Immunisation 95% of 2 year olds fully immunised
88% 98%
Rangatahi/ Pakeke (20-64)
Failure to Treat (Did not Attend rates)
Reduce disparity 13% 5%
Kaumatua/ Kuia (65+)
Ambulatory Sensitive Hospitalisations 00-74 age group
118% of national rate 175% 132%
Why is this priority? Inequities between Māori and Non-Māori health are present in every life stage. The indicators in the table above are areas of inequality that are important to the people of Tairawhti, by ensuring these areas are highlighted we can be sure they are kept at the forefront of activities. Reductions in these indicators will be as a result of long term investment, targeted activities can provide short term impacts in these areas however a long term reduction is the favoured method to ensure the inequities that exist are reduced to a point at which they disappear.
What we will focus on? Not all of the areas above are mentioned in the table below due to the fact some areas are already underway (eg. Immunisation, WCTO quality measures), activities listed in this table support areas already included through this plan.
What are we going to do By When Expand the use of Telehealth facilities across the district as a way to reduce the current failure to treat rates
Throughout the 2015/16 year
Continue to monitor incidence rates of skin infections in our region Ongoing
Continue to increase immunisation rates of 2 year olds in our region as per the immunisation section of this plan
As per the immunisation section of this plan
27
Data as at 30 September 2014. Indicators for the Well Child / Tamariki Ora Quality Improvement Framework - September 2014. http://www.health.govt.nz/publication/indicators-well-child-tamariki-ora-quality-improvement-framework-september-2014
Tairawhiti Māori Health Plan 2015/16 22
Tapiritanga / Appendix: The Day I Turned Purple – (A patients account)
It's not an easy thing to survive a cardiac arrest; my dad would testify to that had he survived his
almost five years ago now. He was home alone with no hope of answering the challenge that stopped his heart beating. I came so close to the same fate, the compressed weight in my chest, how easy it would have been to just take a pain killer and go to bed, welcoming whatever came, thinking it'll be alright mate, the pain will go once the painkillers kick in, willing myself to believe this would be the case but knowing in my heart of hearts I needed to get up and get myself to hospital. Almost crippled with mounting pain and anxiety I drove myself to the Emergency Department of
Gisborne Hospital, presenting myself to reception while announcing my rheumatic fever heart problems with a leaky valve and now crushing chest pain.
The response was immediate; there was no sitting in the waiting room for the next available physician. I was ushered through to a consultation cubicle where a doctor and two nurses popped aspirins and GTN sprays under my tongue while getting an intravenous line into my arm to administer morphine. Oh that seductive pain reliever was a welcome friend, easing the pain away from my chest and calming my mind. The doctor is asking me what pain level I'm experiencing between 0 at the low end of the scale and 10 the extreme, comforting me with his soothing words telling me that I made the right choice to come to hospital and that I would probably be kept in overnight for observation. I'm doing my best to relay my pain levels to him to assist him in administering the required dosages to bring my condition under control. I'm starting to feel less anxious and the pain appears to be less intense then all of a sudden an explosion of pain in my chest bursts through my pain barriers sending my arms flaying around and then.........
Like in the changing scene of a film, my senses were affronted when I awoke to a completely different room and a completely different medical team. It was like waking from a deep sleep, not knowing or remembering where or when I fell asleep and waking up in an unfamiliar environment. One of the first people I recognized was Dr. Rob Wilks, a doctor that not so long ago was a work colleague when I was managing a medical centre. I was confused as the immediate past didn't come flooding back to me, on the contrary I was wondering what Dr. Rob was doing in my bedroom. Dr Rob was saying "it's a miracle, had you not got yourself to the hospital you would be at home dead." Now reality is kicking in with this sobering thought and bringing my memory into sharp focus, I now remember driving myself to the hospital and presenting to the ED reception, I remember the first team working to reduce my pain to zero and attempting to increase blood circulation but there's a couple of missing pieces in this puzzle. My chest now hurts with a different pain and the ED team that included Dr. Rob have left the room and I am alone with Rosina, an ED nurse who explains that I had had a heart attack and also suffered a cardiac arrest. Not only had I died but from her account, I had turned purple. It is recorded in my medical notes that one shock of the defibrillator and one minute of CPR brought me back to life, which explains the new pain in my chest from CPR compressions.
I will always be grateful to the Gisborne Hospital ED team for saving my life, allowing me to avoid an appointment with Evans Funeral Services, the only funeral service in Gisborne. My newfound lifesaving nurse "Rosina" is now explaining that I will be placed in the Coronary Care Unit of Gisborne hospital overnight then I will most likely be transferred to Waikato hospital the following day. Waikato hospital is the base hospital for Gisborne and has a specialist heart unit.
Rosina and I are now joined by a doctor from CCU who pauses to read my notes before addressing me. I'm still absorbing the revelation that Dr. Rob and Nurse Rosina have placed before me and am silently thanking the powers that be for my survival. In retrospect, had I gone on the planned bike ride earlier that day with my mate Pete I would most certainly be dead. Taking all that has just happened to me in the last two hours into consideration, I'm surprised when the doctor before me
Tairawhiti Māori Health Plan 2015/16 23
starts berating me for driving to the hospital. I can't believe this guy, had I not taken the action I had, I wouldn't even be having this conversation with him. I would be dead. Maybe he would be happy had I done the right thing by ringing for an ambulance and died waiting?
I don't know what the statistics are for people dying of heart attacks while driving themselves to hospital or of injuring or killing others in the process, all I know is that I didn’t know what I was experiencing in terms of the chest pain but I knew I needed help, so I made a calculated risk that I could drive safely to the hospital 1.4 kilometres from my home and therefore would take half the amount of time for me to get to the hospital as it would to wait for an ambulance to get me there, if an ambulance was immediately available to answer my call? Given that I had a heart attack and a cardiac arrest within a short time of arriving at the hospital, I believe I made the right choice. By comparison when waiting for an ambulance the next morning to take me and the paramedic flight team to the airport, we had to wait for one hour. Before I knew it a porter is pushing me through the hospital corridors to the coronary care unit. Upon arrival I'm greeted by the care staff and instructed to alert them of any pain, I'm placed in a prime observation position right in front of the office and allowed to go to sleep. I close my eyes and try to sleep but can't quite get there. I just can't seem to calm my mind long enough to achieve the deep sleep to recharge my batteries and to recover from the trauma my body has just experienced. There are more questions than answers floating around in my mind and the constant reminder that I could very easily have another heart attack at any moment is doing my head in. I am hooked up to a monitor where all of my vital signs can be observed from the office so in theory I should have confidence that all is well in my world. Slowly but surely a calmness settles over me, I know that I'm in best place I can possibly be given the circumstances and fatigue is finally rocking me gently to sleep. I am drifting on a gentle sea, Tangaroa rocks me to and fro, to and fro, to and fro..........It is 3.00am and I am finally asleep.
I awake with a start, I'm gasping for air, I can't breathe, and I’m drowning. This isn't a bad dream, I can't breathe, I feel panic set in, I'm wide awake now I take note that it is 4.50am as my eyes dart around my new environment searching for answers. I see the nurses in the office and know I need their help, I press my buzzer, and my assigned nurse takes note and looks at me through the glass panels of the observation office while she stands up, I press the buzzer repeatedly now and she moves swiftly to my side, inquiring as to what the problem is. Between gasps I inform her I can't
breathe, she reassures me I'll be alright then pagers a doctor who appears quickly on the scene, a quick response but still too slow for me as I struggle to get air into my lungs. Through her stethoscope the doctor listens to my chest and announces to the nurse that I'm rattling. They get an oxygen tube into my nose then it seems that I'm surrounded by doctors. The big thing is to get oxygen into me but the mask they keep placing over my mouth and nose feels more like its suffocating me, I'm ripping it off as fast as they are trying to apply it. Quickly they administer some
furosemide through the IV in my arm and inform me that I have fluid on my lungs and the furosemide will drain it off through my system and allowing me to pee it out. I'm informed that relief will be rapid. Still gasping for breath I watch the clock and within 10-15 minutes I'm rattling less and breathing more........phew, what a way to start the day. A familiar face is now in front of me, I met her the previous evening she was most insistent that my next of kin needed to be informed that I'd had a heart attack and that I am presently in Gisborne hospital coronary care unit. We were having this discussion late at night and there is no way I'm agreeing to wake people close to me at this late hour only to stress them out and ruin their sleep, besides, what can they do with this new knowledge of my current situation?. I try to rationalize with her but her argument is that something might happen to me overnight, the subtext being that there is still a real risk of me dying should I have another heart failure. This line of reasoning helps to strengthen my resolve not to tell anyone until the morning, one way or the other, dead or alive, this news can wait.
Tairawhiti Māori Health Plan 2015/16 24
Breathing more easily now albeit with a good deal of rattling still echoing from my chest, I watch the time tick away until it is 7:00 am. I consider this a reasonable time to start ringing people to advise them of my situation. I start with my next of kin, my brother Rodger who lives in Auckland, then I
move on to mates Nellie and Ralph who help with going to my place, packing a bag for my visit to Waikato and getting me some summer pajamas. Peter Brown – General Manager Hauora Maori TDH who is a personal friend arrives to check out my situation and Mark – Whanau Ora Pakeke soon joins us, I share my story of the previous night's events and there is a general consensus that I am a very lucky chap indeed. I request a karakia, and then I feel I'm set for my next adventure at Waikato Hospital. The outcome of my stay in Waikato Hospital was major open-heart surgery giving me a triple bypass, replaced mitral valve and repaired tricuspid valve. The surgeon was Mr Nicholas Odom, a fine surgeon indeed. Two months later from my heart attack and cardiac arrest, I am well down the road to recovery and looking forward to the rest of my life. I have shared this story so maybe hospital staff can appreciate my perspective as a patient. I hope it is of some use. Once again I would like to thank the Gisborne Hospital ED staff for saving my life.
Te Aturangi Nepia-Clamp
Patient: Gisborne Hospital 23-24 November 2014
Early Wave by Karen Eddy https://www.flickr.com/photos/tourismeastland/8658468521/
