Primary health care the New Zealand way

Abstract

Many Maori perceive hospitals and general-practice surgeries as unfriendly environments and can be reluctant to seek health care at these institutions. To combat this, one of the primary health care facilities, the Te Rangimaire clinic, is located on the marae, or sacred meeting place, so that Maori feel more at ease. clinic has two general practitioners, who are well trusted in the Maori community Reverend Marie Collin, a member of the Ngati Kahungunu tribe, one of the largest Maori tribes in the Wairarapa region, speaks glowingly of the clinic at Te Rangimaire marae. She said that the service had become so popular that it was necessary to extend the hours and relocate the clinic from an old homestead on the marae to larger rooms in a new building housing the marae's communal dining room. Although the doctor, Cath Becker, is of European ancestry she is culturally sensitive, understands Maori protocol and is well respected by the community. Our kaumatua (Maori elders) are very comfortable coming here, says Collin. The doctor knows how to handle our people and what we do differently. As an example she cites a relaxed attitude to appointments. If our people are running late it is no big deal. It's not an issue. People just arrive and take their turn. Clinics such as the one at Te Rangimaire are the result of a cultural shift in the way health services are delivered to Maori. Helen Kjestrup, a member of the Health Care Nursing Advisory Committee for the Wairarapa region, is helping develop relations between Maori and the Health Organisation. It has been slow, but it is happening, she says. To do this, she attends hui, Maori community meetings. Kjestrup believes that establishing health-care clinics in places where the Maori people feel comfortable has improved their access to health care. New Zealand's primary health care system has undergone dramatic changes since 2000--changes that government officials say have already improved access to its services for Maori and other groups. Wairarapa region, a sparsely populated agricultural valley between the Tararua mountains on the west and the Pacific Ocean on the east, can claim to have successfully implemented many of these changes. valleys population is a mix of European, Maori and Pacific Islanders, whose health-care needs vary enormously. Wairarapa Health Organisation is addressing these demands by working with the different communities to address the disparities in health between the different groups. Primary Health Organisations are enormously different beasts, says Joy Cooper, general manager of the Wairarapa District Health Board. There is a huge variety of styles and sizes. In Masterton, one of the main towns in the valley, there is a community centre for Pacific Islanders, Cameron Community House, which local general practitioner Dr David Nixon visits for one hour a week. A primary care nurse also visits the centre for four hours a week. [ILLUSTRATION OMITTED] Cameron Community House and Te Rangimaire are just two of the many primary health care services and facilities in the Wairarapa region; others include general-practice surgeries and hospital-based services such as community nursing. Most primary care providers are coordinated by the Wairarapa Health Organisation, which is overseen by the district health board. Health Organisations are the local structures for implementing New Zealand's Health Care Strategy that was launched in 2001. core of the strategy is to reduce health inequalities, engage communities and improve the prevention and management of chronic illnesses. strategy was based on the Declaration of Alma-Ata, says Dr Tim Kenealy, a senior lecturer at the Department of General Practice and Care at the University of Auckland. …