LEADING FOR OUTCOMES: Health system change / Community primary care / Population health / CVD / Diabetes

Victory Community Health Centre (VCHC) is the result of years of work by community members, with the support of health and social service providers, Healthcare Aotearoa, local schools, the Nelson City Council and government departments.

The centre is fully aligned with the Primary Health Strategy and targets population health in deprivation 7-10 areas of Nelson, with a specific focus on the Victory area community. The area has a high concentration of deprivation 8-10 areas relative to the rest of Nelson. Victory Primary School’s student population is 24% Māori, 10% Pacific and 10% Asian - figures substantially higher than Nelson’s average. The school was recognised in the community’s Social Wellbeing Report 2002 as a school that actively operates as a central hub for its community.

VCHC aims to improve the nationally targeted health status of Nelson’s Māori, Pacific, refugee and low-income status groups by being:

• community owned,
• affordable,
• accessible, and
• appropriate to health needs, taking into consideration ethnic and cultural factors.

VCHC aims to reduce health inequalities and improve health and wellbeing by supporting Victory residents to improve their access to health and related services. A particular emphasis is on reaching those people not currently accessing services.

The centre aims to benefit the community by:
• focusing on whānau ora,
• taking an early intervention and holistic approach to health, and
• reducing duplicate services and their associated costs.

VCHC operates from a purpose built space attached to Victory School.
A number of health providers work from the centre, including a Māori Diabetes Educator Nurse, a PHO access nurse, Plunket nurses and independent midwives. Other providers on offer include Work and Income New Zealand, Whakatu Marae Health and Social Services, Pregnancy Help, Arthritis New Zealand, the Asthma Society, Parents as First Teachers, cervical screening and community law advice. A play group has formed and a kohanga reo has just opened.

The centre came about through the commitment of people like Briar Campbell-Maaroufi, who worked with a dedicated team to draw up a business plan and gain funding. Briar died in 2003, and momentum for the project slowed. Meanwhile, an initiative hosted by Victory school - the Victory Urban Village - was up and running, with funding from the Ministry of Social Development’s Community Initiatives scheme. The Victory Urban Village established community clinics with a number of social service organisations.

In July 2006 Victory School began building a new school hall. The potential was seen for collaboration between the school and its community and far-sighted individuals at the school proposed that additional space be built to provide for a health centre.

The advent of the Government’s Primary Health Care Strategy, and the establishment of a local primary health organisation (PHO) in 2004, had also led to hope that alternatives to a traditional medical clinic model were possible.

A ‘revival’ meeting was held, with strong support for a health centre which focused on wellness and health prevention – and which brought together health and social service providers under one roof. A steering group was formed and discussion began with Victory School.

The outcome of all this hard work is the Victory Community Health Centre, happily operating since March 2007. The centre is now looking at its future direction and sources of further funding.

Trisha’s iwi is Ngati Kuia; “I wasn’t brought up Māori – my dad lost contact with his family. 15 years ago I discovered my Māori heritage, and wanted to give something back to Māori health”. Trisha did her community nursing training in the 1970s and more recently her registered nurse training. She’s currently writing her master’s thesis on the impact of stress on the blood glucose levels of Māori with type-2 diabetes.

Trisha has just over 50 clients, some of whom come to see her at the clinic, some of whom she visits at home. Trisha believes this flexible approach is critical to delivering effective health services. “Health practitioners need to be flexible – we have to tailor our services to clients, rather than the other way around.” Her clients are predominately Māori or people who prefer a kaupapa Māori approach to health.

Trisha sees her role as a facilitator of wellness. “I aim to have a diabetes wellness focus rather than a diabetes illness focus”. Trisha’s approach is holistic, “so while I’m educating and supporting clients to manage their diabetes, I’m also talking over other health and home concerns they and their whānau may be having.

“My clients appreciate honesty, and I always work from where a client is today – not in the past, or the future. I’ve found that more and more of my clients are now checking their glucose levels and looking at their diet”.

Trisha continues to visit clients who don’t want to know about their own diabetes status, and sometimes finds her persistence rewarded. “One client said he’d take his medication because I kept on visiting him”.

A large part of Trisha’s role is networking and building links within the Victory area and the wider Nelson community. She has visited all GP practices in Nelson to offer a diabetes screening clinic for the practices’ Māori clients, and hopes to have those running shortly.

She has instigated a Māori and Pacific men’s group, which meets once a week to exercise at a local indoor swimming pool. Trisha gives them health checks quarterly, and is seeing an improvement in their health.

Trisha attends hui to offer diabetes screening, and has started to build links with businesses to offer the same.

“I also see my role as supporting the people who are caring for people with diabetes”. This means working alongside carers and other practice nurses with Māori diabetes clients.

Trisha’s vision for the future? “Individuals and whānau in control of their diabetes and general wellbeing. An indication this is happening would be most of my clients dropping in to see me at the centre for a chat, rather than me going out to them.”

Penny has a background in nursing and community work. She nursed for many years in Wellington, before moving to Nelson and taking a job as a community house co-ordinator and then as the co-ordinator of the Department of Internal Affair’s Community Development Grants Scheme for the top of the South Island. She returned to nursing a few years ago and recent roles have included Whānau Ora Nurse and then Tamariki Ora Nurse for the Te Korowai Trust – a Nelson-based health and social services organisation. Penny has been in her current position for one year.

“Health is life. My guiding principle is participation and belonging for individual and whānau.”

Penny’s client group are a mixture of referrals and people who come to see her through networking.  “Loitering with intent” is how Penny describes a big part of her role. She is always on hand at the centre’s many events, to say hello, have a chat, and offer more if needed.

Penny is as much community worker as nurse. She’s on hand to support clients who can’t always negotiate through the health and social service systems. An example of this is the young mum she’s supporting to get out of a caravan and into her own home. Another example is the referral from Nelson’s Night Shelter of a young man who needed to get his income support sorted.

“We need to connect with people in a variety of ways for them to build confidence to take responsibility for their health”. Penny has been involved in setting up a playgroup at the centre with this view in mind. The playgroup provides a valuable function in its own right, but also brings people into the centre, which heightens the visibility of other services on offer.

Penny is a member of VCHC’s Committee, and involved in the centre’s future development, and the role of the PHO within that. Ideas for new initiatives at the school are always evolving.

Penny’s vision of the nurse’s role in a primary health care setting is empowering clients to “trust their own judgements and abilities to manage their wellness”. She feels a barrier to this vision is existing contracts, which tend to be based on individual diseases rather than wellness as a whole. Although the current PHO model offers more flexibility, “the means of getting there needs to be much more creative”.

Penny gives the example of an initiative she established in her former role as a Tamariki Ora Nurse. In response to their request, she set up a weekly exercise class for mothers with young children, and while the mums were exercising, she looked after the children. At the end of the class, everyone would cook and eat a meal together, using healthy ingredients Penny had provided. Many people questioned a nurse providing childcare. Yet “exercising, having fun, sharing a healthy meal together – this was a really valuable experience for everyone involved – and far more valuable than sitting down and telling them what they should be eating”.

Trisha Falleni: trisha@ngatirua.co.nz
Penny Molnar: penny@nelsonpho.org.nz
Victory Community Health Centre: (03) 548 4779