This report, based on interviews from across the organisation (Ngāti Porou Hauora),has been developed to help assess the effectiveness of our response to the threat of COVID-19; determine the impact on organisation function and morale; and identify learnings. It is too early to fully evaluate the response, and COVID-19 is not over, but we thought it was useful to capture some of the organisational responses and experiences of the journey while fresh in the mind.
Click here to read the report
Anezka Hoskin is hoping that a career in medical genomics will help in the fight against diseases currently affecting the Māori community.
Anezka, a SING Aotearoa alumni, is completing her University of Otago masters project with Professor Tony Merriman and Dr Phillip Wilcox, as part of a significant research partnership between the University and Ngāti Porou Hauora
From Wednesday 1 April, Coast communities will have their own Community Based Assessment Centre (CBAC) providing immediate support for patients with respiratory conditions. The Ngati Porou Hauora CBAC is based at Te Puia Springs Hospital and will operate on a 24 hours basis.
Last Thursday the CBAC servicing the Gisborne community opened at the War Memorial Theatre. Both the Te Puia Springs and Gisborne CBACs have been recently established to provide a place for patients having breathing difficulties or showing signs of respiratory illnesses(such as pneumonia) to be assessed by a doctor.
Under the current Level 4 Covid-19 lock down, the majority of patient consultations are taking place over the phone to abide with social distancing measures. However for patients with respiratory issues, there is a greater need for kanohi ki te kanohi assessments to be conducted,to help identify what further treatment is required.
Rose Kahaki, CEO of Ngati Porou Hauora, says the process to be assessed at the Te Puia Springs CBAC follows the same protocols as other CBACs that have been set up in other regions recently.
“Call your local Hauora clinic in the first instance and the GP will determine whether you need to be seen by the CBAC. If it’s after hours however, contact Te Puia Springs hospital and one of our clinical staff can make the referral.”
Dr Willem Jordaan, GP and Clinical Leader for the NPH Puhi Kaiti clinic in Gisborne has been redeployed to run the Te Puia Springs CBAC. Dr Jordaan will join the East Coast team who are currently providing GP services to the five Hauora clinics on the Coast and in Kaiti. We have also accepted an offer of assistance from Dr Nathan Joseph, former chair of Te Ohu Rata o Aotearoa (the Maori Medical Practitioners Association), who is taking leave from his West Auckland GP practice to assist Ngati Porou Hauora.
The CBAC is the latest addition to the services Ngati Porou Hauora is providing as part of their Te Mate Karauna (Corona virus) response preparations. Last week the Covid-19 test drive through opened at Te Puia Hospital. Appointments are made for people who have been referred by Health Line or a NPH GP. To have the swab test you do not need to get out of your car, as a nurse will conduct the swabbing through your car window.
• If you think you may have Covid-19 symptoms, please call the Healthline number 0800 358 5453. If you can’t get through to the Healthline, call your local NPH health clinic or Te Puia Hospital (06) 864 6803.
• The Covid 19 test drive-through at Te Puia Springs is open from 9am to 4pm every day.
NB: No walk ins. If you turn up without an appointment you will be turned away. If you or your whanau are unable to get to a swabbing centre, your GP will make alternative arrangements for testing. If you require assistance with transport for Covid-19 testing, please contact Te Puia Hospital (06) 864 6803.
• The Ngati Porou Hauora CBAC at Te Puia Springs is open 24 hours via referral from your GP. If you are having trouble breathing or showing respiratory illness symptoms, please contact your local Hauora clinic for a referral. If it’s after hours, call Te Puia Springs Hospital (06) 864 6803. If you live in Gisborne, contact your local GP or Healthline 0800 358 5453.
Since the Level 3 and 4 Covid-19 alerts were announced by the government a week ago, Ngati Porou Hauora has actioned a range of measures to help prevent the spread of Te Mate Karauna (Corona virus) and created new systems to deal with cases identified within our rohe.
One of the first immediate actions was the introduction of the process to access medical advice from Hauora clinics. The majority of consultations are now conducted by phone or video call,instead of kanohi ki te kanohi, and Ngati Porou Hauora Chief Executive, Rose Kahaki, says the new system is working well.
“Our Hauora clinics and their respective communities have adapted quickly to this new process,and the results are very noticeable. There has been very little foot traffic within our clinics andour hospital, which is helping to reduce the risk of community transmission to our patients, theirwhanau and our kaimahi.”
“Our Hauora kaimahi have taken on huge workloads and pressure to help us to prepare and respond to this ‘unprecedented’ situation,” says Rose.
“In a very short space of time, they have had to constantly learn new protocols and procedures in line with the Covid-19 directives from the Ministry of Health. Because this virus is so new, and the guidance we receive from the Ministry and government changes on an almost daily basis,we all have had to constantly re-think and re-adjust how we do things and what resources we need.”
“However, this issue isn’t only isolated to Ngati Porou Hauora. All over the motu, from the smallest PHOs to the biggest DHBs in the country, we all have had to adapt to a constantly evolving environment. None of us in this modern era, have ever dealt with a global pandemic,but we are quickly adapting and learning what we need to do to look after our communities here at home.”
Included within the scope of NPH kaimahi who have had to quickly adapt, are the Caregivers who assist pakeke with their home-help needs.
“We have an amazing workforce of around 46 Caregivers out there, all members of our communities, who have stepped up and taken on the additional protocols for caring for our pakeke in their homes,“ says Rose.
“They are well aware of the risks of community transmission and are vigilant in undertaking the necessary new procedures, such as the wearing of PPE (Personal Protective Equipment) gear.As essential service workers, their contribution to helping us to continue to provide services under the present conditions to our pakeke is invaluable.”
Although the necessary systems are being put in place across Ngati Porou Hauora, Rose acknowledges support from the community is extremely vital in helping to combat Te Mate Karauna within the rohe.
“We thank members of the community who have been adhering to the ‘Noho ki te kainga’ message. It really is true - Stay Home and Save Lives. As the Iwi health services provider, we can only do so much. However, if we all work together, to follow the guidelines that have been set, we can help protect our most vulnerable from this ngangara Mate Karauna.”
• If you think you may have Covid-19 symptoms, please call the Healthline number 0800 358 5453. If you can’t get through to the Healthline, call your local NPH health clinic or Te Puia Hospital (06) 864 6803.
• For more information about Covid-19 go to the official website www.covid19.govt.nz or the Ministry of Health website www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus
Yesterday the national four-week lockdown began and Ngati Porou Hauora urges all our whanau to help eradicate Te Mate Karauna (Covid 19) by staying at home, and only venturing outside to access essential services or for exercise.
“Me noho ki te kainga e te iwi,” says Rose Kahaki, Chief Executive for Ngati Porou Hauora. “To break the transmission chain of the virus we all need to practice self-isolation and social distancing under the Level 4 alert.”
“This means only having one designated person leaving your house to get stores from the shop. Or to visit one of our Hauora clinics as directed by clinic staff or to pick up your medicine. Going for a walk to get some exercise is okay, but when-ever you do leave your property and are around other people that are not from your household, please remember to practice being at least 2 metres away from them.”
“We also support the pleas made recently by Tairawhiti emergency services, and ask our whanau to not go out hunting,fishing, gathering kaimoana or horse riding. If there is an accident or incident, this potentially exposes the emergency crews, their whanau, and health care workers to transmission of the virus. It also places more strain on the health services of our district. We are all in this together.”
“We support the work over the past few days of the Health Protection Officers from Hauora Tairawhiti DHB.”
“They have been meeting all passengers arriving at Gisborne Airport to ensure they are aware of self-isolation protocols. This includes not only providing information to whanau returning from overseas, but also to whanau coming back from around the country and visitors from outside the region.”
“The Health Protection team have also been following up on the safety and well-being of local people who have been referredto them by Healthline. Some of these people have arrived into the country within the last 2 weeks and were instructed to self-isolate, and to keep away from other whanau members within their household. We are working closely with Hauora Tairawhiti, and made aware of developments as they arise.”
“In the last few days there were rumours of a suspected Covid 19 whanau member in Ruatoria, causing a high volume of concerns from members of the community. We are here to reassure you this is not the case. We have followed up with the whanau and the Health Protection team, and we can confirm that the person has been tested and the test has been proven negative.“
“We need to continue to be vigilant, and we will work together with the Health Protection team and whanau, to ensure our whanau are safe and practicing self-isolation (including bubble within a bubble).”
“As of 1pm yesterday, there were no reported cases of Covid 19 in the Tairawhiti region. To ensure it stays that way, and to keep our pakeke and whanau are safe, we must all continue to be vigilant, remember to horoi o tatau ringaringa, practice social distancing when around others outside our households, and to keep trips outside the home to a minimum.”
“We also urge voluntary members supporting the community to keep safe, abide by the rules and ensure you maintain a 2 meter distance away from others. If there are any concerns, contact Ngati Porou Hauora.”
“To be informed with latest national developments, we encourage you to watch the daily briefings by the Prime Minister and Director General of Health on television and social media. They usually occur around midday or early afternoon.”
· If you think you have Covid-19 symptoms, please call the Healthline number 0800 358 5453. If you can’t get through to the Healthline, call your local NPH health clinic.
· To read the statement about NPH’s recent changes to operating health services in the rohe, go to the website www.nph.org.nz
As a result of yesterday’s announcement by the government that the Covid-19 Alert level has been raised to Level 3, and will move to Level 4 by midnight Wednesday 25 March, Ngati Porou Hauora (NPH) has made the following changes to the health services we provide to Ngati Porou whanau in the Tairawhiti region.
In alignment with this announcement, these changes are being made to help prevent the spread of the Corona Virus to our Ngati Porou communities.
• We are trying to prevent contact between patients
• Minimizing face to face consultations
• Increasing video and audio consultations
• Encouraging whanau to self-isolate
To enable us to continue to provide Health services to our Ngati Porou communities on the coast and in Gisborne, it is important during this time of national lockdown that everyone unites in the fight against Covid-19, tiaki a tatau pakeke, Horoi o ringaringa, noho ki te Kaenga!
• If you are not feeling well and need to see a doctor or nurse, please continue to contact NPH. However please contact us by phone to make an appointment. Do not visit the clinic.
• We are here to treat people who are unwell. Winter is approaching; people will still get sick; we don’t want anyone to wait till they are really sick. We want them to call us early before their health gets worse.
• If you need a repeat of your prescription, or need help with administrative matters like ACC referrals, contact us by phone. Please do not visit the clinic.
• If you think you have Covid-19 symptoms, please call the Healthline number - 0800 358 5453. If you can’t get through to the Healthline, call your local NPH health clinic.
• Your first port of call will be the receptionist. The receptionist will ask you some questions to help decide whether you need to contact the Healthline, need help with administration matters or you need to be referred to the nurse.
• The nurse will determine whether you need to have a doctor’s appointment and will make an appointment with the GP which will be conducted over the phone, face to face or video call.
• Consultations are free to all enrolled patients – effective immediately.
• There is a single point of entry to the hospital which is the main entrance. All other entrances will be closed.
• The main door will be locked from 5pm everyday throughout the night, this is to maintain safety for staff, patients and whanau in the community.
• The duty nurse will open the door for those who need to come into the hospital.
• The Te Puia hospital ward will be on lock down. However, we are considering the issue of visiting, and we will make a decision as soon as possible.
If you or a member of your whanau has:
• a fever, sore throat, shortness of breath or coughing
• returned from overseas in the last 14 days
• or have been in close contact with a suspected or confirmed case of Coronavirus
Call the Healthline on 0800 358 5453 for advice. The call center is open 24 hours a day. If you can’t get through to them, call Te Puia Hospital on (06) 864 6803.
• If you do fit the criteria for Covid-19 testing, you will be directed by Healthline or your GP, to the nearest swabbing centre. There is one at Te Puia Hospital and one in Gisborne.
• The swabbing centre at Te Puia Hospital is a drive through. Do not get out of your car, the nurse will conduct the swabbing through your car window.
• These are not walk-in centres. You will need to meet the criteria for testing and be referred by the national Covid-19 Healthline or by your GP. If you turn up without an appointment you will be turned away.
• If you or your whanau are unable to get to a swabbing centre, your GP will make alternative arrangements for testing. If you require assistance with transport for Covid-19 testing, please contact the Hauora.
• Please note we are following the guidelines by the Ministry of Health, which at this point has set criteria for testing. If one whanau member meets that criteria, it doesn’t mean that your whole whanau will be tested. NPH is following the same guidelines that all health providers around the country are following.
• There are limited resources available at this time, so NPH has to prioritise who they test. We cannot swab everybody.
• We will be driven by public health direction and regulations- these could also change as things develop.
• Please be patient as this is a process that everyone around Aotearoa must follow.
The free Flu vaccination programme will continue to be rolled out to our Ngati Porou whanau who are most at risk. This includes: pakeke over the age of 65 years, pregnant women, people with a history of respiratory ill-ness, people with chronic health conditions and those who are immuno-compromised. While the flu vaccination won’t protect you from Covid 19, it will help to ‘flatten the curve’ of demand on our hospitals this winter.
• NPH teams are working with whanau who are needing vaccinations to be administered in their homes.
• Whanau who can travel to a Hauora clinic, will have the flu jab administered in the Clinic Car park. Verbal consent will be required prior to the vaccination being administered.
• If you are not enrolled with Ngati Porou Hauora, but fit the criteria for a free flu vaccination, please contact your local Hauora clinic.
• For people who don’t meet the free flu vaccination criteria, further vaccinations are being planned to be rolled out on April 13.
For all other Covid-19 related information and the latest news go to www.covid19.govt.nz
For contact details of all Hauora clinics go to www.nph.org.nz
Four Ngāti Porou people participated this year in the week-long Summer internship for Indigenous peoples in Genomics - SING. The substantial advances in this field and the increasing focus on Māori populations and indigenous species have highlighted the urgent need for Māori to engage and understand enough about the technical, ethical and cultural issues that are being raised. SING is an initiative that emerged from the Te Waka O Tama - a recent project and is now a key activity within Genomics Aotearoa. SING is run by Assoc Prof Maui Hudson, Dr Phil Wilcox and Katharina Ruckstuhl, and is designed to develop our understanding of genomics alongside some of the best researchers in New Zealand.
Indigenous Genomics Aotearoa is a network of Māori with expertise across the fields of genomics, informatics technology, business and environmental stewardship. The network is being developed as part of a Vision Mātauranga Capability Fund project led by the University of Waikato, The University of Auckland, and the University of Otago with support from Ngā Pae o te Māramatanga Māori Centre of Research Excellence, and two National Science Challenges (Biological Heritage and Science for Technological Innovation). Some of the topics covered in SING were: Introduction to Māori research and ethics, introduction to genetics, epigenetics, ELSI research in tribal communities, bioinformatics, Māori perspectives and gene editing. A highlight of the internship was a presentation from Dr Joseph Yracheta, a faculty mentor from SING USA, bringing his experience working with American Indian and Alaskan Native interns. Four Nāti applied for the internship and gathered for a week in late January with fourteen other Māori participants. The Nāti interns were Ben Rangihuna, Anezka Hoskins, Matiu Bartlett and Huti Puketapu-Watson.
Ben Rangihuna is from Tikitiki and is currently studying medicine at Otago University. This year he will be studying quantitative genetics alongside Dr Phil Wilcox (Rakaipaaka). Anezka is an emerging young Ngāti Porou scientist, currently completing her Master’s degree. She aims to make a significant contribution to the field of genetics, and plans to proceed to a PhD in Human Genetics and to apply for entry to one of the top five programmes in the world (in the UK, USA, or continental Europe). Matiu Bartlett is from Wairoa Hawkes Bay and moved to Gisborne 6 months ago to work at Ngāti Porou Hauora in Te Hiringa Matua which is a new parenting support service working with hapu mama who are struggling with drugs and alcohol.
Huti Puketapu-Watson, Deputy Chair of Ngāti Porou Hauora (NPH), also participated in the SING internship to help build capacity in the emerging arena of genetics given that NPH has great potential to become a leading iwi health service provider in the movement towards precision or personalised medicine. This potential has been developing through NPH’s long-standing research programme with the University of Otago research teams led by Prof Merriman and Dr Te Morenga, and our contributions to the Te Mata Ira project led by Maui Hudson to develop Māori guidelines for genomic research and bio-banking. Also as Chair of the Ngāti Porou Miere Board, Huti learnt that the Honey Landscape research currently being carried out by Ngāti Porou Miere in collaboration with other iwi & Plant and Food and Landcare, had significant relevance in the discussions because that research focuses on DNA profiling of our manuka. Dr David Chagne presented an outline of the Honey Landscape research to demonstrate what was undertaken in the process of gene research and editing.
A young Ngāti Porou geneticist is using DNA from her own people to fight Type 2 diabetes.
Māori suffer from the condition at nearly twice the rate as non-Māori.
Twenty-two-year-old Anezka Hoskin is part of a team at Otago University researching whether there is a gene that makes Māori and Pasifika people more prone to Type 2, or adult onset, diabetes.
The team previously found two genotypes that link Māori and Pasifika people with gout, which may account for their high prevalence of gout.
Now they want to know whether there is a similar genetic link between Māori and Type 2 diabetes.
The research is part of a decade-long partnership with Ngāti Porou Hauora and much of the DNA comes from Ngāti Porou people who donate a blood sample.
Anezka says it's a huge privilege and a big responsibility to handle the tapu specimens from her own iwi, including her own whānau.
The lab practices tikanga Māori when handling and disposing of Māori DNA samples.
Anezka’s interest in genetics began when her sister was diagnosed with Type 1 diabetes in childhood. Type 1 diabetes is known to be genetic while Type 2 diabetes is often linked with obesity and diet.
Anezka hopes that if they do find a genetic link to Type 2 diabetes it will help remove the blame and shame that people often feel.
She believes feeling whakamā often prevents people from seeking treatment.
Corrina Parata is currently the sole midwife for the East Coast, and after 18 years, says she still gets goosebumps when she recollects all the precious moments. Corrina believes that people who work on the wild and remote Coast build a specific set of skills that are different from urban health professionals. Corrina was inspired to be a midwife when she attended the birth of her niece. After a bad experience with the care at a large hospital, her sister decided to home birth despite complications. With the support of a midwife the baby was delivered safely. “The empowerment and healing for my sister to be able to take back control was so important for her. This experience and feeling the energy in the room that day made me want to become a midwife” Corrina said. Corrina decided to train though the Tihei Mauri Ora program under Becky Fox at Wintec. There weren’t many registered Māori midwives at that time, and Corrina remembers this kaupapa Māori based training being really powerful.
During her training she reflected on her own experiences having a child as a young Māori woman, and realised the lack of cultural safety practiced in the health system back then. She wanted to change this. It makes sense that Corrina then came to work for Ngāti Porou Hauora where Ngāti Poroutanga (the local culture) is recognised as a core value and vital for health and wellbeing. She says that Ngāti Porou Hauora supports her to run a midwifery service that works within her own culture. “When women give birth here they usually do so knowing that whānau who have gone before them were also born here. Through the practice of midwifery, you become a kaitiaki. Not just through supporting each child being born on their tūrangawaewae (cultural homeland), but in advocating to make sure we maintain a maternity service here on the Coast.” It isn’t just the midwifery service that works this way, it is across the whole service. “If there is family needing karakia or waiata.
All the staff drop tools and get in there to support. I feel like my wairua (spirit) is intact working this way.” Corrina believes that people who work on the Coast build a specific set of skills that are different from urban health professionals. Because it is wild and remote, it is even more vital to provide quality care and so the team have sharp and diverse skills. It can be consuming and overwhelming especially with the challenges of winter – no power, flooding, trees down over the roads, the water pump isn’t going. This is the reality of rural practice. You just need to carry on. It’s not for the faint hearted. Working this way over the years has made Corrina reflect on the bigger view of public health. She says that she never used to be political, but this work has developed her as a person. She is now a staunch feminist and advocate for social justice. “Why should Coast whānau not have access to quality care? Just because we choose to live rurally that shouldn’t be denied of us. It is this that gives me the burning flame to stick it out when so many say “oh I’d never work there”. Despite currently being the only midwife on the Coast, Corrina has regular contact with practitioners all over the country.
She remotely mentors five rural midwives in other areas of New Zealand, and meets regularly with a group of other rural midwives. This group shares ideas to improve their service and often have robust debates where they challenge each other on their practice and decisions. This online community of practitioners supporting each other is huge for preventing burn out – something we are seeing in the media as a concerning issue for midwives. Corrina also finds healing in the natural environment of the Coast. She loves fishing and the ocean. “I knew the local community had accepted me when they told me where the best fishing spots were” Corrina laughs. Twenty years and more than 500 babies later, Corrina says she still gets goosebumps when she recollects all the precious moments. “It is the highest calling and greatest honor to care for women and their families through the birth of a child. Women can feel quite vulnerable and frightened so you have to look after their wairua as well as the medical side. Being a midwife means whānau (families) place their trust in me and that trust means everything.” Looking forward, Corrina strongly believed that Ngāti Porou Hauora should continue to look at how we grow our own midwives, and is excited about the opportunities the learning institute will offer in moving forward with this goal.
For centuries Te Puia Springs has been a sanctuary of cultural significance and healing for Māori. The site is particularly significant for Ngāti Porou, but was also known as a place of peace, where Māori from other tribes and people in conflict, could come to heal in safety. This historical context sits firmly beneath the recognition that redeveloping the hospital facilities at Te Puia is a key step to improving the health of our people within one generation.
This year, with support from New Zealand Lottery we have been able to have completed an independent Feasibility Study on the redevelopment of the facilities in Te Puia. The study has been carried out by Impact Consulting and looks at the potential not for a ‘bigger hospital’, but rather to redesign the existing infrastructure and unlock the potential for a more holistic facility which will better serve our community. The project is an invitation which seeks to draw other significant community stakeholders together in Te Puia to collaboratively improve health, social and economic outcomes for our region.
When we think of “health”, most people instantly think of preventing or curing physical sickness ie. a hospital. However, from a Māori perspective health is more about wellbeing. It encompasses much more than our bodies and is intrinsically linked to all we do, including our social interactions with others. It is fantastic to have a document which really unpacks the details of what this could look like and what is needed to bring it to reality. We believe this Feasibility Study will be a powerful tool in helping us move forward with this important project.
Introduction Gout is a severely debilitating inherited disease affecting 10-15% of Māori and Pacific men and 6% of European men. It is caused by too much urate in the blood. As urate builds up in the blood it forms crystals in the joints, which cause an immune reaction leading to inflammation (red, hot joints) and severe pain. Conditions related to gout include diabetes and kidney and heart disease. People with gout often develop two or more of these conditions. International updates A United States company (ArdeaBiosciences) has developed a new drug for gout, called Lesinurad. It works by increasing the amount of uric acid excreted in the mimi. This is different to allopurinol that works by slowing the production of uric acid in the blood. We hope that Lesinurad will be available in New Zealand in a few years. National updates Variations have been found in genes which produce proteins that control the amount of uric acid leaving the body via the mimi, and these variations are more common in Māori. This provides scientific-evidence for using alternative drugs that work in the kidneys to help remove this excess uric acid. These drugs (such as probenecid and benzbromarone) are used with people for whom allopurinol does not work well. Lesinurad (mentioned above) could also be a good option in the future. We know that some kai can trigger gout in some people who already have uric acid crystals.
To find out the role of some foods and drinks in urate levels we used United States data to calculate the role of diet compared to genes. Genes are overwhelmingly dominant in determining uric acid levels. With diet having such a small role this points to the importance of using allopurinol to lower uric acid levels to get rid of the gout. Local update, previous findings ABCG2. The biggest highlight was that the ABCG2 gene plays a strong role in gout by triggering the gout attack. This gene is interesting because its function is changed by a chemical called circumin that is found in the spice turmeric. We are now working with University of Auckland scientists to test if an existing drug can work on ABCG2 to stop gout, we have just got NZ Health Research Council funding for this work. We have found other genetic variants in this gene that are specific to Māori, but these variants are very rare. ABCC4. We have also found a version of another gene (‘ABCC4’) that is involved in making the urate high by getting rid of less uric acid in the mimi. This version is found in Māori and Pacific people, but not in Pākehā. It is part of the explanation as to why uric acid is naturally higher in Māori and Pacific men. LRP2 (megalin). This gene plays a role in gout in Tairāwhiti, and in other Māori and Pacific Island people in Aotearoa NZ. What is very interesting about LRP2 is that its genetic function is over-ridden by alcohol drinking. There is one variation of the gene that decreases the chances of gout by about a quarter.
This version is present in 1 in 8 of Māori in Tairāwhiti. When a person with this version drinks any alcohol their chance of gout is about 4.5 times higher than someone with this version who does not drink. We do not know what the megalin gene does in the body, but it may be involved in getting rid of uric acid in the mimi. Tomatoes. We found that tomatoes play a role in triggering gout in some people. This confirms what people with gout in Tairāwhiti have been telling us. How tomatoes do this is not yet known, but probably tomatoes trigger gout in some people when their uric acid level is already high and the crystals are there. There is no need to avoid tomatoes if they don’t cause your gout. The best way to stop gout is getting the uric acid low with the drug allopurinol. Sugary drinks. We found that people with gout were drinking less sugary drinks, meaning that the message about people with gout not drinking sugary drinks works in Tairāwhiti. Interestingly there were also less gout attacks. And we found that people with gout who do drink sugary drinks have higher uric acid. Local update, new findings CREBRF. The recent exciting finding is the CREBRF gene. A specific change in this gene, found only in people of Māori and Pacific ancestry, causes weight to increase. But, at the same time, it protects from diabetes. This tells us that some causes of obesity and diabetes are different in Māori than other populations.
We think that increased muscle mass in Māori combined with good fat is behind this apparent paradox. With the Maurice Wilkins Centre (a national research centre based in Auckland) we are proposing more local research to understand this. (If you are wondering, this CREBRF gene may also control urate levels. We will explore this.) Mitochondria. The other finding we have relates to the energy powerhouses in your body, the mitochondria. There are dozens of these in your body and they convert the energy from your kai (e.g. glucose and fats) to the energy that your body actually uses (‘ATP’). We have found that part of the cause of gout is when the mitochondria get stressed – this helps trigger off the gout attack. We do not yet know exactly how the mitochondria get stressed. We also hope to explore this in the next phases of the study. What does this mean for improving health care? What does mean for improving how we prevent and manage both the gout, and the other related conditions? We are now considering how whānau and doctors & nurses can use this precise information - about the ways genes work with your kai, and with the drugs used to treat gout (e.g. allopurinol) – to better treat and prevent these conditions. We look forward to discussing and receiving your feedback on some of these possibilities in community hui and related meetings. Key messages about Gout 1. Hit the target <0.36 uric acid levels in your blood to avoid a gout attack. 2. Your gout is not ‘cured’ even if the pain goes away. Take your medication EVERY DAY. 3. Your genes play an important role in gout, not just your kai. 4. Drinks lots of water, milk isgood too. And avoid sugary drinks and food. Thanks and acknowledgements We recognise the commitment of many people in the successful continuation of this project and take this opportunity to thank the people who have participated and the research team, including technical staff, for taking care of and processing participants’ gifted samples. We also thank the funding bodies that recognise gout as an important disease to be researched and better understood, managed and treated in Tairāwhiti. The Health Research Council of New Zealand has been the major funder, with funding also coming from Lottery Health, the University of Otago and the Heart Foundation of New Zealand.
A waiata (song) has recently been gifted to the mental health team at Ngāti Porou Hauora. Presented by John Coleman of Tokomaru Bay, this waiata is a special tribute to a woman and past consumer of the mental health service, who has since passed away. Waiata have long been an effective method for maintaining well-being for Māori. It is an expression of emotion and a traditional form of healing. Over the past few decades, Ngāti Porou Hauora have been privileged to have had support from John and over this time he has written the organisation hundreds of songs. John comes from a line of gifted Ngāti Porou composers including Tuini Ngawai and Ngoi Pewhairangi.
Through waiata John has recorded the history of hauora on the Coast. Whenever there has been a hui or significant moment, there has also been a waiata that helps us remember who was there and what the kaupapa (topic of discussion) was. Often visitors have been able to take away the gift of a song as a special reminder of their visit. This waiata, however, is slightly different. In his younger days, John worked in the NPH mental health service, and it was here that he came across this particular song. A woman who was battling mental illness at the time brought in the English version of the song and explained that when she heard it, she felt like it was singing about her. The lyrics resonated deeply. However, she asked that John translate it to Māori as she believed this would be more beautiful and useful to her in her healing journey. Years later, John was reminded of the song. With the Ngāti Porou Hauora team recently visiting and consulting with the community around our model of care, and the nationwide Government Inquiry into Mental Health and Addiction he decided it would be a useful tool to help people to understand the perspective of those suffering from mental health issues and addiction. Here is the song: Lace covered window
Original by New Faces / Nga kupu by J.T. Coleman I te reo
hikoi I tea o, anake,
O pumau, ka huri, muri new e.
Ka tangi roimata, maumahara,
Nga whakaaturanga matapihi.
marama e kore I kitea,
Na konei, ko te whiu, I tea o nei,
E pumau kia kume te aria e,
Tirohia te aria matapihi.
rapa noa nga mahara kei whea ra.
Ko wai e tau nei I a koe.
Me kume te aria kia mohio ano
Te aroha kei reira mo koe ra.
hikoi korua mo ake
Waihotia na pouri, mamaetanga,
Ka nga ra whiti-mai apopo,
Tu where te aria matapihi,
Whiti ra te aria matapihi.
When you walk through the world all alone,
And your dreams turn to ashes behind you,
Then the tears in your eyes will remind you,
Of a vein through a lace covered window.
Doesn’t seem very clear anymore,
In your world everything is uncertain,
How you wish you could pull back the curtain,
Just to see through that lace covered window.
you’ll never know what life has in store,
What’s waiting there to greet you.
So pull back the curtains and maybe once more,
True love is there to meet you.
Verse 3: So
you walk side by side through the world,
No more times full of darkness & sorrow,
Every day is a bright new tomorrow,
When you open that lace covered window,
Let the sun through that lace covered window.
A new pilates class has started in Te Araroa run by Ngāti Porou Hauora Physiotherapist Anne Hewetson. The weekly class is held at Hinerupe (the local marae) and has a growing mix of local people attending regularly, especially kaumātua (elders). The initiative has been started as a proactive way to keep people strong, mobile and to prevent falls, as well to boost recovery for those who have had injuries or operations. The exercises focus on increasing levels of strength, balance, flexibility, muscle tone, stamina, and well-being. The ability to modify exercises to meet differing needs makes it a great community activity. “People are commenting about how good it makes them feel.
There has been increased mobility in some members and it has given people a greater understanding of what their bodies are capable of and what it feels like to have a good stretch.” - Tracey Morris, Rural Health Nurse Because the Physiotherapist is only in the area once a week, the goal is to train a local person to take over the classes going forward. This will give people greater access to recovery and rehabilitation sessions. The team at Matakaoa Clinic are also wanting to start a regular walking group. The staff walk most mornings already but are keen to get more locals involved. The Huringa Pai movement in Gisborne has certainly helped inspire the idea.
These activities all fit in with Ngāti Porou Hauora’s bigger vision to transform the East Coast into one of the world’s Blue Zones. Blue Zones are a handful of small areas in the world where people live longer and live 'happier' than anywhere else on the planet. Two of the core ingredients that have been identified in the recipe for a Blue Zone are regular physical activity and coming together as a community.
In partnership Vodafone New Zealand Foundation and Todd Foundation, we are excited to be developing innovative technology which will support parents on the Coast. This project is the first of its kind and has the potential to revolutionise parent’s engagement with children’s health development. The name Pēpi Ora came from a group of young whānau in Ngāti Porou. Pēpi means a baby in infancy and Ora is a state of wellbeing, to be healthy, fit and alive. The app will be an incentive-based programme for young families that takes the ‘Gold Card’ idea, but instead rewards parents for the important contribution they make to NZ society, and improves it by including a points collection and rewards program.
Young parents join our programme at their first antenatal appointment and once fully developed, will be able to collect points through activities such as attending health appointments, completing immunisations and developing and implementing a whānau ora plan. The potential to increase young parent’s active engagement in the health, development and education of their child is currently untapped in New Zealand. The physical Well Child/Tamariki Ora booklet is often forgotten by parents attending appointments, and very seldom looked at between appointments. Pēpi Ora will revolutionise these old systems by offering something that is engaging and culturally-sensitive. The interaction whanau will have with technology through the app, we believe will support actively engaged young parents and as a result, improve future outcomes for our next generation.
In October 2017 Ngāti Porou Hauora’s Frances King and Laine Tangaire a rangatahi (youth) from Rangitukia spent six weeks at the Vodafone NZ Foundation’s Change Accelerator Program surrounded by a team of tech experts from Dev Academy and Vodafone. This unique opportunity saw the concept of Pēpi Ora come to life through a prototype which we have now taken back to the Coast for development. This year we are undertaking a formal trial of the program with whānau on the coast and local businesses. Evaluation from this will inform the development of the next phase: a ‘native app’ that we can roll out across the whole community. This project is the first of its kind and has the potential to be scaled locally, nationally and internationally. Scaling the program will be dependent on the success of this pilot and the level of interest from key stakeholders including the Ministry of Health, NGOs such as Plunket, Māori health service providers and local businesses contributing to the rewards programme. Once trialed and refined into an attractive, functional app; this program has great potential.