Cardiology care closer to home for East Coast

5:09 pm on 17 December 2020

A cardiology team in Gisborne is crediting stronger relationships with Ngāti Porou for the success of recent remote clinics up the East Coast.

Cardiology nurse practitioner Tracy Low, left, and Hauora Tairāwhiti head of cardiology Gerry Devlin.

Gisborne-based cardiology nurse practitioner Tracy Low, left, and Hauora Tairāwhiti head of cardiology Dr Gerry Devlin. Photo: Alice Angeloni / LDR

The burden of heart disease falls unequally on Māori and Pasifika, a problem further compounded in isolated and high deprivation areas.

Hauora Tairāwhiti director of cardiology Dr Gerry Devlin said the team had been looking at their services and how they could operate differently.

"If you do it the same way, you're going to get the same answers.

"Bringing the service to the community, we think, is an important way of making it easier to engage with us."

Their team saw 26 patients over two days in Te Puia Springs and Ruatoria in October. Eighteen patients were Māori.

It played out very differently a decade ago when they struggled to fill the visiting clinics.

The relationships with Ngāti Porou were a key difference, and pivotal to the recent clinics' success, Devlin said.

"Part of what we've done in the past two years is building relationships with the communities and being asked to come up and do the clinics is a testament to this."

Māori health provider Ngāti Porou Hauora chief executive Rose Kahaki said cardiac problems were a "big issue" for whānau living on the coast.

They had held specialist clinics in Te Puia over many years, and had seen increased attendance, but their ability to offer specialist care "closer to home" was dependent on two important factors.

"The interest of the doctor to service the coast and the district health board's willingness to fund the service," she said.

Hāuora Tairāwhiti's cardiology team saw 26 patients in Te Puia Springs and Ruatoria over two days in October.

Hāuora Tairāwhiti's cardiology team saw 26 patients in Te Puia Springs and Ruatoria over two days in October. Photo: Ben Cowper / Gisborne Herald / LDR

The recent clinic was "very successful" and they were looking to apply the same model to other areas such as obstetrics, gynaecology and ophthalmology, Kahaki said.

According to the Heart Foundation, Māori and Pacific people are 1.3 times more likely to suffer a heart attack or stroke, and four times more likely to die of heart disease before the age of 65 than non-Māori.

New Zealanders living in the most deprived areas are twice as likely to die from avoidable heart disease before the age of 65 compared to the least deprived.

Gisborne scores high on the social deprivation index, with income levels below the national median.

Devlin, who is the medical director of the Heart Foundation, presented a paper on heart health and equity to the government prior to the election.

He said health workers were often intent on and passionate about addressing inequities, and made a beeline straight for solutions, but relationships were "really important".

"Lots of people in health, we want to get on and solve things, but solving things is much more challenging than going in and saying 'hey, I've got a solution for you'."

Kahaki said Ngāti Porou Hauora was moving into a "more proactive rather than reactive space" to address health inequities.

"We are working through plans at the moment to support whānau better from a wellness and preventative to treatment continuum.

"First this involves understanding the unique make-up and strengths of each community and using it as part of the solution."

They were setting out to learn from models with better outcomes than their own and understand the health of each person and community through baseline data and tracking progress over time.

They were also supporting their workforce through training, education and mentoring to better support whānau.

These moves come as Tracy Low qualifies as Tairāwhiti's first cardiology nurse practitioner - an advanced nursing role with the licence to diagnose, investigate and be the lead clinician.

Low said they were looking at running the cardiology service up the coast more regularly.

"The community up the coast has been under-serviced for so many years - we need to make sure that whatever we say that we're going to do, we do it."

"It does come down to the sustainability of our services, our clinicians and our skills."

Devlin said, a few weeks after the recent clinics, a patient up the coast called up the hospital.

"She was phoning up to express her gratitude. She said she hadn't felt so well in such a long time. She felt back to normal," he said.

"That person, it's no trivial matter that we've made a difference to someone who, goodness knows if or when we would have got to see her through the normal model."

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