Caring enough to knock on the right doors – New Zealand Doctor Online

The loss of jobs and income anxiety, and lack of transport are the main barriers to getting help.

The bar was set at the first stop on the first day of South Seas Healthcares new mobile clinic.

A nine-year-old boy had been getting treatment for brain injuries after being found lodged between a bed and wall. He hadnt attended any follow-up appointments in weeks, his mother was not responding to calls or letters, and the practice wanted to know why.

It was just the case the tara, south Auckland -based general practices new service had been established to address.

The concept is simple: put two nurses in a campervan and send them out to check on anyone who, for whatever reason, cant make it into the practice.

And the problem, says mobile lead Cherry Elisaia, could be seen in the mothers eyes the moment she opened the door. The property was home to four families, it was packed, and this solo mother was stressed beyond endurance.

Her sons care came on top of her day-to-day responsibilities and was divided across orthopaedic specialists, the spinal unit, general practice and the Ministry of Social Development (MSD); she did not have a car.

She lost control of his appointments and just froze, says Ms Elisaia.

The mother soon realised her South Seas visitors were there to help, not to threaten or take her son, and her tears flowed. The memory of that day has become motivational fuel for the three team members, Ms Elisaia, registered nurse Niteeka Naidu, and support worker and driver Tasi Eniata.

With the teams support, the mother has reconnected with the practice, where the wellbeing hub is also ensuring she receives ongoing help and her financial entitlements. The change, they say, has been as dramatic as it has been rewarding. The story is related to New Zealand Doctor Rata Aotearoa as the trio finish their morning briefing.

We tag along to see how their day pans out. Calls of see you guys and have a great day sound out as all three of the team head out the door.

Most of our stops will be cold calls to patients who have disappeared from the clinics waiting room despite the need for ongoing treatment and multiple attempts to make contact.

Its a Wednesday, the second of three days a week spent seeing new patients. Mondays are about triaging the fresh referrals and planning the week, and Fridays are dedicated to the most urgent follow-ups.

In the month after that first visit on 17 May, the mobile clinic received more than 100 referrals. Most are from South Seas, others from agencies such as MSD and Work and Income.

South Seas mobile team is a trial approach that will be assessed at the end of the year. Two months in, they are already exposing the need hidden behind closed doors and pulled curtains.

Patient self-referrals are also being taken but not all are accepted. As word gets out that nurses can come to you, they have heard from chancers saying they need a home visit because the traffic is heavy. Yeah, nah.

Todays schedule features six stops, starting in the outskirts of tara, then heading south to Manurewa, before returning via Mngere. Four are to chase up repeat did not attends (DNAs).

This may seem a lot of resource to spend knocking on a door but, as they have found, there is no telling why a patient has suddenly fallen silent.

Our first stop is straightforward: an elderly woman, too frail to leave her home, who is being monitored for haemochromatosis. A quick wellness check and bloods, and were happy to leave her.

Our next visit looks to be gnarly, which is why Chanelle Robinson, a navigator with South Seas wellbeing hub, is along for the ride.

Ms Robinson is not giving much away, but the patient cant leave the house (Youll understand why), and needs urgent medical and welfare assistance. The team put on their biggest smiles as they knock and enter the home.

That was really good, he was in tears, says Ms Elisaia when they return. Despite 20 years of nursing, she is almost in tears herself.

The man they have just seen is a solo dad, who has fallen through wide systemic cracks.

Growing up in Samoa, he had been treated there for lymphoma before immigrating to Levin as a skilled worker.

After settling in, he and his wife had two children and were just making a life for themselves, when his lymphoma returned, with the added complication of his single tumour becoming two. But he had a great relationship with his GP, who organised a dietitian and specialist support.

Then his wife died and, without access to social housing, he and his children were sent to tara three years ago; his medical records were lost in the process. His support evaporated, and his weight ballooned.

The good news was, he had got his weight down from 307kg to 270kg. But with his tumours now the size of footballs, he cannot walk properly or leave home without assistance, and his toileting is dependent on his daughter, in year 9 at school, and teenaged son, who is working and studying part-time.

The mans tears, the team tells me, were because someone, anyone, cared.

Hes motivated to get going and his head space is good, says Ms Elisaia, but hes stuck, lost in the system, and needs medical attention.

He told them he was grateful for the visit, saying, I just cant come out to see you.

The nurses pause for a moment to process, then: Okay, Tasi, where to now?

The trial arose out of COVID-19, from connections formed between practice, community and NGOs during the ongoing response, and the deep need for help within south Aucklands communities.

South Seas Healthcare chief executive Silao Vaisola-Sefo says it is also a means of reconnecting those who lost touch with the practice over lockdown.

We know people dont come in unless they are really sick and during lockdown about 70 per cent of consultations were virtual so we know people werent coming in but, even when things went back to normal, we still werent seeing them.

So, we see the mobile service as filling the gap between our community outreach work and the pop-up clinics.

The service has a budget of about $500,000, which comes from Ministry of Health, Counties Manukau DHB and South Seas overhead budget, with the specification that the focus is on health needs created by the pandemic.

A second vehicle is now a possibility. Similar programmes also are set to start, at Turuki Healthcare in Mngere and The Fono in west Auckland.

Ms Elisaia, the team leader, was born in Dunedin and raised in Western Samoa. She is the daughter of mental health specialist and GP Malaefou Elisaia, who helped establish psychiatric care in Samoa and, with his wife, a nurse, formed an island-hopping mobile health team.

Ms Elisaia went on to become one of a group of Auckland nurses who headed to Darwin five years ago to find work.

After working in Aboriginal health, she was signed to a lucrative new role setting up and rolling out a cardiothoracic unit in a large trauma centre when she flew home last March for her daughters graduation. Then lockdown hit.

At first it felt like a holiday but, after five months, she felt twitchy; she took up the role of lead nurse at the Waipuna COVID-19 assessment centre.

When that closed, she moved to the tara COVID centre, and it wasnt long before Mr Vaisola-Sefo wandered over to discuss a mysterious new mobile service that may or may not happen.

This looked like her opportunity to follow her much-missed late fathers wishes: He always told me Pacific people are under-represented in healthcare, so go work with Pacific people, and this has been the first time Ive felt like Ive been doing that. I now see being stuck in New Zealand as a blessing.

For her part, Ms Naidu migrated from Fiji in 1996 and got into aged care with Counties Manukau DHB before life came at her hard. After becoming a mother, she lost her husband to cancer in 2019.

She says the mobile clinic has become an invigorating change of pace with child-friendly hours. Im just grateful to have this opportunity, its something completely different for me. Her experience in palliative care, unfortunately, is already proving useful.

Driver and admin person Mr Eniata, is a 23-year-old who had been labouring on building sites when a cousin and nurse at the Glen Innes COVID-19 assessment centre suggested he get involved: Climbing around putting panels on buildings wasnt a good look for me, so I took a [chance] and Ive just rolled with it.

After starting off in security, he shifted to the tara centre, where he joined the mobile team and is being trained to provide basic medical assistance, including COVID-19 vaccinations. With a little prodding, he may eventually have a crack at nursing.

He says being able to help make a difference within his community is a source of pride. His physical presence also provides reassurance to his colleagues.

Dogs are a constant worry, as is the reaction of people who may have reasons for staying under the radar. The nurses have already had several instances where someone is clearly home, but their knocks and calls are stubbornly ignored. As we drive up silent cul-de-sacs, its rare to see people out. But silhouettes can be seen moving behind curtains, so we know our progress is being watched.

Im told the reactions were worse before Mr Eniatas aunty got involved with an idea.

The nurses had been working in scrubs, which seemed to alarm people, so they decided they needed a uniform. A rummage through auntys Henderson shop turned up the perfect Polynesian fabric with the South Seas colours, blue and purple, and a dash of pink, the colour of warmth, wellbeing and caring, says Mr Eniata. Its an honour to be able to go into peoples homes, so we need to look good.

By the end of our day, patients have been treated and our four DNAs were now accounted for, a rare accomplishment, apparently.

One had been uncontactable since tests revealed abnormal results. She is now back in touch with her GP and was another of those visited who burst into tears.

In a stroke of luck, the nurses also met the wife of a man with diabetes who had been missing for three months, so hadnt had his quarterly blood tests and health-coach sessions.

The final two patients of the day were in good health, had their contact details updated, and received opportunistic flu vaccinations.

Such work means coming face to face with harsh realities, says Ms Elisaia, and they arent restricted to living conditions.

Inflexible bureaucracies are an ongoing challenge, and the team remains baffled by a battle with MSD over a man in his 20s with renal failure and requiring dialysis three times a week. Despite letters from his GP and a specialist, they ended up arguing with officials who point-blank refused to believe a man so young could be that sick.

Unfortunately, the time spent following up such cases means the clinics ability to take on new patients is being compromised and, says Ms Elisaia, another van will soon be needed.

Its not as if they are at risk of running out of work: The conditions we are still finding people in, and especially the health conditions we have seen, are just surreal, and the loss of jobs and income, anxiety, and lack of transport are the main barriers to getting help. Then there are patients who wont seek medical attention because of their residence status, or they simply arent aware of the resources available to them.

Its just sad, so for me its about teaching people to take back control of their health and being involved in getting their health back. Education, or just being an advocate, is key. Its about letting people know there is support out there, says Ms Elisaia.

That is the positive in this story, there is help out there, and we just have to navigate them towards finding it.

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Caring enough to knock on the right doors - New Zealand Doctor Online