Simple things make a big difference to Pacific Island health outcomes

Pacific Island people are more successful in keeping an eye on their cardiovascular health than any other demographic group in New Zealand, according to the government’s ‘More Heart and Diabetes Checks Health Target’ trend.

Fifita McCready (left) with nutritionist Paula Matawalu at one of the practical cooking demonstrations run by the centre.

The health target statistics show the Pacific population has consistently achieved higher numbers of cardiovascular (CVD) risk assessments than the national total over the past 5 years, sitting on 75.5% for the first quarter of 2014 compared to the national average of 69.2%.

One initiative helping achieve those statistics is the community-based diabetes care offered at the Tongan Health Society’s Langimalie Centre in Onehunga. Diabetes nurse Fifita McCready, who runs the diabetes and long-term condition clinic there, says access to regular checks and tailored healthy living programmes make it easier for people to self manage their condition.

‘I aim to provide a nurse-led one-stop-shop so people don’t have to run from one place to another for screening and other health and non-health needs,’ Fifita says.

The Langimalie Centre was established in 1997 to offer comprehensive health care to local Tongan people and the wider community. In 2001, a diabetes clinic was set up, and then a diabetes and long-term condition clinic was established in 2003.

Accessibility is really important for the community, Fifita says. At Langimalie there is plenty of parking and people don’t have to take time off work to transport their parents to hospital. Services such as regular specialist visits and monthly retinal screenings help the community access the care they need.

There are just over 920 people on Langimalie’s diabetes register. Fifita provides ongoing care plans, health literacy and education for the people referred to her by the centre’s doctors.

‘Our goal is to try to diagnose early and keep our people out of hospital. Before the clinic started people would be sent to hospital for diabetes management.’

People who are pre-diabetic are recalled by Fifita every 6 months. She sees others weekly, monthly or 3-monthly. There are clinic doctors available for those requiring further treatment and specialists visit once or twice a month.

Like most of the staff at Langimalie, Fifita is fluent in Tongan and English, making it easier to build trust and confidence with patients.

Dr Glenn Doherty, CEO and medical director.

‘It can make a big difference to patients to discuss their medication in their own language. Many say in the past they have not been sure why they’ve been given medication. It also is important that we understand the community’s values and culture.’

Fifita also encourages her patients to keep their diabetes under control through group activities that involve exercise and better diet.

This group session approach is a new way of achieving innovative self-management strategies, Tongan Health Society (THS) chief executive officer and medical director Dr Glenn Doherty says. Dr Doherty says they are in the process of developing the service with further initiatives for Tongan clients in 2015.

Cooking classes effective and fun

To emphasise the importance of a healthy diet Fifita organises practical cooking demonstrations 6 times a year in a customised kitchen within the centre.

The cook, who is funded by Diabetes, Self Management Education, prepares everyday food in a healthy way, then serves it in healthy sized portions.

A dietician speaks about diet using posters and test tubes to demonstrate the fat content in various foods, such as corn beef and coconut cream. The cooking demonstrations usually attract between 10 to 20 people, men and women.

The vege garden outside the hall where exercise groups are held.

Music, exercise and lunch another hit

Combining Tongan music, exercise and lunch has been another healthy past time for Langimalie patients. The exercise group is run at a local hall by a fitness instructor every Monday morning.

While the group exercises, a healthy lunch is prepared using greens grown by the diabetes patients in a vegetable garden at the hall. Sometimes there is a short health talk between exercise and lunch.

‘Between 40 and 60 people attend each week. They come for social reasons, for their health and because they love hearing Tongan music,’ Fifita says.

Group exercise more successful than doing it alone

A YMCA gym-based exercise project, Living Life Well, was piloted earlier this year with a group of Fifita’s patients. The 10-week exercise programme ran weekly over 2 hours at 2 YMCA gyms, 1 in Panmure the other in Onehunga, attracting people from middle-age to mid-seventies.

Fifita says her patients were particularly receptive to the group exercise approach.

‘I don’t think any of them would have turned up regularly if they’d been doing it alone. They all knew each other had diabetes so they encouraged and motivated each other. A number lost weight. One woman started gardening again, something she had been incapable of for some years. There was sharing and fun.’

The Living Life Well project was designed by YMCA, Diabetes NZ Auckland Branch and Pharmaco to improve risk factors and health outcomes for people with diabetes and other long-term conditions, such as heart disease.

Before the programme started, Diabetes NZ Auckland Branch provided training for the trainers about diabetes and the risk of low blood sugar (hypoglycaemia) in an exercise setting that included explanations of how to recognise and treat low blood sugars, says branch manager Ruth Davy.

‘We also ran a session on diabetes management for the participants that emphasised nutrition and detection and management of low blood sugar levels.’

Panmure YMCA fitness business manager Salil Warekar helped organise the programme, including the fitness testing and measurement guidelines and participant follow up.

‘They were kept engaged and updated with new exercises that were fun and challenging. Upon retesting there were positive results, such as improved energy levels and sleep patterns, higher physical fitness and decreased stress levels. There was a gradual drop in their diastolic blood pressure and some lost body weight as well. Many showed signs of improved balance and flexibility, too,’ Salil says.

YMCA Auckland chief executive Peter Fergusson says the pilot programme was a unique opportunity to provide access to what the YMCA has to offer to people who have diabetes.

This story is part of Tongan Health Society’s Langimalie Centre cardiovascular disease projects.

Read the next story in this series: Free group exercise is what cuts the mustard for 61-year-old.

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