WHĀNAU ORA CASE STUDY
Implementing Fale 'o e Tonga – A Tongan approach to Fanau Ola
Mafi was referred to Fanau Ola services after she had her sixth child. Her Lead Maternity Carer was concerned that Mafi would struggle at home with three children under three years of age. Mafi was initially contacted by her Tongan Navigator by phone to organise a time to meet.
Fakafeiloaki Famili –
Founga fakahoko ngaue
When the navigator arrived at Mafi's house, Mafi opened the door slightly but did not ask the Navigator to come in. Mafi said she didn't know why the midwife sent the Navigator without talking to her. She told the Navigator that she is a good mother and asked what she had done to make the Midwife think she wasn't.
The Navigator gently explained to Mafi that she hadn't done anything wrong. She explained her role and told Mafi that the service is free and voluntary and that she could withdraw at any time. After the explanation Mafi let the Navigator come inside.
The Navigator started the talatalanoa by talking about herself. She told Mafi about the organisation she works for, her role, the church she attends and where she is from in Tonga. She was looking for some common ground but without success. Mali had nothing to say.
The navigator kept searching for something that would engage Mafi and finally established that Mafi was a talented seamstress. Mafi told her she was busy trying to finish dresses for an entire bridal party that weekend. Seeing Mafi had so much to do the Navigator told Mafi it would be better if she came back at another time. Mafi was very grateful and they agreed to meet the following Monday. The fatongia - duty to meet - had been established.
While the Navigator hadn't achieved what she wanted with the first visit, it was clear that if she continued to occupy Mafi's time when she had other things going on, it was unlikely that Mafi would engage with the service.
Talatalanoa
When the Navigator returned the following week Mafi was very friendly and welcoming. She apologised for not having the time to talk during the previous visit. It was clear that because the Navigator had made a decision that made life easier for Mafi - the sacred space (va) and faka'apa'apa had clearly been established.
Mafi said there was a lot going on for her. The Navigator asked her what some of those things were and she said:
She has not been happy about the way the midwife treats her. Mafi said the midwife arrives at the house without making an appointment saying she 'is just driving past'. Sometimes Mafi has just put the children down for a nap and the unplanned visit means they wake up, getting very overtired and unsettled. Mafi it's the midwife fault that the children are unsettled. (This sentence sounds as if the Navigator is saying this. Need to check) Mafi said she has been avoiding the midwife’s calls and hasn't seen her since leaving hospital three weeks ago.
She shouldn't have taken the last-minute request to do the dresses, but it meant there would be more income.
Her sewing machine broke and she had to borrow one. All this made her worry about being able to make money.
She said she had hardly slept in the last two weeks and was very tired.
Mafi was then quiet for some time so the Navigator asked her who the children were in a family portrait that was on the table next to them. Mafi explained that her husband had been married before and had seven children. The photo is of his seven children and their five children, including the newborn baby. The family had 13 children between them.
Mafi agreed to complete the assessment process. She said Tevita, her husband, was too busy to attend but she would talk to him about it.
| Who | Age | Relationship | Medical Overview |
|---|---|---|---|
| Mafi | 38 years old | Mother | No post-partum check-ups |
| Tevita | 47 years old | Father | Gout |
| Hope | 8 years old | Dauqhter | Asthma and eczema |
| Serenity | 6 years old | Dauqhter | Asthma |
| Precious | 6 years old | Dauqhter | History of chest infections |
| Faith | 3 years old | Dauqhter | Chest and ear infections |
| Trinity | 1 year old | Dauqhter | Immunisation not up to date |
| Christine | 3 weeks old | Daughter | Immunisation not up to date |
| Control of Daily Lives | Mafi said decisions in the house are made jointly by her and her husband. Her husband has a good job and they manage well. They live at home with their six children. Her step children sometimes come over to help with the children. They are mostly teenagers/young adults. Her parents live in Tonga and they have some responsibilities to help them. She said life is simpler in Tonga and you don't have as many complications. |
| Well-being and comfort/Family and Friends | Mafi said generally the family gets on well. She said sometimes her husband's ex-wife interferes and this has resulted in them having a physical fight in front of the children. Mafi said aside from the ex-wife, her biggest challenge is getting sleep. |
| Nutrition and Health Literacy | Mafi said even though her English isn't very good she will still ask a lot of questions. She doesn't care if it takes people a while to understand her. Mafi said she will keep asking questions until she understands. Mafi says she will go to the market and buy vegetables to make a big soup. It is cheap and healthy and feeds many people. She has been unable to breast feed any of her children. She said it's too hard so she puts them straight on formula. She said buying formula is a significant cost for the family. The children. are often sick. They have a lot of chest infections and coughing. Mafi will sometimes walk with them to the Doctor, but mostly she will manaqe it herself at home, until they get better. |
| Safety | Mafi has a good relationship with Tevita. She said that the main stress between them occurs when Tevita's ex-wife causes problems. Mafi said Tevita will just 'be too quiet' and this makes her angry because his ex-wife will take advantage of him. She said she did not want her children to witness violence, but recently they had seen her fighting with Tevita's ex-wife. The children got upset. |
| Community participation and involvement | The family have little to do with the local community. Mafi knows the staff at the school and at the medical centre. Her main interaction with other community members comes through her Church activities and from people who come to see her to get dresses made. |
| Church, family cultural groups | The family attend the local Mormon Church. They are very involved with Church activities and events. They tithe 10% of their income. They believe tithing is not a matter of dollars, but a matter of faith. If they could afford more, they would pay more. They also send money to Mafi's parents. She said they don't require much, but her sewing helps to earn extra money for things like this. |
| Work and Family | Tevita is employed full time. Mafi has never worked (formally) in New Zealand. She gets a good income from sewing dresses for other Tongans in the community. People find her through word of mouth. |
| Home environment | Mafi and Tevita own their own home. The home is very cold. Mafi said they don't like to have heaters on because it costs too much and she gets a headache. They have netting covering the windows but there are no curtains. There is a rug in the lounge room but no other floor coverings in the house. The lino in the kitchen has been ripped up. Three of the four elements on the stove don't work so there are two gas hobs on the kitchen bench. The bathroom has a significant amount of mould. The yard has two cars that are rusty and don't work. Tevita was going to fix them but he didn't have the time or the money. |
| Fokotu'utu'u ngaue – Setting Family Goals | Fakahoko ngaue | By When | |
|---|---|---|---|
| Make sure our family is healthy | Referral to Well Child/Tamariki Ora. Ensure immunisations up to date | Mafi & Navigator | End of Month (June 2014) |
| Referral to lactation specialist to implement a plan to see whether Mafi can be supported to breastfeed | Navigator | End of Month (June 2014) | |
| Referral to GP for post-partum check- ups and for Mafi | Navigator | End of Month (June 2014) | |
| Make our house nicer, make it warm | Application to Auckland City Council for home insulation subsidy | Navigator | End of Month (June 2014) |
| Investigate whether Fanau Ola Fund can pay remainder of home insulation cost | Navigator | End of Month (June 2014) | |
| Sew curtains to put up in the house | Mafi | End of July 2014 | |
| Clean and paint bathroom | Mafi & Tevita | End of July 2014 | |
| Make sure our children get a good education | Look into ECE costs for 1 and 3 year old | Mafi & Tevita | End of July 2014 |
| Maintain our income | Investigate whether Fanau Ola Fund can buy a new sewing machine | Navigator | End of July 2014 |
| Relationship guidance | Seek guidance from Church Bishop to help Mafi and Tevita manage relationships in a positive way | Mafi & Tevita | End of Month (June 2014) |
Fakama'opo'opo –
Reviewing and Reflections
After two weeks Mafi and the Fanau Ola Navigator sat down together to review progress and reflect on the plan. Some good progress had been with the 'healthy family' goals underway.
After the initial goal setting the Fanau Ola Navigator had made contact with the local Curtain Bank. The Curtain Bank confirmed they could provide made to measure, thermal-lined curtains at no cost. There would however be a delay of two weeks before the curtains could be provided. Although Mafi is a gifted seamstress, she agreed that getting curtains from the Curtain Bank would save her time and she would not have to source the fabric.
Mafi and Tevita said they did not have any money to buy paint to fix the bathroom. It was agreed that this will be added to the application for funding from the Fanau Ola Fund.
Ola 'o e Ngaue
Ola 'o e ngaue (reflecting on outcomes)
Every two weeks Mafi (and sometimes Tevita) would meet with their Fanau Ola Navigator and reflect on progress being made to achieve their goals. Sometimes they required support from their Fanau Ola Navigator to follow-up with other agencies. For example, when they didn't hear from the Early Childhood Centre after leaving three phone messages, their Fanau Ola Navigator went with Mafi to visit the Centre and get the information they required.
Katoangai
Once all the goals had been achieved, the Fanau Ola Navigator had a final meeting with Mafi and Tevita. At this meeting the Fanau Ola Navigator talked about the journey they had all made, where they were when they started and what they had achieved. They talked about what this shift meant to the family and to Mafi and Tevita as a couple. The Church Bishop also came and offered his congratulations to the Mafi and Tevita. They said some prayers of thanksgiving and shared a cup of hot chocolate to celebrate the goals they accomplished.
Fakahounga
Mafi and Tevita said that it was important for them to 'give back' to the organisation that supported them. They were advised by the Fanau Ola Navigator that she could not accept any gifts. Mafi and Tevita insisted that they would like to do something, to acknowledge all the support and assistance they had received. The Fanau Ola Navigator told them about an ethnic specific community consultation process that the organisation was running. The purpose of the consultation was to seek input from people who used their services so that service improvements could be identified and made. Mafi and Tevita stated they would be honoured to attend and provide input.
Tauhi Vaha'a
The Fanau Ola Navigator closed the case by reinforcing the new skills they had all (including the Navigator) gained as a result of going through this journey together. The Navigator stated that this stage signals the end of the current status of their relationship and marks the start of a new phase.