Planned Contribution – Urban Attachment
My name is Francesca Casciola and I am a final year medical student at the University of Auckland. The following report will detail my experience as a trainee intern at the Tongan Health Society (THS) Kelston Mall clinic as part of my General Practice attachment. It will include a description of my experience as part of an outreach clinic and a reflection on my learning as a result.
The Kelston Mall/Langimalie Medical Center is a bustling practice that serves a diverse population. This population is predominantly Pacific but now includes a rising Indian and South Asian presence. As such, my clinical experiences stretched a broad range of medical presentations.
Under the wider umbrella of the THS, I was offered the opportunity to participate in an outreach clinic. These clinics are a wonderful initiative that embodies patient centered medical care. In collaboration with local Auckland Tongan churches, the THS provides a range of screening, immunization, and dental services directly to the community. It does so by truly understanding the people it serves and tapping in to one of the most powerful elements of this culture – the community itself. In partnership with church leaders, these mobile clinics are actively addressing prominent health disparities within Aotearoa’s population while making healthcare more equitable, approachable and accessible.
It is a well-known and poorly addressed fact that Pacific peoples in Aotearoa experience a substantial gap in healthcare outcomes when compared to their pākehā counterparts. Despite making up only 8% of the total population, they experience a disproportionate burden of disease, primarily due to structural racism (1). One of such disparities is the prevalence of diabetes. At 72%, this is significantly higher than their pākehā/NZ European counterparts (1). The outreach clinics provide valuable diabetes screening and advice, and even conduct ongoing research into the rates and prevalence of diabetes among young people. During my outreach clinic experience I was stationed with this research team. Here we screened young people including taking stock of health behaviors via a questionnaire, completing a bioimpedance scan, and checking HbA1c levels.
…It does so by truly understanding the people it serves and tapping in to one of the most powerful elements of this culture – the community itself.
It’s a reflection of true healthcare, unhindered by Eurocentric models and practices and allowing science and cultural humility to improve the health of a community.
I have reflected on my experience during this outreach clinic and within the practice. I am thankful to have had my final general practice attachment at the THS for many reasons. The abundance of diverse patients and presentations and the organized, calm demeanor of the clinic and its staff allowed me to focus on my learning. On the outreach experience I was able to witness an improved model of healthcare delivery, one that was culturally informed and built by and for Tongan and Pacific peoples. The Pacific patients whom I met in the Kelston clinic and at the outreach clinic were fiercely loyal and caring of their family. This meant that many patients were accompanied by their supportive relatives. I began to see how to practice medicine with flexibility, as the caretakers in the family would often put the health of their relatives above their own. Having multiple people attending the appointment was an opportunity to check in on everyone present, rather than just the booked patient. Similarly, the church was an important location to connect with patients. By changing the location of the healthcare delivery but maintaining its backbone of compassion, THS can reach those within its community who may not have the time, funds, health literacy or flexibility to attend the Kelston clinic. It’s a reflection of true healthcare, unhindered by Eurocentric models and practices and allowing science and cultural humility to improve the health of a community.