Personal Contribution Report
Mālō e leilei, my name is Makayla Wadsworth and it is my pleasure to discuss my experience being a fifth year medical student with The Tongan Health Society (THS) at the Kelston Clinic. Throughout my time at THS I have gained new clinical and personal skills that I wish to carry throughout my medical career.
During my four week placement at the Kelston Clinic I had the privilege of meeting a diverse group of patients with a diverse range of needs. The Tongan Health Society puts the pacifica worldview at the forefront of care, but I have also seen how this benefits not only the Pacifica community, but Indian, Southeast Asian and Māori communities. Utilising a holistic approach to patient care looks like treating patients as people and not as pathology. This report will elaborate on my experience as a student at the THS Kelston Clinic and my planned contribution at the Outreach event at the Free Church of Tonga.
Why do we need the THS Outreach Clinics?
Evidence tells us Pacifica communities face significant health disparities in Aotearoa¹. Pacifica people make up 8% of the population² and have a life expectancy six years shorter than European/Pakeha people in Aotearoa. Secondly, the comorbidity burden is highest among Māori and Pacifica New Zealanders and these morbidities are developed much younger than the European/Pakeha population¹. The bleak statistics illustrate the huge need for the socioeconomic barriers to healthcare to be addressed in our most vulnerable populations. Primary care is unique in that it is the only part of the health system where preventative medicine occurs³. Whether that be immunisations, screening, cessation and follow ups, all these important aspects of preventative medicine fall onto the shoulders of our GP’s and where THS is excelling, is in ensuring that the Pacifica community are at the forefront of preventative health. THS outreach clinics help to address the socioeconomic barriers many Pacifica families face when it comes to accessing health care. By having the outreach clinic at the Free Church of Tonga, it allows for patients to bring their family to a community nexus where there are health practitioners who speak Tongan that are able to connect and form meaningful relationships with them to feel connected to their mo’ui (wellness and wellbeing). Families who engage with the event not only get a full list of their vitals, opportunities to get throat swabs, vaccines and information on screening programmes, but they are also able to get fuel vouchers and food. Pacifica families can leave the THS Outreach clinics with a deeper understanding of their health but also a deeper sense of community.
Where THS is excelling, is in ensuring that the Pasifika community are at the forefront of preventative health.
The results of the THS Outreach Clinics
I was proud to present a figure from the latest THS Outreach report at my GP Symposium illustrating that the proportion of Pacifica families engaging in the Outreach Programmes this year alone has doubled⁴. What these outreach clinics encourage is further engagement of Pacifica people with their primary care practitioner so that topics such as diabetes management and smoking cessation can be discussed further with patients after they have been alerted by the outreach events to see their doctor if necessary. However in healthy patients, the programme allows them accessible ways to get flu vaccines and preventative rheumatic fever throat swabs.
This exceptional mahi is reflected in the many accolades the Tongan Health Society has been awarded5 for the work they have done with their patients, most notably the Prime Minister’s COVID-19 Response Recognition Award and winning General Practice of the Year in New Zealand two consecutive years in a row.
What I learnt at the THS Outreach Clinics
Admittedly, I had not worked closely with the Tongan community in my time as a medical student up until this placement. I began this placement feeling very out of my depth and concerned that I may accidentally be culturally insensitive. Participating in the THS team at the Outreach Clinic I had the privilege of working closely alongside Tongan nurses who were generous enough to teach me some Tongan to use with patients. At the particular station I was working at, my job was to take blood pressure and blood sugar readings. I would greet patients with ‘Mālō e lava mai’ which means ‘welcome’. If they were diabetic I would use the Tongan term ‘suká’, and this would help some patients who didn't speak a lot of English understand why I was taking their blood sugar. To say goodbye to patients once I had measured their blood sugar and blood pressure I would say ‘Alu ā’ which is a way to say goodbye to those that are leaving. Utilising my very limited Tongan helped me better connect with patients and I could see they felt more relaxed around me when I tried my best to share their language. This experience taught me that putting myself in a vulnerable position and trying to learn something new to better connect with patients helps break down the power imbalance between health professionals and patients that we often see in a Western health care setting.
What I learnt in my placement at the Kelston Clinic
During my clinical placement at the Tongan Health Societies Kelston Clinic, I was fortunate to have my own consultation room which meant I was working independently for most of my placement. I was able to gain consent from patients before seeing them, take a history and examination, then make a plan which I presented to Dr Inder after each appointment. Dr Inder would then review my notes, see the patient himself and afterwards would provide me with feedback and relevant teaching. This was incredibly useful because over the weeks I noticed I got more systematic with my history taking and examination skills. I now feel at the end of this placement that I am more confident in building relationships with patients and developing my skills in whakawhanaungatanga. I also feel more clinically competent in my ability to identify red flags and make diagnoses.
Practically, I got very efficient at taking blood sugar levels and managed to get faster throughout the day. I also became very succinct at taking a smoking and alcohol history because I felt more comfortable asking those personal questions with the more patients I met and built connections with. I really valued the inclusivity of the Tongan Health Society’s team, as I felt included and safe to learn which made seeing hundreds of patients a lot less nerve wracking.
Personally, I felt this day was very important for my confidence and competence as a future health professional. I can now appreciate how efficient the outreach programmes are, how culturally safe they are and how they generate a feeling of community which is important in Pacifica culture. The Outreach Clinic didn’t feel like the sterile hospital environment I am used to, it felt like a whanau gathering, a place to be safe together.
I have had the privilege of learning valuable skills from Dr Doherty and Dr Inder in my time at the Kelston Clinic. I have been able to witness and appreciate the immense work ethic and dedication it takes to run a clinic committed to treating Aotearoa’s most vulnerable communities but also the mana required to tackle New Zealand’s inequitable health system first hand through pioneering outreach programmes. I want to personally thank the team at the Tongan Health Society for welcoming me with open arms and aroha and creating an environment conducive to my personal growth as a future doctor.
Consequently, my main takeaway from my time with the Tongan Health Society is that the ‘cure’ is in the community.
Malo ‘aupito and well wishes,
Makayla
References
New Zealand Ministry of Foreign Affairs and Trade (no date) Pasifika New Zealand, New Zealand Ministry of Foreign Affairs and Trade. (Accessed: 04 July 2024).
Jarota, M. (2023) ‘The Role of Primary Care in Preventive Medicine: Promoting Wellness and Early Detection’, International Journal of Public Health & Safety, 8(4). doi:ISSN: 2736-6189.
Tongan Health Society (2024) ‘Pacific Outreach Services Report’. Page 10