Helping across borders

Last month’s South Pacific Nurses Forum in the Cook Islands stressed the importance of cross-border health learning.

By NZNO president Grant Brookes

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NZNO representatives spend time with World Health Organization chief nursing officer Elizabeth Iro (centre). From left, NZNO president Grant Brookes, Pacific Nursing Section chair ‘Eseta Finau, kaiwhakahaere Kerri Nuku and kaumātua Keelan Ransfield. Photo/Abel Smith

“Our country borders should not be used as an excuse not to help each other.” With these words, Cook Islands Health Minister Vainetutai Rose Toki-Brown opened the 19th South Pacific Nurses Forum (SPNF), held in the capital, Avarua, last month.

The conference attracted about 300 participants, including official delegations from the 13 forum countries.

NZNO/Tōpūtanga Tapuhi Kaitiaki o Aotearoa was represented by kaiwhakahaere Kerri Nuku, chief executive Memo Musa, Pacific nursing section chair ‘Eseta Finau and president Grant Brookes, supported by kaumātua Keelan Ransfield.

Many others from New Zealand also participated – from academics to clinicians to leaders of nursing organisations. There were 45 presentations over four days on the theme, Transforming leadership – Nurses as change agents for non-communicable diseases (NCDs) in the Pacific. A strong focus was on the need for nurses to help each other across borders.

The South Pacific comprises nine of 10 countries in the world with the highest obesity rates, threatening a “tsunami” of NCDs across our region. The impacts of climate change were likewise highlighted as requiring regional collaboration.

We were reminded that the causes of these looming health crises also lie outside the borders of Pacific nations.

New Zealand’s and Australia’s multi-faceted role in the Pacific was showcased in a number of presentations. Since 2015, a mobile eye clinic, provided by the Fred Hollows Foundation, has delivered services to more than 23,000 people in Fiji, from nurse-led screening clinics to free spectacles, to cataract surgery and diabetic retinopathy laser treatment.

In the Kingdom of Tonga, support from Waitematā District Health Board (DHB) has enabled nurse leaders to develop and implement a culturally appropriate clinical governance framework.

Co-presenting with Janine Mohamed of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Nuku highlighted the role of Te Rūnanga o Aotearoa in creating an emerging alliance of indigenous nurses in the Pacific and beyond.

Maternal and child health

One day of the forum focused on midwifery and maternal and infant health. Vice-president of the International Confederation of Midwives (ICM) Mary Kirk spoke of ICM’s “twinning programme”, which pairs midwifery associations in high-income countries with those in low and middle-income countries (LMICs). “The benefits don’t flow only one way,” she said. “Both learn from each other.”

Presenters from LMIC island nations reported measures to tackle NCDs and other population health needs, measures that, in some cases, are more advanced than those in New Zealand.

A majority of Pacific countries have already introduced a tax on sugary drinks, while Tokelau has banned sugar-sweetened beverages altogether.

Strong nurse-led primary health care (PHC) and public health services in many Pacific countries have resulted in some higher health coverage indicators, eg vaccination rates, compared with New Zealand.

Presentations on nurse-led NCD clinics in the northern group of the Cook Islands (where there are no airfields and ships may visit once every four months), and in Tonga’s Vava’u group set the gold standard for universal health coverage and “leaving no-one behind”, no matter how remote.

A role delineation project in the Solomon Islands has mapped the country’s PHC services, nursing workforce distribution and workloads, utilisation rates down to clinic level, and current and projected population health needs. A national plan to improve health coverage and health equity, while at the same time balancing workloads and matching the nursing workforce to demand, has developed. New Zealand might benefit from developing such planning capacity.

The very idea of a border between New Zealand and the Pacific seemed to disappear altogether in some presentations. Manukau Institute of Technology senior academic lecturer Metua Daniel-Atutolu presented on a recent student placement in the Cook Islands. This aimed to strengthen students’ clinical and cultural competence to practise among Pacific communities in New Zealand.

Auckland parish community nurse (PCN) Loli Channing described how her role fits with the “healthy village action zone” model of care. This model was developed to align with the values of Pacific peoples in New Zealand. She encouraged conference participants to explore the role of the PCN in their own Pacific nations.

Auckland District Health Board clinical nurse specialist in HIV Sonya Apa Temata presented an approach to health and well-being based on Cook Islands indigenous epistemologies, developed in Aotearoa.

The four days of the forum demonstrated the truth of a quote from the ICM vice-president’s talk, which we would do well to remember: “If I go alone, I may go faster. But if we go together, we will go further.” •

(First published in Kai Tiaki Nursing New Zealand, November 2018. Reposted with permission. Additional coverage held over to the December issue).

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