Pacific citizens: Though 50 years ago there was not much contact ...

Pacific Cooperation Foundation: Just as the Asia 2000 Foundation was ...

Tackling Pacific Island problems from within the Parliament: Strategic thinking about ...

The agenda: THEN: Social issues were important ...

Improving partnership: There is a need to revive the Pacific Islands ...

Tackling blindness among Pacific peoples: Tongan public health specialist ...

HIV AIDS - moral and medical solutions: Public health and other policy planners...

Tongan job solution: Managed employment is a Tongan New Zealander's private ...

The new tertiary landscape - what's in it for Pacific peoples?: Education is ...

Making good citizens: In our Pacific region, and elsewhere in the world ...

Involving Pacific peoples in local decisionmaking: The question all New Zealand ...

Tangata Pasifika? Michael Powles, who has worked ...

Endorsing good governance: Former New Zealand career diplomat Gordon Schroff ...

Need not be conflict: Issues in Pacific governance - where one size does not ...

Cooperation wins: Greater regional cooperation on common issues might ...

APEC and PECC: Though New Zealand seeks to be a good international ...

Advocacy on market access: The Pacific Islands Trade and Investment ...

Being Pa'alagi: The Being Pa'alagi programme, in which I looked back ...

Collaboration key to achieving vision: The vision of the Ministry of ...

Talk to all pacific cultures with one voice:
Ethnic Communications

Tackling blindness among Pacific peoples

Tongan public health specialist Dr Sitaleki Finau talks with Anthony Haas about comprehensive policies for addressing pressing health problems – from blindness prevention to HIV AIDS prevention.

Political will

The agenda of New Zealand’s associate minister of Pacific Island Affairs, Taito Phillip Field, includes the huge question of diabetes, of preventable illness that confronts our communities.

It is really sad because it can be avoided. We can make a big difference if people really understand changes of habits, or diet, or smoking, says Samoan-born Taito Phillip Field, the first Pacific Island MP in the New Zealand Parliament.

Luamanuvao Winnie Laban, the first Samoan woman MP in the NZ Parliament, and Associate Minister of Health Ruth Dyson, have been championing New Zealand’s Pacific Peoples Blindness Prevention Initiative (PPBPI), which seeks to pilot a community-based solution at Auckland’s Langamalie Health Centre, owned and run by the Tongan Health Society Inc.

Dr Finau, CEO of the Tongan Health Society Inc, is also Professor of Public Health and Head of the School of Public Health and Primary Care at the Fiji School of Medicine, on leave without pay from the Department of Māori and Pacific Health at the University of Auckland medical school.

The Tongan Health Society is lead Pacific provider in the PPBPI initiative. It has followed the national notion of integration and equal partnership with other providers to create a model for dealing with diabetes and what arises from it.
The Tongan Health Society Inc is a community based and controlled health initiative for all New Zealanders.

Public health responsibility

Dr Finau says the notion of lifestyle diseases puts the onus on the individual. It assumes that, if only the individuals were more responsible, they could easily change their lifestyle. “Current knowledge is that the individual’s action and behaviour are determined by the system they live in,” he says. “For example, if you are poor you eat fatty foods. It is the cheapest calorie you can get. It is the poverty that is the problem.

“ Poor nutrition is more a systemic rather than an individual problem. So the notion of lifestyle diseases perpetuates the view that the individual is responsible for what they do. It is also counter-intuitive to the way Pacific peoples think about lifestyle.

“ Lifestyle is not an individual thing for Pacific peoples. For them it is a family, community, national way of thinking.”

Individual diseases – system problem

Unemployment, poverty, housing, lack of transport and access are some of the determinants of the health status of the people and their ability to access and use the services available in New Zealand.
Dr Finau says research shows Pacific people’s risk factors for developing diseases are greater than the average New Zealander. The magnitude of illness is higher as well. But the use of health services is lower than the average New Zealander. Unemployment and poor access contributes to those who need care most getting the least care.

Of the all the non-communicable diseases, diabetes is the one that has been underplayed.

Diabetes is a failure of the body’s systems, not a single individual problem. Diabetes flourishes in an environment that fosters people getting fat.

Meeting Pacific needs in New Zealand

Dr Finau says recent studies show that 80% of the blindness amongst Pacific people is due to diabetes.

“ Diabetes and blindness are system problems and need a systemic approach. The search for a solution needs to be integrated between the various organisations that can prevent blindness. That is a “must” says Dr Finau.

He says “we” need to address prevention of diabetes, because it has a roll-on effect. “We need to manage the root cause of diabetes, including making appropriate food and safe exercise environments available.”

Dr Finau does not understand why there is not an agricultural policy in New Zealand to address the production of Māori or Pacific Island food, so that it is cheaper than the more refined foods. Address the notion of poverty and purchase of cheap food. Make less diabetes- generating foods cheaper.
Traditional Māori and Pacific Island diets are less conducive to diabetes than those that are fat or calorie intensive.

Recent studies, including in Tonga, show that people have got the message that they need to eat healthy foods. But they lack the resources to implement the knowledge. Fatty food is all they can afford in relation to their income.
Some Island countries use tax and import barriers to say, ‘don’t send us the fatty foods’. So the fatty mutton and turkey tails are stopped. But the people turn to other fatty foods available such as fatty pork and chicken.

“ Fat is fat regardless of source and is dangerous in many forms,” says Dr Finau.

The Langamalie model

There has been an assumption in NZ that one model fits all, he says.
What the Langamalie model is doing is showing the delivery mechanism that has worked in one situation. Given a chance it can deliver the technology for delivery of blindness prevention.

Langamalie invests more in nurses. Many of the things doctors do are not needed, says Dr Finau. Nurses and community health workers can do these and do them better. This would be cheaper than the existing model. For example, in monitoring diabetics’ eyes nurses can take photos of the retina. Then the ophthalmologists can sit in their offices and diagnose.
Langamalie takes the technology to the people, without compromising standards, rather than taking people to the technology.

Partnerships

Langamalie does not have resources to do these things by itself, so it seeks equal partnerships with decision-making processes where all are involved. The rest is technical. Dr Finau says technical issues to deal with blindness are not innovative – the innovation is with the delivery mechanism and addressing access.

We need partnerships with technical organisations, and the community. We need services to be community-driven and thus get understanding of their needs.

Persistence

Auckland Tongan Advisory Council president, Melino Maka, says tools for blindness prevention should include video and radio – media that can penetrate the masses.

Use a simple message and key Pacific leaders to deliver it, he says. Feature Tongan church leaders, people with sports profile and medical people that have connections with the people.

Get the video with its supportive message in front of target audiences in places such as the Tongan churches – firstly seeking support by providing leaders with information on the potential benefits of the campaign.

The way the message is delivered may determine whether Pacific Islanders attend as much as pa’alangi for eye checks.

“ In the last six months I have demonstrated loss of 20 kilos”.

Sometimes people just talk about diabetes and other health issues.

“ You have to walk the talk,” he says.

Find out more!

Eseta Finau
Email: [email protected]
Tongan Health Society
29 Hill St, Onehunga, Auckland
Tel: 64 9 636 3629
Fax 64 9 636 3229

Published 3rd qtr, 2003

Watch this space!

“If you are poor you eat fatty foods. It is the cheapest calorie you can get. It is the poverty that is the problem.”
Dr Sitaleki Finau

Diabetes is a failure of the body’s systems, not a single individual problem. Diabetes flourishes in an environment that fosters people getting fat.

Nurses can take photos of the retina then the ophthalmologists can sit in their offices and diagnose.

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