Mana Tū
A new study aims to help Māori living with poorly controlled diabetes improve their health.
People with poorly controlled diabetes have a significant impact on the hospital system, often presenting with complications. A staggering 80% of them are Māori or Pacific Islanders, according to health researcher Dr Matire Harwood.
Dr Harwood is leading the Mana Tū study that uses kaimanaaki-whānau (community champions) to help people with diabetes achieve better control.
The project came about, explains Dr Harwood, because it was clear from previous studies that things like poverty, housing, and a lack of engagement with the health system were affecting people’s ability to take charge and live a fulfilling life with type 2 diabetes.
Evidence from work done overseas with indigenous communities shows that case managers working within primary care practices could have a positive impact on these patients.
Members of the Mana Tū kaimanaaki team from left clockwise: Taria Tane (network manager), Janine Thomas (health psychologist), Kimiora Hawkins (kaimanaaki at Whangaroa Health), Ngaraiti Rice (kaimanaaki at Otahuhu Health Centre), De Ann Nicholls (kaimanaaki at Papakura Marae), Richard Cooper (kaimanaaki at Papakura Marae) and Laura Broome (research manager).
A 12-month trial is currently operating in five GP practices – four in Auckland and one in Northland. The case managers, who are called kaimanaaki-whānau, work as clinical ‘champions’ in each practice to identify people with poorly-controlled type 2 diabetes. They recruit them to the study and work with them and their whānau for 12 months to help them take control of their diabetes.
Currently, patients with poorly controlled diabetes are often left to their own devices, getting no more support than three-monthly GP visits. Doctors often struggle to get patients engaged, or to even attend appointments.
People with an HbA1c greater than 65 are the ones who are going to end up on dialysis, blind or with amputations, says Dr Harwood.
So what do the kaimanaaki do once people are on board with the programme?
There will usually be group education to start, says Dr Harwood. Then, they’ll discuss each person’s needs.
“We’ll ask what are the things that are going to help you take control of your diabetes?”
The answers vary from person to person. Dr Harwood shares some examples:
“Someone would say it’s all good telling me to cook healthy kai, but my kitchen is rubbish, I don’t have a functioning oven. So the group went to the person’s house on a weekend and cleaned up the kitchen. Then they worked with the local supermarket to get it stocked with spices to cook healthy food.”
For others, exercise was a challenge, but not in ways we might expect.
One woman said: ‘I’m too ashamed to go out and exercise because everyone makes fun of me being so fat’. So the group organised for a donated bike to be set up on a rotator system in her house, like an exercycle. She lost 50 kilos and is now happy to get outside and go for a walk.
It’s this kind of empowering approach that can have lasting impact, believes Dr Harwood.
She hopes the project will provide proof that this type of programme works, and that in the future it will be funded through primary care.