NATIONAL PASIFIKA MIDWIFERY CO-ORDINATOR maternity care for Pacific non-residents

In March, Pasifika midwifery was invited to present at Moana Connect’s “Pacific Child Wellbeing” conference in Manukau, Tāmaki Makaurau. Moana Connect is an independent Pacific research group, committed to capturing the voices of Pasifika families and communities, for positive change. At the conference, they also released their 10-year action plan “Tamaiti ole Moana 2033”.

It was an empowering Pasifika space with panels of politicians, clinicians, researchers and consumers, all sharing their thoughts, findings, dreams and aspirations. Our breakout session was on “Protection and Autonomy”. It was a tall order to deliver an engaging, meaningful and thought-provoking 15-minute kōrero.

Elani Mafi, a proud Tongan LMC who works in South Auckland, was my copresenter and our presentation was titled “Midwifery - waters of protection”. We used an analogy between a midwife and amniotic fluid - both protective of the whakapapa of whānau. The reference to water also acknowledged our deep connectedness as Pasifika peoples to the moana.

I gave a whistle-stop tour of midwifery autonomy in Aotearoa - highlighting the opportunity of self-employment, and the real gem, continuity of care with a named carer - Elani’s true passion. The approach was a talanoa, defined as an open and informal discussion, and also an established Pacific research methodology.

Elani shared her love of whānaucentred care, and the moment became overwhelming. Her tears flowed as she recounted a collective story of non-resident pregnant wāhine, of predominantly Tongan and Samoan descent, whose journeys have multiple barriers. They are not entitled to free maternity care and have difficulty finding a midwife, as many want payment upfront. They encounter stress when navigating a foreign system and the financial burden can lead to limiting costly investigations like scans and blood tests. Their care is being compromised due to fiscal pressures and the joy of having a baby is often overridden by anxiety, with the anticipation of an invoice from Te Whatu Ora.

Elani’s account was humble, considered and unrehearsed. She was emotional and whakama raising the topic and exposing herself and our people. She provides midwifery care at no cost, as many midwives do - a selfless act and one that Elani had wanted to remain hidden, yet having the intention to raise this plight.

The eligibility criteria for non-residents is presented in a 6-page document on Te Whatu Ora - Health New Zealand’s website. It reads in plain English, that belies the complexity, emotion and unfairness. Aotearoa’s Pacific neighbours fill workforce shortages that contribute to Aotearoa’s economy, and their mere presence embellish the fabric of the country’s society. A review of their eligibility status is warranted. Pacific workers’ responsibilities often go beyond these shores, to across Te Moana-Nui-a-Kiwa to whānau who are financially dependent on them.

Aotearoa taxpayers bear the financial burden of non-residents’ debt, with the largest being Tāmaki Makaurau based Te Whatu Ora. At the time of writing this, I was unable to find itemised costs and therefore could not distinguish actual debt for Women’s Health. Interestingly, the Cook Islands, Niue and Tokelau, known as New

Zealand Realm Nations, qualify to receive Aotearoa citizen entitlements under this jurisdiction. Citizens of these nations are transferred to Aotearoa for acute medical episodes.

At the conclusion of our presentation, the Q & A session drew out experts in the audience who shared their experiences of supporting non-residents within the industry and personally for whānau. Due to necessity, they had doggedly discovered alternative routes to satisfy authorities. Such is the richness of talanoa - an open and informal discussion. Kia manuia ~ malo aupito. square

Mana

When you flow through my body I know

I am caught in the current of a river Larger than the length of my own lifetime

It bends where we have all been before same rapids other waters our veins my blood I know

I am in the flow of something greater than my own self

AMELLIA KAPA REGISTERED MIDWIFE