HAUORA KAIMAHI IN THE TAIRĀWHITI

We continue our travels around Aotearoa New Zealand, meeting each region’s Diabetes Community Coordinator. In this issue, we meet Hēmi Houkāmau, our hauora kaimahi for the Tairāwhiti region.

Suddenly needing to move house was the event that forced Hēmi Houkāmau out of retirement and back into fulltime employment. Having already celebrated his final day at work, he was served with a 90-day notice to vacate. His landlord wanted to sell up, so Hēmi had no choice but to go in search of a new home. However, with Gisborne’s housing crisis and sky-high rents up there with Wellington and Auckland, he quickly found his ‘Super’ and part-time job just wasn’t enough to get by on.

He says he stumbled on the Diabetes Community Coordinator role early in his search for a fulltime job. ‘In my past life, I’d been a facilitator of academic and pastoral care for tertiary students. That helping people thing appealed to me and I applied. Lo and behold, I was offered the position.’

A carpenter by trade and teacher by profession, Hēmi taught at both primary and tertiary level before he chose to return from Wellington to his city of birth, Gisborne. He was whāngai (adopted) as a pēpi, leaving the region when he was just a young child. Hēmi says he is pretty sure both of his mothers had diabetes. ‘I don’t know if I’m predisposed to diabetes, but if I’m not then certainly my previous lifestyle would’ve contributed to me being prediabetic.’

A man of many hats, one part of his role involves running the Diabetes Self-Management Education (DSME) programme; a free six-week course for people who have recently been diagnosed with type 2 diabetes. Each twohour session covers everything you ever wanted to know about the condition and is supported by a team of four clinicians: a dietitian, a pharmacist, and two lead diabetes nurses.

‘I imagine my role as a facilitator or as a Kaiāwhina – the person who prepares the programme, until clinicians come in to explain the finer details of diabetes, and its complications, to the attendees.’

As the weeks go on, Hēmi notices people becoming more comfortable with each other. Whereas at the start of the course, some people hold back asking questions – he reassures them that the only silly question is the one you never ask because you’re worried what others might think. He notices that it’s not long before someone pipes up, following a leftfield question, saying ‘I wanted to ask that question’.

No matter how intimate or curious the queries, Hēmi says the team is able to handle them with aplomb.

Hēmi freely admits it wasn’t a smooth beginning when he started last August. Not coming from a medical background, he says he felt the pressure of the new role. ‘I’d done the training, but still I felt way out of my depth in terms of diabetes knowledge.’ But as he continues to understand diabetes as a condition and make more connections within his community, he says things are now falling into place.

Patients are referred to him from a number of areas – medical centres, the extended care team, and even self-referrals brought to him by word of mouth. The courses are run during the day as well as in the evening to accommodate as many people as possible.

8351 SQUARE KILOMETRES

Hēmi has a huge geographical area to cover. It is a region with many people in need but also with too few medical professionals to service the area. Many regions were isolated before Cyclone Gabrielle came to visit, and her aftermath still makes travelling from one area to another a challenge. Hēmi’s patch runs from Pōtaka in the north to Muriwai in the south, heading inland to Tiniroto, then across to Mōtū, with everything in between. And of course, there’s Gisborne city with a population of 37,000. Naturally understated, Hēmi says it’s going to take a while.

Although a solo role, Hēmi has connected with Kasey Brown, who works for Ngāti Porou Hauora as their diabetes coordinator for the East Coast. ‘We’re committed to collaborating with one another and trying to ignore any political boundaries that might exist.’ Hēmi says that Kasey has pulled together the numbers of people living with diabetes on the coast and that they are frightening.

‘I’m taking one day at a time, rather than trying to save the world tomorrow.’

SUCCESSES AND FRUSTRATIONS

Hēmi has seen many examples of people who come to the programme and admit to leading a lifestyle that is not consistent with keeping diabetes at bay. Inevitably, by the time we’re middle aged, a particular lifestyle is well ingrained and it can be difficult to change patterns.

He says he will come across more than a few people who are in denial. ‘The thing is when people took at themselves in the mirror, and they look fine on the outside. That gives a false impression of good health. They don’t have any hakihaki (rash) on their face, they’re not coughing constantly, and they believe that what they’ve been eating and drinking for the last X amount of years has not done any real damage. That is until they start to lose some sensation in the feet. Or until their vision goes blurry. Or until they have renal problems.’

Isolation plays a part too, with people living away from whānau and falling into bad habits. If there is no one in your home to support or monitor you, you can basically do what you want. There’s no outside voice encouraging you to put that fizzy drink down. ‘I can think of one person at the moment who’s not making any attempt, and if it continues there’s going to be a tangihanga (funeral) soon.’

Hēmi says, ‘It doesn’t make sense. Why would you not try? Trulicity is a wonder drug for weight loss, yet some of our people haven’t been to pick up their repeats at the chemist. And it’s subsidised. Not like it’s costing an arm and a leg. It doesn’t make sense. We’re trying to help, but they’re not doing a lot to help themselves.’

He says it’s frustrating when he knows there’s a real need out there.

‘Some people are screaming out for help and here we are spending an hour at someone’s house who couldn’t give a toss. But our boss reminds us to at least be trying everywhere we can to help people manage their diabetes.’

At the end of the day, Hēmi’s job is to share the information on how to self-manage diabetes. ‘If people take it on board, great. If they don’t, there’s not a wretched thing we can do about it.’

EVERY LITTLE CENTIMETRE OF IMPROVEMENT

But Hēmi has also encountered many successes: people who have made positive changes. He has seen people make healthy changes to their diet, lose a substantial amount of weight, and go from doing no exercise at all to walking around the block two times a day.

Another of the hats that Hēmi wears is that of a Health Coach for Pinnacle, a Primary Health Organisation in Tairāwhiti region. In this role, he continues to engage with attendees from past programmes, checking in with them once they’ve completed the DSME course. He gets their consent to phone, text, or even pop in to see ‘graduates’ from time to time. He has a grand plan to pull them all together at the end of the year and celebrate achievements attained, no matter the size. ‘The celebration for me is when people make the decision to learn how to manage their diabetes and understand as much as they can about their condition.’

After his first DSME course finished, he asked the participants for feedback. ‘Listening to the progress they’ve all made and how much they’ve appreciated the programme, I have to say that I got quite emotional.’

NŌ HEA KOE? (WHERE ARE YOU FROM?)

Being whāngai and raised far from his birthplace, Hēmi says there’s a barrier that often comes up when meeting fellow Ngāti Porou. ‘I was at the RSA, and this guy asks me “where you from?” I said I’m from here. He looked at me and said, “No, you’re not.” I said yes, I am. He says, “Where were you born?” I said here. He’s says, “How come I haven’t seen you?” I said, we moved away when I was just starting school. He says, “Where did you go to school?” I said Wellington. He says, “Oh, you’re not from here, you’re only born here.”

Hēmi says that cut deep but that he understands where he was coming from. ‘If you’re not that snotty-nosed, cheeky little brat that everyone knew as a youngster or the guy who used to play wing for a rugby club or the one that got arrested for growing dope, then it’s really hard to crack those communities.’

He says the benefit of the DSME programme is obvious but, because no one knows him, it’s an ongoing frustration. ‘The Houkāmau name is known the length and breadth of Tairāwhiti. But that doesn’t matter diddly squat. So, there is this mistrust – “who is this guy again? Who knows him? Where did he go to school? Who are his parents? Does he have any kids?” All this kind of stuff. If you can’t make any real connection that’s more than 15 years old, then it’s really difficult.’

‘For years I’ve anguished that this is where I should’ve grown up. It was my whāngai whānau that took me down to Wellington.’ But Hēmi refuses to let it get him down. ‘You can’t let it become baggage. I refuse to carry it around with me. If I do, it’ll weigh me down.’

Hēmi says he is committed to seeing out the rest of his days in Tairāwhiti. ‘All my kids are in Wellington. All my grandchildren, and my great-grandchildren. I’ve told them, I’m never coming back to Wellington. I’m going to die up here. With all the highs and lows, this is where I want to be. This is where I should’ve been my whole life.’

When asked how long he can see himself in this form of mahi, he replies, ‘I’ll probably work until I’m 70 and then hand my keys in.’

BROADER APPROACHES

For Māori, there is still a residue of mistrust of Western medicine, so Hēmi is happy for the content he runs to not be the ‘be all and end all’. He encourages locals to locate and use rongoā Māori – traditional healing that encompasses herbal remedies, physical therapies, and spiritual healing. But it needn’t stop at local healing, he says. It can be from any part of the world.