Māori children are 46 times more likely to be hospitalised with rheumatic fever than Pākehā children. Mana Kidz, a network of dedicated nurses, is working to change that.
The first few weeks back at school are considered one of the “busy seasons” for the Mana Kidz team. Pirihira Puata, a nurse prescriber and one of the team leads at Mana Kidz, says she and her colleagues working in schools across Counties Manukau spend the weeks after summer holidays getting on top of all of the nicks, scrapes, infections and other healthcare issues tamariki have picked up over the break.
“We’ll find all our summer goodies,” jokes Puata (Muriwhenua) of the start of term one. “Skin infections, sore throats, cellulitis, scabies, allergies.”
Running sore throat assessments, doing ear checks, skin health checks and general health checks and prescribing treatments for illnesses and allergies are just part of the huge role Puata and the Mana Kidz nurses take on during the school year. In that time they’ll see over 34,000 tamariki across 85 schools.
Introduced in 2012 by the National Hauora Coalition (NHC), Mana Kidz’s initial purpose was to address the concerning amount of rheumatic fever cases in Counties Manukau – an area with some of the worst rheumatic fever statistics in Aotearoa. In the 13 years since, the programme has evolved into a more comprehensive healthcare service to meet whānau needs. Today, Mana Kidz works to ensure tamariki are able to access no-cost healthcare in a setting that is both convenient and comfortable for them and their families.
Despite their services being centred in schools, the Mana Kidz nurses’ work doesn’t stop when the end of day bell rings. “We do home visits. We treat the whole family, not just the one kid in the school. We work with schools we’re not contracted to, because the siblings are there,” says Dr Rachel Brown (Te Atiawa, Ngāti Mutunga ki Wharekauri, Kāi Tahu, Tuahiwi, Kāti Māmoe), chief executive of the NHC.
“On the weekends our staff are going out there and they’re giving education and information, because often our whānau don’t know what the symptoms are, how serious a sore throat can be, so we’re looking at things that can help the whole family.”
The NHC is a Māori-led healthcare organisation that works with community-connected organisations to deliver health and social programmes in support of health equity for all New Zealanders. Their programmes – like Mana Kidz – aim to reduce inequities in healthcare, particularly for communities that encounter disproportionate negative health outcomes, like Māori, Pasifika and new migrants.
Dr Anneka Anderson (Kāi Tahu, Kāti Māmoe) is a medical anthropologist, associate professor at University of Auckland and NHC team member. Anderson says a key benefit of Mana Kidz is its focus on equity, rather than equality – a focus she says is often misunderstood.
“Equity is about understanding that people have different outcomes and different resources and treating them according to that… Mana Kidz is an equity program, set up to level the playing field so that our rangatahi ideally have equal health outcomes to others.” In short, Mana Kidz addresses resource gaps that can lead to poor health down the line.
With Māori 46 times more likely to be hospitalised with rheumatic fever than European children, and Pacific People over 100 times more likely, equity versus equality is a crucial distinction to make. Counties Manukau is the region that records the highest numbers of rheumatic fever cases in Aotearoa, hence the need for Mana Kidz to operate there.
“In New Zealand 100 years ago, it was white soldiers who were dying of rheumatic heart disease, and the same variables are influencing Māori and Pacific People now: crowding, crap housing and an unresponsive healthcare system,” says Anderson. “Māori and Pacific People are inequitably affected. It’s not genetic.”
Rheumatic fever starts with a sore throat caused by Group A Streptococcal bacteria. If left untreated, or if the treatment given is incorrect, the bacteria can cause rheumatic fever, a delayed autoimmune reaction to the bacteria. Rheumatic fever can damage heart valves leading to rheumatic heart disease. Accurate diagnosis and timely, appropriate treatment all play a key role in avoiding this negative outcome. Mana Kidz works proactively to ensure tamariki have the opportunity to get the right diagnosis, early, and receive the right care.
Since Mana Kidz began, the story has been one of success. In its time, the programme has contributed to a decline in acute rheumatic fever (ARF) cases in the Counties Manukau region. One 2017 paper reported up to a 57% reduction of ARF cases over two years in which the Mana Kidz clinics were operating.
The success of Mana Kidz so far can be largely attributed to the programme’s focus not just on quality care but care that is culturally led by a workforce that reflects the community as well. Nurses working for Mana Kidz speak a variety of languages including English, te reo Māori, Samoan, Tongan and Niuean.
“If there is a language barrier, I ask one of my colleagues to come over and kōrero with me and the whānau,” says Puata.
For whānau in high-risk communities, having nurses and health workers on-site five days a week at school gives them a crucial chance to build a trusting relationship, and allows the care to be more comprehensive when it is given.
“We hire people that live and breathe and speak the languages of those communities, and we train them and develop them so they know these people, they are trusted in these communities,” says Brown. “Those relationships are built on trust, and they’re built on the reliability and integrity and credibility of our teams.”
This trust means the nurses are able to work in collaboration with school communities to ensure whānau feel empowered to take care of and speak up for their own health and wellbeing. “It’s about working with the whānau so that they have their own rangatiratanga to determine how they see their health needs, and that’s really important. It’s really important to be able to give them that autonomy,” says Puata.
Over its 13 years, Mana Kidz has survived on varied funding. It’s not clear what the future of this funding looks like, but with its record of success, the team at NHC and Mana Kidz are desperate to continue their mahi in Counties Manukau for as long as possible.
“It’s been an ongoing negotiation for many years at different levels to try and get funding,” says Brown. “We’re trying to expand it, trying to increase it, we’re looking at pay parity for nurses and our workers.”
“This work is definitely a priority for us and our populations. But is it a priority of the government? We want to make it a priority.”
The Mana Kidz team is full of hope that one day the organisation may get the chance to fully spread its wings. “We want a Mana Kidz at a coordinated national level, supporting local workforce initiatives and development and training in the regions,” says Brown.
Until then, Anderson, Brown, Puata and all the nurses, health workers and whānau support workers involved want to continue helping whānau to lead healthy lives, without the burden of preventable, treatable illnesses.
“When you see the kids that you’ve nursed throughout their school years go off, and then they’re having children, and their children are coming back. That’s such a beautiful thing,” says Puata.
“Working with our kura, our mainstream schools, our kids and our whānau and the staff of the schools as well, they become your family. It’s all about that.”
