Ma¯ori cancer navigators pave the way
Emotional and practical support for patients overcomes issues of trust and access, writes
Afriendly face, a good listener, and support from someonewho knows the system and the culture could be the key to stemming shocking cancer mortality rates for Ma¯ori.
Massey University researcher Monica Koia says all Ma¯ori should have access to Ma¯ori cancer navigators, a service first introduced in New Zealand in the Midcentral District Health Board region.
Chrissy Paul is one of four navigators in the district, based at Te Wakahuia, one of the iwi health providers contracted by the board. ‘‘It came about because our board wanted to reduce inequalities for Ma¯ori with cancer.’’
The statistics show that despite being only 20 per cent more likely than the rest of the population to be diagnosed with cancer, Ma¯ori are twice as likely to die from it.
‘‘For some people the first time they get cancer is the first time they have been to hospital,’’ said Paul.
‘‘We tend to be mistrusting of health systems, of most systems, because we have not done very well in them.
‘‘People just don’t go to appointments, because they don’t ask for help.
‘‘They are too scared to call the doctor because they don’t want to hear what they have to say.’’
Paul, who often drives people to appointments ormeets them there, said that sometimes her assistance was a short, simple intervention.
In one case, she was asked to contact a 21-year-old man with testicular cancer who had failed to attend two appointments.
He had already explained he could only get time off work to go to Palmerston North Hospital appointments on Fridays.
Within a couple of days, he was given a Friday appointment.
Paul said therewas now a regular contact person at the hospital who would manage those sort of booking requests.
She said there were a lot of reasons why Ma¯ori did not keep appointments, and the sorts of jobs they had, and their wha¯nau’s dependence on their income, meant dealing with cancer was not always their top priority.
Paul hasworked with another Feilding patient, Prim Wikaire, for three years.
She has had cervical cancer, bowel cancer, and breast cancer, twice.
Paul said Wikairewas a strong and capable woman in her 60s who was a role model for others.
Two years ago her husband John was diagnosed with cancer, and his asthmawas so bad that surgery was out of the question.
And so Paul has been supporting her to support her husband through a terminal illness, which claimed his life two weeks ago.
Paul said cancer had taken a terrible toll on Wikaire’s family, with several relatives dying even during the period they had been working together.
Koia said her research showed patients who used the navigator service gained significant benefits.
The trusting relationship helped make the range of healthcare services they dealt with less daunting.
Koia said the reasons for higher Ma¯ori death rates from cancer ranged from late diagnosis, delayed access to treatment, and transport challenges getting to services.
A Feilding woman who asked to remain anonymous said Paul had been a practical and emotional rock through her cancer treatment.
She has breast cancer, which has spread to her spine.
‘‘Therewere a lot of oncology appointmentswhen I only focused on certain things, like ‘terminal’. There were times I was too scared to ask certain things.’’
But Paul would be her shoulder to cry on, to remind her the doctor had explained there were things they could do to help her live longer, and better.
She also supported her through the tragic loss of her daughter who took her own life as her mother struggledwith a devastating cancer prognosis.
Koia said the navigator initiative needed to be better resourced around New Zealand if the health system was to adequately address inequalities for Ma¯ori.