Abstract
This study offers insights into the user-perspective of health provision in rural Aotearoa New Zealand and provides suggestions to ways in which practical community-driven, local level as well as systemic level change can be made to improve the health outcomes of rural Pasifika. Migration from Tuvalu to Aotearoa New Zealand is a part of a Pacific-wide phenomenon that has gained significant momentum since the early 1970s. Aotearoa New Zealand is now home to almost 5,000 Tuvaluans, including new migrants through to third generation Aotearoa New Zealand-born Tuvaluans. These new migrants face numerous challenges in learning new systems of education, social services, housing, and health. As a minority population within a minority (Pasifika) population, the health experiences of Tuvaluan-Aotearoa New Zealanders have thus far been enveloped into the broader experiences of Pasifika across Aotearoa New Zealand.
This qualitative research project explores health and well-being among the Tuvaluan population in the rural North Otago town, Oamaru. It is the permanent home to almost 4000 Pasifika, including 187 Tuvaluans. Rural Tuvaluans experience the Aotearoa New Zealand healthcare system in a markedly different way to urban-dwelling Pasifika. A community-based approach and the photovoice method were used to encourage Tuvaluan participants to share their stories about their pursuit of “ola lei” (good health) in their new chosen home. Four men, thirteen women, and seven talafou (youth) were brought together in a series of four separate reflection sessions that allowed participantsto bring their health experiences to life. These reflection sessions served as an empowering and advocacy space where participants laughed, learned, cried, and offered suggestions for change. This study found that the Tuvaluan concept of health and wellness differs not only from Western modes of thought but also from other Pasifika communities. The ways in
which Tuvaluans see and interpret health have a major impact in how they understand and act upon health information. The results of this study indicate that rural Tuvaluans are experiencing many of the same health challenges as other Pasifika populations in Aotearoa New Zealand. Their rurality however, and their specific Tuvaluan approach to health and wellbeing, can serve to intensify already existing health and socioeconomic inequities. At both primary and tertiary levels, the Aotearoa New Zealand healthcare system is in largely failing to respond to the pressing health issues faced by rural Pasifika.
Local and national recommendations stemming from this study include the recognitions that rural Pasifika face different challenges to urban-dwelling communities; improved processes for specialist health care in rural communities especially for mental health, prenatal care and delivery site choice, diabetes and dialysis support; integrated shared care plans that are understood and lead to effective self-management; using the strength of existing Pasifika community networks to push culturally and linguistically relevant health initiatives that involve community at every stage; and pushing the boundaries of health funding so that community needs are fore fronted rather than those of the funder. Lastly, this study calls for the revolution of the provision of health care as a whole: embracing difference, promoting holistic approaches to health, prevention, and management of illness by embracing the power of Pasifika communities through innovation and partnership.