Since the Tongan Health Society was established in 1996, it has evolved into Langimalie - a community-owned, Pacific Primary Health Organisation (PHO). Voyages paid a visit to see one its health centres in action.

Since Langimalie became a PHO in 2003, it has built a patient base of nearly 7,000 people. Chief executive Paul Lavulo says the PHO now runs two medical centres, one in Onehunga and another in Glen Innes. He estimates Langimalie’s 38 staff see as many as 32,000 people in a year. Paul can remember far more humble beginnings – one full-time doctor and a collection of doctors and nurses working for free – but says the need for Langimalie was evident from the beginning.
“Tongan people had difficulty going to mainstream providers. Communication was a big problem. Even if they didn’t understand what the doctor was saying, our people would just say ‘yes’. That meant prescriptions weren’t always relevant. So there was a big need and community leaders decided to set up a Tongan clinic. That’s how it started – it was a community-driven initiative from the beginning.”

Affordability of access was a key issue for the Tongan community, says Lee Ahokovi, Langimalie’s clinical nurse advisor. “People could afford our lower cost care. We wanted a clinic driven by community needs which would provide easy access to primary care for our people. Somewhere their language was going to be spoken, because unless you deliver health in a language people understand, you are not gaining anything. It was a culturally appropriate and culturally aware service, which is important because cultural sensitivity is an imperative component of a client’s holistic care.” Langimalie’s growth since then has been spectacular and unique.

“We are unique in that our clinics and PHO are owned by the community, not by doctors,” notes Paul. “That means our first concern is the health of our community. It’s not only about running a business. That’s why we’ve kept our prices very low and affordable to our community.”

Lee is convinced that holistic, community-driven initiatives hold the key to improving Pacific people’s health outcomes.

“We speak their language and understand their culture. We bring an approach that makes a difference. For example, we are running a diabetes clinic here, and we are offering a full range of services such as cervical smears, mammograms and triage services. It is like a ‘one-stop-shop’. This means people don’t have to travel all over Auckland to access these services. We also go out and assist our people with their visits to hospital by interpreting for them.”

Langimalie is involved in a host of health initiatives aimed at engaging Pacific communities. Taniela Lutui and Sione Foliaki run this aspect of the PHO’s activities.

“I’m working on the Healthy Village Action Zone initiative,” says Sione, who joined Langimalie a year ago. “We work with a group of churches to keep our community healthy by organising exercise programmes and promoting health messages and nutrition advice at nights and during the weekends.” Taniela, the public health manager, says Langimalie runs a wide range of health promotion activities – from well child, asthma and youth-at-risk services to mobile, school-based nursing.

“These types of programmes are reaching people who wouldn’t have been reached through mainstream providers. Working through the churches is an example of engaging with our people. We work with their local church, talk to the minister, organise a time to talk to the whole congregation and arrange for our public health team to weigh people, check for diabetes and hypertension. We do a health profile of people attending the church and then tell them the data.”

He says the two major health problems facing the community are obesity and diabetes.

“Now most churches are running two aerobic classes a week. Taking the clinic to the people is helping to keep them healthy and preventing them getting worse. It’s a very preventative approach.”

Taniela and Sione have been encouraged by the community response to these initiatives to date.

"These types of promgrammes are reaching people who wouldn't have been reached through mainstream providers.
Taniela lUtui"

“These are long-term issues, but we are making progress,” says Sione. “We know people are participating, that’s the first hurdle. We’ve set up health committees in 10 churches so that they can slowly take over responsibility for running their own health programmes. We’re building the capacity of these communities.”

There are currently about 50,000 Tongans in New Zealand and 90 percent of them live in Auckland. The Tongan community is growing and has the highest fertility rate in the country, notes Langimalie board member, Dr Siale ‘Alo Foliaki. He believes empowering communities to look after their own health will be essential for the long-term sustainability of services. “The government is going to have to look at other options than funding purely provider-driven initiatives,” says ‘Alo. “Providing more doctors, nurses and social workers is costly. What we need to do is engage our communities as active participants in their own health. That’s why our organisation is unique. We are owned by the community, we’re an integral part of it. Managing community expectations of what we do is hard work and very energy and time consuming. However, when I think of all the church meetings and gatherings we organise, to fund all of that activity would be unaffordable. But it is those people’s involvement which stops their marginalisation.”

Lee Ahokovi says she has found working at the PHO an interesting contrast with her previous role in secondary care.

“We need to bring Secondary and Primary health care much closer together and recognise the voice of the Tongan community on things that will improve the quality of patient care.”
Lee AhokoVi

“It’s clear to me we need to bring secondary and primary health care much closer together and recognise the voice of the Tongan community on things that will improve the quality of patient care. I feel sometimes that [in New Zealand] we develop health policies that do not reflect the Pacific perspectives of health, which includes culture, respect and our values. They are very ‘palangi’. People need to come and hear our voices and experience. We know about our Pacific people. We need more research into Pacific health.” Financial challenges remain for Langimalie, says Paul. “Maintaining our fees, which are among the lowest in the country, means our people can afford access to doctors. But it also means we need support from government. That’s why the government’s recent low cost initiative has helped tremendously. Similarly, we support the idea of pay parity for our nurses but at the moment we don’t have the resources to sign up for that. But we know it’s important to retain our nurses for primary care otherwise all our nurses will end up going to the hospital to work in secondary care.”

"What we need to do is engage our communities as active participants in their own health."

dr siale ‘Alo Foliaki

After spending a morning at Langimalie, it is clear that there’s a great deal of pride in what has been achieved and plenty of optimism for what lies ahead. Lee says the PHO has developed its own way of doing things.

“We do have our own way of running our business. Most meetings are conducted in Tongan and we have a Tongan family prayer at the start of the day. It’s an easy environment to work in. I just feel so good here,” she says.

Paul is determined that Langimalie will have a lasting impact on the health of his community.

“For me, the future is about the health of our people. According to the statistics we are among the worst – diabetes, life expectancy, infant mortality, it goes on. I think, through a concentrated effort, we are hoping to make a difference to the lives of our members. The statistics will tell us whether we are catching up in 15 or 20 years, but that’s what I’m striving for. The health of our community is about reaching out to them every day. Giving them the skills and knowledge that will make a difference to their lives.”.

Making a Difference – Langimalie’s Diabetes Clinic 

Langimalie set up a ‘one-stop-shop’ for diabetes services in Onehunga in 2003. Here Tongan patients can speak Tongan during consultations, listen to Tongan music and relax in an environment where their cultural concerns are taken into account.

Every patient seeing a doctor at the clinic for the first time is given a finger-prick blood sample, which is tested for diabetes. If the blood sugar level is high the clinic does further glucose blood tests. Then a management plan is drawn up according to the patient’s needs, taking a holistic approach. This early intervention combined with the clinic’s computerised recall system enables Langimalie to identify patients much earlier for appointments, blood testing, education and subsequent management of their condition.

This proactive, holistic, culturally-based approach can make a huge difference to a person’s health. In 2002 Mrs X was in poor health – she was short of breath, had back pain and was frequently missing her Insulin. When she did run out of medication, she was using her husband’s medications and insulin instead. She was coughing, smoking, eating too much and was sore. The swelling in both her legs meant she was unable to come and see the doctor and she had started to use oxygen at night.

In 2003 she was referred to Langimalie Diabetes Clinic and after a full assessment was placed on a diabetes management plan. She and her husband, who also has diabetes, were fully educated in Tongan about their condition and its management. Over the next few years, Mrs X felt welcome and comfortable enough to drop into the clinic to discuss her condition over a cup of tea. She stopped smoking within the year. She became a regular member of an exercise class and started exercising every Monday. Her breathing improved and so did her diabetes and her kidney function.

As the graph below shows, her HbA1C measurement (the average sugar level in her body) has fallen over three years from 11% (high) to between 6 and 7% (normal).