Managing financial costs

Cost is another one. So, you know, I often say to my palliative patients, ‘So you know how you used to book in, and you used to have to turn up at a certain time? Now we’re in a space where I’m going to allow you to come in whenever you need to. And there’s no cost to that.’ So, I try to, when they’re in that phase, make it easy, and then [say] ‘When you can’t come in, then I’m going to come to you.’ We’re not hard into that, but like I don’t make the GPs do that, but I, being the Medical Director, I like to lead by example. And I also am looking when hiring people, for that aroha. So, you actually have to be a special person to work in here because it is not for everyone. So that’s what we’re trying to attract; a kind, caring, empathetic, good communicators, understand kaupapa Māori. So, if you’ve got all of that, you’re probably going to end up treating and caring for your palliative patients similar to what I, what I do.

Well they need to know who their GP is. They need to be connected to that person. I think in this day and age people are flitting and floating, they’re not connected because they can’t afford to go to the GP so that’s a real government, political issue isn’t it? So, because if they can’t afford to go, they don’t know who they are, how are they meant to get the support? So that’s a really big barrier. So, connecting them to their GP where… it doesn’t have to be a Māori GP, but maybe they’ve got a Māori ngākau. [A caring heart] is really important because they can understand that whānau a little bit differently, and without judgement... so what I mean is having a heart, a heart of Māori just being like understanding the Māori world. So that they know, and most of the time like we’ve got some GPs at [name of medical centre], who aren’t Māori, but they’re very- got at Māori ngākau. You’d think they’re Māori because they’ve worked there so long, and they’ve been born and bred into this culture of [name of place] that they feel like they’re Māori and they know exactly in their eyes how they want to treat somebody.

To do with the illness or their needs, sometimes if we feel comfortable with one another… the one question I might ask carers and whānau, and our tūroro [patient] is, ‘In this time and moment, currently on this day, what’s the most important thing?’ They will come up with all sorts of things. Because I know when you’re being open, asked an open question immediately you’re thinking ‘what are they asking me?’ So, they might think of all those things that feel real. And it might be things like housing and financials and food, and where we can get a mirimiri [massage], and transport and [about] the power bill, and the doctors’ bills. And then gently you can start to get into how the illness is actually affected their lives, or where there’s journey’s come from, or where’s its going… Yeah and I tend not to ask invasive questions. I tend to let them feel their way until we’re both comfortable with each other.

How do they travel? How do they get there? I mean we’ve got the hospital bus but that’s not suitable for some people. I mean… we’ve still got metal roads, windy roads and yeah so some have to come across on the ferry from [place] to come down so.

...so that’s one of my roles as well, is making sure that they can get down [to health services for treatment] and how are they going to come? Or [I] book them on the bus and we’ll make sure they’re booked on the bus… [A] lot of health professionals say, 'oh well we’ve got to maintain their independence and let them do it.' I said 'no sometimes you got to guide them. You’ve actually got to guide them, step by step. Be there with them, and once they’ve got it, they’ve got it. They can do it themselves; but sometimes they’ll just say ‘oh well you can just [say to the family] here’s a number… ring them, catch the bus’. But some whānau can’t do that yeah. I had a patient and, oh for some of them, not just one, I’ve done it for quite a few, that have had to go to [health facility in the city]. So, what I do is I write it down step by step; each day, what time, you know, what time you’ll catch the bus here. Where do you get off? Where you’re going to from there like to the [cancer clinic]. So, what time you’ll get there. And where do you go to from there. So, you’ve got to do it step by step. Each little step you’ve got to write it down.... Yeah and that’s just [to] reassure them… then they feel quite comfortable; they feel, a bit safer to know exactly where they’re going to be at what time even, yeah.