New Zealand: Starship community health Katie Martin January 2018

POPULATIONS PRACTICUM OBJECTIVES 1. Use evidence-based practices, health care technology, and effective communication strategies to guide the essential public health interventions throughout childhood. 2. Use data from pediatric population assessments to identify the influences of the determinants of health (environmental, social, political, legal-ethical, economic, behavioral, and cultural) on delivery of care to the pediatric populations. 3. Assess the health status, health care access, and emergency preparedness needs of the pediatric population in Auckland. 4. Participate with healthcare providers and community leaders at Starship Community in the planning, implementation, and evaluation of health interventions. 5. Collaborate with healthcare providers and community partners at Starship Community to promote clinical prevention and pediatric population-focused health. Apply knowledge from nursing and related arts and sciences to the care of selected community based aggregates.

AUCKLAND, NEW ZEALAND A country in the southwestern Pacific Ocean consisting of 2 main islands (A brief history, n.d.) New Zealand Population ~4,500,000 people (World Population Review, 2018) Auckland Population ~1,400,000 people (World Population Review, 2018)

BACKGROUND INFORMATION The Māori were the first to settle in New Zealand before being joined by Europeans in 1642 (A brief history, n.d.) Many health disparities exist among the Maori and Pacific Islanders compared to the European population due to many of them living in over-crowded government housing areas and being less educated Fortunately for these individuals, the health system in New Zealand has been mostly government funded since the early 1940s, and public funding currently accounts for 83 % of total health-related costs (Gudsell, 2015) Top 5 Childhood Health Issues (Ministry of Health, 2018) 1. Childhood obesity 2. Delayed development 3. Asthma 4. Emotional and/or behavioral issues 5. Rheumatic Fever

STARSHIP COMMUNITY A public health service available to high-needs and high-risk children and families Funded by the Auckland District Health Board (ADHB) “Starship Community is a multidisciplinary team of professionals providing nursing, allied health, technical and cultural support to children, young people and their families living within the Auckland DHB area” (Health Point, 2018)

RHEUMATIC FEVER Rheumatic Fever is a serious illness that is common in New Zealand among the Maori and Pacific Island children ages 4-19 It begins as Strep Throat that is left untreated; the Strep bug travels through the bloodstream and can lead to damage in the heart as well as swelling and pain in joints (Heart Foundation, 2016) It is highly likely that a combination of crowded housing conditions and socio-economic deprivation, barriers to primary healthcare access and untreated strep sore throat infections lead to higher rates of rheumatic fever among Māori and Pacific people (Ministry of Health, 2017) RF in the United States RF among Auckland Europeans RF among Maori/Pacific Islanders 0.005% of the population 0.1% of the population 3% of the population

INDIVIDUAL-LEVEL INTERVENTIONS PRIMARY Starship Community educates high-risk children and their families during their well-child assessments about how to prevent Rheumatic Fever SECONDARY Performing health assessments on individuals suspected to have Strep Throat or Rheumatic Fever as well as teaching the parents what signs to look out for (fever, painful joints, and skin rash) (Heart Foundation, 2016) TERTIARY Starship Community provides Penicillin injection to all individuals diagnosed with Rheumatic Fever every 28 days for either 10 years or until the child is 21, whichever is longer (Heart Foundation, 2016)

COMMUNITY-LEVEL INTERVENTIONS PRIMARY Starship Community goes into the schools and provides education about the importance of frequent hand hygiene as well as the importance of coughing into your elbow SECONDARY Starship Community performs school-wide throat swabs throughout the school year to screen for Rheumatic Fever TERTIARY Starship Community provides education to children and families affected about the importance of maintaining a healthy lifestyle to prevent the recurrence of Rheumatic Fever including not smoking, managing their weight, and eating heart healthy foods (Heart Foundation, 2016)

SYSTEM-LEVEL INTERVENTIONS PRIMARY The ADHB provides Starship Community the funding and resources necessary to provide education to the public about what Rheumatic Fever is and how it occurs SECONDARY The ADHB provides Starship Community the funding and providing resources Performing school-wide throat swabs throughout the school year to screen for Rheumatic Fever (Heart Foundation, 2016) TERTIARY The ADHB has the policies in place that require Penicillin injections be given to all individuals with Rheumatic Fever every 28 days for either 10 years or until the child is 21, whichever is longer, and this is not optional (Heart Foundation, 2016)

CONCLUSIONS The work being done by both the Auckland District Health Board as well as Starship Community is very important to the pediatric population in Auckland Because Rheumatic Fever begins as Strep Throat, it can be prevented by taking caution when coughing, kissing, sharing cups, sharing toothbrushes, and sleeping in the same bed as others (Heart Foundation, 2016) Because many of the Maori and Pacific Islanders in Auckland live in over-crowded areas, it is important that we promote good hygiene and cleanliness in their home environment as well as in the schools

HIGHLIGHT OF CLINICAL EXPEREINCE For one of my clinical days I had the chance to go out with the ear nurses and set up a free, mobile ear van clinic in a church parking lot. Many children and families (primarily Maori and Pacific Islanders) came by to utilize this free service. The ear nurses were able to provide ear treatments and make further referrals that these children might not have received otherwise. I think this is a great service and something that we could utilize in the United States.

HIGHLIGHT OF CULTURAL EXPERIENCE During our time there, we had the chance to visit the Waitangi Treaty Grounds Here we learned about the history of the Maori and what they believe is important This opened my eyes to another culture and helped to better understand where they come from and what things are important to them which improved the care I was able to provide to them

References A brief history. (n.d.). Retrieved from https://www.newzealandnow.govt.nz/living-in- nz/history-government/a-brief-history Gudsell, K. (2015). Average salaries nudge $75k... for some. Retrieved from http://www.radionz.co.nz/news/national/281067/average-salaries-nudge-$75k-for-some Healthpoint. (2018). Starship community service. Retrieved from https://www.healthpoint.co.nz/public/community/starship-community-service/ Heart Foundation. (2016). Rheumatic fever and rheumatic heart disease [Brochure]. Auckland: Author. Ministry of Health. (2017). Rheumatic fever. Retrieved from https://www.health.govt.nz/our- work/diseases-and-conditions/rheumatic-fever World Population Review. (2018) Retrieved from http://worldpopulationreview.com/