In collaboration with co-director of the Otago Global Health Institute, Professor Philip Hill, chief executive of South Seas Healthcare Trust Lemalu Silao Vaisola-Sefo and founding members Dr Debbie Ryan and Dr Teuila Percival outline why they believe South Seas’ village model approach, employed in the South Auckland Delta outbreak, should be adopted for Pacific communities across Aotearoa.
It is time to expand on a successful ‘by community, for community’ approach to dealing with the pandemic.
In the first fortnight of the Delta outbreak, the Pacific community was hit hard following a super-spreader event in the Pacific Assemblies of God (AOG) church.
South Seas Healthcare Trust, a major Pacific health provider, entered into a contractual arrangement to support the Pacific households affected by the outbreak and instigated a ‘village model’ approach to support those affected.
With Pacific cases now again on the increase, and a national move to the traffic light system on December 3 likely to result in Covid-19 cases spreading across New Zealand, we believe our model should be expanded to better serve Pacific communities throughout the country.
Pacific success against Delta in Auckland
A combined-church AOG rally of more than 500 people in Māngere on August 15 became a super spreader event for the Delta variant of Covid-19, with daily case numbers in Pacific people reaching more than 60 per day over the next fortnight.
The situation looked grim and an urgent change was needed for Pacific communities in South Auckland in response to the large numbers.
In contrast, by the time Auckland moved from Alert level 4 to 3 on 21 September 2021, the numbers of cases in Pacific people had dropped dramatically, averaging fewer than 10 per day.
Furthermore, while the overall case numbers started increasing in the first week after the alert level shift, case numbers in Pacific people stayed down for over a month.
So what were the key features of the successful response to Delta in Pacific peoples?
A new approach based on Pacific strengths
The Samoan proverb, “E fofo e le alamea le alamea – the solutions for our problems lie within our own communities” stems from the Samoan cultural belief that the challenges the community face are the collective responsibility of the village and aiga (family). In national surveys, Pacific people report high levels of material deprivation and poor housing compared with other ethnic groups, but social bonds and community values are notable strengths.
South Seas developed an approach to working with the AOG Samoan Community Cluster that was inspired by the application of a traditional Samoan village structure to an urban setting: “E sui faiga, ae tumau le faavae” – ways of doing things may change but the foundations remain the same.
This approach was based on listening and building respectful relationships. Bridges were built to services and support, and established structures and strengths in the church were used for communication and organisation, testing and contact tracing. Testing centres were set up where and when it suited church leaders, and incorporated wellbeing hub support with food and care packs for families. Consistent communication enabled these support packages to be mobilised quickly to all in need.
The village model
The approach used seven critical elements.
1. Understanding the system: Each village has its own set of rules. South Seas took on the role of understanding the landscape of government ministries, public health guidelines and clinical practice and ensured that these were reframed, applied and communicated in ways that were appropriate to the needs of Samoan communities affected by the outbreak. It acted as a bridge between government agencies, community, and families.
2. Culturally and linguistically appropriate support: An 0800 Helpline was established with staff fluent in Pacific languages. This removed barriers to communication so families could access support and advice easily over the phone.
3. An ethos of service and comprehensive care: Leadership in the village context involves tautua (service) that encompasses tausi (stewardship) and care. Alongside the testing station that had been established at the Otara Shopping Centre, South Seas set up a wellbeing and food hub to respond to large-scale urgent needs for food parcels and grocery vouchers, testing and vaccination support, wellbeing support and emergency social services funding. Modern technology and client management systems were used to support the work of care team navigators who coordinated personalised integrated care to each family, helping with health, education and housing services. Key data, provided regularly to the Auckland public health coordination centre, informed adjustments in real time.
4. Village leadership roles: Providing tautua means understanding the village approach to hosting. South Seas took on the role of hosting a number of leadership groups to guide their work. New teams and roles created during the response included crisis management teams, ‘Rally your Village’ coordinators and village representatives. Trusted individuals in the community and the AOG church were asked to take on roles of spokesperson(s), community group administrators and community networkers, to enable everyone to get through Covid-19 together. Village coordinators brought in their ‘village networks’ for a Rally Your Village drive-through vaccination event.
5. Established, trusted relationships: Relationships across the community that had developed over a number of years enabled the health provider to set up a food hub and relocate a wellbeing hub using a community recreation centre and community hall. Local businesses and other donors donated services, resources and other items to support the village vaccination campaign. Services were accessible to communities while maintaining public health precautions. Key community leaders trusted that their families and communities would be cared for and looked after by a trusted local provider.
6. Community Village Fono: A number of community fono were held via various media, Zoom and in person with social distancing. These played a critical role in mobilising community leadership support through Faifeau (church ministers), Matai (chiefs) and head of families, households, and navigators from each family. South Seas would co-host community fono for one event, multiple times, to ensure a well-coordinated approach that was considerate of village norms (prayer and seeking permission to engage; and inclusion, whereby everyone was able to speak) to ensure success.
7. Everyone together as a village: the health provider was able to work with more than 50 partners, including churches, sports clubs, health providers and other social service organisations. Working with Penina Trust, for example, a wraparound health service that included transitional housing support was made available for families exiting MIQ and hospital.
We need to, and can, apply these lessons across New Zealand.
The interconnectedness of Pacific people in New Zealand is a significant strength and it would not be difficult to establish an integrated Pacific response capability across New Zealand over a relatively short time-period.