Reaching out to the hard-to-reach

1 July 2010

For nearly two decades the WONS health trust has been reaching out to Auckland women who otherwise fall below the radar of the health service. FIONA CASSIE talks to WONS founding trustee, nurse and CEO Ruth Davy about their work.

It’s all about catching the moment.

A Pasifika woman spots a mobile health clinic outside her local church and pops in.

The working mother of five has never had a smear before, but seeing the van at the right place at the right time and the chance of a smear for free – well she takes the plunge. The well women WONS team also takes the opportunity to find out more about her and her health. They settle down for a chat and find out the woman is really tired, has iron deficiency, bladder problems and insomnia. So they talk to her about iron supplements, share some pelvic floor exercises and talk about paying a visit to her GP.

“And we told her to cut down the tea and coffee she was using to manage her tiredness as that was making her tiredness worse, as she couldn’t sleep,” says Ruth Davy.

“She was thrilled and went away empowered.” It is everyday stories like these that keeps Davy motivated. “I’ve worked 25 years in women’s health and I don’t want to do anything else.”

You have to have passion for the cause to keep a service going that is reliant on donations and charitable grants for half of its funding.

The origins of WONS, the nursing, education and health promotion service formerly known as the Well Women’s Nursing Service, are in the 1988 Cartwright Report. The report, arising from the inquiry into the National Women’s Hospital “unfortunate experiment”, recommended a national cervical screening programme, including women-centred mobile community cervical cancer screening.

The initial team – most like WONS’ chief executive Ruth Davy were nurses working as smear-takers for Family Planning – began providing a mobile community service in Auckland in 1989.

Losing their health board funding in 1991 prompted them to form the charitable trust and seek contract funding of their own. And nearly 20 years later WONS is still out there in the Auckland community reaching out to women who could otherwise fall under the radar of conventional primary health care. About half their funding comes from district health board and Ministry of Health contracts, but the rest comes from donations and funding grants so they can deliver above and beyond their contracted services.

“I am passionate about reducing inequality and I love working with women in the community,” Davy says.

“I’m always astounded by their resilience and the fun you have (working) with these women.” Despite the adversities they face Davy finds the women “amazing”. “It’s a very enriching role.”

WONS takes its cervical screening clinics to marae, Plunket rooms, churches, the Salvation Army and, even on occasion, people’s homes. Across the decades WONS has embedded a well women approach into its work and, reflecting the changing make-up of the city, provides culturally appropriate health promotion to not only Ma¯ori and Pasifika people, but also new migrant and refugee communities. Along the way the service has also become a New Zealand Qualifications Authority (NZQA)-accredited training organisation, offering a vaccinator course for primary health care nurses and a cervical smear-taker course, along with short community courses in women’s health promotion.

Three of the original 1989 team are still involved with WONS, including Davy as chief executive, Monique Fredatovich as general manager of operations and Margaret Clark. Another founder, Sheila Alexander was instrumental in setting up and running the vaccinator training programme for many years. The service currently has 20 staff, including six nurses and seven contractors – mostly in the area of health promotion. Not to forget the volunteers.

And not to forget the women they are there foremost to serve – the hard-to-reach, highly mobile or newly-arrived migrant woman.

Davy says the nurses really enjoy their work – the chance to be independent, do their own referrals for abnormalities, offer breast checks, have time to discuss bladder control and generally take a holistic well women approach. “We cross huge multiple needs and our nurses are very adept at meeting those needs.”

With a commitment to cultural diversity, they have culturally appropriate health promoters working with them to build trust and confidence in the women including, in recent years, its own Chinese and Korean health promoters to try and turn around the low smear uptake in Asian communities. Davy says it has also been a matter of raising awareness in the Asian community of the lack of sexual health and sex education that has lead to high levels of sexually transmitted infections (STIs), among mainland Chinese women in particular.

Getting communities to help themselves is also promoted through its ‘Sisters in Health’ model, where ‘sisters’ attend a one-day workshop, then facilitate women’s health ‘pamper days’ as fundraisers, when women can turn up to their local marae or community centre to get their nails done, have a feed, a chat about health and a smear.

Pamper days held in recent weekends have lead to about 50 Ma¯ori and Pasifika women getting smears who had previously fallen through cracks in the system. In the past WONS has also run its own netball tournaments and waka ama (outrigger canoe) races to get the word out in a healthy and fun way. Plus its own take on the Tupperware party – ‘the smear party’.

Davy was part of the national cervical screening strategy promotion consultation group that lead to recent television advertisements focusing on fun, friendship and family to push the screening message.

It hasn’t always been an easy two decades and Davy and her team have needed to be clever as well as passionate to keep the service running. They have won the vital district health board and Ministry of Health contracts and have also kept the grants and donations rolling in to bolster that contract income. “It has been quite stressful over the years managing it.”

They recently held an inaugural ball to raise money for the service, which is also setting up the WONS Endowment Trust to ensure the service’s future economic viability.

“We are really proud of where we’ve come from and what we have and done and still looking to the future.”

With the health sector strapped for cash, the service’s latest contract sets a target of offering 800 more smears a year (to 2300) with no increase in funding. Which is no easy task for any CEO.

So Davy, who has just finished her masters in public health, is “incredibly grateful” to part of a Ministry of Health-funded public health leadership programme which is building confidence by reinforcing her successes and identifying her weaknesses.

Which is all grist to the mill for Davy in her work to reach out to those “really, really hard to reach” women to bring them back into the fold of primary health care.

And she wants more nurses to join her cause and step out beyond general practices’ doors, with outreach and mobile clinics to draw in more of these women.

For though WONS has done training in men’s and child health for the primary health care sector its heart is in working with women. “For it’s women that hold the families together.”

And keeping women well – like that Pasifika working mother of five – can keep a family well.