The Fono

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Skin Deep

The Fono is working with the Auckland Tuvaluan community to address the alarming rates of skin and soft tissue infection (SSTI) rates, as well as prevention methods to stop the escalation.

There’s a world Dr John Kennelly encounters that most New Zealanders are totally unaware of.

Contrary to the perception of improvements in the delivery of health, John’s world as a GP and acting-Clinical Director of The Fono reveals a situation which is worsening, particularly among Pacific communities.

“It’s acknowledged that skin infection rates are higher overall among Pacific and Maori communities compared to the overall population,” says John, who first dealt with it among the Maori community in Whakatane, where he began his medical practice.

“But overall rates had been coming down, and that includes Maori and Pacific communities.”

More recent studies, however, shows skin infections are on the rise again, which leaves him frustrated and angry.

“Why do we put up with this?” he asks.

“I know why. It’s because the Pacific population is put in the minority category, so it’s not a big deal for the mainstream New Zealander.”

The worsening trend began in 2013. It shows no sign of decreasing, which he attributes to the poor state of housing and general living conditions which many families endure. Auckland’s housing costs are also among the highest in the world.

“Pacific people have jobs, but they’re generally not paid much and it often involves shift work, which makes it more difficult for families to manage. It’s not easy when you regularly have to travel across Auckland,” says John.

It’s little wonder, he adds, families and relatives live under the same roof to share the burden, even if it spreads the likelihood of infection. He says such hardship is hidden from other family members due to the shame.

“One of our Samoan nurses said to me, ‘I used to go to church and everyone looked so pristine’,” John recalls.

“She took a role where she met people in their homes. The nurse admitted she had no idea how many of our families were suffering, yet she was part of that community. She said, ‘Our people are proud, so they don’t like it when others see them like that, with a whole family crammed into one bedroom or living in a cold, crowded garage. It affects their self-esteem.’”

Westside with the Tuvalu community

John recalls a particular case with a Tuvaluan nurse who came into The Fono with her six-year-old daughter. John noticed the daughter was walking with a limp. Her mother said it wasn’t a problem, convincing John her daughter was fine.

A day later the girl was in the intensive care unit, having been diagnosed with staphylococcus, a bacteria that can cause serious life-threatening infection.

“Staphylococcus lives on the skin, but if the skin is broken for some reason, like eczema, scabies or an abrasion, it gets into the blood stream. If that happens, it can get into the bone and spread into the lungs, which causes pneumonia,” says John.

“Thankfully, she came right.”

John asked the mother where her daughter could have got it. She found out her cousins had visited the home and were all covered in sores.

Another life-threatening situation was averted when a girl was taken to the emergency department due to back pain.

“Kids at her age hardly ever get back pain, so they presumed it was a muscle problem and sent her home. A couple of days later she returned, still in pain, and went to the clinic waiting room. She had real trouble walking, so they put her onto a wheelchair, then a bed. Her back was very tender,” John recalls.

They contacted Starship Hospital, who said the girl probably had a bone infection. An MRI proved she had an abscess in one of her bones through her spine. It was another close call, but she survived relatively unscathed.

“I’ve been in practice for 40 years and have never seen such high rates of skin infection before,” he says.

“They come here from the Pacific islands and life is so different. A lot of kids in places like Tuvalu just sit in the water for much of the day because it’s so hot. It’s island life and many don’t quickly adjust to New Zealand life and what’s required to remain healthy. That’s why initiatives such as these are so important.”

The Fono is one of six primary care provider teams selected by the Health Quality and Safety Care Commission for the Whakakotahi initiative, designed and driven by the primary care sector. It was selected to work with Auckland’s Tuvaluan community to develop and test culturally-appropriate methods to address its high rate of SSTI infections.

John says working with the Tuvalu community as part of the Whakakotahi initiative is ideal.

“The Tuvalu community are relatively new migrants from the Pacific and are predominantly based in West Auckland, which makes it easier to monitor,” he says.

“What’s rewarding is they’re receptive to looking at new things. It’s done with joy, humbleness and a sense of gratitude, which a lot of others could learn from.”

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Dr John’s Quick Tips to Stay Clean

  • Wash your hands with soap regularly
  • Wash towels regularly, including hand towels 
  • Wash and dry your dishes properly
  • Trim fingernails and toenails to prevent dirt underneath
  • Clean remote controls, door handles and bench tops 

Read more about caring for skin infections