At the rugby, at church, on Facebook or listening to the radio, Maori and Pacific Island patients cannot avoid reminders of their Hutt Hospital appointments.
Missed appointments cost the health system millions of dollars a year, and rates are highest among Maori and Pacific patients.
Hutt Valley District Health Board's Maori and Pacific unit decided to tackle the problem using community networks, and now saves the DHB an estimated $75,000 a year.
Rates of missed appointments have halved for Pacific patients in paediatric, rheumatology and ear, nose and throat clinics. Maori patients missing diabetes appointments have plunged from 20 per cent to 8 per cent since last June.
"I won't be satisfied until we get that to zip," Maori health manager Kuini Puketapu said.
She realised she and her three staff had family or friendship links to most of Hutt Valley's 24,000 Maori residents. Puketapu herself has 200 cousins and 1500 Facebook friends.
"The biggest asset we have within our team is they're all local, born and bred in the Hutt Valley. Huge whanau links should never be underestimated in terms of their value."
Staff now approached the most stubborn appointment avoiders at social occasions, or messaged them on Facebook - particularly effective for those who refused to answer phone calls from "private" numbers.
"If you're under the radar and want to stay under the radar, and an unknown number comes up on your phone, you're not going to respond," Puketapu said. When hiring staff, she looked for people with good social networks and plenty of extra-curricular activities. "You could have all the degrees in the world and you wouldn't be able to do this work."
The biggest barrier for Pacific patients was language, so the hospital ran ads on Samoan radio stations each morning urging patients to attend their appointments, Pacific health director Tofe Suafole Gush said.
Her staff spoke Tokelauan, Samoan and Tongan between them, which made a huge difference to attendance at the rheumatology clinic, whose patients were 90 per cent Pacific Islander, she said.
Next target is other ethnicities. Pakeha rates might be lower, but they missed more appointments in total, Puketapu said.
Diabetic turns life around
Two months ago Linda Ratana would eat 36 packets of Raro juice powder each week, straight from the packet, with a spoon.
A type 2 diabetic, her blood sugar was a stratospheric 29 millimoles per litre, but she didn't take her pills. Then a Maori health worker at Hutt Hospital began driving her to and from appointments, and her attitude changed completely.
She has now sworn off sweet drinks, eats salads, and this week her blood sugar measured 8.1, just outside the healthy range of 4 to 8.
Chatting to whanau liaison worker Miriam Coffey in her car made Ratana, 55, realise how serious her health problems were. "You can lose a limb - well, that scares you. I just thought I was fine," she said.
Ratana has six children and 27 grandchildren, some of them living with her in Elderslea. A couple of family members own cars, but would have to leave work or childcare to drive her to health appointments.
The Maori health team stepped in when she missed 17 out of 20 dental appointments. Coffey said the hospital was not a taxi service, but Ratana was a special case.
Being the head of such a large whanau, Ratana's new healthy lifestyle would trickle down through the generations, Coffey said.
Personal attention changed Ratana's attitude straight away, diabetes nurse specialist Anne-Marie Heffernan said.
- The Dominion Post
Should fluoride in water be the responsibility of central government?