Research fatigue among Tongans in Aotearoa: an exploratory study introducing the Fei'umu research method for empowering the researched.

INTRODUCTION: There has been a number of references in the literature to over-research and research fatigue, but rarely have the concepts been empirically investigated, and never for Pasifikans. There have been claims that researchers have built careers out of the 'natural experiment situations of the Pacific with minimal benefits to the researched, e.g. the Tongans. In response, an exploratory investigation into the New Zealand Tongan communities' understanding of and participation in, research, (HRC Seeding Grant No. 11/529), was conducted. METHOD: We consulted 2 different church meetings in Auckland (approximately 50 people in each group). We also engaged in talanoa/discussions of the issues with 5: church leaders from different denominations; Tongan researchers; business owners; and 5 community leaders from Auckland, Wellington, Hamilton and Christchurch, respectively. RESULTS: The study found, that the Tongan communities are subjected to a variety of research, information, and data gatherings, from a myriad of agencies. The respondents used a variety of mechanisms to avoid discomfort, get rid of researchers as expediently as possible, including; heliaki, white lies, sarcasm, or give expected answers, thus confirming research fatigue. The interviews and surveys employing the Tongan language and ethnic specific research approaches were preferred, especially for sensitive issues. The study suggests that ownership of the research process will improve the robustness of the data collection, and the community ownership of research outcomes. CONCLUSION: The presence of research fatigue will threaten robust data collection and ownership of research findings. This paper discussed research fatigue and its dangers, and suggest ways to address this problem, before researchers are driven further from the researched communities and the utility of research knowledge.

Cultural democracy: the way forward for primary care of hard to reach New Zealanders.

The use of cultural democracy, the freedom to practice one's culture without fear, as a framework for primary care service provision is essential for improved health service in a multi cultural society like New Zealand. It is an effective approach to attaining health equity for all. Many successful health ventures are ethnic specific and have gone past cultural competency to the practice of cultural democracy. That is, the services are freely taking on the realities of clients without and malice from those of other ethnicities. In New Zealand the scientific health service to improve the health of a multi cultural society are available but there is a need to improve access and utilization by hard to reach New Zealanders. This paper discusses cultural democracy and provide example of how successful health ventures that had embraced cultural democracy were implemented. It suggests that cultural democracy will provide the intellectual impetus and robust philosophy for moving from equality to equity in health service access and utilization. This paper would provide a way forward to improved primary care utilization, efficiency, effectiveness and equitable access especially for the hard to reach populations. use the realities of Pacificans in New Zealand illustrate the use of cultural democracy, and thus equity to address the "inverse care law" of New Zealand. The desire is for primary care providers to take cognizance and use cultural democracy and equity as the basis for the design and practice of primary health care for the hard to reach New Zealanders.

Genetic diversity and linkage disequilibrium in the Polynesian population of Niue Island.

Isolated populations that recently have been derived from small homogeneous groups of founders should have low genetic diversity and high levels of linkage disequilibrium and should be ideal for mapping ancestral polymorphisms that influence complex genetic disease susceptibility. Populations that fulfill these criteria have been difficult to identify. We have been looking for Polynesian populations with these characteristics, because Polynesians have high rates of complex genetic diseases. In Niue Islanders all ancestral female (mitochondrial HSVI sequence) and 90.4% of ancestral male (Y-chromosome haplogroup) lineages are of Southeast Asian origin. The frequency of European Y-chromosome haplogroups is 7.2%. The diversities of mitochondrial HSV1 sequences (h = 0.18 +/- 0.05) and Y-chromosome haplo-groups (h = 0.18 +/- 0.05) are lower than values published for any other population. Ten autosomal microsatellites spaced over 5.8 cM show low allele numbers in Niue Islanders relative to Europeans (55 vs. 88 total alleles, respectively) and a modest reduction in heterozygous loci (0.71 +/- 0.02 vs. 0.78 +/- 0.02, p = 0.04). The higher linkage disequilibrium (d2) between these loci in Niue Islanders relative to Europeans (p = 0.001) is negatively correlated (r = -0.47, p = 0.01) with genetic distance. In summary, Niue Islanders are genetically isolated and have a homogeneous Southeast Asian ancestry. They have reduced autosomal genetic diversity and high levels of linkage disequilibrium that are consistent with the influence of genetic drift mechanisms, such as a founder effect or bottlenecks. High-powered linkage disequilibrium studies designed to map ancestral polymorphisms that influence complex genetic disease susceptibility may be feasible in this population.

Rheumatic fever and rheumatic heart diseases in Fiji: a review from the surveillance system (1996 -2000).

The Surveillance System for many Notifiable Diseases in Fiji is described by many as inadequate. This system includes the reporting and recording of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD). Prominent amongst the inadequacies of this system is the under reporting and the diagnostic dilemma and classification of he cases. Under-reporting was estimated at about 40% in Viti Levu, 44% in Vanua Levu, and 66% in the outer islands. This paper reviews the Surveillance System pertaining to ARF and RHD and describes the trends and demographic distribution of ARF and RHD in Fiji during the period 1996-2000 while highlighting the problem of the system A retrospective review of admission records of the Pediatric Ward, Colonial War Memorial Hospital (PW/CWMH), Suva, Fiji, from 1996 to 2000 was undertaken. Admission books were cross-checked with patient folders, when required, to avoid inaccurate counting of cases. Data obtained were analyzed and compared with those obtained from the Ministry of Health (MoH) during the same period. Under-reporting of ARF was documented with fewer ARF cases reported less than the actual number of ARF cases admitted to PW/CWMH in 1998 to 2000. On average, 18 ARF cases were reported each year for a cumulative incidence of 2.3 per 100,000 population; 173 RHD cases were reported each year for a cumulative incidence of about 21 per 100,000 population during this 5-year period. The problems seemed to be more prevalent among the Fijians compared to Indians; children in the 5-9 age group were more affected by ARF and those in the 10-14 age group were more affected by RHD. There was no statistically significant difference in the mean age between Fijian and Indian cases for both ARF and RHD. Under-reporting was apparent in the surveillance of ARF and RHD in Fiji. The cumulative incidence of ARF in Fiji appeared much lower than that reported from other Pacific countries. There is a definite need to improve the Disease Surveillance System and to sustain an effective ARF/RHD prevention programme are needed in Fiji.

The First Tongan Health Professionals Conference: seeking cultural democracy for health.

The Tongan Nurses Association of New Zealand (TNA) organized the First Tongan health Professionals Conference as part of workforce Project funded by the Ministry of Health in supporting Pacific professional organizations. The conference theme was Cultural Democracy as an overarching philosophy for provision of ethnic specific health and social services in. New Zealand. The underlying motive for the conference was to place nurses in the context of health professionals and to promote the idea that Tongan nurses are needed and are willing to support all Tongan health workers. New Zealand. Dr Debbie Ryan, Chief Advisor Pacific Health to the New Zealand Minister of Health, opened the Conference. Several other Tongan health professionals expounded on the achievement of Tongan health workers in New Zealand and noted that these achievements were closely associated with their beliefs in "Tonganess" and the unique place all Pacificans have in New Zealand health. This conference generated much enthusiasm for Tongan ethnic specific health service provision, health work in general and nursing in particular. The fact that the nurses organized the First Tongan Health Professionals Conference was seen as a unique leadership initiative, emanating from the good will and trust usually expected of the Tongan nursing professionals at the health service level and in the community. There was desire to continue this type of ethic specific approach to enhance equity and decrease health disparities in New Zealand.

Human resource development in environmental health for Palau--a model program for Micronesia and the Pacific.

In Palau, prior to 1997, the highest degree qualification in Sanitation Division (now called Division of Environmental Health) under the Bureau of Public Health, Ministry of Health, was a Diploma in Environmental Health from the Fiji School of Medicine. By September 2003, during an Environmental Health Planning and Management Workshop (NEHAP), Human Resource Development (HRD) was declared as a priority area and therefore was incorporated into the Palau National Environmental Health Action Plan. The Palau NEHAP HRD goal is to develop a human resource development plan for environmental health, which builds a career ladder with incentives. The initial public health courses in environmental health commenced in August 2004. A total of 25 participants registered for the sentinel course--PH 122: Introduction to Environmental Health. Students represented Palau's varied environmental health workforce, which included representatives from the National Division of Environmental Health and state sanitation programs. In December 2004 the Diploma of Public Health (DPH) Program in Palau was finalized The environmental health workforce of Palau is very fortunate to be included in the Palau AHEC programs. This have come about due to the ongoing Ministry of Health support of environmental health program in Palau.

Fijian participation in health research: analysis of Medline publications 1965-2002.

UNLABELLED: The driving force of health research in the Pacific has been the expatriates. The common practice has been that health professionals from developed countries come and do research, without much involvement by local experts, take the data off shore to analyze and publish elsewhere, without benefiting the researched communities. OBJECTIVES: this paper examines the participation of Fijians in health research publications on Fiji; identifies the most researched health areas; and discusses the implications for health priorities and research capacity development in Fiji. METHODS: Medline published papers were used as database using "Fiji" as the search word. Two hundred and ninety-eight (298) health-related publications were retrieved from July 1965 to April 2002. Direct and indirect interviews were conducted for the identification of authors. Reviewing abstracts and full-textpapers were performed for the ascertainment of studied subjects of papers. RESULTS: The 298 papers identified include 275 (92.3%) descriptive studies (including community/population surveys, case series and cross-sectional studies); four (1.3%) case-control studies; eight (2.7%) cohort studies and 11 (3.7%) unknown-type studies. There were no randomized-controlled trials (RCT) or community intervention trials (CIT). Turning to authorship, there were more expatriates (82.3%) than local researchers (17.7%) out of a total 815 authors. There were fewer Fijians who had been sole and first authors (12.5% and 13.5%, respectively), and a significant difference between the proportion of non-Fijians to have contributed as sole and first author compared to that of Fijians (c2=6.4, df=1; p=0.01). Among the Fijian authors, males contributed five times more than females. Indo-Fijians (58%) participated more than indigenous Fijians (40%). Indigenous Fijian females contributed significantly more than Indo-Fijian females (c2=4.77; df=1; p=0.02). The majority of the authors (70.4%) were in the forties and fifties age groups. The staff from the Fiji School of Medicine (FSM) contributed only 12.9% to the total Fijian authorships. The remaining Fijian authors were affiliated with the Fiji Ministry of Health (MoH), the University of the South Pacific (USP) and other Fiji Government entities. The most researched areas were Non-communicable Diseases (13.4%), Infectious Diseases (11.4%), Health Services (10.4%), Nutrition and Dietetics (9.1%), and Mental Health (7.0%). The least researched areas were Cancer (2.3%), Gerontology (2.0%), Biochemistry (1.7%), Traumatology (1.7%) and Dermatology (1.3%). Only 31 (16.6%) out of 187 journals with papers about Fiji were available in the FSM Library. There was a significant increase of health publications over the studied period (r=0.502; 0.001

Retaining Pacific cultural values in modern health systems.

The adoption of bureaucratic management systems in Pacific health care systems has been without much effort to accommodate Pacific cultural values and practices. Some features of Pacific culture fit well with the common features of bureaucracy, while others do not. Pacific cultural values of support for the individual by extended families have the potential to enhance the health system. We contend that the Pacific nations ought to develop management systems that will accommodate bureaucratic needs or organisation and the cultural needs and strengths of the people who work within them and use them.

Health challenges of some urban Cook Island women in New Zealand.

Cook Island women (CIW) in New Zealand are disproportionately represented among almost all of the negative health statistics. They predominately occupy the lowest socio-economic level, present with high rates of heart disease risk, cervical cancer and smoking. Furthermore, they delay seeking treatment until their diseases are at an advanced stage. The primary aim of this study was to identify the health challenges that some CIW in New Zealand regarded as salient. We were also interested in the cognitive representations generated by health challenges, such as the cause, the consequences, the timeline, and the degree of control they felt they had. The types of coping strategies employed in response to health challenges were also explored, as was the participant's appraisal of the effectiveness of their efforts. Answers to semi-structured interviews were categorised using QSR NUD*IST Release Version 4.0. The results indicate that women are most concerned about their diet, exercise, obesity and diabetes. Their answers demonstrated that they: often feel overwhelmed by health challenges; believe that they have little control over the cause of these challenges; and that they have a tendency to minimise their consequences. Furthermore, the women were more likely to engage in emotion-focused coping, and appraise their problem-focused coping strategies negatively.

Commentary on diabetes and Tongans in Aoteroa.

Diabetes is a global challenge without universal personal solutions. A special diabetes clinic of the Tongan Health Society Incorporated, at Langimalie Health Centre, Onehunga, Auckland has about 1166 Tongans with diabetes in its register. This experience is very much the experience with Tongan diabetes patients and may be common to other Pacific ethnic groups. The characteristics of these diabetic patients can be explained through an understanding of the ethnic specific characteristics of Tongan populations. Among Tongans, illness and diseases are synonymous with symptoms. Non-communicable diseases have been labeled as the diseases of affluence in Pacific countries. Food is a high priority cultural commodity. Food consumption at personal level is determined and controlled at household level. Therefore patients with diabetes have little control over food preparations and meals. The study showed that the common sense association between food preference and food consumption was incorrect, mostly due to the inability to access the preferred food. The universal personal solution for diabetes is embedded in the ethnic specific fabric of populations. There should be more research by Tongans on Tongans so that ethnic specific nuances of language and behaviours of Tongan diabetes patients may be better understood and disentangled.

SIDS among Pacificans in New Zealand: an ecological perspective.

Sudden Infant Death Syndrome (SIDS) or Cot Death has unevenly affected ethnic groups more in New Zealand. This paper examines risk factors for SIDS from a political ecology perspective. The New Zealand Cot-Death Study (1987-1990) identified four modifiable risk factors of major concerns. These became the targets of a national prevention campaign. The four modifiable risk factors were: prone sleeping position of the baby, lack of breast feeding, maternal smoking and bed sharing. These four risk factors are more prevalent amongst Pacific and Mäori than others in New Zealand, and are influenced by cultural and other factors. This paper discusses these from a Pacific perspective. Through a discussion of the socio-economic situation of Pacific people in New Zealand and drawing on political ecology theory, it also challenges the classification of some risk factors as 'unmodifiable'. It argues that, through addressing the low socio-economic status of Pacificans, the so-called 'unmodifiable' risk factors are modifiable. Addressing these wider inequalities would contribute to the govaernment's aims of closing the social and economic gaps affecting Pacificans' health status and reduce the risk of SIDS among Pacific infants.

SIDS or Sitisi: plight and response of Pacificans in New Zealand (Aotearoa).

Sudden Infant Death Syndrome (SIDS) or Sitisi was considered a rare event among Pacificans worldwide. However, recent findings in New Zealand (Aotearoa) have shown that at least 33% of Pacific infant deaths in New Zealand since 1991 have been due to Sitisi, and the incidence of Sitisi among Pacificans has been on the increase since 1986. These findings have necessitated the development of a Pacific response, especially since a National SIDS Prevention Programme in Aotearoa, implemented in 1991, had led to decreasing rates amongst Pakeha (Europeans) only. This paper reports the Pacificans' experience with Sitisi and the response to the control of yet another epidemic amongst migrants. The response included research; community consultation; and training of Pacifically appropriate Community SIDS Educators. The importance and initiation of community-based strategies is central to the Pacificans' response to Sitisi and its determinants. The success of this approach provides a model for intervention and health promotion, at least, among Pacificans globally.

Health transition among Pacificans: unpacking imperialism.

What and who defines health? In the Pacific at least, health is not only an individual's state of well-being. It also refers to the positive state of the social body i.e. how people within a community interact with each other and with their environment to produce positive and desired effects. Even death can be viewed as a positive stage in human life if it facilitates the achievement of well-being as one transit or translocates to the next stage of 'eternal bliss'. The pursuit of health and well-being has resulted in many challenges over time in many communities. Health transition has been seen as a phenomenon that can be defined by the various eras of disease occurrence. Various morbidity and mortality indicators are used to measure these. According to health transition theorists, this phenomenon is linear and similar for all societies. However, this linear approach is not cognizant of the many dimensions of social, mental, physical and spiritual well-being that encompasses the life and death of Pacificans. This paper attempts to tease out the various forces that have influenced the health transition phenomenon in the Pacific. Specifically, it argues that the forces of imperialism, colonialism and globalization have largely influenced health transition in the Pacific in a manner that is to some extent, both unfavorable and oppressive. It raises the difficulty of using morbidity and mortality as measures of transition in societies where people do not die but are believed to just translocate to another life. The paper ends by suggesting alternate ways of looking at the multidimensional processes of health changes in the Pacific.

In-country and community-based postgraduate family practice training for Micronesian physicians--the Palau AHEC: a collaborative effort.

The U.S. Institute of Medicine in its 1998 review of the health care systems among the U.S.-Associated Pacific Islands (USAPI) identified promotion of primary health care (PHC) and training of the regional health workforce including postgraduate training for physicians as priorities. With the support of the health leadership of the USAPI and the Republic of Palau, the John A. Burns School of Medicine (JABSOM) of the University of Hawaii captured U.S. federal Area Health Education Center (AHEC) funds to implement a postgraduate program to train Family Practitioners - physician specialists in primary care for the region. The Palau AHEC has evolved into ajoint activity of JABSOM, the University of Auckland Faculty of Medicine and Health Sciences (UAFMHS), the School of Public Health & Primary Care--Fiji School of Medicine, and Palau Community College to provide Diploma-level training in Family Practice and Community Health for Micronesian physicians.