Whānau isolating in overcrowded homes need more than a phone call, clinic says

Tuesday, 16 November 2021

Papakura Marae delivers food parcels and medical support to Covid-positive whānau. (First published November 2021.)

Sleeping on a mattress under a tarpaulin in the front yard of his overcrowded house is the only solution for one Covid-positive man to isolate at home.

Inside are children, kuia, and other whānau also in isolation, anxious for the health of the man outside, and afraid Delta will put down its roots indoors.

Nearby, more than a dozen other families are in isolation after household members tested positive for the virus, which is quickly infecting them as well.

To isolate at home the residence must pass a public health risk assessment: the Covid-positive person must be able to isolate safely away from others, they need phone and internet connection, transport, and have kai and other basic necessities, according to the Counties Manukau DHB guidelines.

Dr Matire Harwood of Papakura Marae Health Clinic is delivering kai and medical support to Covid infected whānau in the area.

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The environment of overcrowding and deprivation these families are in is increasing as Covid-19 continues to spread across Auckland and into the regions, and community services need to step up to help them get through it, nurse Nicole Walters said.

Donning PPE, she and Dr Matire Harwood visit 15 families isolating in overcrowded homes without basic necessities, at least twice a week.

Their car was packed to the brim with food and health provisions before they started making house calls, plugging the welfare gap left in the wake of the daily public health check-in phone calls.

On Tuesday, a Ministry of Health spokesman said that home isolation would play a large role in the response to increasing positive cases across New Zealand.

When a person is notified they have tested positive, public health officials will do a risk assessment of their situation to ensure home isolation was acceptable and their health needs were being provided for, he said.

If it wasn’t safe for them or their household to isolate at home they may be asked to move into MIQ, he said.

“Home isolation is playing an increasingly important role in supporting the health system to better manage Covid-19 cases in the community, and this will reduce the need for transfers to MIQ.”

But Walters said the system wasn't working, and her clinic was picking up the slack.

“We know our families, and for the public health [service], they don't know them and think a phone call will cut the mustard.”

From left, Dr Matire Harwood and nurse Nicole Walters keep themselves safe in PPE as they visit covid-positive whānau.

For the past month the clinic has been providing wraparound support after Walters recognised the increasing burden on families stuck in their homes without so many of the things that middle-class New Zealand homes take for granted.

Isolating with your family at home would be much easier with electronic games for the kids, television, internet, multiple bathrooms, individual rooms, even backyards and money for food delivery, Walters acknowledged, but for the families she serves, those are luxuries well out of their reach.

Instead the clinic was focused on the personal touch.

“The main thing for us was putting eyes on the people, going over there, face to face,” Walters said.

Walters said if health services wanted to provide adequate care for people in isolation, home visits and face-to-face conversations were essential to see the reality of how people are living.

She admitted it has been exhausting mentally keeping up with the Covid-19 response, as well as going the extra mile with welfare packs and home visits, but that was what was needed, and others needed to follow suit as the number of people isolating increases.

Dr Matire Harwood packs her car with kai for whānau in isolation.

“It’s going to look terrible, it’s just going to double and triple, but we have to get the resources to get to these people, and in a timely fashion, too.

“I just do what I have to do and think about it later.”

Stewart Borland says isolating at home with Covid-19 is unsafe after his friend, who was in his 50s, died in Auckland's Mt Eden.

On Monday, there were 3628 active community cases across the North Island, according to the Ministry of Health.

In Auckland more than 4000 people were being supported by public health staff in home isolation, with Waikato supporting 321.

Of the positive cases isolating at home, almost half were Māori.

Twenty-three per cent of cases in home isolation were Pasifika, 22 per cent were Pākehā, 5 per cent were Asian, and 2 per cent were Middle Eastern, Latin American or African.

Harwood thought a robust framework would have been developed to ensure Covid-positive people were cared for adequately, but it soon became clear they needed to put in extra work.

It’s a different world compared to the isolation that affluent neighbourhoods were experiencing further north, Harwood said.

“It’s not as easy for some people,” she said.

“That’s why we did this. We saw the first two [people] pass away and I just don’t want that happening in our community. There are gaps and I’m just here to fill that.”

Last week a man in his 60s was the third person to die while isolating at home with the virus in Auckland. A 40-year-old man with the virus was found dead in his Manukau apartment by a family member and a man in his 50s also died while isolating with the virus in an apartment block in Mt Eden.

Families do have the option of isolating in MIQ facilities, but Harwood found that for some, their mental health suffered.

It’s better for them to be at home, but a simple phone call from a public health official won’t cut it, she said. They need increased welfare and provisions.

On top of the physical health concerns the clinic has for whānau, mental health was another area that was being forgotten.

Living with 12 people in a three-bedroom home that has no internet, no entertainment, a small yard and a serious virus was putting a huge strain on families, Papakura Marae chief executive Tony Kake said.

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“It’s too cramped. Any isolation for more than 24 hours, that would be difficult for any of our whānau.

“There are going to be breaches because people just need breaks from each other.”

Kake said he thought the more affluent parts of Auckland had forgotten about or had no understanding of the hardships that South Auckland communities like Papakura were facing.

Papakura, alongside other areas with high Māori populations, came in first place on the 2013 deprivation statistics.

Overcrowding increases the risk of contracting infectious diseases and, with nowhere else for them to go, they’re stuck in the petri dish of Delta.

Kake implored the community to open their cupboards as the marae had, and organise a system to ensure those who were isolating now, and the many more who will have to in the future, had the resources they needed to get through the crisis as MIQ won’t have enough rooms to take them.

“We haven’t got enough facilities to meet the demand or the future demand.

“We’ll just empty our cupboards. I want to offer our support to other GPs across the area.”