Ta'elega i Petesa (Fa'anaunauga mo se vaifofō pei o Petesa): Longing for a Bethesda Solution

Abstract

For the New Zealand health system, overuse of Emergency Departments (EDs) is a significant concern because it increases staff workload, affects patient care quality, and is largely avoidable. Especially since most patients, self-presenting is best managed in primary care settings. As inappropriate attenders have increased, the ED system has been put under more pressure, raising concern nationwide. According to Thornton et al. (2014), the Middlemore Hospital ED is experiencing a huge strain due to inappropriate attendance, and about half of the self-presenters are of Pacific Island descent. However, more is needed to know why Pacific patients self-present to EDs instead of seeing their healthcare provider. This research explored the experiences of Emergency care services for Samoan families in South Auckland. As Pacific peoples consist of many ethnic groups, ethnic-specific research is needed to understand why Pacific people self-present to Middlemore ED. This research gains insight into the experiences of Samoan families in South Auckland, and their reasoning behind choosing Middlemore ED or their primary healthcare provider when they are sick. This qualitative study conducted in-depth face-to-face talanoa sessions with three Samoan families who attended the Matagaluega Aukilani Saute PIPC congregations of Papakura PIPC, Wiri (Satauro o le Faaolataga) PIPC and Manukau PIPC. Talanoa sessions were semi-structured and underpinned by the Talanoa method and the Talatalaga a Aiga methodology. The data was analysed using thematic analysis. Based on this study’s findings, participants decided whether to visit the Middlemore ED or their primary healthcare service, largely according to their level of illness. They are the following: whether the pain was manageable at home, whether they were unsure of the illness, or if they were unable to manage the pain at home. Participants discussed many barriers, including cultural competency, lack of time, lack of a Pacific workforce, language barriers, discrimination, financial barriers, citizenship status, and long waiting times. The enablers in accessing primary healthcare services included family, tertiary education, and rapport with their primary healthcare provider. Recommendations from this research provide strategies for supporting Samoan families living in South Auckland to access primary healthcare services and understanding as to why Samoan families choose to access either the Middlemore ED or their primary healthcare provider when they are sick. This research can contribute to developing new solutions to benefit the Samoan community in New Zealand.