The small community of Wairoa hopes it will get a big say on what it desperately needs as the health reforms begin.
The Wairoa district is home to over 8000 people and 70 percent are Māori. Photo: RNZ/ Tom Kitchin
On Friday, district health boards disappear and Health NZ and the Māori Health Authority take over.
A key part of the new system will be so-called locality networks - a way for districts to spell out what services they need.
Wairoa, in Hawke's Bay, with a population of about 70 percent Māori, is part of a pilot scheme figuring out how these localities will work.
Wairoa District Council chief executive Kitea Tipuna says people in Wairoa have to "smile through the pain" because if its shortage of health services. Photo: RNZ/ Tom Kitchin
Kitea Tipuna is the Wairoa District Council's chief executive, and on the local working group for the health locality prototype.
Although not a health professional, he had his own personal experience with the complex local health system.
Four years ago, he had a burst appendix and had to rush to the local hospital.
"I went up to the hospital 'cause the pain was so excruciating. I went up at 4am and we've got a one ward hospital - and it's great, it is great. The nurse sort of looked at me, the doctor came and said "oh my gosh, we will be flying you to Hastings."
He was in hospital for a week, then had to call up his family, which he said took a lot of planning.
"My sister had to drive [two hours] from Wairoa to Hastings to pick me up to drive me home once I got discharged. And so these things many people who have the luxury of having a state-of-the-art hospital in their cities, in their towns, don't realise that families in Wairoa, this is what we have to deal with."
Wairoa officials believe people might have a chance to determine their own futures under the new health structure.
Wairoa Hospital has a ward, basic emergency department and GP practice on site. Photo: RNZ/ Tom Kitchin
The locality will develop plans to best suit the community.
Tipuna said there were several issues that needed to be solved. For instance, Wairoa has not had a dentist for adults in two years.
"Our people have to smile through their pain and they do so graciously. But once they have to get to a point where they have to have some sort of emergency dental work they have to travel outside of the district."
Part of the local rest home also had to shut, with those needing hospital level rest home care sent out of the district, away from their whānau.
"Ten of our kaumatua now have to have care outside of our district, so we're unable to deliver that locally, just because of the skill shortage."
Tātau Tātau o te Wairoa general manager Lewis Ratapu says kapa haka could be funded by the new health reforms to help with mental health. Photo: RNZ/ Tom Kitchin
Lewis Ratapu is general manager of Tātau Tātau o Te Wairoa - a post treaty settlement group.
He sits on the new Tihei Tākitimu Partnership Board, which will help deliver health services for Te-Matau-a-Māui or Hawke's Bay under the new Māori Health Authority.
He said Wairoa people struggle to access health services.
"Our actually average wage is not great, and why that's a problem here in Wairoa is our cost of living is so high. We've got one supermarket, a cabbage cost $8 I saw the other day."
He remembered a story about a grandmother taking her mokopuna into ED instead of the doctor, because she could not afford it.
"She was part of a low-cost practice, only paying $10 to see a doctor and then $5 for a script, but that was the bread and milk for the week."
He was excited about the possibilities under the Māori Health Authority - for instance it could fund arts and culture initiatives - like kapa haka.
"We don't think of it as a health initiative, but what we know through kapa haka and there's been some recent research that has shown the health benefits of kapa haka, 'cause there's a lot of training that goes into kapa haka, there's a lot of social interaction, there's a lot of pride and that has all sorts of benefits on people's health, particularly people's mental well-being."
Another problem is methamphetamine and last year, Wairoa was ranked third highest for meth use in the country.
Enabled Wairoa chief executive Shelley Smith is developing a methamphetamine strategy for Wairoa, to help the town overcome its problem with the drug. Photo: RNZ/ Tom Kitchin
Enabled Wairoa chief executive Shelley Smith has developed a strategy to help the community beat the drug.
Even though it was early days, she hoped it would help the locality decide where to put its focus.
"What's happening in the methamphetamine space could inform what might be needed in the localities space, in terms of clinical or non-clinical support for people on methamphetamine."
One whakataukī - or proverb - the people of Wairoa use when it comes to health is hei oranga wairua, hei oranga tinana.
"Physically I might be unwell, but I might have some underlying cultural, spiritual emotional issues that also need to be addressed. So it's not just looking at individuals, [but] looking at whānau holistically," Tipuna said, explaining the whakataukī.
The people of Wairoa hope this will be addressed come the big reforms, starting this week.