Throwing out the rule book: that’s how Turangi rolls

Tractors, ski fields, hot chickens and horses have all featured in the first five weeks of Pihanga Health’s mobile vaccination service. 

The nurse-led vaccine van, Shotz on Whānau, is the only mobile COVID-19 vaccination service in the Taupō District. Operating four days a week, it takes the vaccine to some of the most remote places in the country. 

“We’ll go wherever there’s an arm and someone who wants a vaccine,” says Pihanga Health practice manager, Hilary Morrish Allen. 

“We’ve thrown out the rule-book. It’s about being opportunistic and getting people vaccinated wherever they are. Doing what works for the community – that’s how Turangi rocks and rolls.” 

Going to the people who need it most

Since the end of September, Shotz on Whānau, a Maui campervan in a previous life, has taken the Pihanga nursing team from nearby Motuoapa on the shores of Lake Taupō, south to National Park, and up to Mokai in the north. 

They’ve administered vaccines on the Whakapapa ski field, outside the local supermarket, in forests at 5am with forestry gangs, to parents outside local kura and farmers at the Tihoi Tavern. Seeing people show up on horseback, in a tractor or on an ATV is no surprise. 

“People have told us they really appreciate us taking the vaccine out to them,” says Morrish Allen. “It demonstrates that we can’t just assume the people who haven’t been vaccinated yet are all anti-vaxxers. These are really remote, often lower socio-economic groups, who can’t afford the two-hour return drive or cost of a full tank of petrol to go into town and get vaccinated. 

“They have so many pressures and stressors in their life, getting the vaccine just doesn’t feature high on the priority list of things they have to do each day to survive. Many are working in manual industries and remote locations where they need to be present every day. But if you make it easy for them, they will get it done.” 

Shotz on Whānau came to life relatively easily, with a quick question from Morrish Allen to Lakes DHB about funding a campervan for mobile vaccinations. The DHB approved the request in just three hours. 

Pihanga Health nurses and the Māori roopu in the cold chain accredited practice led the vaccination van set up and strategy. Community vaccination data quickly identified gaps in the area, making Māori and remote communities a priority. 

Staffing cover was a crucial consideration. Having local, known nurses in the mobile service, with established and trusted community relationships, was important. 

The van, a Maui campervan sourced from Auckland, was on the road 10 days after funding had been approved, complete with drawers of vaccination gear, road cones, flags, a portable electric chilly bin and the all-important tea kettle and muffins. 

Local community support also came to the fore. The local fire service offered secure overnight parking, while St John provided an emergency medical technician to work in the GP practice, so Pihanga medical centre assistants (MCAs) could be released to support nurses in the van. 

Strength of community relationships

Pihanga Health works closely with local Māori health provider, Tuwharetoa Health, and Morrish Allen says the trust is a highly trusted problem solver in the community. The two organisations teamed up to contact people with one vaccine dose, and Shotz on Whānau has been invited to Tuwharetoa health events, including a recent Well Child event. 

Morrish Allen also engaged Amplify, the local chamber of commerce group, to promote the mobile service to employers. The offer to travel directly to workers on the mountain and in the forests has been well received. 

“Local businesses have provided incentives for people too. Forest managers gave out prizes for the forestry gang with the highest number of vaccinated crew. DOC gave us fishing licences; the local New World gave out hot chickens; Hammer Hardware Turangi provided prizes; and Century 21 supported events with prizes and kai. The King Country Trust gave us $10,000 for incentives targeting Māori under-30 years of age to get vaccinated. 

“It’s this attitude to get it done that makes it work,” she says. “Proactively solving a problem on a community basis. It’s about people and relationships now, not just numbers.” 

Kōrero key to building trust

Building relationships means providing information and a chance for people to ask questions. Many people in remote communities have genuine fears and questions about the COVID-19 vaccine, but no way to get trusted answers. 

The first van visit will often simply be to kōrero with people, before going back a second time to offer vaccinations to those that want them. “Being in a flexible environment where they can talk to nurses they trust helps people make a decision,” says Morrish Allen. 

Pinnacle Inc nursing director, Jan Adams, agrees. “Having a trusted health professional to talk with is really important. 

“That interaction when you sit with someone, going through their questions and having a conversation even just about their general health – it’s something that nurses do particularly well.” 

She says the Turangi initiative illustrates the flexibility and creativity that is now needed to get to hard to reach populations. 

“We’re proud to see this nurse-led initiative,” says Adams. “It’s something we can learn from and share those learnings around the network.” 

So far, a total of 5,828 people have been vaccinated by Pihanga Health, including vaccinations given by the mobile Shotz on Whānau service. Māori patient population vaccinations have increased by 10%. 

“People just keep on coming,” says Morrish Allen. “We’ll keep going for as long as we can.”