e
WAIKATO WOMEN S HEALTH ACTION CENTRE
PAULI NE NORRIS
V I V I E N N E M 0 R R E L L
CAROLINE MASK ILL THE WAIKATO WOMEN S HEALTH ACTION CENTRE (WWHAC)
August 1987 - July 1988
Pauline Norris
Vivienne Morrell Caroline Maskill
Health Services Research and Development Unit Department of Health, PO Box 5013, Wellington, NZ - 1989
g? FOREWORD
This report is part of a wider policy evaluation process. In 1986 the Department of Health established the Primary Health Care Initiatives Scheme, to fund a number of projects exploring alternative ways of delivering primary health care. The Initiatives Scheme funded several projects, including in 1987, three women s health centres. These were The Health Alternatives for Women (THAW) in Christchurch, the Dannevirke Women s Health Centre (DWHC) and the Waikato Women s Health Action Centre (WWHAC) in Hamilton.
A separate unpublished evaluation report has been compiled on each of these centres. The information available has also formed part of a more comprehensive discussion document, which includes summaries of the evaluations of the three centres.
This is published under the title Profiling Women s Health Centres : A Evaluation of a Primary Health Care Initiative . Copies are available from the Health Services Research and Development Unit, Department of Health, P 0 Box 5013, Wellington, for $15.
DISCLAIMER
The views expressed in this report are those of the authors and do not necessarily represent the policies or views of the Department of Health. ACKNOWLEDGEMENTS
This research would not have been possible without the co-operation, time and energy of the women of the Waikato Women s Health Action Centre. Among other things they recorded their activities over the evaluation period, participated in interviews with the researchers, and read and discussed earlier drafts of this report. Thanks are also due to the people of Hamilton and nearby areas who participated in the community response interviews.
Julie Bunnell designed the evaluation. She also Conducted some of the research before leaving the Department at the end of 1987.
We are grateful to our colleagues at the Health Planning and Research Unit, Christchurch and the Health Services Research Development Unit, Wellington for th eir support. In particular we would like to thank Pauline Barnett and Penny Brander for their comments.
Pauline Norris Vivienne Morrell Caroline Maskill SUMMARY OF KEY FINDINGS
WWHAC (In Hamilton) officially opened to clients in August 1987. The WWHAC collective was formed from a group which began meeting during 1986.
WWHAC s main activities were providing information to women, individually or in groups, community work, cervical screening, networking with other agencies and advocacy. This range of activities is described in the report although some activities were difficult to evaluate.
Over 90% of visitors and telephone callers were female and about 70% were in the 20-45 age group. Maori visitors and callers were,slightly under- represented compared with the Hamilton population, although ethnicity was not recorded for a third of the clients. The attenders of courses, workshops, seminars, speaking engagements and meetings came from a wide age range.
The most common reasons for visits were health information (35%), counselling/support (19%) and inquiries/requests (17%). The most common reasons for telephone calls were inquiries/requests (29%), health information (25%) and counselling/support (13%).
Client satisfaction was mainly assessed by the WWHAC workers. Attempts to gain this information from clients themselves were unsuccessful.
Fifty-six percent of telephone callers and 64% of visitors were considered to be "very" or "somewhat" satisfied although for one third of the clients, the satisfaction level was not recorded. Ninety-four percent of courses, workshops and seminars and 85% of meetings and speaking engagements were rated as successful by the WWHAC organisers.
Of the 24 clients who completed questionnaires, 59% were satisfied.
A range of community and health groups were interviewed to gauge support for the centre. Fourteen of the 16 interviewees supported the centre s continued existence. They perceived that the main impact of the centre was on women who used the centre, community agencies and support groups. I
CONTENTS
Foreword
Acknowledgements Page
Origins of the Well-women clinic initiative 1 The Evaluation
- The aims of the evaluation 7 - The methods 7 - The process 9 - Data collected
Background of WWHAC 12
WWRAC s Account of their history 16
Activities of WWHAC 24
- The New House 24 - Drop-in and Phone Calls 25 - Referral 26 - Lunches 26 - Other Activities at the House 27 - Use of the House by Other Groups 27 - Speaking Engagements and Meetings 28 - Courses, Workshops and Seminars 28 - Major Projects 29 - Community Health Groups 31 - Other Activities 31 - Political Activities 32 - The Future 32
WWHAC: The people and the organisation 33 The users of WWHAC:profiles and satisfaction of levels 37
Funding and money 43
Community Response 46 Summary 55 References 57 Appendix A: Summary of log sheet data Appendix B: Record of speaking engagements and meetings Appendix C: Record of courses, workshops and seminars Appendix D: Smear campaign Appendix E: WWRAC Talking with your doctor I - I -
WAIKATO WOMEN S HEALTH ACTION CENTRE
THE ORIGINS OF THE WELL-WOMEN CLINIC INITIATIVE
The funding of pilot well-women clinics was part of a new initiative in primary health care. To understand its origins within the Health Department it is necessary to look at both this initiative and the work of the Women s Health Committee of the Board of Health in suggesting and promoting the concept of well-women clinics.
The Women s Health Committee
In 1985 the Women s Health Committee of the Board of Health was established. It was to advise the Board on matters relating to policy on New Zealand women s health, in particular to identify current and future needs in the area of women s health and to establish priorities. In order to determine the priorities, the Women s Health Committee called for submissions from the public. Many submissions calling for improvements in present services and new health care options for women were received. Thirty-three Iof these called for the establishment of well-women clinics, women s health centres or wellness centres. A member of the Women s Health Committee had visited well-women centres in Australia and the committee considered that this was a. n appropriate model for service delivery. Maria Brucker, secretary to the committee, prepared a paper summarising the submissions that had been made.
Submissions suggested that well-women s centres "need to provide alternative types of care to traditional models" and promot[e] ... women s self-health , care". Well-women s clinics were seen to be community-based. Some argued that "the medical profession doesn t consider women s problems to be a priority". A well-women s clinic would provide women with information so that they could make informed health care choices and thus take responsibility for their own health. Clinics were seen as a form of effective illness prevention and health promotion as well as being involved in the early detection of disease. One person thought that centres should be run by lay people because "women s health has progressively become medicalised to the point where women now turn to the experts , for advice, treatment, care, etc on what are perfectly normal experience . s or social problems". I OWAO
The following services were suggested: resources on physical and mental health, alternative medicine screening for illness, programmes related to mental health (eg, provide counselling, self-help groups, assertion training etc), advice on non-life threatening matters (eg, menstrual problems, pre menstrual tension, menopause, diet, stress, depression, , access to abortion, pregnancy testing).
The Development of the Primary Health Care Initiatives Programme
In June 1986 the Director General of Health (George Salmond) approached the Minister of Health (Michael Bassett) about the possibility of funding a new Primary Health Care Initiative. New projects would be given one-off funding as an experiment in alternative method(s) of delivering primary health care. The Minister agreed in principle to fund one or more primary health care initiatives, and requested that proposals be prepared and submitted. $637,000 was allocated to the initiatives.
Proposals were developed under the auspices of an informal working party chaired by Dr. Bob Boyd, from the Clinical Services Division of the Department of Health. (Following the 1986 restructuring of the Department, the working party was serviced by the Primary Health Care Programme.)
The Well-Women s Clinic Proposal
The working party considered that it was appropriate for one initiative to be directed specifically at women and Dr Judith.-Johnston (Chairperson of the Women s Health Committee and Director of the Health Services Research and Development Unit) was asked to develop a proposal. The first proposal she developed outlined three options - a community health centre, well-women clinics, and small grants for women s health activities. Both the Primary Health Care Programme and the Minister of Health supported the well-women clinic proposal. This was outlined in more detail in a further proposal. This noted that women were expressing increasing dissatisfaction with various aspects of health care services, in particular:
"the lack of health advice and education for women"
"the emphasis on curative rather than preventive medicine ,, and "the lack of holistic or total health care which accommodates physical, social and mental well being" I - 3 -
"difficulties in the relationship between women and health professionals in the present fee-for-service system" and thus "the need to develop a collaborative approach to health care,,
The model which was suggested to address these concerns and at the same time involve women taking responsibility for their own health and taking part in decision making about health care services, was that of well-women clinics. These
might offer, for example: I
broad-based preventive healtheducation to women of all ages;
screening and testing services with follow-up diagnostic procedures where appropriate; services targeted to the particular health needs of premenopausal, menopausal and post menopausal women;
specialist counselling in relation to fertility, contraception, nutrition, etc;
support services for groups such as Young Mothers Support, Anorexia and Bulimia Groups, Child Care groups and Age Groups amongst others; information and referral of common gynaecological infections and STDs.
In addition such clinics could offer a limited general practitioner service for women specific concerns. It was noted that:
Over the past decade women s groups have advocated such an approach and some attempts to establish such services have been made. Such groups and approaches have primarily suffered from a lack of resources and funding. These initiatives do provide the basis or framework on which a well-women clinic could be developed. It is necessary that such groups be given the opportunity to test their approach and to demonstrate the value and viability of alternative ways of delivering health care ... it is suggested that a general invitation be given to those involved in women s health to put forward detailed proposals for the establishment of pilot well-women clinics in various locations. This invitation should be unrestricted and not tagged; the important variable is that the initiative is based, managed and administered in the community... I - 4 -
The proposal recommended that a research/evaluation project should run in tandem with the overall initiative to provide the formal assessment.
Dr Johnston and the Women s Health Committee continued to develop and support the proposal and it was approved as one of the Primary Health Care Initiatives.
Approval of the Cabinet Social Equity Committee
In July 1986 the Director General of Health formally requested that the Minister of Health seek the approval of the Cabinet Social Equity Committee to allocate $125,000 to the Well Women s Clinic Pilot Project.
In August that year the Cabinet Social Equity Committee approved $125,000 to go to two or three clinics. It was agreed that the allocation of funding would be decided by a Steering Committee comprised of two representatives from the Department of Health and one representative from the Ministry of Women s Affairs.
Other Primary Health Care Initiatives which were funded were Independent Nurse Practitioners, a Healthline, Union Medical Clinics, Maori Community . Health workers and a cervical screening project [McGrath 1989].
Announcement of the Well-women Clinic pilot project At the end of August 1986 the pilot well-women clinic project was jointly announced by Michael Bassett, Minister of Health, and Ann Hercus, Minister of Women s Affairs. A deadline of October 17 was set for the submission of detailed proposals to the Department of Health. In the Press release the Minister of Health said:
The well-women s clinic idea centres on wellness and the promotion and maintenance of good health, rather than on curative services which treat illness .... It would encourage an holistic or total view of health care which incorporates the physical, social and mental well-being of women. While well-women s clinics may provide a range of services, their focus should be on health education and information, and the prevention of ill health, aspects which are often difficult to cover adequately in the present primary health care services. In this way well-women s clinics would complement and enhance the primary health care services already provided by general practitioners. The way in which well-women s clinics are set up will be important .... To be effective and at the same time be sensitive and responsive to the specific health needs of the women in 11 - 5 -
their communities, well-women s clinics must be established and managed by those involved in that community and its health services.
About 800 leaflets explaining the application procedure were mailed to all groups and individuals on the Women s Health Committee mailing list and the Ministry of Women s Affairs mailing list, plus all Hospital Boards and District Offices of the Health Department. The leaflet was also reprinted in the magazine Choices.
The leaflet explained that:
While there are no set guidelines, the important features will be that the project:
- is planned, run and managed in the community; - adopts a primary health care approach
- meets the needs of women in the community;
- has clear aims and objectives which provide health services for women;
co-ordinates with existing services; and uses funds in an effective and efficient way. It was suggested that groups should include information about themselves, their goals, the support for the project, management and how funds would be allocated. The leaflet noted that an evaluation by Department of Health researchers was part of the funding package.
Maria Brucker from the Primary Health Care Programme acted as a point of contact for applicants, handling enquiries and checking applications to see that they contained enough information.
Selection of the successful proposals
At the closing date of 17 October 1986 thirty three applications had been received, totalling hundreds of pages of material. Applicants were a diverse range of groups: existing women s health groups, new associations or coalitions of women, and established groups that wished to move into new areas. Urban areas, provincial areas, and rural areas were all represented. Ten of the applications were from the South Island, and twenty-one from the North Island. The remaining two were geographical floaters , being proposals to develop workshops and videos on women s health. The steering committee which selected the successful proposals noted: - 6 -
The most impressive feature of these proposals was not ... their variety, but the depth of enthusiasm, energy, and commitment evident in them. The thirty-three applications represented an immense amount of work, carried out in a short period of time, by a diverse range of New Zealand women. Reading through the applications was an exciting and also humbling experience. It was also an experience tinged with regret, knowing that choices had to bemade, and that many excellent applications would have to be declined [Bunnell 1987].
The Ministry of Women s Affairs became involved at this stage - it had one representative on the Steering Committee. The other two members were from the Department of Health. Two meetings were held to consider the applications. These were attended by a number of advisers from the Health Department, as well as the official members of the Steering Committee. All those who attended read and discussed the proposals. The proposals were assessed in terms of: overall impressions, the make-up of the group applying, support from the community, management, and goals and philosophy. The assessment process also registered impressions and feelings derived from the tone and style of the proposals. Individual committee members , knowledge of the groups or areas concerned was also considered relevant to the assessment procedure (Bunnell 1987]. Six proposals were selected as top priority by the end of the second meeting. A team of three people from the Health Department and one from the Ministry of Women s Affairs visited these six groups in November 1986. The visiting team then prepared summary reports of their visits, which were discussed by the full committee on 9 December 1986. The committee s recommendations for funding were forwarded to the Minister of Health a few days later.
After some negotiation, three groups were agreed upon by the committee and the Ministers of Health and Women s Affairs, and the three successful groups were confidentially offered funding just before Christmas. All replied affirmatively early in January, and a public announcement followed on 15 January. The Health Alternatives for Women (THAW) in Christchurch and the Dannevirke Women s Health Group were granted $50,000 each, and the Waikato Women s Health Action Group was granted funding of $25,000. The letters from the Ministers of Health and Women s Affairs emphasised that the funding was a one-off , arrangement and encouraged groups to develop relationships with local hospital boards.
Each of these groups received a further $30,000 in the following year (for 1988-9). An additional $70,000 was made available for two more women s health groups. Previous I - 7 -
submissions were reconsidered and Te Kakano o Te Whanau also made an application. A committee made up of people from the Health Department and the Ministry of Women s Affairs decided to allocate $30,000 to the Taranaki Well Women s Network and $40,000 to Te Kakano o te Whanau.
THE EVALUATION
The Aims- of the Evaluation
The aims of the evaluation were to follow and document the establishment of the well-women clinics, to describe them, and to assess how well they achieved their own goals and contributed to those of the Primary Health Care Initiatives Scheme.
The initial areas for evaluation were:
1. Origins of the Well Womens Clinics Initiative,
2. Establishment of the Clinics (since THAW was already well established this is lessimportant in the evaluation of THAW than the other clinics),
3. Services provided and the Service providers 4. Client Profiles
5. Client Satisfaction
6. Community response (this includes the centre s interaction with official bodies, health professionals, and women in the community) 7. Financial Status [Bunnell 1986)
At the beginning of the evaluation it became clear that the term clinic was inappropriate and the organisations wished to be described as centres. WWHAC had made this clear to the selection committee when they visited Hamilton.
The Methods of the Evaluation
The methods used were the result of collaboration between the researchers and WWRAC. Several meetings were held to discuss both the type of information to be gathered and the methods. The WWRAC collective were encouraged to make suggestions and comment on the proposals put forward by the researcher. Details of the type of information sought and the methods used were: - 8 -
"I. Origins of the Well Women Clinics Initiative:
Description of how the initiative developed, with information from written records and interviews with key people; description of the procedures and criteria used for the allocation of funding.
2. Establishment of the Clinics
Description of the setting-up phase, including the specification of objectives, and translation of aims and objectives into specific services and activities. Information to be derived primarily from interviews and participant observation.
3. Services provided, and the Service Providers
Description of the services provided and activities undertaken by the clinic, and description of the personnel who provide or facilitate the clinic s services and activities. These services and activities may change during the lifespan of the clinic, as a result of feedback from clinic users, or as new needs become apparent in the community. Attention will also be paid to the satisfactions and disappointments of the service providers. Information for this part of the evaluation will be derived from participant observation and key informant interviews. 4. Client Profiles
Data to be recorded should include: sex, aget ethnicity, marital and familial status, educational status, housing status, occupation or source of income, reason for attendance, service provided, and fee charged (if any). It may also be desirable to query the client s source of information about the clinic, and why they chose the clinic alternative in preference to orthodox services. 5. Client Satisfaction
This could be assessed by postal questionnaire, or telephone or personal interview at a specified time after contact with the clinic. Some combination of these may be desirable: for example, all clients to be given a postal questionnaire, and a sample of clients to be interviewed personally. Another option might be to invite clients to a feedback/discussion group. I - 9 -
6. Community Response
The response of the wider community to the clinic, and the nature of the clinic s interaction with traditional health services, need to be considered in this part. It may be advisable to incorporate a description of the community in which the clinic is located, the population it is intended to serve, and the nature and level of existing health services. Participant observation and -interviews, both in the clinic and in the community, will provide the information for this section of the evaluation. 7. Financial Status
This part of the evaluation should examine the income and expenditure of the clinic, projected versus actual costs, financial decision making mechanisms, and the clinic s progress in locating and securing alternative sources of funding. Any systems for staff remuneration and/or charging clients should be described, and an assessment of the degree of voluntary work performed should be made. Information from this section will come from the clinic s financial records, plus interviews with clinic personnel and management [Bunnell 1986].
Log sheets for telephone calls, visitors, and talks were drawn up in a collaborative process between the researchers and WWHAC. Log sheets were piloted by WWHAC and revised where necessary.
WWHAC agreed to provide a brief account of their history and provided a copy of their budget and actual expenditure.
The Process of the Evaluation
The evaluation outlined in this report differs somewhat from that initially envisaged. Some are -as are not adequately covered (notably client profiles and satisfaction) and data collection overall was somewhat sporadic. There are several reasons for these inadequacies- some practical, others relating to the relationships, and perceptions of the relationships, between WWHAC, the Department of Health as funding body and the Department of Health evaluators.
Due to changes in staff at the Health Services Research and Development Unit, more than one Department of Health researcher was responsible for this evaluation. None were based in Hamilton. One Wellington-based researcher, Julie Bunnell, was to have carried out the evaluations of all three pilot well-women centres. When she left the Department, two others from Wellington took over the WWHAC I - 10 -
project - one doing the administration and analysis of log data, the other doing the community response interviews and part of the writing of this report. The final field work was done by a fourth person who was based in Christchurch. This succession of changes in personnel was unfortunate because it meant that no one researcher had a comprehensive understanding of the whole process of the evaluation from start to finish. It was also problematic for WWHAC, who often did not all know who was responsible for which areas of the evaluation.
WWHAC had both positive and negative feelings about the evaluation. When collective members were asked to reflect on the process, many said that they saw the need for evaluation and accountability. Most of their concerns about the evaluation related to its perceived emphasis on quantitative aspects, and to obtaining demographic information and feedback from consumers. The time-frame of the evaluation, WWHAC s expected input and the relationship of the evaluation to funding decisions were other areas of concern.
Some WWHAC members felt that the evaluation was not picking up what they considered to be one of the most important aspects of WANIHAC s work: informal networking and sharing of information. They felt that focusing on numbers of women who received WWHAC services distorted and underestimated WWHAC s role and effects. Each contact with one woman can have effects on others as they become aware of WWHAC and start to think about and talk about health issues. They argued that WWHAC s goals and views of appropriate measures were not the same as those of the Health Department and the evaluation measured WWHAC against the Health Department views while not taking enough account of WWHAC s. The ability of the Department to judge what women s needs were, and therefore-the degree to which WWHAC met them, was questioned by WWHAC members. WWHAC believed that its worth could not be assessed by counting the number of visits made to the centre. WWHAC members wanted the evaluation report to cover the way WWHAC worked and the philosophy of the centre but were concerned that it would not do so because of a fundamental incompatibility and lack of understanding by the Department of its alternative way of working. WWHAC members felt that because of the evaluation requirement, they may have tried to evaluate things which should not have been evaluated. Consumer satisfaction was a particularly difficult area. They noted that it was "really inappropriate to thrust papers at" and post forms to women who came to the opening week activities. Some women may have been making tentative steps towards finding out about women s health and may have been put off by the forms, especially if they were not confident about filling in forms. Asking for written consumer feedback from one day - 11 -
sessions may have been the most problematic part of the evaluation ^ Obtaining feedback from visitors to the Centre was described as like asking a friend who came over for a cup of tea to fill in a form as she was leaving. WWHAC also felt that the evaluation was carried out too soon - it argued that community initiatives take a long time to become established. An on-going assessment for five years was suggested as a better way of evaluating WWHAC. There was some concern among WWHAC members about the time and energy the evaluation required of them. This workload was unevenly carried by those who were responsible for logging events, calls and visitors, and those who liaised most with the researchers. Only one or two WWHAC members were paid for part-time work and the others devoted up to twenty hours per week of voluntary work. The tasks required by the evaluation added to this. If the costs to WWHAC of the evaluation had been included in the grant from the Health Department, WWRAC believed the evaluation could have been much better. Accuracy suffered because the co-ordinator was supposed to attend to women visitors and callers as well as record these. This meant that when the centre got busy fewer visits and calls were recorded because the co-ordinator did not have time to do it. WIKIHAC had assumed that the results of the evaluation would have had some bearing on the decisions the Department of Health made about future funding. The decision to cease funding of the pilot centres after early 1989 destroyed this belief and cast doubt on the usefulness of the evaluation. One member mentioned that she would have liked more feedback about the progress and findings of the evaluation from the researchers. Although the list of organisations to be interviewed to gauge community response was developed in consultation with WWHAC, there was a delay between the development of the list and the interviews. This may have meant that some groups which WWHAC liaised with were not included. Since the interviews, WWHAC had more contact with some of the organisations interviewed.
Data Collected Because of the difficulties encountered in this and the other well-women centre evaluations some of the focal areas were covered more adequately than others. - 12 -
Client profiles and satisfaction proved to be the most difficult areas to explore. Data on age, sex, ethnic group, and participation in the paid work-force were collected to varying extents. Why consumers chose WWHAC instead of other services is not known. Most of the data on satisfaction gave WWHAC s perception of the users satisfaction rather than direct feedback from the user.
The response of established health services along with community organisation and support groups with whom WWHAC might liaise was the only indication of community response.
Very little information was collected on the activities of. the community workers employed by WWHAC because they were not funded by the Health Department.
Data were collected over a ten month period from August 1987 to July 1988 and this should be kept in mind while reading the evaluation report.
BACKGROUND OF WWHAC
On 16 October 1986 the Waikato Womens Health Action Centre (WWHAC) collective applied for funding from the money allocated to well-women clinics . The application said: (WWRAC)is a new group which, at the time of the funding announcement, was already exploring ways of meeting objectives similar to the intention of the pilot scheme. The group came about originally because we simply could not ignore the interest and concern about women s health issues expressed all around us ....
Founding Philosophy of WWHAC
The members of Hamilton Women s Health Action Centre recognise that health and well-being are the right of all people.
We believe that good health is not confined to efficient bodily functioning, but includes all aspects of personal and community life. How a person habitually thinks, feels and acts is intimately connected with physical functions. our concept of health encompasses all facets of individual life, and recognises too that the environment of a community, and the ways its members interact, deeply affect the well- being of individuals within that community.
We believe that individuals should have the knowledge and the resources to maintain their own health, and to - 13 -
maintain the health of others in their family, whanau, neighbourhood and workplace. The organisation is set up and run by women, whose reproductive function and traditional role as primary carers has made us the chief consumers of health services. At this time in the history of our society the united voice of women can make a positive contribution to our major objective, which is wellness for all people in our community, regardless of gender, race or age. The aim was described as: To establish a Women s Health Action Centre to liaise between the resources of the community and existing health services so that they become accessible and acceptable to women. To achieve this the group intended to work on four fronts - education, information, support and liaison. They elaborated on some of the methods they thought they would use to achieve these goals: 1. To provide a telephone line modelled on the Citizens Advice Bureau, to enable women to make effective use of existing health agencies. 2. To encourage women to drop in, and to make use of the library and information resources. 3. To promote courses on massage, nutrition, alternative medicines, ante-natal classes, reproduction, contraception, parenting, coping with menopause, mastectomy, hysterectomy, etc, and mobilising these to make them accessible in the suburbs. 4. To employ a nurse practitioner who would answer queries, help women to understand their own and their family s bodily functions, provide appropriate counselling, run education courses, and refer women to appropriate services. 5. To employ a house co-ordinator to arrange timetables, maintain order in the^house, answer correspondence, maintain the library, and co- ordinate the activities of voluntary helpers and tutors. 6. To develop a register of able tutors, and a body of resources for use in educational courses.
- 14 -
7. To develop a computer-documented membership network of-many thousands of local women, and to help them get in touch with each other, and resources , to work on specific health-related objectives and activities.
Letters of support were enclosed from 17 people, most of them representing groups and organisations.
The centre planned to become an incorporated body and had a central collective of up to 12 women who had individual portfolios of responsibility. The central collective made the decisions about the use of funding and development of services, based on information provided by representatives of issue-based groups and geographically based health groups:
The collective will work to develop geographic health groups based in the suburbs, as well as issue based groups. The specific issues to be addressed will be decided on by members of each group. A "supporter registration form" was sent out with the first newsletter (March 1987). Among other things this asked if women were interested in joining a health group in their area and/or a special interest group and if so, to specify the topic of interest. At the bottom of the form was noted "as the portfolios get up and running, you may be invited to join a support group in a particular interest area. However, filling in this form does not commit you to anything."
From a list of 156 supporters dated 25 June 1987, 94 had said they were interested in an area health group and 66 in a special interest group. The centre also produced an age breakdown of its supporters in 1987, as follows:
At 25 June 1987 At 25 November Age Grouping Number % Number % Under 20 nil 0 1 0.4 4520-30 25 16 19 30-40 55 35 88 37 40-50 45 29 57 24 over 50 28 18 39 16.5 Not recorded 3 2 7 3
Total 156 100 237 100 The supporters list of 25 June had women with a wide range of experience. There were large numbers with nursing backgrounds, teaching, experience in counselling/social work or work with groups, involvement in other community or voluntary groups and alternative health practitioners; some I - 15 -
had clerical/financial backgrounds, librarians, church group involvement, and other health practitioners, such as psychologists, physiologists, radiographers, dietitian, doctor and pharmacist.
Two suburban groups were underway by mid-August 1987. The March 1987 newsletter said
each collective member will be focussing on a specific area of responsibility (ie they will accept a portfolio). To spread the load and involve as many women as possible in the activities and decision making, each portfolio holder will have the responsibility of developing a support group within their area of interest.
At 16 March 1987 Portfolios were divided into: Administration Education - Public Relations - Research and Evaluation - Resource and Information - Womens Health Groups
A public meeting was held on 4 April 1987 which about 130 people attended.
The centre obtained a house from the City Council, in Grey Street, on the other side of the river from the main shopping and business area of Hamilton. The two-storied house was on a back section. There were two big rooms downstairs - one used as an office, the other as library/reading room/playroom, plus a kitchen and entry foyer. There were three rooms plus bathroom/toilet upstairs.
The house was staffed from 18 May, from 10.00- 2_00 Monday to Friday but at this stage was open to supporters and not the public. Two collective members were paid for 8 and 12 hours per week each on a temporary basis until a permanent co-ordinator could be appointed. This was funded by a $1000 setting-up grant from the City Council s Community Assistance Programme (CAPS). One co-ordinator said in late July (before the official , opening) that they were getting a lot of phone calls and some women with health problems had called in.
Problems were experienced with the house from the beginning. These are discussed in the next section. I - 16 -
The centre s opening week began on 9 August 1987. Approximately 330 women attended events during the week, some came several times. The general feeling from the Group was that it was very successful, the only problem was that volunteers who provided childcare had not felt part of things-.
A seminar on Health after 50 1 was organised at the Waikato Technical Institute at the end of the opening week. Topics included Changing Relationships, Physical Health Issues, Alternative Health Care, Living Alone, Maori Women s Perspective on Health and various opportunities for women after 50. This was attended by about 70 women and was followed up with a discussion series at WWHAC. The seven weekly meetings were not as well attended but provided an opportunity for the attenders to share their knowledge and experiences, provide support for each other and learn about health-related issues.
One of the first workshops to be held was run by a psychologist from Auckland about anorexia and bulimia and fashion trends. About fifty women attended.
WWHAC was asked to prepare an account of its history. The result is included here in italics.
WWHAC S ACCOUNT OF THEIR HISTORY (This was written by WWHAC in September 1987)
The beginning of a community group is a process which must be understood against the local historical and political background of the time. In June 1986 the political climate in the women s community in Hamilton was in a very fluid state. Attempts had been made the previous year to set up a women s community centre. Rape Crisis and Battered Women s Support Line were sharing a house let to them by the City Council. Funding was difficult for these groups, their future was uncertain, the work they were doing was urgent, exhausting, and endless. At the Waikato Technical Institute, New Outlook for Women courses had been running for several years, raising awareness of, among other things, the commonality of women s health needs. At Waikato University, a vigourous women s studies programme had brought together many diverse, concerned, intelligent women. The Hamilton City Council had developed its Recreation and Welfare Department, employing several Community Development officers, all of whom were strong women with good networks and skilled at working in community groups. - 17 -
Discussions about the need for a women s health centre in Hamilton began in several places more or less simultaneously. Chance remarks among women who were active in the women s community resulted in informal meetings in Te Whenua, the women s room at the University. At one of these meetings, one student community activist knew that the closing date for applications for the Community Assistance Programme funding was the following day. The meeting had already agreed that funds were needed for an exploratory phase. An application was to be successful, giving the group $1000 which was eventually used for the production of initial newsletters, postage, and publicity for public meetings early in 1987.
Battered Women s Support Line heard of the new initiative through the network, and a group of women concerned with the new proposal was invited to meet with them. This meeting tackled the issue of the differences and similarities in the objectives, of the two centres. As a result, the meeting gave unanimous support to the health centre concept. Battered Womens Support Line offered the new group. accommodation in the sunroom of their council house, although it was recognised that this would be temporary. The new group was clear that they would not completely exclude men from their premises, whilst they acknowledged the need for a safe house for women. The Battered woman s support LinelRape Crisis Centre was seen as the safe house. The process of identifying the objectives of the new centre now began. Central in this process was the participation of a Hamilton City Council Community Development Officer, Lindsey Holzer. Lindsey had attended a seminar held at Waikato University on the proposed area health board. She could see that there was room for community organisations in the new health structures, and was aware of other similar initiatives for women s health in other parts of NZ. Lindsey was effective in mobilising city council awareness of the new project. The council supported fact finding visits to health centres in other cities, including the West Auckland Women s Centre and THAW in Christchurch, the latter with funding from the MacKenzie Foundation. Encouragement for the idea of a centre came from all sides, but few of the encouragers felt they could give time and energy. Several small meetings were attended by the same four women. Some of these women had known each other previously through their work; others became colleagues through their shared concern with the new project. There was a tutor from Waikato Technical Institute (WTI), a public health nurse, a community worker and a university tutor. In August 1986 this group produced the first set of objectives as follows: I - 18 -
to disseminate health information by effective use of networks, and by sharing educational skills;
to meet the health needs of women in suburbs;
to be a central source or collection of information on health, especially women s health;
to support other groups working on health-related issues.
One Saturday afternoon, early in September, a meeting of these women, and their children, produced the philosophy which is the basis of the Centre as it now stands.
At the end of August the Ministers of Health and Women s Affairs had announced the Well-Women Clinic Pilot Project. The group decided to find out how much support there might be in the community for an application. They produced a two page document which stated the objectives, the philosophy, and suggested ways in which these objectives might be put into practice. They then went about showing this document to people in key positions in the health services and voluntary agencies, as well as to people in the community.
On October 2nd, a meeting of representatives of a wide range of community groups was called, to establish the degree of support for an application for Well-Women Clinic funding. This meeting was not advertised publicly, and relied on informal networks to invite groups. This process of using networks was successful in that it reached a wide variety and large numbers of women s groups: its failing was there was no attempt made to systematically ensure that all groups who should have been represented in fact were. This later resulted in some difficulty for the group, as will be shown.
The basic philosophy and objectives were accepted unanimously by the meeting, and letters to support the Well- Women Centre application flooded in. There was good support from existing health agencies, as well as from women s groups, and individual women. The proposal which was finally submitted comprised some 50 pages. It took many hours of discussion to reach a point where the proposal could be written, and many more hours of typing, and photocopying to get it into the post. With the exception of the Community Worker, all the work done was unpaid. Six women were now fully involved. All of them had families with children, and four had full time jobs. The whole initiative went into recess from exhaustion in November 1986. News of the success in Well-Women Clinic funding came through on Christmas Eve. Most of the group were on holiday with their families throughout January. There was not even time to celebrate. I - 19 -
The group reconvened on 29 January 1987 with one new member, br inging the total to seven. The problem of enlarging the steering group was one which proved difficult to solve. Informal contact with other women drew, mostly, one of two responses: either the woman did not have timelenergy, or she said she would support it but didn t feel able to be involved. The group tended to be see,n, rightly or wrongly, as strong and capable and this may have distanced from them some women who could have been involved. This is still an issue for some members. Many women, though unable, they said to join the collective, asked what they could do. Usually there was no answer - what was needed was women who had energy and confidence to start processes, rather than be told what to do. We were not up to telling others, and were in serious need of guidance ourselves. This is a phase which could have been done better.
Concern that Maori women should be served by the Centre prompted us to call a meeting of representatives of several Maori and Pacific island women s groups. This meeting was very supportive of the Centre s concept, and one woman from this meeting volunteered to join the Collective. Unfortunately her membership was short-lived,- as she was overtaken by the prior needs of family and full-time job.
Relationships within the group were always important. And so, as the Collective gradually expanded to twelve, the new women needed time to learn about each other, and about what had gone before they joined. February and March saw the group holding weekly meetings in a community (council) house. Finding a time to suit everyone was difficult, and the group eventually settled on 5 pm. This meant many jaded, tired meetings ended in ragged disarray, as important business like when1how the first money should be paid by the Health Department got mixed up with other important business like whether families could stand it if we were not home by 7.30.
The changing composition of the group during this period made it very difficult to decide on a meeting procedure which was workable. The group had no chairwoman or secretary, except that it did have by this time a minutes secretary. Often women went home after meetings disgruntled at the apparent lack of a business-like approach. Although a great deal was getting done, it often did not seem this way. in the minds of the women involved, getting the job done . often competed for priority with the need to care for one another.
The issue of leadership never came up. Tacitly, the women agreed that each had her strengths, and was able to lead as her strengths became the appropriate ones to follow. By March there were 12 women in what was now referred to as the Collective. Frustrations with lack of meeting procedure had I - 20 -
resulted in sustained attempts to delegate facilitation for each meeting. One member, Shirley Burton, had chosen to work for voluntary organisations rather than look for a career in paid work. Shirley had secretarial and managerial skills and had bought herself a computer for Christmas . Fortunately for the group, she taught herself to use the computer, doing useful jobs for WWHAC such as making and sorting lists of members, printing and so on. Shirley made community development a whole new field for computer companies, who are yet to discover it.
Some of the frustration felt by the Collective during these weeks was because the things being done in meetings were primarily administrative. The group tackled such difficult agenda items as whether to become an incorporated society or an incorporated Trust. Such issues take a long time to do properly, and at this early stage in the life of the group it seemed necessary for all members to participate in the debate and subsequent decisions these issues required. This avoided the problem of an "in-group", but added to the time required from all the members. Most-of the members at some stage or other during this time felt impatient because the group was only maintaining its own administration - it was not doing what it had set out to do, namely, reach women, with health information, education, resources and support. In retrospect, however, it was very important that we did those things for ourselves, and for one another, that we wanted to do for all women, as well as set up the Centre. It is safe to say that the support each member receives from belonging to the group is now recompense for the long hours of frustration and weariness, though the contradictions and conflicts of interest involved for us in getting there must be obvious to all who read this.
In the middle of February news came that the City Council were to give the group tenancy of a two-storied house close to the Centre of the city. New tenancy laws meant that the tenancy could not be taken up until May 18th, The group still had a philosophy and objectives, and though it had some ideas about strategy, it was difficult to decide how best to use the limited energy available within the group. Specific objectives had to be formed, and a wider, more efficient administrative structure had to be found.
A Sunday afternoon meeting in mid-March, with, this time, many more children running round Lindsey & Heinz s farm, addressed these issues. The result was a very clear vision of the administrative structure, which allowed for separate and distinct teams with specific objectives, each headed by members of the Central Collective (as it was now to be called), to be developed using the voluntary woman-power which was still being offered to the group in increasing volumes. These teams were to address funding, education, public relations and liaison, resources, administration, and I owsm
the setting up of the suburban health groups. The Central Collective was to be the policy-making forum to which teams reported and submitted their ideas for approval. Above this was to be the Trust, whi .ch would have a supervisory or grandmotherly role, and would give guidance on overall direction and finances. The real teeth of the organisation were to be the Central collective.
The issues of which specific objectives to follow was addressed by calling another public meeting. The meeting was advertised widely. 130 women who attended at 1.00 pm on Saturday afternoon 3rd April were asked to tell the Collective what they want,ed the Centre to do for them. The responses were very like the original set of ideas submitted for the Well-Women proposal, but gave a bett-er idea of priorities. Support and networking through neighbourhood health groups came out very strongly, with an equal emphasis on information resources on specific women s health issues such as PMT and menopause. The group now felt secure that it had a mandate for action. What were we waiting for? The answer turned out to be: the house. Once the house became available in May, the Centre became a reality. Working bees mobilised women who had offered help. A wonderful, calm spirit of community combined with common purpose characterised the working bees - the same spirit has prevailed at meetings of many different people in the house ever since.
The Collective now faced the challenge of appointing a co- ordinator. Deciding how the principle of sharing power equally with all women applied - in this case was a challenging debate which we all enjoyed. Should we advertise or not, when members of the Collective wanted the job? How should we interview our peers, and choose between them? In the end we opted for an interim appointment for 3 months, during the setting up phase and two collective members, each offering different but, we felt, complementary strengths, took up the position. There was enough money for 4 hours a day, five days a week. The co-ordinators, with helpers, set about finding furniture, arranging the growing library of pamphlets and books put together by the resource team, setting up filing systems, letting the community know we existed, dealing with enquiries of all kinds, and welcoming anyone who came to the house. We began to feel more assured as we saw our systems beginning to work. collective meetings became less frequent, now at 12 day intervals (though still at 5 pm) - support teams were developing, volunteers came from everywhere and gave their time for such things as funding applications, activity planning, and creating and maintaining resource files. The media had constantly expressed interest in what we were doing, but having seen how the Dannevirke group was treated in a Sunday paper, we learned quite quickly how to resist - 22 - the temptation to respond precipitantly to their apparently inevitable urgent and sensationalising approaches. our contacts with the media have been mostly very positive - most of the reporters who have approached us seem to support our initiative, and in a town the size of Hamilton the nature of these contacts is more in the style of networking. The same can be said of contacts with the health services. Many women in key positions in both the mainstream and "alternative" health services are on our supporters list. Some of the women may have felt challenged by the reluctance of the Centre to give the provision of specific services high priority. The Centre has consistently encouraged groups and individuals with ideas to put them into effect themselves. Rather than do their project for them, we see the Centre as the hub of a large network, where women on similar paths can meet and-derive energy.
The primary cause of the Centre is education. This is promoted by meeting requests for speakers, arranging meetings on specific topics, and by helping to set up neighbourhood health support groups. By these means the Centre reached well over 500 women in its first 3 months. A feature of requests for speakers is the number received from rural groups. Speakers invariably find it extremely easy to get discussion on health issues with groups going, and sometimes have been overwhelmed by the response of women who seemed to need only "permission" to talk about their health with one another. Often speakers have seen long term problems ameliorated, if not solved, through this process of sharing information and support.
The house had been staffed since 8 July, and we felt a celebration was called for. Rather than ask a visiting dignitary to "Open" the Centre, we decided to have an opening celebration in August, beginning with a gentle ceremony to endow the house with the spirit of women. To follow this Sunday celebration, our education team arranged a week of lunch time discussion topics. The media were alerted and we received good publicity throughout this period.
There was only one blight on our horizon. A feminist group which was represented within the collective, had for some time been trying to persuade us that our occupation of the. house was in fact at the expense of a Maori women s group, who had wanted this particular house for two years. We were accused by the pakeha feminist group of benefiting from our middle-class respectability in the eyes of the City Council, at the expense of the Maori group who, it was said, did not have the advantage of being seen as equally respectable. Much agony surrounded this issue. We tried to retrace the steps which had yielded up the house, and felt blameless. - 23 - which perhaps we were. But, the feminists argued, you are benefiting from bureaucracy which acknowledges your values, and not those of the Maori group. This, they alleged, is racism, and we were benefiting from it. In such a situation, they argued, the right thing to do is to turn over our privilege to the Maori group. The WWHAC Collective met with the Maori group. As a result of this meeting, where we heard how it came about that the Maori group felt they had a prior claim to the house, the WWHAC Collective decided to sign the lease over the Maori women s group, and vacate the house.
This was three days before our opening celebration on 9 August. The Maori women urged us to go ahead with our opening. They had said all along that they support the take (business, agenda) of WWHAC, and will no doubt continue to do so. We investigated sharing the house with them, but after discussion with Maori women, it has been agreed that for now, at least, it is better that we work together separately. The handing over of the house has made the ongoing sharing of resources and information certain. From all this we learned that true acknowledgement of the tangata whenua required a more careful consultation process in the early phases of setting up our group. We felt we had done this - subsequent events proved we had not.
WWHAC is now looking for new premises. The Maori women s group is waiting "till we find our new whare" and they recognise this may take three or four months. WWHAC is in good heart. The opening week went very well over 300 women passed through the house. Many local women gave their time to lead the lunch time discussion sessions, which worked beyond expectations. The gifting celebration was just that, with a lovely spirit prevailing in spite of - or was it because of - the decision to move announced that day. The week ended with a seminar under the joint auspices of WWHAC and Waikato Technical Institute on "Health for Women after 50". Seventy older women thoroughly enjoyed that Sunday, and most wanted the connections made that day to be on-going. As the education team flopped from exhaustion, it was realised that ways must be found to teach other women - to give them the confidence - to organise for themselves. Their energy, and their need can be tapped together. We feel proud of our Centre, and proud of everything that we have done. in the future we will have ongoing discussion groups in the Centre and in the suburbs; specific services such as a masseuse, reflexologist, counsellors; student nurses doing routine checks, even a free legal adviser. The widening variety of telephone and personal enquiries indicates we are reaching a broad spectrum of women, some of whom we have been able to help substantially. All these developments are happening as this goes to press. - 24 -
As our first phase draws to a close, the Collective is changing slightly, and the process of appointing a new co- ordinator is under way.
We are not assured of ongoing funding but the response of the women of Hamilton and the greater Waikato area is sufficient encouragement to indicate that what we are doing is necessary, worthwhile, - and extremely cost-effective.
Moving House
The shift set the Centre back because time and energy were spent finding new premises, instead of running the Centre. It was a very unsettled period for WWHAC and the public. The co-ordinator reported that quite a few women thought the Centre was folding, since they did not know where it was going.
On the 27th November WWHAC moved to the house which the Maori Women s Centre had vacated.. Although there were mixed feelings about this house at the beginning, a coat of paint lightened up the interior and the house now felt like WWHAC s home. Its more central location and street frontage led to an increase in numbers of women dropping in and, one member reports, the decision to relinquish the house to the Maori women had increased the mana. of WWHAC.
ACTIVITIES OF WKHAC
In an article in Good Health [1987] WWHAC members said they aimed to work on four fronts:
Education, by spreading health information through the community; information - to be a source and collection for information on women s health; support - for groups and individuals by providing a meeting venue and secretarial backup; and liaison between health services and the people who use them.
The New House
WWHAC is now in Collingwood Street, a few minutes walk away from the main street and close to the major shopping area. The house is next door to the Housing Resource Centre and over the road from the Waikato Technical Institute. There is a dairy/lunch bar next door and the Rape Crisis Centre and a women s drop-in centre down the road. - 25 -
The house has a large ^shop-front l window. The front room is decorated with posters, newspaper clippings and pamphlets on health-related issues. The bank of pamphlets can be seen from the street and people (male and female) from the Polytechnic are often seen reading the information through the window as they eat their lunch outside. Sometimes they come in to take pamphlets. The central meeting room, behind the front room and invisible from the street, has a circle of comfortable chairs and couches as well as the library and folders of resource material. It has three rooms off it. The largest is used by groups who want a private meeting place. Part of it is screened off and contains a bed, used for cervical screening. Another . small room is used for counselling and provides a pleasant, quiet space for women who want it. The office is small and has a photocopier as well as a couple of desks. There is also a small kitchen, where coffee and tea are continually available, and a toilet and handbasin. All the rooms are decorated with posters and health information. WWHAC is building up a library of books. Women browse through these when they are at the centre and they are also available for loan. WWHAC asks for either a donation for the loan or a deposit which is refunded when the book is returned. Other information is available in pamphlets and photocopied information sheets. These can be read at the centre or photocopied. A group of psychiatric survivors , had an art exhibition at the house. Other women artists may also display their work.
Drop-in and phone calls Women phone or drop in to the house during opening hours (10am - 4pm) Monday to Friday for health information, referral, support, a chat, or to have their lunch. Young people on Access courses sometimes come in groups at lunchtime, as do those from Polytechnic courses. Sometimes the centre becomes really busy and the co-ordinator finds it difficult to deal with all the requests on her own. WWBAC would like to be able to employ two people to be at the house. This would also enable it to extend the hours it is available. When WWHAC provides services to groups or individuals the emphasis is on empowering the women to help themselves, rather than fostering dependence. WWHAC tried to keep a record of the number of people dropping in and phoning the centre during the evaluation. During the 10 months when the information was collected, 439 visitors and 595 telephone calls were recorded. However, - 26 - this was probably an under-estimate of the total number of contacts with the centre. For example, 135 "extra" visitors were noted informally, but full log sheets were not completed for them. Data were , collected for part of August 1988 but this has not been included. The co-ordinator noted that the efficiency of logging decreased during the shift to the new house, although she noticed an almost immediate increase in numbers,of visitors at the new location. The centre closed down between 18 December 1987 and 18 January 1988, although the co-ordinator, a community worker and some others visited occasionally and the answerphone was kept on to allow women to leave messages. The co-ordinator believed that telephone calls dropped in frequency when WWHAC stopped running courses and therefore stopped advertising. This was evidence that women were using the centre in other ways in response to this advertising. Overall, the accuracy of the log data was dubious. We cannot be sure how many calls-and visitors were not recorded. More information on visitors and callers is included in Appendix A (which summarises the log sheets completed by WWHAC) and in the sections Client Profiles and Client Satisfaction , below. This includes data on the reasons women came to WWHAC.
Referral WWHAC sent a questionnaire to doctors asking what services they provided. About 70% replied and the information is now available to women who phone or visit. There was a suggestion from a doctor, interviewed in the Community Response section of the evaluation, that some doctors felt that the questionnaire divided services artificially. He said some doctors were put off by this.
WWHAC decided not to keep other information about doctors (in a hot and cold doctor file , ) because it felt it would work against developing a good working relationship with doctors. If a lot of women mentioned a good doctor, however, WWRAC passed that information on when others were looking for a doctor.
Lunches On the third Friday of each month the collective members met at the house for lunch. These lunches were open to any women who wanted to meet the collective. - 27 -
Other activities at the house One collective member was a trainee counsellor. She offered counselling at the house on Friday mornings. Sessions cost $10 - the money went to WWHAC, not the counsellor - and charges were reduced or waived if women felt that they could not afford $10. The co-ordinator pointed out that having counselling at the house was particularly valuable because women who came for counselling felt that they were able to come to the centre for support at other times too.
WWHAC worked with Catholic Social Services, Parentline, and Single Parents to provide first a linking service and then a support group for women with post-natal depression. Initially current sufferers were put in contact with ex- sufferers who could offer support and practical advice. Increasingly they began to ask for a group in which they could share experiences and fortnightly meetings were arranged. An eating disorders group met at the house on Tuesday afternoons and most Wednesday-evenings. It was facilitated by the co-ordinator and a woman doctor. The group grew as women learnt about it from a radio talkback, media releases and letters to the editor from WWHAC.
Use of the house by other groups The house was also used by other groups. WWHAC s policy on this was that if a fee was charged to participants (for example, at courses) then WWRAC would charge 10%, with a $5 minimum. The house was not to be used by groups who disagreed with WWHAC s philosophy. On Tuesday evenings the house was used by a group of lesbian women. As well as providing support and counselling for each other they talked with others who rang up during the evening. The largest room off the main area was used as a meeting place by a group of women psychiatric outpatients who felt more comfortable meeting away from the hospital. Other groups that met in the WWHAC house included a Spiritual Healers Group and a Women s Alcoholics Anonymous for women with alcohol problems. - 28 -
Speaking Engagements and Meetings
WWHAC spoke to and shared information with women of the Latter Day Saints church, the Hamilton Day Care Centre Trust, Medical Social workers, Mothers Support Groups, Citizens Advice Bureau, Catholic Social Services Homemakers, Access trainees and many other groups. Recently the women of the Latter Day Saints Church invited WWHAC back to their group. WWHAC has been asked by the Health Department to take part in an Open Health Day. Topics for WWHAC talks included women s health issues, WWHAC, cervical cancer screening, women with disabilities, funding, Maori health and meetings with other community groups.
WWHAC kept a record of meetings and speaking engagements they participated in between September 1987 and May 1988. This included the date, topic, the group involved, numbers attending and an assessment of the success of the event. In 1988 the age range of participants was also recorded. The data on speaking engagements are recorded in Appendix B.
During the months of September, October and November 1987, a total of 19 meetings and/or speaking engagements were recorded. A total of 29 meetings and speaking engagements were recorded for the four months of February, March, April and May 1988. Approximately 910 people, mostly women, attended these occasions. in the last four months the events were quite unevenly spread.
In the last four months events which were either organized by WWHAC or the main speaker/ facilitator was a WWHAC member were distinguished from meetings attended by WWHAC members or jointly organised with other groups. Twenty three were in the former category and six in the latter. Feedback was not obtained from the audience or other participants so the perceptions of the speaker or facilitator provide the assessment of success. They were asked to rate this on a scale of 5 = very successful, 4 = somewhat successful, 3 neither successful nor unsuccessful, 2 = somewhat unsuccessful, and 1 very unsuccessful. The average success rating for all 48 events was 4.5 and most events were recorded as 5 (very successful).
Courses, Workshops and Seminars
As well as drawing on the expertise and knowledge of collective members, WWHAC often invited speakers from outside the collective to run workshops and seminars.
WWHAC attempted to keep a record of courses, workshops and seminars they ran. The date, subject, duration, number attending and an assessment of the success of the event were - 29 - recorded. The age range of participants was recorded in 1988. The resulting data are in Appendix C.
It should be noted that recording of courses, workshops and seminars was extremely sporadic, so that these events are a considerable under-representation of WWHAC s activities during this period.
During the months of July, August, September, October and November 1987, a total of 8 courses, workshops and seminars were recorded. Another 8 were recorded between February and May 1988. In total, approximately 320 women attended these sixteen events. A wide age range was represented.
Again the assessment of tutors and facilitators is the major source of information about the success of the events. The average success rating was 4.5 (on the scale described above) and again the most common assessment was 5 or very successful.
Major Projects
With the Advanced Diploma in Nursing students WWHAC carried out a major project on cervical screening. A questionnaire was developed by one ADN student and distributed with WWHAC s newsletter. At a meeting of groups interested in cervical smears held in October at the Trade Union Centre, other groups requested that they be able to distribute the questionnaire to their women. These groups were the Hospital and Hotel Workers, P.S.A., N.Z.N.A., Telecom, Labour Department, Waikato University, Disabled Citizens, City Council Community Workers, and Occupational Health nurses. The total response was 634 women. An analysis of the first 125 responses was carried out by a nursing student but the subsequent numbers led WWRAC to decide to seek funding for the analysis. Nineteen information and discussion sessions about cervical screening were held between 7 September and 24 November, involving 214 women. An education kit was developed by an ADN student who was also on the WWHAC collective. WWHAC worked hard to publicise its activiti es. This resulted in a feature article and a news release in the Waikato Times, an article in the Hamilton Press, a news bulletin, interview and talkback on three different radio stations. A training programme for practice nurses to learn how to take cervical smears was arranged and General Practitioners were invited to allow their practice nurses to attend. Seventy five nurses attended the day-long programme where they practiced taking smears on volunteers who provided feedback and evaluation. - 30 -
A Department of Health doctor provided cervical smears at the centre on Monday afternoons. A copy of the results was sent to each woman, with an accompanying explanation. The doctor did not want to do smears for women who already had a G.P. Since the evaluation was completed she has stopped working at the centre altogether. WWHAC thought this was because she did not want to antagonise other doctors.
The cervical screening campaign involved all of the WWHAC teams, as well as women not previously associated with WWHAC. WWHAC felt that the timing, the multi-faceted planning, the adequacy of its research and networking contributed to the success of the campaign. (More information is included in Appendix D.) Despite the immediate results of the cervical smear campaign, there was some evidence that many doctors were refusing to allow their practice nurses to perform smear tests, in spite of WWHAC s training.
WWHAC employed several community workers for two three-month periods with grants from the Community Organisation Grants Scheme (COGS). Little information about its work was collected by the researchers because the money did not come from the Department of Health. The first group of community workers worked largely with the Maori community. They organised and/or attended many hui, encouraged Maori lay- women to attend the cervical screening training sessions, learnt about the medicinal properties of plants and trees and how these medicines were applied by the Maori people. One worker was involved in the committee which sought to establish a health clinic at a marae. Another was involved in one to one contact, workshops, seminars and education programmes about herbs, reflexology, iridology and massage (Community workers report, 1st December 1987).
WWHAC received $9000 from the Department of Health s Community Health Initiatives Fund (CHIFS) to research and produce a pamphlet called Talking to your doctor . This involved discussions with interested GPs and community input. A draft was produced and displayed around the walls in the central room. Women who used the centre were invited to make comments and it was taken back to the doctors for further comment. As well as eventually producing a pamphlet this exercise allowed WWHAC to increase their contacts with women and doctors. (The pamphlet was produced after the end of the evaluation period, it is included as Appendix E.)
A similar pamphlet for practitioners of alternative medicine was suggested. WWHAC intended to gather more information on the options available and obtained more feedback from women who have consulted alternative healers. - 31 -
Conununity Health Groups
WWHAC saw its work as fitting a community development model. One of the goals was to stimulate the development of a "caring consciousness" in the community.
The first community health groups which WWHAC helped to form were in the suburbs of Glenview and Pukete. One used a workshop kit (the SuperHealth Kit) designed by Dr John Raeburn at Auckland University Medical School. The other included sessions on breast self-examination, foot massagel talking to your doctor, and alternative health. The average attendance was around six per group. The co-ordinator noted soon after they started that "These need lots more time and energy from WWHAC to be successful; more involvement and more time. But not necessarily more structure: the group using the SuperHealth Kit (which is very structured) didn t work any better than the unstructured group". Soon afterwards both groups ceased to meet.
The experiences of these groups led WWHAC members to think that more extensive networking was needed in a suburb before a group could be started. They came to favour a slower approach. In 1988 WWHAC also decided to decrease its focus on seminars and courses. Because of low attendance figures it felt that the education programmes were trying to offer too much in a short time. Instead it decided to take smaller steps, to try to form a group fairly slowly in one suburb and then to learn from and build on that. A suburb was chosen (Melville) which had a medical centre and public health nurse who were sympathetic to WWHAC. Contacts were made and meetings held with the nurses and doctors at the medical centre, the public health nurse, the community co- ordinator at the High School and the secretary at the local primary school.
After extending networks in the Melville community WW1HAC initiated a series of discussions at the school. The programme included: the pressure on women to look good, physical health issues, stress, reflexclogy, pre menstrual tension and menopause. Although most of these occurred after the evaluation finished, feedback from WWHAC suggested that it was very successful and attendance increased dramatically at each session.
Other Activities
In April and May 1988 WWHAC organised two walks for women (and children). They hired the Hamilton City Council van to take women out into the bush for a day walk. - 32 -
WWHAC was one of a number of women s groups who worked together to prepare the Women s community calendar - a monthly calendar of events of interest to women. It was free and advertising space was sold to meet costs.
WWRAC prepared and distributed seven newsletters. These provided information on the current activities of the centre as well as notes on other happenings and current issues. There was space for supporters to place advertisements.
WWHAC liaised with country women s groups and have helped and encouraged them. These included groups at Morrinsville, Waihi, the Oparau Country Women s Institute, and a Te Awamutu group.
The Dannevirke Women s Health Centre organised a weekend to share ideas and knowledge in October 1987 where WWHAC women met with women from THAW and DWHC. Three collective members attended a Women s Electoral Lobby conference and conducted workshops on setting up Women s Health Centres. The National Gathering of Women s Health Groups in Bulls in July 1988 provided an opportunity for WWHAC members to share ideas with other women s health groups and centres.
Political Activities
When the Mothercraft Unit at the Waikato Hospital was threatened with closure a representative from WWHAC joined the Task Force which opposed this move. The group organised a march and wrote a submission to the Hospital Board. WIK7HAC provided support to other women s groups. It supported the Women s Refuge when neighbours made complaints to the Council about noise levels.
WWHAC was also aware of the importance of not being too radical , in order to hold the appeal of all women. Neither did it wish to alienate existing health services.
The Future
Some WWHAC members would liked to have had a doctor or a practice nurse operating from the centre. A collective member who was a nurse would have liked to have provided this service if funding was available. The doctor who facilitated the eating disorders group considered starting up a practice in the room next door (which WWHAC was considering renting) if she stayed in Hamilton for the following year. The importance of providing suit-case clinics for women in small towns and rural areas was noted - 33 -
by one member. WWHAC is aware, though, of some doctors opposition to these types of services.
Other aspirations for the next year included securing on- going funding, strengthening networks, finding a retired journalist on the supporters list so that WWHAC could respond quickly and effectively to issues as they were raised in the media, and setting up training for volunteers.
WWHAC held a Future Directions meeting in December 1987. Each team made recommendations for the following year. Some of the recommendations have already been achieved (and are described above). Others included: advertising regularly, designing a WWHAC poster, paying the co-ordinator for more hours of work, seeking funding from the Arts Council for a mural, organising a time-out , weekend for WWHAC helpers, providing child care at the Centre for WWHAC users, volunteers, and other women, holding a women s wellness festival, improving WWHAC s outreach by instituting a travelling roadshow l , developing tapes for use as resources.
WWHAC: THE PEOPLE AND THE ORGANISATION
WWHAC s activities were organised and provided by the central collective, various teams, paid workers and volunteers.
The Central Collective, the organising and decision-making body of WWHAC, consisted of thirteen women in June 1987 and nine women in July 1988. The present collective members are mostly in their thirties and forties, with an age range from late twenties to late forties. All the present collective members are Pakeha. Two Maori women were on the collective for a while but left. WWHAC members think that Maori women often would prefer to put their energy into specifically Maori groups, working for Maori. Almost all the present collective members had children, some were married or in de facto relationships, others were separated, divorced or widowed. At the time of writing the report three were tutoring at the Waikato Technical Institute - in community and social work skills, nursing, and women s courses. One was a student of the community and social work course. One. was a full-time student at the university, another was a university lecturer. There was a public health nurse on the collective. The collective members brought a fairly wide range of skills and experience to the centre, including community work, nursing, teaching and clerical experiences. They also had contacts with a number of other organisations including the Waikato Mental Health Foundation, school - 34 - councils, the Polytechnic and so on. WWHAC say this is very helpful for building networks.
Collective members contributed different amounts of time and energy to WWHAC, depending on their other commitments, interest in the present projects and activities. Paid workers generally worked more hours than they were paid for and some noted that it was easy to over-commit yourself. Clear definitions of jobs lessened the chances of this happening.
One collective member was skilled in book-keeping and enjoyed this work. She did all the books, paid accounts and made sure that WWHAC stayed within its budget. Another collective member had a home computer and secretarial skills - she kept the supporters list up to date, and prepared the newsletter and funding applications.
When asked about the positive aspects of working with WWHAC many collective members gave working with the other women as an important reward. One said "Working with people you really like on things you all agree on and getting somewhere on those". Working with and for women and having an impact on women s lives were mentioned, as was WWHAC s way of working. Seeing the centre start, watching resources accumulate, telling people you meet about WWHAC, finding such a wonderful co-ordinator, having good relationships with a wide range of other groups, the cervical smear campaign, and the increasing numbers of women dropping in were all noted. One woman mentioned that her experiences as a consumer of health services had led her to believe in and to join WWHAC. WWHAC was seen by collective members as a way of empowering women through knowledge so that they could take charge of themselves.
Negative features of working with WWHAC included aspects of the bi-cultural issue, lack of funding, and insecurity of funding. This led to difficulty in planning activities and hiring workers. Some collective members were angry about the amount of unpaid work that had to be done because of lack of funding. Most collective members also had many other commitments. This led to another disadvantage that some mentioned - sometimes the collective was not as able to spend as much time as they would have liked on responding to events and on building up connections among the group. Disagreements within the group were noted as other bad bits . The degree of political activity of WWHAC and the amount of emphasis to be placed on alternative health were sources of occasional conflict. In 1987 two women noted their concern about the dominance of tertiary backgrounds in the group. One hoped that the team structure would alleviate this because the support groups would be made up of a diverse range of women. Since other - 35 -
team members were not interviewed it was difficult to assess whether this had occurred.
Since the collective was first established in late 1986 seven collective members have resigned - often due to other. demands on their time. Some had continued to work on WWHAC teams after their resignation from the collective. Three new members joined. Six of the original members remained.
With the exception of the temporary co-ordinators who WWHAC appointed when they first opened, paid positions were always advertised. When collective members applied for them they withdrew from the collective s decision-making process.
The position of coordinator had been occupied by three women since WWHAC started. Originally two collective members job- shared the position on a temporary basis. When the position of permanent co-ordinator was advertised collective members were allowed to apply but were not given preference. Twelve applications were received. Four collective members short- listed and interviewed applicants. The new co-ordinator started work in September 1987. Although she was paid for 25 hours per week, in fact she worked about 40.
The way the co-ordinator s role was envisaged changed since she was appointed. Originally it was thought that she would be involved in community work. Her role was summarised by WWHAC as making health information available to women, facilitating communication between collective members, provision of immediate counselling, establishing and maintaining networks between community groups, organising volunteers, and a small amount of community work. When the co-ordinator was appointed her job description noted that she would be responsible for her own supervision. She arranged this.
In September 1987 WWHAC received $7000 from COGS for community work. WWHAC originally thought it might add this to the co-ordinator s salary to enable her to do community work outside office hours. Instead it decided to appoint four community workers. The jobs were.advertised and some collective members applied. Two collective members and two others were appointed. This caused some friction and one person subsequently left the collective. The community workers were to make suggestions about the content of the job. They were appointed for 12 to 15 hours per week for 12 weeks, ending in the middle of December. WWHAC received another COGS grant for approximately the same amount in 1988, which it again spent on wages for three part-time community workers.
Employment of the first group of community workers was not without problems. They sometimes failed to submit weekly reports to the collective, and did not always come to - 36 -
appropriate meetings. Lack of job structure was also a problem. WWHAC did not wish to impose too many constraints on the community workers work, but the workers themselves felt the need for more concrete guidelines about what the collective wanted from them, and the terms of their employment. These problems seemed resolved with the second set of community workers. A job description was prepared and accountability clarified. The last community worker who was employed was supervised by a community worker at the City Council.
Some of the community workers had nursing experience. This was felt to be a useful background for this type of community work since having some medical knowledge was reassuring for some women who the workers came into contact with.
Volunteers often helped at the house. WWHAC had no formal training for volunteers, although it hoped to eventually. Sometimes WWHAC had many volunteers, at other times there were fewer. This was largely because many women moved on to do other things, like return to the paid workforce. Some used volunteering at WWHAC as a kind of stepping stone and a way of building up confidence. Providing training for volunteers was one of WWHAC s aims for the next year. The co-ordinator suggested that volunteers may be more useful to the centre if they came in in pairs. Then they could support each other and the co-ordinator would be free to do other work.
ORGANISATION
At the beginning of the evaluation WWHAC noted the importance of setting up structures that would work, and that would not fall down if key people were not there.
The WWHAC central collective, the decision-making body, met every ten days. There was considerable emphasis on the process of meetings. Facilitation was shared, with different women taking turns each week, and the health and maintenance of the group was considered to be important. Meetings needed to be enjoyable and the work of WWHAC had to feel worthwhile or group members would lose their enthusiasm.
The co-ordinator, although not part of the collective, attended collective meetings and participated equally in decision-making.
The meetings became more efficient as the collective members grew to trust each other more. This had a negative side- effect - it may have made it difficult to bring new women into the collective. - 37 -
WWHAC wanted to establish a Charitable Trust. The power was still to reside with the central collective rather than the Trustees. A member of the collective was to be chair of the board of trustees. The process of establishing a trust was almost completed although it took a lot of the energy of a few collective members throughout the year.
The original team structure of WWHAC was outlined above. By the end of the evaluation period the team structure was still in place but was much more flexible than was originally planned. New teams arise in response to ideas and issues.
THE USERS OF WWHAC: PROFILES AND SATISFACTION LEVELS WWRAC completed log sheets for visits and telephone calls received over the ten month period between September 1987 and June 1988. 439 visits and 595 telephone calls were logged. This may be an under-representation of the numbers of visitors and calls WWRAC received. Similarly, the recording of demographic information and reasons for calls and visits may have been inconsistent over time and between individuals doing the logging.
Visitors and telephone callers were predominantly female (about 91% female, 4 - 5% male, the rest unrecorded). The majority were in the 20 - 45 age group. The under 20 age group was particularly under-represented compared with the Hamilton female population.
Table 1: Percentage of WWRAC Visitors and Callers in Age Groups Compared to Hamilton Female Population
Hamilton WWHAC 1986 census telephone WWHAC population callers visitors
Under 20 33.9 1.2 4.8 under 14 22.4 15 - 19 11.5 20 - 45 39.3 72.8 67.7 over 45 26.8 17.1 20.5 The census categories are 20 - 44 , and 45 and over . An article about WWRAC in the New Zealand Nursing Journal (Andrews 1987) said:
- 38 -
Although most of the support for the centre is from women in the 30 -50 age range, the centre is not aiming at any particular age or group. The 30 - 50 group, it is suggested, are the main care-givers in society, so they are correspondingly in need of care themselves and therefore more likely to be among those who use the centre most.
Maori visitors and telephone callers were probably slightly under-represented when compared with Hamilton city Maori female population. A lower percentage of people from "other" ethnic groups also called or visited WWHAC than would have been expected from the Hamilton population profile. Since workers considered it inappropriate to ask for information on ethnicity, this was not recorded on about one third of the log sheets, and its accuracy could be in doubt.
Table 2: Percentage of WWHAC Visitors and Callers in Ethnic Groups Compared with the Hamilton Female Population
Hamilton WWHAC 1986 census telephone WWHAC population callers visitors
European 81.9 53.8 54.9 NZ Maori origin 14.3 10.3 11.4 Other 3.2 0.8 0.5 Not recorded 35.1 33.3
The information collected on work status is presented below, however, a large proportion of log sheets did not contain this information. The number of visitors who were studying was high - some of these were groups of students collecting information for projects.
Table 3. Occupation of WWHAC Visitors and Callers
WWRAC WWHAC telephone callers visitors
Paid work 32.9 22.3 At home 13.3 14.4 Study 4.0 20.7 Not recorded 49.7 42.6
Information on where WWHAC users lived was not recorded in the majority of cases (about 80% of log sheets). From the available information, however, most of the visitors and callers came from Hamilton itself rather than from other districts. - 39 -
The most common reasons for visiting or telephoning WWHAC were to obtain health information, and to make inquiries or requests, (See Table 4).
Table 4: Percentage of Visitors and Callers Using WWRAC For Specified Reasons
WWHAC WWHAC telephone callers visitors
Health information 25.2 35.3 Inquiries/Requests 29.4 17.2 Counselling/Support 12.7 18.9 Referral/Liaison 6.1 2.9 Other 27.1 23.9 Not Recorded 0.3 1.7
Health information was usually related to women s health e.g. cervical smears, hysterectomy, breast cancer, contraception, and post-natal depression. There were also queries about such issues as anorexia nervosa, diet, complementary therapies, diabetes, smoking, grief and Maori health. Manv of the visitors to the centre looked at the available pamphlets, borrowed books on the topic of concern and photocopied relevant information.
Inquiries and requests included.a lot of visitors and callers who were interested in general information about WWHAC, some of whom requested comments or statements and some who requested talks from WWHAC.
Counselling and support were also common reasons for visiting the centre. Examples of this type of contact included giving advice or support to workers from other agencies who were trying to help their women clients, counselling on relationship difficulties, family and work concerns, coping with chronic illness and lack of accommodation.
Referral and liaison were the least common reasons for contact with WWHAC. Only formal referrals were usually recorded under this category, however, with less formal suggestions about contacting other organisations being recorded in the "other" group or included in the processes of counselling and support.
Among the entries under the "other" category were administrative issues (such as organising courses and meetings), offers of help or support, requests for information on other agencies and courses or meetings run by I - 40 -
other agencies, recommendations for books relating to women s health, requests for help with submissions, and requests for names of women who may be interested in setting up various support groups.
The data collected were not sufficient to allow many conclusions to be made about user satisfaction. The most systematically collected data came from the log sheets for visitors, telephone callers, speaking engagements and courses, workshops and seminars. The visitor and telephone caller log sheets included a section where the co-ordinator recorded her perception of the users likely satisfaction. On the speaking engagements, courses and seminars log sheets the co-ordinator or tutor recorded the perceived success of the event.
The visitor and telephone caller log sheets included a section where the co-ordinator recorded her perception of the users likely satisfaction (Table 5). Table 5: Satisfaction of Telephone Callers and Visitors for the Period 1 September 1987 to 30 June 1988.
% of Callers % of Visitors (n=595) (n=439)
Very satisfied 40.5 48.7 Somewhat satisfied 15.6 15.5 Neither satisfied nor dissatisfied 9.7 4.6 Somewhat dissatisfied 1.3 0.9 Very dissatisfied 0.2 0.0 Not recorded 32.6 30.3
There was a high level of satisfaction of visitors and telephone callers - in over half the cases where satisfaction was recorded, the caller or visitor was considered to be , very satisfied . Other sources of information about client satisfaction were the log sheets completed by those tutoring or facilitating courses, workshops. or speaking to groups. Most of these activities were rated as very successful , or successful, (Table 6). The mean success score for the recorded courses, workshops and seminars was 4.5 (using a scale of 1-5), with only one event being considered to be unsuccessful. The average success rating for meetings and speaking engagements was 4.0 on the same scale. I - 41 -
Table 6: Percentage of Courses, Workshops, Seminars, Speaking Engagements and Meetings Rated as Successful
Courses etc. Meetings etc. (n=16) (n=49)
5. Very Successful 62.5 49.0 4. Somewhat Successful 31.3 36.7 3. Neither Successful nor Unsuccessful 0.0 4.1 2. Somewhat Unsuccessful 6.3 0.0 1. Very Unsuccessful 0.0 0.0
Not recorded BE 10.2
The only information directly from users about their satisfaction came from feedback forms handed out at coursesf workshops and so on.
Twenty four user feedback questionnaires were completed in 1987 and in 1988 a further attempt was made to use these but none were completed. This was a common problem for all the women s health centres. The reasons are discussed in the sect i on on the Process of the Evaluation , above. The respondents showed a fairly similar demographic profile to the visitors and telephone callers. The small number of those who completed the feedback questionnaire however, made comparison difficult. I - 42 - Table 7: Demographic Profile of Feedback Questionnaire Respondents
Number Age
Under 20 0 20 - 45 17 over 45 7 Ethnicity
Pakeha 18 Maori 1 Other 3 Not recorded 2 Locality
Hamilton 20 District 4 Occupation
At home 6 Paid work 9 Study 1 Combination 8 Not recorded 0 The satisfaction rates of the 24 users who completed questionnaires are shown in Table 8. The maj-ority of respondents were satisfied with the activity which they had attended, with many being extremely or very satisfied.
Table 8: Satisfaction of Respondents who Completed Feedback . Questionnaires
Number Percentage
1.Extremely dissatisfied 1 4 2.Very dissatisfied 0 3.Somewhat dissatisfied 1 4 4.Neutral 5 21 5.Somewhat satisfied 4 17 6.Very Satisfied 7 29 7.Extremely satisfied 3 13
Not recorded 3 13 Mean Satisfaction Rating = 5.1 - 43 -
Thus, all the evidence suggests a high level of satisfaction with the services provided by WWHAC.
FUNDING AND MONEY
Although WWHAC knew that community based projects could take a long time to become well established it felt there was pressure for it to show concrete results during the original twelve months of Department of Health funding. The evaluation added to this feeling.
Since WWHAC received only $25,000 from the Department of Health when it had hoped for $50,000 it had to supplement this with funding from other sources. Many members mentioned the time and energy which needed to be put into funding applications as being one of the frustrating aspects of working with WWHAC.
Despite all the effort put into finding other funding,-WWHAC still felt that it did not have enough money. Some of the effects of lack of funding were described by the co- ordinator:
We ran a very successful Focus on Women s Health series in Melville and could have done similar ones in other suburbs if we had more funds- to pay for child- care, speakers, organising time, venue.
We continually see women who would like to try Alternative Health therapy who haven t the money to bridge the gap between a visit to the G.P. and a health therapist and we would like to have available a fund to bridge that gap- which would give women a real choice. We would like to have funds to cover the cost of speakers so we can truly give women a choice without being influenced by lack of money and a commitment to make courses available to all women regardless of their income.
WWHAC thought it could reach more women if it had more money to advertise activities. It felt it had done very well with a very small amount of advertising.
One collective member said that the Department was getting a "good deal" out of WWHAC because of the amount of unpaid work which was done. She was annoyed that WWHAC s future would be determined by the "men in Treasury". Another said "I have some anger, I suppose, at the politics of the whole business. The anger is at the fact that we re being used by the Health Department. Our energy is being used, our time is being used - for an experiment. They re getting I - 44 -
something for nothing." WWHAC workers were concerned too that voluntary work (which is usually done by women) was not taken as seriously as paid work. They pointed out that this work in fact held the community together and that present funding structures made the conditions of voluntary work difficult because funding was always difficult to get and the future uncertain.
BUDGET
In its application for funding the centre put forward the following budget, based on a hoped for allocation of $50,000:
Accommodation costs 7,000 Salary(house co-ordinator) 23,500 Mileage allowance for co-ordinator 2,000 Secretarial needs (including computer and photocopier) 11,000 House Furniture 4,500 Office Operating costs 500 Beginning the library 1,000 Collecting and collating information 500
Total 501,000 When it was awarded only $25,000 WWHAC had to revise its original budget and also sought other sources of funding. The revised budget was:
Salaries 18,050 Rent 5,500 House Costs 2,400 Resources 3,000 Operating Costs 4,850 GST 3,200
Total 37,000
House costs comprised setting up house; power; telephone and house supplies. Operating costs comprised mileage; collective expenses; newsletters, copying and postage; and office supplies.
Towards the end of 1986 WWHAC received a setting up grant of $1,000 from CAPS (City council). Over the evaluation period it also received two grants of about $7,000 from COGS (Community Organisations Grant Scheme) which were spent on wages for community workers.
WWHAC income and expenditure from their operating account during the year ending 31 March 1988 was as follows: I - 45 -
WWHAC OPERATING ACCOUNT
STATEMENT OF INCOME AND EXPENDITURE IN THE YEAR ENDING 31ST MARCH 1988
INCOME Drawings from Trust Account $28,000.00 Donations from supporters 1,928.85 Lottery Board Grant 1,100.00 Ministry of Women s Affairs Grant 570.00 Roy McKenzie Foundation 580.00 Speaking Engagements 347.45 Department of Social Welfare Travel Grant 250-00 Miscellaneous 287-05 Interest from Trust Bank on Account 53.45 Balance in account 31.3.87 445.52 $33,562.32
EXPENDITURE Wages $18,708.46 G. S. T. 3,212.50 Rent 3,175.25 Resources 1,369.43 Travel Expenses 1,315.30 Collective expenses 1,215-00 Miscellaneous 1,493.19 Photocopying, printing, postage 723.51 Office Supplies 595.55 Event expenses 407.83 Power 434.98 Petty Cash 358.06 Repairs and Maintenance 207.24 Telephone 367.54 $33,608.24
Like the other pilot well-women centres WWHAC received $30,000 from the Health Department for the 1988-89 year. It was advised that this was the last funding available from the Health Department. The need to secure ongoing funding in order to (at least) keep the centre open increased stress levels among collective members. They expressed concern the women of Hamilton would still end u p without a centre and WWHAC s work could be lost. - 46 -
WWHAC members were concerned about how the move toward an Area Health Board would affect their chances of funding in the future. One expressed the hope that the Department of Health would provide some guide-lines for Area Health Boards and persuade them to fund organisations like WWHAC which concentrate on prevention and education. Others were cynical about the chances of WWHAC getting funding from Area Health Boards, given the emphasis on treatment rather than prevention in the health services. They noted as an example, that it was easy to count how many broken bones had been fixed but less easy to measure the effect of prevention. Dependence on Area Health Boards for funding was also seen to have disadvantages for WWHAC since it clearly linked it into the established health services . This would conflict with WWHAC s role as an advocate for women within those services.
COMMUNITY RESPONSE
The opinions in this section were obtained from interviews with representatives of 14 groups or agencies and two others who completed the same questionnaire and posted it back. The list of groups represented appears at the end of the section. The list was worked out in consultation with WWHAC towards the end of 1987. The interviews were carried out in April 1988. In hindsight the list of groups may have been compiled too early, there were a number that WWHAC had subsequently had contact with that were not interviewed and two who were interviewed, later said their level of contact with WWHAC had gone up since the interview.
Contact
Ten questions were asked about contact the respondents may have had with the centre - including visits, telephone calls t meetings, referrals, correspondence, and working together. The number of respondents who had had such contact, As well as the frequency of contact, was measured.
Twelve of the 16 had met a representative of WWHAC at a meeting or conference, but this was usually only one or two times. In terms of frequency of contact, the highest was in telephone calls to WWHAC. Of the 10 who had telephoned WWHAC, five had done so more than six times. While only eight had made referrals to WWHAC this was second highest in terms of frequency. (Three had made more than six referrals and four had made 3 to 6.) - 47 -
Visits and telephone calls from WWHAC were fairly high in frequency, while visits to WWHAC, working together, and referrals from WWHAC were fairly low. only four were aware of any referrals from WWHAC, with four not sure.
Most contact had been with community agencies, such as the trade union health and safety officer, rape crisis centre, city council community affairs officer and women s network, rather than health organisations like the hospital, college of general practitioners, medical and nurses associations. This situation may have changed since WWRAC began to prepare the Talking to your Doctor pamphlet.
Ppinions about aims, services and clientele
Four questions were asked seeking respondents perceptions of the women s health action centre - what they thought its aims were; what it did; who used it and why. In response to the question "What do you think WWHAC s aims were?" ten said it was to improve or promote women s health - the concepts of holistic health and wellness were frequently mentioned. Six of these ten mentioned other aims as well, while for four this was the only aim given.
Seven said WWHAC aimed to educate and provide information on women s health issues. Two gave this as the only aim. Four said it aimed to make women more aware of their rights and to make them more assertive. Four said -WWHAC provided support and a place for women to go. Two said it aimed to be an alternative to established health services. Most of those interviewed had a reasonable idea about the type of activities and services WWHAC offered. Several said they received WWHAC s newsletter. Only one respondent said they had no idea, and two others could only list one or two activities.
When asked what kind of people used it, the majority believed it was mainly white, middle-class women. Other words used were the "aware", "politicised" and "well- educated". One said the opening hours probably precluded lower socio-economic working women from using it. Although a few said WWHAC was aiming at Maori, unemployed and lower socio-economic women, none knew whether or not it was reaching them.
Three commented that the organisers were mainly white, middle-class, well-educated women and this could be reflected in the types of people who used the centre. One of these stated "a lot of people who used it are connected with it." - 48 -
one person believed poorer women used it to get advice about whether to go to a doctor.
The six whomentioned age groups all thought it was used by women in the mid-20 s to 50 age range.
Two believed a wide range of women used it, while two said they did not know.
When asked why they thought people used the centre, two gave no opinion, and two said it was for specific information or activities of interest. The remaining opinions, with the numbers expressing them, were:
- cost - cheaper than elsewhere (6) - non-threatening, sympathetic (5) - accessible (3) - run by women (3) - services not available elsewhere (3) - women who want to take responsibility for own health (2) - meet other women (1) - dissatisfaction with professionals (1)
Impact
Five questions were asked seeking opinions about whether the centre had had an impact on other health and social services, ie. general practitioners, hospital, public health services, community agencies and support groups. If it had had an impact, whether that was positive, negative or they were not sure if it was positive or negative.
One question was asked about the impact of the centre on the health of women who used the centre and two questions asked whether the respondents had received any positive or negative feedback about the centre.
Respondents believed the centre has had most impact on the health of women using it, on community agencies and support groups.
Table 9 summarises the results. (The numbers represent the numbers of respondents making these comments e.g. four believed the centre has had a positive impact on GP services).
- 49 -
Table 9: Impact of WWHAC on services
YES NO NOT Positive Negative Not Sure SURE Impact Impact Impact on: G.P l s 4 6 5 Hospital 1 6 8 Public Health 4 2 5 5 Community groups 9 2 5 Support groups 8 1 6 Women using 10 6 centre
Those believing the centre has had a positive impact on GP s thought it helped women to ask more of their GP s; and that doctors were made more aware of women s needs that they may not have been meeting very well (e.g cervical smears). One of those who said the centre had no impact on GP s, said it supplemented them - people still went to their GP. Another who thought it had no impact, nevertheless said in another part of the interview that WWRAC isolated women from the total health care that a general practitioner dealt with.
This question also prompted comments on the perceived opinions of doctors about the centre. One respondent thought GP s perceived it as "subsidised half-baked" competition. Another mentioned a letter that WWHAC had sent to GP s asking something like - "we re doing a portfolio of GP s, do you offer the following..." and listed a number of things such as breast examinations, blood pressure testing, etc. The respondent believed a number of GP s felt this to be artificial, that you could not split things up like that. There was a feeling that WWHAC had a set view of general practitioners. Prior to the interview the representative of the College of GP 1 s had rung ten Hamilton doctors for their views about WWHAC. Most were neutral and had had no involvement. One was quite positive about it, while one commented that some doctors felt threatened by it. A few respondents commented on the training that WWHAC had organised for practice nurses in the taking of cervical smears. There was a divergence of opinion over the value of this. One believed it was.a. practical way of tackling the issue of women . wanting to be examined by a woman. Another thought that cervical smears should be part of a broader examination and if a woman wanted it done by a woman she should go to a woman GP.
One suggested that training practice nurses was also a way of seeking to influence GP s. - 50 -
Only one person thought the centre has had a positive impact on the hospital. Most were not sure (8) or thought it had no impact (6).
The reasons given by those who thought WWHAC had a positive impact on public health services were that it is another agency nurses can refer people to and that they promoted the same sort of things.
Despite the perception that WWHAC had not had much impact on health agencies, two from "within" the system felt it important that WWHAC acted as a pressure group.
Nine people thought WWHAC has had a positive impact on community agencies. The reasons were that it was another group agencies could refer people to and they complemented each other.
Three of the community agencies however, said there was not much liaison. The Family Planning Association were disappointed that it had not been approached for assistance with the cervical education programme as it probably did more smears than any other agency in the Waikato and was responsible for the training of a number of young doctors. Another group . was aware of only one referral from WWHAC in the past year. It had stronger connections with the Maori Womens Centre and Rape Crisis Centre than with WWRAC. This was partly because the role of these other two was clearer and also because it felt the level of training of those involved was higher than WWRAC s. When this section was being written, a few months after the interviews, both these groups were contacted by the researcher to see if they wanted to add anything further. They both said that contact and involvement with WWHAC had greatly improved since the time of the interview.
Those who believed the centre had a positive impact on support groups gave similar reasons to those for the impact on community agencies.
One mentioned that WWHAC had helped set up some support groups. Another, however, thought it should not try to set up parallel services. one person who had had contact with two or three groups said she did not think there was a lot of liaison at the moment. There was some concern that WWHAC may act "for and not with" women, that there should be more liaison because it could not do it all itself.
One thought there had been a,negative impact on support groups. This was mainly because of competition for funding. - 51 -
Others chances of getting money was not enhanced by WWHAC getting money.
Ten believed the centre had a positive impact on the health of women using it. Six were not sure, most saying they would hope so but they did not know.
Seven had received negative comments about WWHAC and nine had not. The negative comments included: comments from doctors, especially about cervical smears and the fact the centre was government subsidised;
criticism in the early.stages that WWHAC may do things to or for women not with them. This comment was made by two respondents, one believed WWHAC had addressed this issue;
- not being open at hours that suited working people; - only for women;
- not being able to get them when they were supposed to be open;
- some involved looked at things from "too feminist" a perspective;
- comments from Maori women "that place is not for us".
Eight had received positive comments about WWHAC and eight had not. The comments were about cervical smears, that the location was accessible, general comments that it had been helpful, people like getting the newsletter and general appreciation that the service is available.
Future
Three questions were asked about the future of the centre. Respondents were asked one question about whether they supported, opposed or had no opinion about its continued existence and two questions about funding. Fourteen of the sixteen supported it, while two were not sure. Comments in support included:
- women s health deserves prominence - there was a need for such a resource group, also a need for a pressure group to "bring about positive change in existing services".
- it empowered women towards self-responsibility - 52 -
accessible and responsive to community needs.
One person said they would "support anything to add to understanding of a person s health, but it is a luxury - how much does it advance health?"
The two respondents who were not sure said:
"the concept is good and there s certainly the need but would rather see it scrapped than see this tokenism continue - needs to be properly set up and staffed professionally with good referral agencies around."
"so many of these things come and go. So much depends on the quality of the people running it. Would hope it continues to be balanced in its leadership and unbiased in presentation. Funding problems often alter the nature of an organisation... needs to be a place specifically for women s issues but maybe broader based than health ... its almost an extravagance when there is a shortage of funds for some groups".
On the question of funding, respondents were told that WWHAC had been given $25,000 for one year s operation, did they think that was too high, too low, about right or have no opinion?
Ten believed it was too low and the other six were not sure. Of those who believed it was too low one said it needed at least $50,000 - the same as the other women s health centres. Another believed it should have $100,000 to be able to employ full-time staff as well as pay koha to tutors,etc. One who did not specify an amount, nevertheless said it should have at least two full-time staff. One commented that funding should be guaranteed for at least three years; "this sort of ineffective dishing out needs to be stopped - money is given to new organisations setting up, then they collapse. Would rather see it going to those already set up and going well". Another said there was some frustration that WWRAC received funding to do things that others have been doing for a long time without funding. The other funding question asked respondents where they thought future funding for WWHAC should come from.
Three thought an Area Health Board, when established, should fund them and four others thought mainly an Area Health Board, but with contributions from: DOH Head Office (1), women who use the centre (2) and city council and women who use the centre (1). Three thought the Department of Health should provide funding - head office (2) or district office (1), another thought a combination of the two, and a further one thought mainly from head office but with contributions - 53 - from city council and a nominal amount from women. The remaining four stated:
Government (unspecified) plus a small amount from women using the centre (1)
Ministry of Women s Affairs (1)
Multiple sources, including contribution from women (2) General Comments
Respondents were asked if they wanted to make any further comments. Some took the opportunity to express their support, such as -
admired the effort put in by dedicated women - mostly voluntary and the way they did it non-hierarchical feminist mode. philosophy was sound, also a large part to play in educating the public generally about women s health
endless admiration for getting it going Some made suggestions:
perhaps an area for them could be to sit with women at hospital going for tests (for support) perhaps they should aim to identify goals of real concern and make organisations already in existence carry them out
could maybe work in liaison with other groups who open out of work hours, however shouldn t step into the crisis area unless other groups fold or needed them A few expressed general opinions:
"women they would like to reach they probably don t - (these women often have] lack of confidence, knowledge, initiative, opportunity (transport),"
seemed to be more focus on physical health than total health
pressure for them knowing they were being evaluated - have to work faster; may have caused problems of trying to do things for women rather than empowering them enormous potential for work in these type of clinics, especially serving low SES who could not afford a GP - 54 -
took a while to get established. Doubted their future when they were in Grey street, too far away.
And some criticism:
Did not think they had a strong foundation in areas of staffing, continuation and evaluation. Did not think they had enough knowledge of group processes and how to keep things going.... Too wide a brief - WWHAC had been vague and energy diffuse.
LIST OF GROUPS INTERVIEWED
New Zealand Medical Association, Waikato branch
New Zealand Nurses Association, Hamilton branch
Health Development Unit, Medical officer of health and principal public health nurse
Royal New Zealand College of General Practitioners, Waikato faculty
Waikato Polytechnic, Director of Nursing and Health studies
Hamilton City Council, Community Affairs officer Trade Union Centre., Health and Safety officer Citizens Advice Bureau Rape Crisis Centre
Family Planning Association
University of Waikato, Director of Women s Studies Women s Network
Link House Agency (group and individual counselling agency) Maori women s centre
Waikato Hospital Board, Chief nursing officer In its fifth newsletter (December 1987) WWHAC summarised its -perceptions of its public relations in 1987:
Overall we seemed to fare quite well in the media, this year. We did several radio talkbacks, and most of our press releases were printed, with the exception of the one we wrote with THAW and the Dannevirke Group after our visit down there. Relationships with the doctors and the hospital . hierarchy seem fairly cordial. We - 55 -
wrote to doctors several times this year, and have had a very encouraging number of replies. Of course, not all were happy with us, but we have (mostly) managed to allay fears. We have the responses to a questionnaire from doctors, describing their services, so we are in a position to tell you what services are, or are not offered by individual doctors. Shirley has been a community representative on the committee looking into the transition of the Hospital Board to an Area Health Board this year, trying to keep women s perspective up front- a duty she has not always found comfortable or easy."
SUMMARY
Since WWHAC was awarded Department of Health funding it made considerable progress on its goals. It set up a house which operated as a resource, information and referral centre. A co-ordinator was employed and she ensured that the house was open and welcoming for women visitors. The centre was being used by other groups and for several different activities, including individual counselling sessions and support group meetings.
WW14-AC had a high level of activity and contact with women during the evaluation time. Organised activities were successful and satisfaction among users of the centre also seemed to be high. Overall, a considerable amount of valuable information and counselling was given to the women of Hamilton. It was likely that considerably more contact with WWHAC occurred than was recorded. However the available information suggested that there was a higher, degree of contact with certain groups of women (eg 20- 45 year olds) than with others, and additional strategies may have to be adopted to reach out to other groups.
WWRAC had shown considerable initiative in seeking funding to supplement that from the Department of Health. Nevertheless, it was worried about its future after the Department of Health pilot scheme ended. WWHAC wa-s gaining a public profile in Hamilton. It used the media and informal networking to extend its range of contacts. Although it cannot afford to spend as much as it would like on advertising, one of the collective members said that when she mentioned WWHAC now, after a year of operation, people knew what she was talking about.
WWHAC workers thought that there were several factors which were essential for its success. These were getting a good co-ordinator, finding a suitable house, appointing community workers and having someone to.do the administrative work. - 56 -
The fieldwork section of the evaluation was completed in July 1988. Since then WWHAC completed the Talking to Your Doctor pamphlet, the series of activities in Melville was very successful, WWHAC became a charitable trust and more activities were happening at the house. - 57 -
REFERENCES
Andrews, Christine [1987] HEALTH CENTRES FOR WOMEN NZ Nursing Journal August 1987:14-15
Bunnell, Julie [1986] Well-women clinics : an evaluation project proposal Unpublished paper October 1986. Department of Health
Bunnell, Julie [1987) Well women.clinics : Allocation of Funds Unpublished paper. Department of Health
Good Health [1987] MAKING THE WELLNESS CONNECTION Good Health 2(5) July/August 1987
McGrath, Fran [1989] PRIMARY HEALTH CARE INITIATIVES AN OVERVIEW Unpublished report, Wellington Health Services Research and Development Unit, Department of Health
NZ Department of Statistics [1987] NZ Census of Population and Dwellings Ser i es B, Report 6 APFENDIX A : S144%W OF LCG qfEl INRIM4TIM
Visitors to Waikato Women s Health Action Centre September 1987-June 1988
SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN TODE %OF Tom TOTAL NO. OF VISITORS 34 50 33 33 18 61 66 51 46 47 439 100.0
SEX Female 31 47 , 30 29 17 56 54 48 45 43 400 91.1 Male 2 2 2 0 0 2 2 3 1 4 18 4.1 Not Recorded 1 1 1 4 1 3 10 0 0 0 21 4.8
(EXTRA VISITORS 0 0 0 0 0 0 27 61 47 5 135)
AGE <20 2 3 0 0 0 7 2 5 1 1 21 4.8 20-45 28 37 26 29 12 34 28 31 39 33 297 67.7 >45 3 10 6 4 6 14 25 8 5 9 90 20.5 Not Recorded 1 0 1 0 0 6 11 7 1 4 31 7.1
ETHNICITY Pakeha 25 28 20 33 10 32 17 23 27 26 241 54.9 Maori 4 14 4 0 5 9 6 3 2 3 50 11.4 Other 0 0 0 0 0 0 1 1 0 0 2 0.5 N/Recded 5 8 9 0 3 20 42 24 17 18 146 33.3
OCCUPATION At home 11 14 3 4 4 7 4 6 3 7 63 14.4 Paid Work 13 14 8 18 6 9 7 8 3 12 98 22.3 Study 4 11 12 0 1 18 12 11 9 13 91 20.7 N/Recorded 6 11 10 11 7 27 43 26 31 15 187 42.6
LOCALITY Hamilton 22 27 3 5 1 11 0 2 0 0 71 16.2 District 4 2 6 1 1 1 0 1 0 1 17 3.9 N/Recorded 8 21 24 27 16 49 66 48 46 46 351 80.0
REASONS FOR VISIT Hlth Info 8 8 5 11 8 26 41 28 25 23 183 35.3 Inq/Reqts 15 16 7 6 1 n 10 10 7 4 89 17.2 Consl/Supt 7 10 6 11 1 7 8 17 9 22 98 18.9 Ref/Liaise 7 3 0 0 1 0 0 0 3 1 15 2.9 Other 8 20 13 16 8 15 25 9 7 3 124 23.9 N/Recorded 0 0 5 0 0 3 0 0 1 0 9 1.7
SATISFACTION OF VISITOR Very sat 17 18 7 1 6 41 44 32 27 21 214 48.7 Smwt Sat 7 12 5 1 4 9 4 3 7 16 68 15.5 Nthr/Nor 2 3 1 1 0 1 4 3 4 1 20 4.6 S/dissat 0 1 0 0 0 1 1 1 0 0 4 0.9 V/dissat 0 0 0 0 0 0 0 0 0 0 0 0.0 N/Recded 8 16 20 30 8 9 13 12 8 9 133 30.3
Some visitors had more than one reason for visiting. The percentage is calculated using the total number of reasons.
Extra visitors were those for whom log sheets had not been completed but they were noted as having "dropped in". Telephone Calls to Waikato Women s Health Action Centre September 1987-June 1988
SEPT OCT NOV DEC JAN FEB MAR APR MAY JUNE TOTAL % CFTL TOTAL NO OF CALLERS 78 89 61 17 15 53 77 62 53 90 595 100
SEX Female 71 75 58 17 14 47 66 59 51 87 .545 91.6 Male 5 6 0 1 5 7 1 1 3 32 5.4 Not Recorded 2 8 0 0 0 1 4 2 1 0 18 3.0
AGE <20 2 0 0 0 0 0 2 2 0 1 7 1.2 20-45 60 65 51 16 10 36 43 38 42 72 433 72.8 >45 13 20 7 1 5 7 18 10 7 14 102 17.1 Not Recorded 3 4 3 0 0 10 14 12 4 3 53 8.9
ETHNICITY
Pakeha 56 64 44 9 10 12 29 19 36 41 320 53.8 Maori 9 5 9 3 2 16 6 4 1 .6 61 10.3 Other 1 0 0 1 0 0 0 3 0 5 0.8 Not Recorded 12 20 8 4 3 25 42 36 16 43 209 35.1
OCCUPATION
At home 14 25 7 2 2 5 10 7 0 7 79 13.3
Paid Work 27 37 27 7 7 11 18 16 15 31 196 32.9
Study 3 3 2 2 2 2 3 3 0 4 24 4.0
Not Recorded 34 24 25 6 4 35 46 36 38 48 296 49.7
LOCALITY
Hamilton 31 51 6 0 2 3 4 5 0 5 107 18.0
District 8 8 0 0 0 0 0 0 0 0 16 2.7
Not Recorded 39 30 55 17 13 50 73 57 53 85 472 79.3
REASONS FOR CALL Health
Information 15 19 14 7 2 13 23 17 19 35 164 25.2 Inquiries
& Requests 44 35 20 4 4 9 22 19 11 24 192 29.4 Counselling
& Support 7 12 4 2 1 8 15 20 6 8 83 12.7 Referral & Liaison 12 13 0 0 .0 4 2 4 2 3 40 6.1 Other 14 24 23 6 9 23 177 27.1 18 8 24 28 Not Recorded 0 0 2 0 0 0 0 0 0 0 2 0.3
SATISFACTION OF CALLER
Very satisfied 34 26 19 4 3 26 41 29 18 41 241 40.5 Somewhat
Satisfied 12 22 8 5 1 10 8 93 4 11 12 15.6 Neither / Nor 4 12 6 4 1 5 4 5 8 9 58 9.7 Somewhat
dissatisfied 0 3 0 1 1 0 2 0 0 1 8 1.3 Very
dissatisfied 0 0 0 0 0 0 0 0 0 1 1 0.2 Not Recorded 28 26 28 3 9 12 22 24 16 26 194 32.6
Some callers had more than one reason for calling. The percentage is calculated using the total number of reasons. APPENDIX B
WAIKATO WOMEN S HEALTH ACTION CENTRE RECORD OF SPEAKING ENGAGEMENTS AND MEETINGS SEPTEMBER 1987 TO-MAY 1988
NOTES
1. "Numbers" refers to the approximate number attending the meeting. The four possible entries are 5, 15, 35, and 50; these correspond to the four categories on the log sheets of less than 10, between 10 and 20, between 21 and 50, and more than 50.
2. "Success" refers to the rating made by the facilitator or speaker. The categories and corresponding ratings are as follows: Very successful = 5, Somewhat successful = 4, Neither successful nor unsuccessful = 3, Somewhat unsuccessful = 2, and Very unsuccessful = I.
Date: 7 September Topic: Cervical cancer screening Group: WWHAC Numbers: 15 Success: 5 Date: 14 September Topic: Introduction to WWHAC Group: Chartwell Young Women s Group Numbers: 5 Success: 4
Date: 22 September Topic: Cervical cancer screening Group: Combined Trade Unions Numbers: 15 Success: 5
Date: 23 September Topic: Women s health issues Group: Morrinsville Women s Group Numbers: 35 Success: 5 Date: 25 September Topic: Women s health issues Group: Young unemployed people Numbers: 15 Success: 5 Date: 6 October Topic: Cervical cancer screening Group: Disabled women Numbers: 15 Success: Not recorded Date: 13 October Topic: Cervical cancer screening Group: New immigrants Numbers: 15 Success: 4
Date: 14 October Topic: Issues relating to disabled women Group: Disabled women and related workers Numbers: 15 Success: 4
Date: 16 October Topic: Women s health issues Group: Young unemployed people, Te Aroha Numbers: 15 Success: 5 Date: 20 October Topic: Cervical cancer screening Group: Public Numbers: 15 Success: 5 Date: 20 October Topic: Women s health issues^ Group: Whanau Community House, Fairfield Numbers: 5 Success: 4
Date: 20 October Topic: Cervical cancer screening Group: Public Numbers: 15 Success: 5 Date: 22 October Topic: Cervical cancer screening Group: Public Numbers: 5 Success: 5 Date: 27 October Topic: Cervical cancer screening Group: Public Numbers: 5 Success: 3 Date: 2 November Topic: Women s health issues Group: Young unemployed people Numbers: 5 Success: 5 Date: 5 November Topic: Implementing education program in workplace Group: Trade union Health & Safety officers Numbers: 15 Success: 5
Date: 10 November Topic: Cervical cancer screening Group: Disabled unemployed Numbers: 15 Success: 5
Date: 20 November Topic: General health issues Group: Students, Waikato Polytechnic Numbers: 5 Success: 5 Date: 24 November Topic: General health issues Group: Unemployed people Numbers: 15 Success: 5
Date: 29th January 1988 Topic: Cervical screening Group: Maori women Numbers 5 Age: 30-40 Success: 4
Date: 2nd - 5th February Topic: Cervical screening, breast self examination Group: general public Numbers: 50 Age: 16-80 Success: 4
Date: 23rd February Topic: Allocation of lunding from Cancer Society Group: Cancer Society Numbers: 5 Age: 30-40 Success: 5 Date: 23rd February Topic: Forming a Health Coalition Group Group: Health Coalition Numbers: 15 Age: 20-55 Success: 4 Date: 25th February Topic: Mutual support for group Group: Maori community workers Numbers: 5 Age: 20-5,0 Success: 4
Date: 26th February Topic: Meeting of various community groups Group: Community worker, "golden oldies", library workers, SPELD Numbers: 15 Age: 30-70 Success: 4
Date: 1st March Topic: Discussion of client s health problems Group: WWHAC Numbers: 2 Age: ? Success: ?
Date: 3rd March Topic: Maori health, particularly young people Group: Rongatahi Youth group Numbers: 15 Age: 20-65 Success: 4
Date: 5th March Topic: Assessment of Whaiora week Group: Runanga o Kirikiriroa Numbers: 15 Age: 20-65 Success: 5
Date: 8th March Topic: Maori health and healing Group: Maori Women s Centre Numbers: 5 Age: 20-50 Success: 5
Date: 11th March Topic: Cervical screening, assessment of free health checks at Kirikiriroa and-Maori Land Court (whalora week) Group: Maori women Numbers: 15 Age: 35-50 Success: 4 Date: 15th March Topic: WWHAC services Group: New Start for Women (polytech group) Numbers: 15 Age: 18-50 Success: Date: 16th March Topic: AIDS hui Group: AIDS hui Numbers: 50 Age:
Success: 5
Date: 16th March Topic: Information about WWHAC Group: Chartwell.Golden-Oldies Numbers: 50 Age: 60-80 Success: 3
Date: 18th March Topic: WWHAC and foot massage Group: University of Waikato continuing education Numbers: 35 Age: ? Success: 5 Date: 21st March Topic: WWRAC and women s health issues Group: Nursing students Numbers: 35 Age: 18-45 Success: 4
Date: 21st March Topic: WWHAC services Group: Access group (retailing) Numbers: 15 Age: 17-50 Success: 4
Date: 23rd March Topic: Women s health in the workplace Group: Occupational health nurses Numbers: 50 Age: 35-55 Success: 4
Date: 23rd March Topic: WWHAC and health information Group: Fire Service occupational health nurses Numbers: 5 Age: ? Success: 4 Date: 23rd March Topic: WWHAC, placement of students for practical experience Group: Polytech. nursing tutors Numbers: 5 Age: 25-35 Success: 4
Date: 28th March Topic: WWHAC, Area Health Board Group: Advanced nursing students Numbers: 35 Age: 25-45 Success: 4
Date: 28th March Topic: WWHAC services, health issues Group: New Outlook for Women course Numbers: 15 Age: 30-40 Success: 4
Date: 29th March Topic: WWHAC services Group: Access students Numbers: 15 Age: 18-30 Success:
Date: 29th March Topic: Training needs of WWHAC and similar groups Group: Training Council Numbers: 5 Age: 30-50 Success: 5
Date: 6th April Topic: COGS funding and selection of committee Group: Group to select new COGS committee Numbers: 100 Age: 20-60 Success: 5
Date: 7th April Topic: WWHAC services Group: Day Care Centre committee Numbers: 15 Age: 30-40 Success: 5
Date: 9th April Topic: Cervical screening education day, workshops Group: Mixed Numbers: 35 Age: 30-50 Success: 5 Date: 19th - 20th April Topic: Practical community work Group: Mixed Numbers: 35 Age: 30-66 Success: 5
Date: 21st April Topic: Setting up course on health needs for Melville women Group: WWHAC,community worker, public health nurse Numbers: 3 Age: 30-40 Success: 5
Date: 25th May Topic: Working together with group Group: Parentline Numbers: 5 Age:. 30-50 Success: APPENDIX C
WAIKATO WOMEN S HEALTH ACTION CENTRE RECORD OF COURSES, WORKSHOPS, AND SEMINARS JULY 1987 TO MAY 1988
NOTES
1. "Numbers" refers to the approximate number of women attending the course, workshop or seminar. The four entries of 5, 15, 35, 50 correspond to the four categories provided on the log sheets of less than 10, between 10 and 20, between 21 and 50, and more than 50.
2. "Age" is the age range of the group of women who attended.
3. "Success" refers to the rating made by the tutor or facilitator. The categories and corresponding ratings are as follows: Very successful = 5, Somewhat successful = 4, Neither successful nor unsuccessful = 3, Somewhat successful = 2 and Very unsuccessful = 1.
Date: Wednesday 22 July Course: Eating Disorders, with Jasbindar Singh Duration: 2 hours Numbers: approximately 70 Success: 5
Date: Tuesday 11 August Course: Physical Well-being Duration: 2 hours Numbers: 15 Success: 5 Date: Wednesday 12 August Course: Eating for Health Duration: 2 hours Numbers: 35 Success: 4
Date: Monday 28 September Course: Emotional Well-being: Post-natal depression Duration: 2 hours Numbers: 5 Success: 4
Date: Wednesday 30 September, Course: Eating for Health #1 Duration: 2 hours Numbers: 5 Success: 5 Date: Thursday 1 October Course: Health After 50: Arthritis Duration: 2 hours Numbers: 15 Success: 4
Date: Wednesday 7 October Course: Eating for Health #2 Duration: 2 hours Numbers: 5 Success: 5
Date: Wednesday 14 October Course: Eating for Health #3 Duration: 2 hours Numbers: 5 Success: 5
Date: Tuesday 2nd February - Friday 5th February Course: Cervical screening and breast self examination Duration: 7 hours for 4 days Numbers: >50 Age: 16-80 Success: 4
Date: Tuesday 3rd March Course: "New Outlook for Women" Duration: 1 hour Numbers: 15 Age: 30-40 Success: 5
Date: Tuesday 3rd March Course: Women s Health Issues (for Polytech. class) Duration: ? Numbers: 15 Age: 18-55 Success: 5
Date: Sunday 27th March Course: Day trip to Mount Pirongia Duration: 7 hours Age: 7-50 Numbers: 15 Success: 5 Date: 26th May Course: Giving informati-on about-W-WHAC to Catholic Social Service group, and discussion Duration: 1 and 1/2 hours Numbers: 35 Age: 25-45 Success: 5
Date: 27th May Course: Pelvic floor awareness Duration: 1 hour Numbers: 5 Age: 35-50 Success: 5
Date: ? Course: Eating disorders #1 Duration: 1 and 1/2 hours Numbers: 15 Age: 18-50 Success: 2
Date: ? Course: Eating disorders #2 Duration: 1 and 1/2 hours Numbers: 15 Age: 18-50 Success: 4 APPENDIX D I
fk f Sf-IL-AR C EliIt IPF1,16N,
Waikato Womeri-s Health Action Centre (WVY HAC) re-sporided to cC)T1-,--PFr1
among Vil aikato Women about cervical carjr- er- aE^- a r suit of tri E rQati( D , ) 7,1
Vill ornen s Hospital enquiry by planning a cervical srnear campai. c1n.
Four Advanced Diploma Nur-sin q Students had elected assicnrneint to WWHAC for their v,^, eek of clinic @I exc)erienc.e. I t was, decided that in ^-=- [Jlls and knowledcIe of these nu -)u I d L,---Str be utilict: ,d til carnpaian. An initial meetirrzI with Eleanor Hor tL on and Coll p -ri ^ c-lly ( A ,-,L,I 4,1 pr. and their tutor, Barbara Taufa iciduced a plan of action for ^VHACIf (Appendix A).
As we beqan, tentatively, to work toward our objective z I nere ",^asi sorne doubt felt by both the community and ourselves, as to hov, 1 effective we to could be. The response thi c-, campai g n rias been faA r bevond ouF areatest expectations I t would seem the tirniria vv as Fiah lL arid th c" ericrqv e ,--endedl V V a S. W C) r- t ri V ! h i I e.
T h^^ mu I t ip I i r- i ry of ac t i on^, tak en m -I e c^ f or 0 i f f 1 1 i F epo r 1 1 ng. -,3 h e a ci i n -, s v^-, i I i t^ e u c, e
Specif ically
Action ReSearch with Women in the Wail-lato
B. Education with women
C Media Coveraae
s 1). . Liaison with other Intere ted Group-c
E. SErvilce Development
F. Sumirnary
G. Futur e Directions
Tht-Sle^- V1.11 1 be address.ed separately. 2
A - ACTION PLSEA14CII WITH WOMEN
On the 7th September 1987 a decision was rnad .? to design and cjFcu -1a Lt- 2. survey for WWHAC supporters. Colleen K ell^/ (ADN) undertook to fol-ry-julafr7 a questionnaire. (Appendix B) This was printed and circulated as plannea with our bimonthly newsletter.
At a.meeting of groups interested jr, cervical smears ., held on 2-1nd at the Trade Union Centre, further p roups; re q uested tt--iat thev be aL-,]-,- 7C.; to distribute the questionnaire their wornen. The-rc no^i, e I- e He S, p 1 1 -6 1 and Hotel Workers, P.S.A, N.1-7.N.A., Telecom, Laboul- De p artment , Waikat-D University, Disabled Citi2ens, City Council Community . Workers, and various Occupational Health Nurses-
by r 1\1) On -5th October an analysis of the responses was done Julie Young (Af) At this. point I -I S responses had been received. (Analysis appears on A n t^, P pendl.,, F-".j At the WWHAC Collective meeting on 19t-h NovernDer the responses to the survevI were recoanised- to be bCVDnd1 ouF capacitv0 to 3-nalvse. tl,^ decisi. or) was made b y the Collective to seek fundino to prepare: LI I- data for r)ubliCatiDn. The to^al resiDonse now stands at 6-
Comment:
It is hoped that the survevI has-
- Raised women s awal-eness of cervica l, screeninc.
Initiated discussion among women about cervical screenjnQ.
- Giver) women a place of contact to discuss their o p tions^ and choices; in health care delivery.
- Given ^%., ornen a place of contact to discuss cervical screening.
Beer! a meariS to encourage womer, to netwo,-k a r-11 C, 1-1,3 t r -1 1 SC -C IV e
Provided a data base for the campaign for \^^v,.IHAC.
the Provided encour-aaement for W\A/HAC Colilectiv,2—
3
B. EDUCATION WI 1- 11 W011EN
The following information and discussion sessions were held reqardina, cervical screening-
DATE TAKEN BY NO. GPOUP
I -) f 7th Sept Trish Wright V ^V JIAC
-,L.2nd Sept C-lennis Woodc. 115 i ,F ade Uri I or,, 62, 11 ea. 3t, P- 2-)rd Sept Trish Wright [Ior-rinsvi"Ile V Vomens aroun, 25th Sept Irish Wright Uriemployed aroup 6th Oct Sue Cobroucjlh Pub I ic leanor Horton New immiarants I 3th Oct E I 4th Oct Marie Postill 14 Disabled WOMer)
I 6th Oct Trish Wright 1 1 Te Aroha unemPloyed or-oup
20th 0 C t Trish Wright 6 Fair-field V Ihanau community
(Dt h oc 4L Eleanor Horton 12 Public -, .-, nd Or- L E I eanor Hort or) Publ i.-- t h 0 C "L Eleanor Horton Pub I i C n d N o v Trish WriQht Y.M.C.A. L-InernDloved arou- 5th I-,Jc)\.! Irish Wright W.T.I. students E-) t h N o v Eleanor Horton Trade Union Delegates
I Ot h Nov Trish Wright 12 Disabled unemployed grou^^
11 0th Nov Trish Wriaht 8 W.7.1. students - 23rd Nov Trish Wright 6 Youth Resourcel--entrl-e 24th Nov Grace Paul VVrianQaroa I Iarae
An education kit was developed by Eleanor Horton for future edu --atlion sessions. This was further distributed by Anne Berghan, Health and Safetv Officer to Unions, for education in the workplace.
Numberous informal discussions have taken place.
info r-matior, and resources have been ri q athered f rom rnam,,, ar;--, as , lrl^
Health Department T. H. A. \A/. N.Sw Womens network and numeorous lourrials C. MEDIA COVERAGE
The experience of working with the media has been one of areat learninq on for workers Eleanor Horton and Marie PoStill, the campaign. Inte,rest and cooperation from the media has beer, varied.
The following list is a r-eCDrd of successful irlteraCtionc--
^. 1. Waikato Times (Provincial Distribution) Discussion was initiaL in October I - ,:I th with Sus ie Lonqdill and resu Led4 a feature a, ticle appearing on 21 4th October. (Appendix C)
Waill- ato Times. News release from the meetinq of qr-oups inteaFesLe -J in cervical screening appeared I st October (Appendix D)
3. Hamilton Press (free Citv paper delivered to ever y, household in Hamilton). Discussion initiated,witlh Annette Tavjr)- resulted in an article which aDpeared 2 1 st October. (Apperidix F).
4. 1ZH F^,adio News Bulletin on 9th November de s .--.,- I C" the VA^I r-IAI-- campajori and enCouraged women to asll their p,-a-- tLjL6 nu,-s,^s I I C^ cervical smear servi. cve was of f ered at their rnedical centrc-
5. 91 FM Radio Interview discussing the campaign, v.,orT-ien s responsibility, aMd the availability of varied services. November 4th.
6. - Radio Waikato Talkback on WWHAC cervical campaign. I (TaLnecs of the radio interviews are held at WWHAC-)
r Contact has been m. ade with N-Z. Herald, Community newspapers and Women s Weekly, and these will be followed up in the fUtUFe. 9
D. LIAISON
The Cervical Smear Proar-amme has meant that WWHAC has liaised with a wide variety of groups with interesting and encouraging spin offs. I
These are,
GROUP DEVELOPI -1ENT Waikato Polytechnic 4 ADI^ students placed f or 5 weei^s total
Maori Women s Centre Letter off SUDPort Request for use of Cervical Screenina for Maori Wornen undertaken by WWHAC.
Parentline Letter of support and askina for he4) with low income women,
City Council Community Workers a. a.
Catholic Social Servicesa - a.
Trade Union Health and Safety Officer Eduction opportunities fol- low income women Resource Development Cervical Smear interest qroup
Family Planning Providing education Application for suitcase clinic funding for Training of their nurses the above.
Nursing and Health Studies Dept. W.P.T. Use of physical and administrative facilitiess.
Disabled Living Centre Education and survey opportunities
Dannevirke Womens Encouragement and support
T. H. A. W. A.A. A Flyinq Speculum service in hours of dire need. Poyal Commission on on Social Policy Submission Cervical Sci cernna
an Hamilton Medical Lab. Support and "Expert" for Practice Wurse Waikato Hospital Lab. Training,
Medical Association Support encour-aciinci nurses trainin q throucin their newsl0teF.
Medical Officer of For openina doors to Lat)(Jlr-atory facilities foi Health WWHAC.
to G-P. Association Encouraoinci, GP-c, allow nur-ses to attend training
Health Dept Nursing Encouraging Pural P.H,N s to tr-ain
Media N e w s k 111 s f o r \A, W HA C
Continuing Education Proaramme planned for -April Q-E S, t r ^ lhe:ar to frorn Sandra Coney and tc-ac.h self examination of breasts and cer-\.11>1,
Waahi Marac Health Women at Whanaaroa have had smeaFs taker) Centre on Marae. To apply for Rural Women fundina for- screening proarammes.
Kirikiriroa Rununga To apply f or Urban women f unding f or- screening proqr-ammes
Health Dept Maori To investiciat-P ways of getting I laorl worrien in Community Workers on board a culturally S en SItiV e V^,aV 7
E_ SEPVICE DEVELOPMEN1
A report in Kai Tiaki maqazine (August 1987) of a successful sr-near campaign in a General Practice prompted us to initJate a prograrnme oll education for, Practice Nurses (Appendix F).
p - General Practitioners were a proached by mail on 22nd September with a, copy of the "Smear Campaian" article and an invitation to allow their nurses to participate in a tra .ining programme to enable them to offer t.,-,ip same, excellent service (Appendix G).
A pr oup of practice nurses was consulted to check that the level of p interest in such a programme was adequate to beoin. The re s onse wa,_1, most positive.
I W a I i-,, at c) Po I y "LeChni c Nursina and He a I th Stud es Department w a s, a pp roached seekina cooperation. Betty Ta y lor (a tutor) undertook 1L c, a,rrancie ph\ -,Ica] facilities and adn-iinistrat i on f or t w o, da^ I o n a. proqrammes for practice nurses.
to An invitation nurses, throuahout the Waikato and C cl)romandel re0ion wa--. the distributed. r-^ecistrations for course were so r^un-ierou_s that thre^, further days were arranged. We felt that it was important that the aroups at should be kept around 15 peolple to enable optinium learni. no for a] 1. ..
to We are orateful the people who acted as quides th r ou g h th p s-F day-c., specifically Eleanor Horton (ADN), Dr Bruton (C y topatholoWst), DF Ballantyne (G.P.) and Lauren Nlllcre^i. ,L- (Practice Nurse). The programme could not have eventuated except for the 40 brave women who,volunteered to have cervical smears taken by amateurs, They willingly did this to help other -%l o rnen have crioices which may allow them to underoo screenin-,:^. The task, of finding such women was one of the most diff icult throuohout the ca,—npajqn and broucht home to us the sensitivitv t1hat worner) have to t h i _S. 1 C_ S U E-.
Mention must also be- made of the effect of the traininq or, r-nany nurses Some were very nervous before taking smears and did --)o with some deq, ,-ec- of trepidation. Their confidence in their own abilit y visib lj^ in^reased bv the end of the day. Many were aware that. their f utuFe use and e development of their new skills depended upon the coop ration of their f I lb
ernploying dL,)ctor-. It is planned that they could be C^)F)ta .-te^dr lrj tlI );:: ! ut.j." V,^ with recard to their success. These days have (^iven t^jp C)ppurt,_,Fh4^ to establish their own support networks to discuss wa y s of improvin q thE , service offer-ed to their clients.
The dates on which the programmes ran were^
28 October-
3 November
4 November
I I NoVember
I Decemb e,r
There has been interest in our programme fr-orn Contraceptive Choice in Auckland, a medical centre in Taupo, and Wellington Polytechnic. F. SUMMARY
The process has been one of go with the flow". It has included over 30 meetings, billions of phone calls, and many disconcertinq dinner table discussions.
1. 75 Practice and Public Health Nurses attended a da y s education arid trairdrici.
2. 634 women were moved torespond to a questionnaire on cervical screenina.
21 9 women attended education ses. . )- ions.
4. 40 women giving quality feedback on cervical screenina while in a compromised position.
5. A Collective looking forward to a Christmas- break.
he most IM^)Drtant outcome though, is that WV, HAC are ricw.! abl e 4L leoitimately provide a cervical screening service as an alterna t ive to th-- pr- e c- ent service to Waikato women. This will begin in the new ye a!-.
To conclude, here are three snippets from the cami.)alqn^
A doctor in a small town rang the centre excited with Our Drogramme. He knew that his women clients were not being adequately serviced for. cervical screening. They were not coming forward for smear5. He.felt it was because in a small community he inevitably had frequent SOCj2l contact with women and they were embarrassed. He felt it essential that his practice nurse could provide an alternative.
Worn-sr, at V^Ihangaroa 111aFae have had their f ir st smear"
One of our collective members bravely had her first smeaF in ther fifth decade of life. 10
G. VUI UPF DIPLCI IONS
Future directions could be -
a) To survey nurses as, to what they are doing now as a result oil training.
b) To f urther support initiatives f or, v,^, omen who are Maori or of low income.
C To provide a service -for, such women at minima l, cost. (i.e. equipment
d) To acquire fundinq to provide a hiah quality servicve.
e) 7o further interact with G.Ps re g arding worrien s, cynaecologicall issue-C.
f) To analyse the data gathered thr-ouall-, research
0) Self examination workshops for women. I 4u I," ITU. , ;jA Find it difficult to remember day to day details? Keeping a diary is a good way of keeping track of what is happening with your (and your children s) health. III Tell your doctor 4k III Ask for a second opinion r^o YOU The N.Z. Board of Health has produced a booklet for you to lid
record details of your monthly cycle, smear tests, pregnan- R Talk to the Doctors nurse cie.,,, and so on. (Available from your local Womens Health 0 Centre, or the Department of Health). X Talk to the Womens Health Centre (if there is one in your town) M III Change your doctor 0 ^d LISTENS carefully to what you say.
IS A GOOD TEACHER. Will explain clearly and simply what you will need to do.
GIVES you the reasons for the advice being given.
SETS OUT risks and benefits of the treatment being suggested.
DISCUSSES treatment options with you.
GIVES you choices.
KNOWS that you are not wasting lime when youask for help to stay well,
WANTS you well!
Like most of us, doctors can be wrong. IF YOUARE NOT WELL MAKEANOTHER APPOINTMENT! If the doctor is often wrong - change your doctor . DEVELOPING
It is YOU who takes responsibility for your health.
I t i s YOU who has to take responsibility for yourflamily s health.
It is YOU who pays for consulting the doctor. For further copies of this publication contact: P AJR Waikato Womens Health Action Centre, YOU should therefore expect satisfnclory service. 151 Collingwood St, P.O. Box 269, H,-irnilton, Ph W341 ......
Ask the Doctor or nurse for these details at your first visit. DO take time to explain the -problem clearly. Keep this information handy - in the front of your phone book Practice at home what you want to say! You are responsible for your own health. If things do go is a good place. (maybe with a friend or partner) wrong or you want advice, you and your doctor can work DO say what really worries you about the problem. together to make decisions. For example, after describing the problem you You will need to feel comfortable to talk with your doctor and might say "What really worries me about this share your concerns and symptoms. is...." Different things take different amounts of time. When you If these suggestions help you, share them with your family make the appointment it helps if you can tell the nurse or DO take a friend or partner along for support if that will and friends. receptionist whether it is:- help.
IR Urgent DO expect to be treated as a person
IR A routine matter needing a short time When the Doctor has heard your reasons for coming you will usually be asked questions so that ZJP • A routine matter needing careful reconsideration they can be clear about your problem • A diffibult problem requiring a long appointment They will then suggest treatment. Many women do. Maybe because we feel that- • A family consultation, when you need to have your You can ask the doctor why a particular form of treatment is R The Doctor knows so much child/children examined as well as yourself being recommended.
The Doctor is the expert PLEASE remember to cancel the appointment if you can t The Doctor s time is too precious to waste get there at the time given. LISTEN CA1A11FULLV`.^ i j54.21j, , Q.
Being sick is being a failure! DO feel comfortable to take notes. We will be embarrassed. (Some people take a tape recorder!)
14 Our children won t behave in the surgery. DO make sure you know what the likely effects of the DON T apollogise for coming. People don t usually drugs will be - what improvements you should notice, how go to their doctor when it Is not necessary. It s okay to be sick. Not pleasant, but okay. quickly, and what the possible side effects could be.
DO make sure you know how long the treatment is to last. REMEMBER DOCTORS ARE PEOPLE TOO!! DO tell your doctor if you will have difficulty paying the account, or if you are a beneficiary who is eligible DO ask when you can expect improvement for a larger subsidy. DO ask how to tell whether the treatment is working. MAKINGANAPPOIN DO telf the doctor at the beginning of the appointment what DO find out what you should do if the treatment does not Feeling comfortable when you go to the Doctor begins with is worrying you. work. understanding the appointment system. If there are several things, give the Doctor Good doctors make sure you know: a quick outline of all of them, before getting involved in one problem. ^gg AFMIDU DON T-UNDEASTAND IR what services they offer. tiZ 4k, ...... IM when to ring to make an appointment. DO try to be clear about the symptoms: - What changes have you noticed? • SAY that you do not understand how long is allocated for each appointment. When do the symptoms occur? • ASK politely for the advice to be repeated, or written when and where to ring for urgent calls. Is there pain? 0 How often does it happen? down. M How much does it hurt? how to ensure you get routine checkups N When did it start? • SAY if the advice seems wrong repeat prescriptions • DOfeef free to ring the nurse later if you are still not X how to get the results of tests. DO take a list of things you want to ask ! sure about what the Doctor said.
......