Health and wellbeing for Māori

Developing strong relationships with your patients and their families leads to greater accuracy in diagnosis, improved treatment plans and greater continuity of care.

This is particularly important when you are working with Māori patients and their wider whānau, where genuine relationships and connection to culture are vital to care outcomes. With Māori patients especially, the therapeutic relationship you develop with them needs to be built on trust and collaboration. Without a good foundation in these relationships, Māori patients are likely to feel alienated by the therapeutic process, making it even harder for them to engage with you.

This series of interviews was recorded in 2018 with Tāmati Kruger. Tāmati is a kaumātua, a respected elder, of Ngāi Tūhoe, and was the chief negotiator in Tūhoe’s settlement process with the Crown.  These interviews came about during development of a resource on dementia care for Māori.

The rich content of these interviews is designed to give you broad cultural insight, as guidance for all primary healthcare practitioners wanting to create greater satisfaction for both patients and practitioners and to achieve better health outcomes for Māori within their practice.

Ko tēnei te mihi maioha ki a koe e Tāmati, i tōu ngākau marae, i āu korero mārama, i tāu tohatoha mātauranga.  He iti nā Tūhoe ka mārama te Pō.

 

Social connection

Whānau and iwi are linked with physical, spiritual, emotional and intellectual wellbeing. These things are collective and social, people rely on contact and connectedness with others to be whole and healthy.

    

Wāhanga o te tangata: Components of self 

Tāmati explains how the search for knowledge is spiritual and intellectual, and that humans have at least three aspects that we are driven by:

  • Hingengaro or Intellect - we imagine, think, process things. In some societies this is considered the most important aspect of a person, whereas Māori also value emotional intelligence and gut instincts.
  • Whatumanawa or Instinct - how a person will dig down into their 'soul' or gut to determine what is right or wrong.
  • Action or stamina - where your strength and courage comes from, to keep going with those principles and values and virtues that  you believe in.

Mauri ora depends on being aware of and acknowledging all of these points. In health, begin with investigating the wairua or the spiritual state of a person. In order to successfully engage with someone around their health, a connection with their wairua is vital as wairua has great influence over all other aspects of a person.

   

Mana

Mana is the external existence of some kind of influence, or power.

It is an idea/phenomena that does not exist by itself, it is co-joined with other beliefs/traditions/concepts that include Mauri (life force) and Tapu (the sacred and unknown). Tāmati cautions not to consider it in isolation as this invites misinterpretation.

 

Mauri ' life force' and Tapu 'the unknown' live side by side

Though we may not think it is important day to day, Mauri impacts us all in our everyday lives. The things you do in your life measure you as a person, this is a truism that articulates Mauri. It is a concept that pre-exists our habitation of the world.

Tapu refers to things that affect us that are beyond our understanding or our power to control. There are many things that we have little influence over, we must learn to live with these things and to respect them. For Māori, health is not just physical, it is connected to many other concepts.

 

Whakapapa

A belief and tradition recognising connections between everything in the natural and spiritual world - including, but not confined to, people. It helps us understand the responsibilities and standards of behaviours expected within different relationships.

 

Mauri ora

In this video (3.39 mins) Tāmati explains the term hauora, and talks about a more relevant holistic wellbeing concept that inherently ties and connects all the aspects of an individual’s health. He talks about the difficulties in achieving the balance, or mauri ora.

  

Wai Warea

In this video (5.32mins), Tāmati talks abou the Tūhoe/Māori understanding of dementia within the context of a whole life: "If your life was a day, how would you spend it?"

Dementia is part of the human condition, a part of the flow and cycle of life. People with dementia need to be around those who have the collective memory - that becomes their own memory.

 

Te Ao Kikokiko

Dementia is referred to as a mate (death), but it is not viewed as a punishment. Tāmati talks about how that is so (3.11 mins).

 

Implementing Toiora

Tāmati talks about setting up Tūhoe medical centres in order to overcome issues such as suspicion of doctors and unaffordability of health care within the Tūhoe community. He talks about operating outside of the system in order to gain the necessary control, and bringing the Crown in as an investor rather than a decision maker. Finally he discusses Tūhoe’s goals of moving towards toiora, in which health does not rely on doctors, but rather involves everyone in the community (7.59 mins).

   

Crown - Iwi relations around health

There is always to way to work together. There in un-learning and re-learning to be done though.


    

Increased cultural competency skills results in greater doctor and patient satisfaction, with better health outcomes, especially for Māori.

As additional resources and background, Pharmac's Te Whaioranga, Māori responsiveness strategy and the NZ Ministry of Health website outline the Government's commitment to increasing access, achieving equity and improving health outcomes for Māori.

 

Peer group discussion points

Tāmati describes a Māori concept of knowledge (wananga) that includes both spiritual and intellectual components
    • What do you know about the spiritual beliefs of your Māori patients?
    • Do you feel confident asking about spiritual beliefs during a consultation?

    Māori require genuine relationships that are connected to culture and underpinned by trust and collaboration or they may feel a lack of trust in the process, such that they choose not to follow your advice or take medication.

    • Do you feel your patients feel this connection enough to experience intended health outcomes?
    • Is there more your practice could be doing to upskill eveyone who interacts with your Māori patients and their whānau?

    Consider the inventory scores you usually use for assessing depression or anxiety (such as the PHQ-9, GAD, or the Kessler). After listening to Tāmati’s description of mauri ora, do you feel these inventories adequately assess mental wellbeing for Māori?

    • Are there other questions you might now consider asking your Māori patients?

    Patients with dementia benefit from being surrounded by others whose collective memory can overcome their own memory loss (wai warea). Consider your Māori patients with dementia.

    • Do they have adequate support or are they at risk of isolation?
    • How does your practice enable consultations with those who are caring for your Māori dementia patients?

    In the clip “Implementing Toiora”, Tamati describes how Tuhoe Medical Centres seek Iwi-led solutions to improving outcomes for their community.

    • How does your practice engage with your local Māori community?
    • Can you identify opportunities for improving these relationships?

    Reflect on the MedTalk and the peer group discussions you have had. What might you do differently in your own consultations to improve wellbeing for your Māori patients and their whānau?

    Date Published: 
    Thursday, July 25, 2019