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1 . NI I-
2. FOREWORD
PAI( l I
SECTION 1. INTRODUCTION WHITE
ii. PROGRAMME OF THE HUT WHAKAORANGA
iii. PHILOSOPHY OF HEALTH
IV. PRIORITY RECOMMENDATION FROM THE HUT WHAKAORANGA
V. FUTURE DIRECTIONS
VI. IMMEDIATE FOLLOW UP
VII. CONCLUSION
PART IT RECOMMENDATIONS FROM 11111 WIIAKAORANGA
PART 1 11 APPEND ICES YELLOW
087825 ="t Of Health wellivon HE.MIHI
E. nga mana, e nga reo, .e nga karangatanga maha a nga -hau e wha,
Lena kou Lou, tena koutou, tena koutou katoa.
Tena koutou i nga ii iii ai tua kua h:inga at u, Rua hi.nga inai i
.tena, i teria a o ta Lot.i inarae kainga . Haere uga mate -haere hi La huinga a to KahuraiigI, hi a ratou kua wheturangitia. I!eoi nga null, nga tangi 1i a koutou.
Me huri uga whakaaro hi a tatou te huriga ora , tena koutou
tena koutou, tena tatou. He mihi tenei hi a koutou, e hika
ma :1 tae tinana ma:i hi te Hui Whakaoranga. Me mihi ano hoki inaua hi a koutou nga ringa awhina o te inarae o Hoani Waititi.
Kei Le whahamoemit;i, kei te whakawhetai ma te wahanga, i
tukuna mai hi a matou. E ai ki te korero: Ma te pai o nga mahi o muri, ka ora ai a mua.-
F: whai ake nei te whakarapopotohanga o nga take I tutuki i te Hui
Whakaoranga hei whakaarohanga ma tatou, te iwi Maori, me te hunga
hoe I te waka o te Tari o te Ora a to Kaawanatanga. Waanangahia mai, kokirihia, whakatinanatia hei ara ki te hauora o
te iwi. Ko te tunianalco kia mau tonu I a tatou nga tikanga a Koro, a Hui, Pakeke ma. Ahakoa nga awangawanga o te Ao Hurihuri, kua tae tenei ki te wa me whakatakoto he korero, me maumahara tatou hi nga tikanga nei hei tikitiki puinau mo taua mo
te tangata.
Kel te haere nga wero a Te Tan o te Ora kia whakauru atu tatou
1 ki. roto ki nga wahanga maha a a ratou kaupapa, o a ratou whakahaere. Kia whakawhaaititia mai nga whakahaere a nga tan katoa hel whariki mo nga ahuatanga e pa ana ki te rapu I te ora mo nga iwi katoa a te motu; aa, kia maarama ai ki a tauiwi te Ao
Maori, ma tatou tonu e whakamaarama, ma tatou tonu ratou e tohutohu. No reira, e te whariau, kati noa I konei.
Kia kaha, kia maia, kia manawanui. Ma te Atua tatou e manaaki, e tiaki.
Na maua nba, Na nga pononga a te iwi,
W Potaka
P Ngata
Nga Kai Hautu o te Komiti Whakahaere. FOREWORD
In my first annual report as the Director- General of Health I highlighted the very marked improvement in the health of the
Maori and non-Maori from 1946 - the year I graduated in medicine
- to the present day. The most striking rate of improvement has been the health standards. of Maori people due largely to environmental and preventive measures, the control of infectious diseases and advances in curative medicine. However, differences in health standards between the Maori and non-Maori still exist, and while we can look back with some pride on the accomplishments of the past, we need to identify those areas that require special attention for the future.
Many sicknesses of today are associated with the way we live.
Their control is very much in our own hands and they are unlikely to be solved by some outstanding new drug, scientific or technical discovery. We need to clearly identify different approaches to resolve our health concerns and in the area of Maori health this must include Maori involvement and participation at the outset in order to do better for the future.
Aotearoa is entering a new, exciting phase in her history. Our
future rests with the ability of our various institutions,
communities and individuals not only to resolve by consensus our
economic and social concerns, but also our emerging
multiculturalism. Each group in our society should be encouraged
to preserve its own identity, be able to Acknowledge, understand
3 and respect each other s quite diverse views and yet contribute to its overall wellbeing and future direction. There is richness. in diversity, and the challenge to each of us and to the health service is to do better than we are at present.
The Hui Whakaoranga was a historical event for the health service in New Zealand. The various Health Department officials,
Hospital Board members, representatives of other Government departments, private and voluntary agencies and health workers came to listen to Maori people define health in their own terms, identify their health concerns and aspirations, and share the solutions that have been developed to meet these. Maori people have clearly demonstrated their capability of providing a valid and legitimate Maori perspective of health. They eojant to be involved in making decisions that affect • their health and wellbeing. Maori people desire self -determination and the ability to maintain control over their own destiny. This presents •a challenge to today s health system and requires a commitment to cross-cultural understanding, a change in attitudes and a change in the way things have been done in the past.
Since the Hui, several health initiatives have been fu.Lhdr developed and several regional Hui have been held and others are planned. The Koputu Taonga programme in South Auckland shows how, several government agencies can share resources, work together and contribute to the development of skills and dissemination of information so that families can make choices to improve their
4 quality of life. The training of Ngà Ringa Aroha at Waahj is another example of the community development approach to disease prevention and health promotion as part of an overall tribal development programme. Several others are in the pipeline and have reached the planning stage. Many barriers and difficulties have been encountered along the way and we should all take note of these and avoid repeating them. The development of these initiatives provides a springboard for other local tribal or community based health programmes.
It is impossible to meet the many and varied information needs that health agencies, organisations, whanau and individuals might have. It is hoped that this report will be widely read and discussed on marae, in homes and in committee rooms throughout the country. The report is presented in three parts.
Part One summarises the planning and organisation
of the Hui. It outlines briefly the philosophical
foundation of health from a Maori point of view and
ranks the main recommendations of the Hui in an order
of priority. It also includes some of the important
concerns and aspirations of Maori people related to
health and the style of delivery of health services.
Furthermore it includes a framework of concepts or
notions for the future direction of health services in
the area of Maori health, and for all New Zealanders
Part Two lists the recomendations from the Hui.
Part Three, the Appendix , contains the Hui Programme, the Keynote papers, evaluation reports and a
list of all participants .
This report challenges the health system and those who work in it
to do better than at present. I am sure that we can achieve this
by working together.
Dr R.A.Barker
Director General of Health
6 PART 1
SECTION 1: INTRODUCTION
The Hui Whakaoranga was held at HOani Waititi Marae, Glen Eden,
Auckland, from 19-22 March 1984, with the theme of promoting a positive view of Maori Health. The Hui was sponsored by the
Department of Health and the programme was worked out in consultation with the New Zealand Maori Women s Welfare League, the New Zealand Maori Council, the Hoani Waititi Marae Committee and the Departments of Maori Affairs and Education. It was held in recognition firstly, of the growing number of health initiatives that were developing in Maori communities, and secondly, that despite the considerable improvements in recent years, there still exists a disparity in health status between
Maori and non-Maori people.
The objectives of the Hui Whakaoranga were:
(1) To provide an opportunity and forum for organisations and
individuals concerned with Maori health to meet, discuss and
share ideas, experiences and information related to health
matters.
(2) To promote a view of the positive aspects of Maori health.
(3) To develop a mechanism to plan, co-ordinate, monitor and
evaluate intervention programmes related to Maori health.
As health is an integral part of the culture of any group of
people, the Hut Whakaoranga was an opportunity for Maori people
to define health in their terms and to talk about the solutions that have been developed or might be developed to meet their needs. The Hui Whakaoranga was timely in that, it provided a focal point for the Department of Health to inform Maori people, health agencies and health providers that for 1984 and 1985, Maori.
Health had been identified as a priority area in terms health. intervention strategies, health education programmes and efforts to improve cross-cultural understanding between Maori . people and health providers.
Advice was sought from representatives of Maori organisations,
Maori communities, health agencies, some Hospital Boards, the
Departments of Maori Affairs and Education, interested
individuals and the Ministers of Health and Maori Affairs as to how the objectives could be achieved.
The Department of Health, in support of the Department of Maori
Affairs Tu Tangata programme and its philosophy, saw that it was
no longer appropriate to determine health related programmes
without first consulting and involving Maori people. The
Department saw its role as working in collaboration with Maori
people to identify their health needs and to propose initiatives
that would be supported at the local community or tribail. level.
In taking this stance, the Department of Health sees its role now
and in the future as providing technical, advisory and
administrative assistance to Maori people within the resources it
has available. In adopting this role, the Department has a
responsibility to inform Maori people what resources are
8 availbie and how access to them can be gained. It also involves being a facilitator and co-ordinator, thereby acting in a supportive way to Maori people and Maori health initiatives.
9 PART
SECTION II: PROGRAMME OF. THE HUI WHAKAORANGA
The programme of the Hui Whakaoranga was constructed to allow
representatives from the government, the Health Services and
Maori people the opportunity to talk about Maori health. The
programme was worked out with a defined programme to allow time
for all of- these different interest groups to put forward their
views and for workshop discussions and opportunities for people
to get to know each other.
The Hui Whakaoranga was officially opened by the Ministers of
Health and Maori Affairs. Key people were invited to give
addresses about particular aspects of health and solutions that
their community, tribal group or organisation had implemented.
All keynote addresses given embodied a similar theme, that is,
that health is more than the absence of sickness; it is about
people and-their development. Information given in addresses was
used as a basis to stimulate discussion in workshop sessions.
The workshops were a most important part of the Hui Whakaoranga.
Only in informal groups did participants feel comfortable to
discuss freely their own views about particular issues and feel
able to appreciate the similarities and differences that exist
between Maori and other cultural groups. Each workshop was asked
to formulate a statement that represented the consensus view of
each group.
10 The recommendations that have emerged from the Hui WhaIcaoranga
incorporate philosophical principles about Maori , health and suggest means and ways by which these principles can be
achieved.
Evaluation of the Th!
Following the Hui Whakaoranga an evaluation questionnaire was
prepared and sent to all participants . The evaluation
questionnaire was used to: assess whether the objectives of the
Hui had been achieved, rank the recommendations in order of
priority and allow participants to make further comments about
the Hui.
The response received from the evaluation questionnaires was
extremel y positive and feedback from participants has been most
appreciated by the Department of Health. Information received
trom the questionnaire, the recommendations and general
correspondence have provided guidance in putting together this
report and suggesting future directions for the development of
Maori health.
There exists a general consensus that the Hui Whakaoranga
achieved the objectives of promoting a positive view of Maori
health and provided an opportunit y to improve cross cultural
communication and understanding between Maori people and health
workers.
It One oF the main cr.i ti (:1 5108 thaI.parl.;i.cjpants made about Lite
organisation of the tlui was that; they would have liked more time
I C) P11 r 1 .t ci pat e in workshop ((:1 SCUSS ions . IS WO•U I d have enabled
the recomiiieiiclat ions proposed to have been discussed in more depth
to determine the details of implementation. It is pleasing
that discussion of these recommendations has continued to take
place in regional areas to ensure that they are consistent with
tribal and community group aspirations. Regional health hu i are being organ i sed around the country.
Participants have also expressed their appreciation to the people
of the Hoani Wal. t it :i Marne in being such warm and generous hosts.
The food provided reflected that this was a health lini
The appendix of this report (Yellow sect; ion) conl ains:
I . Prograniiuie of the Uui Whakaoranga.
2. Speech given by the Honorable A.(. Marolni, Minister of Health.
:i. Speech given by (lie honor hie R. Couch, Niinistei of Maori
Affairs
Address given by Dr. Bai lo Iii. rector Hencral of (teat t h.
5. Te Taha Hi nengaro: Address given by Dr. Mason fiurie.
6. Ic ¶l aha Whanan: Address given by Mrs Rose Pere.
7. The Waah i Marae Project: Address given Ii y N rs Pa i ha Mahu t a
H. The Ratikawa I r i ha I P1 ann ing Experience and Ilea ] t Ii
Address given by Professor Whata Winiata.
). Community (teal I h C I in ics: Address given by Mrs Puli O Brien.
I U. Report back of Workshop Discussions.
12 11 . Evaluation of the Hui Whkaoranga by Dr. Eru Pomare and Di .
Cohn Mantell.
12. Participants who attended the Hui Whakoorariga
13 PART 1
SECTION III: PHILOSOPHY OF HEALTH He Whakamaramatanga : An Explanatory Note.
It. is important. to CJ lPiLiSI II l Ii f)rJ,1 lirlilig tJlflt the fe h lowi ng
section on the phi .tosophv of to provide a
cul tura l Iraniewor k an (1 Cab r e on wh i cli 1. he coiire f) I. of EIeI I lii from
a Maori perspective can he more easily understood and addressed.
It is a Maori view and acknowledges w:i t h due respect and
sincerity the many and varied tribal, subtr.tb.al , fam:i. I.y and
individual Maori beliefs.
To understand the programme, keynote addresses arid
recommendations that have emerged from the flit Whakaoranga it
is necessary to appreciate the mean:irig of hen I, tb from a Mnor.i
perspective. Health is one of the foundations on which the
future development of a. group of people depends and. t. his is
intimately linked to their historical, social, cultural
economic, political and environmen tal circumstances. 11. cannot. be dealt with in isolation or separated front overall development of any group of people. heal th often reflects who
you are, where you have come from and the direction in wh i ch you are going in the future. It Maori perspect:i.ve of health embraces
the following:
1.NOTION OF HEALTH
The notion of what is health varies between one orgriiiisat I Oil. cultural group, iwi ( tribal, group), hapu (subtrihal group)
zi whanau (family) or individual and another. The World Health
Organisation defines health as a state of complete physical mental and social
well being and not merely the absence of disease or
infirmity
A Maori view of health is broader in that it incorporates
spiritual component holistic philosophy. It is
"a state of complete spiritual, mental, family and
physical unity, harmony and wellbeing"
Maori people believe that these various dimensions cannot. he
• viewed separately. They are interelat:ed to form a whole and are
• the cornerstones on which good heal tb is founded..
• 2. FOUNDATIONS OF HEALTH
The foundations of health from a Maori viewpoint, have their roots
in Te Ao Tawhito the Old World, where the spiritual, social,
cultural and economic circumstances of the Maori was governed by
the lore of Tapu. Tapu means more than sacred or religious, it
is a means of social and behaviour control that maintains the
• harmony, balance and unity of the mind, body, soul and family of
man. It. protects and nurtures exist. ing resources of tribal
• wellbeing and ensures a continuity with the past and future
through a s y s t em of 1,1 kanga (customs and values) , t.ure (lore)
• ritenga (customary practices), hawa (rituals), kärakia
( incantation), and awesome resj)ect . Moreover, i t: fosters an
integrated set Of values, beliefs and attitudes that promote
behaviour conducive to the ongoing health, we. lIhei rig and welfare
of the community.
15 3. TE WHENUA: THE LAND
According to Maori tradition land, health and wellbeing are
intimately related. From To Ao Pouri, the Dark World that
Ranginui, the Sky Father and Papal uanuku, the EarIhmoj,her
embraced, came Te Ao Marama, the Light World of their many
children. Tane Mahuta breathed into lline-ahu- one to create marl.
Surrounded by the spiritual and physical universe of Pangi,, and
their other children, Papatuanuku became Fe likaipo, the Night
Nurturer which personifies her maternal, care giver role and also
Te Koopu, the Bosom Womb which personifies her materna I care--
giving and repository role. Spiritual conti nuity with the past is
maintained by returning man to the bosom of l apatnanuku at death, and with the future by placing To Whenua (tile p I. acent a) of
the newborn in its earthly resting place soon after hi. rth
Land provides resources for man s growth and development
Mailwas entrusted w:i iii the responsibility of taking care of
land and environment. Land is a taongn, a precious gift guardianship of which is vested in the whanau group (famil y arid kin) and passed on from one generation to the next. At tempts to abuse, desecrate and misuse the I and invokes the anger of the tupuna (ancestors) and tipua (gods). If the lore of Tape is broken and disputes occur over land, then sickness, death and war are the common outcomes. Pahul (prohibi lion) is anothet mechanism that is used to protect and conserve land resources.
Land promotes a positive sense of tribal, .whflU and individual wellbeing. It. is a place where one has l urangawaewae (a place to
16 stand) , the place of one s roots and where one has a sense of belonging. It is the vital link between one s tipua, tipuna and
the ongoing living world.
4.TE WHANAU: THE FAMILY The main social, living and learning unit: in Maori society was and still is the whanau, an extended family system based on whahapapa (enealoic-alg It insh :i.p ) Li, es . Whaka pa pa :i S t. he essential element that links man with his past and present worlds. Several whanau un:i.t s niaI- up a hapu (sub -tribe) while
several subtribes constitute an i.wi. (tribe). A tribe was often named after one of the main wuka (canoes) that came in one of the migrations from Jiawniiki. o an eponynious ancestor. Tribal
ieadershr p in earl y da y s was vested in the nut: 1,or:i Lv of the
rangiti.ra (chief). The chief s main advisor was the tohunga, an expert in tribal be, customs, history and spi.r.i luau lv.
Individuals are seen not only as members of the whnnar.r and hapu, but as a human nianri :festa t.jon of their t.ipunrr (forebears) with certain functions, roles and obligations to fulfill during different stages of the life cycle. The kaumatun (elders) are respected and given special status because of their knowledge, wisdom, life experience and links with the past. Mokopuna
(grandchildren) and taniariki ( children) are cherished because they represent continuity with the future and need nutur- ing, protect ion and guidance. Parental roles extend across the whanau or tribal group and decisions concerning the health and wel lbeing
17 of a person involved the advice, support and counsel of the wider
extended family group.
5 TE MARAE: THE MARAE
The focus of the family and tribal, activity was, and sI. ii l.is, the
marae. While now the term marae refers to a whole physical
complex of buildings, traditionally it was I lie rev r tyn rd in front
of the main meeting house. It embraces a human and spiritual
dimension and is now a p.1 ace whore a person has Turangawnewne.
It is where one has a sense of identityl:y and where Maori language,
oratory, values and phi tosoph y arc reaffirmed. TI fosters so I I
respect, pride, social controt and strengthens family
relationships. TI. is where the dead farewel led, meetings held
and tribal or family issues are discussed
6. NGA TIKANGA MAORI: MAORI VALUES
The Maori value and beliefef system centred on maintaining balance
and harmony between man and his natural, physical and spiritual world. They were socially and culturally integrative in
that they fostered open debate and discussion, COnSenSUS decision making and patterns of behaviour that acknowledged and promoted
the dignity, worth and pride of man, his whanau and tipuna. The elders, tohuriga and wanamiga (centres of learning) are given the responsibility of teaching and maintaining tribal, customs, protocol and values. Learning is a lifelong experience and is done through the art of developing very good listening and oral communication skills.
Maori values were perceived as Iaonga Likanga, precious gifts
18 imparted to man from one s ancestors.
"He taonga tuku iho tuku iho
Treasures passed down from one generation to the next".
Example ; are
AJ?OILA Conveys the iio tori of love, cniirc ..n,
(om[);sI on and hospit.a.ti iv in its widest.
S ens e.
MAN A A KIT A N GA
n Means Ca r ing, shari g, r e s p e c t and
hospitality.
AWHINATANGA
Incorporates the concept of assistance,Lance,
to help, to relieve and to embrace.
W H A N A U NG A TANG A
Is the element that provides the strength,
warmth, support and understanding in family
and kinship relationships.
TIAKI
Means to take care of, cherish, nurture and
t.o be a guardian..
19 7-.CONCEPT OF LIFE
Tihei Mauri Ora!
I sneeze: It is life.
(He Tau: An exclamation)
Te Tapu: It is sacred
Te Mana: It is prestigous
Te Ihi: It is powerful
Te Wehi: It is fearsome
Life is considered a taonga given to man from his parents, the wai run (spirit) of his t upuna and Tane--Mahu L a . It i ucorpora ted
virtues that personified the tapu, the mann, the i hi and the web i nature of life. A newborn babe taking its first hau (breath), and tihei (sneeze) of life invokes the wairua and inauri (vitality spark) of life. Oranga (health and wellbeing) are the expeete(t outcomes and it is envisaged that the infant will grow up and develop the knowledge, wisdom and skills to maintain the vi rtucs that are essential br .1 i.fe and good health, ronfidnrc-, digni tv and pride.
fe IIauori and Te Wa;iora are cocepts that. convey notions of wellness and wellbeing in its widest physical 011(1 spiritual sense. An impoitaiit. [unction and role of parents, randparent.s and the whanau, is to harness the resources and strengths of its stir round wairun, support systems and 1, h e natural world to ensure (lie total. grnwt:h, deve.lopnioiit 1n(] potent in] o the growing ch:i it!. mdi vi dual. or w1annu group.
HE CONCLUSION
Maori people see themselves as part of the whole universe and as
always living in harmony and balance with their spiritual, physical and natural world. A Maori philosophy of health has its
rots in, Te Ao Maori, the Maori Universe and embodies unity of
the mind, body, soul and family of man, namely:
TE TAHA WAIRUA: SPIRITUAL WELLBEING
Te Taha Wairua is the immaterial, spiritual. soul of a
person. It determines who one is,, where one has come from
where one is going to and is perceived as present: all the
time and everywhere. I I. p r o v :1 des a d y 1) F1 mi c Ii nk wi iii ones
tipua, tupuna, between members of a whanau group and
which strengthens the taoriga/t:ikanga values of one s cultural
sys tern.
TE TAHA HINENGARO : MENTAL WELLBEING
Te Taha Hinengaro is the mnenin.t and emotional aspect of a
person. Central to the concept; of {i.nemmgarol- is the
principle of f lauri, the vital i t.y spark or .1 ifc essence of a
person. It is the principle that determines how one feels
about: onesel Confidence andself esteem are important.
ingredients for good health.
FE TAIIA WIIANA U : FAMI. tY WE ILBE I. NC
Te Taha Whaim nu is the extended familyy sys1.em that embraces
all whakapapa (genealogical)and present day neighbourhood
21 support ties. It is still the principal social, living and
learning unit in Maori society and it is important that it
has the resources and skills to provide the sustenance,
support and an environment that is needed for good health.
TE TAHA TINANA: PHYSICAL WELLBEING
Te Taha Tinaria recognises the physical or bodily aspect of a
person. It is the part that western medicine focuses upon
and cannot be dealt. wi iii separately from the family, spir:ituni
mental and environmental world of the Maor.i.
RELEVANCE TO THE PRESENT AND FUTURE
It is clear that. many factors that.influence health toda y , occur in the euvi ronnient; outside the health system. They can he attributed to determinants such as unemployment, housing, SOC 1O economic status, educat:i onui attainment: 011(1 exposure to mode,- ii lifestyle d:iseases, . issues associated With the use of heal L services, compliance w:i th modern health care and di. fferent. cultural perceptions of health and sickness also ji.ay a role.
The notion of health from a Maori point of view must be understood and addressed from a holistic perceptive.
"To achieve health requires a sense of spiritual,
mental and physical wellbeing which depends on
the security of one s self in relation to one s
family and community, as well as the knowledge and
comfort from one s roots and cultural background"
(Hui Whakaoranga: Hoani Waititi. Marae).
22
PART 1
SECTION IV: PRIORITY RECOMMENDATIONS FROM THE HUI WHAKAORANGA
Part icipanis were asked to evaluate the ilni and rank the
recommendations in order of priority to provide guidance for
future action. From the evalun t:i on quest. i ofla:i res cocci ved
following the Hui, the major recommendations were:
(1) That the primacy of To Tuha Wai. run be recogn:i sod liv
institutions throughout New Zealand. it (2) That. health un(.1 d c a U :tona.I inst.t.ut.ioils recogn:i so Macri
culture as a positive resource and To Taha flinengaro as an
essential part.
(3) That. support. he given to esinbl ish nwrae--based community
initiated projects/programmes, to meet needs which have been
defined by local people or promoted through local Maori
organisations such as the New Zealand Women s Welfare League, the
New Zealand Maori Council and Tribal or Maori Committees
(4) That the lack of Maori personnel in the health services be
redressed by - promoting, in schools and on inarae, health service
vocational opportunities
- establishing local., regional, tribal and marae
health personnel objectives
(5) That assistance be given to health workers and professionals
with an interest in Maori health) to improve their cross-cultural
understanding and communication skills through:
- ongoing education wananga, seminars, workshops
- working with and sharing their shills with Mann
23 voluiit. p ers and cuJii in tin itv-hppo j n Le cl p sons.
(6) That priority hegiven to iiiiportnnt diseases and sicknesses
that are amenable Lu modern medical treatment. , e.g. ditibetes,
kidney, heart,, and chest diseases, hepatitis and ear diseases.
(7) That attention he given to improving the heal th/sickness
knowledge of Maori people by:
- using simple language and avoiding medical jargon
- using the services of bi-lingual. resource people
- improving cross-cultural communication skills
(8) That hospital boards and other voluntary agencies be
encouraged to use Maori people i.n an advisory, consultative
capacity in relation to the delivery of health care.
(9) That the Departments of Health and Maori Affairs support marae based community health initiatives.
(10) That policies on community health centres be aimed at. networking people and agencies so that they work together.
(11) That existing mechanisms of resource at. location be reviewed with a vi ew to providing flex ib i. Ii. t in resource it c amid allocation by health service agencies so they. can respond to locally defined needs.
24 ( 12) That. the Hui endorses and strongly commends the considerable
health component within the Te Kohanga Heo Trust programmes.
(13) Thai the Te Kohanga Ueo Trust and centres cont. i n u e to promote health in its widest sense:
- through its disease prevention and health promotion
activities
- by encouraging the desire for kaumatua and
Whanau to share their expertise
21
\ PART 1
SECTION V: FUTURE DIRECTIONS
INTRODUCTION
These recommendations for future action from the Hui Whakaoranga offer a number of challenges to the future development: of health services in Aotearoa and the growth of New Zealanders as a whole.
People can -contribute towards determining their own destiny if they are prepared to work together as members of :faini lies, communities and organisations, to achieve common goals and objectives. Working-together, however, requires a commitment to the, sharing of power,. the distribut:t on of resources in a fair and just manner, and the acceptance of a wide range of diverse cultural values and beliefs.
1. A HOLISTIC APPROACH TO HEALTH
A holistic concept of hen i.th is acknowledged b y man y (lIt Iferent. groups in New Zealand. For Maori people, as already expi ained. holistic a i.p roach to health must: include s p:irituai., mental family and physical dimensions. Such an approach cannot: hi achieved unless health worker.i gain a clear Maori perspecLi vi of health. The outcome should he that the y treat the whole person.
This cannot. he achieved unless government, departments and the various private and voluntary health agencies work together to achieve common goals and objectives. National and local inter departmental mechanisms need to be esl.:abl i.shed to ensure t lia t policy dec.i s:ions are cc,--ord itiated, ava.i [able resources are used
26 effectively, and people encouraged to work together as a team.
As a step in this direction, to ensure a Maori hoistj.c
perspective in all health policy decisions, a Standing Committee
on Maori Health has been re-established under the new Board of
Health. This committee will provide independent advice and
guidance ihrough the Board of health to the Minister o:U Ilea 1. tit.
The Department will seek the Board s guidance on Maori matters
This advisory body should be representative of the di ifererit.
Maori communities and tribal, groups. It should include kaurnat.ua
of Maori cominun it i. es., organ i sat :i.oiis and heal t h workers. Ka 1.1 in a t. no would bring an intimate. knowledge and experience of the Maori. world while the health worker would bring skills and knowledge of
the health system.
2.FLEXIBILITY AND CHOICE
A real challenge to the future development of health services is whether health agencies can, respond more appropriately to the diverse range of cultural values and beliefs t. It a L e x i s 1
Aotearoa. It wi].i require a departure from the traditional restraints that. have applied in the. past. A greater flexibility will be needed in the way procedures are administered and services ultimately provided. Diversity rather than uniformity should be encouraged in a multicultural society. Different people will have different needs and not all health care, information and intervention programmes are suited to all people.
Instead, people should be given choices in selecting the type of health care and information most appropriate to their needs. The
27 health system must be flexible enough to accomodnl e different.
definitions of health and sickness and to provide health rare in
different ways. There are many ways, for example , in which primary
health care can be provided. The desire to establish community
based Marae Health Centres with Locally trained workers should be
accepted and understood as valid expressions of flexibility and
choice. To a si in :i I ar way , t mi. (. I on a I Mao rii bet, I i rig and health
practices should he included as a le g itimate and valid choice for
people within the health sysl.ein.
3. COMMUNITY PARTICIPATION IN HEALTH
There is a tendency to impose health services on people.
Individuals and groups should have the right to participate in
matters relating to their own health. There are many ways in
which community participation can be included in the process of
health and sickness decision making. All health initiatives
should be discussed, developed, supported and controlled at a
local level. .The.rnarae is the arena and forum where discussions
and debates concerning the future direction and development of a
Maori tribal or community- group -takes place. Decisions affecting the future direction of Maori people, therefore ,should be made on
the marae in consultation with and involving appropriate groups concerned.
New models of deploying resources and of providing a service are evolving. Te Kohanga Reo Whaiiau Centres and Te Koputu Taonga skills programme in Otara are two examples. . They encourage community involvement and participation. The knowledge and
28 skills of kawnatua, the 1a,i t.iaki (supervisors) and parents are
recognised iii Te Kohanga Reo Whaiiau Centres. Each of their
contributions sI.reruttiens the Whannu. The way in which a whariau
develops, however, is dependent; upon the pace that they together
learn, grow, and develop. iii.! ormat.ton sharing and st I .L I [earning
are also the important elements in the Te Koputu Taonga Programme
again using the resources that are already available in the
community. The exciting aspects about these programmes are that
they use the Maori social and cultural value system to improve
people s se1festeem , to share what resources they have
available and they get enormous strength fr om the whannu
group.
4.EQUITABLE ALLOCATION OF RESOURCES
There are two main resource issues relating to current aspirations in the area of Maori health. The first issue, that of applying whatever resources are to be made available in ways
that are consistent with the desires of the Meori people, and which follow- consultation with them, has already been mnTi t. :i oned
In brief, the Maori people believe that the re-direction of a substantial proportion of the resources already allocated on
their behalf, away from its present use and towards health and healing practices based on their own culture and [,ei .1 ( f systems will achieve better results.
The second :issue is the equitable share of resources that should he dedicated to Maori health matters. Equality and equi t:v are
2 5) different concepts. In relating them to resource provision for
health, equality would mean that all groups in society would have
the same level of resources and health measures.appiied to them.
according to some pre-determined policy. On the other hand, equity involves the concepts of fairness and justice and its application would mean that resources would be dedicated to the health of different groups in whatever amounts are necessary to achieve the same or similar health outcomes..
Because the sickness patterns and health needs amongst groups in society are different, the mere provision of equal opportunities for health or equal access to health care services will rarely achieve the same outcomes in terms of health status. The gap between the Maori and non-Maori on measures of health status such as levels of sickness, death rates and length of life is substantial. The narrowing of this gap will almost. certainly require, for some time, a higher level of funding than has been the case in the past. While such a share might.. he "unequal " , ii. would at the same time be justifiably "equitable"; it would mean that in the short term measures aimed at Muon i health would receive preference in the allocation of funds.
The Maori people are offering to divert a greater share of their own resources to the quest for better health. This commitment must be matched b y a greater share of funds from the Government and other agencies.
30 PART 1
VI. IMMEDIATE FOLLOW—UP
In the Department s view the following are possible ways in wh-ich the major recomendations could be implemented.
l.Te Taha Wairua
Maori people should be seen as a resource in working towards the implementation of the recommendations. They should be invited to explain the cultural; significance of, their values and beliefs and to suggest ways in which for example, Te Tatie Wait-u8, or ic Taha
Hinengaro can be incorporated within the phi iosoi:diy arid administrative arrangements of both central and local government agencies..
The tohunga and kaumatua are among the most important people in the Maori. world. They arE viewed as the experts J. ii matters roncemnin g the Maori sprii . psyche and rami .1 v, [01(1 1. It i functi 0fl in this area must be ucknowi edged and rnA(ic legitimatee by the health services. The shills t.iiev have in the art, of healing complements the skills of the health professional in the science of heal I n g. The two go hand iii hand and both have a I eg j t. i ma t function and role to perform. Some hospitals and doctors use the services o the lohuuga and kaumatun but. this is of ten on an informal voluntary basis. Access by tohuriga and kauniatua to patients in hospitals and institutions shouhi he made easier.
In this context the Department of Health has established a
31 resource group which is comprised of mainl y M;ioi i health
personnel to assist in the preparat: ion of broad !"formation
guidelines for hospital boards, Professional health organisatons, teaching institutions and other health workers.
It is intended that. the informat:ion disseiiiinnt.ed will include explanations of the meaning of the four cornerstones of health:
l c Taha Wai run; of To Taha Iii nengaro: i e Taha Wiini,nu and To Inha
Tinana. Further, the resource group will by looking at wa y s and means by which the Loht.inga UIICI knuIIRil.Ua may he re(oi,:i sod and given due status for the health rare they prov.id .
2. Maori Health Personnel
The newly os tab 1 Wellod tica.1 I Ii r rv I cr s l er nil I ( oman i s s i n" a imd I 1,
Slate Srires Uon,riissi.oii should lake a lendernhip role in redressing !he , imnt.ciJ arice of Maori l oo! . l in the Iica,l lb svl.o,n.
Information about c:1i e r opportunities available both in the
Public and Health Svrvioes siiciiid be l)1()IIi%I.l.II.e(l on iriurne an(i in schools, highFighl lug the special ski] Is and individual qualities that. at-c desired by specific occupations . This information would help tribal and community groups to facilitate human resource planning. The achievement of a greater number of
Maori people in the-Health Service who have niainta med their Taha
Maori will help in £1 uence the way in whichcii lien]. Lii is defined and health care provided.
Each year a limited number of places are availableto for Maori and
32 Pacif ic, (stand students to cuter medical. school undr, t.hr.
and Pa ci tic Island preference scheme. The State 5r .rvj ce
Coinjniss:ion has a Iso expanded the ruimhor of p I aces avaJ lahi e (or
Maori and Pacific Islanders to join the Ptibl ic Service tILroIigIi
the Maur i arid Pa i fic Island .Juriior l?erriii IIII erit r, choinr .
Opportuni I :i Os are olso n.va i [able for graduates iii the .Ii.injni
Management Train i 11 if Scheme inn jul nt. I by (lie Iiosp I la Itoards
Association arid the health Lteparlrinor i ! Those it iat iv es should
P u (I P ITS I. oud nih (I acce(, I f- (I I S 1)0 I I ( I es n F pus i t. i y e act 1 (III I.o
improve the ha lance of Maui i and Paci tic Is 1 and people iii 1, lie
Public: and Health erv ices.
The cal I for more Mnori nt.nrser, is now begi III) ing to he addressed.
This year the Depar t;nients of Maori Affairs arid Educat. ion have
established four re--entry nursing courses at. t.ec fin Cal-
i nst itutes in Auckland, Rotorua and Palmerston North for Maori
and Par i Ci c .1s I and st, u d e n t s . One of Lhe two courses in Au chIt and
is specifically for mature students. Other professional health
groups may wish to adopt a similar inILiaIL y e I o that,I wir i C: Ii has
recently been taken by the nursing profession. however, greater
publicity should be given to these initiatives to ensure that.
Maori people are fully aware of the vocationa.i opportun it. ies that
are aval labi.e and that the advice of Maori people issought. on
how the opportun ities call improved arid expanded.
3. Cross-cultural Communicationc! ing it To far I I it; at e c ross—cul I; ura I commun I ca t. 1. on a (I It ride is I arid i rig a number of positive initi.alives could be undertaken b y government
33 departments, heal, Lb agencies and educational institutions. In
1985 the Department of Health plans to hold a number of marae courses in col iaborat.on wi Lii the Slate Services Commission to provide deparl;mental. o f f i cers with the opportunity to gain an understanding of Muon i cu I turul Va toes and beliefs. Other I,ea.l ii, agencies such as hospital boards may 1. ike to do the same to improve the understanding and knowledge of their health workers and to provide an opportunity to establish close links with Maori communities. This would be one way in which hospital boards could become more responsive to Maori health needs and encourage the development of marae or community based programmes to combat diseases such as middle ear infections, asthma and diabetes.
Educational institutions, should ensure that some input about the values and attitudes of different cultural groups in New Zen [and towards health and sickness is included in training programmes for health providers. The Department; of Health plans in the near future to compile a booklet, written by representat:ives of different cultural groups explaining their attitudes and values towards dying, death and grief. More wilt ten info rmat ion is needed from representatives of different cultural groups so that; this can be included :in thethe education of health workers.
Cross-cultural cominunicat ion is a two way process. in order to facilitate this two--way process, opportunities should also he given to Maor-i health workers to reaffirm their Taha Maori ad establish or st.rengLhen their links at, a lr ;i hal and common i tv and whanau level. Health agencies should encourage and support Mann
:t I health workers to a t. t. end Maor i Warianga , learn Maori I an gl.tagr and become resource people for Maori community health initiatives.
Maori heal t workers caii play an important role in b u i Iding bridges between health agencies and Maori people. The recent establishment of a National Council of Maori nurses is an example of a group which is committed to carrying out this role and to improving the delivery of health care to Maori people.
The networking of people as a community resource is one of the important recommendations that emerged from the thu. Whakuoranga.
The establishment of networks can occur by holding regional health hu I . A number of these healthh hu i have been held around the country. The positive outcome that has occurred is that a number of health workers have identi lied themselves as resource people to the local community and are prepared to share their knowledge and skills to support the development of Maori health initiatives . Regional health hui should be supported by health agencies. however, comniuni t.y based initiatives also need financial, advisory, technical and administrative resource support.
5. T The Department of lien] lii supports I lie philosophy of Te Kohanga
Reo Whanat.t Centres and would 1 tke to help them to continue promoting health in i Is widest. sense. Support. should therefore be
35 given to Maori people to develop health promotion programmes, bil-ingual video, print and . ,media material, which would be suitable to their. needs.- In recognition of the need to have suitable health promotion material from a Maori perspective the
Department of Health is establishing a small library specialising -
call in films and bi-lingual print material which lent to whanau groups and to health workers.
The policy of Te Kohanga Reo Whanau Centre, however, is to invite health provider groups such as. Public Health nurses and
Departmental medical: officers and other health a g encies to establish con tact with them and to work together to ach:i eve common goals , and objectives using the combined skills and resources of the Maori and modern heal 1:ii service worlds. This approch should be accepted by health workers.
36 PART 1
SECTION VII CONCLUSION
Maori people 110W waiil; to
define health for themselves
identify their own specific health concerns
and to devise solutions to meet these
see health as part of who we are, where we
have come from and where we are going
take responsibility for their own health
be involved in their own health care
seek information from health workers so they
make their own decisions
work together with healtIiorkers, but to
control their own growth as individuals
and as a group
ensure health workers recognise that there
are many ways of healing and maintaining
health
have health initiatives community based and
where possible centred around a marae
see a more equitable allocation of health
health resources into community based,
preventive and health promotion programmes
PART II
RECOMMENDATIONS FROM THE HUI WHAKAORANGA
The recommendations from the Hui Whakaoranga refl ect the broad
understanding of heal Lb taken by participants at the lEui. , and the
importance of building and achieving a holistic perspective of
health.
SECTION LRecommendations from the Taha Wairua Workshop
L.1 That the primacy of Te Taha Wairua be recognised
by institutions throughout New Zealand.
1.2 That support and special status be given to the
tohunga and traditional health practices to
facilitate their recognition and utilisation in
the health services.
1.3 That the employment of "Minita Maori" in all major
hospitals and institutions in New Zealand be
encouraged. These governing bodies should invite
Maori District Councils, New Zealand Maori Womens
Welfare League, Tribal Authorities and Te Runanga
Whakawharaunga i nga Hahi o Aotearoa to help them
in their selection process.
1.4 That the employment policies of New Zealand
institutions recognise and reflect the spiritual
and cultural values of Maori people.
38 1.5. The institutions be encouraged to recruit and
train employees who will guide and develop
policies for the needs of Maori people so that
they can maintain and enhance spiritual health.
SECTION 2. Recommendations from the Taha HinenAaro
2Ib22
2.1 That health and educational inst. I tutions
recognise Maori culture as a positive resource
and Te Ta.ha 1Iinenaro as an essential part:
2 -.2 That support be given to estab ] ish mnrni based
communIty in it :i a ted proj ect. s/programmes to meet. needs
which have been defined by local people or
promoted through local M a o ri organ:! s,at. i otis such as
the New Zealand Maori Women s Welfare League, New
Zealand Macri. (oiinc i .1 , r ihal or Muon., committeeS.
: . :3 That support: be given to denti fying and encouraglng
the use at Muon. personnel itt exist ing health
service agencies.
2.4 That: the lack of Macri personnel in the health services
be readdressed by:
(a) the promotion of the concept Of a Ma or
preference quota in training schemes.
(b) promoting in schools and on niarne health services
vocational opportunities.
39 (c) establishing local, regional, tribal, ma I-
health personnel objectives.
2.5 That the wider ramifications of the care of
Maori people in existing long and
intermed -iate care institutions such as rest homes and
geriatric units he explored.
2.6 That. the feasibi lily of includ:itiff, Maori
spirituality in heal lb education programmes
in schools and 1...... I iary educational i 1 st. i t.ut:to,is
ii e i a V es I i. g a t c (I
2.7 That assistance he given to lien 1, lb
workers and pro less i. ona is wit: h an in t res t in
Macu- i. If Eli to improve the:ir cross--cu 1 iura.1
unders Landing and communication ski. I Is through:
(a) ongoing education wananga, seminars,
workshops;
(b) incorporating Maori studies, and language
as an integral component of their
training curriculum;
(c) working and sharing thei.r skills with Maori
volunteers and coinmun tty-appointed persons.
SECTION 3. Recommendationsfrom the Te Taha Whanau Workshop
3.1 That the concepts and phi .tosopliv of Fe Whanau espoused
by Mrs hose Pere be available t.o all those who
participated at the Hui and be promulgated amongst
40
health care provider groups.
3.2 That support be given to Matua Whangai and/or Whaau Support/Resource Groups be set up by Maori people
where:
(a) none are available, for example in a hospital;
(b) a need is demonstrated;
(c) Maori families don t have links with a marae
(d) to work, communicate and liaise with other services, health professionals and Maori
groups.
3.3 That formal links be established between Maori communities and health service organisations. A
liaison co-ordinating group be established to identify
local health issues, priorities and to plan and
implement programmes.
3.4 That frlaori people be encouraged and supported in standing for hospital boards, advisory/ management
committees and executive positions in professional
organisat.ioflS.
SECTION 4.Recommen ,dations for the Th
4.1 That the Department of Health: ( a) compile a register and guidelines:iiies of "community
health initiatives" so that it can be made
available and used by other Maori groups;
(b) fund Health Co-ordinators to marae-based
41
projects to aid the training of voluntary
health workers;
(c) with the Department: of Maori Affairs, support
further health hui on a regional/tribal basis;
(d) recognise and encourage a return to traditional
Maori methods of preventing and treating health
problems.
1.2 That. prior- i Ly be g:iven to important.
diseases/sicknesses that are amenable to modern
medicine i.reat.riient , e.g. (I ahetes, ti dney, heart.
and chest:. diseases, hepat:i t.is and ear disease.
That. attentiont. ciii. :1 on he given to improving t he access and use
of modern health care services by Maori people by
act. :i vi 1. I es S u (,. 11 as:
(a) support :i rig the Department. of Ilea lth s Priority
Programme;
(b) provision of heal t:li education and disease
prevention programmes;
c running marae courses, seminars on the use of
health services.
1.4 That: attention he given to improving the
heal tb/sickness knowledge of Maori people by:
(a) using simple language and avoiding medical jargon;
(b) using services of bi-lingual resource people;
4 ..
(c) improving cross-cultural communication skills.
4.5 That attention be given to providing information and programmes using the appropriate cultural, audio-visual
facilities, targeted to focus on certain life-style
behaviour factors, e.g. smoking, accidents, alcohol
and drugs.
4.6 That hospital hoards and other volunteer agencies be
encouraged to:
(a) provide advisory and support services for disabled persons in a marae-based community setting;
(b) use Maori staff in an advisory consultative capacity in relation to the care of Maori people;
(c) allow voluntary workers to work alongside hospital board-based health professionals in a supportive
capacity.
SECTION 5.Recommendations from the Waahi Mar g e Pro,ject W2k22
That this Hui recommends to Government
"That priority be given to tribal and marae-based initiatives in
terms of capital development and on-going salary maintenance."
SECTION 6.Recommendations fromthe
EXperience of Health
6.1 That the Department of Statistics and Health Service
Agencies record:
(a) a person s ethnic/cultural affiliation;
43
(b) the Hapu, Twi, Marne affiliation of all New Zealand
residents on existing and future data collection
systems.
6.2 That a "Maori we] l_nesstt measure be developed covering
for example:
weekly hours of exercise
- number of contracts with iiiarae in a given period
hours in spi r i.uai , wlianau, cultural, language
activities per week etc.
6. That the Hui record (here is an aversion to further
resources expended on scientific research on Maori.
pee l) -I e
6. "1 Thai it (roInpro fit ise method of parLlei.patory
deve I opmnent research" he formed which al lows:
(a) a gradual , intelligent and progressive use of
gathered data in keeping with local Maori needs as
i-xp r esse d by Ihem
(b) a .ii! 1ng and development experience in
which there is a continuing interaction between
people and those whom they have engaged
so that goals, changes, programmes and directions
can be negotiated.
44
SECTION 7.Recommendations from the 2!!PtY gfpjjh
Centres Zg l i pi cs Wo rkshop
7. 1 That the Department of Health arid Mnor.i Affairs support Marne Community health initiatives.
7.2 Thai policies on coinmunty heal Lb centres lie aimed at,, networking peopl.e and agencies so that they work
t o g e 1. he r
7.3 That ex:i.s Li.31g Inr (:IinnisJns oi resourCe a.I .1 ocnt.tofl be reviewed with a view to providing flexibility in
resource USC and all ocat:i.on by servicehealth
agenc- les so that: they can respond to locally
defined needs.
7.4 That the triple S scheme proposed by the Review Committee on Primary Medical Care should be examined as
a possible source of funding for community initiatives.
7.5 That the possiblity of other sources of funding such as Accident Compensation commission and voluntary
agencies, Internal Affairs Department should be
investigated.
7.6 That where the need for a par Li cular community henll.h service has been established and partial funding has
been provided by either private or voluntary groups,
the balance of funds be provided by government: as soon
as possible.
45 7.7 That where warranted, cn1.rai government provide on--
going funds for community health centres/1 inic
s e r v .t ce s
7. H That: an accountabi. 1.i, I;y struclure be esiahl:islied 11)
in trnr fuw.li.ng from government, and other agencies
7.9 That an inC orrnati on syt.ern be established to provide
advice and knowledge on health initiatives.
7. 10 That. hosp:i.tai boards be encouraged to make use of
provisions under the Hospital Act to assist individuals
who cannot afford to pay for items essent .i a] to
their health e.g. vision glasses.
7.11 That provision made for community health centre/clinic-
services to be implemented on a trial pilot basis
e.g. the Foxton Nursing/Counselling Clinic operated on
an experimental basis by nurses.
7. 12 That provision be made for the ownership of community
health clinic facilities to be given to local
communities.
SECTION 8.flecommendations from the Te Kohanga Reo Workshop
8.1 That Hui endorses the considerable health component and
strongly commends ihe Te Kohanga Re(.-) Trust l rograinune
and its workers.
I (3
. 2 ThaL the Ministers of Educal:ion, Maori Affairs and lie 1 th: (a) support the Te Kohanga lleo Programme with increased funding and administrative support for its
COfltlflUC(l development
(b) implement the Te Kohanga Reo concepts, objectives and teaching methods throughout the education system;
(c) recognise the considerable teaching skills of resource persons such as kait jaki by on-going salary support.
8.3 That the Te Kohanga Reo Trust and Centres: (a) continue to promote health in its Widest sense through its disease prevention and health proniot ion • activities ( b) utilise nori-Maori speaking health pro iess:i.or,ais and Maori nurses in: - an advisor - a supportive - a teaching role or funot; toll (c) encourage the desire for Kauniatun and To Whanau to share their expertise.
8.4 That the principle be acceptod that health is soni p thiig thaL is (lone wi lh people afI(l not. h1 horn.
47
8.5 That the Minister of Labour increase the voluntary organ isat ion
training programme for trainees in Te Kohanga Reo from one to two years.
8.6 That the Department of Health support and assist the Department
of Education in finding health education material nationally
and internationally suitable for the promotion of health through the To Kohanga Reo Whanau centres.
SECTION 9- Ot her recommendations that emerged during the Hui.
9.1 That the Department of Health prov.i do an estimate
and analysis of the expenditure from Vote: Health on Maori people.
9.2 That the Mill isLet ol Health acknowledge the
establi.s lime nt of the Nat ic nal Council of Mann
Nurses and recogii:tse the need for a National base
with full-time nursing personnel.
9. 3 That the half-Way houses for the rehab .i Ii tnt.ion of
ps y chiatric pair louts he estal, l.:i.shed.
9.4 That the I)epartment. of lieu I ili Fund a fain.i 1 y
therapist in the Mangene Community.
SECTION 10-Further recommendations that have been proposed
throughj h^^ evaluation qLif^ajionnaire of the Hui Whaka o rarig g,
48 TO. 1 That in the organisation of the new Area Heal lb
Boards, Maori people be appointed to each
committee concerned.
10.2 That the Maori language and culture be included in
all flied] cal and nursing training rograininc,
taught by Maori people.
to. 3 That increased time be given to Maori language,
Maori News and programmes of interest to Mann.
people on Television.
10.4 That Health Department and Hospital Boards shou.l d
not. exploit. Maori people willing t.o provide
voluntary services; remuneration should be given
possibly III the FOJUi of a kola.
49 PART 11.1
APPENDICES
TABLE OF CONTENTS
1 Programme of the fiul Whakaoranga
Speech given by the Honorabl e , A . G . Mal co mi Minister of Health.
3 Speech g veil by the Honorable H. Couch, Minister of Maori
Affairs.
Li Add resss given by Dr. Barker Director General of Health.
Te Taha Hinengaro: Address given by Dr. Mason Dune.
6. ic Taha Whanau: Address given by Mrs Rose Pere.
7. The Waahi Marae Project••. Address given by Mrs Raiha Mahuta.
Ii The Raulcawa Tribal Planning Experience and Health:
Address given by Professor Whata Winiata.
9. Community Health Clinics: Address given by Mrs Puti O Brien.
10 Report back of Workshop Discussions.
11. Evaluation of the Hui Whakaoranga by Dr. Eru Pomare and
Dr. Cohn Mantell.
12 Participants who attended the Hui Whakaoranga.
5() PROGRAMME
Monday, 19 March 1984
3.00 pm Powhiri - Whakaekenga, Mihimihi
5.00 pm Dinner
7.30 9.30 pm Hoani Waititi Marae Committee (The content and organisation of this session to be arranged by the marae committee)
9.30 pm Supper
Tuesday, 20 March 1984
5.45 Get up
6.00 - 6.45 am "Te Rapu Ora" Joanne Robinson Health and physical fitness programme
7.15 am Breakfast
8.30 am Mihimihi (Tangata Whenua)
9.00 am Formal welcome and opening addresses by Hon A G Malcolm, Minister of Health and Hon M B R Couch, Minister of Maori Affairs
10.30 am Morning Tea
11.00 am Keynote address Dr Tamati Reedy, Secretary of Maori Affairs "Tu Tangata - how its philosophy is an integral part of planning Maori Health programmes."
12.00 - 1.00 pm Lunch
1.00 pm Theme: A Maori perception of health: a holistic view
Keynote Speakers -
1.00 pm 1 Te Taha Wairua (Spiritual Health) Reverend Hone Kaa
1.40 pm 2 Te Taha Hinegaro (Mental Health) Dr Mason Dune
2.20 pm Afternoon Tea
3. 00 pm • 3 Te Taha Whanau (Family Health) Mrs Rose Pere
3.40 pm 4 Te Taha Tinana (Physical Health)
4.15 pm Free time - an opportunity to get to know each other
6.00 pm Dinner
Evening Session
7.30 - 9.00 pm Maori Women s Welfare League Research Programme (The content and organisation of the session to be arranged by the League)
Supper
Wednesday, 21 March 1984
5.45 am Get up
6.00 - 6.45 "Te Rapu Ora" Joanne Robinson
7.15 am Breakfast
8.30 - 10.00 am Mihimihi/Karakia (Tangata Whenua) Four workshops on a Maori perception of health
10.00 am Morning Tea
10.30 am Keynote address: Dr Barker, Director-General of Health "Health Services in New Zealand - a historical perspective"
11.05 am Discussion - Chairperson Tangata Whenua
12.30 - 1.00 pm Lunch
1.00 - 2.30 pm Guided tour around Hoani Watiti Marae complex 2.30 - 4.30 pm Keynote speaker 2.30 pm • 1 The Waahi Marae project Dr Robert Mahaha
3.00 pm 2 The Raukawa Tribal Planning Experience and Health Professor Whata Winiata
3.30 pm Afternoon Tea
3
3.45 pm 3 Community Health Clinics Mrs Ani Black, Ruatoki - a consumer viewpoint
4.15 pm 4 A health education model for a Maori setting Kohanga Reo Anna Jones
4.45 - 6.00 pm Four workshops Participants to choose one workshop 7.30 pm Dinner/Social
Thursday, 22 March 1984
5.45 am Get up
6.00 - 6.45 am Te Rapu Ora
7.15 am Breakfast 8.30 am Mihimihi/Karaka (Tangata Whenua) 9.00 - 10.00 am Report back on workshops Each workshop spokesperson to present on agreed upon statement of keypoints and issues raised for discussion 10.00 am Morning Tea
OPEN FORUM
10.30 - 12.00 noon "How can the New Zealand Health System respond to Maori Health Needs?" (Chairperson Tangata Whenua) 12.00 - 1.00 pm Lunch
1.00 - 2.00 pm General Summing up and Recommendations (Chairperson Mr Wiremu Kaa)
"What sort of mechanism is appropriate to plan, co-ordinate and evaluate intervention strategies or programmes related to Maori Health both regionally and nationally?" 2.00 - 3.00 pm Poroporoaki: (Farewells) HON A G MALCOLM, MINISTER OF HEALTH IN ASSOCIATION WITH THE MINISTER OF MAORI AFFAIRS, HON M B R COUCH TO OPEN THE HUI WHAKAORONGP. MAORI HEALTH PLANNING WORKSHOP AT HOANI WAITITI MARAE, GLEN EDEN, AUCKLAND ON TUESDAY, 20 MARCH 1984, AT 9.00 AM
MEMBERS OF HOANI WAITITI MARAE, VISITORS FROM ALL THE CANOE AREAS AND THE FOUR CORNERS OF NEW ZEALAND.
GREETINGS TO YOU ALL.
GREETINGS TO ALL THOSE THAT HAVE PASSED ON.
I FEEL THAT YOU ARE WITH ME TODAY.
GREETINGS TO THOSE OF US WHO ARE ALIVE.
GREETINGS TO ALL OF YOU THAT HAVE ARRIVED TO PARTICIPATE IN THIS HISTORIC HUI WHAKAORANGA.
I COME FROM TAMAKI MAKARAU AND I LIVE BETWEEN MAUNGAKIEKIE AND MAUNGAWHAU. (FAMILY HISTORY - ARAMOANA/PORT CHALMERS/SCOTLAND/TO MINISTER OF HEALTH)
AS MINISTER OF HEALTH I AM COMMITTED TO IMPROVING THE HEALTH OF ALL NEW ZEALANDERS.
EVER SINCE I HAVE BEEN MINISTER, I HAVE HAD A PARTICULAR INTEREST IN MAORI HEALTH, BECAUSE THE STATISTICS TELL US IT IS NOT AS GOOD AS IT COULD BE.
WE HAVE ALWAYS KNOWN ABOUT THE PROBLEMS OF MAORI HEALTH AND WE APPLIED A GREAT AMOUNT OF RESOURCES OVER MANY YEARS TOWARDS BRINGING ABOUT IMPROVEMENTS.
WHAT HAS BEEN MISSING UNTIL LATELY HOWEVER, HAS BEEN THE ATTITUDES THAT WOULD FINALLY HELP US TO CLOSE THE GAP.
A VERY IMPORTANT STEP WAS THE DEVELOPMENT OF TU TANGATA BECAUSE THAT HAS ENCOURAGED THE MAORI PEOPLE TO TAKE A GREATER RESPONSIBILITY FOR IDENTIFYING THEIR OWN HEALTH PROBLEMS
AS THE MAORI PEOPLE WERE SEEN TO STAND TALL, THE PAKEHA BECAME MORE INCLINED TO PAY ATTENTION AND THE RESULT IS THAT WE HAVE SEEN GREAT IMPROVEMENTS OVER THE LAST FEW YEARS BOTH BY THE MAORI PEOPLE AND BY THE HEALTH SYSTEM.
LET ME GIVE YOU SOME EXAMPLES THAT MAY SURPRISE SOME OF YOU.
IN AUCKLAND, ALL FOUR PSYCHIATRIC HOSPITALS NOW HAS A LIST OF MAORI TRADITIONAL HEALERS WHO ARE ABLE TO BE CONTACTED FOR THOSE PATIENTS WHO WOULD LIKE TO USE THEIR SERVICES. 2
THEY HAVE ALREADY MADE A VALUABLE CONTRIBUTION AND WILL CONTINUE TO IX) SO IN HELPING MAORI PEOPLE 10 BE MORE QUICKLY DISCHARGED FOR PSYCHIATRIC HOSPITALS.
AN OAKLEY MARAE COMMITTEE HAS BEEN FORMED AND IS CURRENTLY NEGOTIATING WITH THE AUCKLAND HOSPITAL BOARD 10 ESTABLISH A MARAE AT OAKLEY HOSPITAL.
I WISH THEM WELL IN THEIR NEGOTIATIONS AND I HOPE THE AUCKLAND HOSPITAL BOARD RECOGNISES THAT A MARAE IS MORE THAN A BUILDING IT IS A PLACE THAT ACKNOWLEDGES AND RESPECTS ALL THINGS MAORI.
THIS YEAR MY DEPARTMENT IS IDENTIFYING MAORI HEALTH AS A PRIORITY AREA.
THIS MEANS THAT THE FULL RESOURCES OF THE DEPARTMENT OF HEALTH WILL BE AIMED AT PROMOTING A GREATER UNDERSTANDING OF SOCIAL, CULTURAL, BEHAVIOURAL AND TRADITIONAL WAYS OF THE MAORI PEOPLE. IN THE MINDS OF ALL HEALTH WORKERS AND THOSE INVOLVED IN HEALTH SERVICES.
THE WAAHI MARAE PROJECT AND THE WAIORANGA CHARITABLE TRUST ARE JUST TWO OUTSTANDING EXAMPLES OF COMMITTEES WORKING TO ESTABLISH A HEALTH CENTRE LOCATED IN A MARAE SETTING.
BOTH THESE PROJECTS BELIEVE THAT PREVENTION IS BETTERN THAN CURE, THROUGH THE DEVELOPMENT OF A WIDE RANGE OF HEALTH ORIENTATED PROGRAMMES THAT ARE RELEVANT TO THEIR RESPECTIVE COMMUNITIES.
THE PALMER5TON NORTH RESOURCE GROUP HAS ENCOURAGED THE PALMERSION NORTH HOSPITAL BOARD TO APPOINT A MAORI HEALTH EDUCATION LIAISON ADVISER TO ACT AS A LINK BETWEEN HOSPITAL SERVICES IN THAT AREA AND MAORI COMMUNITIES.
MY DEPARTMENT HAS ALSO THIS YEAR ESTABLISHED A POSITION FOR A HEALTH EDUCATION ADVISER TO WORK WITH MAORI COMMUNITIES IN THE NORTH AUCKLAND, AUCKLAND, WAIKATO AND ROTOPUA AREAS.
THROUGHOUT THE HISTORY OF HEALTH SERVICES SOME OF THE MOST IMPORTANT INNOVATORS HAVE ALWAYS BEEN NURSES.
NURSES ARE THE PEOPLE THAT PROVIDE A BRIDGE BETWEEN THE TECHNOLOGY OF HEALTH SYSTEMS AND THE PEOPLE WHO NEED HELP.
LAST YEAR I THREW DOWN A CHALLENGE IN REGARD 10 MAORI NURSING AND A FINE GROUP OF NURSES HAVE RESPONDED BY FORMING A NATIONAL COUNCIL OF MAORI NURSES.
I ATTENDED THEIR HUI LAST MONTH.
I CANNOT SPEAK j-X) HIGHLY OF THIS GROUP.
IT HAS THE FULLEST SUPPORT FROM AND RESPECT FOR THEIR MAORI ELDERS AND IT IS ALSO A TOTALLY PROFESSIONAL GROUP OF NURSES.
ALL THE HEALTH SERVICES SHOULD LISTEN TO THESE PEOPLE AND RESPOND TO THEM. 3
I HAVE CALLED ON ALL THOSE IN HOSPITAL SCHOOLS OF NURSING TRAINING AND IN TECHNICAL INSTITUTES, TO ENSURE THAT THEY MAKE SPECIAL EFFORTS TO ENCOURAGE AND RECRUIT MAORI NURSES.
LAST YEAR THE MANAWATU POLYTECHNIC HELD THE FIRST PRE-NURSING COURSE FOR MAORI SECONDARY SCHOOL STUDENTS, AND THIS YEAR THERE WILL BE FOUR OF THOSE COURSES AT AUCKLAND, ROTORUA AND PALMERSTON NORTH.
I SPOKE FROM THE SHOULDER TO THE HOSPITAL BOARDS ASSOCIATION ONLY A FEW WEEKS AGO AND I AM NOW CONFIDENT THAT. ALL HOSPITALS IN NEW ZEALAND WILL MAKE SURE THAT THE WHENUA IS AVAILABLE FOR THOSE PARENTS WHO WISH TO TAKE IT AND I HAVE ENCOURAGED DISTRICT NURSING SERVICES TO USE THE RESOURCES OF MAORI FAMILIES IN NURSING THEIR OWN IN RESPECT FOR MAORI FEELINGS AND CUSTOMS.
MAORI HEALTH HAS BEEN IMPROVING RAPIDLY.
IT IS NOT YET AS GOOD AS IT SHOULD BE AND WILL BE BUT WE SHOULD NOT ALLOW OURSELVES TO BE TALKED INTO A FEELING OF GLOOM.
THAT FACT IS THAT NO GROUP IN OUR COMMUNITY IS IMPROVING IN HEALTH AS RAPIDLY AS THE MAORI PEOPLE ARE IMPROVING.
AT THE SAME TIME, THE HEALTH SYSTEM IS RAPIDLY BECOMING MORE UNDERSTANDING OF THE PHYSICAL AND SPIRITUAL NEEDS OF MAORI PEOPLE.
I WANT TO ENCOURAGE THE MAORI PEOPLE TO BECOME MORE INVOLVED WITH OUT HEALTH SYSTEM.
IT IS NOT THE PAKEHA S SYSTEM, IT IS THERE TO SERVE ALL OF US.
LAST YEAR THE GOVERNMENT PASSED LEGISLATION WHICH WILL ENABLE THE SETTING UP OF AREA HEALTH BOARDS.
AS THESE ARE FORMED, THEY WILL BRING TOGETHER THE ACTIVITIES OF THE DISTRICT OFFICE OF HEALTH, AND THE HOSPITAL BOARD SO AS TO FORM A REGIONAL ELECTED BODY RESPONSIBLE NOT JUST FOR RUNNING HOSPITALS FOR SICK PEOPLE BUT RESPONSIBLE FOR PROMOTING THE HEALTH OF THEIR LOCAL COMMUNITY.
AREA HEALTH BOARDS WILL HAVE SERVICE DEVELOPMENT GROUPS AS PLANNING BODIES TO CO-ORDINATE THE PUBLIC, PRIVATE AND VOLUNTARY SECTORS IN PROVIDING HEALTH CARE IN THAT REGION.
LAY PEOPLE AND LAY OPINION IS VALUABLE ON THOSE SERVICE DEVELOPMENT GROUPS.
IN ADDITION THE ACT ALSO PROVIDES FOR THE ESTABLISHMENT OF COMMUNITY COMMITTEES UNDER AREA HEALTH BOARDS.
THE LEGISLATION WILL SHIFT THE EMPHASIS AWAY FROM SICKNESS TO HEALTH AND IT PROVIDES THE OPPORTUNITY FOR HEALTH SERVICES TO BECOME CLOSELY TIED TO THE COMMUNITIES THEY SERVE.
IT IS VERY IMPORTANT THAT THE MAORI PEOPLE PARTICIPATE FULLY AS AREA HEALTH BOARDS EMERGE. 4
IT IS IMPORTANT THAT WE ALL UNDERSTAND THAT HEALTH IS NOT SOMETHING THAT IS GIVEN TO US BY THE GOVERNMENT OR BY DOCTORS OR BY HOSPITALS.
HEALTH IS OUR OWN RESPONSIBILITY.
IF WE ARE NOT HEALTHY, EITHER AS INDIVIDUALS OR AS A COMMUNITY THEN WE CANNOT BLAME SOMEBODY ELSE.
IT IS NOT THE GOVERNMENT OR THE DOCTORS THAT CAUSE SMOKING OR DRINKING, OR ACCIDENTS, OR DIABETES, OR EAR INFECTIONS IN CHILDREN, WE MUST ACCEPT OUR OWN INDIVIDUAL RESPONSIBILITY FOR THOSE THINGS, WHETHER WE ARE PAKEHAS OR MAORIS WE MUST ACCEPT RESPONSIBILITY MR OUR OWN PERSONAL HEALTH.
WE MUST ACCEPT RESPONSIBILITY FOR THE HEALTH OF OUR PARENTS AND OUR CHILDREN AND WE MUST ACCEPT RESPONSIBILITY FOR THE HEALTH OF OUR COMMUNITY AS A WHOLE, THROUGH OUR INVOLVEMENT IN THE ORGANISATION AND MANAGEMENT OF THE HEALTH SYSTEM.
IT IS NOT A PAKEHA HEALTH SYSTEM.
IT MAY HAVE HAD iDO MANY PAKEHA VALUES AND ATTITUDES IN THE PAST BUT THAT IS CHANGING RAPIDLY.
JUST AS THE NUMBERS OF MAORI PEOPLE PARTICIPATING IN THE HEALTH SYSTEM ARE CHANGING RAPIDLY.
MAY YOUR DISCUSSIONS AT THIS HUI BE FRUITFUL AND CONSTRUCTIVE.
GOD GUIDE YOU IN YOUR THOUGHTS AND YOUR WORDS, GOD BLESS YOU AND KEEP YOU ALL. MINISTER OF MAORI AFFAIRS BEN COUCH: OPENING HEALTH HUI AT AUCKLAND WITH HON. A G MALCOLM, TUESDAY, 20 MARCH 1984.
E aku matua e kui ma e koro ma tena koutou, tena koutou, tena koutou.
Ka tangi ake ki a ratou kua mene ki te pa, kua huri ki tua o te arai kua tae ki te hono ki wairua. Waiho I runga i te korero haere atu koutou, haere, haere.
Ka mihi ake ki a tatou nga kanohi ora kia ora tatou katoa.
Noreira e aku maatua haere mai I runga 1 té karanga..o te ra haere mai me nga ahuatangakatoa kel runga i a koutou haere mai I runga I te tumanako hono iho ki te aroha.
There are two things we should be considering when we discuss the subject that has brought us together. The first is that there is no such thing as Maori health, or Pakeha health; there is only people health.
And the second is that a great deal of the health problems all New Zealanders face is self-inflicted. We eat, drink and smoke too much; and we exercise too little. That combination destroys our bodies; and we blame it on ill-health.
When we see trained sportsmen and women competing, we do not say that this man or woman is a fine example of Maori fitness, or Pakeha fitness. We just say that they are fit; and we know it is because they look after their bodies, exercise them, do not over-feed them, and avoid anything that will damage them. Not everyone can be a top sportsman; but each of us can give our bodies the same type of care - even if not to the same degree.
I stress the fact that health Is not racial because, when some people talk of Maori health problems, they try to use the fact that we are Maori as some kind of an excuse.
But that s all it is, in most cases - an excuse to avoid facing facts. So our first step must be to face the fact that we cannot blame our poor health on the fact that we are Maori; or that we have less money, or lower-paid jobs, or any other of the arguments some people use to give this subject a racial twist. If over-eating, drinking or smoking contribute to any one person s health problems, 2
they will do exactly the same to him or her, whatever race they may belong to. Health has no race; and neither has self-indulgence, and lack of self-discipline.
If we Maori have lost our health - once we discount specific ailments and diseases - it is largely because we have lost pride in our own bodies. We cannot blame anyone else but ourselves for that.
And when we talk of our culture, it would not be out of place to include some physical culture. Our people of earlier days would have felt themselves disgraced to be fat and out of condition, particularly while still young and in the prime of life.
Why have we lost that pride in strength and fitness? Surely it is as much a part of our traditions as any other.
Another aspect that is much discussed these days is the apparent reluctance of Pakeha hospitals and doctors to consider Maori ways and outlooks. It has been claimed that Maoris have to go against their culture to fit in with Pakeha institutions.
While there is some truth in this, there is another side to the argument that most of us have observed, but few have mentioned I saw a newspaper report the other day concerning recent discussions about alleged reluctance by some hospitals to return Maori after-births to the family. A senior nurse - I think it was here at Auckland - was reported as saying that her hospital did this whenever a family requested it, but this only happened about 12 times a year. Most families made no such request.
There are two sides to this, also. Either fewer Maori families are interested in keeping up this tradition - or they are too over-awed by the hospital routine to have the courage to ask. But, if they do not ask - and, if necessary, insist - how are hospital staff to know what they want?
Most Pakehas I know are quite prepared to go along with the traditions of other races, as a matter of courtesy. But, unless someone tells them what those traditions are, what the cultural needs may be, they have no way of knowing. 3
How can they? Could you or I go into the homes or churches of people of other races, and be sure we were not offending against their beliefs or outlooks? We could not - unless we knew what those beliefs and traditions were.
It is sometimes said that spelling out these things is not the Maori way. Well, that may be all right if you are living in a country of mind-readers; but, otherwise, it is rather difficult for people with no knowledge of our traditions, and no way of finding out about them, to understand what we re making a fuss about.
If you meet people who are rule-bound and insensitive, by all means complain, and loudly. But if you meet people who don t know what you want - and . you won t tell them - how can you blame them for not knowing? They are in an impossible situation - and we have put them there.
For complete understanding, we must always consider both sides. We must remember that other races also have their customs; and if we expect them to consider ours, it is up to us to respect theirs.
One small example; to many Polynesian people, it shows respect to avoid eye contact during, for example, a job interview. But, in the Pakeha tradition, a man who will not look you straight in the eye when you are talking to him is probably dishonest, and certainly unreliable. From small misunderstandings like that, great differences grow.
I work about 200 yards from the motorway in Wellington. The motorway was built through a cemetery, which was later turned into a park. Now, to the Maori, the total environment - inside and outside the person - is part of their perception of self. That is why it disturbs us to see people sunbathing in this cemetery, or sitting on the graves while chatting away and eating their lunch.
But, to other races, this can be quite normal, and neither disrespectful nor irreverent. It is simply a matter of cultural outlook and tradition. 4
In the same way, our request for the ewe, the afterbirth, can be distasteful to people of other races, who do not understand how important to us is our ritual of the tohi ceremony.
The point I am making here is that much of this lack of understanding can be overcome. Most Pakehas are ready to adapt to avoid discourtesy to the sincere beliefs of others - if someone will explain to them what those beliefs are. As I said earlier, there are not many mind-readers around, of either race; and occasionally it might pay us to remember that, before we label people as insensitive, we should be sure they know there. is something to be sensitive about.
Doctors, nurses and hospital staffs are busy people, with a great deal to do, and usually not enough time in which to do it.
But if they were not caring people, they would not be in the profession of caring for others. And 1 am sure you will find - and no doubt Mr Malcolm will agree with me here - that most of them will do what they can to accommodate our needs as far as possible.
That is all we can reasonably ask. If we are to accept the benefits of new medical skills and technology, we must be prepared to adapt our ways to its needs to some extent.
We are not alone in this, because Pakeha people have also had to give up some of their more traditional ways to fit in with hospital routines that do not - to give one simple instance - allow for unlimited numbers of visitors at any hour of the day or night.
What I am saying here is that there is a middle way, and we must be prepared to help find it. When we talk, as I have heard some talk, of hospital patients being offered a cup of tea, while their visitors are not offered one, we see this as rude and uncaring. But we do not consider the extra work and expense if staff had to make dozens of extra cups of tea each visiting hour; nor the work of caring for other patients that would have to be neglected. A modern hospital is not a social centre, and this is one of the areas in which it is up to us to adapt to others. 5
Courtesy, goodwill and understanding on both sides can cure most of our problems in dealing with doctors, nurses and other medical staff. It is not true that Pakeha medicine only treats the body; they may approach matters differently from us, but you will find most of them willing to listen, and to learn. Understanding is a two-way form of communication, and we must do our share.
I am speaking today in no spirit of criticism. What I am hoping to do is to stimulate discussion by putting forward a viewpoint that is not always sufficiently considered.
If you disagree with me, well and good; but please consider what truth there may be in what I have said. Your conclusions may be different; but, at least, you will have considered all views; which is the basis for reasoned discussion..
If there is any difference between Maori and Pakeha health, it is mostly in our approach to it. We do not grow vegetables, fruit or trees, by planting them in the soil and then going away and forgetting all about them. Nor can we maintain good health by being born with it, and neglecting it from then on. Good health is an active quality, calling for good sense, sensible living and self-discipline.
Apart from specific diseases, as I said earlier, most people who enjoy good health have earned it. The rules are the same for people of all races; good eating, plenty of sleep and exercise, and moderation in all things.
Those are the rules; we break them at our peril. And, just as the first rule of swimming is to stay afloat, - and if you break that rule, you drown - so our health, Naori. or Pakeha, depends mostly on ourselves. This is equally true for physical, mental and spiritual health; and I hope that all these aspects that make up each person will be given their proper place in your discussions this weekend.
I wish you all well in those discussions in what I am sure ..will be a most valuable hui.
Noreira e kui ma, e-koro ma, kia .piki tonu te hauoratanga, taha-tinart taha-wairua. MAORI HEALTH HUI HOANI WAITITI MARAE 19-22 MARCH 1984
ADDRESSED BY DR P A BARKER DIRECTOR-GENERAL OF HEALTH
THE TITLE I HAVE BEEN GIVEN FOR MY ADDRESS IS HEALTH SERVICES IN NEW ZEALAND THE HISTORICAL PERSPECTIVE, BUT I IX) NOT WISH TO FOLLOW THIS TITLE STRICTLY BECAUSE I COULD OCCUPY THE WHOLE OF THE REST OF THE HUI IN TALKING ABOUT THIS ASPECT AND IT IS A MORE SUITABLE TOPIC FOR A PUBLICATION RATHER THAN AN ADDRESS.
THERE ARE, HOWEVER, A NUMBER OF POINTS IN THE HISTORICAL BACKGROUND OF HEALTH IN NEW ZEALAND WHICH I WILL HIGHLIGHT. IT IS IMPORTANT THAT WE REMEMBER THE IMPORTANT FOUNDATIONS ON WHICH OUR STANDARDS OF HEALTH ARE BUILT AND NOT IMAGINE THAT WE CAN GIVE SOLE CREDIT TO MODERN TECHNOLOGY.
THE PAKEHA WHO ARRIVED IN NEW ZEALAND LAST CENTURY CAME FROM THE TYPE OF ENVIRONMENT WHICH WAS NOT CONDUCIVE TO OPTIMUM HEALTH. THIS WAS ONE OF THE REASONS INDEED WHY PEOPLE IMMIGRATED TO NEW ZEALAND FROM THE UNITED KINGDOM IN ORDER TO GIVE THEMSELVES A HEALTHIER LIFE THAN THEY HAD BEEN ABLE TO ENJOY IN THE RELICS OF THE INDUSTRIAL REVOLUTION WHICH EXISTED IN THE UNITED KINGDOM AT THAT TIME.
THE MAJOR HEALTH PROBLEMS OF THAT ERA WERE, OF COURSE, INFECTIOUS DISEASES AND OF THE INFECTIOUS DISEASES THE MOST IMPORTANT ONE WAS TUBERCULOSIS. DESPITE THE FACT THAT MANY OF THE PAKEHA HAD HAD A LONG RACIAL EXPERIENCE OF TUBERCULOSIS AND HAD DEVELOPED SOME DEGREE OF IMMUNITY TO THE DISEASE THE INCIDENCE OF TUBERCULOSIS IN THE PAKEHA WAS STILL HIGH.
ON THE OTHER HAND, THE MAORI HAD NO RACIAL EXPERIENCE OF THIS DISEASE AND AS WITH A NUMBER OF (YIEER DISEASES SUCH AS MEASLES, OF WHICH THEY HAD HAD NO EXPERIENCE, THEY FELL EASY VICTIMS TO THEM.
THE INCIDENCE OF THESE DISEASES IN MAORIS WAS, IN SOME CASES, ABSOLUTELY DISASTROUS BUT, IN ANY EVENT, INCIDENCE WAS VERY MUCH HIGHER AND THE DISEASE VERY MUCH MORE SEVERE THAN IT WAS IN THE AVERAGE PAI(EHA.
THE PAKEHA ALSO FOUND THAT THERE WERE AREAS OF HEALTH IN WHICH HE SUFFERED MORE THAN HE DID IN THE UNITED KINGDOM.
EXPOSURE TO THE ULTRA VIOLET LIGHT IN THE LATITUDES OF THE UNITED KINGDOM WAS NOT NEARLY AS EXTENSIVE AS IN NEW ZEALAND AND AUSTRALIAN LATITUDES AND SO THE PAKEHA STILL SUFFERS A MUCH HIGHER INCIDENCE OF CANCER OF THE SKIN THAN DOES THE MAORI WHO IS MUCH BETTER PROTECTED BY THE PIGMENT IN HIS SKIN FROM THESE SORT OF DISEASES.
ANOTHER IMPORTANT DIFFERENCE IN THE HEALTH FEATURES OF THE TWO RACES IS THE GENETIC SUSCEPTIBILITY OF ALL POLYNESIAN PEOPLE TO DIABETES WITH A CHANGE FROM THEIR TRADITIONAL DIETARY HABITS TO THOSE MORE CLOSELY REESEMBLING WESTERN DIETS AND THEIR PRONENESS TO OBESITY ON THESE SORT OF DIETS. THIS HIGH INCIDENCE OF DIABETES IS FOUND THROUGHOUT THE PACIFIC AND AMONG AMERICAN INDIANS ON THE PACIFIC COAST. 2
THE DEPARTMENT OF HEALTH WAS ESTABLISHED IN 1900 BY THE PUBLIC HEALTH ACT WHICH WAS DESIGNED PRIMARILY TO DEAL WITH INFECTIOUS DISEASE AND, PARTICULARLY, AN EPIDEMIC OF PLAGUE WHICH WAS INTRODUCED INTO THE COUNTRY ABOUT THAT TIME.
THE REPORT OF THE DEPARTMENT IN THAT YEAR DISPLAYS FAIRLY CLEARLY THE BASIC PROBLEMS OF THE TIME AND THE ONES ON WHICH, AS I HAVE SAID BEFORE, THE WHOLE OF OUR STANDARDS OF PUBLIC HEALTH REST: THESE ARE:
(1) THE PROVISION OF A PURE WATER SUPPLY; (2) THE PROVISION OF ADEQUATE WASTE DISPOSAL SYSTEMS; (3) THE PROVISION OF GOOD HOUSING; (4) THE PROVISION OF ADEQUATE FOOD SUPPLIES AND THE PROTECTION OF THESE FOOD SUPPLIES FROM CONTAIMINATION; AND (5) SOUND PERSONAL PRACTICES IN SANITATION AND HYGIENE.
ARISING OUT OF THESE BASIC CONCEPTS THERE ARE A LARGE NUMBER OF RELATED ACTIVITIES WHICH CONTRIBUTE TO OUR HEALTH BUT IN THE EARLY PART OF THIS CENTURY THESE WERE THE MAJOR PROBLEMS WHICH DR POMARE AND HIS COLLEAGUES WERE FACED WITH AMONG BOTH MAORI AND PAKEHA.
DURING THE FIRST HALF OF THIS CENTURY IMPROVEMENTS IN THESE AREAS MADE BY FAR THE GREATEST CONTRIBUTION TO IMPROVEMENTS IN OUR STANDARDS OF HEALTH. IT IS THE MAINTENANCE OF STANDARDS IN THESE ENVIRONMENTAL AREAS WHICH WILL PRESERVE THE STANDARDS OF HEALTH WE HAVE PRESENTLY REACHED.
THE ANNUAL REPORT OF THE DEPARTMENT OF PUBLIC HEALTH IN 1900 CLEARLY DISPLAYS THE PROBLEMS FACED BY AND THE OBJECTIVES OF THE PUBLIC HEALTH DEPARTMENT OF THE DAY.
THE SECTION ON MAORI HEALTH IS INTERESTING, AND I QUOTE:
"DR POMARE WAS APPOINTED HEALTH COMMISSIONER FOR MAORIS RIGHT THROUGHOUT THE COLONY. MAORIS WERE INVITED TO KORERO AT WHICH SANITATION WAS THE CHIEF TOPIC. THESE MEETINGS WERE PRODUCTIVE OF GREAT GOOD SO MUCH SO THAT IT WAS DECIDED TO CONTINUE THE WORK OF PHYSICAL SALVATION AMONGST THE MAORIS.
"DR POMARE S DUTIES WERE TO CX) AMONG THE MAORIS, VISIT THEIR VARIOUS PA S. INQUIRE INTO THEIR GENERAL HEALTH, CONDITION OF THE WATER SUPPLY AND THE DIVERSE INGENIOUS IF NOT SCIENTIFIC METHODS EMPLOYED IN THE DISPOSAL OF NIGHT SOIL. ALREADY HE HAS TRAVELLED OVER A CONSIDERABLE PART OF THE NORTH ISLAND AND EVERYWHERE HE HAS BEEN RECEIVED WITH OPEN ARMS AND ENTHUSIASM. THE ADVANTAGE OF HAVING AN ADVISER BY REASON OF HIS NATIONALITY TO ENTER INTO THEIR THOUGHTS AND MINDS AND BE ABLE TO VIEW OBJECTS FROM THE MAORI POINT OF VIEW IS UNDOUBTEDLY GREAT."
THE NEXT MAJOR DEVELOPMENT IN THE CONQUEST OF INFECTIOUS DISEASE CAME WITH THE INTRODUCTION OF ACTIVE IMMUNISATION AGAINST VARIOUS INFECTIOUS DISEASE. THESE ADVANCES GAVE US A RAPIDLY INCREASING CONTROL OVER DIPHTHERIA, TETANUS, WHOOPING COUGH, POLIOMYELITIS, MEASLES AND RUBELLA. 3
THE CULMINATION OF THIS MODE OF PREVENTION CAME IN 1980 WHEN THE WHO WERE ABLE 10 ANNOUNCE THAT SMALLPDX HAD BEEN ELIMINATED FROM THE WORLD. THIS WAS A DISEASE WHICH AFFECTED NEW ZEALAND LITTLE BUT HAD FOR MANY CENTURIES RAVAGED OTHER PARTS OF THE WORLD.
WHAT I HAVE SAID IS THAT MOST OF THE IMPROVEMENT IN HEALTH IN THIS CENTURY HAS RESULTED FROM ENVIRONMENTAL AND OTHER PREVENTIVE METHODS. THESE HAVE MADE A MUCH GREATER CONTRIBUTION THAN OTHER ADVANCES IN CURATIVE MEDICINE, VALUABLE AS THEY UNDOUBTEDLY ARE.
LET ME, HOWEVER, SOUND A WORD OF WARNING. EVERY PREVENTIVE HEALTH MEASURE THAT HAS BEEN INTRODUCED HAS BEEN ATTACHED BY A SMALL BUT VOCIFEROUS GROUP OF PEOPLE. THIS HAS OCCURRED FROM THE DAYS WHEN JEENER INTRODUCED SMALLPDX VACCINATION THROUGH TO THE PROVISION OF PURE WATER SUPPLIES, ADEQUATE WASTE DISPOSAL SYSTEMS, IMMUNISATION AGAINST MANY TYPES OF INFECTIOUS DISEASE AND, OVER THE LAST 20 YEARS - FLURODATION OF THE WATER SUPPLY - THE GREATEST ADVANCE THAT HAS EVERY BEEN MADE IN PREVENTIVE DENTISTRY.
WHY ARE THESE PEOPLE SO OPPOSED 10 THE PREVENTION OF DISEASE? SURELY IT IS THE OBVIOUS APPROACH. PREVENTION IS SURELY BETTER THAN CURE.
ONE OTHER POINT I WOULD MAKE ABOUT PREVENTIVE AND CURATIVE MEDICINE. THESE ARE NOT MUTUALLY EXCLUSIVE ACTIVITIES - THE ONE BEING GOOD AND THE OTHER BAD. THEY ARE BUT THE DIFFERENT FACES OF HEALTH.
I WOULD BE HAPPY 10 HAVE A METHOD OF PREVENTION OF APPENDICITIS BUT, UNTIL SUCH A METHOD IS FOUND, I AM HAPPY THAT THERE ARE SURGEONS WITH THE SKILLS TO OPERATE.
WHAT THEN HAS BEEN ACCOMPLISHED IN MY WORKING LIFETIME.
I GRADUATED IN MEDICINE IN 1946 AND A COMPARISON OF RESULTS BETWEEN THEN AND NOW SHOWS:
THE COMPARISON WITH THE PRESENT DAY IS STRIKING. INFANT MORTALITY AMONG MAORIS WAS 74.62 PER THOUSAND LIVE BIRTHS AND FOR NON-MAORIS 26.10. 1980 FIGURES ARE 19.9 FOR MAORIS AND 12.0 FOR NON-MAORIS. THERE WERE 1465 CASES OF SCARLET FEVER AND 1683 CASES OF DIPHTHERIA. SCARLET FEVER IS NOW A DISEASE OF LITTLE IMPORTANCE AND THERE HAS ONLY BEEN A HANDFUL OF DIPHTHERIA CASES IN NEW ZEALAND OVER RECENT YEARS.
IT WAS RECORDED THAT THERE WAS A MARKED INCREASE IN THE NUMBER OF CASES OF POLIOMYELITIS IN JANUARY, FEBRUARY AND MARCH OF 1946. THERE HAVE BEEN ONLY 3 CASES OF POLIOMYELITIS SINCE 1962. THERE WERE 76 NOTIFICATIONS OF PUERPERAL SERIES, A DISEASE WHICH IS NOW VIRTUALLY ELIMINATED.
THE TOTAL NUMBER OF NEW ZEALAND DEATHS FROM TUBERCULOSIS WAS 956 (A RATE OF 5.4 PER 10,000) WHICH IS 27 TIMES THE 1980 TUBERCULOSIS DEATH RATE OF 0.2 PER 10,000 (64 DEATHS).
THE 1946 NOTIFICATION RATE FOR TUBERCULOSIS IS 10 TIMES THE 1982 RATE.
MANY MORE FIGURES COULD BE PRODUCED BUT WOULD SERVE ONLY TO DISPLAY THE SAME PATTERN, IE - 4
THAT THERE HAS BEEN A VERY SUBSTANTIAL IMPROVEMENT IN THE HEALTH STATUS OF ALL NEW ZEALANDERS DURING THIS CENTURY.
• THAT IN GENERAL MAORI RATES STARTED AT THE TURN OF THE CENTURY FROM A POINT WELL BEHIND THE PAKEHA RATES.
• THAT MAORI RATES HAVE IMPROVED TO A FAR GREATER EXTENT THAN PAKEHA RATES BUT STILL LAG BEHIND TO SOME DEGREE IN MOST CATEGORIES.
• THAT THE DIFFERENCES ARE NOW SUFFICENTLY SMALL FOR US TO IDENTIFY PARTICULAR TARGET AREAS FOR ATTENTION EG, THE MAORI INFANT MORTALITY RATE IS THE SAME AS THE PAKEHA ONE WAS IN 1977.
THERE ARE SOME PARTICULAR PROBLEMS OF MAORI HEALTH, EG IN THE CARDIOVASCULAR AND METABOLIC AREAS WHICH REQUIRE SPECIAL TARGETING AS THEY WILL INVOLVE PROBLEMS NOT NECESSARILY EXPERIENCED IN MORE TRADITIONAL RESEARCH AREAS OVERSEAS.
IN SHORT WE HAVE COME A LONG WAY BUT, AS ALWAYS IN HEALTH, WE STILL HAVE SOME WAY TO GO.
THERE IS NO REASON WHATEVER FOR PESSIMISM. THIS HUI WILL, I HOPE, HELP US TO IDENTIFY MORE CLEARLY DIFFERENT APPROACHES TO HEALTH PROBLEMS AND I CAN ONLY REPEAT DR POMARE S VIEW IN 1900 THAT MEETING WITH MAORIS ON THEIR MARAE IS OF GREAT VALUE TO US ALL. "TE TAHA HINENGARO"
AN INTEGRATED APPROACH TO MENTAL HEALTH
M. H. DURIE
Director of Psychiatry Palmerston North Hospital.
HUI WHAKAORANGA HOANI WAITITI MARAE AUCKLAND
MARCH, 1984 AN INTEGRATED APPROACH TO MENTAL HEALTH
M. H. DURIE
What is mental health?
Although mental health is often delineated as a separate area of enquiry, based to a large extent on the state of
the mind, its thoughts and feelings, the notion of the mind itself has only developed in response to the evolution of Western scientific thinking. The philosophy of Cartesian Dualism proposing mind and body (or mind and matter) has divided health into physical health and mental health. Only in very recent times have the limitations of this dualism become apparent, and
attempts to synthesise the concepts of mind and body (1) have led health professionals towards the so called holistic approach in medicine.
The holistic approach is in fact, a very familiar one in traditional Maori society. Health, from a Maori perspective, has always acknowledged the unity of the soul, the mind, the body and family; the four cornerstones of health: te taha wairua, te taha hiriengaro, te taha tinana, te taha whanau.
Mental health as a separate entity has little traditional meaning, although the profound influences of mental attitudes, thoughts and feelings have long been recognised by Maori practitioners as vital forces affecting the health -2--
of individuals and the community as a whole. (2) While
Western medicine tended to emphasise bodily health, at the expense of those functions which could not be
explained by the laws of physics, Maori theories of health minimised mechanistic forces in favour of the
strong influences of mental attitudes and supernatural powers. (3)
Mental health, even in Western terms is not readily defined,
and there is sometimes confusion between the terms "mental health", "mental illness" and "psychiatry". Abstract conceptual models of mental health are probably less helpful than those which seek to obtain an
appreciation of mental health by focussing on the reality in which we live. (4)
Obviously, not everyone lives in the same reality, and notions of mental health are thus very much bound by culture and by time. A mentally healthy child living in contemporary Western society would likely be regarded as disturbed if he lived in the Victorian era. Different times have developed different norms, in much the s nw way that different cultures interpret similar phenomena in vastly different ways. Any consideration of Maori mental health today must therefore acknowledge a unique cultural heritage, and the approach of the twenty-first century.
To seek only a traditional interpretation of mental health would be to deny the impact of time, while to disregard -3-
the importance of a traditional culture in favour of
widespread Western concepts would be to deny the reality in which Maori people live.
Who defines mental health?
For the most part, definitions of health and mental health
have come from professionals, (5) medical practitioners, psychologists, sociologists, nurses. But whether mental
health professionals are the most appropriate people to
convey a notion of health is a moot point, since very often the professionals are much more aware of ill health, and social disorder, and might be better described as mental
ill health professionals. The expertise of the professional is more obvious when it comes to the study of dysfunction
rather than the promulgation of health. Who then, can
legitimately enunciate the ideals of mental health, and more to the point, the mental health aspirations of Maori
people? As with other facets of life, statements about health might be expected to emanate from the Marae, (6) and from elders known to be aware of the needs of their people. It is likely that numerous such statements have in fact already been made, though not necessarily heard, particu- larly if matters of health are looked upon as the exclusive province of Western trained health profesionals. -4-
A prescription for mental health?
There is one definition of mental health however, which cannot be overlooked. Although written in 1949, its relevance to the present reality, and to the dawning of the twenty-first century, is undisputable. I refer to a succinct statement made by the late Sir Apirana Ngata:
"E tipu, :e rca, mo nga ra o tou ao. Ko to ringa ki nga rakau a te Pakeha,
heiora mo to tinana,
Ko to ngakau ki nga taonga a o tipuna,
hei tikitiki mo to mahunga, Ko to wairua ki te Atua, nana nei nga
mea katoa."
Grow up, a tender plant, for the days of your
world, Your hand to the tools of the Pakeha for the
welfare of your body,
Your heart to the treasured possessions of your
ancestors, as a crown for your head, Your spirit to God, the creator of all things.
This proverb has been widely quoted throughout New Zealand.
It is presented here as a laudible prescription for the mental health of Maori people. The statement commences with the acknowledgement that growth does not occur without nurturance 1 nor without the advent of fresh challenges. ("E tipu, e rea, mo nga ra o tou ao"). Mental and -5-
emotional attitudes are the product of growth and Ngata
issues a warning that the child may eventually live in a world unfamiliar to its parents or grandparents. He then
sets out the three basicnutriments requiredto effect optimal growth.
Firstly, he has no hesitation in embracing the world of
technology. Ngata and many Maori leaders before and after him, have been quick to recognise the positive aspects of Western culture, and the advantages they can confer on the wellbeing of the individual and the people. Education
can lead to a greater participation in the technological world, a world that Ngata sees as a crucial ingredient for growth.
Secondly, he advises the child to seek strength, meaning and dignity in the attitudes and teachings of the ancestors.
He identifies Maori culture as a further vital force, without which growth will be stunted.
Thirdly, he emphasises the spiritual dimension, the limitations of the corporal world and the need to nourish the soul so that growth might be complete.
These three aspects of mental health are not unfamiliar, and there are many who are comfortable with all three. But Ngata s prescription for mental health implies more -6- than an ability to experience three different types of living. These three factiOns must somehow become inte- grated, fused together, to produce a total identity that can cope with the complexities of modern society. There is some debate as to whether the task is possible. Conflicts between the technological, scientific attitude, tribal traditions and expectations and spiritual experience are numerous. It is difficult enough to survive in one world, let alone three, simultaneously. Yet, that is what is proposed as an ideal goal for the mental health of Maori people.
The interface
To achieve this goal, thought will need to be given to the creation of opportunities for exposure to education, technology, Marae association and spiritual experience (7, 8). Such exposure will need to make sense to the student, so that it can be incorporated into his own world and lifestyle and not remain an interesting, but essentially foreign field of endeavour. For the youth steeped in Maori tradition, Western education, learning and tech- nology must have some relevance to his background. For the youth familiar only with a Western lifestyle, the
Marae must have some relevance to his own needs and those of his family.
In spiritual matters, some promising integrative trends have developed in separate denominations within New Zealand. -7-
Various Church bodies have begun to incorporate Maori values, symbols and organisational structure, so that the
Maori participation can be enhanced, albeit from a different cultural perspective. A course in Business Studies at Massey University has similarly attempted to include Maori students by offering a syllabus and a structure which is recognisably Maori, yet geared to the demands of a computerised society.
Generally, however, such interfaces between for example, the world of technology and the traditions of the Marae, are all too few. While many Maori men and women are able to excel in Western pursuits, often it is at the expense of their basic identity and cultural affiliations, a matter of regret, even distress to them and their children in later years.
If Western educational and vocational systems have been slow in presenting themselves in a culturally acceptable manner, so too have some Maori people been hesitant in searching for innovation and change at a Marae level.
Others have steadfastly avoided exploration of the Pakeha world simply because it was not Maori. Likewise, Western institutions have not often recognised a responsibility to develop the whole person, encouraging and facilitating the attainments of cultural strengths alongside technical skills. -8-
Are mental health concepts helpful?
The situation has not always been helped by some mental
health theories and practices. A popular mental health concept in recent years has centred on the importance of the individual who is seen as a self-sufficient, self- motivated and self-assertive person. There has been pre-occupation with the "whole person", "a total person", "a person in his own right", independent of others, and
free to do "his own thing". Good mental health has been
equated with independence, directness and severance of
generational ties. It is a peculiarly Western view, which in Maori terms, is the antithesis of mental health. Interdependence, (9) (rather than independence) is considered
desirable in Maori society, personal ambition is less
healthy than the ambition of people for their children, and
direct or blunt speaking is not necessarily regarded as the epitome of communication skills. To be "totally independent"
and "a separate person" is, in Maori terms, to be unhealthy.
Another trend in Western mental health circles attempts to account for human behaviour and interaction by scientific observation and analysis. This is a mechanistic approach, again at odds with Maori beliefs, (10) and quite incompatible with Ngata s third requirement for good mental health, i.e. the development of a spiritual awareness and an acknowledgement of man s limitation. -9--
If Maori youngsters are to grow towards a state of health, they must be presented with an integrated set of values. Their own cultural attitudes must not only be accepted but actively fostered, no matter what the field of endeavour.
Are cultural factors recognised?
There is little doubt that Western culture has added to the health of the nation, and all its inhabitants. But, it has also been associated with a regrettable tendency over the years to regard some aspects of Maori culture as undesirable from the point of view of mental health. The care of children is a case in point. Child health experts were critical of the role of the extended family as a positive force for the development of mental health. The nuclear family was seen as ideal, and many Maori grandparents, uncles and aunts were actively discouraged from taking their own grandchildren. The results of that directional change are now well known and widespread, and the inadequacies of the nuclear family, as a secure unit for children, has become all too familiar. Meanwhile, Western child health experts have become much less certain about those earlier theories, and some have come full circle to support the Matua Whangai scheme, even reprimanding the extended family for not caring enough about their youngsters.
A failure to appreciate the natural environment as a component of Maori mental health is further evident in recent and historical land legislation. The deliberate - 10 - policy of moving families away from their traditional lands, ignored the spiritual and cultural bonds that made up a vital mental health force. Within a generation, uprooted families, advised to seek the-tools of the Pakeha, lost self esteem, confidence, status and became alienated from their own past. Mental health cannot be isolated from man s environment, and recent concerns from environmentalists, Maori and non-Maori, have raised the issue of cultural,pollution. Self-esteem, a basic ingredient of mental health, is difficult to maintain when a reef, river or other landmark of tribal pride and heritage is covered with effluent, treated or untreated. (11) Cultural pollution must be seen as a force against positive mental health, affecting not only an individual, but a whole community. In this regard, the Motonui dispute, and others like it, are very much issues of mental health.
Similarly, it is now a matter of historical regret, that language was never recognised as a basic unit of health. Kohanga ReQ (Maori language kindergartens) can be described as a mental health measure, made necessary by an earlier policy that discredited the Maori language as a useful tool for the 20th century, and committed two or more generations of Maori parents to endure communication frustration in two languages.
A further major source of cultural conflict, and one with strong mental health connotations has been the "tangi" (12)
(funeral rites). Early missionaries often regarded the - 11 -
process as barbaric and undisciplined, health authorities viewed it as unhygienic, even hazardous, while employers saw it as an invalid excuse for unwarranted time off work. After many decades, the intrinsic health benefits of such a mourning style have been acknowledged by Western health experts and re-affirmed as positive for mental health. Even so, not all employers are impressed.
Mental health professionals
The field of mental health is a broad one, and it is a matter of considerable concern that trained Maori personnel
are in an extreme minority. The number of Maori psychiatrists and psychologists combined, can be counted on one hand.
Maori psychiatric social workers, occupational therapists or professional counsellors are similarly scarce, whilst there are no Maori child psychotherapists at all. Yet,
statisticians are able to confirm a disproportionately high number of Maori patients or clients who have not been
able to obtain good mental health. While the promotion of mental health is a task for politicians, educators, , elders, mothers, fathers - indeed the whole of society - the demand for professional mental health workers will likely remain and probably increase. It is imperative that a
Maori perspective of health be understood by those professionals. it is time also, that those relevant professions took more active steps to correct the ethnic imbalance among their members. It is now well established that cultural barriers, no matter how skilful the expert, - 12
impede the attainment of health, (13) and members of one culture are likely to be much less effective when dealing with members of another. The advent of even a minimal number of Maori professionals may be decades away. In the meantime, the presence of many non- professional, non-paid Maori counsellors could be acknowledged. They already have skills and knowledge, but lack official recognition and the opportunity to develop their skills. The possibility of further training and then paid employment merits further discussion, while the scarcity of Maori or bi-cultural professionals is so apparent.
Summary
In this paper an attempt has been made to understand mental health rather than to focus on ill health. Mental health cannot easily be separated from total health, and the dichotomy between mind and body is essentially a product of
Western scientific thinking. Attempts to define mental health have been generally unsatisfactory, Often failing to consider time and culture. A statement made by the late
Sir A.P. Ngata merits further attention as a prescription for mental health. In it, the growing Maori child is urged to combine technological, cultural and spiritual worlds. An integration of these often contradictory dimensions presents certain difficulties, and it behoves Maori and pakeha institutions to increase the range of experience for Maori youth, and to do so in a manner which acknowledges and enhances those other worlds. Mental health - 13 -
theories themselves, often hinge on Western concepts which are-alien to Maori thinking. The pre occupation with independence and individuation and a mechanistic approach to human behaviour are cases in point. In contrast, traditional Maori concepts of health have often been discouraged. Methods of child care, land and environmental legislation, language and the significance of bereavement, need to be seen as foundations for Maori mental health. The appreciation of cultural differences in mental health will require greater understanding by mental health professionals and a greater number of Maori professionals is urgently required in the mental health field. There is an immediate place also for the greater recognition and training of the voluntary counsellors already working among Maori people.
An integration of technology, traditional Maori culture and spirituality is an ambitious goàl but it should not be an unattainable one, and may in fact become the prototype of good mental health for all New Zealanders in the 21st century. - 14 -
REFERENCES: 1. SALK J. "Western Science, Eastern Wisdom:-the great synthesis". World Health Forum 1981; 2 : 398-402.
2. BLAKE PALMER G. "Tohungaism and Makutu". J. Polynesian Society 1954,63; 2 : 147-163.
3. DURIE M.H."Maori Attitudes to Sickness, Doctors and Hospitals". N.Z. Med. J. 1977; 86 : 483-485.
4. ROBERTS C.A. "Primary Prevention: to the Present" in Roberts C.A., Primary Prevention of Psychiatric Disorders. Ontario. University of Toronto Press 1968.
5. JAHODA,M. Current Concepts of Positive Mental Health. Joint Commission on Mental Illness and Health. Monograph Series No. 1. New York: Basic Books, 1958.
6. WALKER R. "Marae: a Place to Stand" in ed. King M. Te Ao Hurihuri. Wellington: Hicks, Smith & Sons, 1975. 7. MAHUTA R. "Maori Communities and Industrial Development" in: ed. King M. Tihe Mauriora. Wellington: Methuen Publications 1978. 8. KAWHERU I.H. "Increasing the Maori Contribution in Manufacturing Industry" in: ed. Thomson K.W. and Trlin A.D. Contemporary New Zealand. Wellington: Hicks,Smith & Sons. 1973. - 9. RANGIHAU J. "Being Maori" in ed. King M. Te Ao Hurihuri. Wellington: Hicks, Smith & Sons, 1975.
10. MARSDEN M. "God, Man and Universe" in ed. King M. Te Ao Hurihuri, Wellington. Hicks, Smith & Sons, 1975. 11. Waitangi Tribunal. Report, findings and recommendations of the Waitangi Tribunal on an application by Aila Taylor for and on behalf of Te Atiawa tribe in relation to fishing grounds in the Waitara district. Wellington: Report to Minister of Maori Affairs 1983. 12. DANSEY H. A view of death. In ed. King M. Te Ao Hurihuri. Wellington: Hicks, Smith & Sons, 1975.
13. VARGHESE F.T.N. "The Racially Different Psychiatrist: • Implications for Psychotherapy". Australian and New Zealand Journal of Psychiatry 1983; 17:329-333.
Rose Rangiiriezi Pere T&Fknga it te oranga 0 re whanau Pr6iJext. 01-e health of the family)
THE OCTOPUS as a symbol
wooro huie.nro The task I have at the present time is to write a statement about family health. In expressing some of my innermost thoughts cognizance is given to many others who are also voicing their views about the same issue.
I do not express my views as an expert but as a grandchild of many grandmothers and grandfathers who have influenced my philosophy of life. The symbol I am using to define family health as I understand it, is te wheke , the octopus. Only a limited interpretation of my basic beliefs can be given in English.
An explanation of the symbol is as follows:
- The body and the head represent the individual/family unit.
- Each tentacle represents a dimension that requires and needs certain things to help give sustenance to the whole. - The suckers on each tentacle represent the many facets that exist within each dimension. - The eyes reflect the type of sustenance each tentacle has been able to find and gain for the whole.
- The intertwining of the tentacles represent a mergence of each dimension. The dimensions that have been mentioned need to be understood in relation to each other and within the context of the whole because there are no clear cut boundaries. I will now make reference to each tentacle by beginning with:
Wairuatanga (Spirituality ...) Sustenance is required for the spiritual development of the individual, the family, and is of the utmost importance. The Creator, the most powerful influence we have, is recognised as the beginning and the ending of all things. The Creator has planted a language and given a unique identity to me and my Maori forebears. We have given this identity an earthly form. Our forebears transmitted numerous incantations, beliefs to help give sustenance to this spiritual existence. The closest I can get to the Creator is to retain and uplift the unique identity he has given me. The world view of the Maori is that people are the most important of all living things in the physical world, because we believe we are in the image of the Creator. We do not support the Darwin theory and do not classify ourselves as belonging to the animal kingdom. Mana ake (uniqueness in this context ..)
Just as one is aware of a child s heredity from forebears there is also an awareness of those things that make a child unique. This uniqueness is a part of the individual s own mana as a whole. This concept also applies to the family unit. If a family receives sustenance that gives them a positive identity with their mana intact - then that family will have the strength to pursue those goals and those assets that can uplift them. 2
Mauri (life principle, ethos ...) If great importance and support is given to the mauri of each individual in the family, in time the individual, the family will appreciate the mauri in other people, the mauri in meeting houses, the mauri of traditional courtyards, the mauri of trees, the mauri of rivers, the mauri of the sea and the mauri of mountains. The traditional courtyards and the mountains of New Zealand have heard and felt the mauri of the language as spoken by our Maori forebears before the intrusion of any other. The mauri of the language and the inauri of everything else that has been mentioned is very important to the family unit and the way it can withstand negative influences. Ha A Koro Ma A Kui. Ma (The breath of life from forebears) The breath of life mentioned here relates to the heritage that has come down from Maori forebears. Sustenance from knowing one s own heritage in depth is important. A basic belief is that one s future is linked up with one s past so that if the heritage is firmly implanted then the members of the family will know who and what they are, the unique identity that they have, will remain intact. Families who have had their heritage transmitted to them have a strong central core that can enable them to become universal people.
Taha Tinana (The Physical Side) The family must receive sustenance for its material and bodily needs. The general guidelines required would relate to medication, suitable foods, suitable and appropriate clothing, appropriate means of shelter, different types of recreation including physical education, everything that pertains to physical survival. The body is regarded as sacred and requires a set of disciplines. The head is regarded as the most important part of the body and has its own set of restrictions, tapu placed on it. If one does not take care of his or her head, then worrying about everything else pertaining to the body is pointless. Tremendous respect is given to the body and the way one should apply it, and use it. A mother cherishes and nurtures her child in the womb, and when one is old enough to take over the responsibility of his or her body, then this cherishing, and nurturing must continue. As a child and grandchild I remember the physical warmth, the tremendous flow of love that I received from my many parents and grandparents. They taught me to adjust and to accept change - to think things out for myself.
Whanaungatanga (the extended family, group dynamics) Whanaungatanga is based on the principle of both sexes and all generations supporting and working alongside each other. Families are expected to interact on a positive basis with other families in the community to help strengthen the whole. Families receive sustenance for this dimension when 3
they feel they have an important contribution to make to the community they live in. Genealogy whakapapa is an important part of whanaungatanga. It is the basic right of the child to know who his or her natural parents are even if he or she is adopted out. The spirit of the child amongst other dimensions begins from conception and relates to the child s forebears. A basic belief of the Maori is to expose a child to his or her kinship groups as soon as possible and throughout the whole of his or her life time. The extended family is the group that suports the individual through a crisis or anything else of consequence. Kinship identity is most important. Affection, physical warmth and closeness of members of a kinship group is encouraged and fostered. Traditional men and women who did not produce children of their own could foster a relative s child or children. Some of our most famous ancestors and Maori people of more recent times did not produce any issue of their own, but were still regarded as most outstanding leaders and tribal parents. The concept of Matua - Whangai foster parents is becoming prevalent throughout Maoridom again.
Whatumanawa (the emotional aspect ...)
Sustenance and an understanding of emotional development in the individual, and the family as a whole is considered important. Children are encouraged to express their emotions so that the people who are involved with the parenting know how to support, encourage and guide the children. Crying for joy or sadness by both sexes is regarded as natural and healthy by the Maori. This form of expression is not regarded as a weakness. Emotional involvement and interaction are regarded as important meeting points for human beings.
Hinengaro (the mind ...) Approaches of learning that arouse, stimulate and uplift the mind are very important. My immediate forebears believed in the aristocracy of the mind and despised anyone who tried to tamper with the mind. The mind if nurtured well knows no boundaries, and can help one to traverse the universe. Intuitive intelligence is encouraged and developed in some individuals to a very high degree. There is a strong belief in exercising and using all of the senses on a regular basis. Waiora (Total wellbeing ...)
If each symbolic tentacle receives sufficient sustenance for the whole when the eyes of the symbolic , family unit will reflect total well being. Wairoa is my definition of health as shared with me by my elders. If the medical people .wish to help Maori people face up to the challenges confronting them in today s world, then I feel that some cognizance must be given to the philosophy I have tried to share within the limitations.Ons.
Ma te Kaihanga tatau e arahi e tiaki kaore he maria i tu atu i a Ia. Kua ia te timatanga me te inutunga o nga inea katoa. Naku noa Na Rangimarie Pere Wlth}1I ItAPJE TRUST
•; [T _•( •) : - 1 j
,fC \ ••,J..-. I . / \/: 1!. • I I •) .-
THE WAAHI NAPAE PROJECT
Paper delivered to Maori Health Planning Workshop
Hui Whakaoranga
at
Hoani. Waititi Marac, Glen Eden, Auckland, 19 - 22 Rtrch 1984
TABLE OF CONTENTS
HE Mliii INTRODUCTION PERSONAL BLCVGROUNL) IDEOLOGY
HIS1ORICAL 11L RSPECTIVE THE DE10GR7 .PHY OF TA1NUI A CHRONOLOG OF TAINUI DEVELOPMENT THE DEVELOPMENT SCENAP.IO DEVELOPMENT MODELS THE W?th}JI IJEALTI! PROJECT CONCLUSION REFERENCES APPENDIX iaiha Malaita Awhina I-louse Waahi Pa, Huatly 21 March 1984 THE WAA111 MIUU\E PROJECT
HEflUX E n9aa. iwi e tau nei, e koro inaa e kui inaa teenaa koutou. Ahakoa na to kaupapa kee taatou I karanga e tika ma kia mihi poto ki o taatou mate, ki te hunga wairua i. tua o te aarai. Nooreira ngaa mate aa tau aa marama aa wiki o nanahi tata nei, haere koutou haere koutou haere. Tiihei mauriora, ki a taatou ki to hunga ora, ngaa maataa waka o rimga ± o taatou rnarae, ngaa kaihaituu o to iwi i roto i teenei ao huriliuri teenaa koutou.
INTRODUCTION The title of this talk was suggested to my husband during the early planning stages of the conference. Unfortunately he is not able to be here and so my task is twofold. It is firstly to tender his apologies at not being able to attend, and secondly, to talk about our experiences at Waahi. In doing so I am reminded of submissions currently directed at various quangos, conferences and seminars seeking representation of WorIefl s groups and I4aori people. In agreeing to appear here then in some small way I am attempting to cover both minority viewpoints.
PERSONAL BACKGROUND Before beginning I should at least give you a personal sketch. I am from Karetu and belong to the Ngaati ?.lanu sub-tribe of Ngaati Hine. I attended Queen Victoria School, Auckland Girls Grammar and then went on to study physiotherapy in Dunedin. After qualifying in 1964 we moved to Auckland, where I worked at Auckland Public, Cornwall, and then in 1968 went into private practice with Len Ring who specialised in sports medicine therapy. In 1972 we moved to Hamilton where I worked at Waikato Hospital specialising in . rehabilitation of motor neurone diseases.
A disturbing trend in recent years is the tendency to categorise the Maori as an interest group or disadvantaged minority. In this Wc the system denies the fundamental rights of tanqata whenua status and the steady erosion of Maori rights since the advent of colonisation. 2
From 1976-78 we spent two years in Oxford. I worked at the Cowley Road and Longworth. Hospitals. in 1979 we moved hack to Waahi where I work as administrator for the Waahi Iarae Trust, which is responsible for the marae itself and for the various Kiingitanga properties vested in the trust. My job is to ensure that the farm blocks are well zr.anaged, that the finances are in order, that the, trustees are kept up-to-date with developments and that government and private sector organisations are aware of our operations.
IDEOLOGY
Let me begin by saying that if one were to ask Waikato what is their major ailment, the response would be Raupatu (confiscation). The ideology behind the developments at Weahi and the implications they have for Waikato and Tainui generally have been summarised in reports prepared by Mahuta and Egan. These reports cover the early history of the people, some basic statistics on l4aoridom; the role of education; the social and political organisation of •Kiingitanga and the oryanisation of the marae itself. The Wanhi Report outlines the beginnings of the development process within the community as a result of the building of the power station at fluntly. It refers briefly to the hassles and negotiations which took place between the locals and government officials, and finally the plan and implemenLation strategies which have been initiated in order to place our people on a development path.
HISTORICAL PERSPECTIVE
Evcrsince contact the state has found it difficult to work with and through Tainui structures and organisations because of fundamental. conflicts in ideology and the resistance of the people to Paakeha domination (Ward, King,
A full account of the Waahi Marae Trust s activities are contained in the 1983 Annual Report (see Appendix).
For a fuller background to the confiscation issue, Michael King s biography of Te Puce summarises the main issues fairly well.
The studies by Alan Ward, Michael King and Tony Simpson are particularly helpful in understanding the historical perspective. 3
Simpson) . Regardless of their involvement in recent months with the Treaty of Waitangi protest, it is a fact that: Waikato did not sign the Treaty. In an attempt to halt settler encroachment onto Waikato lands - these lands were placed under the protection of the Maori King. This resistance led to the Land Wars and eventual confiscations of large ti-acts of tribal lands. The mid-1800s are a sorry chapter in New Zealand history - a history that is largely ignored by the system. It will take an imaginative act of political will to remove this carcinoma from the minds of Waikato descendants. Until one understands this historical experience ad tracks it through the lives of subsequent Tainui leaders such as Taawhiao, Taamehana, Nahuta, Te Puc; Te Hurinui and others, it is very difficult to comprehend the way these people operate and how they are att.empting to bring about their own realities. A visit to a doctor would involve a diagnosis, a course of treatment, and all things being equal - a good prognosis. Unfortunately this analogy in the case of Tainui falls short on all three counts. The physician (i.e. the state) recommends a total bypass with a palliative treatment regime which will maintain the patient in a totally dependent state. What we are saying is that any definition of health must encompass the social, political, economic and environmental fields if it is to have any relevance to the ailments within Maoridom.
Given this perspective, Andre Frank s development of under-development theory, Paulo Friere s analysis of educational submersion and Steven Lukes treatment of power, suddenly makes sense when applied to Tainui t s situation in particular, and I daresay to flaoridom generally. Whether it is in the field of health, education, employment, politics or whatever, the classic reaction of authorities is that there must be something wrong with Faoridom and not with the system of democracy in this country.
Roger Keesing 1983. :443-456 provides a stimulating and thoughtful general account on the creation of the third world and the development of underdevelopment. His analysis draws on the work of Frank, Fuatado, Dos Santos, Wallerstein and others.
In her study of the Guatemalan economy Smith concludes that capitalism everywhere creates and depends upon the development of some parts and the underdevelopment of other parts (Smith 1978:611) 4
THE DEMOGRAPHY OF TA I NUI
Let me turn now and provide a brief demographic description of the people am concerned with. In a paper prepared by Ted Douglas, a demographer at the University of Waikato, he states that the Tainui human resource totals 120,000, half of whom live within the I4okau hi Taamaki boundaries. If we accept his analysis, then what we are saying is that one in every threeNaori belongs to or is affiliated with Tainui. In terms of the 120 marac throughout Tainui we could say there are, on average, about a 1,000 people per rnarae. This, of course, is over-simplifying the situation.
If we look at the 60,000 core Tainui some further observations of their demographic characteristics can be made. This 60,000 core comprises 35,000 who live in the Waikato-Maniapoto land district (minus Tauranga) and the balance of 25,000 reside in the region north of Tuakau, corresponding roughly with the rugby unions district. From this cursory analysis, it :s important that government departments (including health) understand the demography of their clientele, before attem pting to address issues affecting them. This reality continues to be a blind spot in the eyes of policy--rtakers.
A CHRONOLOGY OF TAINIJ1 DEVELOPMENT
Perhaps the first phase of tribal/government sponsored developments occurred during the time of Te Puea from the 1920s onwards. Initially To Puea cooperated with Ngata in promoting land deve).opment schemes throughout Tainui Later she moved on to developing the marae and towards the end of her life attempted to establish the organisation to continue with her work.
The second phase of development occurred with the construction of Kimiora. During the early 1970s the leadership mobilised the movement to raise over half a million dollars to establish the complex at TurangawaeWae.
A precise figure for the Tainui population is difficult, but Douglas provided the following estimate from a survey conducted in 1.981-82 (Douglas, Nottingham, 1982). 1 laori living within Tainui boundaries 88,000 Non-Thinüi living within rrajj.luj boundaries 20,000 Tainui living within boundaries 68,000 Tai.nui living outside boundaries 20,000 People of Tainui descent working elsewhere 30,000 Total Tainui population 118,000 Douglas estimates that most of those non-Tairiui. Maori live in the South Auckland suburbs of Manqere, Otara, Otahuhu, Manurewa and Papakura. A sizeable group also live in Hamilton. 5
The third phase was the redevelopment of Waahi, the establishment of IIuaina and the restructuring of inarae management committees.
THE DEVELOPMENT SCENARIO
The Tainui Report published last year is an attempt to survey the human and natural resources in Tainui. How mar11 people have we got? Where are all our lands and coastal resources? What should we be doing? How are we currently positioned within, the New. Zealand Maori. context?
The Lands Federation Confe-ence brought together trustees and management committees of all 438 Trusts and Incorporations and attempted to seek consensus on development strategies, in areas such as banking policy, purchasing procedures, training, employment, and acting as a lobby group. The strategic report which should be completed later this year is an attempt to put together a strategic plan outlining where we are, where we want to be at various points in our development, and how we propose to achieve these objectives in the short, medium and long term. The question might well be asked what then are some of the developments within this scenario?
DEVELOPIflNT MODELS
1. Within the South Auckland area, we have the Huakina Developmnt Trust who, with the cooperation of New Zealand Steel, have embarked on an ambitious people/xnarae development programme in addressing such issues I as unemployment, under-education, youth recreation, management training and more effective land use policies.
2. The activities of the WaahiMarae Trust are well documented and cover a wide range of similar issues. The specific health project I will refer to shortly.
In his paper on Maori examination failure, Ian Mitchell writes "that the failure by educational authorities to get at the root of Maori under- achievement in School Certificate makes it very tempting to accept the Marxist analysis that an "under-educated proletariat" is essential for the survival of the capitalist system; that the existence of such people makes possible the continued provision of a cheap labour force for labour intensive industries, and that Maoris provide a convenient source of such labour, having been stamped "failed" by a culturally foreign education system". 6
3. The Tainui Trust Board based at Nyaruawahia is the principal statutory authority for the people and its activities are governed by the Trust Boards Act. The main thrust of the Hoard s activities over the next few years is to expand its economic base so that it can become more independent and effective in serving its beneficiaries. At the present time the Board administers two farms and hopes to triple its assets over the next three years.
4. In the Tai Hauauru area we have the Taharoa C block as the largest of the few incorporaLi,ons within Tainui. Their main task is to administer the investment royalties paid by New Zealand Steel.
5. Within I laniapoto we have the King Country Pact and several large incorporations, of which Tiiroa is the most notable. An outline of their activities is contained in the appendix.
6. Ngaati IIauaa have recently taken control of the Mamakomaru Block as 438 Trust. Within the next few months it is hoped to conclude negotiations for the return of the Hanqawera Block to benefit flgaati Wairere, Ngaati Paoa and other sub-tribes in that area.
7. Although the Jlauraki tribes belong to Tainui, it has been difficult to involve them in the development strategy because of historical circumstances and the fact that many of their ).and claims have not yet been settled. Given the potential of their region, tourism seems to be the logical thrust for the region.
This then is a sununary of the scenario, to convey some idea of its breadth and the attempts being made to overcome the historical handicap of raupatu. Given the general concern expressed at state intervention policies in many areas of life, you will see that our objective is to expand and consolidate the tribal economic base and thus progressively reduce dependency on the state. 7
THE 1ThiH.l }3EALTII PROJECT
This background summary I hope has served to give you some idea of what people in Tainui are on about from an ideological and developnei;tai perspective. I want to turn now to the more specific concerns of this conference, namely the Health Project at Waahi and its implications.
The project was the brainchild of a visiting medical anthropologist who lived with us at Waahi for., several months. It was due to her persistence and enthusiasm that the local people and Health Department decided to cooperate in establishing a pilot programme on the mnrae. Visits were made to Ruatoki and Whakatane and a seminar was held at the marae to discuss ways and means of establishing the project. Then the Labour Department approved the appointment of a ].i.aison officer and two trainces on a V.O.T.P. to work with a nurse to get the show on the road. rIhe objectives are contained in Corinne Shear-Wood s paper.
I would like to turn to some of the issues which confront us at Waahi and to enumerate these as a series of questions that the trust posed to our health team. The questions are -
1. What in our view constitutes a healthy community? 2. What numbers are we talking about? 3. What are the most prevalent health problems for us? 4. What is community health? 5. Where do we see the medical practitioners fitting into the programme? 6. What are the long-term plans for continuity of this programme? 7. Where do you think the priorities of a marae-based centre should be? 8. What resources ae required to make the programme more effective? 9. If we have a statement to make about what our centre is, what would that statement be? 10. In your view, is the centre operating to the rnarae s satisfaction, or could it operate just as well off the inarae? 11. What makes it different from other health centres that you have seen? 12.. What would our ringa aroha see themselves doing at the end of this programme?
13. What would be the minimum number of people that our programme could train?
The details of the project are covered in Shear-Wood (1982). 8
1 hope that these questions will provide a basis for discussion during the workshop session. We have for our panel members of the health team, fluakiria personnel and a research assistant to the Tainui Trust Board. I should add that the team has not had the opportunity to respond to these questions and it is hoped that arising out of the discussions our own thinking will become clearer.
CONCLUSION
This paper has been concerned with outlining a very small health training project within the context of a marae development programme. The operations at Waahi, however, can only be understood against the background of a much larger tribal development programme which, in turn, has been determined by the nature of its historical experience and Tainui s position within that whole field of Maori-Pakeha relations. Good health is not just physical wellbeing, but indeed encompasses a whole state of mind. This in turn is influenced by historical, environmental, social and economic factors. We all know the difficulties we face in convincing our people of the benefits of good health when so many face the prospect of life as the unemployed, under-educated, untrained and under-capitalised segment of this egalitarian society.
In a way the thrust of this presentation is more concerned with the "politics of health". Fundamental to the politics is a clear definition of the problem. In order to do that we must ask the right questions. We believe the problems of Maori health are embedded within the wider political/economic issues of under-development. If we were to address the problem of under-development more honestly then I believe we will have gone a long way towards resolving the problem. If one can claim licence from Boris Pasternak -
"We are healthy when we live within the measure of our true possibilities, do what we can, and allow the rest to be added as pure gift and grace."
We must vigorously explore the limits of our possibilities. As George Bernard Shaw would have some people see the world as it is and wonder why, others imagine it as it could be and ask why not?
Kei whea ra taatou I roto I teenei tuu aahuatanga. Kei a tauiwi raanei te rongoa keia taatou raanei te whakaoranqa. Ka mutu mai i konei aku koorero. Nooreira teenaa koutou kia ora mai taatou. 9
REFERENCES
Berilstcin, Henry (ed.), 1976. Underdevelopment and Development The Third World TodaX, Penguin Books Ltd., Auckland.
Douglas, E.M.K., 1982. Tairjui Population : The Hunan Resource. In Proceedings of Tainui Lands Federation Conference, Occasional Paper No. 18, Centre for Maori Studies and Research, University of Waikato.
Freire, Paulo, 1977. Pedagogy of the Oppressed, Penguin Books Ltd., Auckland.
He Huarahi, 1980. A Report of the National Advisory Committee on Iiaaori Education.
Keesing, Roger M., 1981. Cultural Anthropology: A Contemporary Perspective, second edition, Bolt, Rinehart & Winstone, New York.
King, Michael, 1977. Te Puea: A Biography, Hodder & Stoughton, Auckland.
Luices, Steven, 1976. Power: A Radical View, The Macmillan Press Ltd., London.
Mahuta, R.T. & Egan, K., 1981. Huakina: Reportto New Zealand Steel, Occasional Paper No. 13, Centre for Maori Studies and Research, University of Waikato.
Mason, Gene & Vetter, Fred, 1973. The Politics of Exploitation, Random House, New York.
Pomare, Eru W., 1980. Maaori Standards of Health: A Case Study of the 20 year period 1955-1975, Special Report series No. 7 MedIcal Research Council of New Zealand.
Scott, Dick, 1.976. Ask that Mountain, The Story of Pariha}:a, Heinemann, Southern Cross, Auckland.
Shear-Wood, Corinne, 1982. Blood Pressure and Related Factors among the Maori and Pakeha Communities of Huntly, Occasional Paper No. 3.7, Centre for Maori Studies and Research, University of Waikato.
Sider, Gerald 11., 1976. Jumbee Indian Cultural Nationalism.and El1inogei.ss 161-172. In Dialectical Anthropology, Vol. No. 2.
Simpson, Tony, 1979. Te Riri Pakeha, A. Taylor, Martinborouyh.
Smith, Carol A., 1978. Beyond Dependency Theor y : National and Regional Patterns of Development in Guatemala; American Ethnologist Vol.5, No.3.
Tapper, Ted & Salter, Brian, 1978. Education and the Political Order, The Macmillan Press Ltd., London.
Waitai, Rana, 1982. Nqa Whakaaro, A Viewpoint on flaaori Issues, Staff Paper No. 2. • A_Report to the Now Zealand Planning Council.
Walsh, A.c., 1971. More and More Maaoris, Whitcombe & Tombs, New Zealand.
Ward, A.D., 1973. A Show of Justice: Racial Amalgamation in 19th Century New Zealand, Oxford University Press. Tii) 1iUKAVA TIi3!L F.LJNNIIG
E):.PEF?J :I CE AND i{EAJYJ7H
(1) Introduction
In August 1975 the ilaukawa Trustees began to discuss a 25 .-year experiment in tribal developant. They wanted to learn what being prepared for the 21st centuir would mean to their hapu ., iwi and runanga and they sought insights into the prescriptions which would help their confederation to get ready for the yea•:• 2000 and beyond. They labelled the experirrnt WhaI:atupurange Rua Mano - Generation 2000.
In the eight years sine 1975 the Trustees have received reports on the experiment at their monthly meetings, Whakatupuranga Rua Mono has desied and directed just over 100 hat involving 6 ) 500 participants and, in the latter half of this period, Te Wananga o Raulzawa has been pursuing its prograrrinie of teaching and research. Mthough tr.e evidence of progress toward the objectives of the experiment is uncertain and while most observers would be hesitant in their evaluation of the programme it would be reasonable to claim that in contrast to eight years ago the Trustees now have sets of the following:
(a) measures to describe the activities and general condition of an hapu, and I wi or a run an ga
(b) principles to guide their decision-makin g and
(a) prescriptions for their journey toward the year 2000.
Regrettably, aside from financial data on income, expenditures, assets and liabilities for hapu or iwi committees, the measures and data bases which are available to describe the activities and conditions of an hapu, an iwi or a runanga are, typically, quite crude. Nceiet1eless, a little progress has been made by the Trustees in the aeasuremont of human and physical. resources of hapu, iwi or rananga and of the activities of these groups. The Trustees have developed ways to quantify, directly or by proxy, resources such as w nanaungatanga., wairtiatanga, whakapapa and the reo. 1. A body of 69 people from the iwi and hapu of the runancja of Ngati Raukawa, Ngati Toaran gatira end To Atiawa whose score of mrae art located in the region between the Raoqit:ikei River and Porirua. Their principal task, as specified in the 1936 flativ Pupoes Act, is to acntan.ster Raukawa Maraca in OtJd. MOM
Four principles to guide the Trustees in their decision-making were fashioned early in the experirn3nt. These continue to serve this function and are as follows: ti( a) Our people are our wealth and their development and retention are of utmost importance. (b) The marae is the principal home of each hapu and as such it must be well maintained and thoroughly respected. (c) The activities and procethu es of the Trustees must guarantee the revival of the Maori language and the maintenance and development of Mao ri tan ga. (d) We must insist on greater control over our present and future circumstances."
Each of these and the set itself is relevant to the discussion in this paper. However, only the first will be explored further.
The Trustees, in collaboration with educational trusts of the runanga,2 are committed to a series of residential hui for the teenagers of the confederation. This series, on which further information is given bclo;1, and other hui and activity including the search for technology which is appropriate to the runanga s long-term development, are among the prescription for the Trustee s journey toward the year 2000.
(2) People Development and Retention
The Trustees believe that they can assist the work of schools, governnrnt departments and other agencies by drawing on the strengths of tribalism (including identification with, obligation to, pride in and group solidarity of the tribe). Some of the ideals to which the Trustees aspire are: "(a) That the members of the Confederation know or have access to information on their origins and whnicapripa (at least the last 3 or 4 generations thereof) and are contributors in one way or another to the well-being of their hapu and marae.
2. The Otaki and Porirua Trusts. The earnings of these trusts are Used to support the educational pursuits of children (i.e. , people under 20) of Ngati Raukawa, I gati Toarangatira or To Atiawa.
(b) That an increasing proportion of our inerribers are able to speak !.!aori and are familiar with their hoputanga.
(c) That all of our children whether born out of the conventional and publicly announced state of wedlock or not are embraced by and raised under the influence of their hapu.
(d) That all of our children are so instructed as to ensure that their intellectual, physical, emotional and spiritual capacities are fully developed.
(e) That the quality of health among our members be as high as any group in the world.
(f) That all of our members contribute to the common good and, in particular, that we have no members: (1) in goal or in other detention centres as we }now them today (ii) in orphanages (iii) in hospitals except for serious illnesses which are unavoidable (iv) without an activity in which they are productively engaged (v) in old peoples homes or (vi ) who can justify the claim that they are without a place to stand."
The reference to health in items ( c ) and (f)( iii) abo\ ro focus on the individual notwithstanding the hapu, iwi and rurianga context which is being asserted in this paper; and, it will be apparent that the comparison is between members of the rurienga and the healthiest in the world. The standard of comparison will change as health performances in order countries change; for our purposes it is important to note that the comparison is not with the Pakeha experience. The focus and the coiilpa:rison are intentional. Individual members who are healthy (in physical, mental, spiritual and family terjns)are necessary (but are not sufficient) for their hapu, iwi and rananga to be healthy too.
A comment on the comparison is appropriate. To make the comparison with and to target on the Pakeha standard of health, which is not the highest in the world, could mean that the quality of health of members of this confederation would be unlikely to surpass that of the Pakeha and could remain unnecessarily low relative to world standards. 4
By definition an ideal is unattainable. Nonetheless ideals are valuable beca4se of their rotes as targets (and challenges) for those who would adopt them. In the case of the confederation of iwi and hapu of the Raukawa Trustees casual observation would suggest that there are huge gaps between the ideals which are listed above and the current realities. The \Thakatupuranga Bua 14ano Generation 2000 programmes, the work of To Wan3nga o Raulcawa and other endeavours under the umbrella of or in association with the Raukawa Trustees are being preser:i.bed, designed and implemented with the narrowingof these gaps in mind.
( 3) }Iapu and Iwi Surveys
The Department of Statistics produces very little data which are directly helpful to the tribal, planning of the Raulawa Trustees (or, I suspect, of any other tribal- runanga). The Trustees have undertaken their own mini- census and have compiled a data base from the returns. In the summer of 191-19E32 there were 975 interviews conducted and in the saire season of
193-198 a further 350 were interviewed.
The principal purpose of the Interviews is to gather information which can be used to fonn a view of the general position of each hapu and iwi and of the runanga. 3 The section on personal health is simple in the extreme. The instructions to those doing the interviews vere:
"(a) Describe the member s state of health and any health problems which the member has: (i) General health. (ii) Special. problems.
(b) Describe who the member seeks help from: (i) General Practitioner. (ii) Family tohunga. (iii) Some other specialist.
(d) Describe any special remedies which the member has."
3. There are a number of side-benefits which accrue to the interviewees and to those doing the interviews. These include heightened aware- ness of fainiliness and of the nature of hapu and iwi planning; and, gaining insights into communication and techniques of interviewing. 5
The results can be described just as simply: (a) 90 per cent of those interviewed said that their general health was good. In contrast to this, of the total interviewed, 25 per cent said that they had a special health problem! Obis pair of results suggests that "good health" is seen as "normal health" including special problems where they exist.. This al.J.itude would he unhealthy if a consequence of it were that the special problems are accepted as normal and need not receive attention.)
(b) Fewer than 10 per cent of the inLervicves said that a tohunga was on their list of health consultants. (c) Two thirds of those interviewed could describe one or more special rerne(hes winch they had.
Very little was asked of the interviewees and naturally, little was received. Those doing the interviews were not equipped to do more. In addition the health section was only one of seventeen sections in the interview guide.
It is proposed that a round of "health interviews" be conducted next suiniar. Jvmb3rs of the confederation who are given appropriate training in health intervievi.ing would be employed to carry out this work. Elementary tests and questions (having to do with age, weight, height, blood pressure, frequency and purpose of clinical visitations and so on) will expand considerably the information which is in the data base at present.
A new section which had to do with attitude of mind toiard hapu or iwi was added to the interview guide which was used at the 12th 4-day residential hul for the young people (for the most part, teenagers) in January of this year. The following is an extract from the initial analysis of the interview responses: "Sixty young people were interviewed (including some of the tutors). Their ages ranged from 11 to 24 years. The majority of the interviewees (forty-one) were scholarshipholders (all teenagers).
4. Report on the Twelfth Residential flu! for Scholarshipholders (and families) of the Otaki and Porirua Trusts Board by Pakake Winiata clathd 17 January 1984. 6
The analysis of the key questions answered by the interviewees gave some inortant indi.eatiow: as to the state of the young people at the hiii. We found that only 40 per cent of those interviewed could name one set of great grandparents and, more important, only 5 per cent could name more than two sets of great grandparents. These results indicate that their knowledge of their whanairngatariga is not very good. Over 80 per cent of the interviewees said they could not nonverse in Maori a little or at all. The percentage is much higher (95 per cent) if the tutors who were interviewed are excluded.. Ilost of the young people knew the names of their marae and hapu, but 80 per cent of them visited their ma.ae fewer than five times a year which indicates poor involvement in hapu activities. They were all familiar with the Otaki and Porirua Trusts Board, but only about half of those interviexed had heard of the Raulcawa Trustees of Te Wananga o Raulcawa.
The interviews reveal that more emphasis is put on non-hapu related personal aspirations. Attaining good academic results, finding a job, travelling and good health and happiness featured more e prominently than hop r lated aspirations like learning Maori, history attending more events at the marae and learning and kawa.
The final series of questions were designed to try and get the interviewees to think about their potential contribution to their inara.e, hapu and iwi in the future. There were some distressing results from these questions. When the interviewee had decided to skip a class or to not prepare for exams J)i OpCl ly or not to complete assignments, very few (10 per cent) of them asked themselves "Is this good for my hapu?"; but, even more dlistuxbing, a majority of them indicated that they would still have skipped the class etc., even if they had asked themselves this question. Almost all of those interviewed said they would conndt now to learning more about their whanaungatanga, attending more hul at their marae, learning Maori, passing exams and to maintaining their respect for their parents and other elders. Not as many of the young people were willing to conruit to participate in mre more church activities.
When the interviewees were asked to list and rank their personal attributes that should be considered by their hapu in making its report to accompany applications to the Otaki and Porirua•Trusts Beard, the majority of them indicated that knowledge of the Maori language was the most important, with about 15 per cent saying that attendance at hapu events and potential contribution to hapu as the most important attributes."
(4) Inadequate Data Base
The interviews which have been conducted represent between 3 and 4 per cent of the population of the nmanga. The data produced are interesting but they do not comprise a data base which would be appropriate to the planning exercise in which the Raukawa Trustees are engaged. A data base which is comprehensive, current, easy to maintain, easily accessible, inexpensive and so on is required. Unfortunately, the Statistics Department is not up to the task, the Health 1partment is riot doing what is necessary, local practitioners do not have the time or the inclination and the Raukn.va Trustees do not have the resources to design and maintain an appropriate information system.
(5) Relationships_with Health_Organisations
The Raukawa Trustees have had close contact with the Wellington Clinical School of the Otago lkiiversity Medical School. Students and staff from the clinical school have had two residential seminars on Raukawa Marco and a group of scholarshipholders and other young people of the confederation have returned a visit to the clinical schoo]..
At the other end of the region spanned by the Raukawa Trustees is the Palmerston North Hospital Board. Dr 11ason Dune (a former scholarship- holder of the Otaki and Ponirua Trudts Board), Miss Te Aira Henderson, appointed by the Board last Septeider to the position of Maori Health Education and Liaison Officer, and senior officers of the Board have shown an active and sincere interest in lvlaori health. Three major one-day hui have been initiated by one or more of those people and the Raukawa District Council in the last twelve months.
5. The Dc-an of the Clinical School, Dr Johnson, and staff members, Drs Ian Pryor and Eru Poinare (a nir±rier of the confederation) have been prominent in making the necessary arningoinonts. a
The interest in health matters in the confederation and in the wider Maori community of the region has hsen greatly enlivened by the exchanges between the Trustees (and other Laori sections of the region) and these two health organisations, namely, the Wellington Clinical School and the Palmerston North Hospital Board. If this interest is maintained for the next three to five years its effects will penetrate and should influence favourably the life style and other factors which are seen to be among the deternd.narits of the suspected poor health performance of members of the Maori people in the Raukawa Trustees region.
For its part Whalcatupuranga Rua Mano will attempt to make a contribution to the maintenance of interest in health issues by continuing to include in the pigraimies for the three 4.-day hul per year for young people a session on health.6
(6) Conclusion
The tribal development programme of the Raukawa Trustees takes a view of health which extends from the individual through the whanau, hapu and iwi to the runanga. The Trustees are in search of an understanding of what a healthy confederation of its hapu and iwi is and of how to achieve that state by the year 2000. They have been engaged in their experirent in tribal development for eight years and have iicovered some procedures, principles and prescriptions which they find helpful.
A major aspect of the Trustees programme is the development and retention of their people and a health objective is specified ang the ideals.
The Trustees face a major problem in the inadequacy of healthca-id other data for planning. Their response to this has been to conduct surveys of their people themselves. At this point their data bases are scant and their information system fails on most of the criteria by which such systems are evaluated.
6. A 4-part framework which was used by Dr Mason Dune in his presentation to the 10th young peoples hui (held in May 1983), was very well received. He described each of the following concepts and drew a parallel with the four corners of a meeting house each of which was necessary: Taha Hinengaro Taha Wairua Taha Whanau Taha Tinana IJ
Close working relationships with health organisations in their region have raised the level of interest in health among the hapu and iwi of the confederation of Ngati Raukawa, Ngati Toarangatira and Te Atiawa and challenge to the Trustees development experiiixmt and prograntn, IThakatupurr-inga Rua Mano, is to feed and strengthen this interest.
Whatarangi Winiata Wellington 19 Tharch 194 COMMUNITY HEALTH CLINICS IN THE EASTERN BAY OF PLENTY
THE RUATOKI-MAAKA CLINIC
by
PUT! O BRIEN
INTRODUCTION
I feel honoured to speak in place of Ani Black. I spent six years between 1951 and 1957 working with Tuhoe people. I was stationed in Taneatua and travelled back and forth to Ruatoki and Waimana. All the old people were alive then. The people from Tuhoe are so rich in Taha Maori and Taha Wairua. Within themselves, whatever they decide, we know that it would be a success.
1. The Clinic The Beginning
From the people s point of view there were several theories and reasons as to how the Ruatoki Clinic came about. One theory said that they had so many ear problems that they had to have an ear clinic service. I was still working with the Health Department in 1977. I wasn t too far away in Te Teko and Kawerau and we all knew that the Tuhoe people had many health problems and illnesses. The children had high admission and readmission rates to hospital with undiagnosed and untreated diseases. Pakeha type medical care had been provided by the late Dr Golan Maaka who, right up until he died recently at the age of 75, was seeing patients at his rooms in Whakatane. Over the last few years this was on an irregular basis, he was ailing himself. Patients used to sit under the big trees and on the grass waiting for Golan to arrive, if and when he did. Otherwise, they would go straight up to the hospital to be seen, often at a late stage of illness.
In my view, one of the main reasons why the clinic was established was through the discussior that took place between the Public Health Nurse, the Tuhoe people that she worked with and the Supervising Public Health Nurse from the Rotorua District Health Office. The Public Health Nursebased in Taneatua kept saying - "I can t come to you, you are supervising me but I will not go until I have seen them all (patients)". 2
The Supervising Public Health Nurse went to speak with Dr Short, the Medical Superintendent at Whakatane Hospital. Dr Short was a community-minded sort of person and was keen on providing community based health services. He made us work and think about it in this way. The Supervising Public Health Nurse had, early in her career, worked with Dr Smith at Rawene up North and suggested that a small health clinic could provide a suitable base for the Public Health Nurse to work from.
2. Setting up the Clinic
I visited Ruatoki to ask Tom Williams the Headmaster of the Primary School and some of the mothers for their views. It seemed that the idea of a joint project involving the Health and Education Department Services didn t go across very well to start off with. Other similar welfare type projects in the valley had failed in the past but it didn t take very long before the Western Tuhoe Tribal Committee agreed to become involved and help the project through. Discussions with the South Auckland Education Board, the Whakatane Hospital Board and the Department of Health were very good; everyone was keen and willing to help, the people were involved all the way through.
3. Obiectives of the Clinic
It was agreed that the clinic would be established to -
(1) meet the health needs and to improve the health status of the Ruatoki Community;
(2) provide a base for the delivery of primary health care where none existed other than visits by the Public Health Nurse;
(3) provide health care which the community accepts;
(4) establish a baseline of health data on the child population in Ruatoki.
4. Sitina of the Clinic
It was felt that the school would be the best site for the clinic because it was on neutral ground. There are about nine marae within a 2 mile radius of the Ruatoki School, representing different subtribes and family groups of Tuhoe. One important contribution the community made concerned the siting of the building. 3
The architect said: "The school is here; the clinic is to be there. Turn it around to face the main road because all the people go along there."
The people didn t want it that way. So they whispered into Tom s ear: "When the building comes, you hop in there and switch it around!"
And they did. By the time the architect had come back, the clinic was facing the school. That was what the kaumatua wanted. They wanted to sit in their clinic and look out and see their mokopuna. They were very fortunate too because Ruatoki had been chosen to be the first bilingual school in New Zealand. Also, a Maori headmaster had been appointed to develop the programme. The two ideas to meet the health and education needs received urgent priority and attention by everyone concerned.
5. Funding
Funding for the clinic was made available through the Community Health Fund from the beer and tobacco tax. This covered costs of the building, furniture, equipment and establishment expenses. The building was a pre-fabricated, relocatable 3 bedroom home type plan which was modified. Personnel from within the hospital were selected to man it. The hospital board also agreed to maintain it and rent space to a general practitioner. The District Council sealed the road outside, the Power Board removed a power pole and provided underground cables and the Royal Forest and Bird Protection Society planted the clinic area with shrubs and herbs that are important in Maori medicine.
6. Servicinq the Clinic
The clinic is now the focal point of the health service to the Ruatoki Community. It was called the Maaka Clinic after the late Dr Maaka, who provided many years of service to the Tuhoe. (1) General Practitioner Services f Dr Carl Jakobsen visits the clinic twice a week. It has become necessary for him to learn body language with our people and to learn the Maori language. He has learnt it very quickly and has established a very good working relationship. A visit to the clinic is a social occasion. It is the people s clinic and they are comfortable in it. 4
(2) Public Health Nurse The Public Health Nurse based at Taneatua also visits the clinic at the same time as the doctor and works from there. They work very closely together.
(3) Special Clinics Clinics have been run by visiting staff such as the Paediatrician, Ear, Nose and Throat Specialist and the Dietitian. While the ear problems have been reduced significantly by the clinic and visiting specialists, the weight watchers classes and primary health care services are now the main users.
(4) When the clinic was first opened at the end of 1977, a Child Health Survey was carried out on all children in the valley. About 300 children aged between one month and 15 years were examined. About 89% had a health problem. Ear disorders (81%) and skin diseases (18%) were the most common disorders. The prevalence of middle ear disease, hearing and skin problems and other treatable diseases clearly established the need for an improved health care service for the Ruatoki people.
7. Evaluation of the Clinic An evaluation of the clinic after one year showed that it has been a success from both the community and health service points of view. The general community feeling is that the clinic has been a great thing. Parents, teachers, the public health nurse, doctor, dietitian and community leaders have all been involved. The community regard the clinic as their own. They have had a chance to influence its development and progress.
THE. AFTERMATH Several other community health clinics have been established since. The Te Teko Clinic was set up in 1980 following a similar protocol to the Ruatoki. one. However, the lack of a general practitioner service, the nature of the community and its proximity to Kawerau and Edgecumbe has slowed and affected its development. The Forestry Department established a clinic in Minginui in 1979, which is serviced by the doctor and public health nurse in Murupara. Te Kaha plan to upgrade its clinical facilities for a visiting doctor from Opotiki and the public health nurse. Requests for similar clinics for Waimana, Cape Runaway and Raukokore have also been received - from the community themselves. All of these have shown that health clinic facilities in the grounds of schools in a rural area that is predominantly Maori can provide a base for the delivery of health care. The involvement of the community in all stages of development and co-operation - especially of the hospital board, Department of Health, general practitioner and the South Auckland Education Board, has been very important. The costs, I am sure, are minimal when we look at the distances that isolated people have to travel and the amount of money that goes into big hospitals. Small, community based health clinics are a viable way of providing health care to isolated, rural areas. Chairperson: Mrs Elizabeth Murchie
TE KOHANGA REO WORKSHOP REPORT RECOMMENDS THAT THESE REMITS BE SUBMITTED TO THE FOLLOWING:
MINISTER OF HEALTH:
1 That this Hui strongly endorses Te Kohanga Reo and having noted the considerable health input in-its programme through its philosophy of Whanau which nurtures in an atmosphere of harmony and joy, seeks from the Minister, his support in resources and personnel for the continued development of these health programmes.
MINISTER OF LABOUR:
2 That this Hui recommends the VOTP be increased from one year to two years for trainees in Te Kohanga Reo programmes. MINISTERS OF EDUCATION AND MAORI AFFAIRS:
3 That this Hui endorses Te Kohanga Reo and seeks increased financial and administrative support for Te Kohanga Reo in its continued development. We mean administrative support be in way of stationary and on-going financial assistance for all Te Kohanga Reo Centres. MINISTER OF EDUCATION:
4 That this Hui endorses Te Kohanga Reo and recommends that Te Kohanga Reo objectives, concepts and teaching methods be implemented throughout the education system.
5 That the teaching skills of the resource people (Nya Kaumatua) who service Te Kohanga Reo be recognised by payment of wages. TE KOHANGA REO TRUST:
6 That this Hui recommends that a health component be included in a health programme for trainees of VOTP.
POINTS AND COMMENTS:
- The supportive attitudes from health professionals to work with Te Kohanga Reo on health matters, this is the best place to teach health. Te Kohanga Reo is the finest thing to happen for the promotion of health throughout New Zealand.
- This Hui recognises that Whanautanga was the philosophy that eminated from the Te Kohanga Reo group yesterday. 2
The display of this group showed us songs significant to social and health messages regarding physical and mental health as well as spiritual development and marae protocol. Each Kohanga Reo Centre is a unique set up to meet the needs of a specific community.
- The desire for Kaumatua and Whanau to share their expertise. - Dietary habits are an important component in the activities of Te Kohanga Reo because what is served to these young children is important to their whole growth.
- Utilisation of non Maori health professional in a teaching role. It was stressed that when the Whanau feel comfortable with themselves, then and only then will they ask the advise of health professionals. WAIATA 0 TE HUI WHAKAORANGA
Te Whanau Ora E Hoa Ma Ko Nga Mokopuna Te Waka Ko Te Kohanga Te Reo Hoea Ra Te Marae E Takoto Nei Nga Kupu Pupuritia Tihei Mauri Ora Tihei Mauri Ora
Chairperson: Dr Salxnond
RAUKAWA TRIBAL PLANNING EXPERIENCE AND HEAlTH WORKSHOP
Discussions focussed around the health and planning aspects of the programme. The group identified that theinforination presently available for these purposes is very limited and there need to be ways and Means of gathering that information and making it available in a form in which it has value and can be used for this specific purpose.
Three sorts of information:
1 Information available from the census. 2 Information available from on-going data - collection which is gathered by many of our institutions.
3 Ad-Hoc studies or studies which can be carried out in a particular point in time which shed light on a particular problem. 3
We have accepted the fact that in the past, much of the research which has been-done in Maori health has nothrought the benefits which have been claimed of it and we accept entirely much of the criticism which has been levelled at such research. In this regard werecognise the importance of studies such as that which was presented to us by the Maori Womens Welfare League, which is clearly an example of people participating in their own research and using the technical resources available to them to gather and use information for their own benefits and own use and we suggest that, this must be a model which we want to see very much more in the future. Research must be done with people, it must not be done on people or to people and this has got to be a feature of research not only in Maoridom, but also in all aspects of health care and health care delivery generally. RECOMMENDATION:
We need to gather information which relates to the hapu, so that there is information which can be given from the census and other resources which can be made directly applicable to tribal groups and can be used for planning purpose.
We believe it is important to develop health indicators of positive health which relate directly to the problems that you have in hand. Some Of these indicators can be obtained from social science and from the traditional health research. Other indicators Maori people will have to develop themselves, relating to their own particular situation and which takes into account of the four aspects of health which we have been talking about for the last four days. I think we all understand that the people wish to be in charge of this, that the people wish to study, to work and to gather information which will be useful to them. They have a right to the resources which are available from government departments and other sources, but there must be no misunderstanding as to who is in charge of these projects, who this work is being done for and who is going to use this information and to what end.
Chairperson: Dr Herewini Ngata COMMUNITY HEALTH CLINICS:
Clinics should not be based solely on a medical model for health care delivery. A community health clinic can be used to provide a wide range of community based services for example, legal advice, budgeting and financial advice, but the accent of the role of a community clinic should be dictated by the actual community itself. The community clinic should be a method of providing appropriate services as an alternative to those services which are institutionally based. It is also a means of developing preventive services and health education programmes. It can also provide means of co-ordinating the various community services which are appropriate in meeting the health needs of the whole person, given that funding can be available from government agencies, ie: Social Welfare, Health, Education, Justice, and Maori Affairs and Internal Affairs Departments. It is also hoped that funding or part funding can be obtained from private and voluntary organisations and service clubs. 4
The goals and objectives of the clinics should be to meet the health needs of the local community, that is the justification of services provided for such clinics. It should not be dependent solely on meeting a need for curative services as an alternative to institutional rather it should be acceptable and permissible for services to be provided of the basis that they may relate to some part of the spectrum of total health, te Taha Wairua, te Taha Hinengaro, te Taha Tinana and te Taha % hanau. It is important to envisage that the provisional service from community health clinics must be based upon the Maori aspects and perceptions outlined above. It must he recognised that because of the present system of government funding, there will be occasions when funding for a particular service will need to be drawn from more than one vote. Where part of the funding has been arranged from the private or voluntary sector and the need to provide a particular community health clinic service has been accepted by all parties it is imperative that funding from government sources be provided in a timely manner. There must be maximum flexibility to enable local communities especially the consumers to determine the types and methods of delivery of community health clinic services in their locality both urban and rural settings. The probability of other sources of funding should also be investigated for example, Accident Compensation Corporation, and The Internal Affairs Funding For Under 25 s. The triple S Scheme proposed by the review committee on primary medical ill care should be examined as a possible source of funding, in relation to appropriate community health clinic services.
Provision should be made for the ownership of community health clinic facilities to be handled over the local community, where appropriate and again putting more responsibility back to the community.
Where warranted, central government should continue to provide additional funds from the central reserve for Community Health Clinic Services. Hospital boards should also be encouraged to use provisions under the Hospitals Act to assist people who cannot afford to pay for items substantial to their health. The main things to consider, as regards to Community Health Clinic Services is that the activities of the health clinic are defined by community demand and there would be multiple agencies involvement with regards to their use and funding. HUI WHAKAORANGA AT HOANI WAITITI MARAE AUCKLAND, 19-22 MARCH 1984
From: Dr Eru Pomare, Senior Lecture in Medicine, Gastro-enterologist, Wellington, Clinical School of Medicine
INTRODUCTION: I found the Hui a very valuable experience and I am sure that you and your organising Committee now have many ideas to chase along. With any such meeting, there is of necessity a limit to the number of participants and so some individuals will always complain that they have been left out. Bob Simon, from Porirua Hosital, was one who spoke to me on a couple of occasions, thinking he should have been invited: I wonderered also about other Maori Doctors as there seemed to be relatively few of us there. Personally, I am most grateful to the Health Department for paying my way and also to you Pat for all the organising which you did. What then about the Hui itself? The participants were understandably people who were in the Health field and on the whole were older people. I know there was the feeling by some of the younger participants that more young people should be involved in such Hui and I would endorse that. Who the young people might be is another question, but a useful input could come from secondary school pupils and young employed or unemployed. When we talk about Health matters, we are often talking to roughly the same group of people, and it is the people beyond that group who are perhaps the more important.
While still on the same theme, I shall express some concern here about the outcome of the Hui. You will have collected for instance, many submissions, new ideas and recommendations. It would be too easy to shelve the fruits of our discussions and for the Health Department to say they have done their bit for Maori Health for 1984. There has been much talk and this needs to be followed up by action From personal experience, I have seen much hard work put into some of these Health issues only to see them relegated to th The programme itself, seemed a very reasonable one, though as events turned out, the time factor curtailed many interesting sessions. I guess if we are to learn anything from this Hui then it would be to allocate a large amount of free time with fewer structured sessions. With the workshops, for instance, 2 there was just too little time I felt to do justice to the issues under consideration. The workshops were also far too big and of necessity meant that some people never had a chance to say anything or if most spoke, then that could only just he accommodated in the time available. The groups therefore, generated ideas which may appear to you at this time to he a jumbled mess. Certainly the workshop guidelines were admirable but not practical for many of the workshops to follow to the letter. There were common themes however which emerged from all the workshops and such themes would seem to be worthy of further follow-up.
I think overall that the small group activities are very important as it gives more people the chance to air their views without feeling too inhibited by a larger audience. As the programme turned out, one lot of workshops with more time probably would have been best.
Having the politicians etc, at the beginning is fine for them but in terms of the Hui, it would be far more useful to have them listen to submissions at the end. I guess they wouldn t show if that were the case?
On reflection, it is interesting how some people use such meetings as propaganda exercises. I had expected for instance to learn a lot more about the Waahi Marae Project, its history, its problems and what it meant to the people. What we got was a socialogical/anthropological overview. The Raukawa Tribal Planning experience I think would have been very interesting to many people, but there wasn t anything said about the health objectives which were formulated for te Runanga. Even the Maori Nurses came through strongly, especially at the finish
Hoani Waititi Marae was a great place to hold this Hui, and Peter Sharples and his group looked after us superbly well. thought it was a great way to start the day off with Joanne Robinson s Jazzercise and in retrospect, I wonder if there could have been other ways in which healthy activities might have been promoted.
To me the most valuable aspect of the Hui was the informal contact I had with a large numbe of people involved in a wide spectrum of activities. I was very interested to hear all about the Waahi project even if this did not come through at the formal presentation or the workshop. Likewise, I was also pleased to learn of other initiatives either in the melting pot or just underway in other parts of the country. Clearly, there is a lot of activity going on and that is very exciting indeed. For me, such a meeting enabled me to get up-to-date with what is going on, and to share experiences with others. It is my view that the informal contact as opposed to the formal sessions is the most valuable part of these Fluis, and for that reason alone the Hui was a great success.
There was a strong feeling in Te Taha Tinana workshop that further health workshops should be held in other regions of the country and that younger people should be encouraged to atten. I would enclose those views. 3
Finally, I think it was a great credit to the Health Department that both Doctors Barker and Salmond were there for the whole time. All too often the people who are going to make the important decisions on our behalf do so through secondhand information. I am sure both Doctors Barker and Salmond were able to gauge the sincerity of the many viewspoints that were expressed during the week. REPORT TO DEPARTMENT OF HEALTH
Hul WHAKAORANGA
Held at Hoani Waititi Marae, 19 - 22 March, 1984
INTRODUCTION
When I was asked before the Hui by Dr. McLeod to write this report, I was both hesitant and sceptical. I was aware of the mana in which many of the speakers were held and public comment or criticism would do little for the cause of Maori health. The topics seemed so great that I saw this report becoming a chronicle of the events or a list of dismal statistics. I was sceptical that the marae protocol, with its freedom for all to speak and its attention to an individual s rights may have been too polite a place for the formulation of a Health Plan for the Future in a period as short as three days.
I was pleasantly surprised. Firstly, the conference dealt only with health, its promotion and maintenance and embodied in this was the conviction that it was necessary to start with the young. Maoris at the Hui wanted the right to determine for themselves how health dollars should be spent and pointed to ongoing projects as evidence of their ability to design and run alternative health programmes.
Two things remain to be mentioned in this introduction. One was the strength of women on the marae. Their spokespersons invariably swayed the audience with the quality of both their arguments and their oratory. Secondly, the services provided at the Waititi Marae were outstanding, both from a cultural and domestic point of view.
THE MEETING
The Hon. A.G. Malcolm, Minister of Health and the Hon. M.B.R. Couch, Minister of Maori Affairs, were welcomed onto the marae to open the Hui. Mr. Malcolm set the tone for the meeting by emphasising some of the positive aspects of health amongst Maoris - quite a change from the more usual stress on the dismal side. He foreshadowed the meeting s intent to pay more attention to the spiritual needs of healthy individuals. He encouraged Maoris to become involved in health, either professionally, e.g. nursing or members of proposed area Health Boards, or personally, e.g. the prevention of obesity, stopping smoking.
The Hon. M.B.R. Couch claimed that in his view there was no such thing as "Maori Health", only "People Health" and that the former term had been coined to excuse some from facing the facts that much ill-health was self-inflected. He then expressed a view that health institutions were staffed by sympathetic sincere staff and that if the practices they were following within hospitals seemed unacceptable to Maoris, it was likely to be because of ignorance rather than a reluctance to fit in with Maori customs. It was up to Maoris to inform and educate health professionals in their traditions and not expect them to be mind-readers.
Dr. Tamati Reedy s message was simple: Fitness equates with health and well- being, and fitness is one s own responsibility. -2-
The discussions on Tuesday afternoon on the theme of "A Maori Perception of Health" was one of the highlights of the whole Hui and took a holistic view, including spiritual, mental, family and physical health.
The Rev. Hone Kaa warned that a community that separates the spiritual from physical health does so at their peril. Racial institutions, including the church and the health care services had denigrated Maori spirituality and attempted to replace it with another doctrine. The blatant racism in the health services would only be overcome by:
(a) a major review and change with the services currently administering Maori health care.
(b) redirection of funds to encourage Maori health initiatives
(c) increasing the number of Maori doctors, (though he warned of the danger of them becoming "perfect house niggers")
(d) establishing Health Clinics where doctors, lawyers and social workers were available to provide early intervention for the problems inter- fering with healthy living.
(e) Hospital Board social services increasing their numbers of Maori social workers up to 25% of the total.
In the session on Te Taha Hinengaro (Mental Health) Dr. Mason Dune focussed on Mental Health rather than Mental Ill-Health and considered the topic under the headings:
(a) What is Mental Health?
Dr. Dune reminded the audience that the holistic view of health was a very familiar one in traditional Maori society and acknowledged the unity of the soul, the mind, the body and the family. Western medicine in contrast emphasised body health at the expense of those functions that could not be explained by the Laws of Physics.
(b) Who says so?
In deciding who should define Mental Health he warned that experts study dysfunction rather than the promulgation of health. Further, as with other facets of life, statements about health emanating from the Marae have undoubtedly been made, though not necessarily heard, particularly if matters of health are looked upon as the exclusive province of western-trained health professionals.
(c) What is the prescription for Mental Health?
One such statement, written in 1949 was used by Dr. Dune to illustrate his prescription for Mental Health:
"Grow up, o tender plant, for the days of your world, Your hand to the tools of the Pakeha for the welfare of Your body, Your heart to the treasured possessions of your ancestors as a crown for your head Your spirit to God, the creator of all things".
Ngata -3-
The proverb acknowledges that growth does not occur without nurturance or new changes, such as embracing new technology. It then advises the young to seek strength and dignity in the teachings of their ancestors and finally advises to pay heed to spiritual dimensions.
Mrs. Rose Pere introduced the topic of Family Health and illustrated those eight aspects that she believed contributed to a person s wellbeing as the tentacles of an octopus. These were:
1. Wairua - spiritual wellbeing 2. Mana - uniqueness of the family gives sustenance 3. Mauri - life force 4. Ha - the breath 5. Whanaungatanga - group dynamics 6. Wha tumanawa - emotional aspect of a person 7. Upoke - physical needs of the family 8. Hinengaro - the mind.
The initiative of Maori women in health matters was really grasped by the Maori Women s Welfare League. Their nationwide survey Of women s health broke new ground with so many League members collecting data vital to the nation s health. Mrs. Elizabeth Murchie and Mrs. Georgina Kirby are to be congratulated for their remarkable efforts.
Dr. R.A. Barker, Director-General of Health, provided a sympathetic historical perspective of health services in New Zealand. He emphasised the vulnerability of Maoris in former times to epidemic infections and, later, to metabolic diseases. He again emphasised that, apart from immunisation, "medical practice" had contri- buted little to the nation s health when compared to general provision of pure water or good housing. For whatever reason though, there had been substantial improvement in the health status of all New Zealanders and in general the Maori rates of disease, while still inferior to the Pakeha rates, were improving at a more rapid rate.
The session on Wednesday afternoon outlined some Maori health initiatives that were (a) widely accepted by the local people and (b) were successful in not only the delivery of acute health care, but in fostering the maintenance of a healthy community.
Mrs. Mahuta described the Waahi Marae Trust Project at Huntly, an example of community development that linked economic measures, employment opportunity, Maori culture and health care all incorporated as a Marae Project.
The Raukawa Tribal Plan, under the stewardship of Dr. Whata Winiata, may be New Zealand s most ambitious community health and development plan. The trustees began in 1975 discussing a 25-year plan for people of Ngati Raukawa, Ngati Toarangatira and Te Atiawa tribes who live in the many Maraes between Porirua and the Rangitike! River and set:
(a) measures to describe activities and general condition of the tribe (b) principles to guide their decision-making activity (c) prescriptions for their journey towards the year 2000.
Four principles guided the trustees in their decision-making:
(a) people are the wealth and their development and retention are important (b) the Marae, as the principal home of each hapu, must be maintained and respected. (c) the trustees must guarantee the revival of the Maori Language and culture. (d) they must insist on greater control over their own futures. -4-
Hence, under (a) People Development: the trustees aspired to:
(i) have members aware of their origins and family trees (ii) increasing the proportion speaking Maori (iii) have all children welcome within the extended family (iv) develop fully children s intellectual and physical capapities (v) raise the quality of health to that of best in the world (vi) have all members contributing to the common good with nobody in gaol, orphanages or old peoples homes etc.
The baseline measurements for this scheme have been undertaken by young people of Te Raukawa.
The third topic of the session was the description of Community Health Clinics at Ruatoki by Mrs. Puti O Brien, formerly a Public Health Nurse in the area. The provision of facilities by Whakatane Hospital provided a precedent other Boards could follow.
Finally, Mrs. Anna Jones provided a very practical lesson on the strength of Te Kohanga Reo as a learning experience. With 250 Kohanga Reo in New Zealand there is a wide network already functioning and instilling health concepts into children under four years of age.
COMMENTS:
1. Dame Whina Cooper, in her inimitable way, said on the first day that she expected action, not more words - a very pertinent observation from a founder member of the Maori Women s Welfare League who has been making suggestions on Maori Health for more than 30 years.
2. The positivity of this health Hui was remarkable with barely a mention of the rather dismal statistics on Maori Health and I believe this positive attitude is justified when one hears of Maori initiatives already functioning. The obvious emphasis on health rather than sickness was a refreshing change.
3. Attendants at the Hui all seemed to be saying "start with the young" - a sentiment often expressed in Pakeha medicine but rarely followed.
4. The acceptance of the models for health care already in existence should encourage the Department of Health to extend and experiment with Maori-based centres for Maori communities.
5. New Zealanders, including Maoris, must be encouraged to "tend to spiritual aspects of one s being", for in this lies one of the keys to good health.
6. The power of Maori women as community leaders was apparent. The Maori Women s Welfare League have been well served by their leaders, past and present and in all community projects discussed their contributions were obvious.
7. The recently established Maori Nurses Association was strongly represented and expressed a Health Professional viewpoint. It is clear they want to adopt a more active role in Maori Health Care.
8. By concentrating on the positive aspects of Maori Health-and the provision of health skills to the young, no time was wasted on fruitless discussion as to who was to blame for poor health amongst Maoris. Both Ministers held that good health was earned and poor health equated with neglect or excesses. -5-
9. Maoris want to determine their won destiny and expect a greater voice in the allocation and distribution of health resources.
10. The Health Department is to be congratulated for its willingness to hold such a Hui to judge what Maoris perceive as health needs.
11. Hoani Waititi Marae proved to be a remarkable location for such a Hui. Few of the visitors could fail to be impressed by the excellent standard of accommodation and catering the Marae provided.
Finally, I personally thank the Department of Health for giving me the opportunity to attend. It may have been the most important meeting on Maori Health held for forty years - time alone will tell.
COLIN D. MANTELL PARTICIPANTS WHO-.ATTENDED- .THE HUI WHAKAORANGA
Ms 1 Young MRS S PRENTICE Medical Social Worker Board Member Middlemore Hospital Cook Hospital Board AUCKLAND GISBORNE
MRS P O BRIEN MRS E MURCHIE Bay of Plenty Hospital Board Research Director WHAKATANE NZ Maori Women s Welfare League
MRS C PURDUE MRS H WILSON Board Member Tai Tokerau Area Representative Auckland Hospital Board NZ Maori Women s Welfare League AUCKLAND
MR W PLEYDELL MRS P WETINI Staff Nurse Community Officer Oakley Hospital Department of Maori Affairs AUCKLAND TAURANGA
DR W PARKES MRS M TAIKATO Geriatrician Medical Student Northland Hospital Board WELLINGTON WHANGARE I
MS J WENN MR M PAUL (AND MRS PAUL) Chief. Nurse Waiariki District Representative Taranaki Hospital Board New Zealand Maori Council NEW PLYMOUTH
DR D BARRY PROFESSOR C MANTELL Paediatrician Obstetrician/Gynaecologist Hawkes Bay Hospital Board Clinical School of Medicine HASTINGS AUCKLAND
MRS V O SULLIVAN PROFESSOR W WINIATA (AND MRS Chairperson Keynote Speaker WINIATA) Waikato Hospital Board Department of Accounting HAMILTON Victoria University WELLINGTON
MS M SOMERVILLE MR S WARU/MR 3 TAMAKI Chief Social Worker Representing Mr A Phillips Thames Hospital Board THAMES Ms Harriet Chase Mrs R Hurst Hamilton National Vice President NZ Maori Women s Welfare League
Ms Teuira Mareroa Member of Steering Committee National Council Maori Nurses on Maori Health Auckland WELLINGTON
Ms A Henderson Mrs M Wikaira Maori Health Education Adviser Tainui Area Representative Palmerston North Hospital Board NZ Maori Women s Welfare League PALMERSTON NORTH
Miss A Moody Mrs M Nairn, Northern Regional Officer Dental Practitioner NZ Nurses Association AUCKLAND AUCKLAND
Ms E Davies Dr I Hassall Auckland Deputy Director Royal Society of Health of Women and Children (Plunket) AUCKLAND Mr P Sciascia Mrs M Bruce Assistant Director President Maori and South Pacific NZ Federation of Voluntary Arts Council Welfare Agencies WELLINGTON Chairperson Wellington Hospital Board Mr R Ellison WELLINGTON Te Waipounamu District Representative NZ Maori Council
Mrs Tuwhakaraina Dr J Newman Tauranga-Moana District Representative Representative New Zealand Paediatric Society NZ Maori Council AUCKLAND
Miss A Delamere Ms H Wislang Adviser Department of Community Health NZ Maori Women s Welfare League Tauranga Hospital WELLINGTON TAURANGA
Dr M Paewai Dr M Upsdell Medical Practitioner Representative Royal NZ AUCKLAND College of General Practitioners• AUCKLAND Mr W Parker Dr JVHodge Visiting Lecturer Director Victoria University New Zealand Medical Researci WELLINGTON .:Council ,AUCKLAND Dr R Barker Dr P Ngata Director-Genera l of Health Community Medicine Registrar Department of Health Coordinator of the Steering Wellington Committee Department of Health Wellington Dr J Holden Deputy Director Division of Health Promotion Ms L Dyall Department of Health Advisory Officer Wellington Review and Development Secretary of the Steering Committee Dr B James Department of Health Director of Mental Health Wellington Department of Health Wellington Mr N Te Hiko Senior Executive Officer Mrs M Bazley Hospitals Division Director of Nursing Member of the Steering Committee Department of Health Department of Health Wellington Wellington
Dr P Kinloch Mr G Garlick Research Officer Senior Advisory Officer Management Services Research Unit Hospitals Division Department of Health Member of the Steering Committee Wellington Department of Health Wellington
Dr J Brownlie Medical Officer of Health Dr G Salmond Whangare i Deputy Director-General of Health Member of the Steering Committee Department of Health Miss L Dickson Wellington Principal Public Health Nurse Hamilton District Office of Health Mrs A Barham Principal Public Health Nurse Member of Steering Committee Mrs M de Ridder Rotorua District Health Office Principal Public Health Nurse Gisborne District Office of Health Miss T Bradley Nurse Adviser Mr B.Potaka Member of Steering Committee Senior Exectuvie Officer Department of Health Chairman of the Steering Committee wellington Department of Health Wellington Mrs 3 Keith Dr I Prior WELLINGTON Epidemiology Unit Clinical School of Medicine WELLINGTON
2 Rer,resentativeS of Mr S Edwards Alcoholic Liquor Advisory. Dental Practitioner Council ROTORUA Representative NZ Medical Association Mr Ross AUCKLAND Chairperson NZ Dental Association
Dr R Jackson Department of Community Health Dr P Gow Clinical School of Medicine Rheumatologist AUCKLAND Middlemore Hospital AUCKLAND Mr B Elliott Dr P Hutchison Tokanui Hospital Obstetrician/Gynaecologist TE AWAMUTU AUCKLAND
Dr M Abbott Mrs W Walsh Director Taumaranui Hospital Board Mental Health Foundation of TAUMARANUI New Zealand AUCKLAND
DEPARTMENT OF NURSING STUDIES, MASSEY UNIVERSITY: Dr FSewell Ms M Pybins Department of Community Health Ms 3 Bodding Clinical School of Medicine Ms I Madjar AUCKLAND
Mrs M Hammond Mr J Fahey Ikaroa Area Representative Director Accident Compensation Corporation New Zealand Maori Council WELLINGTON WELLINGTON
Ms W Aorangi AUCKLAND DIVISION OF NZ CANCER Accident Compensation Corporation SOCIETY: AUCKLAND Mr 3 Gaiser Mr P Liddell Ms B Marshall Mr N Pearce Research Officer Dr S Tonkin Clinical School of Medicine Representative WELLINGTON Paediatric Society AUCKLAND Ms Ora Campbell H Timoko Carringtbn Auckland AUCKLAND
Ms Lena Reiman Ms E Ngata
Carrington Te Atatu AUCKLAND AUCKLAND
Ms Nellie Hipplolite Ms A Ngata
Carrington Te Atatu AUCKLAND AUCKLAND
Ms E Redwood K Ngata Kingseat Hospital Te Atatu AUCKLAND AUCKLAND
Ms M Baker Dr H Ngata Pharmacy Hospital Te Puia Hospital AUCKLAND WAIAPU
Ms H Tukukino Mrs K Ngata Waikato Hospital Board Tairawhiti ki HAMILTON TAURANGA
Rongo Manapori G Williams Wanganui Hospital Board Carrington Psychiatric Hospital WANGANU I AUCKLAND
Audrey M Butler Ms W Overy Manukau Technical Institute Fiji Red Cross AUCKLAND AUCKLAND
Ms T Rangiwhetu Mr H A Murray Wanganui Hospital Rehabilitation League WANGANU I AUCKLAND
Dr J Davey Mr R Edwards NZ Planning Council Rehabilitation League WELLINGTON KAITAIA Mrs H Allen Miss N C Neilson Principal District Nurse: Waikato Hospital Board Cook Hospital Board HAMILTON GISBORNE
Dr R G Güdex (AND MRS GUDEX) Dr A 3 Sommerville Obstetrician/Gynaecologist Waikato Hospital Board Waikato Hospital HAMILTON HAMILTON
Mrs O.Ohia MRKTito TAURANGA Northland Hospital Board Representative NORTHLAND
Ms R Henry Ms A Cochrane-Pihama Aotea Area Representative ACCORD NZ Maori Women s Welfare League Auckland AUCKLAND
Ms J Robinson A Maree Millac MBE Department of Maori Affairs Taitokerau Maori District AUCKLAND Council Whangarei Mrs T. Rangiwhetu WANGANUI
Mr I Irwin G L Tustin Tai Rawhiti District Representative Dietitian NZ Maori Council Department of Health GISBORNE AUCKLAND
Mr J Wilson Miss P Carroll Charge Nurse Executive Director Tokanui Hospital NZ Nurses Association TE AWAMUTU WELLINGTON Mr E Murray 3 F Kett Staff Nurse Charge Nurse Tokanui Hospital TE AWAMUTIJ TE AWAMUTU
Mrs J Kett Mr D Hansen Charge Nurse Maori Affairs Department Tokanui Hospital Henderson TE AWAMUTU AUCKLAND Mrs K G Kirby Mr P O Brien National President Manakau Technical Institute NZ Maori Womens Welfare League AUCKLAND AUCKLAND
Mr J Tañgiora Mr L Tangaere Takitimu District Representative Chairperson NZ Maori Council Waiapu Hospital Board TE PUIA
Dr B Gregory Dr . R Mahuta Member of Parliament Keynote Speaker for Northern Maori Waahi Marae Trust HUNTLY
Dr M Dune Mr P Creevey Keynote Speaker Contract Researcher Psychiatrist Kihikihi Palmerston North Hospital
Dame Whina Cooper Mrs L Manuel Foundation Member/Past President Pal Rawhiti Area Representative NZ Maori Women s Welfare League NZ Maori Women s Welfare League
Mrs A Koopu Mrs I Kingi Waiariki Area Representative Women s Health League NZ Maori Women s Welfare League ROTORUA
Mrs B Hunapo Mrs P Makiha Managere Branch Chairperson NZ Maori Women s Welfare League Auckland Maori Nurses Association AUCKLAND
Mrs T McDowell Mrs E Grooby Mangere Branch Te Waipounamu Area Representative NZ Maori Women s Welfare League NZ Maori Women s Welfare League AUCKLAND
Mrs L Whiteside Dr E Pomare Mangere Branch Gastroenterologist NZ Maori Women s Welfare League Department of Medicine AUCKLAND Clinical School of Medicine WELLINGTON
Ms E Te Pau-Konui Dr A Ruakere Lkaoa Area Representative Medical Practitioner NZ Maori Women s Welfare League OPUNAKE
Dr S Walker Mr T Winitana Medical Practitioner HAMILTON AUCKLAND
Maaka Tibble MsOOhia 1-léalth/Whanau Royal NZ Foundation, Ngapeke Whaioran,g.a. Centre-Project... for the Blind AUCKLAND TAURANGA
Ms E van der Werff Ms J Cairns . Health Department Ngapeke Whaioranga Health Takapuna Whanau Centre Project AUCKLAND TAURANGA
Ms S Tuhakaraina Ms V Cooper Department of Health Ngapeke Whaioranga Health/Whanau Centre Project Takapuna TAURANGA AUCKLAND
Margaret Rose O Sullivan Ms 3 Crawford Department of Health National Heart Foundation Takapuna AUCKLAND AUCKLAND
Mrs B Pótaka Mr C Fisher Lower Hutt National Heart Foundation WELLINGTON AUCKLAND
Ms E Blackwell Ms R Rata Department of Health Social Work Department Takapuna Carrington Hospital AUCKLAND AUCKLAND
Ms B Te Wheoro Ms 3 Schaveren Public - Health Nurse Mt Albert Centre Manurewa AUCKLAND AUCKLAND
Mr S Mathieson Ms H Te Hemara State Services Commission Community Officer AUCKLAND AUCKLAND
Mr A Tana Ms M Smith Alcoholic Advisory Council Tokanui Hospital Board AUCKLAND TOKANUI
Mr M Raerino Mrs Anihira New Zealand Maori Council A.L.A.C. AUCKLAND TAUMARANUI Ms R Henry Ms N Andrews Maori Women s Welfare League Department of Health Regional Aotea HAMILTON TAUMARANU I
Ms C Manihera Dr A Cowan Maori Women s Welfare League Medical Officer of Health TAURANGA Department of Health SOUTH AUCKLAND
Ms R Norman Ms H Puru Accident Compensation Commission Maori Women s Welfare League AUCKLAND AUCKLAND
Ms T Hetet-Matatahi Ms M Szaszy Waahi Marae Liaison Person Maori Women s Welfare League HUNTLY AUCKLAND
Ms S Filipo Ms E Tito Fiordland Community Health Worker Diabetes Field-worker ROTORUA Otahuhu AUCKLAND
Ms B Holm Mr D Nepia Prime Minister s Department AUCKLAND Social Affairs WELLINGTON
Ms J Takarangi Ms B Allen Maori Health Resource Maori Women s Welfare League Team Member AUCKLAND PALMERSTON NORTH
Raukina Leather Ms M Larkin 12 Makara Road AUCKLAND PARAPARAUMU
Ms D Hutchins Ms J Te Hermara Maipa Department of Health AUCKLAND GISBORNE
Dr M J Paparangi Reid Dr R Flight Te Rarawa House Surgeon Department of Health Middlemore Hospital Takapuna AUCKLAND AUCKLAND
Mr R Munro Ms R Te Miringa Huriwai Northland Community College Mental Health Foundation Board Member WHANGAREI AUCKLAND
-A Dr J McLeod Medical Officer.of Health Takapuna District Office of Health Member of the Steering Committee Takapuna
MrWKaa Director, Maori and Pacific Islands Education Department of Education Member of the Steering Committee Wellington
Mr D Curry Chief Executive Officer Division of Public :I1ea1t11 Department of Health Wellington
Mr M Hollis Director of Health Education Department of Health Wellington
Dr H Buchan Community Health Trainee Auckland
Mrs K Kereama Raukawa Area Representative New Zealand Maori Council Feuding
Mrs H B Allen Principal District Nurse Cook Hospital Board Gisborne
Mr D Snelgar Northland Health Services Advisory Committee Whangarei District Office of Health Whangarei
Mrs B Kill Health Education Regional Adviser (Wellington) Department of Health Wellington
Ms H Delamere Thompson Mrs E Flight Middlemore Hospital Maori Women s Welfare AUCKLAND League AUCKLAND
Dr F B Sill General Practitioner ROTORUA
Ms S Tuhakarainga Tauranga Moana District Council TAURANGA
B McCormick Henderson House AUCKLAND
Dr J S Te M Allan AUCKLAND
Mr H M Te W Williams Director Te Reo 0 Aotearoa AUCKLAND
Tarat i-Hohepa-B irks Redwood Haven Therapeutic Community SWANSON
Ms Donna Awatere Te Koputu Taonga AUCKLAND
Mr Winston Maniapoto Probation Service AUCKLAND
Mr Brendan Scully Carrington Hospital AUCKLAND
Ms Wiki Anderson AUCKLAND WA 300 [QI 87825 Planning .... k oP (1984 Auckland)
WA 300 [Q] MAO 1984 87825
Library DGpe,tmnf of Health ftlongton /
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