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[Q]14A01984
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="t Of Healthwellivon
087825
CONTENTS
1 .NI I-
2.FOREWORD
PAI('lI
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 ITRECOMMENDATIONS FROM 11111 WIIAKAORANGA
PART 1 11APPEND ICES YELLOW
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 koutoui nga ii iiiai tua kua h:inga at u,Rua hi.nga inaii
.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
nganull,nga tangi 1i a koutou.
Me huri uga whakaaro hi a tatou te hurigaora , tenakoutou
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 tewahanga,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
economicandsocialconcerns,butalsoouremerging
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 ofproviding 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 theHui
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
DepartmentsofMaori AffairsandEducation,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
responsibilityto inform Maori people what resourcesare
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.cjpantsmade aboutLite
organisation of the tlui was that; they would have liked moretime
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.Speechgiven by the Honorable A.(.Marolni,Ministerof
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 HEALTHHe Whakamaramatanga : An Explanatory Note.
It.is important. to CJ'lPiLiSI*IIl Ii'' f)rJ,1 lirlilig tJlfltthefe 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
sinceritythe many and variedtribal,subtr.tb.al ,fam:i. I.yand
individual Maori beliefs.
Tounderstandtheprogramme,keynoteaddressesarid
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. hisis
intimatelylinkedto 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.
culturalgroup,iwi ( tribal, group), hapu (subtrihalgroup)
zi
whanau (family) or individual and another.The World Health
Organisation defines health asa state of complete physical mental and social
well being and not merely the absence of disease or
infirmity
A Maoriview of health is broader in thatitincorporates
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 Tawhitothe 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), andawesomeresj)ect . Moreover,i t: fosters an
integrated set Of values,beliefs and attitudesthat 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 Icare--
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
Landprovides 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 individualwellbeing.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 (genealogic-al It insh :i.p ) Li, es . Whaka pa pa :i S t. he
essential element that links man with his past and present
worlds.Severalwhanau 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
migrationsfrom Jiawniiki. o aneponynious ancestor.Tribal
ieadershr pinearl yda y s was vested in thenut: 1,or:i Lvofthe
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,
butasa 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,socialcontrotandstrengthensfamily
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
responsibilityof 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
Means Ca r ing, shari ng, 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 IIauoriand Te Wa;iora are cocepts that. conveynotionsof
wellnessand wellbeingin its widestphysical011(1spiritual
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,supportsystems and 1, h e naturalworldto
ensure (lie total. grnwt:h, deve.lopnioiit1n(] 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: allthe
time and everywhere.I I. p r o v :1 des a d y 1) F1 mi c Ii nk wi iiiones
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.Centraltotheconcept;ofl- {i.nemmgaroisthe
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 esteemare 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
economicstatus,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.
(2) That.healthun(.1d it c a U :tona.Iinst.t.ut.ioilsrecogn:i soMacri
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
thatare amenable Lu modern medicaltreatment. ,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 amidallocation 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.
holistica i.p roachto health must:includes 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.
Thiscannot. 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 areused
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
guidanceihrough 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
recognisediii 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
availableand theyget enormous strength fr om the whannu
group.
4.EQUITABLE ALLOCATION OF RESOURCES
Thereare two main resource issues relatingtocurrent
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 ('fsystems
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 kaumatuaare among the most important
people in the Maori. world.They arE viewed as the expertsJ. 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 onan
informalvoluntary 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
resourcegroup which is comprised of mainl yy M;ioi'ihealth
personnel to assist in the preparat: ion of broad !"formation
guidelinesforhospitalboards,Professionalhealth
organisatons,teaching institutions and other health workers.
Itisintended that. the informat:ion disseiiiinnt.edwillinclude
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
meansbywhich the Loht.inga UIICI knuIIRil.Ua may here(oi,:i sodand
given due status for the health rare they prov.id'.
2. Maori Health Personnel
The newly os tab 1 Wellod tica.1 I' Iir rv 'I cr's l'er nil I ( oman i s s i n" a imd I 1,
SlateSriresUon,riissi.oiishouldlake alendernhiprolein
redressing !he ,'imnt.ciJ arice of Maori l'oo! . l' in the Iica,l lb svl.o,n.
Informationaboutc:1i'e'ropportunities available bothinthe
Public and Health Svrvioes siiciiid be l)1()IIi%I.l.II.e(l on iriurne an(iin
schools,highFighl lugthespecialski] Isandindividual
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 ticIsland preference scheme.The State 5r . rvj ce
Coinjniss:ionhas a Iso expanded the ruimhor of p I aces avaJ lahi e(or
MaoriandPacific Islanders to join the Ptibl ic ServicetILroIigIi
theMaur iaridPa i ficIsland.Juriiorl?erriii IIII eritr, choinr'.
Opportuni I :i Osareolson.va i [able for graduates iiithe.Ii.injni
ManagementTrain i 11 ifScheme inn jul nt. I by (lieIiosp I la Itoards
Association aridthe health Lteparlrinor i !Thoseit iat iv es should
Pu (I P ITS I. oudnih (Iacce(, I f- (II S 1)0 I I ( I es n F pus i t. i y eact 1 (IIII.o
improvetheha lance of Maui' i and Paci tic Is 1 and peopleiii1, lie
Public: and Healtherv ices.
The cal I for more Mnori nt.nrser, is now begi III) ing to headdressed.
Thisyearthe Depar't;nients of Maori Affairs arid Educat. ionhave
establishedfourre--entry nursing coursesat.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 eI o that,I wir i C: Iihas
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
Tofar I I it; at ec ross—cul I; ura I commun I ca t. 1. on a it (I It ride is I arid i riga
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 teninfo 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 ionis a two way process.in order to
facilitatethis two--way process,opportunities should alsohe
given to Maor-i health workers to reaffirm their Taha Maoriad
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 supportedby
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 -
in films and bi-lingual print material which calllent to
whanau groups and to health workers.
The policy of Te Kohanga Reo Whanau Centre, however, is to invite
healthprovider groups such as. Public Health nursesand
Departmental medical: officers and other health a gencies 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.
1.2That support and special status be given to the
tohunga and traditional health practices to
facilitate their recognition and utilisation in
the health services.
1.3That 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.
1.4That 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
trainemployees 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
2.1That health and educational inst. I tutions
recognise Maori culture as a positive resource
and Te Ta.ha 1Iinenaro as an essential part:
2 -.2That 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 peopleor
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.
: . :3That support: be given to denti fying and encouraglng
the use at Muon. personnelitt exist ing health
service agencies.
2.4That: 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.
2.5That the wider ramifications of the care of
Maori people in existing longand
intermed -iate care institutions such as rest homes and
geriatric units he explored.
2.6That.thefeasibi lilyofinclud:itiff, Maori
spirituality in heal lb education programmes
in schools and 1........... I iary educationali 1 st. i t.ut:to,is
ii e i a V es I i. g a t c (I
2.7Thatassistance he giventolien 1, lb
workersandpro less i. ona iswit: h anin t res tin
Macu- i.If Elitoimprovethe:ircross--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
3.1That 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.
3.2That 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.
3.3That 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.
3.4That 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
4.1That 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.
1.2That.prior- i Lybeg:iventoimportant.
diseases/sicknesses that are amenable to modern
medicine i.reat.riient ,e.g.(I ahetes, ti dney, heart.
and chest:. diseases, hepat:i t.isand 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;
crunning marae courses, seminars on the use of
health services.
1.4That: 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.
4.5That 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.
4.6That 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 Marge 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
6.1That 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 coveringfor example:
weekly hours of exercise
- number of contracts with iiiarae in a given period
hoursin 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. "1Thaiit(roInpro fit isemethodofparLlei.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 resse d by Ihem
(b) a .ii! 1ng and development' experience inwhich 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. 1Thatthe Department of Health arid Mnor.i
Affairs support Marne Community health initiatives.
7.2Thai 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
7.3That 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 health service
agenc- les so that:they can respond to locally
defined needs.
7.4That 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.
7.5That the possiblity of other sources of funding such as
Accident Compensation commission and voluntary
agencies, Internal Affairs Department should be
investigated.
7.6That 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
7.7That where warranted, cn1.rai government provide on--
going funds for community health centres/1 inic
s e r v .t ce s
7. HThat: an accountabi. 1.i, I;y struclure be esiahl:islied 11)
in trnr fuw.li.ng from government, and other agencies
7.9That an inC orrnati on syt.ern be established to provide
advice and knowledge on health initiatives.
7. 10That. 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.
7.11That 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. 12That 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
8.1That Hui endorses the considerable health component and
strongly commends ihe Te Kohanga Re(.-) Trust l'rograinune
and its workers.
I (3
. 2ThaL 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.
8.3That 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- Other recommendations that emerged during the Hui.
9.1That the Department of Health prov.i do an estimate
and analysis of the expenditure from Vote:Health
on Maori people.
9.2Thatthe Mill isLet' olHealth acknowledgethe
establi.s lime ntofthe Nat ic'nal Councilof Mann
Nurses and recogii:tse the need for a National base
with full-time nursing personnel.
9. 3That the half-Way houses for the rehab .i Ii tnt.ion of'
ps y chiatric pair louts he estal, l.:i.shed.
9.4ThattheI)epartment.oflieu I iliFundafain.i 1 y
therapist in the Mangene Community.
SECTION 10-Further recommendations that have beenproposed
throughj h^^ evaluation qLif^ajionnaire of the Hui
Whaka o ra rigg,
48
TO. 1That in the organisation of the new Area Heal lb
Boards,Maoripeople be appointed toeach
committee concerned.
10.2That the Maori language and culture be included in
allflied] caland nursingtrainingrograininc,
taught by Maori people.
to. 3That increased time be given to Maorilanguage,
Maori News and programmes of interest to Mann.
people on Television.
10.4That Health Department and Hospital Boards shou.l d
not.exploit. Maoripeople willingt.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
5.00 pm
7.309.30 pm
9.30 pm
Tuesday, 20 March 1984
5.45
6.00 -6.45 am
7.15 am
8.30 am
9.00 am
10.30 am
11.00 am
12.00 -1.00 pm
Powhiri - Whakaekenga, Mihimihi
Dinner
Hoani Waititi Marae Committee(The content and organisation ofthis session to be arranged bythe marae committee)
Supper
Get up
"Te Rapu Ora" Joanne RobinsonHealth and physical fitnessprogramme
Breakfast
Mihimihi (Tangata Whenua)
Formal welcome and openingaddresses by Hon A G Malcolm,Minister of Health andHon M B R Couch, Minister ofMaori Affairs
Morning Tea
Keynote address Dr Tamati Reedy,Secretary of Maori Affairs"Tu Tangata - how its philosophyis an integral part of planningMaori Health programmes."
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 pmAfternoon Tea
3. 00 pm
3.40 pm
4.15 pm
6.00 pm
7.30 -
•3 Te Taha Whanau (Family Health)Mrs Rose Pere
4 Te Taha Tinana (Physical Health)
Free time - an opportunity to get toknow each other
Dinner
Evening Session
9.00 pmMaori Women's Welfare League ResearchProgramme(The content and organisation of thesession to be arranged by the League)
Supper
Wednesday, 21 March 1984
5.45 amGet up
6.00 -6.45
"Te Rapu Ora" Joanne Robinson
7.15 amBreakfast
8.30 -10.00 amMihimihi/Karakia (Tangata Whenua)Four workshops on a Maori perceptionof health
10.00 amMorning Tea
10.30 amKeynote address: Dr Barker,Director-General of Health"Health Services in New Zealand -a historical perspective"
11.05 amDiscussion - Chairperson Tangata Whenua
12.30 -1.00 pmLunch
1.00 -2.30 pmGuided tour around Hoani Watiti Maraecomplex
2.30 -4.30 pmKeynote speaker
2.30 pm•1 The Waahi Marae projectDr Robert Mahaha
3.00 pm2 The Raukawa Tribal PlanningExperience and HealthProfessor Whata Winiata
3.30 pmAfternoon Tea
3
3.45 pm
4.15 pm
7.30 pm
3 Community Health ClinicsMrs Ani Black, Ruatoki - aconsumer viewpoint
4 A health education model for aMaori setting Kohanga ReoAnna Jones
Four workshopsParticipants to choose one workshop
Dinner/Social
4.45 -6.00 pm
Thursday, 22 March 1984
5.45 am
6.00 -6.45 am
7.15 am
8.30 am
9.00 -10.00 am
10.00 am
Get up
Te Rapu Ora
Breakfast
Mihimihi/Karaka (Tangata Whenua)
Report back on workshopsEach workshop spokesperson to presenton agreed upon statement of keypointsand issues raised for discussion
Morning Tea
OPEN FORUM
10.30 -12.00 noon
12.00 -1.00 pm
1.00 -2.00 pm
2.00 - 3.00 pm
"How can the New Zealand Health Systemrespond to Maori Health Needs?"(Chairperson Tangata Whenua)
Lunch
General Summing up and Recommendations(Chairperson Mr Wiremu Kaa)
"What sort of mechanism is appropriateto plan, co-ordinate and evaluateintervention strategies or programmesrelated to Maori Health bothregionally and nationally?"
Poroporoaki: (Farewells)
HON A G MALCOLM, MINISTER OF HEALTHIN ASSOCIATION WITH
THE MINISTER OF MAORI AFFAIRS, HON M B R COUCHTO OPEN THE
HUI WHAKAORONGP. MAORI HEALTH PLANNING WORKSHOPAT
HOANI WAITITI MARAE, GLEN EDEN, AUCKLANDON
TUESDAY, 20 MARCH 1984, AT 9.00 AM
MEMBERS OF HOANI WAITITI MARAE, VISITORS FROM ALL THE CANOE AREAS AND THEFOUR 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 HISTORICHUI 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 NEWZEALANDERS.
EVER SINCE I HAVE BEEN MINISTER, I HAVE HAD A PARTICULAR INTEREST IN MAORIHEALTH, 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 AGREAT AMOUNT OF RESOURCES OVER MANY YEARS TOWARDS BRINGING ABOUTIMPROVEMENTS.
WHAT HAS BEEN MISSING UNTIL LATELY HOWEVER, HAS BEEN THE ATTITUDES THAT WOULDFINALLY HELP US TO CLOSE THE GAP.
A VERY IMPORTANT STEP WAS THE DEVELOPMENT OF TU TANGATA BECAUSE THAT HASENCOURAGED THE MAORI PEOPLE TO TAKE A GREATER RESPONSIBILITY FOR IDENTIFYINGTHEIR OWN HEALTH PROBLEMS
AS THE MAORI PEOPLE WERE SEEN TO STAND TALL, THE PAKEHA BECAME MORE INCLINEDTO PAY ATTENTION AND THE RESULT IS THAT WE HAVE SEEN GREAT IMPROVEMENTS OVERTHE 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 MAORITRADITIONAL HEALERS WHO ARE ABLE TO BE CONTACTED FOR THOSE PATIENTS WHO WOULDLIKE TO USE THEIR SERVICES.
2
THEY HAVE ALREADY MADE A VALUABLE CONTRIBUTION AND WILL CONTINUE TO IX) SOIN HELPING MAORI PEOPLE 10 BE MORE QUICKLY DISCHARGED FOR PSYCHIATRICHOSPITALS.
AN OAKLEY MARAE COMMITTEE HAS BEEN FORMED AND IS CURRENTLY NEGOTIATING WITHTHE AUCKLAND HOSPITAL BOARD 10 ESTABLISH A MARAE AT OAKLEY HOSPITAL.
I WISH THEM WELL IN THEIR NEGOTIATIONS AND I HOPE THE AUCKLAND HOSPITAL BOARDRECOGNISES THAT A MARAE IS MORE THAN A BUILDING IT IS A PLACE THATACKNOWLEDGES 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 AIMEDAT PROMOTING A GREATER UNDERSTANDING OF SOCIAL, CULTURAL, BEHAVIOURAL ANDTRADITIONAL WAYS OF THE MAORI PEOPLE. IN THE MINDS OF ALL HEALTH WORKERSAND THOSE INVOLVED IN HEALTH SERVICES.
THE WAAHI MARAE PROJECT AND THE WAIORANGA CHARITABLE TRUST ARE JUST TWOOUTSTANDING EXAMPLES OF COMMITTEES WORKING TO ESTABLISH A HEALTH CENTRELOCATED IN A MARAE SETTING.
BOTH THESE PROJECTS BELIEVE THAT PREVENTION IS BETTERN THAN CURE, THROUGHTHE DEVELOPMENT OF A WIDE RANGE OF HEALTH ORIENTATED PROGRAMMES THAT ARERELEVANT TO THEIR RESPECTIVE COMMUNITIES.
THE PALMER5TON NORTH RESOURCE GROUP HAS ENCOURAGED THE PALMERSION NORTHHOSPITAL BOARD TO APPOINT A MAORI HEALTH EDUCATION LIAISON ADVISER TO ACTAS A LINK BETWEEN HOSPITAL SERVICES IN THAT AREA AND MAORI COMMUNITIES.
MY DEPARTMENT HAS ALSO THIS YEAR ESTABLISHED A POSITION FOR A HEALTHEDUCATION 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 IMPORTANTINNOVATORS HAVE ALWAYS BEEN NURSES.
NURSES ARE THE PEOPLE THAT PROVIDE A BRIDGE BETWEEN THE TECHNOLOGY OF HEALTHSYSTEMS AND THE PEOPLE WHO NEED HELP.
LAST YEAR I THREW DOWN A CHALLENGE IN REGARD 10 MAORI NURSING AND A FINEGROUP 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 ITIS 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 INTECHNICAL INSTITUTES, TO ENSURE THAT THEY MAKE SPECIAL EFFORTS TO ENCOURAGEAND RECRUIT MAORI NURSES.
LAST YEAR THE MANAWATU POLYTECHNIC HELD THE FIRST PRE-NURSING COURSE FORMAORI SECONDARY SCHOOL STUDENTS, AND THIS YEAR THERE WILL BE FOUR OF THOSECOURSES AT AUCKLAND, ROTORUA AND PALMERSTON NORTH.
I SPOKE FROM THE SHOULDER TO THE HOSPITAL BOARDS ASSOCIATION ONLY A FEW WEEKSAGO AND I AM NOW CONFIDENT THAT. ALL HOSPITALS IN NEW ZEALAND WILL MAKE SURETHAT THE WHENUA IS AVAILABLE FOR THOSE PARENTS WHO WISH TO TAKE IT AND IHAVE ENCOURAGED DISTRICT NURSING SERVICES TO USE THE RESOURCES OF MAORIFAMILIES 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 ALLOWOURSELVES TO BE TALKED INTO A FEELING OF GLOOM.
THAT FACT IS THAT NO GROUP IN OUR COMMUNITY IS IMPROVING IN HEALTH AS RAPIDLYAS THE MAORI PEOPLE ARE IMPROVING.
AT THE SAME TIME, THE HEALTH SYSTEM IS RAPIDLY BECOMING MORE UNDERSTANDINGOF THE PHYSICAL AND SPIRITUAL NEEDS OF MAORI PEOPLE.
I WANT TO ENCOURAGE THE MAORI PEOPLE TO BECOME MORE INVOLVED WITH OUT HEALTHSYSTEM.
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 SETTINGUP OF AREA HEALTH BOARDS.
AS THESE ARE FORMED, THEY WILL BRING TOGETHER THE ACTIVITIES OF THE DISTRICTOFFICE OF HEALTH, AND THE HOSPITAL BOARD SO AS TO FORM A REGIONAL ELECTEDBODY RESPONSIBLE NOT JUST FOR RUNNING HOSPITALS FOR SICK PEOPLE BUTRESPONSIBLE FOR PROMOTING THE HEALTH OF THEIR LOCAL COMMUNITY.
AREA HEALTH BOARDS WILL HAVE SERVICE DEVELOPMENT GROUPS AS PLANNING BODIESTO CO-ORDINATE THE PUBLIC, PRIVATE AND VOLUNTARY SECTORS IN PROVIDING HEALTHCARE 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 COMMUNITYCOMMITTEES UNDER AREA HEALTH BOARDS.
THE LEGISLATION WILL SHIFT THE EMPHASIS AWAY FROM SICKNESS TO HEALTH ANDIT PROVIDES THE OPPORTUNITY FOR HEALTH SERVICES TO BECOME CLOSELY TIED TOTHE COMMUNITIES THEY SERVE.
IT IS VERY IMPORTANT THAT THE MAORI PEOPLE PARTICIPATE FULLY AS AREA HEALTHBOARDS EMERGE.
4
IT IS IMPORTANT THAT WE ALL UNDERSTAND THAT HEALTH IS NOT SOMETHING THATIS 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 CANNOTBLAME SOMEBODY ELSE.
IT IS NOT THE GOVERNMENT OR THE DOCTORS THAT CAUSE SMOKING OR DRINKING, ORACCIDENTS, OR DIABETES, OR EAR INFECTIONS IN CHILDREN, WE MUST ACCEPT OUROWN INDIVIDUAL RESPONSIBILITY FOR THOSE THINGS, WHETHER WE ARE PAKEHAS ORMAORIS WE MUST ACCEPT RESPONSIBILITY MR OUR OWN PERSONAL HEALTH.
WE MUST ACCEPT RESPONSIBILITY FOR THE HEALTH OF OUR PARENTS AND OUR CHILDRENAND WE MUST ACCEPT RESPONSIBILITY FOR THE HEALTH OF OUR COMMUNITY AS A WHOLE,THROUGH OUR INVOLVEMENT IN THE ORGANISATION AND MANAGEMENT OF THE HEALTHSYSTEM.
IT IS NOT A PAKEHA HEALTH SYSTEM.
IT MAY HAVE HAD 'iDO MANY PAKEHA VALUES AND ATTITUDES IN THE PAST BUT THATIS CHANGING RAPIDLY.
JUST AS THE NUMBERS OF MAORI PEOPLE PARTICIPATING IN THE HEALTH SYSTEM ARECHANGING 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 YOUALL.
MINISTER OF MAORI AFFAIRS BEN COUCH: OPENING HEALTH HUI AT AUCKLANDWITH 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 HUIHOANI WAITITI MARAE19-22 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 ZEALANDTHE 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 ABOUTTHIS ASPECT AND IT IS A MORE SUITABLE TOPIC FOR A PUBLICATION RATHER THANAN ADDRESS.
THERE ARE, HOWEVER, A NUMBER OF POINTS IN THE HISTORICAL BACKGROUND OF HEALTHIN NEW ZEALAND WHICH I WILL HIGHLIGHT. IT IS IMPORTANT THAT WE REMEMBER THEIMPORTANT FOUNDATIONS ON WHICH OUR STANDARDS OF HEALTH ARE BUILT AND NOTIMAGINE THAT WE CAN GIVE SOLE CREDIT TO MODERN TECHNOLOGY.
THE PAKEHA WHO ARRIVED IN NEW ZEALAND LAST CENTURY CAME FROM' THE TYPE OFENVIRONMENT WHICH WAS NOT CONDUCIVE TO OPTIMUM HEALTH. THIS WAS ONE OF THEREASONS INDEED WHY PEOPLE IMMIGRATED TO NEW ZEALAND FROM THE UNITED KINGDOMIN ORDER TO GIVE THEMSELVES A HEALTHIER LIFE THAN THEY HAD BEEN ABLE TO ENJOYIN THE RELICS OF THE INDUSTRIAL REVOLUTION WHICH EXISTED IN THE UNITEDKINGDOM AT THAT TIME.
THE MAJOR HEALTH PROBLEMS OF THAT ERA WERE, OF COURSE, INFECTIOUS DISEASESAND OF THE INFECTIOUS DISEASES THE MOST IMPORTANT ONE WAS TUBERCULOSIS.DESPITE THE FACT THAT MANY OF THE PAKEHA HAD HAD A LONG RACIAL EXPERIENCEOF TUBERCULOSIS AND HAD DEVELOPED SOME DEGREE OF IMMUNITY TO THE DISEASETHE INCIDENCE OF TUBERCULOSIS IN THE PAKEHA WAS STILL HIGH.
ON THE OTHER HAND, THE MAORI HAD NO RACIAL EXPERIENCE OF THIS DISEASE ANDAS WITH A NUMBER OF (YIEER DISEASES SUCH AS MEASLES, OF WHICH THEY HAD HADNO EXPERIENCE, THEY FELL EASY VICTIMS TO THEM.
THE INCIDENCE OF THESE DISEASES IN MAORIS WAS, IN SOME CASES, ABSOLUTELYDISASTROUS BUT, IN ANY EVENT, INCIDENCE WAS VERY MUCH HIGHER AND THE DISEASEVERY MUCH MORE SEVERE THAN IT WAS IN THE AVERAGE PAI(EHA.
THE PAKEHA ALSO FOUND THAT THERE WERE AREAS OF HEALTH IN WHICH HE SUFFEREDMORE THAN HE DID IN THE UNITED KINGDOM.
EXPOSURE TO THE ULTRA VIOLET LIGHT IN THE LATITUDES OF THE UNITED KINGDOMWAS NOT NEARLY AS EXTENSIVE AS IN NEW ZEALAND AND AUSTRALIAN LATITUDES ANDSO THE PAKEHA STILL SUFFERS A MUCH HIGHER INCIDENCE OF CANCER OF THE SKINTHAN DOES THE MAORI WHO IS MUCH BETTER PROTECTED BY THE PIGMENT IN HIS SKINFROM THESE SORT OF DISEASES.
ANOTHER IMPORTANT DIFFERENCE IN THE HEALTH FEATURES OF THE TWO RACES IS THEGENETIC SUSCEPTIBILITY OF ALL POLYNESIAN PEOPLE TO DIABETES WITH A CHANGEFROM THEIR TRADITIONAL DIETARY HABITS TO THOSE MORE CLOSELY REESEMBLINGWESTERN DIETS AND THEIR PRONENESS TO OBESITY ON THESE SORT OF DIETS. THISHIGH INCIDENCE OF DIABETES IS FOUND THROUGHOUT THE PACIFIC AND AMONG AMERICANINDIANS ON THE PACIFIC COAST.
2
THE DEPARTMENT OF HEALTH WAS ESTABLISHED IN 1900 BY THE PUBLIC HEALTH ACTWHICH WAS DESIGNED PRIMARILY TO DEAL WITH INFECTIOUS DISEASE AND,PARTICULARLY, AN EPIDEMIC OF PLAGUE WHICH WAS INTRODUCED INTO THE COUNTRYABOUT THAT TIME.
THE REPORT OF THE DEPARTMENT IN THAT YEAR DISPLAYS FAIRLY CLEARLY THE BASICPROBLEMS OF THE TIME AND THE ONES ON WHICH, AS I HAVE SAID BEFORE, THE WHOLEOF 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 RELATEDACTIVITIES WHICH CONTRIBUTE TO OUR HEALTH BUT IN THE EARLY PART OF THISCENTURY THESE WERE THE MAJOR PROBLEMS WHICH DR POMARE AND HIS COLLEAGUESWERE FACED WITH AMONG BOTH MAORI AND PAKEHA.
DURING THE FIRST HALF OF THIS CENTURY IMPROVEMENTS IN THESE AREAS MADE BYFAR THE GREATEST CONTRIBUTION TO IMPROVEMENTS IN OUR STANDARDS OF HEALTH.IT IS THE MAINTENANCE OF STANDARDS IN THESE ENVIRONMENTAL AREAS WHICH WILLPRESERVE THE STANDARDS OF HEALTH WE HAVE PRESENTLY REACHED.
THE ANNUAL REPORT OF THE DEPARTMENT OF PUBLIC HEALTH IN 1900 CLEARLY DISPLAYSTHE PROBLEMS FACED BY AND THE OBJECTIVES OF THE PUBLIC HEALTH DEPARTMENTOF THE DAY.
THE SECTION ON MAORI HEALTH IS INTERESTING, AND I QUOTE:
"DR POMARE WAS APPOINTED HEALTH COMMISSIONER FOR MAORIS RIGHTTHROUGHOUT THE COLONY. MAORIS WERE INVITED TO KORERO AT WHICHSANITATION WAS THE CHIEF TOPIC. THESE MEETINGS WERE PRODUCTIVE OF GREATGOOD SO MUCH SO THAT IT WAS DECIDED TO CONTINUE THE WORK OF PHYSICALSALVATION AMONGST THE MAORIS.
"DR POMARE'S DUTIES WERE TO CX) AMONG THE MAORIS, VISIT THEIR VARIOUSPA'S. INQUIRE INTO THEIR GENERAL HEALTH, CONDITION OF THE WATER SUPPLYAND THE DIVERSE INGENIOUS IF NOT SCIENTIFIC METHODS EMPLOYED IN THEDISPOSAL OF NIGHT SOIL. ALREADY HE HAS TRAVELLED OVER A CONSIDERABLEPART OF THE NORTH ISLAND AND EVERYWHERE HE HAS BEEN RECEIVED WITH OPENARMS AND ENTHUSIASM. THE ADVANTAGE OF HAVING AN ADVISER BY REASON OFHIS NATIONALITY TO ENTER INTO THEIR THOUGHTS AND MINDS AND BE ABLETO VIEW OBJECTS FROM THE MAORI POINT OF VIEW IS UNDOUBTEDLY GREAT."
THE NEXT MAJOR DEVELOPMENT IN THE CONQUEST OF INFECTIOUS DISEASE CAME WITHTHE 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 WEREABLE '10 ANNOUNCE THAT SMALLPDX HAD BEEN ELIMINATED FROM THE WORLD. THIS WASA DISEASE WHICH AFFECTED NEW ZEALAND LITTLE BUT HAD FOR MANY CENTURIESRAVAGED OTHER PARTS OF THE WORLD.
WHAT I HAVE SAID IS THAT MOST OF THE IMPROVEMENT IN HEALTH IN THIS CENTURYHAS RESULTED FROM ENVIRONMENTAL AND OTHER PREVENTIVE METHODS. THESE HAVEMADE 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 MEASURETHAT HAS BEEN INTRODUCED HAS BEEN ATTACHED BY A SMALL BUT VOCIFEROUS GROUPOF PEOPLE. THIS HAS OCCURRED FROM THE DAYS WHEN JEENER INTRODUCED SMALLPDXVACCINATION THROUGH TO THE PROVISION OF PURE WATER SUPPLIES, ADEQUATE WASTEDISPOSAL SYSTEMS, IMMUNISATION AGAINST MANY TYPES OF INFECTIOUS DISEASE AND,OVER THE LAST 20 YEARS - FLURODATION OF THE WATER SUPPLY - THE GREATESTADVANCE THAT HAS EVERY BEEN MADE IN PREVENTIVE DENTISTRY.
WHY ARE THESE PEOPLE SO OPPOSED '10 THE PREVENTION OF DISEASE? SURELY IT ISTHE OBVIOUS APPROACH. PREVENTION IS SURELY BETTER THAN CURE.
ONE OTHER POINT I WOULD MAKE ABOUT PREVENTIVE AND CURATIVE MEDICINE. THESEARE NOT MUTUALLY EXCLUSIVE ACTIVITIES - THE ONE BEING GOOD AND THE OTHERBAD. THEY ARE BUT THE DIFFERENT FACES OF HEALTH.
I WOULD BE HAPPY '10 HAVE A METHOD OF PREVENTION OF APPENDICITIS BUT, UNTILSUCH A METHOD IS FOUND, I AM HAPPY THAT THERE ARE SURGEONS WITH THE SKILLSTO OPERATE.
WHAT THEN HAS BEEN ACCOMPLISHED IN MY WORKING LIFETIME.
I GRADUATED IN MEDICINE IN 1946 AND A COMPARISON OF RESULTS BETWEEN THENAND NOW SHOWS:
THE COMPARISON WITH THE PRESENT DAY IS STRIKING. INFANT MORTALITY AMONGMAORIS WAS 74.62 PER THOUSAND LIVE BIRTHS AND FOR NON-MAORIS 26.10. 1980FIGURES ARE 19.9 FOR MAORIS AND 12.0 FOR NON-MAORIS. THERE WERE 1465 CASESOF SCARLET FEVER AND 1683 CASES OF DIPHTHERIA. SCARLET FEVER IS NOW A DISEASEOF LITTLE IMPORTANCE AND THERE HAS ONLY BEEN A HANDFUL OF DIPHTHERIA CASESIN NEW ZEALAND OVER RECENT YEARS.
IT WAS RECORDED THAT THERE WAS A MARKED INCREASE IN THE NUMBER OF CASES OFPOLIOMYELITIS IN JANUARY, FEBRUARY AND MARCH OF 1946. THERE HAVE BEEN ONLY3 CASES OF POLIOMYELITIS SINCE 1962. THERE WERE 76 NOTIFICATIONS OF PUERPERALSERIES, A DISEASE WHICH IS NOW VIRTUALLY ELIMINATED.
THE TOTAL NUMBER OF NEW ZEALAND DEATHS FROM TUBERCULOSIS WAS 956 (A RATEOF 5.4 PER 10,000) WHICH IS 27 TIMES THE 1980 TUBERCULOSIS DEATH RATE OF0.2 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 SAMEPATTERN, IE -
4
THAT THERE HAS BEEN A VERY SUBSTANTIAL IMPROVEMENT IN THE HEALTH STATUSOF ALL NEW ZEALANDERS DURING THIS CENTURY.
•THAT IN GENERAL MAORI RATES STARTED AT THE TURN OF THE CENTURY FROMA POINT WELL BEHIND THE PAKEHA RATES.
•THAT MAORI RATES HAVE IMPROVED TO A FAR GREATER EXTENT THAN PAKEHARATES BUT STILL LAG BEHIND TO SOME DEGREE IN MOST CATEGORIES.
•THAT THE DIFFERENCES ARE NOW SUFFICENTLY SMALL FOR US TO IDENTIFYPARTICULAR TARGET AREAS FOR ATTENTION EG, THE MAORI INFANT MORTALITYRATE IS THE SAME AS THE PAKEHA ONE WAS IN 1977.
THERE ARE SOME PARTICULAR PROBLEMS OF MAORI HEALTH, EG IN THE CARDIOVASCULARAND METABOLIC AREAS WHICH REQUIRE SPECIAL TARGETING AS THEY WILL INVOLVEPROBLEMS NOT NECESSARILY EXPERIENCED IN MORE TRADITIONAL RESEARCH AREASOVERSEAS.
IN SHORT WE HAVE COME A LONG WAY BUT, AS ALWAYS IN HEALTH, WE STILL HAVESOME WAY TO GO.
THERE IS NO REASON WHATEVER FOR PESSIMISM. THIS HUI WILL, I HOPE, HELP USTO IDENTIFY MORE CLEARLY DIFFERENT APPROACHES TO HEALTH PROBLEMS AND I CANONLY REPEAT DR POMARE'S VIEW IN 1900 THAT MEETING WITH MAORIS ON THEIR MARAEIS OF GREAT VALUE TO US ALL.
"TE TAHA HINENGARO"
AN INTEGRATED APPROACH TO MENTAL HEALTH
M. H. DURIE
Director of PsychiatryPalmerston North Hospital.
HUI WHAKAORANGAHOANI WAITITI MARAEAUCKLAND
MARCH, 1984
AN INTEGRATED APPROACH TO MENTALHEALTH
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 effectoptimal 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 greatsynthesis". World Health Forum 1981; 2 : 398-402.
2. BLAKE PALMER G. "Tohungaism and Makutu". J. PolynesianSociety 1954,63; 2 : 147-163.
3. DURIE M.H."Maori Attitudes to Sickness, Doctors andHospitals". N.Z. Med. J. 1977; 86 : 483-485.
4. ROBERTS C.A. "Primary Prevention: to the Present" inRoberts 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: MethuenPublications 1978.
8. KAWHERU I.H. "Increasing the Maori Contribution inManufacturing Industry" in: ed. Thomson K.W. andTrlin 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 recommendationsof the Waitangi Tribunal on an application by AilaTaylor for and on behalf of Te Atiawa tribe inrelation 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.
************
te01-e
oranga 0 rehealth of the
whanaufamily)
Rose Rangiirie PereT&Fknga
zi it
Pr6iJext.
THE OCTOPUS as a symbol
woorohuie.nro
The task I have at the present time is to write a statementabout family health. In expressing some of my innermostthoughts cognizance is given to many others who are alsovoicing their views about the same issue.
I do not express my views as an expert but as a grandchild ofmany 'grandmothers and grandfathers' who have influenced myphilosophy of life. The symbol I am using to define familyhealth as' I understand it, is 'te wheke', the octopus. Only alimited interpretation of my basic beliefs can be given inEnglish.
An explanation of the symbol is as follows:
-The body and the head represent the individual/familyunit.
-Each tentacle represents a dimension that requires andneeds certain things to help give sustenance to the whole.
-The suckers on each tentacle represent the many facetsthat exist within each dimension.
-The eyes reflect the type of sustenance each tentacle hasbeen able to find and gain for the whole.
-The intertwining of the tentacles represent a mergence ofeach dimension. The dimensions that have been mentionedneed to be understood in relation to each other andwithin the context of the whole because there are noclear cut boundaries. I will now make reference to eachtentacle by beginning with:
Wairuatanga (Spirituality ...)
Sustenance is required for the spiritual development of theindividual, the family, and is of the utmost importance. TheCreator, the most powerful influence we have, is recognised asthe beginning and the ending of all things. The Creator hasplanted a language and given a unique identity to me and myMaori forebears. We have given this identity an earthlyform. 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 upliftthe unique identity he has given me. The world view of theMaori is that people are the most important of all livingthings in the physical world, because we believe we are in theimage of the Creator. We do not support the Darwin theory anddo 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 forebearsthere is also an awareness of those things that make a childunique. This uniqueness is a part of the individual's ownmana as a whole. This concept also applies to the familyunit. If a family receives sustenance that gives them apositive identity with their 'mana' intact - then that familywill have the strength to pursue those goals and those assetsthat can uplift them.
2
Mauri (life principle, ethos ...)
If great importance and support is given to the mauri of eachindividual in the family, in time the individual, the familywill appreciate the mauri in other people, the mauri inmeeting houses, the mauri of traditional courtyards, the mauriof trees, the mauri of rivers, the mauri of the sea and themauri of mountains. The traditional courtyards and themountains of New Zealand have heard and felt the mauri of thelanguage as spoken by our Maori forebears before the intrusionof any other. The mauri of the language and the inauri ofeverything else that has been mentioned is very important tothe family unit and the way it can withstand negativeinfluences.
Ha A Koro Ma A Kui. Ma (The 'breath of life' from forebears)
The 'breath of life' mentioned here relates to the heritagethat has come down from Maori forebears. Sustenance fromknowing one's own heritage in depth is important. A basicbelief is that one's future is linked up with one's past sothat if the heritage is firmly implanted then the members ofthe family will know who and what they are, the uniqueidentity that they have, will remain intact. Families whohave had their heritage transmitted to them have a strongcentral core that can enable them to become universal people.
Taha Tinana (The Physical Side)
The family must receive sustenance for its material and bodilyneeds. The general guidelines required would relate tomedication, suitable foods, suitable and appropriate clothing,appropriate means of shelter, different types of recreationincluding physical education, everything that pertains tophysical survival. The body is regarded as sacred andrequires a set of disciplines. The head is regarded as themost important part of the body and has its own set ofrestrictions, 'tapu' placed on it. If one does not take careof his or her head, then worrying about everything elsepertaining to the body is pointless.
Tremendous respect is given to the body and the way one shouldapply it, and use it. A mother cherishes and nurtures herchild in the womb, and when one is old enough to take over theresponsibility of his or her body, then this cherishing, andnurturing must continue. As a child and grandchild I rememberthe physical warmth, the tremendous flow of love that Ireceived from my many parents and grandparents. They taughtme to adjust and to accept change - to think things out formyself.
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 withother 'families' in the community to help strengthen thewhole. Families receive sustenance for this dimension when
3
they feel they have an important contribution to make to thecommunity they live in. Genealogy 'whakapapa' is an importantpart of whanaungatanga. It is the basic right of the child toknow who his or her natural parents are even if he or she isadopted out. The spirit of the child amongst other dimensionsbegins from conception and relates to the child's forebears.A basic belief of the Maori is to expose a child to his or herkinship groups as soon as possible and throughout the whole ofhis or her life time. The extended family is the group thatsuports the individual through a crisis or anything else ofconsequence. Kinship identity is most important. Affection,physical warmth and closeness of members of a kinship group isencouraged and fostered. Traditional men and women who didnot produce children of their own could foster a relative'schild or children. Some of our most famous ancestors andMaori people of more recent times did not produce any issue oftheir own, but were still regarded as most outstanding leadersand tribal parents. The concept of Matua - Whangai 'fosterparents' is becoming prevalent throughout Maoridom again.
Whatumanawa (the emotional aspect ...)
Sustenance and an understanding of emotional development inthe individual, and the family as a whole is consideredimportant. Children are encouraged to express their emotionsso that the people who are involved with the parenting knowhow to support, encourage and guide the children. Crying forjoy or sadness by both sexes is regarded as natural andhealthy by the Maori. This form of expression is not regardedas a weakness. Emotional involvement and interaction areregarded as important meeting points for human beings.
Hinengaro (the mind ...)
Approaches of learning that arouse, stimulate and uplift themind are very important. My immediate forebears believed inthe aristocracy of the mind and despised anyone who tried totamper with the mind. The mind if nurtured well knows noboundaries, and can help one to traverse the universe.Intuitive intelligence is encouraged and developed in someindividuals to a very high degree. There is a strong beliefin exercising and using all of the senses on a regular basis.
Waiora (Total wellbeing ...)
If each symbolic tentacle receives sufficient sustenance forthe whole when the eyes of the symbolic , family unit willreflect total well being. 'Wairoa' is my definition of healthas shared with me by my 'elders. If the medical people .wish tohelp Maori people face up to the challenges confronting themin today's world, then I feel that some cognizance must begiven to the philosophy I have tried to share within thelimitations.Ons.
Ma te Kaihanga tatau e arahi e tiaki kaore he maria i tu atu ia Ia. Kua ia te timatanga me te inutunga o nga inea katoa.
Naku noaNa Rangimarie Pere
Wlth}1I ItAPJE TRUST
_•( •; [T•) ':-
1 jC \,f••,J..-.
.I/
' \/: 1!. •II' •) .-'
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 MalaitaAwhina I-louseWaahi 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 nato kaupapa kee taatou I karanga e tika ma kia mihi poto ki o taatoumate, ki te hunga wairua i. tua o te aarai. Nooreira ngaa mate aa tau aamarama 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 huriliuriteenaa koutou.
INTRODUCTION
The title of this talk was suggested to my husband during the early planningstages of the conference. Unfortunately he is not able to be here and somy task is twofold. It is firstly to tender his apologies at not beingable to attend, and secondly, to talk about our experiences at Waahi.In doing so I am reminded of submissions currently directed at variousquangos, conferences and seminars seeking representation of WorIefl s groups andI4aori people. In agreeing to appear here then in some small way I am attemptingto cover both minority viewpoints.
PERSONAL BACKGROUND
Before beginning I should at least give you a personal sketch. I am fromKaretu and belong to the Ngaati ?.lanu sub-tribe of Ngaati Hine. I attendedQueen Victoria School, Auckland Girls' Grammar and then went on to studyphysiotherapy in Dunedin. After qualifying in 1964 we moved to Auckland,where I worked at Auckland Public, Cornwall, and then in 1968 went intoprivate practice with Len Ring who specialised in sports medicine therapy.In 1972 we moved to Hamilton where I worked at Waikato Hospital specialisingin . rehabilitation of motor neurone diseases.
A disturbing trend in recent years is the tendency to categorise the Maorias an interest group or disadvantaged minority. In this Wc' the systemdenies the fundamental rights of tanqata whenua status and the steadyerosion 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 asadministrator 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 financesare 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 the1983 Annual Report (see Appendix).
For a fuller background to the confiscation issue, Michael King's biographyof Te Puce summarises the main issues fairly well.
The studies by Alan Ward, Michael King and Tony Simpson are particularlyhelpful 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 generalaccount on the creation of the third world and the development ofunderdevelopment. His analysis draws on the work of Frank, Fuatado,Dos Santos, Wallerstein and others.
In her study of the Guatemalan economy Smith concludes that capitalismeverywhere creates and depends upon the development of some parts andthe 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 attempting 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 providedthe following estimate from a survey conducted in 1.981-82 (Douglas,Nottingham, 1982).
1'laori living within Tainui boundaries88,000Non-Thinüi living within rrajj.luj boundaries20,000Tainui living within boundaries68,000Tai.nui living outside boundaries20,000People of Tainui descent working elsewhere30,000Total Tainui population 118,000
Douglas estimates that most of those non-Tairiui. Maori live in the SouthAuckland 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
as unemployment, under-education, youth recreation,Imanagement 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 thefailure by educational authorities to get at the root of Maori under-achievement in School Certificate makes it very tempting to accept theMarxist analysis that an "under-educated proletariat" is essential forthe survival of the capitalist system; that the existence of such people'makes possible the continued provision of a cheap labour force for labourintensive industries, and that Maoris provide a convenient source of suchlabour, having been stamped "failed" by a culturally foreign educationsystem".
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 ownthinking 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 DevelopmentThe 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 PaperNo. 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 IiaaoriEducation.
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 yearperiod 1955-1975, Special Report series No. 7 MedIcal Research Councilof 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 theMaori 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.ss161-172. 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 RegionalPatterns 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 PaperNo. 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 CenturyNew 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 experimentin tribal developant.They wanted to learn what being prepared for the21st centuir would mean to their hapu ., iwi and runanga and they soughtinsights into the prescriptions which would help their confederation to getready for the yea•:• 2000 and beyond.They labelled the experirrntWhaI:atupurange Rua Mano - Generation 2000.
In the eight years sine 1975 the Trustees have received reports on theexperiment at their monthly meetings, Whakatupuranga Rua Mono has desiedand directed just over 100 hat involving 6 ) 500 participants and, in thelatter half of this period, Te Wananga o Raulzawa has been pursuing itsprograrrinie of teaching and research.Mthough tr.e evidence of progresstoward the objectives of the experiment is uncertain and while most observerswould be hesitant in their evaluation of the programme it would be reasonableto claim that in contrast to eight years ago the Trustees now have sets ofthe 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 andliabilities for hapu or iwi committees, the measures and data bases whichare available to describe the activities and conditions of an hapu, an iwior a runanga are, typically, quite crude.Nceiet1eless, a little progresshas 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, resourcessuch 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 theregion between the Raoqit:ikei River and Porirua.Their principal task,as specified in the 1936 flativ Pupoes Act, is to acntan.ster RaukawaMaraca in OtJd.
MOM
Four principles to guide the Trustees in their decision-making werefashioned early in the experirn3nt. These continue to serve this functionand 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 bewell maintained and thoroughly respected.
(c) The activities and procethu'es of the Trustees must guarantee therevival of the Maori language and the maintenance and development ofMao ri tan ga.
(d) We must insist on greater control over our present and futurecircumstances."
Each of these and the set itself is relevant to the discussion in thispaper.However, only the first will be explored further.
The Trustees, in collaboration with educational trusts of the runanga,2are committed to a series of residential hui for the teenagers of theconfederation.This series, on which further information is given bclo;1,and other hui and activity including the search for technology which isappropriate to the runanga's long-term development, are among the prescriptionfor the Trustee's journey toward the year 2000.
(2) People Development and Retention
The Trustees believe that they can assist the work of schools, governnrntdepartments and other agencies by drawing on the strengths of tribalism(including identification with, obligation to, pride in and group solidarityof the tribe).Some of the ideals to which the Trustees aspire are:
"(a) That the members of the Confederation know or have access toinformation on their origins and whnicapripa (at least th e last 3 or 4generations thereof) and are contributors in one way or another tothe well-being of their hapu and marae.
2. The Otaki and Porirua Trusts.The earnings of these trusts are Used tosupport 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 !.!aoriand are familiar with their hoputanga.
(c) That all of our children whether born out of the conventional andpublicly announced state of wedlock or not are embraced by and raisedunder the influence of their hapu.
(d) That all of our children are so instructed as to ensure that theirintellectual, physical, emotional and spiritual capacities are fullydeveloped.
(e) That the quality of health among our members be as high as any groupin the world.
(f) That all of our members contribute to the common good and, inparticular, 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 theindividual notwithstanding the hapu, iwi and rurianga context which is beingasserted in this paper; and, it will be apparent that the comparison isbetween members of the rurienga and the healthiest in the world.The standardof comparison will change as health performances in order countries change;for our purposes it is important to note that the comparison is not withthe Pakeha experience.The focus and the coiilpa:rison are intentional.Individual members who are healthy (in physical, mental, spiritual andfamily terjns)are necessary (but are not sufficient) for their hapu, iwi andrananga to be healthy too.
A comment onthe comparison is appropriate.To make the comparison withand to target on the Pakeha standard of health, which is not the highestin the world, could mean that the quality of health of members of thisconfederation would be unlikely to surpass that of the Pakeha and couldremain 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 intervieweesand 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.
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The results can be described just as simply:
(a) 90 per cent of those interviewed said that their general health wasgood.In contrast to this, of the total interviewed, 25 per centsaid that they had a special health problem! Obis pair of resultssuggests that "good health" is seen as "normal health" includingspecial problems where they exist.. This al.J.itude would heunhealthy if a consequence of it were that the special problems areaccepted 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 specialrerne(hes winch they had.
Very little was asked of the interviewees and naturally, little wasreceived.Those doing the interviews were not equipped to do more.Inaddition the health section was only one of seventeen sections in theinterview guide.
It is proposed that a round of "health interviews" be conducted next suiniar.Jvmb3rs of the confederation who are given appropriate training in healthintervievi.ing would be employed to carry out this work.Elementary testsand questions (having to do with age, weight, height, blood pressure,frequency and purpose of clinical visitations and so on) will expandconsiderably 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 wasadded to the interview guide which was used at the 12th 4-day residential hulfor the young people (for the most part, teenagers) in January of this year.The following is an extract from the initial analysis of the interviewresponses:
"Sixty young people were interviewed (including some of thetutors). Their ages ranged from 11 to 24 years. The majorityof the interviewees (forty-one) were scholarshipholders (allteenagers).
4. Report on the Twelfth Residential flu! for Scholarshipholders (andfamilies) of the Otaki and Porirua Trusts Board by Pakake Winiata clathd17 January 1984.
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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 ofthe 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 youngpeople 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
prominently than hop re lated aspirations like learning Maori,
attending more events at the marae and learning history 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 intervieweehad 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 themasked themselves "Is this good for my hapu?"; but, even more
dlistuxbing, a majority of them indicated that they would stillhave 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 morehul 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•TrustsBeard, the majority of them indicated that knowledge of the Maorilanguage was the most important, with about 15 per cent sayingthat attendance at hapu events and potential contribution to hapuas the most important attributes."
(4) Inadequate Data Base
The interviews which have been conducted represent between 3 and 4 per centof the population of the nmanga. The data produced are interesting butthey do not comprise a data base which would be appropriate to the planningexercise in which the Raukawa Trustees are engaged. A data base which iscomprehensive, current, easy to maintain, easily accessible, inexpensiveand so on is required.Unfortunately, the Statistics Department is notup to the task, the Health 1partment is riot doing what is necessary, localpractitioners do not have the time or the inclination and the Raukn.vaTrustees do not have the resources to design and maintain an appropriateinformation system.
(5) Relationships_with Health_Organisations
The Raukawa Trustees have had close contact with the Wellington ClinicalSchool of the Otago lkiiversity Medical School.Students and staff fromthe clinical school have had two residential seminars on Raukawa Marco anda group of scholarshipholders and other young people of the confederationhave returned a visit to the clinical schoo]..
At the other end of the region spanned by the Raukawa Trustees is thePalmerston 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 HealthEducation and Liaison Officer, and senior officers of the Board have shownan active and sincere interest in lvlaori health.Three major one-dayhui have been initiated by one or more of those people and the RaukawaDistrict Council in the last twelve months.
5. The Dc-an of the Clinical School, Dr Johnson, and staff members, DrsIan Pryor and Eru Poinare (a nir±rier of the confederation) have beenprominent in making the necessary arningoinonts.
a
The interest in health matters in the confederation and in the wider Maoricommunity of the region has hsen greatly enlivened by the exchanges betweenthe Trustees (and other Laori sections of the region) and these two healthorganisations, namely, the Wellington Clinical School and the PalmerstonNorth Hospital Board. If this interest is maintained for the next threeto five years its effects will penetrate and should influence favourablythe life style and other factors which are seen to be among the deternd.naritsof the suspected poor health performance of members of the Maori people inthe Raukawa Trustees' region.
For its part Whalcatupuranga Rua Mano will attempt to make a contribution tothe maintenance of interest in health issues by continuing to include inthe pigraimies for the three 4 .-day hul per year for young people a sessionon health.6
(6)Conclusion
The tribal development programme of the Raukawa Trustees takes a view ofhealth which extends from the individual through the whanau, hapu and iwito the runanga. The Trustees are in search of an understanding of what ahealthy confederation of its hapu and iwi is and of how to achieve thatstate by the year 2000. They have been engaged in their experirent intribal 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 retentionof their people and a health objective is specified ang the ideals.
The Trustees' face a major problem in the inadequacy of healthca-id otherdata for planning. Their response to this has been to conduct surveys oftheir people themselves. At this point their data bases are scant and theirinformation system fails on most of the criteria by which such systems areevaluated.
6. A 4-part framework which was used by Dr Mason Dune in his presentationto 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 thefour corners of a meeting house each of which was necessary:
Taha HinengaroTaha WairuaTaha WhanauTaha Tinana
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Close working relationships with health organisations in their region haveraised the level of interest in health among the hapu and iwi of theconfederation of Ngati Raukawa, Ngati Toarangatira and Te Atiawa and
challenge to the Trustees' development experiiixmt and prograntn, IThakatupurr-ingaRua Mano, is to feed and strengthen this interest.
Whatarangi Winiata19 Tharch 194Wellington
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 spentsix years between 1951 and 1957 working with Tuhoe people.I was stationed in Taneatua and travelled back and forthto Ruatoki and Waimana. All the old people were alive then.The people from Tuhoe are so rich in Taha Maori and TahaWairua. Within themselves, whatever they decide, we knowthat it would be a success.
1.The ClinicThe Beginning
From the people's point of view there were several theoriesand reasons as to how the Ruatoki Clinic came about. Onetheory said that they had so many ear problems that theyhad to have an ear clinic service. I was still working withthe Health Department in 1977. I wasn't too far away inTe Teko and Kawerau and we all knew that the Tuhoe peoplehad many health problems and illnesses. The children hadhigh admission and readmission rates to hospital with undiagnosedand untreated diseases. Pakeha type medical care had beenprovided by the late Dr Golan Maaka who, right up until hedied recently at the age of 75, was seeing patients at hisrooms in Whakatane. Over the last few years this was onan irregular basis, he was ailing himself. Patients usedto sit under the big trees and on the grass waiting for Golanto arrive, if and when he did. Otherwise, they would gostraight up to the hospital to be seen, often at a late stageof illness.
In my view, one of the main reasons why the clinic was establishedwas through the discussior that took place between the PublicHealth Nurse, the Tuhoe people that she worked with and theSupervising Public Health Nurse from the Rotorua DistrictHealth Office. The Public Health Nursebased in Taneatuakept saying - "I can't come to you, you are supervisingme but I will not go until I have seen them all (patients)".
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The Supervising Public Health Nurse went to speak with DrShort, the Medical Superintendent at Whakatane Hospital.Dr Short was a community-minded sort of person and was keenon providing community based health services. He made uswork and think about it in this way. The Supervising PublicHealth Nurse had, early in her career, worked with Dr Smithat Rawene up North and suggested that a small health cliniccould provide a suitable base for the Public Health Nurseto work from.
2.Setting up the Clinic
I visited Ruatoki to ask Tom Williams the Headmaster of thePrimary School and some of the mothers for their views.It seemed that the idea of a joint project involving theHealth and Education Department Services didn't go acrossvery well to start off with. Other similar welfare typeprojects in the valley had failed in the past but it didn'ttake very long before the Western Tuhoe Tribal Committeeagreed to become involved and help the project through.Discussions with the South Auckland Education Board, theWhakatane Hospital Board and the Department of Health werevery good; everyone was keen and willing to help, the peoplewere 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 statusof the Ruatoki Community;
(2) provide a base for the delivery of primary health carewhere none existed other than visits by the PublicHealth Nurse;
(3) provide health care which the community accepts;
(4) establish a baseline of health data on the child populationin Ruatoki.
4.Sitina of the Clinic
It was felt that the school would be the best site for theclinic because it was on neutral ground. There are aboutnine marae within a 2 mile radius of the Ruatoki School, representingdifferent subtribes and family groups of Tuhoe. One importantcontribution the community made concerned the siting of thebuilding.
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The architect said:
"The school is here; the clinic is to be there. Turnit around to face the main road because all the peoplego along there."
The people didn't want it that way. So they whispered intoTom's ear:
"When the building comes, you hop in there and switchit around!"
And they did. By the time the architect had come back, theclinic was facing the school. That was what the kaumatuawanted. They wanted to sit in their clinic and look outand see their mokopuna. They were very fortunate too becauseRuatoki had been chosen to be the first bilingual schoolin New Zealand. Also, a Maori headmaster had been appointedto develop the programme. The two ideas to meet the healthand education needs received urgent priority and attentionby everyone concerned.
5. Funding
Funding for the clinic was made available through the CommunityHealth Fund from the beer and tobacco tax. This coveredcosts of the building, furniture, equipment and establishmentexpenses. The building was a pre-fabricated, relocatable3 bedroom home type plan which was modified. Personnel fromwithin the hospital were selected to man it. The hospitalboard also agreed to maintain it and rent space to a generalpractitioner. The District Council sealed the road outside,the Power Board removed a power pole and provided undergroundcables and the Royal Forest and Bird Protection Society plantedthe clinic area with shrubs and herbs that are importantin Maori medicine.
6. Servicinq the Clinic
The clinic is now the focal point of the health service tothe Ruatoki Community. It was called the Maaka Clinic afterthe late Dr Maaka, who provided many years of service tothe Tuhoe.
(1)General Practitioner Servicesf
Dr Carl Jakobsen visits the clinic twice a week. Ithas become necessary for him to learn body languagewith our people and to learn the Maori language. Hehas learnt it very quickly and has established a verygood working relationship. A visit to the clinic isa social occasion. It is the people's clinic and theyare comfortable in it.
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(2) Public Health Nurse
The Public Health Nurse based at Taneatua also visitsthe clinic at the same time as the doctor and worksfrom there. They work very closely together.
(3) Special Clinics
Clinics have been run by visiting staff such as thePaediatrician, Ear, Nose and Throat Specialist andthe Dietitian. While the ear problems have been reducedsignificantly by the clinic and visiting specialists,the weight watchers classes and primary health careservices 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 childrenin the valley. About 300 children aged between onemonth and 15 years were examined. About 89% had ahealth problem. Ear disorders (81%) and skin diseases(18%) were the most common disorders. The prevalenceof middle ear disease, hearing and skin problems andother treatable diseases clearly established the needfor an improved health care service for the Ruatokipeople.
7.Evaluation of the Clinic
An evaluation of the clinic after one year showed that ithas been a success from both the community and health servicepoints of view. The general community feeling is that theclinic has been a great thing. Parents, teachers, the publichealth nurse, doctor, dietitian and community leaders haveall been involved. The community regard the clinic as theirown. They have had a chance to influence its developmentand progress.
THE. AFTERMATH
Several other community health clinics have been establishedsince. The Te Teko Clinic was set up in 1980 following asimilar protocol to the Ruatoki. one. However, the lack ofa general practitioner service, the nature of the communityand its proximity to Kawerau and Edgecumbe has slowed andaffected its development. The Forestry Department establisheda clinic in Minginui in 1979, which is serviced by the doctorand public health nurse in Murupara. Te Kaha plan to upgradeits clinical facilities for a visiting doctor from Opotikiand the public health nurse. Requests for similar clinicsfor Waimana, Cape Runaway and Raukokore have also been received- from the community themselves.
All of these have shown that health clinic facilities inthe grounds of schools in a rural area that is predominantlyMaori can provide a base for the delivery of health care.The involvement of the community in all stages of developmentand co-operation - especially of the hospital board, Departmentof Health, general practitioner and the South Auckland EducationBoard, has been very important. The costs, I am sure, areminimal when we look at the distances that isolated peoplehave to travel and the amount of money that goes into bighospitals.Small, community based health clinics are aviable way of providing health care to isolated, rural areas.
Chairperson: Mrs Elizabeth Murchie
TE KOHANGA REO WORKSHOP REPORT RECOMMENDS THAT THESE REMITS BESUBMITTED TO THE FOLLOWING:
MINISTER OF HEALTH:
1That this Hui strongly endorses Te Kohanga Reo and havingnoted the considerable health input in-its programme throughits philosophy of Whanau which nurtures in an atmosphere ofharmony and joy, seeks from the Minister, his support inresources and personnel for the continued development of thesehealth programmes.
MINISTER OF LABOUR:
2That this Hui recommends the VOTP be increased from oneyear to two years for trainees in Te Kohanga Reo programmes.
MINISTERS OF EDUCATION AND MAORI AFFAIRS:
3That this Hui endorses Te Kohanga Reo and seeks increasedfinancial and administrative support for Te Kohanga Reo in itscontinued development. We mean administrative support be inway of stationary and on-going financial assistance for all TeKohanga Reo Centres.
MINISTER OF EDUCATION:
4That this Hui endorses Te Kohanga Reo and recommends thatTe Kohanga Reo objectives, concepts and teaching methods beimplemented throughout the education system.
5That the teaching skills of the resource people (NyaKaumatua) who service Te Kohanga Reo be recognised by paymentof wages.
TE KOHANGA REO TRUST:
6That this Hui recommends that a health component beincluded in a health programme for trainees of VOTP.
POINTS AND COMMENTS:
-The supportive attitudes from health professionals towork with Te Kohanga Reo on health matters, this is thebest place to teach health. Te Kohanga Reo is the finestthing to happen for the promotion of health throughoutNew Zealand.
-This Hui recognises that Whanautanga was the philosophythat eminated from the Te Kohanga Reo group yesterday.
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The display of this group showed us songs significant tosocial and health messages regarding physical and mentalhealth as well as spiritual development and maraeprotocol. Each Kohanga Reo Centre is a unique set up tomeet the needs of a specific community.
-The desire for Kaumatua and Whanau to share theirexpertise.
-Dietary habits are an important component in theactivities of Te Kohanga Reo because what is served tothese young children is important to their whole growth.
-Utilisation of non Maori health professional in ateaching role. It was stressed that when the Whanau feelcomfortable with themselves, then and only then will theyask the advise of health professionals.
WAIATA 0 TE HUI WHAKAORANGA
Te Whanau OraE Hoa MaKo Nga MokopunaTe Waka Ko Te KohangaTe Reo Hoea RaTe Marae E Takoto NeiNga Kupu PupuritiaTihei Mauri OraTihei Mauri Ora
Chairperson: Dr Salxnond
RAUKAWA TRIBAL PLANNING EXPERIENCE AND HEAlTH WORKSHOP
Discussions focussed around the health and planning aspects ofthe programme.
The group identified that theinforination presently availablefor these purposes is very limited and there need to be waysand Means of gathering that information and making itavailable in a form in which it has value and can be used forthis specific purpose.
Three sorts of information:
1Information available from the census.
2Information available from on-going data - collectionwhich is gathered by many of our institutions.
3Ad-Hoc studies or studies which can be carried out in aparticular point in time which shed light on a particularproblem.
3
We have accepted the fact that in the past, much of theresearch which has been-done in Maori health has nothroughtthe benefits which have been claimed of it and we acceptentirely much of the criticism which has been levelled at suchresearch. In this regard werecognise the importance ofstudies such as that which was presented to us by the MaoriWomens Welfare League, which is clearly an example of peopleparticipating in their own research and using the technicalresources available to them to gather and use information fortheir own benefits and own use and we suggest that, this mustbe a model which we want to see very much more in the future.Research must be done with people, it must not be done onpeople or to people and this has got to be a feature ofresearch not only in Maoridom, but also in all aspects ofhealth care and health care delivery generally.
RECOMMENDATION:
We need to gather information which relates to the hapu, sothat there is information which can be given from the censusand other resources which can be made directly applicable totribal groups and can be used for planning purpose.
We believe it is important to develop health indicators ofpositive health which relate directly to the problems that youhave in hand. Some Of these indicators can be obtained fromsocial science and from the traditional health research.Other indicators Maori people will have to develop themselves,relating to their own particular situation and which takesinto account of the four aspects of health which we have beentalking about for the last four days. I think we allunderstand that the people wish to be in charge of this, thatthe people wish to study, to work and to gather informationwhich will be useful to them. They have a right to theresources which are available from government departments andother sources, but there must be no misunderstanding as to whois in charge of these projects, who this work is being donefor 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 forhealth care delivery. A community health clinic can be usedto provide a wide range of community based services forexample, legal advice, budgeting and financial advice, but theaccent of the role of a community clinic should be dictated bythe actual community itself. The community clinic should be amethod of providing appropriate services as an alternative tothose services which are institutionally based. It is also ameans of developing preventive services and health educationprogrammes. It can also provide means of co-ordinating thevarious community services which are appropriate in meetingthe health needs of the whole person, given that funding canbe available from government agencies, ie: Social Welfare,Health, Education, Justice, and Maori Affairs and InternalAffairs Departments. It is also hoped that funding or partfunding can be obtained from private and voluntaryorganisations and service clubs.
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The goals and objectives of the clinics should be to meet thehealth needs of the local community, that is the justificationof services provided for such clinics. It should not bedependent solely on meeting a need for curative services as analternative to institutional rather it should be acceptableand permissible for services to be provided of the basis thatthey 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 fromcommunity health clinics must be based upon the Maori aspectsand perceptions outlined above. It must he recognised thatbecause of the present system of government funding, therewill be occasions when funding for a particular service willneed to be drawn from more than one vote. Where part of thefunding has been arranged from the private or voluntary sectorand the need to provide a particular community health clinicservice has been accepted by all parties it is imperative thatfunding from government sources be provided in a timelymanner. There must be maximum flexibility to enable localcommunities especially the consumers to determine the typesand methods of delivery of community health clinic services intheir locality both urban and rural settings.
The probability of other sources of funding should also beinvestigated for example, Accident Compensation Corporation,and The Internal Affairs Funding For Under 25's. The triple SScheme proposed by the review committee on primary medical illcare should be examined as a possible source of funding, inrelation to appropriate community health clinic services.
Provision shouldclinic facilitieswhere appropriateto the community.
be made for the ownership of community healthto be handled over the local community,and again putting more responsibility back
Where warranted,additional fundsClinic Services.
central government should continue to providefrom the central reserve for Community Health
Hospital boards should also be encouraged to use provisionsunder the Hospitals Act to assist people who cannot afford topay for items substantial to their health. The main things toconsider, as regards to Community Health Clinic Services isthat the activities of the health clinic are defined bycommunity demand and there would be multiple agenciesinvolvement 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 ofMedicine
INTRODUCTION:
I found the Hui a very valuable experience and I am sure thatyou and your organising Committee now have many ideas to chasealong. With any such meeting, there is of necessity a limitto the number of participants and so some individuals willalways complain that they have been left out. Bob Simon, fromPorirua Hosital, was one who spoke to me on a couple ofoccasions, thinking he should have been invited: I wondereredalso about other Maori Doctors as there seemed to berelatively few of us there. Personally, I am most grateful tothe Health Department for paying my way and also to you Patfor all the organising which you did.
What then about the Hui itself?
The participants were understandably people who were in theHealth field and on the whole were older people. I know therewas the feeling by some of the younger participants that moreyoung people should be involved in such Hui and I wouldendorse that. Who the young people might be is anotherquestion, but a useful input could come from secondary schoolpupils and young employed or unemployed. When we talk aboutHealth matters, we are often talking to roughly the same groupof people, and it is the people beyond that group who areperhaps the more important.
While still on the same theme, I shall express some concernhere about the outcome of the Hui. You will have collectedfor instance, many submissions, new ideas andrecommendations. It would be too easy to shelve the fruits ofour discussions and for the Health Department to say they havedone their bit for Maori Health for 1984. There has been muchtalk and this needs to be followed up by action Frompersonal experience, I have seen much hard work put into someof these Health issues only to see them relegated to th
The programme itself, seemed a very reasonable one, though asevents turned out, the time factor curtailed many interestingsessions. I guess if we are to learn anything from this Huithen it would be to allocate a large amount of free time withfewer structured sessions. With the workshops, for instance,
2
there was just too little time I felt to do justice to theissues under consideration. The workshops were also far toobig and of necessity meant that some people never had a chanceto say anything or if most spoke, then that could only just heaccommodated in the time available. The groups therefore,generated ideas which may appear to you at this time to he ajumbled mess. Certainly the workshop guidelines wereadmirable but not practical for many of the workshops tofollow to the letter. There were common themes however whichemerged from all the workshops and such themes would seem tobe worthy of further follow-up.
I think overall that the small group activities are veryimportant as it gives more people the chance to air theirviews without feeling too inhibited by a larger audience. Asthe programme turned out, one lot of workshops with more timeprobably would have been best.
Having the politicians etc, at the beginning is fine for thembut in terms of the Hui, it would be far more useful to havethem listen to submissions at the end. I guess they wouldn'tshow if that were the case?
On reflection, it is interesting how some people use suchmeetings as propaganda exercises. I had expected for instanceto learn a lot more about the Waahi Marae Project, itshistory, its problems and what it meant to the people. Whatwe got was a socialogical/anthropological overview. TheRaukawa Tribal Planning experience I think would have beenvery interesting to many people, but there wasn't anythingsaid about the health objectives which were formulated forte Runanga. Even the Maori Nurses came through strongly,especially at the finish
Hoani Waititi Marae was a great place to hold this Hui, andPeter Sharples and his group looked after us superbly well.thought it was a great way to start the day off withJoanne Robinson's Jazzercise and in retrospect, I wonder ifthere could have been other ways in which healthy activitiesmight have been promoted.
To me the most valuable aspect of the Hui was the informalcontact I had with a large numbe of people involved in a widespectrum of activities. I was very interested to hear allabout the Waahi project even if this did not come through atthe formal presentation or the workshop. Likewise, I was alsopleased to learn of other initiatives either in the meltingpot or just underway in other parts of the country. Clearly,there is a lot of activity going on and that is very excitingindeed. For me, such a meeting enabled me to get up-to-datewith what is going on, and to share experiences with others.It is my view that the informal contact as opposed to theformal sessions is the most valuable part of these Fluis, andfor that reason alone the Hui was a great success.
There was a strong feeling in Te Taha Tinana workshop thatfurther health workshops should be held in other regions ofthe country and that younger people should be encouraged toatten. I would enclose those views.
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Finally, I think it was a great credit to the HealthDepartment that both Doctors Barker and Salmond were therefor the whole time. All too often the people who are goingto make the important decisions on our behalf do so throughsecondhand information. I am sure both Doctors Barker andSalmond were able to gauge the sincerity of the many viewspointsthat 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 bothhesitant and sceptical. I was aware of the mana in which many of the speakerswere held and public comment or criticism would do little for the cause ofMaori health. The topics seemed so great that I saw this report becoming achronicle of the events or a list of dismal statistics. I was sceptical thatthe marae protocol, with its freedom for all to speak and its attention to anindividual's rights may have been too polite a place for the formulation of aHealth 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 itwas necessary to start with the young. Maoris at the Hui wanted the right todetermine for themselves how health dollars should be spent and pointed toongoing projects as evidence of their ability to design and run alternativehealth programmes.
Two things remain to be mentioned in this introduction. One was the strengthof women on the marae. Their spokespersons invariably swayed the audience withthe quality of both their arguments and their oratory. Secondly, the servicesprovided at the Waititi Marae were outstanding, both from a cultural and domesticpoint of view.
THE MEETING
The Hon. A.G. Malcolm, Minister of Health and the Hon. M.B.R. Couch, Ministerof Maori Affairs, were welcomed onto the marae to open the Hui. Mr. Malcolmset the tone for the meeting by emphasising some of the positive aspects ofhealth amongst Maoris - quite a change from the more usual stress on the dismalside. He foreshadowed the meeting's intent to pay more attention to thespiritual needs of healthy individuals. He encouraged Maoris to become involvedin health, either professionally, e.g. nursing or members of proposed area HealthBoards, 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 coinedto excuse some from facing the facts that much ill-health was self-inflected.He then expressed a view that health institutions were staffed by sympatheticsincere staff and that if the practices they were following within hospitalsseemed unacceptable to Maoris, it was likely to be because of ignorance ratherthan a reluctance to fit in with Maori customs. It was up to Maoris to informand educate health professionals in their traditions and not expect them to bemind-readers.
Dr. Tamati Reedy's message was simple: Fitness equates with health and well-being, and fitness is one's own responsibility.
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The discussions on Tuesday afternoon on the theme of "A Maori Perception ofHealth" 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 fromphysical health does so at their peril. Racial institutions, including thechurch and the health care services had denigrated Maori spirituality andattempted to replace it with another doctrine. The blatant racism in thehealth services would only be overcome by:
(a) a major review and change with the services currently administeringMaori health care.
(b) redirection of funds to encourage Maori health initiatives
(c) increasing the number of Maori doctors, (though he warned of thedanger of them becoming "perfect house niggers")
(d) establishing Health Clinics where doctors, lawyers and social workerswere available to provide early intervention for the problems inter-fering with healthy living.
(e) Hospital Board social services increasing their numbers of Maorisocial workers up to 25% of the total.
In the session on Te Taha Hinengaro (Mental Health) Dr. Mason Dune focussedon Mental Health rather than Mental Ill-Health and considered the topic underthe headings:
(a) What is Mental Health?
Dr. Dune reminded the audience that the holistic view of health wasa very familiar one in traditional Maori society and acknowledged theunity of the soul, the mind, the body and the family. Western medicinein contrast emphasised body health at the expense of those functionsthat could not be explained by the Laws of Physics.
(b) Who says so?
In deciding who should define Mental Health he warned that expertsstudy dysfunction rather than the promulgation of health. Further,as with other facets of life, statements about health emanating fromthe Marae have undoubtedly been made, though not necessarily heard,particularly if matters of health are looked upon as the exclusiveprovince 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 illustratehis 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 headYour spirit to God, the creator of all things".
Ngata
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The proverb acknowledges that growth does not occur without nurturance or newchanges, such as embracing new technology. It then advises the young to seekstrength and dignity in the teachings of their ancestors and finally advisesto pay heed to spiritual dimensions.
Mrs. Rose Pere introduced the topic of Family Health and illustrated those eightaspects that she believed contributed to a person's wellbeing as the tentacles ofan octopus. These were:
1.2.3.4.5.6.7.8.
WairuaManaMauriHaWhanaungatangaWha tumanawaUpokeHinengaro
- spiritual wellbeing- uniqueness of the family gives sustenance- life force- the breath- group dynamics- emotional aspect of a person- physical needs of the family- the mind.
The initiative of Maori women in health matters was really grasped by the MaoriWomen's Welfare League. Their nationwide survey Of women's health broke newground 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 theirremarkable efforts.
Dr. R.A. Barker, Director-General of Health, provided a sympathetic historicalperspective of health services in New Zealand. He emphasised the vulnerabilityof 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 purewater or good housing. For whatever reason though, there had been substantialimprovement in the health status of all New Zealanders and in general the Maorirates of disease, while still inferior to the Pakeha rates, were improving at amore rapid rate.
The session on Wednesday afternoon outlined some Maori health initiatives thatwere (a) widely accepted by the local people and (b) were successful in not onlythe delivery of acute health care, but in fostering the maintenance of a healthycommunity.
Mrs. Mahuta described the Waahi Marae Trust Project at Huntly, an example ofcommunity 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 NewZealand's most ambitious community health and development plan. The trusteesbegan in 1975 discussing a 25-year plan for people of Ngati Raukawa, NgatiToarangatira and Te Atiawa tribes who live in the many Maraes between Poriruaand 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.
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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 ingaol, 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 Clinicsat Ruatoki by Mrs. Puti O'Brien, formerly a Public Health Nurse in the area.The provision of facilities by Whakatane Hospital provided a precedent otherBoards could follow.
Finally, Mrs. Anna Jones provided a very practical lesson on the strength ofTe Kohanga Reo as a learning experience. With 250 Kohanga Reo in New Zealandthere is a wide network already functioning and instilling health concepts intochildren under four years of age.
COMMENTS:
1. Dame Whina Cooper, in her inimitable way, said on the first day thatshe expected action, not more words - a very pertinent observation from afounder member of the Maori Women's Welfare League who has been makingsuggestions on Maori Health for more than 30 years.
2. The positivity of this health Hui was remarkable with barely a mentionof the rather dismal statistics on Maori Health and I believe this positiveattitude 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 shouldencourage the Department of Health to extend and experiment with Maori-basedcentres for Maori communities.
5. New Zealanders, including Maoris, must be encouraged to "tend to spiritualaspects 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 MaoriWomen's Welfare League have been well served by their leaders, past and presentand in all community projects discussed their contributions were obvious.
7. The recently established Maori Nurses' Association was strongly representedand expressed a Health Professional viewpoint. It is clear they want toadopt a more active role in Maori Health Care.
8. By concentrating on the positive aspects of Maori Health-and the provisionof health skills to the young, no time was wasted on fruitless discussionas to who was to blame for poor health amongst Maoris. Both Ministers heldthat good health was earned and poor health equated with neglect or excesses.
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9. Maoris want to determine their won destiny and expect a greater voice inthe allocation and distribution of health resources.
10. The Health Department is to be congratulated for its willingness to holdsuch 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 standardof accommodation and catering the Marae provided.
Finally, I personally thank the Department of Health for giving me the opportunityto attend. It may have been the most important meeting on Maori Health held forforty years - time alone will tell.
COLIN D. MANTELL
MS M SOMERVILLEChief Social WorkerThames Hospital BoardTHAMES
MR S WARU/MR 3 TAMAKIRepresenting Mr A Phillips
PARTICIPANTS WHO-.ATTENDED- .THE HUI WHAKAORANGA
Ms 1 Young MRS S PRENTICEMedical Social WorkerBoard MemberMiddlemore Hospital Cook Hospital BoardAUCKLAND GISBORNE
MRS P O'BRIENBay of Plenty Hospital BoardWHAKATANE
MRS C PURDUEBoard MemberAuckland Hospital BoardAUCKLAND
MR W PLEYDELLStaff NurseOakley HospitalAUCKLAND
DR W PARKESGeriatricianNorthland Hospital BoardWHANGARE I
MS J WENNChief. NurseTaranaki Hospital BoardNEW PLYMOUTH
DR D BARRYPaediatricianHawkes Bay Hospital BoardHASTINGS
MRS V O'SULLIVANChairpersonWaikato Hospital BoardHAMILTON
MRS E MURCHIEResearch DirectorNZ Maori Women's Welfare League
MRS H WILSONTai Tokerau Area RepresentativeNZ Maori Women's Welfare League
MRS P WETINICommunity OfficerDepartment of Maori AffairsTAURANGA
MRS M TAIKATOMedical StudentWELLINGTON
MR M PAUL (AND MRS PAUL)Waiariki District RepresentativeNew Zealand Maori Council
PROFESSOR C MANTELLObstetrician/GynaecologistClinical School of MedicineAUCKLAND
PROFESSOR W WINIATA (AND MRSKeynote SpeakerWINIATA)Department of AccountingVictoria University WELLINGTON
Ms Harriet ChaseHamilton
Ms Teuira MareroaNational Council Maori NursesAuckland
Mrs R HurstNational Vice PresidentNZ Maori Women's Welfare League
Member of Steering Committeeon Maori Health
WELLINGTON
Mrs M WikairaTainui Area RepresentativeNZ Maori Women's Welfare League
Mr P SciasciaAssistant DirectorMaori and South PacificArts Council
WELLINGTON
Mr R EllisonTe Waipounamu DistrictRepresentative
NZ Maori Council
Mrs TuwhakarainaTauranga-Moana DistrictRepresentative
NZ Maori Council
Miss A DelamereAdviserNZ Maori Women's Welfare LeagueWELLINGTON
Dr M PaewaiMedical PractitionerAUCKLAND
Mr W ParkerVisiting LecturerVictoria UniversityWELLINGTON
Ms A HendersonMaori Health Education AdviserPalmerston North Hospital BoardPALMERSTON NORTH
Miss A MoodyNorthern Regional OfficerNZ Nurses AssociationAUCKLAND
Dr I HassallDeputy DirectorRoyal Society of Healthof Women and Children (Plunket)AUCKLAND
Mrs M BrucePresidentNZ Federation of VoluntaryWelfare Agencies
ChairpersonWellington Hospital BoardWELLINGTON
Dr J NewmanRepresentativeNew Zealand Paediatric SocietyAUCKLAND
Ms H WislangDepartment of Community HealthTauranga HospitalTAURANGA
Dr M UpsdellRepresentative Royal NZCollege of General Practitioners•AUCKLAND
Dr JVHodgeDirectorNew Zealand Medical Researci.:Council,AUCKLAND
Mrs M Nairn,Dental PractitionerAUCKLAND
Ms E DaviesAuckland
Dr P NgataCommunity Medicine RegistrarCoordinator of the SteeringCommitteeDepartment of HealthWellington
Dr R BarkerDirector-Genera l of HealthDepartment of HealthWellington
Dr J HoldenDeputy DirectorDivision of Health PromotionDepartment of HealthWellington
Dr B JamesDirector of Mental HealthDepartment of HealthWellington
Mrs M BazleyDirector of NursingDepartment of HealthWellington
Dr P KinlochResearch OfficerManagement Services Research UnitDepartment of HealthWellington
Dr J BrownlieMedical Officer of HealthWhangare i
Miss L DicksonPrincipal PublicHamilton District
Mrs M de RidderPrincipal PublicGisborne District
Ms L DyallAdvisory OfficerReview and DevelopmentSecretary of the SteeringCommitteeDepartment of HealthWellington
Mr N Te HikoSenior Executive OfficerHospitals DivisionMember of the Steering CommitteeDepartment of HealthWellington
Mr G GarlickSenior Advisory OfficerHospitals DivisionMember of the Steering CommitteeDepartment of HealthWellington
Dr G SalmondDeputy Director-General of HealthMember of the Steering CommitteeDepartment of HealthWellington
Mrs A BarhamPrincipal Public Health NurseMember of Steering CommitteeRotorua District Health Office
Health NurseOffice of Health
Health NurseOffice of Health
Mr B.PotakaSenior Exectuvie OfficerChairman of the SteeringDepartment of HealthWellington
Miss T BradleyNurse AdviserMember of Steering CommitteeDepartment of Health
Committeewellington
Mrs 3 KeithWELLINGTON
2 Rer,resentativeS ofAlcoholic Liquor Advisory.Council
RepresentativeNZ Medical AssociationAUCKLAND
Dr R JacksonDepartment of Community HealthClinical School of MedicineAUCKLAND
Mr B ElliottTokanui HospitalTE AWAMUTU
Dr I PriorEpidemiology UnitClinical School of MedicineWELLINGTON
Mr S EdwardsDental PractitionerROTORUA
Mr RossChairpersonNZ Dental Association
Dr P GowRheumatologistMiddlemore HospitalAUCKLAND
Dr P HutchisonObstetrician/GynaecologistAUCKLAND
Dr M AbbottDirectorMental HealthNew Zealand
AUCKLAND
Mrs W WalshTaumaranui Hospital BoardTAUMARANUIFoundation of
DEPARTMENT OF NURSINGSTUDIES, MASSEY UNIVERSITY:
Ms M PybinsMs 3 BoddingMs I Madjar
Mr J FaheyDirectorAccident Compensation CorporationWELLINGTON
Dr FSewellDepartment of Community HealthClinical School of MedicineAUCKLAND
Mrs M HammondIkaroa Area RepresentativeNew Zealand Maori CouncilWELLINGTON
Ms W Aorangi AUCKLAND DIVISION OF NZ CANCER
Accident Compensation CorporationSOCIETY:
AUCKLAND Mr 3 GaiserMr P LiddellMs B Marshall
Mr N PearceResearch OfficerClinical School of MedicineWELLINGTON
Dr S TonkinRepresentativePaediatric SocietyAUCKLAND
Ms T RangiwhetuWanganui HospitalWANGANU I
Mr H A MurrayRehabilitation LeagueAUCKLAND
Ms Ora Campbell H TimokoCarringtbn AucklandAUCKLAND
Ms Lena Reiman
Ms E NgataCarrington
Te AtatuAUCKLAND
AUCKLAND
Ms Nellie Hipplolite
Ms A NgataCarrington
Te AtatuAUCKLAND
AUCKLAND
Ms E Redwood
K NgataKingseat Hospital
Te AtatuAUCKLAND
AUCKLAND
Ms M Baker
Dr H NgataPharmacy Hospital
Te Puia HospitalAUCKLAND
WAIAPU
Ms H TukukinoWaikato Hospital BoardHAMILTON
Rongo ManaporiWanganui Hospital BoardWANGANU I
Audrey M ButlerManukau Technical InstituteAUCKLAND
Mrs K NgataTairawhiti kiTAURANGA
G WilliamsCarrington Psychiatric HospitalAUCKLAND
Ms W OveryFiji Red CrossAUCKLAND
Dr J DaveyNZ Planning CouncilWELLINGTON
Mr R EdwardsRehabilitation LeagueKAITAIA
Miss N C NeilsonWaikato Hospital BoardHAMILTON
Mrs H AllenPrincipal District Nurse:Cook Hospital BoardGISBORNE
Dr R G Güdex (AND MRS GUDEX)Obstetrician/GynaecologistWaikato HospitalHAMILTON
MRKTitoNorthland Hospital BoardRepresentative
NORTHLAND
Ms R HenryAotea Area RepresentativeNZ Maori Women's Welfare LeagueAUCKLAND
Dr A 3 SommervilleWaikato Hospital BoardHAMILTON
Mrs O.OhiaTAURANGA
Ms A Cochrane-PihamaACCORDAuckland
Ms J RobinsonDepartment of Maori AffairsAUCKLAND
Mrs T. RangiwhetuWANGANUI
A Maree Millac MBETaitokerau Maori DistrictCouncil
Whangarei
Mr I IrwinTai Rawhiti District RepresentativeNZ Maori CouncilGISBORNE
Mr J WilsonCharge NurseTokanui HospitalTE AWAMUTU
Mr E MurrayStaff NurseTokanui HospitalTE AWAMUTU
G L TustinDietitianDepartment of HealthAUCKLAND
Miss P CarrollExecutive DirectorNZ Nurses AssociationWELLINGTON
3 F KettCharge NurseTE AWAMUTIJ
Mrs J Kett Mr D HansenCharge Nurse Maori Affairs DepartmentTokanui Hospital
HendersonTE AWAMUTU AUCKLAND
Mrs K G KirbyNational PresidentNZ Maori Womens Welfare LeagueAUCKLAND
Mr J TañgioraTakitimu District RepresentativeNZ Maori Council
Dr B GregoryMember of Parliamentfor Northern Maori
Dr M DuneKeynote SpeakerPsychiatristPalmerston North Hospital
Dame Whina CooperFoundation Member/Past PresidentNZ Maori Women's Welfare League
Mrs A KoopuWaiariki Area RepresentativeNZ Maori Women's Welfare League
Ms E Te Pau-KonuiLkaoa Area RepresentativeNZ Maori Women's Welfare League
Dr S WalkerMedical PractitionerAUCKLAND
Mr P O'BrienManakau Technical InstituteAUCKLAND
Mr L TangaereChairpersonWaiapu Hospital BoardTE PUIA
Dr . R MahutaKeynote SpeakerWaahi Marae TrustHUNTLY
Mr P CreeveyContract ResearcherKihikihi
Mrs L ManuelPal Rawhiti Area RepresentativeNZ Maori Women's Welfare League
Mrs I KingiWomen's Health LeagueROTORUA
Mrs P MakihaChairpersonAuckland Maori Nurses Association
Mrs E GroobyTe Waipounamu Area RepresentativeNZ Maori Women's Welfare League
Dr E PomareGastroenterologistDepartment of MedicineClinical School of MedicineWELLINGTON
Dr A RuakereMedical PractitionerOPUNAKE
Mr T WinitanaHAMILTON
Mrs B HunapoManagere BranchNZ Maori Women's Welfare LeagueAUCKLAND
Mrs T McDowellMangere BranchNZ Maori Women's Welfare LeagueAUCKLAND
Mrs L WhitesideMangere BranchNZ Maori Women's Welfare LeagueAUCKLAND
Ms E van der WerffHealth DepartmentTakapunaAUCKLAND
Ms J Cairns .Ngapeke Whaioranga HealthWhanau Centre ProjectTAURANGA
Ms V CooperDepartment of HealthTakapunaAUCKLAND
Ms S TuhakarainaNgapeke Whaioranga Health/WhanauCentre Project
TAURANGA
Maaka Tibble MsOOhia
Royal NZ Foundation, Ngapeke Whaioran ,g.a . 1-léalth/Whanaufor the Blind
Centre-Project...AUCKLAND
TAURANGA
Margaret Rose O'SullivanDepartment of HealthTakapunaAUCKLAND
Mrs B PótakaLower HuttWELLINGTON
Ms E BlackwellDepartment of HealthTakapunaAUCKLAND
Ms B Te WheoroPublic - Health NurseManurewaAUCKLAND
Mr S MathiesonState Services CommissionAUCKLAND
Mr A TanaAlcoholic Advisory CouncilAUCKLAND
Ms 3 CrawfordNational Heart FoundationAUCKLAND
Mr C FisherNational Heart FoundationAUCKLAND
Ms R RataSocial Work DepartmentCarrington HospitalAUCKLAND
Ms 3 SchaverenMt Albert CentreAUCKLAND
Ms H Te HemaraCommunity OfficerAUCKLAND
Ms M SmithTokanui Hospital BoardTOKANUI
Mr M Raerino Mrs Anihira
A.L.A.C. New Zealand Maori Council
AUCKLAND TAUMARANUI
Ms R HenryMaori Women's Welfare LeagueRegional AoteaTAUMARANU I
Ms C ManiheraMaori Women's Welfare LeagueTAURANGA
Ms R NormanAccident Compensation CommissionAUCKLAND
Ms T Hetet-MatatahiWaahi Marae Liaison PersonHUNTLY
Ms N AndrewsDepartment of HealthHAMILTON
Dr A CowanMedical Officer of HealthDepartment of HealthSOUTH AUCKLAND
Ms H PuruMaori Women's Welfare LeagueAUCKLAND
Ms M SzaszyMaori Women's Welfare LeagueAUCKLAND
Ms S Filipo Ms E TitoFiordland Community Health Worker Diabetes Field-workerROTORUA Otahuhu
AUCKLAND
Ms B Holm Mr D NepiaPrime Minister's DepartmentAUCKLAND
Social AffairsWELLINGTON
Ms J TakarangiMaori Health ResourceTeam MemberPALMERSTON NORTH
Raukina Leather12 Makara RoadPARAPARAUMU
Ms D HutchinsDepartment of HealthGISBORNE
Dr M J Paparangi ReidTe Rarawa House SurgeonMiddlemore HospitalAUCKLAND
Ms B AllenMaori Women's Welfare LeagueAUCKLAND
Ms M LarkinAUCKLAND
Ms J Te Hermara MaipaAUCKLAND
Dr R FlightDepartment of HealthTakapunaAUCKLAND
Mr R Munro Ms R Te Miringa Huriwai
Mental Health FoundationNorthland Community College
Board Member WHANGAREI
AUCKLAND
-A
Dr J McLeodMedical Officer.of HealthTakapuna District Office of HealthMember of the Steering CommitteeTakapuna
MrWKaaDirector, Maori and Pacific IslandsEducation
Department of EducationMember of the Steering CommitteeWellington
Mr D CurryChief Executive OfficerDivision of Public :I1ea1t11Department of HealthWellington
Mr M HollisDirector of Health EducationDepartment of HealthWellington
Dr H BuchanCommunity Health TraineeAuckland
Mrs K KereamaRaukawa Area RepresentativeNew Zealand Maori CouncilFeuding
Mrs H B AllenPrincipal District NurseCook Hospital BoardGisborne
Mr D SnelgarNorthland Health Services AdvisoryCommittee
Whangarei District Office of HealthWhangarei
Mrs B KillHealth Education Regional Adviser (Wellington)Department of HealthWellington
Ms H Delamere Thompson
Mrs E FlightMiddlemore Hospital
Maori Women's WelfareAUCKLAND
LeagueAUCKLAND
Dr F B SillGeneral PractitionerROTORUA
Ms S TuhakaraingaTauranga Moana District CouncilTAURANGA
B McCormickHenderson HouseAUCKLAND
Dr J S Te M AllanAUCKLAND
Mr H M Te W WilliamsDirectorTe Reo 0 AotearoaAUCKLAND
Tarat i-Hohepa-B irksRedwood Haven TherapeuticCommunitySWANSON
Ms Donna AwatereTe Koputu TaongaAUCKLAND
Mr Winston ManiapotoProbation ServiceAUCKLAND
Mr Brendan ScullyCarrington HospitalAUCKLAND
Ms Wiki AndersonAUCKLAND
WA 300 [QI87825Planning
.... k oP (1984 Auckland)
WA300[Q]MAO198487825
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