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Page 1: 1 IUI IIHI - moh.govt.nz

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="t Of Healthwellivon

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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

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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11 . Evaluation of the Hui Whkaoranga by Dr. Eru Pomare and Di'.

Cohn Mantell.

12. Participants who attended the Hui Whakoorariga

13

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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)

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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.

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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

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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

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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

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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..

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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

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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

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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).

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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

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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.

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( 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

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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

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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

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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

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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

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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.

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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

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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

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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

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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

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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

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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.

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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

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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.

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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.

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(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

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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

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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;

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(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;

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(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.

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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

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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

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. 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.

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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,

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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

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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()

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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

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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

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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)

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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.

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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.

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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.

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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.

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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,

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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.

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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.

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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.

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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.

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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.

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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.

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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 -

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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.

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"TE TAHA HINENGARO"

AN INTEGRATED APPROACH TO MENTAL HEALTH

M. H. DURIE

Director of PsychiatryPalmerston North Hospital.

HUI WHAKAORANGAHOANI WAITITI MARAEAUCKLAND

MARCH, 1984

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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

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-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

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-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.

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-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

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-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

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-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.

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-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.

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-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.

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-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

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- 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

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- 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,

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- 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

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- 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.

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- 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.

************

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te01-e

oranga 0 rehealth of the

whanaufamily)

Rose Rangiirie PereT&Fknga

zi it

Pr6iJext.

THE OCTOPUS as a symbol

woorohuie.nro

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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.

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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

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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

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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

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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.

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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.

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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)

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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.

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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".

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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.

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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).

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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.

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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.

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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.

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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.

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(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.

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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

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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.

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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

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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.

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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.

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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.

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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.

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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,

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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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3

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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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WA 300 [QI87825Planning

.... k oP (1984 Auckland)

WA300[Q]MAO198487825

LibraryDGpe,tmnf of Healthftlongton

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