Maori & Wareware
Specific Cultural Issues/Factors that need to be considered!
In home and residential care Cultural Competence
Joseph Whanau Whanaungatanga Whakapapa
Whakapapa - Whanaungatanga
• 75 yr old Maori Female • Rest Home Care with Wareware • RN Withdrawn/Depressed • Pictures on the Wall Family Reunion in Cambridge • Daughter lived close by in Community working • 5 children • Tainui/Waikato Descent • 7th Day Adventist – loves her church
Whakawhanaungatanga • Missed the reunion in Cambridge • Anxiety attacks travelling in cars > 30 mins • Explored depression issues with her • Agreed to take medications SSRI • Anxiety improved somewhat after 1 month • Feeling better • Working on Travelling further • RN Surprised. 1st GP She had opened up to?! • Maori Doctor? By Maori for Maori? • Whakawhanaungatanga – Whakapapa?
Paratene Ngata
• Whakarongo – the act to listen • Rongo – to hear • Rongoa – Medicine
Maori & Wareware
• Introduction • Prevalence • Maori Models of Health • Aspects of Care for Maori & their Whanau
Figure 1: Age distribution of the Māori population, males and females, 2013
Figure 1: Age distribution of the Non-Māori population, males and females, 2013
Maori + Non Maori Population Distribution
• 80% Maori under 45 yrs • 61% Non Maori under 45 yrs • 4% Maori 65+ • 14% Non Maori 65+
Maori Population
• 15% Population • 24% of Under 5’s • 4.7% of Over 65+ • 2% of 80+
Dementia Prevalence 2011 • 2011 • Total Dementia Patients – 48182 • Maori with Dementia – 1970 or 4% • Maori 2% of Rest Home Clients • 2025 • Total Dementia Patients – 78267 • Maori with Dementia – 4493 or 5% • Maori as a proportion of dementia patients will continue to
climb! • 2050 estimated 7% • More Maori in Rest Homes!
Types of Dementia • Alzheimers • Vascular • Mixed • Lewy Body • Fronto-Temporal • Parkinsons • Wernicke-Korsakoff • Huntingtons • Creutzfeldt-Jakob • Normal Pressure Hydrocephalus • Downs Syndrome • Other
Maori - Risk Factors
• Depression • Trauma • Substance Abuse • Cardio/Cerebrovascular Disease – twice as
likely to be hospitalised for Stroke and IHD • Likely to be much higher prevalence then
what is evident currently! Why?
Whanau • 70yr old Male • Wareware • CVA • Dependent • Hemiplegia • Dysphasia • Im Taking Him Home!!!!!!!!!!! • Dont forget who I am? • Don’t forget who they are! • Reciprocal Care
Whanau/Reciprocal Care
• Whanau – Birth/Family • Hapu – Pregnant/Clan • Iwi – Bones/Tribe • Close Bonds? • Dementia – not well understood?
Dementia/Wareware
• Forgetful – Normal Aging? • Cantankerous/Hoha? • Diagnosis Dementia i. Mana – how dare you? ii. Stigma – Shock, Negative iii. Whakama – Makutu/Transgression of Tapu iv. Matakite – Communicating with Tupuna, gift
Dementia/Wareware
• Senior Colleagues – psychosis, Te Arai thinner and communicate with those on the other side!
• Whanau more likely to tolerate normal behaviours?
• Seek help from whanau and tohunga or ministers
• Present late with more severe pathology
Maori Models of Health
• Te Whare Tapawha • Te Whetu • Te Wheke • Putahi
• Biomedical Model • Holistic in their approach
Te Whare Tapa Wha/Whanau Ora
Taha Wairua
• Male 76 Maori • Whakawhanaungatanga • Depression/Anxiety • At home, withdrawn • SSRI months helped a little • Tinana/Hinengaro/Whanau • Wairua?
Taha Wairua
• Hadnt been to Church 15-20yrs • Same religion as me • Suggested go to Church • 2 months later Anxiety improved • Stopped taking SSRI • He & Whanau happier. More manageable!
Te Whetu
• Land/Whenua • Body/Tinana • Mind/Hinengaro • Social/Whanau • Spiritual/Wairua
He wahine, he whenua, e ngaro ai te tangata
Land
• Activities Land • Marae • Maori Health Provider – Programmes • Cultural Advisor • Cultural/Clinical Navigators
Dementia Care in New Zealand Barriers for Maori
• Fear of Western Institutions • Exclusion of Culture • Knowledge and Education • Communication of Information • Disjointed Services, Multiple Organisations
Screening Tools for Dementia
1. MMSE – Mini-Mental Status Examination 2. 3M or Modified MMSE 3. Mini-Cog 4. GPCOG - GP Cognitive Assessment 5. MoCA - Montreal Cognitive Assessment
Fear of Medical Facilities & Profession
• Cost • Older Whanau experiences of
Institutionalisation • Hospital – place you go to die • Bad Experiences with Medical Hospitals & GP
practices • Not referred when needed
Maori Principles
• Whakapapa • Whanaungatanga • Whakama • Whanau Ora • Manaaki • Aroha • Mana • Mauri • Pono
• Tapu • Noa • Ea • Aroha ki te tangata • etc
Communication
• Kanohi ki te kanohi • Whakawhanaungatanga • Whakapapa • English – Foreign Workers • Medical Jargon • Labelling • Use of Maori Terms • Tapu & Noa
Whakatauki
• Naku te rourou, nau te rourou, ka ora ai te iwi!