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Pharmaceutical Management Agency
Te Ara Poutama
Reference book
Acknowledgements He mihi maioha tēnei ki ngā kaiāwhina Ko ngā whaea me ngā mātua Koutou ko ngā kaiwhakaruruhau E whakapoipoi, e whāinga hoki Ngā tamariki mokopuna o tēnei ao I te matatauranga heke iho nō ngā mātua tūpuna. Tēnei e mihi kau atu ana ki a koutou I waihotia ēnei taonga hei maramatanga mō te ao whānui Tēnā koutou, tēnā koutou, tēnā rā koutou katoa. With deep admiration we acknowledge the many caregivers The aunties and uncles, mothers and fathers, Those many protectors Who encouraged and fed The generation of today With the understandings passed down from our ancestors We acknowledge all of those Who left behind this treasure chest of knowledge to brighten this world We recognise your physical presence, your wisdom and your spirit.
Te Ara Poutama Reference book
Contents
Te Whaioranga The Treaty of Waitangi Karakia Wairua Important Māori concepts relating to health Models of Māori Health Marae Pōwhiri Matariki Te Reo Māori Kōrero Māori Waiata The State of Māori Health Māori Health Strategies Māori Health Providers Patient Case Study Rongoā Māori Bibliography 2 4 6 8 10 12 14 17 24 28 30 34 36 38 39 41 42 44
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Te Whaioranga
PHARMAC Māori Responsiveness Strategy
PHARMAC is the New Zealand Crown Agency responsible for the management of the National Pharmaceutical Schedule. PHARMAC has been concerned for some time that the benefits of subsidised medicines may not be reaching Māori at the same rates as other New Zealanders. The overall aim of Te Whaioranga, the Māori Responsiveness Strategy Action Plan, aligns with that of He Korowai Oranga (the Māori Health Strategy) namely whānau ora; Māori families supported to achieve their maximum health and wellbeing through the safe and appropriate use of medicines. As PHARMAC moves forward with Te Whaioranga, the Māori Responsiveness Strategy Action Plan, increasingly the organisation will be expected to work with, and alongside, Māori organisations, providers and communities. A better understanding of Māori perspectives and cultural practices will allow staff to move comfortably in a Māori environment and engage much more effectively. The Māori Health Team want to support PHARMAC staff by providing practical insights and tips for working with Māori. The information in this booklet is meant as an introduction only. Māori perspectives and cultural practices can vary significantly across the country and it is important to maintain a cautious and humble approach to establishing new relationships.
Strategic approach
PHARMAC undertook fifteen consultation hui across New Zealand to discuss the issues of access to medicines. This provided the opportunity for whānau, Māori health providers, GPs, nurses and pharmacists to identify areas of need in relation to medicines. Many of the issues and ideas raised at these hui were incorporated into PHARMAC’s Māori Responsiveness Strategy (2002). Six strategic goals were identified in the Māori Responsiveness Strategy: 1. Incorporate Māori strategic priorities; 2. Improve human resources; 3. Improve ethnicity data collection and analysis; 4. Improve performance in negotiating with suppliers and assessing new drug applications; 5. Improve performance in informing Māori about available subsidised medicines; 6. Improve Māori representation and participation. In 2008, Te Whaioranga, the Māori Responsiveness Strategy Action Plan 2007 - 2012 was launched. The 2007 2012 goals were built upon the original 2002 Māori Responsiveness Strategy and incorporated recommendations from a report “Implementing PHARMAC’s Māori Responsiveness Strategy” (2006). The goals are: 1. Integrate Māori strategic priorities; 2. Enhance internal PHARMAC capability in relation to Māori health issues; 3. Improve the quality of data analysis in relation to Māori health; 4. Prioritise Māori health priority areas in Funding and Procurement; 5. Advance Optimal Use of Medicines for Māori; 6. Ensure significant Māori representation and participation within PHARMAC.
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Mauri Ora
The Dynamics of Māori Health
“Manaaki whenua. Manaaki tangata. Haere whakamua.” Care for the land. Care for the people. Go forward.
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Te Tiriti o Waitangi:
the Treaty of Waitangi
PHARMAC acknowledges the special relationship that exists between the Crown and Māori. We recognise the articles of the Treaty of Waitangi expressed through the principles of Partnership, Protection and Participation. PHARMAC will demonstrate its commitment to the Treaty of Waitangi through the following actions: Partnership: working together with whānau, hapū, iwi, Māori communities and Māori organisations to develop strategies for Māori health gain through use of medicines; Protection: ensuring Māori enjoy the same access to medicines as non Māori; and receive at least the same level of health, whilst acknowledging and safeguarding Māori cultural concepts and values; Participation: involving and encouraging Māori participation at all levels within the health sector in planning, procurement, access and optimal use of medicines. This staff training and development reference book, Te Ara Poutama, is part of PHARMAC’s commitment to enhance internal PHARMAC capability in relation to Māori health issues. It is hoped that the content herein will be informative for PHARMAC staff, and will help to enhance understanding of te ao Māori.
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Pupuha, Pupuha ka whakaea te manawa o te rangi e tū Ranginui, Rangiroa, Rangitahunuku Ka tū hōmai te wairua Ora ki tupua, Ora ki tawhito, Ora ki te whei ao, ki te ao marama Tīhei wa mauri ora!
A tauparapara from Northland used to invigorate and strengthen a situation.
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Karakia
Prayers and Incantations
Karakia hold a special place in many Māori activities. Karakia acknowledge the presence of wairua (a spiritual dimension), an important component to Māori life. Traditionally, karakia were utilised in many of the everyday activities that Māori undertook such as fishing, gardening, weaving, carving and cooking. Today karakia will be offered on almost all marae. Many Māori organisations still utilise karakia as a way of bringing the people together, giving thanks for their achievements and asking for protection and assistance as they focus on the work ahead. Nowadays, most karakia that you will hear are Christian-based; however, there are still hapū and whānau around the country that maintain the older traditional karakia.
Karakia to bless kai
Whakapaingia ēnei kai Hei oranga mō ō mātou tinana Whāngaia ō mātou wairua Ki te taro o te ora Ko Ihu Karaiti tō mātou kaiwhakaora Āmene
Bless this kai As nourishment for our bodies Feed also our spirits From the source of all life With Jesus Christ as our saviour Amen
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A karakia to start the day
E te Kaihanga i te aonga o tēnei rā hou E whakawhētai ana mātou i a Koe Mō āu manaakitanga katoa Nāu rā ūtaina ki runga i a tātou katoa Puta noa i te pō, kua pahure nei. I raro i te maru o tōu korowai whakaruruhau Ko whai kaha ana mātou Ki te anga mai e ngā āhuatanga katoa kei mua i a mātou i tēnei rā. E whakawhētai ana mātou i a Koe Mō ngā hua nāu rā i hanga, hei painga Hei oranga hoki mō te ao katoa. Tēnā, ko te whitinga o te rā Te pupuhi o te hau Me te hekenga iho o te ua. Kia pai ai te tupu o ngā mea katoa Hei mea whāngai, Hei mea whakaora hoki, I te tinana, i te hinengaro, me te wairua hoki o tātou te tangata. Tūturu whakamaua kia tina, tina, haumi e, hui e, tāiki e. From the beginning of this new day we acknowledge the creator, and give thanks to You For the nurturing and shelter, That you gave to everyone, Right through the night that has just past Under your protective cloak, We gathered strength, Enabling us to face all the challenges, That will come our way on this day We give thanks to You, For all the good things you have created, Which nourish the entire world. The shining of the sun. The blowing of the wind. The falling of the rain, Which will help all things to grow Feeding… Invigorating… The body, the mind and the spirit of all people This is indeed the way it is, And how it will be forever
The Lord’s Prayer in Māori
E tō mātou Matua i te rangi Kia tapu tōu ingoa. Kia tae mai tōu rangatiratanga. Kia meatia tāu e pai ai ki runga ki te whenua, kia rite anō ki tō te rangi. Homai ki a mātou aianei He taro mā mātou mō tēnei rā. Murua o mātou hara, Me mātou hoki e muru nei I ō te hunga e hara ana ki a mātou Aua hoki mātou e kawea kia whakawaia; Engari whakaorangia mātou i te kino: Nōu hoki te rangatiratanga, Te kaha, me te korōria, Ake ake ake. Amine Our Father which art in heaven, Hallowed be thy name. Thy kingdom come. Thy will be done on earth, As it is in heaven. Give us this day our daily bread. Forgive us our sins As we forgive those who sin against us. Lead us not into temptation, But deliver us from evil: For thine is the kingdom, The power and the glory, Forever and ever. Amen.
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Manaakitanga
Manaakitanga is a significant aspect of the Māori value system and is characterised through the acts of hospitality and kindness. It is an ethic of care which links directly to Māori wellbeing. Manaakitanga is demonstrated on a number of levels from one’s relationship with the local environment, to the cultural practices on a marae and the dynamics of growing a healthy community. The practice of manaakitanga in the home is mana-enhancing and a good indicator of a healthy whānau.
Wairua
“Koro, what is wairua?” the child asked, eyes wide. Wairua, my moko is what gives us life, Handed down to us from a time past. At the moment of your beginning, You shared with me the wairua of our tīpuna; For I am your link with the past, You are my place in the future. The aroha of the whānau has wairua. And their words, their laughter, their tears, The marae, tangi, waiata and whakapapa, Have a wairua that strengthens us, gives us pride.
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Te manu e kai ana i te ngahere, nōna te miro Te manu e kai ana i te mātauranga, nōna te ao
The bird which feasts on the forest owns the miro berry The bird which feasts on knowledge owns the world
So too the sunrise and sunset, The soft summer rain, the raging storm, The song of the birds in the trees, The waves on the beach, The mist rising from the bush, The moonlight on the water, And the embracing darkness of the night. To sit quietly in the wharenui or the urupā, And feel the presence of your tīpuna is to feel wairua. Your arms about my neck , your breath on my cheek, Fills me with a special wairua. For there is wairua in all things that give meaning to life,
To love , to the future. So moko, open your mind, Let your heart love, Your eyes see, Your ears hear Your hands feel. Give of yourself, my moko, For in giving you receive And the wairua grows. Heather Delamere Thomson
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Important Māori concepts relating to health:
Mauri ora and Mauri mate
Mauri is an energy which is present in all things of this world. However, people (and living or moving things) are also vessels for mauri ora, ‘life energy’. You will often hear orators on a marae start their speeches with the words ‘Tīhei wa mauri ora!’ Literally the ‘sneeze of life’. This is a call for life energy to be brought into the hui. When a mokopuna (grandchild) sneezes, you may sometimes hear one of her elders call out ‘Mauri ora!’ The opposite of mauri ora is mauri mate, which relates to the energies of sickness and death. At a tangi or funeral the orators will often change their words to ‘Tīhei wa mauri mate’ to acknowledge the ‘death energy’ which is present. Although these concepts are seldom discussed, the pursuit of places, things and people which can enhance the mauri ora of a person is the ultimate aim of the health sector.
a place, person or thing is dedicated to the gods and set aside from normal everyday use. However, people in various states such as illness and grief, or whilst engaged in important work like carving waka or having tāmoko (tattoo) done, were all considered tapu. Places which are unclean or used in the preparation of kai are also considered tapu. Visitors to a marae are considered tapu when they first arrive, as are various parts of the body or a marae. When you consider the nature of the places, people and things that are tapu, in every situation there is a potential for things to go badly or to turn out well. The common thread to situations which are tapu is that the outcome is uncertain. A positive result requires things to be done correctly and having support from a higher power. Noa is the opposite of tapu. Water and food are considered noa and have the ability to remove tapu. If tapu is associated with uncertainty and restriction, then noa is certainty and freedom. Things that are noa are clean and safe. The process of moving onto a marae involves moving from a state of tapu to one of noa. Similarly the process of becoming well involves harmonizing the tapu and noa of a person.
Mana
The Reverend Māori Marsden1 describes mana as having two aspects, one relating to authority and the other associated with power. The authority in this sense is god-given and the power is dependent on action and performance. On a personal level there is mana which reflects the intrinsic qualities that an individual is born with. Some people are naturally athletic; some show a tendency toward
Tapu and Noa
Tapu is often wrongly linked to the word tabu, and although tapu can have elements of restriction and sacredness associated with it, the core concept of tapu is much broader. Traditionally tapu was the means by which
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mathematics; others are musical or have wonderful singing voices. Often these qualities are passed down through whānau. We see generations of rugby players becoming All Blacks or families full of musicians, doctors and lawyers. This is considered as the mana of a whānau. However, although a person may be blessed with certain abilities and qualities, to enhance their mana they must also demonstrate their abilities through achievement. This achievement provides them with additional power and authority to exercise that mana, and through their words and actions influence and lead others. In this way mana is not something a person can claim with their words. It can only be attributed by others. Mana is not about ego or pride. The wellbeing of a person is directly linked to their mana. Someone who has suffered a substantial loss of mana, or has had few prospects to develop their mana, often becomes depressed and unwell. Providing opportunities for people to enhance their mana, by utilising their abilities through achievement, plays an important role in improving health outcomes.
“In terms of health, therefore, tapu could be seen as a preventative measure as well as a cause of sickness. Conversely, a breach of tapu could lead to illness and even calamity on a widespread basis.”
Mason Durie, (1998), p.8
“The balance between tapu and noa was a dynamic one, moving to accommodate seasonal, human and physical needs within a value system that was holistic to accommodate health interests. Both noa and tapu had meaning for health: noa denoting safety, tapu protection.”
Mason Durie, (1998), p.9 (2003). Royal,C. The Woven Universe: selected writings of Māori Marsden. Te Wānanga o Raukawa: Ōtaki, New Zealand.
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Models of Māori Health
The mauri (life force) of the people, and objects surrounding an individual and the strength of identity through one’s cultural base, are key contributors to health in a Māori paradigm. Contemporary health services often fall short for many Māori due to a limited focus on the physical or psychological wellbeing of the individual. For traditional Māori the importance of wairua (spiritual wellbeing) in the context of the whānau and extended whānau, as well as the wider physical and spiritual environment, play significant roles in the wellbeing of a person. There are several Māori models for health and wellbeing that have been developed over the years to incorporate many of these considerations.
Taha Tinana
physical health
For Māori, physical health is explicitly connected to a person’s spirit, mind and family.
Taha Wairua
spiritual health
Wairua encapsulates the life force around a person and its impact on an individual’s spiritual essence. Wairua requires a consideration of environment, a link to past generations and a connection to higher powers. Traditionally, an examination of an unwell person would include an assessment of the impact that wairua was having on that person’s health. Wairua acknowledges unseen and unspoken energies that can impact on both illness and treatment.
Te Whare Tapa Whā
Mason Durie
1
Taha Whānau
family health
Whānau (family) play an important role in the wellbeing of a person. They can contribute to sickness as well as assist in curing illness. The sense of belonging and strength that whānau can provide is one of the key foundations to Māori health.
Dr Mason Durie recognises four components to Māori health, each of which make up the four walls of a whare; taha tinana (physical), taha wairua (spiritual), taha whānau (family), and taha hinengaro (mental).
Taha Hinengaro
mental health
Thought, feeling and emotions are invariably linked to physical and spiritual wellbeing. Māori acknowledge the vital link that thoughts, feelings and emotions have to overall health.
1
Durie, M. (1994). Whaiora: Māori Health Development. Oxford University Press: Auckland NZ. pp. 69-74.
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Te Wheke
Dr Rose Pere
Te wheke the octopus is a very ancient symbol for many indigenous Pacific peoples. In Hawaii, the octopus is used to define the traditional migration path that people took as they settled in the Pacific. Dr Rose Pere2 utilises this traditional symbol as a way of defining whānau health. The head of the octopus represents the whānau, its eyes the waiora (total wellbeing for the individual and family,) with each of the eight tentacles defining a specific dimension of health. Like tentacles, the dimensions are linked and interwoven stressing the importance of taking a holistic view to Māori health. Wairuatanga Hinengaro Taha Tinana Whanaungatanga Mauri Mana ake Hā a koro mā, a kui mā Whatumanawa
2
Spirituality Mind Physical wellbeing Extended family Life force in people and objects Unique identity of individuals and family Breath of life from forbears The open and healthy expression of emotion
Pere, R. (1984). Te Oranga o te Whānau: the health of the family. Whakaoranga Māori Health Planning Workshop: Hoani Waititi Marae, Mangere Auckland.
Te Pae Mahutonga
Mason Durie
Te Pae Mahutonga is the Māori name for the Southern Cross. In this model, Durie3 utilises this well known constellation as a framework for Māori Health promotion. The four main stars of the Southern Cross represent the mauri ora (cultural identity), waiora (physical environment) toiora (healthy lifestyles) and te oranga (participation in society). The pointers represent ngā manukura (community leadership) and te mana whakahaere (autonomy)
Durie, M. (1999). Te Pae Mahutonga: a model for Māori health promotion. Health Promotion Forum of New Zealand Newsletter(49), 2-5 Dec 1999.
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Marae
The marae is the heart centre of Māori communities. Marae host significant gatherings and are utilised for the tribal, educational and spiritual needs of the people.
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A marae represents a group of people. In many cases the relationship between a marae and its people has been established for many generations.
Most marae are linked to specific iwi, hapū or whānau. However, some marae are associated with pan-Māori collectives in urban centres, schools, tertiary institutions or churches. The word marae or marae-ātea literally refers to the area in front of the wharehui (large meeting house) although today the term marae is generally used for the entire marae complex. The typical marae complex will include a wharehui (meeting house), a wharekai (dining area), and an ablution block. Many marae are also connected to particular urupā or cemeteries, and although they may not be physically connected, the marae and its urupā are considered one facility. Similarly, other marae are closely linked to whare karakia or churches which are in close proximity. Larger marae complexes may contain additional accommodation, meeting rooms and conference facilities. Most marae are set up as reservations and registered under the Te Ture Whenua Māori Act 1993. A group of trustees is responsible for maintaining the facility on behalf of the marae beneficiaries. The day to day running of a marae is most often left to a marae committee made up of tangata whenua or people of the land. The people who keep a marae operating represent the ahikā of the tangata whenua. Literally the word ahikā means ‘burning fire’ which symbolises the role that the ahikā play in keeping the marae going. Through their work the marae and homelands are looked
after and the wharehui (meeting house) and wharekai (dining room) are kept warm and welcoming.
Wharehui
The Meeting House
Many wharehui represent tūpuna or ancestors who link the people of that marae together. Others embody the local environment and history of the people from that area. Wharehui may also display pictures on their walls of tūpuna (ancestors) and whānau who have passed on. Some marae have decorative carvings, tukutuku and kōwhaiwhai patterns adorning their wharehui. As well as acting as the main meeting area for the marae complex the wharehui is used for tangihanga or funerals, providing a final resting place for whānau before they are taken to the urupā or cemetery. As such, the wharehui acts as a link between the living and the dead, between heaven and earth, and therefore sustains a special tapu. The tapu associated with the marae-ātea and wharehui dictates that specific tikanga (protocols) be observed. When visiting marae it is important to seek advice or guidance before entering. Each marae will have its own protocols for pōwhiri or welcoming guests. Although these may vary slightly around the country the themes remain the same.
Tangihanga
Funeral
The tangihanga is at the core of Māori cultural practice. Each marae has its own protocols for tangihanga. From the time of death the tūpāpaku (body) is surrounded by the extended whānau and never left alone. Māori believe that a person’s spirit does not leave this world until they are buried in the ground.
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When a person of great mana dies the interest in their tangihanga will be considerable. They may visit several marae on the way back to their main marae were they are to be buried. There may be great debates about where they should be buried. These debates are part of the tribute to a person’s mana. In some cases the kaumātua of a marae will ceremonially lay claim to a tūpāpaku as a sign of respect, knowing full well that a person is bound for another marae. The guiding factor in these matters will always be the depth of aroha and support that the close whānau express during these debates. When the tūpāpaku is returned to their marae it is held there for three days. The coffin is opened and whānau and friends come from great distances to farewell the person. The tangi provides a time of healing, important for the wellbeing of the person’s whānau. The whānau get an opportunity to hear stories from all the people who visit over the three days of the tangihanga, gaining a greater appreciation about the deceased person’s life, their relationships and achievements. The whānau is supported by the entire marae community and together they spend time with visitors remembering, laughing, crying and sharing the burden of their grief. The tangihanga also provides an opportunity for any unresolved issues to be discussed and sorted out, allowing the whānau to let go and freeing the person’s spirit to depart in peace. The person is usually buried on the third day in the urupā associated with their marae. Everyone then returns with the whānau to the marae before sharing a hākari (feast). As the tangihanga is considered a very tapu time, the sharing of kai is an important part of removing this tapu; it allows everyone involved to return to a state of noa.
Pōwhiri or Pōhiri
Protocols of welcome
Manuhiri is the term used for people who are visiting a marae. As mentioned earlier, new manuhiri to a marae are considered tapu when they first arrive. The aim of pōwhiri is to welcome manuhiri by removing this tapu and allowing them to be noa and to feel at ease on the marae. There are several stages to pōwhiri each of which brings the manuhiri and tangata whenua closer together, both physically and spiritually. Importantly the purpose for the gathering is spelt out and the process of kotahitanga (togetherness) is begun in the pursuit of a successful outcome for the hui.
Toitū te whenua Ngaro ana te tangata People are lost But the land remains
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Stages of a Pōwhiri There are a number of stages to a pōwhiri. However the order and nature of these stages can alter slightly between different iwi.
Each area, and marae, has its own kawa (set of practices) forming a complex yet dynamic experience when visiting marae across the country.
from the marae who have passed on and also consider who they are about to meet, and the kaupapa (reason) that they have come to the marae for. It is important that the manuhiri are composed when they gather at the gate. Tangata whenua will sometimes wait for the manuhiri to quieten down and become calm before bringing them onto their marae. A noisy, talkative group is a sign to the tangata whenua that the manuhiri are not ready to enter or that someone has not arrived yet.
Stage two:
Te Wero The challenge
Traditionally the wero was to ensure that the manuhiri came in peace and held no ill intention to attack the people of the marae. The wero is a challenge to the manuhiri and is nowadays reserved for honoured guests. It is issued by a male kaitaki (challenger) often in traditional dress. He advances on the manuhiri swinging a taiaha and attempting to provoke the manuhiri with his gestures. When he gets close to the manuhiri he presents a taki in the form of a small carved dart or a twig from a tree, which he places on the ground at the feet of the highest ranked manuhiri. He then retreats to observe their response. The taki should be picked up slowly by a male in the manuhiri, as the kaitaki from the marae is waiting to see if there are any men who intend to attack. If the taki is picked up correctly the kaitaki will return back towards the wharehui, leading the manuhiri onto the marae. In some instances there may
Stage one:
Huinga i te wahanui
Gathering at the gate
Before entering, the manuhiri (visitors) gather outside the front of the marae. On some marae there is a carved wahanui (gateway) for manuhiri to congregate around. Coming together at the gateway is an important time for the manuhiri to prepare for entering onto the marae. People will harirū and hongi to strengthen the kotahitanga (unity) of the manuhiri group. Koha (money) will be gathered and handed to the kaikōrero (speakers) to give to the tangata whenua during the pōwhiri. Koha is often given in an envelope with the name of the person giving the money written on the outside. The concept of koha is about reciprocity; hence a good rule of thumb is to ensure to give more than you receive. If possible the koha should more than cover the cost of hosting you. Those who will speak will ensure they understand the kawa (cultural practices) specific to that marae. While they are waiting manuhiri spend time to remember those
be up to three kaitaki from the marae, who come out to challenge the manuhiri.
When the tangata whenua believe the manuhiri are ready to enter, a woman from the marae will karanga (call). This is the first voice to be heard on the marae. The karanga will vary depending on the kaikaranga (caller) and
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the kaupapa (reason) for the hui; however the structure of karanga remains consistent. Most karanga convey a specific welcome from that marae, naming the hapū or whānau that are welcoming the manuhiri and identifying significant landmarks and historical events particular to that area. There is also a welcome to both the living and the dead. Māori carry their ancestors with them particularly when they enter marae and, during the karanga, memories of the dearly departed return as they move onto the marae. If applicable, a specific tupuna (ancestor) may be acknowledged in the karanga, linked to the marae, the manuhiri or both. Finally, the kaikaranga may touch on the kaupapa for the hui adding a particular focus on its importance to the people of the marae. When the karanga first begins the manuhiri proceed respectfully through the gate and towards the wharehui. A kaikaranga from within the manuhiri may reply to each karanga from the marae, telling the tangata whenua who has arrived, which ancestors they bring with them and what they hope to achieve. Hence the meaning of the word karanga emerges, ‘ka ranga - weave together.’ This weaving is an intellectual, emotional and spiritual one. The karanga weaves together the heavens with the earth, the living with the dead, the tangata whenua with the manuhiri, as well as the desires and aspirations of both parties. The karanga flows dynamically between the groups providing a safe passage onto the marae. In Northland you will also hear men from the manuhiri replying to karanga. Manuhiri should stick together as they move forward silently and respectfully. On some marae the kawa is for the manuhiri to pause for a moment in front of the wharehui to remember those who have passed on. On other marae they will be called directly into the wharehui to pay their respects or will pause before sitting down on their chairs.
Stage three:
Te Karanga The calling
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Stage four:
Stage six:
Haka Pōwhiri
Welcoming performance
On occasions, particularly for dignitaries or when tūpāpaku (bodies) return to the marae, a haka pōwhiri is performed for the manuhiri. In some areas this occurs during the karanga, in other areas afterwards. The haka pōwhiri is a sign of respect and eagerness on the part of the tangata whenua to spend time with the manuhiri. Often the words of a haka pōwhiri depict the tangata whenua pulling a rope connected to an imaginary waka (canoe) belonging to the manuhiri, dragging it up onto the marae.
Whaikōrero / Mihi
Speeches and greetings
Once the manuhiri are seated, formal greetings and speeches commence from the men, usually kaumātua (elders), from the marae. These whaikōrero continue and expand on the links that the women began during the karanga. The whaikōrero work in many of the same domains as the karanga, beginning with an acknowledgement of higher powers, tying together the living with the dead through whakapapa (genealogy), expanding on the purpose for the hui, and acknowledging everyone who has attended the hui. The whaikōrero is undertaken by men, as the goal is to ensure everyone is protected both spiritually and physically until the tapu is removed from the manuhiri. Seats are reserved for the men to undertake this task.These seats are known as the taumata in Northland, and the paepae elsewhere. These are the front seats and allow the men to engage directly in what can be confrontational, ‘push and thrust’ type speeches. Whaikōrero means literally to pursue with words. There can be quite a challenging yet jovial quality to the speeches. A pathway is laid down for the groups to come together in kotahitanga (unity) for the kaupapa of the hui. There are usually at least two speakers from both sides, with the tangata whenua starting and finishing the process.
Stage five:
Karakia
Incantations / prayers
Karakia are often offered up at this stage to give thanks for the safe arrival of the manuhiri, to ask for protection over those who have recently died or are not able to attend, and to provide guidance and support for the work to be carried out during the hui.
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Stage seven:
Stage nine:
Waiata tautoko
Supporting song
After each speech a waiata is usually sung to support the speaker. These waiata serve several purposes. Some waiata affirm the identity of the speaker or the groups that have gathered; others convey the intentions of the speaker. In the past, waiata would be composed on the spot, to summarise exactly what the speaker had said, and focus on the important issues. A well supported waiata is considered an indication of a strong and united group with good leadership. A group that sings well together often works well together also. Furthermore, waiata are used to lighten the mood and protect the wairua (spirit) of the hui, particularly when a speaker becomes heated or speaks for too long. Kaikaranga often lead the waiata and in this way the women of the marae maintain a powerful position, retaining rights to both the first and last words during the pōwhiri.
Harirū / Hongi
Shaking hand / sharing breath
Once the whaikōrero are completed, the tangata whenua will line up and the manuhiri will file past them one by one to harirū and hongi. This is the first point of physical contact between the two groups. Harirū is to shake hands. Hongi literally means to smell, and involves the coming together of the nose and forehead to share a breath. If you had not seen one of your parents or children for a long time, you would long for an opportunity to see them and hug them. In an attempt to remember and reconnect you might smell one of their jerseys, or a pillow where they used to sleep. The hongi is also about using another sense to make a stronger connection with a person. To harirū and hongi, take a person’s hand and allow the space between you to close, as your heads and noses come together. When you are about 20cm apart, close your eyes and bow your head slightly so that noses and foreheads touch at the same time. On contact with the other person breathe in. Some iwi share one full breath, others share two shorter ones. The significance of the hongi is that you are demonstrating a degree of trust, allowing a person to come into your personal space. Together you share an essential element of life, air.
Stage eight:
Koha Gift
The last speaker from the manuhiri offers the koha gathered at the gateway to the marae. In some areas, the koha will be placed on the ground; in other areas the koha is handed directly to the kaumātua of the marae.
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Hongi – sharing breath
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Stage ten:
Stage eleven:
Kai food
The sharing of kai plays two important roles. As already discussed, kai is considered noa and is therefore the final step in lifting the tapu from manuhiri. As kai is essential to living, sharing kai is an important part of the pōwhiri. Sharing kai also allows the tangata whenua to demonstrate their manaakitanga (nurturing intentions) towards the manuhiri. Manaakitanga is demonstrated in other ways as well and is mana-enhancing for the tangata whenua. When visiting Māori people in their homes and places of work you may be offered something to eat or drink. This is part of their culture and an important part of making a connection with them.
Whakawhanaungatanga / Mihimihi
Getting to know each other
After the kai, people gather again in the wharehui as one group. Another karakia may be shared and time is spent getting to know each other. People take turns to stand and introduce themselves, tell everyone the reason they have come and what they hope the hui will achieve. People often share their pepeha or identity statement which may define their whakapapa, whenua, marae and important land marks such as mountain, rivers and waterways. Here is a simple example of how you may like to introduce yourself on the marae. Kia ora tātou katoa – Hello everyone Nō Pōneke ahau – I am from Wellington Nō te whānau Jaine – I am from the Jaine family Ko Neville rāua ko Pat ōku mātua – Neville and Pat are my parents Ko Estelle taku hoa rangatira – Estelle is my wife
Nā tō rourou, nā taku rourou, ka ora ai te iwi With your food basket, and my food basket, the people will thrive
Ko Cameron tāku tamaiti – Cameron is my son He kaimahi ahau i PHARMAC – I work at PHARMAC Ko Richard tōku ingoa – My name is Richard Nō reira tēnā koutou, tēnā koutou, tēnā koutou katoa.
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Stage twelve:
Poroporoaki
The closing of a hui is called the poroporoaki. Literally to sever (poroporo) by way of the spoken word. The poroporoaki is about releasing the connection that was formed at the beginning of the hui during the pōwhiri. The poroporoaki can take place in the wharehui or during the final meal together. If time permits, a number of people may stand and share their thoughts about their time at the hui. Importantly the tangata whenua will be acknowledged for their manaakitanga of the manuhiri during their stay. Often hui will be concluded with karakia to help protect everyone on their journey home.
When staying on a marae:
Here are some things to be aware of when you’re staying on a marae; • respect the kaumātua and kuia of the marae and allow them to lead you during your stay • you will be provided with a mattress and pillow • bring a blanket or sleeping bag as well as a towel and toiletries • most wharehui do not permit shoes to be worn inside • avoid sitting on pillows or any area where food is prepared or served • inside the wharehui do not step over anyone who is lying down. This can be a little difficult when the wharehui is full, but if you wait patiently people will move their legs to let you pass • be considerate when people begin to fall asleep. If you need to talk, move outside or into the wharekai • if you have something to add during the hui, wait for the speaker to finish and stand up and share your thoughts
Tikanga Māori
Tikanga Māori are the cultural practices exercised by Māori in their daily lives. Although these practices relate directly to such things as the pōwhiri on the marae, tikanga Māori encapsulate a wider world view defining numerous customs and behaviours. From the root word ‘tika’ to mean true and correct, tikanga Māori have been passed down through generations as a method of maintaining best practice and are based on observation and common sense. It takes time and patience to gain a full understanding of other cultures. Learning about tikanga will enrich your experience of Māori culture.
Waiho i te toipoto, kaua i te toiroa Let us keep close together, not far apart
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Matariki
New Year
Traditional celebrations for Matariki occur at the time of year when one cycle of growth has finished and another is about to begin. New Year celebrations in January denote the first mark of the life cycle in the northern hemisphere. The period of Matariki is the natural new year for the southern hemisphere in our part of the Pacific. The time begins with the predawn rise of the Matariki constellation (Pleiades) and Puanga (Rigel) in the east, during the last week of May. It finishes with the appearance of the next new moon in June or July. The Matariki constellation is a small cluster of stars which glisten like a jewel in the sky. Translated as either ‘little eyes – Mata riki’ or ‘eyes of god – Mata ariki’ the constellation and celebration of Matariki hold a special place in traditional Māori culture. Matariki was a time to assess the harvest and prepare a planting regime for the coming season. In the past tohunga, tribal leaders expert at reading the stars, would look for atmospheric signs in the heavens which would help forecast the weather for the coming season. Along with observations of wildlife behaviour and other natural phenomena, they could predict dry seasons (requiring plantings close to the waterways,) (or wet seasons which would dictate gardens higher up in dryer areas). These traditional practices could decide the wellbeing of the entire hapū for the coming year. Matariki was a time to reflect on the year that had passed and plan for the year ahead. With colder weather setting in it was a time for indoor activities (such as learning) and making preparations for the year ahead. Craftwork would be done during this period to ensure there were enough kete, tools, fishhooks and other important resources required for the coming seasons. It was also a time to share stories and learn whakapapa and whānau and tribal histories. Following the harvest, Matariki was a time to celebrate the abundance of food that had been gathered and preserved. Food was distributed amongst whānau and hapū to strengthen bonds and ensure everyone had enough to get them through the colder part of the year, where provisions were not as readily available. Great feasts were held where karakia, karanga, waiata and haka rang out for several days and nights. A natural end to the cycle of life, Matariki is also associated with great sadness as the elderly and sick often succumb to the colder conditions at this time of year.
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Contemporary Celebrations of Matariki
In recent years there has been a revival of celebrations for the Matariki New Year in Aotearoa. Some iwi have developed partnerships with local businesses and community organisations to deliver extensive programmes throughout the Matariki period with such activities as fireworks, food festivals, traditional Māori games, motor cross, fashion shows and kapa haka performances. At a whānau and marae level, wānanga are being held to learn whakapapa and history, helping to strengthen the connections to marae and hapū. Māori artists are utilising Matariki as a time for exhibitions, and Māori tourism organisations and operators are starting to look for opportunities to promote regional activities. Matariki provides a vehicle for Māori to celebrate being Māori. It is inclusive and affirms Māori cultural identity at a number of levels. Importantly most of the reasons why Matariki was celebrated in the past remain relevant to Māori today.
Matariki will keep you awake”
“Tēnā ngā kanohi kua tikona e Matariki
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Matariki Themes and Activities
As a guide to celebrating Matariki the following themes and activities provide practical ideas for those looking to enjoy the mid winter festivities.
Whakapapa Genealogy
Maintaining a connection to those generations who have gone before is an integral part of Māori culture. Retelling their stories allows this generation to draw inspiration from their successes and avoid making the same mistakes. Suggested Activities: • Start to organise your own family whakapapa book and charts • Record oral histories from elders in your whānau • Organise time for grandparents and grandchildren to share stories • Visit cemeteries and care for family graves • Meet with distant relatives and share pictures and stories about common ancestors
Papatūānuku Mother Earth
There is a strong focus on gardening and nature during this time. Activities focused on the environment are a consistent theme for Matariki. Suggested Activities: • Planning for a spring garden • Gathering seeds and materials • Native tree planting • Developing recycling initiatives • Mid winter visits to native forests and bush land • Discovering about the rongoā (health aspects) and other qualities of plants and trees
Takoha The Gift
With the bitter cold of winter settling in, Matariki can be an extremely difficult time for those in need. Traditionally the harvest was distributed during Matariki to ensure the survival of everyone. Suggested Activities: • Pass some food from your garden over the fence to a neighbour • Run a food drive in your neighbourhood and gift it to a local food bank • Drop a can into the food collection bin at the local supermarket • Do something for somebody who is unable to do it for themselves • Give some of your time to a project • Find a special gift for the needy or elderly in your community • Give a donation to a charity organisation, local school or sports club
Ranginui Sky Father
The night sky represents an encyclopaedia of knowledge for Māori. Traditionally the movement of the stars signalled milestones each year for essential activities like navigation, fishing and planting. The careful study of the heavens also provided inspirational dreams and plans for the future. Suggested Activities: • Visit observatories to get a close up view of Matariki and other stars • Stargaze with friends and family and set new goals for the year ahead • Spend time with your children looking for shapes in the stars and use them to tell stories • Learn the stories of other cultures that are held in the stars
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Whāia te iti kahurangi Ki te tūohu koe, me he maunga teitei
Pursue excellence. Should you stumble, let it be on the highest peak
Hākari The Celebration
The first new moon in June or July is the time for celebrations to begin. With shorter days and colder nights there is no better time to feast and celebrate the year ahead. Suggested Activities: • Mid winter dinner parties • Early morning beach bonfires or barbeques on clear days to view the predawn rise of Matariki and Puanga in the east • Organise a gathering with friends and family to listen to music, dance and sing • New Year’s resolutions
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Te Reo Māori
Following the 1867 Native Schools Act which ordered English to be the only language to be used in the education of Māori children, combined with the urban migration of Māori away from their homelands during the industrial period, the use of the Māori language saw a sharp decline. “It was not realised then what a destructive effect this emphasis on English speaking would have on te reo Māori and ultimately on the culture which is part of our national heritage whether we are Māori or European. ” Waitangi Tribunal Report1 During a submission to the Waitangi Tribunal for the Te Reo Māori Claim in 1986, Sir James Henare described te reo Māori as vital to Māori wellbeing.
common; dedicated tertiary providers offer a wide range of Māori language-based learning opportunities, and a plethora of community level language revitalisation initiatives are underway. The passion for Māori language in Māori communities remains strong and the bastion for the regeneration has frequently fallen to the marae. Through all its trials and tribulations, the marae has maintained a protective domain for the Māori language and, as such, is often vigorously defended by its people. Although the English language is permitted on many marae, the protocols around pōwhiri and mihimihi in particular require at least some acknowledgement of te Reo Māori. Data collated from the Te Puni Kokiri survey of ‘Attitudes toward the Māori Language’3 show that approximately 94% of Māori (and in some categories more) agreed that the following features are of importance for the future good of New Zealand and New Zealanders: • Māori culture and heritage • Māori language: • learning Māori language and culture and understanding Māori issues • Government support Māori language
“The language is the core of our Māori culture and mana. Ko te reo te mauri o te mana Māori”.
(The language is the life force of Māori mana). If the language dies, as some predict, what do we have left to us? Then, I ask our own people who are we?... Therefore the taonga, our Māori language, as far as our people are concerned, is the very soul of the Māori people.” 2 In 1987, the Māori Language Act was passed making Te Reo Māori an official language of New Zealand and establishing the Māori Language Commission. Over the last 40 years there has been a significant resurgence in Māori language learning and use, driven initially from grass roots community initiatives which culminated in the establishment of Kohanga Reo, Kura Kaupapa, Wharekura, and Te Ataarangi classes for whānau. Today national broadcasting in te reo Māori is
Further, with regard to the use of Māori language in the public domain, 93% of Māori agreed or strongly agreed they have a lot of respect for people who can speak Māori.
Developing Māori Language Plans have become integral to the work that many national and local body organisations are undertaking with Māori. Internally these plans consider policies around Māori language
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use, recruitment, training and professional development, proficiency assessment and remuneration. Externally the plans explore an organisation’s external communications in regards to their customer services, Māori language quality assurance, publications, website development and relationship management.
Pronouncing te Reo Māori
Learning to speak te Reo Māori is easy as there are only 15 distinct sounds within the Māori alphabet. They are; five vowels: a, e, i, o, u eight consonants: h, k, m, n, p, r, t, w and two digraphs: wh, ng On the whole, the consonants are pronounced as in English except the ‘r’ is a soft rolled r. The digraphs are pronounced ‘ng’ as in the word singer, and the ‘wh’ is equivalent to the English f’ The following is a quick guide to pronouncing the Māori vowels; a as in tar e as in egg i as in me o as in awe (not ‘oh!’) u as in too There are two versions of each of these vowels; a short version and a long version (denoted by a macron over the vowel).
“Tōku reo, tōku ohooho, Tōku reo, tōku māpihi maurea, Tōku whakakai marihi “My language is my cherished possession, My language is the object of my affection, My precious adornment”
4 1
Report of the Waitangi Tribunal on the Te Reo Māori Claim (Wai11), 1986 p. 16 2 Report of the Waitangi Tribunal on the Te Reo Māori Claim (Wai11), 1986 p. 34 3 Attitudes Toward the Māori Language, Te Puni Kokiri 2000 - 2006. 4 Lyrics from the waiata ‘He Kakano Ahau’ by Hohepa Tamehana, 2001.
To assist Pharmac staff interested in developing their Māori language skills, the Te Ara Poutama programme has assembled an introduction to te Reo Māori along with words and phrases specific to the health sector. A number of websites offer additional support. The Māori Language Commission has a website called Kōrero Māori at www. koreroMāori.co.nz which links learners to a number of resources. Māori Language Net www.Māorilanguage.net provides short online video clips of words, phrases and waiata.
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Kōrero Māori
Some phrases for you to use. Saying hello
Kia ora - Hello, good health, thank you Tēnā koe - Hello to one person Tēnā kōrua - Hello to two people Tēnā koutou - Hello to three or more people Haere mai - Welcome! Come! Mōrena - (Good) morning! Nau mai - Welcome! Come! Ngā mihi ki a koe/kōrua/koutou - Greetings to you Kei te pēhea koe/kōrua/koutou? - How are you to one person/two people/three or more? E pēhea ana koe/kōrua/koutou? - How are you to one person/two people/three or more? Kei te pai ahau/māua/mātou/ - I/we two/we three or more (am/are fine) E pai ana ahau/māua/mātou - I/we two/we three or more (am/are fine) E noho rā - Goodbye (from a person leaving) E haere rā - Goodbye (from a person staying) Hei konā rā - Goodbye (less formal) Pō mārie - Goodnight (Night of Peace) Ka kite anō - See you again Ā te wā - Catch you later
Correspondence / E-mail
Tēnā koe name - Hello name Kia ora / Mōrena - Hello / Good morning (informal) Kia ora mete / e hoa - Hello mate (less formal) Nāku noa nei - Your sincerely (formal) Noho ora mai rā - Be well (informal))
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Hei konā rā - Goodbye (less formal) Ngā mihi o te wā - Seasons Greetings (around holiday periods) Mā te Atua e manaaki - God bless Mere Kirihimete - Merry Christmas Ngā mihi o te Kirihimete me te Tau Hou hoki - Merry Christmas and a Happy New Year
Phrases for working with patients
What are your symptoms? - He aha o tohumate? How bad are the symptoms? - Pēhea te nui o te kino? How long have you been sick? - Pēhea te roa o tō mate? How did it start? - I tīmata pēhea nā? Where is it sore? - Kei hea te wāhi mamae?
Types of pain – Āhua o te mamae
pain - mamae sharp - pākinikini biting / cutting - ngau stomach ache - kōpito aching - kōrangaranga irritation - māngeongeo itchy - naoko
Smoking / Drinking
Do you smoke? - He tangata kai hikareti koe? How many cigarette do you smoke each day? - E hia ōu hikareti i ia rā? Do you drink? - He tangata inu waipiro koe? How much do you drink? - Pēhea te kaha ki te inu waipiro i inuhia e koe?
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Medications
What medications are you currently taking? - He aha ngā rongoā e kai ana koe āianei tonu? How much of each medicine do you take? - Pēhea te rahi o ia rongoā ka kainga e koe? Do you take medicines from any other sources? - He rongoā anō āu nō wāhi kē? Do you take any herbal or traditional medicines? - E kai ana koe i ngā rongoā Māori? Are you allergic to any medicines? - Pāwera ai koe ki tētahi rongoā?
abuse accident alcohol allergy aorta artery back bad big bleed blood blood test body breath burn butter cancer cardiovascular disease care for chest chief / leader cigarette clot cold, Flu collapse coma coronary artery corpse
tūkino aituā waipiro mate Pārewa Ia Matua Ia tuarā kino nui heke toto toto whakamātau toto tinana hā wera pata mate pukupuku mate iaia-manawa tiaki poho rangatira hikareti huki rewharewha hemo mauri ngaro la tuku ngākau tūpāpaku
crazy/confused critically ill cure death dentist diabetes die dizzy doctor drink elder extended family fat (food) fat (obese) feed flesh food / eat good hand health heart heart attack heart beat heart murmur heart rhythm ill immunise insulin
pōrangi tūroro whakaora mate rata niho mate huka mate / hemo āmaimai / āmiomio / ānewanewa rata / tākuta inu kaumātua whānau hinu mōmona whāngai kiko kai pai ringa hauora / waiora manawa / ngākau mate manawa / ngākau hotu manawa manawa wawaro manawataki māuiui ārai mate taiaki huka
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life lung man maybe medical examination medicine mental Health mind muscle nasal mucus neck nerve no nurture pain pot belly revive sickness skin small smoke spirit stomach subtribe sugar sympathy symptom syringe
ora pūkahukahu tāne tērā pea whakamātau ā-tinana rongoā hauora hinengaro hinengaro uaua hupe kakī io kāore atawhai mamae pukutihe haumanu mate kiri iti auahi / momi hikareti wairua puku hapū huka puku aroha tohu pūwero
children terminal Illness throat tickle tribe well woman yes 1 2 3 4 5 6 7 8 9 10 100 1000
tamariki mate kōngenge korokoro ngaoko iwi ora wahine āe tahi rua toru whā rima ono whitu waru iwa tekau rau mano
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Waiata
Traditional Māori chants, collectively known as waiata tawhito, take a number of forms such as mōteatea, oriori, pao and pātere. These waiata acted as important textbooks of Māori history and lore and were an essential component to an oral tradition such as Māori. During a pōwhiri a waiata is offered after each speech as a way of embellishing what the speakers have to say. Standing to sing with a speaker demonstrates that they have the support of the people around them. During a hui waiata can be utilised to lighten the mood, emphasise a point or bring the group back together. Standing to sing a waiata can reinvigorate a waning discussion. You’ll also see waiata used as a way to express appreciation, to thank those who have cooked a hākari (feast) and to express emotion.
Waiata are sung on various occasions for a number of Te Tīmatanga: reasons. The Beginning
It is handy to learn a few waiata to take with you to hui, as the strength of a group’s waiata is considered a sign of their kotahitanga (unity) and correspondingly their mana.
Te Tīmatanga, the waiata has been composed for PHARMAC staff use. It was composed and gifted to PHARMAC by Mr Whetū Tipiwai, kaumātua of the New Zealand Māori All Blacks. The waiata is conceptually similar to the haka performed by the team before every match and spins off well-known Māori folklore relating to the creation of the world and the separation of Ranginui and Papatūānuku by their children. The waiata talks about climbing to the highest peaks of lofty mountains, resonating achievement and ambition. The waiata goes further to describe the importance of whānau and the achievement of all-round wellness embracing the Whare Tapa Whā holistic health model created by Professor Mason Durie.
National Anthem in Māori
E Ihowa Atua, (Ihoa) O ngā iwi mātou rā, Āta whakarongona; Me aroha noa. Kia hua ko te pai; Kia tau tō atawhai; Manaakitia mai Aotearoa.
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Te Tīmatanga
Ū, ū E te tīmatanga e (echo) Ko te pō nui, ko te pō roa Āuē ko te kore. Wehe ngā mātua e Here ngā tāngata e He toa rangatahi He toa rangatira Whakakī ki te maunga Tae atu ki te whenua Āuē Hoki ki te rangi Tae ki te puke runga Piki ake ki te ara poutama Ki ngā taumata e. (2x) Wairua hinengaro Me te tinana e. Tae atu ki a tātou katoa Āue, te whānau e. Ū, ū
The Beginning
Be established In the beginning There was the big and long darkness And there was the nothingness Through the separation of the parents Came the permanence of the human form Youthful passion The creation of a chief Be fulfilled by the mountain As it is on the land Great balls of fire Return to the heavens As you rest (However) ascend along the path of achievement and fulfil your ambitions The spiritual intent, the mind and the body are infused in all of us as well as our family Let us rest and rejoice
Whakarongo
Whakarongo is a waiata written by the famous Māori composer Ngoingoi Pēwhairangi, encouraging people to speak the Māori language whenever possible.
Whakarongo ki te reo Māori e karanga nei Whakarongo ki ngā akoranga rangatira Nā te Atua i tuku iho ki a tātou e Pupuritia, kōrerotia mō ake tonu Tirohia ngā tikanga tapu a ngā tūpuna Kapohia hei oranga ngākau auē Whiua ki te ao, whiua ki te rangi, whiua ki nga iwi katoa Kaua rawa rā e tukua e, kia memeha e Whakarongo ki te reo Māori e karanga nei Whakarongo ki ngā akoranga rangatira Tēnā kia pūrea e te hau ora e He kupu tuku iho mō tēnei reanga Whakarongo!
Te Aroha e
A well known, easy to learn waiata that can be used for many occasions.
Te aroha e Te whakapono Me te rangimārie Tātou tātou e
Through love Trust And Peace We stand together
Whakaaria mai
How Great Thou Art
Whakaaria mai Tōu rīpeka ki au Tiaho mai Rā roto i te pō Hei konā au Titiro atu ai. Ora, mate, Hei au koe noho ai
Taku Tūranga Ake
This is a well known waiata that can be used at tangihanga or during an occasion where great emotion and aroha has been expressed.
Taku tūranga ake I roto i tēnei whare Ka turaturaki te rau o te aroha e Taimaha rukirukir Te tinana i te aroha E kore rawa e tū tika i te taimaha e As I stand In this whare Expressing the depth of my aroha My body is bent over with the weight of my love And I am unable to stand up straight
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The State of Māori Health
The Ministry of Social Development’s Social Report 2008 draws a very different profile of Māori and non-Māori with respect to the determinants of health such as education, employment, income, housing, income support, dealings with the criminal justice system, health, literacy, deprivation, etc. Similarly, risks factors highlighted in the report (such as obesity, smoking tobacco and potentially hazardous drinking of alcohol), position Māori on the wrong side of the scales. Morbidity rates show a 6 year gap between Māori and non-Māori in terms of life expectancy. Disparities between Māori and non-Māori health outcomes are undeniable and persistent: • Māori have the poorest cardiovascular health outcomes in New Zealand and cardiovascular disease remains a major contributing factor for widening life expectancy disparities between Māori and non-Māori (Bramley, et al., 2004); • Cancer is the leading cause of death for Māori. It contributes significantly to differences in life expectancy at birth between Māori and non-Māori. Māori are 18% more likely than non-Māori to be diagnosed with cancer and have a 93% higher mortality rate (Walker, et al., 2008); • Māori aged 45 years or more are four times more likely to be hospitalised for COPD than non-Māori. Māori females are five times more likely to be hospitalised for COPD than non Māori females (Ministry of Health, 2006).
Māori health and improvements over time…a Ministry of Health perspective
1
Māori involvement in the health sector has a long history, including the appointment of Dr Maui Pomare in the early 1900s as the first Māori medical officer of health for the Department of Health. The real growth of Māori participation in the health sector has dramatically escalated however over recent decades. Prior to 1992, the Area Health Boards were beginning to address Māori health issues in specific areas such as cervical screening and mental health, and in health promotion. At the same time around twenty Māori health providers had been contracted by the Boards to deliver community health services. The development of a Strategic Objective by Government to improve Māori health so that Māori could enjoy at least the same level of health as non-Māori, was inserted into the 1993 legislation. This Objective was to form the basis of much of the growth and development of Māori health initiatives throughout the 1990s. The legislation was also a catalyst for the newly formed Ministry of Health. Hekia Parata and Mason Durie undertook a review of the internal structures of the Ministry. The review recommended that a Māori health group (larger than the small unit that existed at the time) be established, headed by a manager who reported directly to the Deputy-General. The Māori health branch was eventually established in 1993.
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Much of the development of Te Kete Hauora (Māori Health Directorate of Ministry of Health) must be viewed in the context of the Māori Capacity and Capability Plan that was released internally within the Ministry of Health in 2001. Focusing on the needs of Māori health, the Plan sought to build Māori management and workforce capacity, and to strengthen the knowledge and awareness of Māori health issues throughout the Ministry.
Position throughout He Korowai Oranga
Initiatives to address Māori health and disability needs in the sector have been based on the three key principles articulated as the Treaty of Waitangi principles - partnership, participation and protection. In He Korowai Oranga (the Māori Health Strategy) these three principles are clearly articulated as follows:
Current Legislative Position
The current legislation, the New Zealand Public Health & Disability Act 2000, now incorporates a number of significant references in relation to Māori health. The New Zealand Public Health & Disability Act 2000 requires District Health Boards to establish and maintain processes to enable Māori to participate in, and contribute to, strategies for Māori health improvement. These, and related requirements, are imposed in order to recognise and respect the Treaty principles and to improve the health status of Māori.
Partnership
Working together with iwi, hapū, whānau and Māori communities to develop strategies for Māori health gain and appropriate health and disability services.
Participation
Involving Māori at all levels of the sector, in decision-making, planning, development and delivery of health and disability services.
Protection
Working to ensure Māori have at least the same level of health as non-Māori and safeguarding Māori cultural concepts, values and practices.
References Bramley D, Riddell T, Whittaker R, Corbett T, Lin R., Wills M, et al., 2005.. Smoking cessation using mobile phone text messaging is as effective in Māori as non-Māori. The New Zealand Medical Journal, 118(1216), 74-83. Ministry of Health, 2006. Tatau Kahukura: Māori Health Chart Book. Wellington: Ministry of Health. Walker, T., Signal, L., Russell, M. Smiler, K. and Tuhiwai-Ruru, R. The road we travel: Māori experience of cancer. The New Zealand Medical Journal, 121(1279), 27-35. Abridged from: http://www.maorihealth.govt.nz/moh.nsf/ pagesma/325?Open
Current Position in Health Sector Policy
While the Government has a duty to govern on behalf of the total population, it acknowledges that Māori health and disability needs are the responsibility for the whole sector. It also acknowledges that Māori communities should be able to define, and provide for, their own priorities for health and be encouraged to develop the capacity for delivery of services to Māori communities.
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Māori Health Strategies
As a population group, Māori have on average the poorest health status of any ethnic group in New Zealand. The Government and the Ministry of Health have made it a key priority to reduce the health inequalities that affect Māori. If Māori are to live longer, have healthier lives, and fulfil their potential to participate in New Zealand society, then the factors that cause inequalities in health need to be addressed.
Whakatātaka Tuarua: Māori Health Action Plan
Whakatātaka Tuarua: Māori Health Action Plan 2006-2011 outlines what the health and disability sector will do to implement the Māori Health Strategy; it includes programmes, policies and interventions. The Action Plan is a valuable tool for contributing to reducing health inequalities between Māori and non-Māori.
He Korowai Oranga: Māori Health Strategy
He Korowai Oranga: Māori Health Strategy1 sets the direction for Māori health development in the health and disability sector. The strategy provides a framework for the public sector to take responsibility for the part it plays in supporting the health status of whānau. The vision of He Korowai Oranga is the achievement of whānau ora, or healthy families. Whānau (kuia, koroua, pakeke, rangatahi and tamariki) is recognised as the foundation of Māori society. As a principal source of strength, support, security and identity, whānau plays a central role in the wellbeing of Māori, individually and collectively. He Korowai Oranga asks the health and disability sectors to recognise the interdependence of people, that health and wellbeing are influenced and affected by the ‘collective’ as well as the individual, and that it is important to work with people in their social contexts, not just with their physical symptoms.
http://www.moh.govt.nz/moh.nsf/ pagesmh/812 http://www.moh.govt.nz/moh.nsf/pagesmh/2285 3 http://www.moh.govt.nz/moh.nsf/pagesmh/2571
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New Zealand Health Strategy and New Zealand Disability Strategy
The New Zealand Health Strategy2 and the New Zealand Disability Strategy3 are the Government’s platform for action on health and disability, including Māori health. The strategies’ principles, goals, objectives, action and service priorities for improving the health and disability of New Zealanders are all relevant to improving Māori health.
Māori Health Providers
There are a number of Māori health providers contracted to District Health Boards throughout Aotearoa. Māori health providers tend to deliver health and disability services to predominantly Māori clients, although certainly not exclusively. What does distinguish the service is the kaupapa and the delivery framework which is distinctively Māori. In addition to contracted Māori health providers, there are also health providers who are significant providers of health and disability services to Māori. The Ministry of Health provides a detailed list of Māori health providers on its website at www.Māorihealth.govt.nz
Te Ara Poutama Reference book 39
Māori Health Provider Melanie Maniapoto
Te Hā Ora Kaituhauora Te Oranganui Iwi Health Authority Aukati Kaipaipa Smoking Cessation Service Mel Maniapoto is one of a team of three dedicated smoking cessation practitioners based within Te Oranganui Iwi Health Authority PHO in Whanganui. Together this small group runs a number of very successful quit smoking clinics in rural and urban settings. They use the Aukati Kaipaipa approach to deliver a “for Māori, by Māori” cessation programme. “It’s about having a passion for the mahi (work)…we are there to support clients who want to quit, without having to judge… kanohi ki te kanohi (face to face), is best for our people…” Client referrals from Te Waipuna Health Centre, local GPs, Whanganui and MidCentral District Health Boards (working very closely with the Smokefree Coordinator) and workplaces ensure that Mel and her associates are kept busy. In addition, self referrals by clients enable the team to provide Nicotine Replacement Therapy and motivational support to the many Māori who access the Aukati Kaipaipa service. Recently, at the request of a local employer, Mel, Sandi Ranginui and Kelly McLean delivered an eight week, workplace smoking cessation programme at Tasman Tanning Co. Limited. The team worked with 32 clients on a weekly basis, motivating life style changes, encouraging peer support and providing the essential patches, gum and lozenges for their quitters each week. Although some attrition did occur (eight had left the programme at the end of eight weeks), 37% managed to quit on completion of the eight week programme with their help and support.
With management support, the team were allowed 30 minutes of paid time each week for staff, and their whānau if they desired, to attend the cessation programme on site. Mel and her team will continue follow up visits every three months. The three smoking cessation practitioners have all received training with the New Zealand Smoking Cessation Guidelines (Ministry of Health, 2007) and advocate the use of nicotine replacement therapy to help smoking cessation. This highly motivated team were acknowledged as the best performing Aukati Kaipaipa service in New Zealand for two years running, and are looking to continue their success, with record numbers recorded again for the past six months. Analysis has shown a quit rate of 38 per cent abstinence at various stages of the twelve month programme. “The Aukati Kaipaipa service that is offered in every region throughout the country works because it is ideally suited for Māori… in Whanganui, our clients can choose to attend a rural clinic in Waverley or come to Te Waipuna or our offices in town, or they can choose to have a practitioner come and visit them at home. This is one of the most popular ways that we work with clients – one on one or working with the whole whānau in the comfort of home, is a powerful way to help people quit smoking”.
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Name: Witi Ashby Age: 53 years Iwi: Ngāti Hine Hapū: Ngāti Tetarawa me Ngāti Kawa Whānau: Tipene/Ashby Motatou Marae/Oramahoe Marae Witi Ashby is a father, a husband, a brother, an uncle and a nephew. He is also a friend to many in Te Taitokerau where he lives with his wife Di Grennell in Whangarei. For many years he has lived with a number of conditions that need to be managed with medications. Witi’s father, Witeria Ashby, died at 47 years from an aneurism; Witi’s sister, Wahine, died at 41 years from heart failure; Witi’s sister, Caroline, died at 41 years from an aneurism; Witi’s mother, Te Aue Tipene, died at 65 years from influenza with complications; Witi’s uncle, George Taki Ashby, died at 45 years of complications from diabetes; Witi’s aunt, Mihi Taki Ashby, died at 33 years from cervical cancer; Witi’s uncle Gray Ashby, died at 51 years from a heart attack. Mihi atu nei ki rātou ko hoki atu ki te kāinga tūturu mō tātou te tangata. Haere tonu, haere, haere haere.
An interview with Witi:
Are you currently taking any medication?
“Yes I do. At the moment I have these conditions: high blood pressure/hypertension, high cholesterol, severe chronic asthma and diabetes and I take Loratadine, Amlodipine, Aspirin, Simvastin, Inhibace, Doxazosin, Metformin, Potassium, Ventolin and Simicort to treat them. I have been treating my asthma since I was 7 years old and I spent time in A&E regularly – I nearly died from asthma as a child. When I was 15 years old we moved to Auckland and my asthma disappeared, but when I returned to Whangarei at 23 years of age, the asthma returned. It has remained a chronic condition for me”.
Why am I feeling dizzy and breathless?
Witi was diagnosed with hypertension firstly in 1998, and started taking medication for this. At the time Witi was working with youth groups and outdoor pursuits, so was extremely fit; however, he began experiencing dizzy spells. He was getting short of breath after exertion, and after a particular caving expedition, he had to sit down. Shortly after this incident, a nurse from Ngāti Hine Health Trust tested Witi’s blood pressure and found that it was dangerously high. She suggested that he should visit a GP, but
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unfortunately it wasn’t until six months later that Witi did seek medical advice. At this visit, his doctor tested him and confirmed that he had high blood pressure. Witi was given a range of tests to identify the cause of his sickness and the conclusion was made that his family history of high blood pressure was being repeated in him.
My struggle with medicines
“Taking my medicines was not a priority for me, because I was determined to continue as though nothing had changed. I took the medicines sometimes, but I’d sometimes forget, but I didn’t worry about it and I ignored the symptoms of my illnesses. I put it down to bad luck.” At one stage, Witi had a dressing table full of medicines that were not being taken correctly. “I would have about 10 bottles of medicines waiting to be taken, that I would forget about. And each day passed by in the same way”. “It was actually the Rust Ave dispensary offering to put my medications into blister packs that made the difference! I wake up in the morning and I’m aware that I have to take my morning meds and if they are still there at night, it’s obvious! If I forget to take Monday, it plays on my conscience – it tells me I have to be consistent. It is an awesome way to keep track of what I have to take. Psychologically, the blister packs motivate me to actually take my medications! The blister packs prompt me to take them every day, at the right time – you have to do it! “Blister packs – these are awesome. It gives you the times, dates and hours to take your medication, morning, evening/bed time. It tells you what days you take them e.g. Monday to Sunday, and at the end of the week the Rust Ave Pharmacy drop off a new supply of the medications at our house.”
“I would have about 10 bottles of medicines waiting to be taken, that I would forget about. And each day passed by in the same way”.
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Rongoā Māori
Rongoā Māori are medicines that are produced from native trees and plants. Many of these have been utilised for generations and have been found to have remedial benefits for a number of health problems. Several Pakehā medical practitioners have integrated rongoā Māori into their health care services. Pip Williams CBE, OBE a former Kaikohe pharmacists from 1934 to 1959 worked with Māori in Northland and has written a book called Te Rongoa Maori which highlights the many things he learnt about the health benefits of various Māori remedies. Here are a few of the rongoā Māori Pip has identified.
Ponga / Mamaku
Silver and Black tree fern Used to help expel the afterbirth.
Rewarewa Toetoe
Used to stem bleeding from a wound.
Used to relieve thrush in babies.
Kawakawa
Used to relieve toothache.
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He mahi kai te taonga The ability to provide subsistence has high importance
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Bibliography
Brougham, A.E. and A.W. Reed. (1963) Māori Proverbs. Revised by T.S. Kāretu. (1987) Auckland: Heinemann Reed. Durie, M. (1998). Whaiora: Māori health development. 2nd Edition. Auckland: Oxford Press. Durie, M. (2001). Mauri Ora: the dynamics of Maori health. Auckland: Oxford Press Jensen, R. (2005) He Pukapuka Reo Hauora Māori. Whaingaroa: Ahuru Press. Marsden, M. (2003) The woven universe, selected writing by Rev Maori Marsden. Edited by Te Ahukaramū Charles Royal. Aotearoa: The Estate of Rev. Maori Marsden. Ministry of Health. (2002). He Korowai Oranga: Maori Health Strategy. Wellington: Ministry of Health. Ministry of Health. (2002). Whakatātaka: Māori Health Action Plan 2002 – 2005. Wellington: Ministry of Health. Moon, P. (2005) A Tohunga’s Natural World. Auckland: David Ling Publishing Occupational Safety and Health Service in association with Māori Language Commission. (2002) English-Māori Glossary of Occupational Safety and Health Terms. Wellington: Department of Labour. Tauroa, H., & Tauroa, P. (1986). Te Marae: A guide to customs and protocol. Auckland: ReedMethuen. Williams, P.M.E. (1996) Te rongoā Māori, Māori medicine. Auckland: Reed
©PHARMAC, 2009 Citation Pharmaceutical Management Agency (PHARMAC). (2009). Te Ara Poutama: reference book. Wellington: Author We extend our grateful thanks to: Stephen Boxall, Creative Director, PHARMAC Piripi Moore, writer, Te Ara Poutama Takapuwāhia Marae for granting permission to take photographs at the marae, Takapuwāhia, Porirua, Wellington, during the PHARMAC Matariki celebration, 2 July, 2009 Moana Tane, Māori Health Manager, Access and Optimal Use, PHARMAC
He aha te mea nui o te ao? He tangata! He tangata! He tangata! What is the most important thing in the world? It is people! It is people! It is people!
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Pharmaceutical Management Agency Te Ara Poutama Reference book Acknowledgements He mihi maioha tēnei ki ngā kaiāwhina Ko ngā whaea me ngā mātua Koutou ko ngā kaiwhakaruruhau E whakapoipoi, e whāinga hoki Ngā tamariki mokopuna o tēnei ao I te matatauranga…
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