Whakawhanaungatanga

Relationship building using a Te Tiriti o Waitangi framework

Central aims of the therapeutic relationship

•Address presenting issue(s)•Build a trusting professional relationship with Māori patients and whānau•Engage Māori patients in their health issues and resultant care

How do you build trust and engage patients?

•Show respect•How you demonstrate and perceive respect is predicated on your specific cultural mores

The Use of the Eyes

Māori – Direct Gaze

ImpoliteChallengingExcludes others

Wandering gaze

ListeningConcentratingSoftening message

Pākehā – Direct Gaze

InterestUndivided attentionNothing to hide

Wandering gaze

BoredomBad mannersEvasionGuilt

Te Tiriti o WaitangiKey concepts

•Tinorangatiratanga (Ko te tuarua/2)•Wenua (Ko te tuarua/2)•Kainga (Ko te tuarua/2)•Taonga (Ko te tuarua/2)•Nga tangata (Ko te tuatoru/3)•Te ritenga (Ko te tuawhā/4)

Tinorangatiratanga

•Part of culture not apart from it

Useful questions...

•Rongoā or traditional treatments •Assessing for potential complementary or conflicting treatments•Kawakawa (Myristicin) or Mirimiri (Massage and manipulation)•Tupuna

Wenua

Health assessed by...

•Looking outward•Interconnected elements•Impaired health based on a breakdown in one’s relationship with wider world•Reflected in our language (meanings of whenua)•Lack of access and connection to whenua

Whangara, East Cape

Kainga

•Whānau support as tool to ensure patient participation•Whānau support in patient care/lifestyle changes•Whānau/hapū/iwi contribution to lifestyle continuation/enhancement•Significance of whānau continuity•Importance of wider community networks such as Public Health nurses and Community Health workers•Workplace support around medication management•Local networks support good communication

Taonga

Wai 11, 1985 - 1986

When the question for decision is whether te reo Maori is a ‘taonga’ which the Crown is obliged to recognise we conclude that there can be only one answer. It is plain that the language is an essential part of the culture and must be regarded as ‘a valued possession’. 

The Waitangi Tribunalhttp://www.waitangi-tribunal.govt.nz/reports (3 August 2011)

•Te Reo Māori

Nga tangata•Based on the idea that the same rights equates to equity/equality (depending on prevailing ideology) and access to health care

Case Study

“Kanohi ki te kanohi”Mobile Clinics, 2008Evening clinics at

shearing quartersGP, Practice Nurse,

Whānau ora worker, Māori Mental Health worker

Rural Otago, South Otago and Hamilton East (Dental Clinics)

Te Whānau a Apanui Community Health Centre

Registered population 1700 (90.5% Māori)Every 2 years free breast screening for

women aged 45-69 yearsMobile service initiated 2003 – 40%

uptake of eligible population2005: 97.9% uptake (98.7%:93.9%)2007: 97.6% uptake (98.9%:91.4%)2009: 96% uptake (at point of

presentation) Na, Dr Rachel Thomson

Te ritenga Māori•Protection of Māori custom•Expressed today through services based on kaupapa Māori (also a Ko te tuarua implementation)

Case Study

Māori for Māori servicesChoice or appropriate

referralNationwide services:

Aukati KaiPaipa or Māori Advisers on Quitline

Iwi based services:He Oranga Pounamu

Urban initiatives: Waipareira Health

Build trust and ensure engagement by...

•Demonstrating culturally appropriate respect•Developing knowledge base and skill set (learning about our culture and language)•Practising and being courageous•Being willing to take part in new initiatives•Working with the key Māori services, workers and networks and building relationships