Kaupapa (Topic):In times when there is difficulty accessing resources, how do you uplift

hauora for Maori?

Fano: Tena koutou, nau mai ki te whakaaturanga o ropu wha tekau ma waru! We will be talking
about strategies to uplift hauora maori in times of difficulty. Kia ora!

Fano Asiata, 21144346

Kia Ora e te Whanau, Ko Fano toku ingoa!
Today I'll be discussing a variety of strategies to help uplift hauora Maori.

It’s evident that Maori are ill prepared or find it difficult to understand, let alone seek
healthcare advice. On that account, I'll be discussing how we can encourage Maori engagement
and ensure whanaungatanga. Whanaungatanga or relational practice is essential in te ao Maori.
The Maori dictionary describes Whanaungatanga as having a sense of belonging, having a
relationship due to working together and shared experiences. Effectual Whanaungatanga is
achievable by honoring key concepts, values or tikanga of te ao Maori. I will be talking about Te
tautoko whanau (or Whanau support). “Ehara taku toa i te toa takitahi, engari he toa takitini e”
- Mine is not the strength of one alone, but the strength of many. This whakatauaki mentioned
by Te Whatu Ora best portrays the pivotal role of whanau support in the success of
whanaungatanga, and wholly contributes to uplifting hauora Maori. According to the Capital
and Coast District Health Board [CCDHB] (2017), te tautoko whanau extends further than the
confines of biological family, with great significance placed on community and familial
connections. Te tautoko whanau practice includes involvement of whanau in the care of a
patient; practicing whanau support as a healthcare professional will see me discussing with
whanau the best care plan for the patient, incorporating whanau in personal cares of the
patient (e.g. showering) and discussing patient care with a nominated whanau spokesperson.
Rolleston et al. (2021) emphasises the importance of family and their support in enabling Maori
to flourish, and serves as a ‘pou’ or pillar in te ao maori. Therefore, implementing
whanaungatanga by acknowledging kawa and tikanga such as te tautoko whanau will
contribute to my efforts as a future health practitioner to support maori engagement and uplift
hauora maori.

It’s no new information that Te Tiriti terms on the Maori version of the treaty were
dishonoured. The origins of this is a result of fabrication and mistranslation. Moon and Fenton
(2002) stated that Henry Williams’ mistranslation of the word sovereignty as Tino
rangatiratanga was purposely done to give Maori a false sense of cooperation when the truth
behind it was the British crown would have full governance over Maori, stripping Maori of their
tino rangatiratanga, and most importantly their rights to make decisions for their own health.
The Waitangi Tribunal stated the crown had duties to safeguard Maori hauora by active
provision of health services, but this fell through (RANZCP, 2022). This is evident by the claims
submitted to and released by the Waitangi Tribunal (2017), stating that the Crown had failed Te
Tiriti obligations due to inadequate active protection for Maori health outcomes, where the
imbalance between Maori and Pakeha have been long standing. Respectively, understanding
this has allowed me to ensure I am executing best practice so that Te Tiriti obligations are met
for the benefit of providing equitable healthcare, and also uplifting hauora Maori. It also makes
me consider including more of the patient in their care plan and decision making.

Lastly, I’ll be honing in on one particular socio-cultural and political context that will enable
improved access to and quality of health care for whanau Maori. Understanding the social
determinants of health is central to effective provision of healthcare. The determinants are
situations in which one’s environment is causing a negative impact on their health, wellbeing
and quality of life. These factors are: housing, transportation and neighbours, racism,
discrimination and violence, education, job opportunities and income , just to name a few. The
point is that as a health care practitioner, knowledge of these barriers to sustaining a so-called
happy life is pivotal in guaranteeing I am able to offer the best care for a patient suffering due
to these circumstances. One way to combat these obstacles is through the use of the Ministry
of Health’s: Health equity tool (Health Navigator NZ, 2021) - this assesses possible interventions
that may contribute to reducing health inequities, and helps improve and strengthen services
and programmes to promote health equity. Therefore, understanding this context enables me
to feel confident that I will be able to offer healthcare that is accessible and equitable for Maori.

‘Ema Valu Tohi, 21143871

Kia ora, my name is ‘Ema Valu Tohi.
As a future health care provider, kawa and tikanga I can embed into my practice are taonga
(treasure and valuables) and he honohono kakano rua (bicultural engagement). Referring to
Capital & Coast District Health Board (2017), taonga is referred to as an object or resource that
holds a very significant value, beyond sentimental to spiritual value and could be worn on the
body to indicate protective significance. Therefore, it is essential to demonstrate respect for
taonga which can be implemented by obtaining consent and discussing with the patient and
whanau first before touching or moving taonga. Capital & Coast District Health Board (2017)
also mentions he honohono kakano rua which involves the goal of being culturally competent
with Maori health care to develop relationships, resulting in better health outcomes.
Furthermore, staff are able to participate in bicultural events such as a Powhiri which is a
welcoming ceremony presented for new colleagues or new buildings, involving a waiata (song)
and karakia (prayer). By attending bicultural events and participating in singing the waiata and
karakia will allow staff to enhance their understanding of Maori concepts and protocols. As a
future health care provider, I will ensure to support the engagement with Maori whanau by
embedding the tikanga taonga by being aware of discussing with the patient and whanau
before touching and removing taonga from its patient, or placing it elsewhere. I will also ensure
to embed he honohono kakano rua into my practice by attending and participating in bicultural
events such as being present and singing along in waiatas, allowing me to enhance my
knowledge on Maori concepts and protocols resulting in better health outcomes with my
Maori whanau patients and promoting whanaungatanga. Overall, resulting in better health
outcomes for Maori whanau.

In my understanding, the Crown had failed to maintain the principles of Te Tiriti O Waitangi,
therefore causing inequitable health outcomes for Maori whanau. New Zealand History (2017)
mentions both treaties had different understandings of the agreement as the Maori version
was purposely mistranslated to the English version, therefore tricking Maoris into giving up
their Tino Rangatiratanga (Sovereignty) and Kawanatanga (Governance) to the British Crown.
More specifically, taking the ability of Maori to participate in their own decision making process
of their own health. The WAI2575 in Waitangi Tribunal (2023) provides over 200 claims of
issues that affect Maori health services and outcomes which mentions that the Crown failed to
partner with Maori in participation in governance to create appropriate health services to result
in better Maori health outcomes. As a future healthcare provider it is vital that I am aware of all
Te Tiriti principles in order to implement them into my practice correctly, so that Maori whanau
receive better health outcomes.

In relation to socio-cultural and political contexts, in order for Maori whanau to gain better
access to and receive quality health care, the New Zealand Nursing Council (2020) created five
key principles in which honours the obligations of Te Tiriti o Waitangi. These five principles are:
Tino rangatiratanga (self determination) which guarantees Maori self determination and mana
motuhake, meaning the right for Maori to be Maori; Patuitanga (partnership) which is the
requirement for the Nursing Council and Maori to develop a strong enduring relationship with
each other; Mana taurite (equity) the requirement of the Nursing Council to carry out equitable
health outcomes for Maori; Whakamarumarutia (active protection) is the requirement of the
Nursing Council to implement culturally safe nursing standards including the practice of cultural
safety to achieve both, extent and nature of Maori health; and lastly Kowhiringa (options)
which is the requirement of the Nursing Council to ensure that all of its services are carried out
in a culturally appropriate way and encourages the expression of te ao Maori models of care
and nursing. By demonstrating these principles as a health care provider will result in uplifting
hauora for Maori or in other words, better health services and outcomes for Maori whanau.
Gina Vete, 21146303
Tena koe! Ko Gina Vete toku ingoa!
In this presentation, I will be talking about two Kawa and Tikanga (customs and traditions) that
are Karakia (prayer) and Te Tuku Whekau (organ donation). As a future healthcare provider,
this can improve the health of Māori by strengthening my whanaungatanga or relational
practice (LO1). Secondly, I will discuss establishing a deeper awareness of Te Tiriti o Waitangi
and equality and incorporating equity into my duties (LO2). Lastly, I will finish by
comprehending some of the socio-cultural and political contexts such as the articles of Te Tiriti
o Waitangi and the Oranga Tamariki report released by the Waitangi Tribunal that have
impacted Māori health(LO3).

According to the Capital and Coast District Health Board (2017), In a hospital context, especially,
karakia is crucial for safeguarding and preserving Wairua, Hinengaro, Tinana, and the wellness
of whanau. An example of what I would do in the situation is
● before and following surgery and other procedures, specifically in urgent or possibly
upsetting circumstances, offer and facilitate Karakia.
Te Tuku Whekau expresses how the burial of an unfinished body may alter many Māori
traditional beliefs and practices. Capital and Coast District Health Board (2017) states that when
Māori patients and their families are presented with the prospect of organ donation, they will
receive the support and space they need to comprehend the idea, have a hui, and make an
informed choice. An example of what I would do is
● Leave the family to have a private discussion about the matter without a clinical team
there.

I am convinced that the healthcare system has failed to provide Māori with equitable and
efficient outcomes in terms of equity. This is because the crown did not uphold the treaty's
tenets and also took decisions on behalf of Māori Whanau that led to unsuitable treatments
and other health effects.
Well firstly, the Waitangi Tribunal Claim, Wai 2575 determined that the Crown violated the
Treaty of Waitangi by failing to implement the Treaty's guarantee of Tino Rangatiratanga
(sovereignty) however, Māori thought they were giving up their Kāwanatanga (Governance).
This, therefore, caused inequality and poor health outcomes for Māori which resulted in Māori
not having the right to participate in resolutions around the creation of health services and
health outcomes due to colonization. According to The New Zealand Nursing Council (2020),
they examined that these five principles provide a more extensive understanding of the treaty.
They are; self-determination, Partnership, Equity, Active Protection, and options.

Two particular socio-cultural and political factors that will enhance and improve access to
healthcare care for whanau Maori in difficult times are, the articles from Te Tiriti o Waitangi
and recommendations from the tribunal claims. Te Tiriti o Waitangi is composed of three
articles that have a Māori and English translation. The Māori translation states that the Māori
were not ceding to the Queen of England their Tino Rangatiratanga but their Kawangatanga.
However, on the other hand, the English version stated that Māori were ceding their Tino
Rangatiratanga. Recognised in recommendations from the Waitangi Tribunal claims a report on
Oranga Tamariki was released stating that Oranga Tamariki was purposely targeting Māori
Whanau even though the same issues were occurring in other non-Maori cultures. Tribunal also
acknowledged that this gap was a result of the greater dynamics of colonialism and systemic
racism as well as the continuing effects of historical injustices against Māori.
Therefore my understanding of Te Tiriti o Waitangi and the Tribunal report on Oranga Tamariki
can be considered a socio-political or cultural context in helping create positive health
outcomes for Māori whanau by upholding Tino Rangatiratanga.

Rachel Suesue, 21139312

Kia ora, ko Rachel toku ingoa.
In my role as a healthcare professional, I can improve my whanaunatanga or relational practice
by providing space for kawa and tikanga to take place and even engaging if invited.

One tikanga I will be discussing is whakapapatanaga or communication. According to Capital

and Coast District Health Board [CCDHB] (2017) Whakapaptanga ensures that healthcare is
provided in an environment that is culturally sensitive to those using it. This is done to respect
various cultural views and requires, as well as to encourage the waiora (health) of the individual
receiving health care. My role as a staff in relation to the whakapapatanga is to advocate for the
patient and their whanau for example ensuring that the individual and their whanau
understand what is happening, and know what support and resources are available (WellSouth,
n.d.).

Another tikanga I will be discussing further is te kai/ papauka/ waitinana (food/linen/body

substances). According to the CCDHB (2017) tapu are sacred items that are kept separate from
noa (unscared items). This tikanga underpins many practices and across many cases, these are
consistent with standard health and safety practices that should be followed by staff. As a staff
it is my responsibility to educate myself on the basic principles of tapu and noa and be able to
practically display these principles with respect. I can support this by not passing food over a
person’s head and using different flannels for washing the head and washing the body.

Health equity according to Braveman (2014) is the concept or goal that encourages efforts to
reduce disparities in health care between economically or socially disadvantaged groups of
people and their greater counterparts. Te Tiriti o Waitangi establishes a framework for Māori
rights to health equity by providing the Crown the responsibility of upholding Māori and Māori
the privileges of equal citizenship, along with the right to equality of outcomes (Medical Council
of New Zealand, 2019). In article 2 of Te Tiriti o Waitangi, highlights the tino rangatiratanga or
sovereignty and how it was written that Māori were promised to uphold their authority. In
article 3, the crown commits to upholding the equal rights of the people of Aotearoa. This
means that crown-funded health providers have an obligation to help Māori achieve equitable
health outcomes (The Royal Australian and New Zealand College of Psychiatrists, 2022). The
crown however, deliberately misguided Māori into surrendering their sovereignty or tino
rangatiratanga, taking away their authority to take part in decision-making. The Tribunal found
that the Crown violated Te Tiriti o Waitangi by neglecting to create and oversee the current
primary health care system to actively address persistent Maori health inequities (Health
Quality & Safety Commission New Zealand, 2022).

In terms of the socio-cultural and political context that could be utilised to improve access to
and quality of healthcare for Māori whanau, I will be explaining the Māori health model of te
whare tapa wha (the four cornerstones or sides of Māori health). There are four equal sides,
each representing one of the four pillars of Mori well-being, which are supported by a solid
foundation. According to Ministry of Health New Zealand (2017) the four dimensions are:
o tama tinana (physical health) which focuses on how your body feels and how
you care for it.
o taha wairua (spiritual health), which explores your your past, present, and
future relationships with the environment, people, and heritage. This is an
important aspect of our mental health. .
o taha whanau (family health) which is about the things that give you a sense
of belonging, the people you care about, and the people you share your life
with. Whanau is extended relationships, not just immediate relatives
o taha hinengaro (mental health) refers to your heart, mind, and conscious
thoughts and feelings. It is about how you feel, how you communicate, and
how you think.
As a healthcare practitioner, one way I can incorporate this into my practise is by providing
emotional support to the individual and their whanau. This allows the individual or whanau to
feel comfortable reaching out for support, which builds stronger bonds and allows them to
communicate their emotions effectively. Another way I can apply this is my practice is providing
a safe space my patient to meditate and connect with their tūrangawaewae (place of
belonging) which, in turn, helps them appreciate the present moment more. Individuals with a
positive mindset are better equipped to deal with challenges, form strong whanau
relationships, and thus improve their quality of healthcare and make access to healthcare more
at ease.
Gina: Conclusively, our group has discussed the importance of demonstrating a variety of kawa
and tikanga into our practice as a future health care provider in order to strengthen
whanaungatanga (or relational practice) for Maori.
Rachel: We also discussed each of our own understanding of equity regarding Te Tiriti o
Waitangi, and understanding its importance to enrich the care we provide as healthcare
professionals.
Ema: Moreover, we explained incorporating different socio-cultural and political contexts which
in turn creates and initiates better health services, and improves the quality of health care for
Maori.
Fano: Collectively, these strategies and reflections will aid our future practice to ensure we are
able to uplift Hauora Maori in times of difficulty. Nga mihi nui!

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