Relationship building using a Te Tiriti o Waitangi framework Whakawhanaungatanga Relationship building using a Te Tiriti o Waitangi framework What’s the use of a 171 year old document? Is it still relevant today?

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 Respect – illustrate using SW panel story. Then link to following slide.

The Use of the Eyes Māori – Direct Gaze Impolite Challenging Excludes others Wandering gaze Listening Concentrating Softening message Pākehā – Direct Gaze Interest Undivided attention Nothing to hide Wandering gaze Boredom Bad manners Evasion Guilt Could use any number of examples such as the use of silence or the raised eyebrow. Teachers record difficulty communicating with young Māori children who kept on raising their eyebrows in class. Interpreted as not understanding so kept repeating info. Children using the raised eyebrow to signify we understand, now move on. Now it’s a form of greeting.(eg. Tourist guide in the far north). The Use of the Eyes

Te Tiriti o Waitangi Key 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)

Part of culture not apart from it 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 Myristicin – phenylpropene (also occurs in parsley, mace and dill). Psychoactive. Acts on central nervous system. Affecting mind and behaviour. Tupuna – use Probation screening questions as example.

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 Wider relationship reflected in reo. Lack of access etc. Sign of poor health. The spiritual domain/tupuna is related to via land (Paikea eg.)

Paikea was the eldest son of a great Hawaiki leader Paikea was the eldest son of a great Hawaiki leader. He was almost lost at sea but was said to have been rescued by an ancestor in the form of a whale who carried him to safety. Eventually he married and founded the descent line that lead to Porourangi, the ancestor from whom the iwi Ngāti Porou descend and Tahupōtiki who is the forefather of Ngāi Tahu. Anne Salmond. Amiria. (Auckland: Penguin, 2005):p.168. 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 Te Reo Māori 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 Tribunal http://www.waitangi-tribunal.govt.nz/reports (3 August 2011) Refer to work at marae. Note the importance of pronouncing people’s names correctly for building trust/relationship/respect. Kaupapa/kupapa example.

Nga tangata Case Study “Kanohi ki te kanohi” Mobile Clinics, 2008 Evening clinics at shearing quarters GP, Practice Nurse, Whānau ora worker, Māori Mental Health worker Rural Otago, South Otago and Hamilton East (Dental Clinics) Based on the idea that the same rights equates to equity/equality (depending on prevailing ideology) and access to health care Ads in community networks, posters, flyers and pay packets (Contractor buy-in).

Te Whānau a Apanui Community Health Centre Registered population 1700 (90.5% Māori) Every 2 years free breast screening for women aged 45-69 years Mobile service initiated 2003 – 40% uptake of eligible population 2005: 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 Whānau a Apanui Community Health Centre

Māori for Māori services Choice or appropriate referral Te ritenga Māori Case Study Māori for Māori services Choice or appropriate referral Nationwide services: Aukati KaiPaipa or Māori Advisers on Quitline Iwi based services:He Oranga Pounamu Urban initiatives: Waipareira Health Protection of Māori custom Expressed today through services based on kaupapa Māori (also a Ko te tuarua implementation) Aukati KaiPaipa: free, nationwide programme. Aims to reduce smoking prevalence amongst Māori and increase positive changes in smoking behaviour, such as not smoking around children or in the car. 8-12 week intensive programme. Face to face, with extensive follow up.

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 Jay’s Dr. As example.