1. 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?

2. 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

3. 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.

4. 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

5. 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)

6. 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.

7. 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.)

8. 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

9. 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

10. 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
(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.

11. 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).

12. Te Whānau a Apanui Community Health Centre
Registered population 1700 (90.5% Māori)
Every 2 years free breast screening for women aged 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

13. 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 week intensive programme. Face to face, with extensive follow up.

14. 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.