RESEARCH, INNOVATION AND ENTREPRENEURSHIP AT THE UNIVERSITY OF WAIKATO
7
BREAKING
DOWN BARRIERS:
Kaumātua and
health professionals
improving
communication.
AT SOME stage in our lives we will have to face a
situation that calls for palliative care, whether it be for
family or whānau, friends or ourselves.
The Ministry of Health and Health Research
Council identified that Māori under use palliative care
services and the organisations wanted to know why.
In a community and academic partnership, the
University of Waikato and the Rauawaawa Kaumātua
Charitable Trust (along with other partners) have
been working together to develop a model for
communication and health literacy around palliative
care for kaumātua (Māori elders) and whānau.
TheTrust supports, advocates and provides positive
programmes, activities and services that enhance the
quality and enjoyment of life for kaumātua, older than
55 years, in a whānau-orientated service. Professor John
Oetzel and Dr Mary Simpson from the Department of
Management Communication at Waikato University
participated in the research project, which was led
by Rauawaawa. “The Trust identified that there was
a communication issue between kaumātua and their
whānau and the medical profession,” says Professor
Oetzel. “So we took a number of approaches to
identify what would help kaumātua and their whānau
consider palliative care when someone close to them
needed it.”
Additional researchers were key collaborators
for the project, coming from the University’s Te
Kotahi Research Institute, Te Runanga o Kirkiriroa,
University of Auckland – Waikato Clinical School in
Hamilton, and the Waikato District Health Board.
CEO for the Rauawaawa Trust Rangimahora Reddy
says the kaumātua-led community-based model
approach to this research worked well because of the
goodwill within the collaborative research team and
the commitment to the kaupapa.
“Throughout the project each group was able to
take the lead at different phases and their ability to be
inclusive and educational provided great workforce
development opportunities for Rauawaawa.
“Dr Simpson and Professor Oetzel were key leads
in the communication and report writing phases of
this research, and for that we are hugely indebted. The
results of the research in essence highlighted what each
party involved in the palliative care process (kaumātua,
whānau and health care workers) felt worked well and
what needed to be improved.”
Dr Simpson says they analysed the material that
hopsices and care agencies used around palliative care
to see if it communicated effectively with kaumātua and
whānau, and whether it fitted with tikanga. “For the
kaumātua and whānau who took part in the study, many
of these materials did not fit well with tikanga. “We
interviewed kaumātua who had experienced palliative
care with friends or whānau, and we also held focus
groups with whānau members, mostly non-kaumātua,
about their experience and of course we talked to
palliative care workers from hospitals, hospices and
people who work with the Trust. Our goal was to find
out what worked rather than what was going wrong.”
And what does work? The answers are hardly
surprising says Dr Simpson. “When health workers
respect and value Māori culture and communicate in
ways that are explained clearly and don’t do ‘doctor
speak’, then people feel more comfortable. It’s more
than delivery of care; it’s showing the patient that he or
she is cared about and being attentive to the nuances of
the culture. You can’t assume people are all the same.”
Maehe Maniapoto, a Rauawaawa trustee, says it’s
most important that kaumātua and their whānau have
enough information so they can ask the right questions
relevant to their respective situations.
Dr Simpson says one of the things people found
useful were communication books, so everything
that was happening to a patient was written down
and people didn’t have to keep repeating what
was happening and what was going to happen.
It also made it easier to talk about issues around
palliative care.
It comes down to a matter of balance, where
medical staff create an environment where it’s okay
to ask questions and the patient and whānau know
what questions to ask, Professor Oetzel says. “Patients
want dignity and respect for decision-making, but also
require information and direction without feeling like
they’re being told what to do. Medical staff need to be
adaptive, but I think there will always be tensions and
a need for give and take.”
As a result, of this research, regular workshops
on palliative care have been built into programmes at
Rauawaawa to ensure kaumātua have the information
before they need it, Ms Reddy says. “Much like
people getting airplane emergency information at
the beginning of a flight rather than when a flight
emergency comes to their attention.”
Better outcomes with better communication
Students research topics close to their hearts
Two University of Waikato students are travelling to the US this year on Fulbright scholarships. One to complete a PhD, the other to talk about his PhD research.
MĀORI tangi are steeped in tradition and are
bound by protocols and etiquette,but at the same
time tangi are evolving as each generation brings
something new or different to
these culture-bound events.
Indigenous anthropologist
at the University of Waikato
DrVincent Malcolm-Buchanan
made tangi the subject of
his doctoral thesis and was
recently awarded a Fulbright
Ngā Pae o te Māramatanga
Travel Award in Indigenous
Development
to
lecture
and present a paper at
the Association of Social
Anthropologists of Oceania
(ASAO) conference in New Mexico.
“I was inspired to research the graveside
topic after walking amongst the headstones at
our private family urupā – where I was surprised
at the elaborate and expensive headstones,” says
Dr Malcolm-Buchanan. “My aunties called one
strip, which includes the headstone of my mother,
the ‘Hilton Hotel row’ which infers notions of
extravagant wealth.”
His doctoral thesis is titled
Cloaked in life
and death: Tangi and Taonga in a contemporary
Māori Whānau
and looks at how tangihanga
have changed over the years and been
influenced by Western culture and how that fits
in the context of the ongoing traditions. “I had
to
be
objective
when
looking at the overarching
universals of death, burial
and grief, and merge that with
my private subjective voice,
as well as that of family, to
articulate tribal – specific
experiences.”
Things are changing at
tangi he says. “We have had
to adapt to technology as our
young people bring in their iPads
and mobile phones as well as
new ideas. We’ve changed what we offer in the
wharekai, providing more healthy options.
“Our headstones seem to be getting more
and more extravagant, so I wonder about the
expense as many Māori are poor.”
Dr Malcolm-Buchanan's doctoral supervisors
were Professor Ngahuia Te Awekotuku and Dr
Tom Ryan at the University of Waikato. Most
recently Dr Malcolm-Buchanan has been awarded
a Postdoctoral Writing Stipendiary Award in the
university's Anthropology Programme.
WAIKATO University doctoral student
Sharon Toi is off to Arizona as the recipient
of a Fulbright-Ngā Pae o
Te Māramatanga Graduate
Award. She will spend a year
in Arizona researching and
writing her PhD in law about
the invisibility of women in
tribal governance.
Ms Toi will be part of the
Indigenous Peoples Law and
Policy Program, College of
Law at the University
of Arizona.
Her research in Arizona –
mainly on the experiences of Pueblo and Navajo
women - will be used as a comparison to what
she has already learned about the roles
Māori women play in tribal governance
and she says she expects to learn that, in
general, Māori women are doing better than
their American counterparts.
“My reading of the situation there is that
it’s pretty patriarchal,” she says.
“From what I’ve read it seems Pueblo
and Navajo women are banned from decision
making whereas Māori women are active
and vocal.”
Ms Toi graduated with an LLB in 1997
and a BA in 1998 from the University of
Auckland and obtained an MBA
in 2008 and an LLM (Hons)
in 2010 from the University
of Waikato.
She says her PhD is aimed
at developing “what I’m calling
gender analysis tools” for
her iwi.
“My case study is of
Ngāpuhi. I’m from the
Hokianga and women there
are very vocal, informed and
active,” she says.
“Women are there but often they are
not recognised. I’m looking at the way
women can influence decision making.”
In most post-Treaty of Waitangi
settlement situations, she says, the
organisations established are based on
corporate or patriarchal models which
“greyscale” or push the involvement of
women into the background.
“The talk is often, settle, settle, settle
and we’ll sort it out later but there are concepts
within tikanga that respect Māori women.”
The complexity of Tangihanga
Māori women in tribal governance
DRVINCENT
MALCOLM-BUCHANAN
SHARONTOI
