Aroha mai, aroha atu - Love received, love returned

Aroha (care, empathy, and compassion) is actioned when health professionals can think, feel, and act with empathy and compassion towards those they care for. Respecting kaumātua for their status and their mana (authority) as tangata whenua (Indigenous people of this land) recognises their uniqueness as New Zealand’s indigenous people and the relationship the Crown (and by extension, health services) have towards Māori whānau. No matter what someone’s circumstances are, being kind and compassionate is what matters when someone is at the end of their life.

Aroha is openly demonstrated between staff and patients at GP K.’s workplace. Showing aroha is a natural way of being, and a natural expression of caring for whānau. The Western bio-medical model approach can be more reserved:

I think we do display it here [medical clinic] well, our aroha. Like I think about some of my teachings back in the day of, you know, ‘do not touch patients, do not do this, do not do that’. Look I hug and kiss nearly every one of my patients. We touch - we touch… there is nothing inappropriate about that at all… I feel like it’s very normal, it’s a very normal part of my [practice] and I think they do too. You know a hug and a kiss on the way out and a touch on the back as you’re going out is to me, is aroha.

It is important for Matilda (community health care assistant) to include the ill person in her conversations, even when they are unable to speak:

“Always, even if they’re not able to [talk], just talk to them like yeah… And their eyes make contact…”

Whaea S. (health professional) emphasised the importance of treating patients with respect and being non-judgmental. She pointed out that people nearing the end-of-life may be struggling. They may need to receive kindness instead of feeling judged. Being kind can help to address inequities when people are preparing to die:

I was in a meeting where the nurses and doctors were talking about our patients [they were negatively commenting on a man who was dying]… I remember [for] a long time sitting there going, ‘This is a man, this is a person. He is a father.’…- And they said, ‘Oh well if he’d done what he was supposed to do he’d have a better life.’ I said, ‘I’ve got to stop you there. We have four emergency doctors here; we have eight nurses… This man knows that he has done wrong in his life. He knows that he’s at end stage renal failure now. He is shit scared of dying and not one of yous has talked to him about comforting him around dying.’

I said, ‘Can we stop, stop with the fact that he’s got [name of gang] tattooed on his neck and he looks like a bull and he’s, gruff and he swears… this is a man who is scared, he’s a little boy inside of a big man’s shell scared of dying.’ Because we all are essentially. And so, my manager said, ‘Oh yeah.’ And you know it started to get brushed off, but I said, ‘Actually this man, the reason he’s not listening to yous is because not one of yous is listening to him. You’re more worried that his partner goes and helps herself to the fridge, that they help themselves to the blankets, that they… want dressings and things like that.

They’re just trying to get to a point where they can go home and do what they want to do. And we’re not helping. He knows he’s dying; he knows all that. What are we going to do about it? What are we going to do to make him comfortable?’ And from that like one of the doctors later on said to me, ‘How do you know you’re doing a good job as a nurse?’ And I said, ‘Here’s a flounder in cream from that man’s wife. While he’s in hospital she’s gone home and cooked me a flounder in cream. Not you, not another nurse, but me. And he’s asked me to eat it with him. So, from a Māori perspective that tells me I’m doing the right thing.’

Healing and caring for people comes from the heart and it is this love GP A. brings to her practice with the Māori patients she sees:

[H]ow I like to treat people is… to treat someone the way that I like to be treated. And, first and foremost is [treat someone] with aroha (care and compassion). [If] you don’t have aroha what do you have? If you can’t show somebody love, regardless of what they bring into that room (what wairua [spirits/ancestors] they bring with them)… our job as practitioners of any sort is to break that down and show [them] actually ‘I love you’… You know, ‘I love you regardless of what’s happening. And, I actually just want to care for you. I want to give you the best opportunities possible’. So, everyone who walks through my room… even if they’re angry… as soon as I walk through that room with them and the door shuts, absolutely it’s all about [them]. Doesn’t matter what happened before… You start with love, aroha, because you know that’s what Io (Supreme Creator) is about.

Recommendations

For health, palliative and social care professionals, we recommend:

  • Reflect on your behaviour to make sure you are practicing with aroha. Aroha and respect cover every area of health and social service provision from the appointment letter that arrives in the mailbox, to the ‘Kia ora’ that greets the person over the telephone and the smiling face that’s waiting for them in reception.

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