Health professionals are kaitiaki (guardians) of those under their care. The agreement that the Crown has with tangata whenua (Indigenous people of Aotearoa New Zealand) outlines the partnership arrangements that the Crown has made with Māori. As government health workers of the state, health professionals have an obligation to uphold the responsibilities the Crown has toward Māori kaumātua and whānau. The end of life is an important area of health for Māori physically, emotionally, culturally and spiritually. The whānau manaaki partnership brings with it a specific obligation to be generous stewards through invoking a trusting, caring relationship. Time is an important resource and time spent wisely can be a great healing support.

Joy (health professional) explains the importance of visiting new patients at their home as whānau often like to sit and have a korero.  A lot of whānau are scared about chemotherapy.  They may have seen a family member have a bad experience or they may have been told stories about chemotherapy. Joy helps to allay these fears for whānau:

Usually a new patient… they just want to sit and have a kōrero (talk). Want to know about treatments you know because I tell you what, for a lot of them they’re still scared around chemotherapy treatment eh? Because they’ve had stories told to them by other whānau or had other members before that had a bad experience with chemo treatment. So, I, I go, and I talk to them either before or sometimes after the consult just to see how they’re doing. And it’s just to help allay those fears you know.

When health and social care professionals take the time to build relationships with kaumātua and their whānau manaaki they are in a good position to support the whānau if they need their help in the future. Mary Te Awhi (hospice kaitakawaenga), highlights how she allocates time to connect with kaumātua who have life limiting illnesses in her community.

So, you know I loosen up my role. I have, every now and again and I’ve got a lovely little group of kuia. At the moment, they are almost house bound really due to their illnesses. And they just love, the visit. … Some of my work, it’s literally social for some of our people. Yes, they’ve got busy families around them. Yes, there are other health professionals coming in to help them, but the thing is I go there, and we just sit and talk. And we have a cup of tea and I go ‘oh, but I’ll make it’ you know. ‘You’ve got to let me make it you know.’ And so, we’ll sit and have a cup of tea; so they are some of my kuia at the moment… I allocate time for them. I don’t specify [time limits] for some of our whānau. And in fact, for most of those that I do visit in the community, I don’t specify time. I allocate the time for them.

Continuity of care (follow-up care for patients from the same doctor) is important to establish a connection with whānau. GP A. highlights the importance, and the meaning, of why connections are so important to whānau:

So even if you’re not Māori- unfortunately we don’t always get a Māori doctor - that is changing which is great but, for the doctors to understand a bit more I don’t think they [all] have the cultural awareness that I believe they should have, which is to the point of, yes, even after an operation that connection’s so important but, following that all the way through. So, if you’re going to follow that, depending on who it is, but a kuia or kaumātua should be [given] the same doctor the whole way through. Not registrars and other people and, you know, it should be a consistent connection. Because we’re all about connection. When we go somewhere, like today I was trying to figure out how I connected to [name] you know, like we’re about connection where we’re from, who’s our iwi so that we know ‘oh yeah this is how we connect.’ So, for the kuia and kaumātua they want to connect to the doctor and maintain that one connection. They don’t want that disconnect because again that stops the healing phase.

GP K. highlighted the importance of kindness and building strong relationships with whānau /patients:

I think if we’re thinking about our [medical] side, it, it’s a big overhaul on how we try to change the hierarchy around doctors and you know ‘doctor knows best’ and all that kind of stuff - so in GP land. But more so, I think in Secondary Care. And not even just GPs you know. [Bringing a] non-judgemental approach, being kind, aroha, being caring; that kind of stuff goes a long, long way. And you can [play] act that, but I think it’s really got to come, it’s got to be genuine kindness that you express that I think helps to facilitate the you know, the growing relationship.

GP A. reflected on what she believed was needed to support kaumātua and whānau:

What I know is there needs to be no time constraints. What the whānau needs is what the whānau needs. And what that healing- what’s required you know; I need to be able to deliver that. So [in a perfect holistic] world where the time constraints weren’t there, where I was supported by other tohunga because I’m still young and, you know I’m always looking to others for the experience. 

There are many people that have different gifts and what I envision is that being able to have all those people in the same room that have different gifts to collaborate and allow that healing to just flourish. And… you’ll hear actually when you’re speaking to other healers like how they heal and the different realms they go through to get to different places. And so if you can imagine trying to interlink all, different healers who work through the house of Rehua, who work through Te Omaireia, who work through rongoā rākau, just trying to collaborate to find that one space where they all can fixate on that healing or whatever it is the patient needs. So yeah, I think for me it’s just time [that is a barrier]. Constraints of time and probably in a system that I work in [Western biomedical] not having the support. Like I don’t have the support because it’s very much about money and it’s very much about how many patients you can push through regardless that I work for a Māori organisation and have done all my life... It’s still the same. We’re still in a system where it’s around money and time.

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