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Rongoā

Include your rongoā healer in your health care team

There were many examples provided in the Pae Herenga study about the benefits of using rongoā and rongoā rākau. Working together with your rongoā rākau practitioner and your health care team and being open about what you want to achieve from the start, will help to make sure that everyone is on the same page. Including rongoā practitioners and health professionals in the end of life journey is important. Working together in collaboration can ensure that everyone knows what is happening. Everyone can contribute to the end of life healing journey to bring good results. For example, health professionals can contribute their knowledge and skills on health and social care while whānau can offer their aroha and manaakitanga supported by their tikanga and natural healing treatments, such as rongoā. Spiritual practitioners also have an important role to play.

Health professionals may have a limited understanding of rongoā and rongoā rākau

Health professionals will most likely have a limited knowledge and understanding of rongoā and rongoā rākau because health provider training does not usually go into this. Health professionals may know very little about the possible side effects Western medications or treatments will have on your rongoā rākau usage. Some clinicians may be suspicious about its value as a healing approach, but this is mainly through their lack of exposure to this approach and some may be misinformed. We provide some stories to highlight some of the barriers that kaumātua and whānau manaaki faced when wanting to use rongoā within some mainstream health care settings (hospital, hospice, and aged residential care facilities).

Kaumātua Ned (rongoā healer) reflected that when health professionals and whānau manaaki work together there are often good outcomes for those who are ill and dying:

The bird who eats of the miro, his is the forest. The bird who eats of the knowledge, his is the world. The bird who takes on both those mantles, his is God who gives us everlasting love. He gives us everlasting guidance. It is not what the hospital can do for Māori, it’s what Māori can do for the hospital. We do not go there expecting them to be a Māori. They’re a hospital. We go there taking our aroha and our spiritual supports to put to the hospital, to support the hospital. In a time of need, when my mum was in her greatest need, their hands were there. And we were fortunate enough to be able to work together to get Mum back to functioning at home with all her wits about her, and all her love for everybody that was there. And it was Mum’s spirit of aroha that was spread over the hospital when we arrived… We were just hopeful that the wairua we took with us, to our Mum, sprinkled on the hospital as a memory for them to look towards other whānau that come…

In her Pae Herenga interview GP S. said that rongoā Māori is important to her patients and they are electing to use it more and more. She is seeing more Māori wanting to stop using Western medicines in favour of rongoā Māori:

I am getting increasing numbers of my Māori patients wanting to switch from their medications to rongoā Māori, and that’s because we have [name of local rongoā healer] and a few other practitioners… up here at [name], our Māori mental health service where they deliver a rongoā clinic. And so, for me, what I say to my patients is ‘Your health and your journey with your health is your [choice/decision], just you know your decision. I’m here to awhi you. And so, if you want to choose an alternative route then ‘kei a koe’.

I guess we know that there’s evidence that goes with the medication that you’re taking so there might be a risk, but I’m happy to support you, on whatever journey you choose to take.’ So, some have stopped. Some continue. I’ve got a woman who had breast cancer. She has been so well since stopping it all, actually. And there’s whānau around here using cannabis creams and all sorts. And you know if it’s going to help their pain; you know, I support that. I obviously don’t say ‘I think that’s okay you can carry on’. I just lay it in their court. You know ‘it is your choice to use the balm. I obviously can’t prescribe that as a practitioner, but it is your choice’.

Highlighting the possible risk options and supporting them in their own health decision making is important. Specialists use caution by letting whānau know that it could be a possible risk:

And I’ve even seen it written in letters by Specialists who say their patients are taking rongoā Māori as well as having the conventional treatment. The letters I’ve seen there’s no- they’re not disagreeing, but they’re indicating that the patient knows of the risks or, ‘I cannot be certain of the risks of taking this rongoā or this Māori plant’ or whatever, you know that sort of thing.

Knowing how to access and find a rongoā Māori practitioner is not always easy:

I was lucky enough to [see] we’ve got some nannies up at [name of] Marae and they deliver a mirimiri clinic. And so while I was managing my own health issues, I asked them if I could join in and do some mahi with them, and yeah they were really awesome and it taught me a little bit about what’s available and enabled me to be able to offer that as an option for patient if they wanted to. I think it’s important that we can, yeah, move, be dual. You know.

Whaea T. (community health professional), has the connections and knowledge to be able to know who to refer someone to if they want to use rongoā. In her Pae Herenga interview, she expressed that whānau need to be able to have knowledge about, and access to, where to go for rongoā Māori. This is a role she is able to carry out and she recommends rongoā Māori to whānau:

… Recent experiences are with our whānau who are at that end. Is access and knowledge of where to go for alternative therapy or treatment and that.

Yeah… rongoā. Which is really not out there yet, up here. And what my knowledge in my previous role… is letting the whānau know… there is some services… it’s just they need to be well informed of it and also have ah, a good informed insight into what they deliver… but also having… you know the information being pono… what’s the word… authenticity… Authentic about giving that information…

Whaea T. felt there was an increasing need for whānau to use rongoā for healing:

There was a lot of need for yeah like the grief and loss, the underlying anxiety you know for our people because a lot of it is not depression. There’s a lot of unresolved issues and the sadness is, a lot of it is it’s just about hopelessness… But a lot of features of anxiety… finding out what, what those type of anxieties, a lot of it is post trauma stuff… A lot of things happening in their life.

Whaea Rawi and Matua Ngawati talked about providing Māori medicine to a person who was in hospital dying. They explained that at that time the doctor who had given permission for the use of Māori medicines knew Rawi and Ngawati, but it was not normal practice to have Māori medicine used in the hospital:

Rawi: There was one particular doctor that we know really well, that allowed us to, we had one whānau that was…

Ngawati: That asked for, for Māori medicine.

Rawi: Yeah, and…

Ngawati: And he ok-ed us to supply it to the dying person. Mm

Rawi: Yeah, at the hospital. You know, and he, he said ‘It’s not normally done’. But you know, because he knew our whānau so well, that he allowed us to bring [it in], yeah you know, that was really good of him too.

Rongoā is used as part of the care given to tangata whaiora (people who live with mental health conditions). Matua R., a mental health professional, reflected:

So [rongoā], it’s a therapeutical [sic] resource that’s available here every Friday from 10am… Whaea [name] does the coordination of that. So, in terms of end of life maybe Whaea probably may potentially use some of the tools [rongoā rākau, mirimiri] that are in our cultural resources for that. But it’s a resource that we use here every week for whānau to help around anxiety, muscle functioning and just typical mirimiri as well.

Vanessa [hospice worker] explained how hospice helped her with learning and achieving her long-term goals to integrate rongoā into her working life to help whānau:

How did they [hopcise management] help? ... sometimes there were bits of education that I wanted to do and attend that didn’t look as though they were strictly relevant or lined up appropriately with liaison work. So, my manager would actually talk to the Chief Exec… and say, ‘Look I’m not quite sure about this, what do you think about that?’ And [the Chief Exec] would say, ‘Well, you know, we’ll let her do it, see where it goes.’ So one thing when we talked about when we’re getting ready for the annual review, and I was interested in rongoā and I had written myself my three year plan for learning about rongoā and what I would need to cover, I thought ‘okay, this is supposed to be about my development and what I want to achieve personally and professionally.’ So, I went to my boss and said, ‘This is what I want to do. This is my three-year plan. This is what I’m going to do. Would the organisation like to help pay for me to do some of these things? I’m going to do it with or without you, but I’d really love it if you’d help me because this is what I’m passionate about.’ And they were supportive in that, you know, which was great.

The power of ‘touch’ was spoken about by Vanessa:

I think for, part of it would be, touch seems very important. And in a way I kind of have cover it off in two ways. I have to think about a hospice clinical way, and I have to think about a Māori rongoā way. And at times I’ve been very mindful about keeping the two separate, or morphing, or documenting differently, while doing one or the other. I don’t mean it’s not intended to be misleading or under the radar, but sometimes that’s just how it’s needed to be. So, if I think about clinically with a Māori patient, touch is important, humour is important. Being able to meet and identify and speak with a whānau where they’re at, without judgement. Somehow people would just comment that I seem to have a peaceful happy āhua and that feels good for them, makes them feel safe. If I think about the rongoā side of things, those other things I’ve mentioned are still true. And for some of them I’m able to offer more in terms of remedies.

Vanessa talked about the challenges within her clinical practice and the use of rongoā Māori:

So when I say ‘remedies’, more in terms of wairākau, pani, actual hands on mirimiri and engagement, more of a wairua style of kōrero, you know, versus a clinical- there’s some restriction about how far I felt I could go within [the] hospice setting. Whereas the things that I can explore and do in a healing setting is different. People would comment that my hands are hot. So, they could have a sensation of one hand in one space, one hand in another space, say on top of the puku and, one underneath and they can feel a sensation or a movement between the two. So, we’ve had that feedback. People pass out and go to sleep, so I know that’s good! They’re resting if that’s happening. People say things that they surprise themselves by saying. That comes out as well. There’s more- sometimes there’s more sense that you’re in a sacred space, I suppose, in some healing settings, than what is possible sometimes in a clinic, in a clinical setting or an inpatient setting. The environment is just different and, yeah different expectations and rules and people and stuff around.

When asked by the interviewer what would the context be where she would find herself being able to administer healing, Vanessa responded:

… there are so many different scenarios that I can share. I will talk about, so I would say that whereas initially I don’t think the organisation had any knowledge about rongoā … I remember asking the Medical Director, ‘When you are assessing a patient how do you ask about what complementary remedies, or things that people are taking, how do you approach that conversation with them?’ Because I was concerned that some Māori patients were using wairākau, but not telling doctors about it. So, I said to the Medical Director, ‘How do you enquire about that?’ And he said, ‘Oh. I don’t.’ ‘So, what [about] traditional Chinese medicine, vitamins, acupuncture?’ ‘No, actually I don’t ask.’ So that gave me an idea of where I needed to start with in terms of acceptability of that, in this space.

Vanessa talks with colleagues and volunteers about rongoā. She also includes the making of rongoā into the day unit programmes with patients, creating an opportunity for whānau to talk about their own experiences and memories of rongoā:

There have been times where I’ve made or I’ve done talks about rongoā with staff, with volunteers, and with our day unit patients. So, our day unit patients will make things like lip balm and skin cream, and things like that together. And we’ll learn and make [them] all along and we talk about wairua and we’ll talk about what remedies, what things their parents would use for them when they were sick and māuiui when they were young. And in that time patients can go back to remembering great times, remembering great healing, and we talk about the things that their whānau did with them at that time. And I think in a sense that memory triggers a comfort that they can bring forward in a way. So, it’s a great tool for that.

Matua Ned (health professional) spoke about his organisation’s commitment to introducing a waka model of end of life care within the health service where he works:

… I’ve always used the waka model because that’s what I was brought up on, in a waka… I’ve always been on the river and I believe what the river, that’s [what] you wanted rongoā, there’s rongoā right there… and that’s what I’ve been doing with our kids over our past, and our adults and our people, is taking them back on the river because that’s the rongoā there. You want wairuatanga, there it is there. Drink it, swim in it, play in it…

So, we’re putting it [our waka model] together then this turned up. And I looked it up ‘nah, no need to reinvent the wheel it’s already here [model from the north].’ So we went through ours, went through this one and we go ‘oh well, this one’s already been gone through the whoever needs to say ‘yes’ and ‘no’ and, we’ve been, we received permission from, from them to put our waka and our own local ones to put a picture of our own waka in there that our people are familiar with.’ And it’s at a stage now where we’re, we just got to get it out there.

Kahu (registered nurse) said that some whānau like to use rongoā rākau, but it is not easy for them to use rongoā when they come into a health care setting; they may not feel comfortable. In her Pae Herenga interview Kahu said that whānau trust her and will ask her for privacy to use their rongoā:

[T]hey [patients/whānau] go ‘Could you just go out for a minute because we’re going to do this.’ And I’ll be [saying] ‘Okay.’ [The whānau says] ‘Can you make sure no one comes in?’ And I put a thing [do not disturb sign] on the door. Hmm because they don’t, yeah, they don’t want to be interrupted or asked, ‘What the hell are you putting that on?’ or whatever.

It is not always acceptable for whānau to use rongoā in the hospital or hospice system Kahu said:

… some nurses will say ‘oh that [rongoā rākau] might interfere with their aspirin’ or ‘that might interfere with whatever’, but at end of life I think ‘what the f***, just give it to them.’ Yeah, they [Doctor] goes ‘Oh hold off on that in case it interferes with your medication.’ [I think] ‘Just wait until they leave, I guess’. Or sometimes they won’t, like yeah... sometimes they won’t. One [Māori whānau manaaki] guy he was like, ‘Oh nah I don’t want to rub that on him [patient] because we were told not to give them anything because that [kawakawa] will interfere with their medication,’ like [it was] just a massage on their leg. Yeah, but they might not have heard it from here, they might have heard it from over in the hospital and just kept that really strong…especially over in that hospital. Mm, I’ve seen it [in the hospital] totally not used.

Kahu said that some staff do not understand the value of rongoā rākau:

But no, don’t get me wrong. Please don’t get me wrong it’s not like that a lot, but there are some staff that will be like that. Yeah. Mostly majority are alright, are okay…

Kahu felt that health professionals need to have access to education about rongoā to help them understand what rongoā is and the meaning it has for Māori:

Yeah, yeah, it’s just about education around it. Yeah [for the health providers] Yes for sure ’because they’re scared of it.

In her Pae Herenga interview, Whaea Lynne said she has witnessed a lack of support for rongoā rākau within the end of life field:

I’ve been at the table when the oncologist [second in charge], has been sitting at the table. The… specialist has said to me, to say this to the family, ‘You need to make your choice and if you choose to go down that road, and, and not do the treatment at the hospital then we’ll have your release papers ready, you can go home this afternoon.’ I’ve sat around the table twice when that’s happened. Twice. Two different people. That’s happened.

And so that whānau just plunges, just plunges. And that particular kuia that I’m thinking of right now, that particular kuia, her face drained and, she didn’t know what to say. So, what happened was it plunged her into a place of fear because all she was saying was that, ‘I will do this, but I also want to have this.’ And she was given the choice in [name of] Hospital…in the Oncology Ward... We’ve got the same thing again because when they’re in crisis it’s extremely important. If an oncologist says to a whānau well, ‘You’ve told us that you want to do rongoā as well, here’s your choice, you either stick with us and do the chemo and the radiation, or you do your rongoā. Make your choice.

So with what we know in the rongoā wai rākau is that there are some things we suggest; that they take the rongoā at the same time that they’re taking the chemo and because it helps (what one does for the other is help to take out what the body doesn’t need). So, it will help to take it out. But what it also does is this [medicine] one here messes with the immune system, so this rongoā here is gonna to boost, boost up and repair that immune system.

Kuia Hana, in her Pae Herenga interview, reflected on the manner [attitude] of a young male nurse who was helping to care for her husband’s sister in hospital, and how she advised him to be patient and respectful when interacting with kaumātua and kuia. Kuia Hana encouraged the young nurse to join with the whānau in bringing some comfort and joy to their dying sister. Waiata was spoken about as an important and valuable form of rongoā that was capable of joining whānau and bringing them together in a healing embrace. Health professionals can learn a lot from whānau who are caring for a loved one at end-of-life:

… when [Arena’s] sister was very ill in [name of hospital], we went there… And she was trying to think, and it was that [song] "Missing in action.” You know that's a real old, old one, “Missing in action.” Anyway, this male nurse comes over, very brazen, comes over and he goes, ‘Oh, I need you now.’ And I say, ‘Kāti, tātari (no, wait).’ I said, ‘Wait.’ And I said, ‘in actual fact, haere mai (come here) and sit and listen to her sing.’ And he stood there, honest he stood there. And we said to [Sister] ‘How does that go?’ And she goes, how does it start again? "The warship has landed," and anyway, she sang it, but you know her voice was really frail, but she sang it.

But you know we were all tangitangi (crying) and anyway I said to this fella, ‘now you understand when things are of importance - wait. Because if she's going to say something to us, we need to remember, and this is also a learning experience for you, to wait. We’re not talking just about now, but in the future, when you need our kaumātua, kuia to come, wait until they're ready don't just come in and say, ‘oh I need you’.’ And he was full of apologies.

Rongoā rākau training and support for health professionals

At present rongoā rākau is not included in pharmaceutical medications. A Rongoā Māori approach focuses on the essence (life force properties) within each plant, the whakapapa (genealogy) of each plant and the environment they inhabit and includes the whakapapa of the healer and the one being healed. Traditionally training in rongoā rākau and the collection, preparation and administering of plants was first introduced to young children and their education continued until they had a full understanding of the plants, their whakapapa, healing properties and uses.

 

Today, training is offered at some Māori universities and tohunga (experts) in rongoā rākau offer field-based training. The ideal would be for rongoā rākau practitioners’ and health professionals to access Kaupapa Māori training in the philosophy and practice of rongoā in all its forms, inclusive of te reo Māori, karakia, waiata and whakapapa and bring this healing approach out into the open for all people to access. At this stage it is often only Māori health professionals who have access to this type of information.

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