Strengthening health and social care services ties with local Māori leaders and health professionals in the community will help to extend upon the cultural skills, capacity and resources of existing staff. Actively employing more Māori health and social care professionals and community support workers reflect an organisation’s level of commitment to increasing their cultural competence.

Joy (health professional) is asked what she thinks the key strengths are that she provides for Māori at end of Life. She reflects on her 18 years of community nursing and her previous connections with whānau:

…I think because a lot of patients that have come through [to the hospital] I already know them [from] working out in the, having worked out in the community for over 18 years. You know a lot of the patients I see coming through I’ve already been visiting them when I’ve been with [name of service]. And knowing the area, knowing the services that are out there....

Being a Māori nurse makes a difference for patients coming into hospital. Patients have expressed to Joy (health professional) how good it is to have a Māori nurse:

...being Māori makes a difference, a big difference as well because when they [Maori kaumātua and whānau] come into the hospital, it’s really, really scary for them still. But if you come up to them and talk to them one lady said to me 'oh you know it’s just so good because you’re Māori.' It makes a big difference and, you know I suppose it’s less scary for them then, yeah.

Māori workforce development is needed to increase Māori staff capacity in every area of health including management, advisory boards, research, cultural supervision, administration, clinical (every field), psychosocial support, spiritual care, allied health and voluntary workers. Kaumātua and whānau manaaki often feel safe and at home in the presence of Māori staff. Liaising with Māori community providers is valuable for establishing coordinated care when it’s needed.

Addressing the needs of the community was a key goal that Kim (community worker whānau manaaki) emphasised during the interview. She worked towards this by listening to what people said and coordinated relevant services to visit the community, or individuals:

It’s not about what I offer, it’s about what the community needs. You know? So, I listen to what people need and then I bring the right things out… So, my motto is, ‘Love is the key, so have a cup of tea.’ So people come in here and they have a cup of tea and a kōrero, and it’s over that that I [am] actually listening to all the things that are wrong with them and then I think, ‘Well there’s a lot of this going on, a lot of depression.’ So, I’ll bring mental health out [to our community to deliver an education session on mental health] … You know what I mean?

Because Kim can work independently in her community she is not constrained by any organisation’s protocols; she explained that she was able to intervene on behalf of different whānau members:

I have a nurse that comes here once a week and then I listen out. Because I’m not… [part of a health organisation]. I can actually say, ‘Aunty blah, blah, blah’s not well today can you go down and check up on her. She’s fell over or she dah, dah, dah, dah.’ And then I can ring the hospital and go, ‘Aunty blah, blah, blah’s in hospital. She went in last night on the ambulance. This, this and this is going [on]. Can you ring her and check up on her?’ You know? So that’s what I do.

Joy (health professional) highlights the important role of iwi nurses, coupled with a public health approach. Being able to visit whānau at home provides an opportunity for nurses to kōrero with whānau early, about concerns, fears and symptoms of possible cancer:

So, we need a lot of community awareness raising. I like to get the iwi provider nurses on board with you know because they have the luxury too of going into people’s homes at an early stage. That a lot of kōrero could be had a lot that diagnosis could be made earlier.

Finding the right Māori person or group to develop and deliver cultural training programmes will ensure that services and staff can pro-actively support kaumātua and their whānau to navigate the health sector more effectively. Health and social care professionals will be able to supply kaumātua and whānau with helpful information to support them with planning for end of life (see Advanced Care Planning guidelines, for example –see below).

Joy (health professional) navigates patients through the health system, making sure services and support are put in place at the start for the patient. Within secondary health care there are a lot of health professionals involved in a patient care journey, even if they are terminal, they can still be having treatment. Therefore, it is important that people have one key health professional who they can phone for advice, who can help them, who supports them through the health system. Joy adds that this is a role she sees herself providing for whānau on their journey within the health care system:

[A]s a clinician it’s just being there to support them [whānau] because sometimes, they don’t know who to go to. You know, even if they’re terminally ill they could still be having treatment, still ongoing care. So, it’s just having that one person they know the name they know the person to or to help you, um, that’s how I see myself as well for them.

...And I guess for me too is making sure they get the support right at the front end and know what they need to do and bringing in all those other services that they need.

Outwards facing, helping Māori to have a better understanding of Aged Residential Care or hospice for example, would be helpful. When care ‘homes’ are well managed and resourced and kaumātua are taken care of, it can have great benefits:

In this story Mary Te Awhi (hospice kaitakawaenga) reflects on a kaumātua enjoying her time at an Aged Residential Care home:

Well I went to visit her [kuia], and this is a rest home where there may well be [other Māori], but I did not see any other Māori… And so, I went to visit her, and I said, ‘Nan, I could hear you when [I] was out at the reception.’ She was holding court…. After lunch she had her knitting, she had her crafts with her, she was talking with some other residents of the rest home and they were just waiting for the music lady to come along for a quiz. So, I said to her, ‘Nan, tell me what you’re doing every day?’ And she said, ‘We have exercises at 9 o’clock. I make jolly sure I’m up, dressed and ready to go. I’m down here for exercises, I participate in everything.’ She, a lady that has been involved with family and community, and, and I just think it was an amazing way to heal for her. She eventually came home, and I said to her, ‘How you doing? How [did] you [feel] at the end of your time in respite? How was that, in the Pākehā world, for you?’ She said, ‘Well, I came to the conclusion [that] I’m not ready to go into care full time, I would like to still be at home. And I know that I can’t do too much, I have to learn to accept some help. No, I enjoyed it.’

"Taking a collaborative approach will help to build a sincere partnership with Māori communities. "

Engaging advice and guidance from local Māori community leaders, consulting Māori kaumātua, drawing on Māori health professionals’ knowledge and the evaluative cultural safety’ perspectives of whānau (via experiential evaluations of health and social care services), will help to identify whether cultural competencies are working effectively to ensure the ‘cultural safety’ of mana whenua (local Māori community). This consultative approach will help to establish the cultural preferences of local whānau and the level of cultural knowledge and practices that staff will need to attain. It can take time to identify rangatira (the right person or leadership group) to consult, and for meetings to be organised. It can also take time to receive feedback. However, when the right people are in place and knowledge is shared it can be very beneficial to support the integration and coordination of health services.

These relationships will be valuable as your new partners will be able to share information about local people, history and customs and can alert you to new things that are on the horizon within the community.

Recommendations

For health and palliative care professionals, we recommend:

  • Being mindful to not overburden Māori communities, leaders and health professionals as they are in high demand by other organisations and groups who may also want their cultural advice.
  • Using whakawhanaungatanga (making connections), build relationships, establish trust and move forward slowly when forming new relationships with Māori communities. A relationship with the right people that develops slowly over time will weather life’s ongoing challenges.
  • Understanding that ideas to improve services may not seem so great to Māori tangata whenua (original people of this land), however, a lack of feedback, or silence, is a not sign of approval for your ideas. Silence may mean that more questions will need to be asked; be prepared to listen to the community’s ideas or advice.
  • Being mindful that local iwi may still be processing Treaty of Waitangi claims or be in an early phase of post-settlement. There may not be the capacity to work collaboratively.
  • Working with Māori groups patiently and respectfully as their timeframes are tight and they may be over stretched with their own community commitments, however, you can ask for referrals to individuals or other groups who may be able to offer support.

For health and palliative care services, we recommend:

  • Giving consideration to initiating appropriate cultural processes to develop the cultural support needed to increase the level of cultural competencies within health and social care services. If you do not know the right (tikanga) customs to help you form partnerships with local Māori you might consider employing a Māori liaison or link person to help you – ask for guidance from people in your organisation or speak to local Māori health providers or advertise among Māori networks. It is better to be humble and prepared rather than cause offence through cultural ignorance. As a starting point, try talking to someone within your organisation who affiliates to local iwi, or make contact with a respected Māori kaumātua or a Māori community group; initiate dialogue and outlay that your organisation hopes to achieve supporting Māori access to health care services and to ensure quality, equitable, outcomes.
  • Māori services may lack resources (both financial and human); we recommend that health and social care services should be prepared to cover any costs (accommodation, travel, catering, room hire) associated with enlisting cultural support. Be mindful that hui (gatherings) to consult and implement strategies with Māori communities will need to be financially resourced and so you will need to ensure your Māori liaison contacts time and expenses are paid for (accommodation, food, travel).
  • Remunerating Māori kaumātua or liaison support people for their time and cover the costs of any Māori staff who contribute to the core business to establish or provide cultural competency training.
  • Including catering expenses into any hui (meeting) you call.
  • Ensuring that you have an appropriate place to run a hui (gathering); the space will need to be large enough to conduct a meeting comfortably and you will require kitchen facilities to enable you to serve kai (food) and beverages as this is an important part of your manaakitanga (hosting) obligations.
  • If invited to a meeting at a marae to progress any cultural competencies initiatives, that you provide a financial contribution towards the meeting. It is customary to offer a koha (gift) at the start of a meeting at a marae.
  • Listening deeply to the views of the Māori community leadership you are consulting with. They may have their own ideas about what they see as the ‘problem’ (i.e. barriers to Māori accessing and receiving palliative care); and may also have ideas about the ‘solution’. This will most likely be the best way to go about increasing cultural competencies in your services.

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