Māori health professionals who work outside their own rohe (region) will usually seek advice from local Māori about the correct tikanga to use in the host area. There are many variations in tikanga between iwi; what is important for one iwi may not be so important for another iwi, rohe-to-rohe – region-to-region. Tikanga may vary at different times and in different circumstances. Māori tūpuna were resilient and adaptable in times of difficulties and their descendants are the same. COVID-19 proved that Māori can mobilise in different ways at end of life to care for their ill and dying, albeit under difficult circumstances and in different situations. Being respectful of peoples’ cultural beliefs helps to keep everyone safe.

For example, Matua Hugh (hospice volunteer) would ask whānau/families if he could leave shoes on when entering someone’s home; he recognised that this is a health and safety practice which is not aligned with Māori protocols:

So, mind you the things that we do, and we get to a Māori house regardless of which house it is, the first question I ask, “Can we leave our shoes on?” … to us it’s a health and safety thing. I said, “I know it’s stepping over our kaupapa, but we also have responsibilities to ourselves, to our safety. And if we want to be performing what it is that we do, there are certain guidelines that we need to do.

In her interview, Kui explained how she works with Māori whānau staying in hospice. Kui emphasised that her role is to awhi the patient and the whānau and to ensure they understand the caring process:

… For Māori, I feel that being Māori… they come closer… they put themselves closer to me… I’m one Māori in the whole of [name of Hospice], I’m the only Māori that works there as a caregiving nurse amongst, yeah there’s no other Māori. So, when we have Māori family of course the nurses deal with, what’s going down for the medication side because we don’t [do that]. All I do is make sure they’re okay. Ask them, if [“you like us to shower [you], would you like to come and help me?’ I could help shower him or her… and just let them know that’s what I’m there for. Is to help in any way I can. Let them understand… I will do anything to make things easier. But I ask them, ‘Are yous okay with what’s happening? Can you give us permission to… would you like us to wash him?’ Because a lot of Māori are very whakamā [embarrassed, shy] and they will not, they don’t want just anybody washing their families.

A simple thoughtful act, like taking your shoes off at a person’s door before entering their home, can show respect and humbleness for people and their possessions. Kahu (hospice nurse) describes her experience of this:

I guess like one time I did go out [home visit]; was quite interesting. I went out with [a non-Māori consultant] … And we went to this whānau’s home, and when I walked in, immediately I looked at the carpet and it was like, you know, very luscious. So, I thought ‘people do not wear their shoes here’. So anyway, I flicked my shoes off, and I walked down this carpet, beautiful carpet. Sit in the room and there’s the photos of all the whānau. Anyway ah, we get in there and this person turns around and goes, [said angrily] ‘It’s you again!’ like that. And then she sees me and goes [said nicely and softly], ‘Oh, I didn’t know you were with her dear. Oh,’ and then sits down and goes, ‘how are you?’ Like that. Right? After she’d like spun out at [name of non-Māori consultant].

To help whānau manaaki uphold their traditions, GP K. said health services require flexibility, to allow whānau manaaki space to be who they are and do what they need for themselves:

I guess I mean for those that know its time, space. Allowing. You know not forcing another way upon [them] do you know what I mean?

Examples of basic tikanga include:

  • When visiting someone’s home it is appropriate to remove your shoes at the door and to allow time for introductions.
  • Provide time and space for whakawhanaungatanga (establishing relationships) and karakia (prayers) and mihi (greetings).
  • Avoid placing medications and hygiene products on tables or surfaces used for food.
  • Ensure the curtains are closed if you are exposing an unclothed kaumātua.
  • It is helpful to have colour coordinated face cloths (for example, white for faces and green for private parts).
  • It is important that you are aware that certain parts of the body may hold specific cultural meanings for kaumātua; avoid passing objects above someone’s head for example. Be very respectful and discrete when you are touching someone’s private parts. There may be a whānau member present that the kaumātua would prefer to have wash them, for example.

Recommendations

For health and palliative care professionals, we recommend:

  • Familiarising yourself with the tikanga care practices of whānau who use your services. If you are in doubt, ask whānau about their care practices and how you can best support them. Some hospices and district health boards have already implemented policies and guidelines to help their staff.
  • Familiarising yourself with organisational policies and guidelines that may already be in place relating to tikanga Māori. If you find that these are absent, be a champion for their development.
  • Growing your awareness of tikanga Māori (Māori customs) and implementing practices that help to support them, especially when working with Māori whānau.
  • Building your knowledge of the Te Tiriti o Waitangi (1840) (the Treaty of Waitangi) and its application within health and palliative care services.
  • Being aware that many Māori whānau today may feel culturally vulnerable having lost contact with their ancestral ties, language and customs. If you feel in need of expert cultural help (supervision, mentoring, and training), approach their employer to
  • arrange this. Every health organisation has a responsibility to provide culturally competent care to ensure Māori feel safe accessing and receiving services.
  • Keeping in mind that not all whānau may be culturally vulnerable.
  • Participation in bicultural training which is helpful for highlighting colonisation and its implications, along with the Crown’s responsibility towards Māori and the necessity of having genuine and sincere partnerships with Māori.

For health and palliative care services, we recommend:

  • Supporting staff to become familiar with tikanga Māori, Māori care practices and the Te Tiriti o Waitangi (1840), and to learn te reo Māori.
  • Providing access to cultural supervision for your staff

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