TE UMANGA WHAKAORA ANTHOLOGY

Transcription

1 NZAOT PRESS TE UMANGA WHAKAORA ANTHOLOGY ---- Cultural responsiveness Art work by Te Rau Designz In support of Te Umanga Whakaora Accelerated Māori Occupational Therapy Workforce Development Strategy, Te Rau Matatini (2009) Te Umanga Whakaora articles reprinted from OT Insight Vol.31 No 1 February 2010 Vol. 31 No 11 December 2010 The Te Umanga Whakaora Anthology is a collection of articles reprinted from the OT Insight The OT Insight is published by Tasman Image Publishing, subsidiary of Adprint Limited, for the New Zealand Association of Occupational Therapists (NZAOT). Views expressed in these articles do not necessarily represent those of the Association, and neither NZAOT or Tasman Image Publishing endorse any omissions or errors in the articles. NZAOT nor Tasman Image Publishing accepts liability for its contents or for any consequences which may result from the use of any information or advice given.

2 and the role of Kaumātua in Occupational Therapy Workforce Development by Jo-Anne Gilsenan Jo-Anne is a member of the Māori Occupational Therapist reference group who supported the development of Te Umanga Whakaora. She works for the West Coast DHB in the Services for the Elderly team and is the current International President of the Allen Cognitive Advisors/Allen Cognitive Network. Kimihia te mātauranga. E ngari, kaua e wareware ki te mātauranga ngā tīpuna. Seek after knowledge but don t forget the knowledge of our ancestors. Te Umanga Whakaora Accelerated Māori Occupational Therapy Workforce Development strategy is designed to ensure Māori receive effective occupational therapy services. It aims to enhance the cultural fluency of the occupational therapy profession. The concept of partnership is imbedded in the strategy as is the development of significant relationships which build Māori responsiveness both within the profession and occupational therapy workplaces. Success of the plan depends on the recognition of these relationships and how well we foster them. Of great significance here is the relationship between occupational therapists and Kaumātua. Kaumātua have held down jobs, raised families, made friends and developed networks within the communities they live in. In sharing their experiences and knowledge, they provide an essential resource to the delivery of culturally appropriate and inclusive health care. Kaumātua are those who naturally take on leadership within whanau, hapū and iwi. They possess the knowledge of Te Ao Māori (Māori world view) which includes understanding of tikanga (lore, custom), te taha wairua (the passing of wairua), te reo, and whakawhanaungatanga (connection of Whānau). Encounters with the health system are often daunting and threatening to Māori who may have had negative experiences in their past. The skills Kaumātua bring help us to ensure culturally safe practices are put in place. They can guide and facilitate interventions with our clients and their whanau. The presence of a Kaumātua at a whanau hui, and the inclusion of tikanga practices and whakawhanaungatanga can support the development of trust and open communications ensuring a culturally safe environment for wellness to occur. Kaumātua can help us by supporting our awareness of cultural norms. With this knowledge we have greater scope to differentiate the underlying issue and provide clarity for appropriate intervention strategies. Kaumātua are generally able to advise on the most appropriate course of action where the primary cause of the issue is culturally based. An important role Kaumātua can fulfill is supporting the development of the Māori occupational therapists self-understanding and integration of this with professional knowledge. I have been very fortunate throughout my career to have encountered Kaumātua who helped me with this process. Their guidance allowed me to connect what I thought of as basic values and beliefs to a deeper understanding of Te Ao Māori. Along side their guidance I also received strong support from various Kaumātua within my own whanau. My relationship with my Great Aunty and her first cousin early in my professional career was invaluable. Through sharing their knowledge and experiences they helped me to understand my responsibility for upholding the mana of my whakapapa. The example they showed me taught me how tikanga sets guidelines and how paying attention to these guidelines leads to successful outcomes when working with Māori. Kaumātua are our respected elders. They bring the knowledge of the ancestors to the present and provide Me mihi ki ngā taonga tuku iho. Ētahi o ngā taonga tuhu iho ko ngā atua o neherā. Greet our heritage (our treasures). Some treasures handed down are the Gods of ancient times. us with opportunities to learn and in turn pass this knowledge through the generations. References: Te Umanga Whakaora: Accelerated Maori Occupational Therapy Workforce Development. Te Rau Matatini, July Whiria Te Oranga: Kaumatua Workforce Strategy for Mental Health and Addiction Services. Te Rau Matatini, April Reasons why NZAOT want a Kaumatua by Kevin Brown and Jane Hopkirk The New Zealand Association of Occupational Therapists is committed to working under the guidance of a kaumatua. In 2009 a process was initiated to agree to commit to identifying a kaumatua to support us. This process is ongoing. Tahi: Te Umanga Whakaora NZAOT has proudly partnered with Te Rau Matatini for the implementation of Te Umanga Whakaora: Accelerated Māori Occupational Therapy Workforce Development Strategy. The strategy provides a practical framework for developing the Māori and non-māori occupational therapy workforce. The Māori population are disproportionally high users of health services. The strategy aims to increase the responsiveness to Māori by occupational therapists. Rua: Kotahitanga - Partnership with tāngata whenua NZAOT is proud to commit to the principles of the Te Tiriti o Waitangi/Treaty of Waitangi. NZAOT strives to create and maintain a working partnership with Māori. A Māori Perspective portfolio council portfolio position has been established since Vol. 31 No.1 February 2010

3 Toru: Tiro Roa Look forward In order to achieve this relationship with Māori, and navigate the cultural processes, a kaumātua is essential. NZAOT strives to ensure it is being culturally appropriate in all aspects of its activities. A kaumātua versed in tikanga and te reo Māori would support and guide this process. Whā: Tū pato - Integrity and respect A kaumātua can foster the relationships NZAOT forms with the Māori community and will engender integrity and respect in this process. A kaumātua is a person who people feel they can trust and has the greater good of their community at heart. Rima: Whakawhanaungatanga - Networks A kaumātua connects families and communities which is mutually beneficial. Ono: Pou Tuarā - Support/Guidance for NZAOT council A relationship with a kaumātua would provide NZAOT council members with the support of knowing decisions made are beneficial to Māori, and have the backing of someone who has mana and specialist knowledge within the Māori community. In particular, a kaumātua would provide support and guidance for the Māori Perspective portfolio convenor. Whitu: Pou Tuarā - Support/Guidance for all NZAOT members A kaumātua can also support and guide members with the bringing together of people in a culturally appropriate way such as at NZAOT clinical workshops and conferences. With NZAOT the ability to represent and use networks to promote the occupational therapy perspective is a priority. Kaumātua have many networks both outside and within the Māori community. Networking includes linking the past and the present in order to shape our future whakapapa. Vol. 31 No.1 February

4 Cultural safety and Cultural competence: MasterChef analogy Na: Isla Emery-Whittington, Ngāti Maniapoto, Ngāti Kauwhata, Ngāti Haua, Ngāti Kahungunu Cultural safety and what this means for occupational therapy practice is a topic of discussion that will very shortly receive international attention by way of the World Federation Occupational Therapy Draft Position Statement on Diversity and Culture due May In my own practice, it seems that occupational therapists are more frequently engaging in critical discussions around the similarities and differences between cultural safety and cultural competence. Ramsden (2002) describes the birthplace of cultural safety as within the wider context of other processes occurring within Māoritanga. Critical discussions about the 1840 Treaty of Waitangi and its place in healthcare today are central to the development of a culturally safe practitioner. Indeed, cultural safety as a concept would not be necessary save for the significant misinterpretations and grievances concerning the Treaty. At the risk of appearing to over-simplify the concepts I would like to outline a way that I explain the differences between cultural safety and cultural competence. As a Māori occupational therapist working primarily with Mā ori whanau, cultural safety is about the client /whanau. Whereas, cultural competence is about being an effective practitioner. Cultural safety is important because people can and have died when they have been placed in culturally unsafe situations. Cultural competence is important because we need to aspire to be more than just safe, reflective and informed in our practice. The analogy of the popular television programme MasterChef to illustrate both safety and competence is useful if simplistic. In essence, the contestants are amateur cooks who compete to prove their culinary skill, knowledge and attitude in order to win the title MasterChef. Despite undergoing and winning a series of tests of their attitudes, knowledge and skills, even the winner is only just able to be called restaurant safe, i.e. they are unlikely to serve a meal that could cause food poisoning. Put another way, they know enough to do no harm. Similarly, a culturally safe practitioner is one who should have skill and knowledge to ensure no client or whanau is at risk of harm through socio-political ignorance. And like the MasterChef contestants, the culturally safe practitioner is fully aware that becoming culturally safe is an enormous job that begins with simple self-reflections such as What is good health? How do I know? and what do others consider to be good health?. Core tasks of the culturally safe occupational therapist practicing in New Zealand include but are not limited to knowing our socio-political history, understanding our assumptions and beliefs, awareness of power and where it lies, (Jungersen, 2002). In contrast, to become restaurant competent, the MasterChef winner needs to experience many opportunities, successes and failures. Regular reflection, knowledge of systems and policies, critical discussion with peers, and implementing change are processes that would enhance both cultural safety and competence. A culturally competent practitioner welcomes opportunities to improve practice and understands that failures are important learning opportunities. The culturally competent practitioner is not only comfortable but is also effective in any number of practice situations. (NB: Comfort level alone is not enough of a measure of competence. Ignorance can be comfortable too). In addition, expertise is sourced where necessary, assimilated accordingly and shared openly. Cultural competence for Māori occupational therapists is described in Te Rau Matatini s (2009) Te Umanga Whakaora Accelerated Māori Occupational Therapy workforce plan. Cultural competence for Māori mental health and addictions workers is also pragmatically described and presented as desirable actions in Matua Raki s (2009) Takarangi Competency Framework. Both documents are written by Māori for Māori and interestingly neither explicitly discusses cultural safety. Neither do I find myself discussing the concept with other Māori health workers very often. I wonder if this is due in part to understanding cultural safety from a wider context than just health thus perhaps making it an implicit part of practice for some. It is perhaps heartening that cultural safety as a local indigenous concept is being utilised to describe effective practice for occupational therapy internationally. A risk however, is that the concept becomes diluted if the original processes that created it are not acknowledged. Becoming culturally safe is not an easy process because it requires an honest self-analysis of beliefs, assumptions and how this impacts practice. I believe that both Māori and non-māori occupational therapists practicing in New Zealand have a vital role in ensuring practice stories, reflections, and expertise are shared with each other and the international occupational therapy community. [email protected] Isla is a member of the Māori Occupational Therapist reference group who supported the development of Te Umanga Whakaora. She works for Raukura Hauora o Tainui (an iwi based kaupapa Māori health service) in the Awhi Mai Awhi Atu Prodrome service. She plans to begin research in occupational changes during the at risk mental state phase. References Huriwai, T., Milne, M., Winiata, T., Eramiha, T., Robertson, P., Rata, N., Armstrong, P., Leef, S. & Armstrong, D. (2009). Takarangi Competency Framework: Training Manual. Matua Raki National Addiction Treatment Workforce Development Programme (NATWDP): Wellington. Jungersen, K. (2002). Cultural safety: Kawa Whakaruruhau An occupational therapy perspective. New Zealand Journal of Occupational Therapy, 49(1), 4-9. Ramsden, I. (2002). Cultural safety and Nursing Education in Aotearoa and Te Waipounamu. Unpublished doctoral dissertation, Victoria University of Wellington, Wellington. Te Rau Matatini. (2009). Te Umanga Whakaora Accelerated Māori Occupational Therapy Workforce Development. Wellington: Te Rau Matatini. Vol. 31 No.2 March

5 Whakawhanaungatanga Building Relationships Na Georgina Davis, from Nga Puhi, Ngati Porou and Ngai Tai descent. Georgina works for Te Puna Waiora (Mäori Mental health) for Counties-Manukau District Health Board. She is part of the reference group for Te Umanga Whakaora and is on the AUT advisory committee. Georgina has a keen interest in dual practice as she believes the essence of occupational therapy and Mäori fit together seamlessly. strong theme that runs through Te Umanga A Whakaora is up-skilling occupational therapists (Mäori and non-mäori) to work in an optimal way with tangata whaiora (client/patient/recipient of health services). This is described with words such as dual competency (cultural and clinical competence) and best practice. It can be done through engaging in professional development, strengthening cultural identity, learning te reo, and encompassing both perspectives occupational therapy and te ao Mäori (Te Rau Matatini, 2009). For me as a Mäori occupational therapist, I have had to practice in a way that encompasses both perspectives whether I wanted to or not. This has been because I work within a Mäori service. I am Mäori and I am an occupational therapist. There is really no other option for my practice and it came naturally to me. It was not until I was able to meet with other Mäori occupational therapists to talk about what I do, and listen to how they practice that I realised that not only is it natural to work in a particular way with tangata whaiora, but that it was because I had an innate connection and therefore understanding with the tangata whaiora. Being brought up with key Mäori values and beliefs enhances the connection I have with other Mäori. Having an inside understanding of a person s culture and circumstance gives you deeper insight when getting to know a person, and assessing them to get an accurate picture of where they are at. As in Tariana Turia s speech It s about bringing everything together, the rich catch of He Kupenga, the fishing net, over-brimming with techniques, tools and talents to mobilise the best opportunities for our whanau. (Tariana, T.H. (2009). Te Umanga Whakaora Accelerated Mäori Occupational Therapy Workforce Development Strategy, and action plan. Speech presented at launch, Wellington). All this equates to being able to enable tangata whaiora in the best way possible. Continuing with the concept of He Kupenga, it can be used as a metaphor for how Mäori occupational therapists practice. A net has to be tailor-made to catch a specific fish. It is the same for Mäori occupational therapists - having to fashion a net with particular skills and knowledge so that we are able to work in a way that is going to enable tangata whaiora to achieve their goals. What strands we would need in our net, depends on the needs of the tanagata whaiora. The strands would represent principles such as tikanga, aroha, te ao Päkehä, te reo Mäori (procedure/reason, love/empathy, the voice of Päkehä, the language of Mäori), along with specific occupational therapy skills. However, there would be key parts that remain the same, no matter how you fashion your net. The most imperative part of my practice would be Mäoritanga and so would be the Taura (main cord), as knowing te ao Mäori is the most important quality one can have when working with Mäori (Dyall et al., 1999; Durie, 1994). Like many Mäori occupational therapists, I have combined what I have learnt at occupational therapy school with what I know as a Mäori, which makes the way I practice as an occupational therapist uniquely Mäori (Te Rau Matatini, 2009). A cord of the net that may stem from Mäoritanga is whanaungatanga [a sense of family connection, relationship through shared experiences, a sense of belonging by working together and kinship rights and obligations (Moorfield, 2009b).] What is the key part of Mäori culture? He tangata the people (Ministry of Justice, 2001). How are relationships built? Whanau the family. Whanaungatanga. People are the most important; whanaungatanga is all about people and relationships. This is a significant part of what it is to be Mäori, and is a normal practice. Spending time with each tangata whaiora I work with is essential. It is not until you make a connection and build trust that you can start to assess and set goals. Tangata whaiora I have worked with have said they appreciate it when the health professional they work with is Mäori because they understand and half the time we are related somehow. There are some specific techniques I use when engaging with tangata whaiora: n greet in a Mäori way with a kiss or hongi, sharing whakapapa and making connections n use of te reo not necessarily fluent, but key words, as this seems to give a deeper meaning for Mäori tangata whaiora n understanding who they are genuinely listening to their story, concerns, aspirations and history n allowing time and space not rushing them and building a relationship first; n being clear with what you can and cannot do; n following through when you say you are going to do something, make sure you do it n karakia use when appropriate and if the tangata whaiora needs it n kai sharing together All of this is part of whakawhanaungatanga (building relationships) and essentially you are building trust. There are certain boundaries and rules that come when you follow a Mäori process and this allows the tangata whaiora to feel safe and connected, as it is something familiar to them. These techniques worked for me with a particular tane (man) that I worked with. For a start, I spent a lot of time just getting to know him, and I was able to get information from him that his key workers were unable to about what was really going on emotionally in regards to his daughter and ex-partner realising that this was actually a core component of how he thought about himself. I believe it was because I spent time with him, just talking about life while walking in the park, having a coffee, that he was able to open up and share with me. As you can see working with tangata whaiora requires particular strands of skills and knowledge. Each tangata whaiora will require a tailor-made net as their needs and goals will be unique to them although Mäoritanga and whanaungatanga are essential strands of He Kupenga and available to us all. Georgina would like to thank the reference group from Te Umanga Whakaora for their contributions and ideas around the concepts written in this article especially Jacob Tahitahi, Jane Hopkirk and Matua Brain Emery. References Durie, M. (1994). Whaiora: Mäori health development. Auckland, New Zealand: Oxford University Press. Dyall, L., Bidgman, G., Bidois, A., Gurney, H., Hawira, J., Tangitu, P., & Huata, W. (1999). Maori outcomes: Expectations of mental health services. Social Policy Journal of New Zealand (12), Ministry of Justice, (2001). He Hinatore ki te Ao Maori: A glimpse into the Maori world. Wellington, New Zealand: Ministry of Justice Georgina Davis Te Rau Matatini (2009). Te Umanga Whakaora Accelerated Maori Occupational Therapy Development. Wellington, New Zealand: Te Rau Matatini. Vol. 31 No.3 April

6 Are you a Ma ori occupational therapist or an occupational therapist who is Ma ori? And does it matter anyway? Na Riwai Wilson Ko Hikurangi te maunga Ko Waiapu te awa Ko Horouta te waka Ko Te Aowera te marae Ko Te Aitanga a Mate te hapü Ko Ngäti Porou te iwi Ko Pahau räua ko Takurua öku Whänau Nö Tokomaru Bay öku Whänau Ko Riwai Eruera Wilson töku ingoa Working for Counties Manukau District Health Board at Whirinaki- Child and Adolescent Mental Health Service. This is a community based service where we visit children, young people and their whanau in homes, schools, in the community, or in our clinic rooms to provide mental health assessment and intervention. I am part of the Kaupapa Mäori team called He Käkano which is a clinical multi disciplinary team specialising in supporting Mäori whänau. Recently, while reflecting on my practice in preparation for a presentation, I was invited to expound on the question: Am I a Mäori occupational therapist, or an occupational therapist who is Mäori? Immediately I was caught yet again in one of my familiar moments where I wished there was a manual that told me how to answer such a question, and to know exactly what was meant by the answer. This mystical manual, which I have fantasised about many times, is compact and easy to read. It holds wondrous information about how to sit contentedly and all-knowing in equal parts within the web of Mäori health practice and occupational therapy. I imagine this manual to be inviting and user friendly, and when I pick it up it says to me, Hey, I m surprisingly good for you and reading me won t hurt a bit. It will be so good in fact that it will feel more like watching TV than reading a book. Back in 2008, I discussed with a colleague (a Mäori psychiatrist no less), my experience of thinking, feeling, and being Mäori with occupational therapy tendencies and the dichotomy it represents within me. Did I really need to bide my time and develop competence within both spheres to find some consolation as she suggested? No I thought, I just needed the magical handbook to give me the answers. Unfortunately no one bothered to invent it. My colleague advised me that the development of this handbook be included in my five year plan. Sure I said with feigned enthusiasm and an empty smile, while my brain contemplated that undertaking being project #103 or project #104 whichever it was, the idea was shelved for more pressing issues. A year later, I realised I had immersed myself in developing my identity and skill set as a Mäori practitioner. I still hated seafood but became so comfortable with that fact that I expressed distinct disdain towards people who ate tuna in close proximity to me. Contrary to common belief, if you don t like seafood you can still actually be a real Mäori. I always remember a story I was told that if I went and held up a bank at gun point today, that in tomorrow s paper my description would include first and foremost that I am Mäori. I diverged at this point and segued from one occupational therapy group to another, with an eagerness to claim back my occupational therapy rights and privileges. I realised there were no privileges but it felt fine. I took on specific occupational therapy referrals from general teams, supervised other occupational therapists, and orchestrated a formidable occupational therapy week that we pushed out to four weeks. Occupational Therapy Month is definitely doable! Two years on I am feeling more settled. I can comfortably describe my clinical practice that interweaves Mäori practice and occupational therapy practice and how these contribute to the efficacy of working with Mäori whänau. Like when I meet new taitamariki I always use the powhiri process to negotiate the relationship with myself and my occupational therapy assessments and interventions. I ll put the finishing touches on my presentation due tomorrow - one that articulates a fundamental Mäori perspective that links to key occupational therapy principles, to show how occupational therapy works within a Mäori team. I ll consult with the cultural advisor in my team to review my korero and provide some feedback which will be: Riwai, there is a wonderful korero emerging here. A question I would like to pose to you is - are you a Mäori occupational therapist or an occupational therapist who is Mäori? Hmmm, come visit and korero with me on this journey further down the track. Vol. 31 No.4 May

7 Whakaora ngangahau me kaiwhakaora ngangahau Occupational therapy and occupational therapists Official te reo title given An approach was made to Te Taura Whiri i te Reo Mäori (the Mäori language commission) to request a consistent name for occupational therapy and occupational therapists by the Te Umanga Whakaora reference group. The commission did not have a name listed for the profession, although have previously given out numerous different names. We have worked with them to confirm a te reo translation. This was completed in early May as stated: Kia ora anö rä Jane, we entered whakaora ngangahau (occupational therapy) into our database developed specifically for capturing newly coined words/concepts, and we will give the term whakaora ngangahau out to anyone who asks us for the Mäori equivalent of occupational therapy. Whakaora means to restore to health and ngangahau is an adjective meaning active, spirited, zealous. So I think the person who suggested this was on the right track. They were trying to convey the idea of reawakening, or restoring to health one s activeness, spiritedness and zeal (occupational therapy). Hohepa MacDougall Kaiwhakamäori / Translator, Te Taura Whiri i Te Reo Mäori / Mäori Language Commission. Past development There has been much input, consideration and previous work put into the Mäori terms used in the profession. A huge mihimihi to all those who have gone before: E kore w taka parapara a öna tipuna, tukuna iho ki a ia. The qualities and talents of past generations will not fail to be fulfilled, they have been handed on to us by our ancestors. (Recorded by Whatahoro Jury for Ngati Kahungunu ki Wairarapa). In considering the name for the profession some very old files were unearthed where Glen Barclay (previous ED NZAOT) contacted the commission stating that: There are at least two names for occupational therapy that have been used by the Careers Service. The first (according to anecdotal evidence) was developed in conjunction with Te Taura Whiri i te Reo Mäori after wide consultation, back in This was in use on Careers Service material in the mid 1990s and the name itself was whakaoranga ngangahau. Currently, on the kiwicareers web site, the Careers Service are using the term kaihaumanu türoro. September The focus of kaihaumanu türoro is on the doer of the therapy, if you like. Haumanu means to revive or restore to health and türoro is commonly used to mean sick person or patient. A kaihaumanu türoro is therefore a person who can revive or restore to health a patient or unwell person (occupational therapist). Hohepa MacDougall Kaiwhakamäori / Translator, Te Taura Whiri i Te Reo Mäori / Mäori Language Commission. The struggle expressed by some Mäori in the use of kaihaumanu türoro is that haumanu is a term often used to refer to clinical. The traditional meaning of türoro is the tools used to make people well, but used colloquially means funny in the head. Often because of these differing meanings, it needs clarification when used. Added to the above mix, is the term used by Te Rau Matatini, also from the commission, of Te umanga whakaora. Usage In this new term of whakaora ngangahau, we see the drawing from previous terms and the confirmation of whakaora ngangahau and kaiwhakaora ngangahau - occupational therapy and occupational therapists respectively. It is felt this term will stand on its own when read by Mäori round the motu (island) and explain itself to them without Mäori occupational therapists there to explain it. There are current requests for this term to be used: n signage in occupational therapy departments n in te reo translated professional pamphlets n for branding in the sector Naku noa Jane Hopkirk 14 Vol. 31 No.5 June 2010

8 Te Umanga Whakaora, the first known Mäori profession specific workforce strategy and action plan to be written in Aotearoa, is entering a new phase of development in July this year. Te Rau Matatini has sponsored this project for the last two years by: n investing 5 salary into the project n providing significant funding to bring the reference group members to regular meetings n enabling the development and implementation of the plan Due to a restructure at Te Rau Matatini their focus is to return to their core business. This means Te Umanga Whakaora will no longer be supported in the same way. Te Rau Matatini will continue to promote the profession to Mäori rangatahi through the Kia ora Hauora program. Implementation of Te Umanga Whakaora will continue as the sector is able to respond and kaiwhakaora ngangahau - Mäori occupational therapists are able to forward it. The contacts for this project ongoing will be: n Jane Hopkirk [email protected] n Isla Whittington [email protected] n Kevin Brown [email protected] Vol. 31 No.6 July

9 Opening the NZAOT Conference I would like some guidance prior to the event about the protocol around the opening. I was not sure what to do, and so afraid I was doing the wrong thing. NZAOT member feedback, 2008 conference. Mihi Whakatau/Official Welcome Speech For some tribes a pöhiri, or pöwhiri, is used for the ritual of encounter on a marae only. In other situations where formal speeches in Mäori are made that are not on a marae or in the wharenui (meeting house) the term mihi whakatau is used for a speech, or speeches, of welcome in Mäori. The whakatau is sometimes used today informally, and a mihi whakatau is the procedure for the NZAOT Shifting Sands Creating our Place conference this year in Nelson. Wellness and wellbeing Te ao Mäori, or Mäori world view, features wellness and wellbeing. For visitors, the customs and procedure of the local people will deliver this wellness and well being - not only for the visitors but also for themselves. This will be thought, felt and known by a person s spirit. Order of events The conference officially opens at 8.30am, Wednesday 8 September. n Delegates please ensure that you have completed registration and taken your place in the conference room by 8.30am. Delegates shall be standing at the beginning of the ceremony when the official party enters. n The Manuhiri (distinguished guests and visitors, keynote speakers, the Frances Rutherford Lecturers past and current, the permanent scientifc programme committee and NZAOT council) shall remain at the entrance to the conference room to await an invitation to enter. n Kaikaranga (person who performs the karanga) will let out a call of welcome (karanga) from the Tangata Whenua (NZAOT local organising committee) to the Manuhiri (visitors) assembled at the entrance. n On behalf of the manuhiri (distinguished guests) a whaea senior lady (Kai Karanga) will respond to the calls of welcome and reciprocate. Teh manuhiri shall be guided to their chairs at the front of the conference room. n Everyone is to remain standing and wait for the announcement to sit. n Kaumätua Andy will open with a prayer (karakia) followed by a mihi (speech of greeting) to acknowledge those present and welcome everyone to Nelson and to the conference. n Mihi is followed by a waiata (song) sung by the tangata whenua. The words will be displayed on the screen and you are all welcome to join in. The waiata is Te Aroha. n The mihi to return shall be undertaken by a male member from the manuhiri. n This mihi will be followed by a second waiata and sung by the manuhiri, the words will be displayed on the screen and you are welcome to join in. The waiata is Whakaaria Mai (How Great Thou Art) Definitions ( Tangata Whenua: 1. (noun) local people, hosts. Indigenous people of the land - people born of the whenua, i.e. of the placenta and of the land where the people s ancestors have lived and where their placenta are buried. Manuhiri: 1. (noun) visitor, guest. Kai Karanga: 1. (noun) caller - the woman (or women) who has the role of making the ceremonial call to visitors onto a marae, or equivalent venue, at the start of a pöwhiri [or mihi whakatau]. The term is also used for the caller(s) from the visiting group who responds to the tangata whenua ceremonial call. Traditionally this role was based on one s status within the hapü or whänau, the eldest sister normally being given the role. Skilled kaikaranga are able to use eloquent language and metaphor and to encapsulate important information about the group and the purpose of the visit. Kaumatua: 2. (noun) adult, elder, elderly man, elderly woman, old man. Vol. 31 No.7 August

10 Te Ara Tika guidelines launched By Dr Paul Reynolds, Pütaiora Writing Group member Hui Whakapiripiri 2010, hosted by the Health Research Council (HRC) and held recently in Rotorua, was an excellent opportunity to launch the new guidelines, Te Ara Tika Guidelines for Mäori Research Ethics: A framework for researchers and ethics committee members. HRC Chief Executive, Dr Robin Olds, presented the guidelines at the Rotorua conference, along with three of the Pütaiora Writing 1 Group members present, Dr Barry Smith, Maui Hudson and Dr Paul Reynolds. Earlier this year, Te Ara Tika was endorsed to be appended to the HRC Guidelines for Researchers on Health Research Involving Mäori. As a result, it is expected that all those who undertake research involving Mäori will read both guidelines prior to making a submission to an ethics committee. The national application form (NAF) for ethical approval of a research project requires that researchers read the HRC booklet Guidelines for Researchers on Health Research Involving Mäori before approving their application 2. The content of the Te Ara Tika document is aligned with the operational standard and acts as a supplement for particular problem areas identified through accredited ethics committee s annual reporting, such as identifying what constitutes adequate consultation and engagement with Mäori 3. The guidelines can be used by a variety of audiences, including: Mäori members of ethics committees to support them in assessing research applications coming before them; ethics committees themselves in the course of their ethical deliberations; and researchers more generally as a guide to Mäori ethical understandings and perspectives. Mäori communities, whänau, hapu and iwi may also use Te Ara Tika as a tool to be able to monitor any research carried out in their communities to ensure it is conducted in an ethical and respectful way. Professor Karina Walters 4 encapsulates this respectfulness in the following quote: Everything we do is about a relationship and goes beyond the individual to include the collective. For example, it is important for genetic researchers to think about the implications of their research, not just for the individual but for the tribe, the iwi, the hapu, all those levels. And back home, Dr Melanie Cheung puts it very simply for us: The most important thing is that I do research that benefits whänau, hapu and iwi. Te Ara Tika is a tool that can be used to assist in identifying whether or not any research application being assessed will benefit whänau, hapu and iwi health and wellbeing. Hard copies of Te Ara Tika will be widely circulated to ethics committees and interested parties for their reference, and limited copies will be made available through the HRC. If you would like to receive a copy please contact Sandra Reid, the HRC s Senior Advisor, Legal and Ethics, [email protected]. Alternatively, Te Ara Tika is available on the HRC website: Publications/Ethics_Reports_and_ Guidelines.html. Notes: 1. The other two member of the writing group are Moe Milne and Dr Khyla Russell. 2. Question F1, Section F: Cultural and social responsibility. 3. An article was written by the Pütaiora Writing Group giving an overview of the framework, which was published in the November 2009 Edition of Ethics Notes, available here: root/publications/periodicals.html 4. From the Choctaw Nation in the USA and presenter at the HRC hosted Ninth Global Forum on Bioethics in Research, 3-5 December Vol. 31 No.8 September 2010

11 Hidden in the Toi Toi: Remembering the Past in the Present KO HIKURANGI TE MAUNGA KO WAIAPU TE AWA KO HOROUTA TE WAKA KO WAIPARAPARA TE MARAE KO RUATAUPARE TE HAPÜ NÖ TOKOMARU BAY ÖKU WHÄNAU KO PAHAU RÄUA KO TAKARUA ÖKU WHÄNAU HE KAIAWHINA KAIHAUMANU TURORO O BOPDHB KO TEOARANI PATRICIA (TRISH) WILSON TÖKU INGOA was born in Te Puia on the I East Coast where I spent the first five years of my life - then my father became a farmer s labourer and we moved to the northern side of Gisborne. My mother, who worked as a nurse, transferred from Te Puia hospital to Cook hospital in the city to work the night shift. My parents and four siblings lived in a three bedroom stationhouse at Waiohika Station which is now the location of the Rhythm and Vines annual festival. After saving for several years we moved into our own home in a new subdivision in the suburb of Kaiti in Gisborne. We spent many weekends travelling back up the coast in our 52 Ford Popular to visit my grandparents in Tokomaru Bay. My father and brothers would dive for crayfish, paua and kina while my sisters and I would wait on the rocks holding the sacks for the kai. We would swim, ride horses near our great grandmothers homestead in Ongaruru; take turns fetching water from the water tanks, and help our nan at Waiparapara marae knead the rewana bread before it went into the coal range. During certain occasions on the marae, as tamariki, we were not allowed to be present - but we would often sneak down and peer with trepidation through the slat fence to see what was happening. Once realising the act was not worth the consequence we would race home to our grandmother, hiding in the toi toi bushes along the way to ensure we weren t seen by anyone, especially our parents. A few years on I met my future husband at a friend s house when I was at Gisborne Intermediate School; he was a third former at Lytton High School. As teenage parents with a young family we were fortunate to have had the support of both our parents and wider whänau to help raise and awhi our children. In reflection I am grateful that my children had the chance to experience their grandparent s special brand of aroha and manaaki. At the age of 47 my husband and I decided to move to Tauranga to be closer to our children who had grown and left home. Having lived my whole life in Te Tairawhiti it was a big move, spurred on by the notion that if we don t do it now, we never will. Gisborne had changed - not in physical terms but by who still remained. Many of my whänau had moved out of town or overseas and most of my pakeke had passed on; great grandparents, grandparents and parents. Although Tairawhiti would always be our home, it seemed somehow conceivable that we could now venture off towards new horizons, as bittersweet as it was. In Tauranga I took a position as an occupational therapy assistant (OTA) having previously worked as a Plunket kaiawhina, community health worker, nurse aide and a research kaiawhina for Ngati Porou Hauora. I had limited knowledge of what occupational therapy was about at the time; all I remember is the occupational therapy room in the old Cook Hospital where I saw patients making cane ware, baskets, chairs and trays. Being an OTA, I soon realised there would be a lot more to learn about the profession. Initially there was some uncertainty about what my role would involve - I hoped there would be more to it than photocopying or collecting and returning equipment. Three and a half years later I have learnt new terminology, tools and techniques that have complimented the skills and knowledge I already had. I can see where I have made contributions to the occupational therapy team and the patients we work with. I see myself having two roles as an OTA: n the first role is to understand and maintain the occupational therapy/ OTA principles and practices; n the second role I have is to tautoko and uphold tikanga principles and kaupapa Mäori processes to manaaki Mäori patients and their whänau to enhance hauora/well being. In the past it was difficult to work simultaneously within these two paradigms. However, with greater understanding and collaboration, Mäori and occupational therapy practices can merge harmoniously. Some of the core practices that I incorporate into my Mäori OTA practice include: Whakamana: Respect for all patients that come into this ward. I treat them how I would treat my own nannies and papas Aroha: Loads of PATIENCE! Whakawhanaungatanga: Meet and greet, introduce myself, whakapapa, whänau connections, mihi Korero: Use Te reo appropriately. Explain to patients about the occupational therapy/ota service and other expectations using appropriate language Tapu/Noa: Appropriate use/placement of utensils/items e.g., combs/brushes are put away in drawers and not left on kai tables. Awareness of Tinana (body); of those parts that are sacred, and of practices important to keep safe Te Wa or Time: Giving the whänau time to settle in to their new environment/rooms/bed spaces and getting used to all the professionals Manaaki: Go over the process and make sure they understand what was said and what is expected of them - this could be ward activities, ADL/s, kitchen practice etc. Ensuring the patient is comfortable/ready for therapy/ intervention Kai: Sharing food, making fried bread or something they can relate to, and enjoy reka paraoa! (sweet bread), pata (butter), and golden syrup! Karakia: Blessing kai, blessing the day, or blessing particular hui and other events Waiata: Sit with patients and sing songs, Mäori and other songs Wairuatanga: Acknowledging and understanding patients connections to whänau, whakapapa, tikanga and whenua, and how these can be utilised to enhance hauora/well being I have come into this role with all my life experiences, practising the knowledge and learnings of my parents, grandparents, whänau and iwi - all that I have accumulated over my professional life. Many things I still carry with me from my years in Te Puia, Ongaruru, Waiparapara and Kaiti, and from the people who have nurtured me and who I have nurtured over the years. I can still recall my grandmother saying Always treat people how you would like to be treated yourself. Occasionally I meet patients at the hospital who are from the coast - people who knew my parents and whänau, and some who I have known previously in a professional context. I have met people both Mäori and non-mäori where there hasn t been an instant link, but with time and interest one is often discovered - whether it be about an old song, pikelets, or how things used to be back in our day. I treasure the opportunities to connect with people; to whakapapa and whakawhanaunga and reminisce about the places and loved ones dearly missed. I have shared tears and joy with many patients as we have recounted our own special moments, hidden in the toi toi. Vol. 31 No.9 October

12 A Look Back To Look Forward Sitting in a room with glass on two sides, looking out onto the bright beautiful grounds of what used to be a corporate play ground and is now AUT Manukau campus, was a fantastic way to spend a Thursday afternoon. Seven Maori kaiwhakaora ngangahau 1 : Kevin Brown, Te Ara Whittington (nee Isla Emery), Jake Tahitahi, Georgina Davis, Jo-Anne Gilsenan, Karen Gallagher, Kaumatua Brian Emery, Siobhan Molloy (ED of NZAOT) and myself Jane Hopkirk on behalf of the OTBNZ, plus baby Mary Davis, joined together at the request of NZAOT to look to the past in order to guide the future! We came together to consider the progress of Te Umanga Whakaora, an accelerated Mäori occupational therapy development strategy (Te Rau Matatini, 2009); how it has been operating over the last year, and where it is headed for the following year and beyond. The journey shows: n the contribution of monthly article s for OT Insight, and a special cultural edition in July 2010 was published, focussing in the main on things Mäori and cultural competency across the workforce n the sharing of the Mäori kaiwhakaora ngangahau experience of practice through the OT Insight; writing professionally; research in Mäori health and the profession, and at presentations at the professional conferences and workshops n the emergence of the development of best practice experiences; evidence for practice; Mäori whakaora ngangahau 2 leadership and support networks n some things need to be worked on in this coming year n and some things are dreams yet to take form Eighteen objectives were identified in Te Umanga Whakaora strategy and each of these were discussed in the meeting, noting targets for 2011, actions associated, and proposed leaders of such actions. Key to the discussions was how NZAOT and Mäori kaiwhakaora ngangahau could work together to further the strategy. The major decisions made were: n For the NZAOT to send Choose Occupational Therapy as your Career and make a difference in the real world 3 (Choose Occupational Therapy as your Career) pamphlets to the regional coordinators of Kia Ora Hauora for distribution when promotion occurs. Kia Ora Hauora promotes the profession to Mäori youth. n Choose Occupational Therapy as your Career pamphlets to be given to Mäori kaiwhakaora ngangahau to circulate to whänau and iwi. n To continue to give ongoing support and awhi of Mäori students in whakaora ngangahau programmes through the Auckland Mäori peer 1 Maori for occupational therapists 2 Maori for occupational therapy 3 support röpü (group) for AUT and WinTec, and through the Mäori lecturers at Otago. n For the NZAOT, through professional development opportunities, to continue to promote responsive working environments for Mäori kaiwhakaora ngangahau. n Encouragement of Mäori kaiwhakaora ngangahau to join NZAOT as members in order to have greater access to professional development opportunities through the professions programmes. n That Mäori kaiwhakaora ngangahau make full use of the up-coming clinical workshops on competence and cultural competence at Waitangi - with opportunity to submit abstracts - possibly to have a full cultural stream. n For a hui for Mäori kaiwhakaora ngangahau to be attached to the next workshop in Waitangi. n That articles written by Mäori kaiwhakaora ngangahau will continue to be supported and published in the relevant publications of NZAOT as they are written. n That a full Mäori perspective special edition of OT Insight will again be presented next year, replacing the monthly articles. n Agreement was also made to meet in a year s time with Mäori kaiwhakaora ngangahau and NZAOT to re-assess the achievements of the implementation of Te Umanga Whakaora (Te Rau Matatini, 2009) strategy for the year, and to set future objectives and actions. The Mäori kaiwhakaora ngangahau honour the support and continued commitment NZAOT has given to this workforce development strategy. Thank you for arranging this meeting and enabling association Mäori member Jo-Anne Gilsenan to attend. Naku Noa Jane Hopkirk Whakaora ngangahau me kaiwhakaora ngangahau Whakaora ngangahau is the Maori term for occupational therapy. Kaiwhakaora ngangahau is the Maori term for occupational therapists. Please refer to the Te Umanga Whakaora column in the June 2010 edition of OT Insight for information regarding the development of these terms. The terms should be used in: n signage in occupational therapy departments n in te reo translated professional pamphlets n for branding in the sector Vol. 31 No.10 November

13 Nä täu rourou, nä täku rourou, ka ora ai te iwi, Your basket, my basket will feed the people 1. Jane Hopkirk whakatauki used in Te Umanga Whakora Accelerated A Mäori Occupational Therapy workforce Development seems an appropriate way to start the last article from the Te Umanga Whakaora team. This monthly article has been a bringing together of the NZAOT basket and the Mäori kaiwhakaora ngangahau basket in a way that has been real and useful, we hope, to all members. This year we have seen monthly articles in the OT Insight from different members of the Te Umanga Whakaora röpü covering a range of topics around the general theme of cultural competence. Jane in Machu Picchu earlier this year The year started in February with an article on kaumätua by Jo-Anne Gilsenan where she stated: Kaumätua can help us by supporting our awareness of cultural norms and Kaumätua are generally able to advise on the most appropriate course of action where the primary cause of the issue is culturally based 2. The news of the appointment of kaumätua Jim Nicholls to NZAOT to advise the council and office staff as required has been greeted with much excitement from Mäori kaiwhakaora ngangahau. March saw the MasterChef analogy by Isla Emery- Whittington where she discussed cultural competence and cultural safety in an innovative way. Of particular importance is where Isla portrayed the potential risk to clients of sociopolitical ignorance, stating that Core tasks of the culturally safe occupational therapist practicing in New Zealand include but are not limited to knowing our sociopolitical history, understanding our assumptions and beliefs, awareness of power and where it lies 3. In March Georgina Davis took us fishing in her article on the place whänau relationships have in her practice. Georgina shares the words of Tariana Turia s speech used at the launch of Te Umanga Whakaora It s about bringing everything together, the rich catch of He Kupenga, the fishing net, over-brimming with techniques, tools and talents to mobilise the best opportunities for our whanau 4. A significant part of practice is the building of trust that comes from building whänau connections with those whänau accessing services. The journey of cultural identity was explored by Riwai Wilson in May with a wish for a manual containing the answers to all our difficult questions we ourselves or people ask us about identity - we are still looking for this! It was with utmost horror that Mäori practitioners saw in black and white Riwai s hatred of seafood! (Needless to say a few share this hatred but keep this a deep secret!) Riwai explored what it is to be a Mäori occupational therapist where he delivers dual practice to Mäori whänau such as using the powhiri model to negotiate effective interventions 5. I wrote for the June magazine on the Mäori terms identified by Te Taurawhiri I Te Reo Mäori (the Mäori Language Commission) for occupational therapy. That beinging whakaora ngangahau, and for occupational therapists, kaiwhakaora ngangahau. These terms have been listed with The Mäori Language Commission and are nationally recognised by them, for use everywhere, including signage 6. July was a special Mäori edition of OT Insight having a mix of articles with non-mäori and Mäori writers. The edition led with a Mäori practice example, followed by articles on the WFOT cultural community of practice and another on its position on culture in practice, the challenges of culturally responsive assessments, a tangata whaiora perspective of recovery through whakaora ngangahau 7, a book review on veggie gardens, the meanest boil up recipe ever, how to become a board member or leader, and snippets on hopes held by young men who still dream despite the disabilities they live with. For September the opening of the NZAOT conference process was shared with members in preparation for the event. The Te Ara Tika Guidelines for Mäori research Ethics launched earlier in the year was a useful resource also highlighted in this column. Hidden in the Toi Toi was an insightful and significant article written by Teoarani Patricia (Trish) Wilson 8 a kaiawhina (occupational therapy assistant) in the October edition. It was a privilege to hear part of her story describing life in a Mäori community and all that that meant for her. She describes Mäori practices that are an integral part of her role when working with whänau. The November edition summarised the commitments made to ensure the continuance of Te Umanga Whakaora Accelerated Mäori Occupational Therapy Workforce Development strategy. The Te Umanga Whakaora röpü want to thank NZAOT for the opportunity to share thoughts, dreams, mutterings and explorations through the monthly articles this year. There have been times of help, how do I say what I want ; times of feeling vulnerable about putting on paper thoughts others might critique; feelings of exposure, even tears; opportunities to share with one another, think on paper, and share what being a Mäori kaiwhakaora ngangahau does. But above all part of the unique and valued profession that is whakaora ngangahau where tangata whaiora are supported to enjoy full participation in their communities. Meri Kirihimete me ngä mihi o te tau hou ki a koutou katoa. 1 Te Rau Matatini. (2009). Te Umanga Whakaora: Mäori Occupational Therapy Workforce Development Plan. Wellington: Te Rau Matatini. 2 Gilsenan, J.-A. (2010, February). Te Umanga Whakaora and the role of Kaumätua in Occupational Therapy Workforce Development. OT Insight, Emery-Whittington, I. (2010, March). Cultural safety and Cultural competence: MasterChef analogy. OT Insight, 31, p Davis, G. (2010, April). Whakawhanaungatanga. OT Insight, 31, p Wilson, R. (2010, May). Are you a Mäori occupational therapist or an occupational therapists who is Mäori? OT Insight, 31, p Hopkirk, J. (2010, June). Whakaora ngangahau me kaiwhakaora ngangahau Occupational therapy and occupational therapist. OT Insight, 31, p Marino, T. (2010). In my opinion! More than just a career. OT Insight, Wilson, T. P. (2010, October). Hidden in the Toi Toi: Rembering the Past in the Present. OT Insight, 31, 15. Vol. 31 No.11 December