Turia: Kahungunu Health Innovation Hui
Kahungunu Health Innovation Hui, Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier
Wednesday 23 April 2008; 4pm
Hon Tariana Turia, Maori Party Spokesperson for Health; and Co-leader
What is this output called Mauriora?
I am very pleased to be here, to be part of this Kahungunu Health Innovation Conference.
And I want to commend Kahungunu Health Services for having the insight to bring together all of the key players throughout Kahungunu to share your thinking about what will make the difference in achieving health outcomes.
As I thought about this challenge – what will make the difference – I couldn’t resist sharing some of my excitement from an event I attended just last week.
The event was the Kapiti and Horowhenua Maori Business Awards, Te Ropu Pakihi. It was the first time I have been to Maori business awards where our kaupapa tuku iho were applied throughout every aspect of their performance.
The exciting thing for me was to see that all of the kaupapa were upfront, as the way forward to achieve Mauriora.
Success was measured in terms such as :
1. Manaakitanga – that manuhiri were comfortable and made to feel valued, whether they be other providers, government agencies, or clients;
2. Ukaipotanga: that the community has a sense of ownership; and that all kaimahi feel a sense of belonging;
3. Rangatiratanga: taking a leadership role in encouraging economic development and independence;
4. Te reo: supporting providers and kaimahi in upholding te reo rangatira;
5. Wairuatanga: supporting each other with our karakia and our aroha;
6. Whanaungatanga: respecting whanau decision making – and the whanau of our manuhiri;
7. Whakapapa: enhancing our iwi/hapu links;
8. Kaitiakitanga: ensuring the safety of people, ideas and spirituality in all our efforts;
9. Pukengatanga: constantly assessing our own professional development and encouraging others.
It was truly inspirational, to be at a hui with people who were innovative, who were forward looking, whose success was measured on the kaupapa passed down from generations beyond.
I believe that when we use our own kaupapa and our own tikanga in everything that we do, that we can confidently claim we are there to represent our whanau, hapu, iwi.
Otherwise, are we not just a brown face delivering a western package?
This, I believe, is the pressing challenge facing Maori health providers - the difference between showing we have completed the outputs negotiated in the contract specifications and knowing we have made the difference.
Tangata whenua health providers have long desired control and responsibility over our own hauora, our own sense of health and wellbeing.
It has always been my view that the shape and direction of tangata whenua health services should be set by tangata whenua, consistent with the aspiration of rangatiratanga.
Rangatiratanga can be measured in the ability to listen, and to hear – to be in touch with the people, to know their dreams and aspirations, to know what they want, and to know how to deliver, and to be accountable for the end result.
He mana hei mana tangata – the strength of the kawai tupuna, the power of our whenua, the power of Maori mana motuhake - provide a solid foundation for driving Maori participation in health planning and service delivery.
And yet so often, it appears to be a case of the tail wagging the dog.
The contractual service agreements negotiated with the Ministry of Health and District Health Boards dictate the performance measures a provider will work to.
‘Maori health objectives’ are frequently set by the contractor rather than the whanau, hapu and iwi which the provider serves.
Dr Amohia Boulton has summarised the mismatch that occurs when the aspirations of whanau, hapu and iwi are stifled within the strait-jacket of the health sector specifications.
In her doctorate research exploring the experiences of Maori mental health providers, Amohia found that the contracts themselves were frequently exposed as insufficient for the broad goals of the services they were supporting.
These contracts were often generic, frozen in time, constrained within the narrow parameters set down by the state, inflexible, overly complex and consistently difficult to interpret and use.
Alongside these paper problems, the actual contracting experience was frequently adversarial, one-sided and lacking any real sense of negotiation or equal bargaining power.
The discord was glaringly obvious in the ways in which both parties assessed the performance management of the service.
While the Crown was concerned with numbers, volumes and inputs, whanau, hapu and iwi were focused on the quality of relationships and interactions that tangata whaiora experienced across their communities.
The challenge we must all face, if we are truly committed to health innovation, is to answer the question, how will our needs and realities as tangata whenua be recognised in the frameworks and performance indicators negotiated with the funder?
How do our indigenous ways of knowing become valued as the cultural landmarks of our journey to glowing health?
Or in other words, what is this output called Mauriora?
In the burgeoning growth of the hauora Maori provider workforce, we have placed considerable emphasis in ensuring there is Maori participation throughout all levels of the health industry.
We have developed Maori health programmes and services, we have consulted with our communities, we have defined and developed the ways in which we respond to the health disparities evident amongst our whanau, hapu and iwi.
But are we always dancing to someone else’s tune?
How influential is our voice in the underlying theoretical frameworks and the health sector strategies that erupt on the scene?
Are the innovative approaches that we know work relegated to be part of the extra-curricula activity – the tikanga driven responses that are not caught within the specifications of the contract?
I look to this concept of mauriora for guidance.
The life principle, the source of our emotions, the principle of our vitality, our mana, our fruitfulness.
Koi to mauri ka tupu, tupu koe i to
Ka rau huihui koe i to mauri,
ka rau matomato koe i to mauri.
How is the unqualified exercise of your rangatiratanga upheld over your whenua, your kainga, your taonga katoa?
Mauriora is so much more than medicine can ever mean.
When your aunty says to you, Tihe Mauriora, after you sneeze, she is not meaning, give that girl a hanky, something for the sinuses, a tablet to take away your congestion.
She is saying behold, there is life!
Tihe Mauriora i te Tae Ao! Tihe Mauriora i te Whai Ao! Tihe Mauriora i te Ao Marama.
In order to truly embrace your life-force, it may well mean we go through the process of whakawatea –stripping away the scars of colonisation, the assault of racism and discrimination which has led to the disparate state of Maori health.
In order to truly celebrate the life-force of Maori, the abject living conditions we are located in must also be recognised and restored to at the very least the quality of life we are entitled to if the Crown is to meet its Article three responsibilities.
Linda Tuhiwai Smith takes that next step forward to assisting us in knowing how we can meet our responsibilities as tangata kaitiaki o nga mana tuku iho, our customary authority handed down by our ancestors.
She describes a journey in which decolonisation and healing processes are followed with mobilisation and transformation. The Maori Party is a very keen disciple of just such a journey – and we know how you of Ngati Kahungunu have always shown your courage in taking charge of your own destiny.
We must all be the physicians who heal ourselves.
Seek assistance as we must all do and as our tupuna before us have always done, but let us all be those self healing physicians.
In thinking about this korero for today I discovered that in September 1898 Ema Mitchell of Pakipaki was one of the first two nursing trainees accepted to train in Napier Hospital.
Interestingly, the recruitment campaign at that period was focussed on having trainees come from families who were considered to be “not too Europeanised”.
And so I wondered what would have been the features of the health practices, the experiences of that time before our society became ‘too Europeanised’.
I wonder what Ema Mitchell of Pakipaki would have thought of the talk about käwai tupuna, rangatiratanga, mauri ora, mana motuhake and an iwi delivered service –would it have reflected all that she knew and believed in at that time?
I wonder what Ema would think of incorporating and using the oriori of Tuteremoana as a gynaecological reference and manual.
Would Ema Mitchell have drawn support from the oriori ‘Pinepine te kura’ to assist the birth of children of Whatuiapiti descent in the birthing room?
What would have been the other resources, the cultural assets that comprised her cultural competency to meet the health needs of her whanau, hapu and iwi?
These are the questions that I imagine you would be considering when you think about outcomes such as Mauriora.
What will be the tikanga-driven practice that drives the frameworks and philosophies you seek to negotiate with the funder?
What will these same frameworks say about how Kahungunu relates to those from outside of your rohe?
If I, as a daughter of Whanganui were to visit the health services of Kahungunu as a person needing care, how would my Whanganuitanga be attended to?
Would the service accorded me be different to the service accorded to a descendant of Kahungunu?
You are probably wondering why it is that at a hui entitled Kahungunu Health Innovation, I have not yet, made much of the word innovation.
Perhaps it is because I think the two words, Kahungunu Health, say it all.
The history, the whakapapa, the waiata, the haka, the living memories that you nurture as Kahungunu quite simply, provide the basis for community action in health, based on the values inherent your own traditions.
You have the relationships, the concept of belonging which helps you to know the future which lies behind you.
You have the skills and the health care knowledge which can be found in oriori like that of Tuteremoana and Pinepine Te Kura.
You have the capability, the tradition of community decision-making which helps to support you in knowing your health outcomes will be stronger.
And you are inspired by kaupapa such as manaakitanga, whanaungatanga, kotahitanga, kaupapa which are our most vital resource in preparing for the generations of the future.
The solutions we seek for our time will not be found by focusing, exclusively, on a relentless search for new ideas, new technology, new drugs, new practice.
Perhaps what we actually need are fresh ideas, fresh approaches, fresh thinking about the problems we have become all-too-familiar with.
Perhaps we are forgetting that our old people faced the same kinds of problems in their times – and their experience and understanding is something we should draw on for ourselves.
Innovation is not the same as discovery.
An adaptation of something tried and true to suit new circumstances is certainly an innovation.
Just because it has been done before, does not mean it no longer works.
Ultimately, the collective investment in innovation that you make as Ngati Kahungunu must integrate the past, embrace the present, and provoke the people’s vision for the future.
I wish you all well in the most important challenge yet.