This assignment will explore the use of traditional herbal medicines and other traditional health practices that pose significant health issues for Maori within Aotearoa/New Zealand. Rongoa, mirimiri and karakia are traditional health practices amongst Maori and have been around for many years. How the health care needs of people wishing to utilise these traditional methods of healing are being accommodated will be looked at.
How the three “p’s” of the Treaty of Waitangi are being incorporated into the health needs of the Maori will also be investigated. The implications of these findings for myself as a beginning nurse practitioner will then be identified and critiqued. Rongoa Maori is the traditional medicine system of the indigenous people of Aotearoa/New Zealand, the use of which has long been established (McGown, 1998). It is a storehouse of Maori history and culture and therefore is considered a taonga (treasured possession) (Jones, 2002).
With the advent of Pakeha medicine the old knowledge of Maori medicine had largely died out (Beattie, 1995), however according to Jones (2002), there has been a resurgence of interest in rongoa Maori over the past two decades. This resurgence has lead to many calls for it to be formalised within the New Zealand public health system (Jones, 2002). Rongoa encompasses several activities at different levels, including spiritual, psychic, physical and ecological (Durie, 1998).
Prayer, or karakia, is used at the spiritual level to restore equilibrium; rongoa (herbal medicine) is used to offer physical relief; mirimiri, or massage, is used for muscular and joint development; wai (water) is used at both spiritual and symptomatic levels to remove physical and spiritual contamination; surgical interventions are utilised at a symptomatic level to alleviate painful swelling (Durie, 1998). The practitioners of rongoa Maori are known as tohunga (Jones, 2000).
Durie (1998), also cites differences in attitudes of Maori and Western medicine, such as a Maori belief that their illness was caused by a breach of tapu (a preventative measure, something that is off limits) rather than by an invasion of bacteria or virus. This is further supported by King and Turia (2002) who state that “for Maori the unobservable (spiritual, mental and emotional) elements are as relevant as the observable or physical elements” (p, 13). Maori people have on average, the poorest health of any ethnic group in NZ, (King and Turia, 2002).
Thornley, Tobias and Bonne (2001) agree, stating that Maori experience a disproportionate burden of disease and injury than non-Maori. This is totally unacceptable and the improvement of the health of NZ Maori is a key focus for the NZ government and the Ministry of Health. Jones (2002, p. ii) believes that ” the ability of the health system to embrace Maori perspectives of health could not only help improve access to health care and bring about health gain, but could also reaffirm the significance of traditional healing as a legitimate Maori cultural asset”.
The Treaty of Waitangi (ToW) is a contract between the NZ Maori and the British Crown and is directly relevant to the providing of health care. There are three articles of the ToW: Article One forms a partnership between the Crown and the Maori, establishing the right for the Crown to govern; Article Two specifies participation and “guarantees Maori self-determination over all their taonga” (Jones, 2002); Article Three specifies protection and gives Maori citizenship rights and social equity (Jones, 2002).
The Ministry of Health acknowledge partnership by “working together with iwi, hapu, whanau and Maori communities to develop strategies for Maori health gain and appropriate health and disability services” (King & Turia, 2002, p. 2). This is continued when the Ministry of Health state that participation will involve “Maori at all levels of the sector, in decision-making, planning, development and delivery of health an disability services” and they offer protection by “working to ensure Maori have at least the same level of health as non-Maori, and safeguarding Maori cultural concepts, values and practices” (King & Turia, p. ).
In He Korowai Oranga, King and Turia (2002) state that the Crown will work with Maori, whanau, hapu and iwi groups to encourage good health and prevent and/or treat disease. This will be holistic in its approach and includes the recognition of Rongoa Maori, thus acknowledging Maori traditional healing practices. This holistic approach to health care is very important for Maori because Western medicine focuses on alleviating symptoms rather than acknowledging the emotional and/or spiritual aspects to an illness.
Another large focus towards improving the health of Maori is to support them within their whanau (family group). The whanau offers a valuable source of strength, support, identity and support that is highly valued in the wellbeing of Maori, individually or as a group (King & Turia, 2002). The idea of traditional medicine and Western medicine practices working side by side is not new. Since the 1970’s the World Health Organisation has sought to incorporate traditional tribal healers into the public health system around the world (Trachtenberg, 2002).
In many countries worldwide this has been achieved and indigenous or traditional healers work alongside or together with conventional medicine practitioners (Jones, 2002). The inclusion of rongoa Maori in formal health documents by the Ministry of Health demonstrate that the New Zealand government is working to integrate rongoa Maori into the formal health system, thus honouring the traditional healing beliefs of its indigenous people. Some sectors of health care have already sought to accommodate the needs of Maori and acknowledged that the health of Maori is very poor when compared to other New Zealand citizens.
This is reflected in the Heart Foundation guidelines (2002), which recommend that “mainstream rehabilitation programmes must be reorientated to meet the needs of Maori” (p. 77). King and Turia (2002) state that the NZ government will support the health sector to make sure that Maori cultural values are included in all aspects of the delivery of health care services. In working towards honouring the Maori Health Strategy, as well as the WHO mandate, Middlemore Hospital in Auckland, New Zealand (NZ), allowed Maori and also Pacific Island Healers to work along side staff last year (O’Hare, 2001).
Hawkes Bay Regional hospital also have a policy that allows for traditional Maori health practices should the patient wish for them. O’Hare (2001) states “that the World Health Organisation (WHO) estimates that up to 80% of the world’s people rely on plants for their primary health care” (p. 38), so the use of plants in healing is something that is universal. McGown (1998), goes on to state that “the Maori have a depth of knowledge about rongoa. It is truly scientific. It is just that they express it in their own way. That’s what we have to learn to appreciate” (p. 9). O’Hare (2001) goes on to say that more scientific scrutiny into Maori traditional medicines is long overdue, and so a one million dollar grant has been awarded by the Health Research Council and Foundation for Research Science and Technology to a Waikato university chemist, Meto To Ota Leach, to study it. Research is important because there is a lack of scientific research into many forms of alternative/herbal/complementary therapies, which can lead to its validity being questioned by people who are used to dealing with a very scientific medical model.
It is also important to perform research into this type of healing because the mention of traditional or alternative medicine can evoke some emotional responses as people may interpret the use of such as a rejection of conventional Western medicine (Kelly & Joel, 1999). Research may help people realise that there are other valid and valuable methods of healing people apart from the bio-medical scientific model. The incorporation of rongoa Maori into mainstream has many implications for nurses.
One of the most important realisations and understandings that I, the nurse must have is that rongoa Maori is not a thing or a product, it is part of the Maori culture and must be respected as such (Jones, 2002). As a nurse looking after patients who may request this form of healing then I must also understand and realise that for many Maori, traditional healers are regarded a professionals in their own right and on a par with medical doctors (Jones, 2002). McGowan (1999) mentions this when he says that Maori healers have a scientific knowledge about their form of healing, however they do not express it in a traditional manner.
Because it is not expressed the same way the bio-medical model is expressed, people who favour the conventional approach, may not understand its validity. It is vital that as a beginning nurse, I provide a non-judgmental environment for the patient to discuss all aspects of their health practices. According to Adler (2003) and Jones (2002), many patients are likely to be receiving care from both medical and alternative practitioners, simultaneously and for the same condition without the integration of either of the therapies. It is also important that I ensure that there is trust between myself and my patient.
Research proves that as many as 80% of people who use traditional forms of healing do not disclose this to their primary health care providers (Wetzel, Kaptchuck, Haramati & Eisenberg, 2003). It is therefore imperative that the patient feels supported in their own health practices so they will tell me if they are taking traditional herbal preparations. This is important because there is a potential for negative drug-herb interactions, and whilst the prevalence of such interactions has been exaggerated they can cause problems in sensitive patients and with patients taking drugs with a narrow therapeutic window (Awang & Fugh-Berman, 2002).
This honours the partnership and the protection articles of the ToW, as I, the nurse, represent the Crown. By forming a partnership with my patient, developing a trusting relationship where they can feel safe and supported in their personal health practices, we can work together to assist them in their journey to health. I honour the protection article of the ToW by understanding their other health practices and knowing what else they are supporting their health with, especially if they are taking herbal preparations as some herbal preparations can potentiate the effects of prescribed drugs.
As a new nurse I would expect to inform myself about commonly used herbs and their effects with prescribed medications, so I may offer advice regarding the safe uses of herbal preparations. Another aspect of Maori traditional health practices that I, the new nurse will respect is the karakia. If this is being performed by the patient’s whanau or another person, then I will need to be aware of this so that I do not interrupt or show a disrespectful attitude when performing nursing cares. Sometimes non-urgent nursing cares may be delayed for a few minutes so that the karakia may be performed.
This honours the beliefs of the patient and it conveys a sense of respect for their spiritual beliefs. It is very important that people get the type of health care that they believe in, as this makes a difference in how fast they recover (The Earths Garden, 15-6-03). Durie (1998), validates this statement when he says that all healing takes place within the context of the persons culture and faith is a critical determinant of a positive outcome. So if prayer forms an important aspect of a person’s health care practices then it is important they are given the opportunity to perform it. This honours the participation of the ToW article.
The patient is not just a recipient of the healing techniques, they are a participant in their care by the very fact that they believe in it and expect it to work. An understanding to tapu and noa is important if I, the newly graduate nurse, am to nurse Maori patients and not inadvertently offend anyone. Tapu forms the basis of law and order, and is of great significance to health and illness in the belief system of Maori (Jones, 2002). It is not written or legislated and often has a sacredness and spiritual aspect attributed to it, however it is not confined to the spiritual realm (Durie, 1994).
Violations of tapu could lead to rebuke, ridicule, intense mental suffering, sickness or death. It could be applied to many things permanently or as a temporary measure to restore harmony after an unsettling incident or to give protection when a crisis was anticipated, for example, to protect a natural resource a fishing ban may be imposed (Jones, 2002). Noa refers to everyday things, the common and those free of restrictions or protection requirements, including food that was ready for eating or a house that was fully built.
Tapu and noa, although contrasting, existed as complementary, synergistic, dynamic balance which depended on seasonal, environmental and human needs. As a nurse I need to understand some considerations around tapu and noa, including asking permission before touching the head area, which is regarded as tapu. Ensuring surfaces that are used for the head (eg. The pillow) and for food (eg. the table) are not in contact with peoples bottoms, so no sitting on tables or pillows is permitted. Ensuring bedpans and urine bottles are not placed on any surface that food will be placed on is another consideration.
This is an issue of hygiene and applies to all patients not only Maori. Traditionally ill health was thought to be caused by supernatural forces or malignant spirits, and attributed to a breach of tapu (Buck, 1977). To combat this, a tohunga was called in to determine the breach and to identify which spirit was involved. This may involve a case history, investigations of the patient’s dreams and investigations of the entire families dreams which were then psychoanalysed and a diagnosis made (Jones, 2002). As a nurse, I must respect the patient’s beliefs regarding this form of healing.
If the patient wants to be psychoanalysed and have their dreams interpreted then I must respect that. The patient may even request pen and paper to write down their dreams whilst they are fresh in their mind, and it would be very important to their healing process for that request to be granted with respect and no outward sign of disbelief or scorn shown by the nursing staff. Mirimiri, is another area of traditional healing that is important to Maori. If I was looking after a patient who requested this form of healing then I would need to understand exactly what the healer wanted to do regarding hands-on healing.
This is because massage is specifically contra-indicated for some illnesses and diseases. As a reflexologist and a masseuse I have an understanding of this and could show the healer other ways of performing hands-on healing without compromising the patient’s health. Reflexology, which is a therapy that uses a precise finger movement to stimulate reflexes in the feet, hands and ears, can be used to help the patient regain homeostasis and it has very few contra-indications (Byers, 2001). This makes it a very safe therapy, which can be successfully used on anyone who wants it.
Whilst reflexology is not specifically mirimiri it would be considered hands-on healing and therefore could be used by traditional healers in the place of massage. The use traditional healing is something that is part of the culture of Maori. It has been stated that Maori have very poor health and the government is working towards solving that problem. Part of this solution has been to acknowledge that rongoa Maori is an important aspect of healing for Maori and strategies have been implemented to allow traditional Maori healers to work alongside conventional bio-medical practices.
This assignment has investigated the implications of this on myself, as a newly graduated nurse and included the considerations I must integrate into my nursing practice to honour Maori beliefs. The three articles of the Treaty of Waitangi are easily applied to health care and their integration into Maori health and nursing cares have been investigated in this assignment. It is important for patients to receive the forms of health care they believe in so for Maori the blending of rongoa Maori and other traditional forms of healing into more familiar health care models can only have a beneficial effect on their health outcomes.