Maori Trends and Paradigms: 1919 to Present Day

Research hauora Maori trends and paradigms from 1919 to the present day Unit Standard 18414

• Gilanne M. Natividad

Identify the Region

The Tāmaki Makaurau region stretches from the South Kaipara in the north to the southern reaches of the Manukau Harbour and covers more than 5,600 square kilometres. It is the smallest of the Te Puni Kākiri regions but contains the largest population of Māori.

Identify the Hauora Maori trends and paradigms

Lung cancer

Is a disease whereby, cells grow uncontrollably in the lung tissue usually beginning in the lining of the bronchi or bronchioles (small tubes in the lungs, through which air passes while breathing). As these tumours enlarge they can block off the bronchi and restrict the airflow into the lung. They commonly spread into the local lymph nodes and occasionally the chest wall. This reduces the airways capacity leading to shortness of breath and coughing. The growth may lead to metastasis, which is when the cancer spreads to other areas of the body.

Smoking is the most common cause of lung cancer and is attributed to approximately 85% of cases. Lung cancer in non-smokers is attributed to a combination of genetic factors, radon gas, asbestos and air pollution, including second-hand smoke. (Cancer NZ)

Cervical Cancer

Is cancer of the cervix, which is the lower part of the uterus or womb.

Cervical cancer develops slowly over time, usually taking many years, when abnormal cells grow on the cervix. These abnormal cells are caused by infection with high-risk types of HPV.

Abnormalities in the cells of the cervix can be detected by cervical screening and removed. Each year there are around 25,000 abnormal smear test results among New Zealand women.

The most important risk factor for cervical cancer is persistent HPV infection.

Other factors may contribute, including:

• Genetics: some women are more likely to get cancer than others (family history)
• Smoking: tobacco is a factor in causing many types of cancer, including cervical cancer. Women who smoke are twice as likely as non-smokers to develop cervical cancer
• Nutrition: women with a diet low in fruits and vegetables have an increased risk
• Number of sexual partners: the more sexual partners a person has, the higher their risk of contracting HPV
• Not having regular smear tests: this increases a woman’s risk of developing cervical cancer. (Ministry of Health, 2014)

Gynaecological cancers are not common cancers but they do take the lives of around 350 New Zealand women each year. Ovarian cancer causes around 190 of these deaths. For all the gynaecological cancers, like most cancers, the risk increases with age.

For ovarian and endometrial (lining of the uterus) cancers the causes are not well understood. However it is known that;

• Women who have not had children

• Women who are overweight

May have an increased risk for these cancers a cause of some cervical, vulval and vaginal cancers is a virus called human papilloma virus (HPV). This is a common sexually transmitted virus. Most women are infected with it at some point in their lives. For most women it will never cause any problems. However, for a few women it causes cell changes that can lead to cancer. (Gynaecological Cancers Information for all Women, 2012)

Colon Cancer or Bowel Cancer

Bowel cancer is named according to where it is found: for example, cancer of the colon, cancer of the rectum or colorectal cancer. This cancer occurs when the cells in some part of the bowel grow abnormally and form a lump or tumour. Most cancers are in the large bowel. Cancer in the small bowel is less common.

How common is bowel cancer?

The latest provisional information available from the New Zealand Cancer Registry1 recorded 2,759 new cases of colorectal cancer in 2008. It is one of the most common cancers among both men and women in New Zealand. It may occur at any age, although 90 percent of cases are found in people over the age of 50.

There are different risk factors in developing Bowel Cancer:

1. Lifestyle

• A diet high in fat and protein and low in fruit and vegetables
• Alcohol consumption
• Weight gain, particularly around the waist
• Low rates of physical activity.

2. Family History of Bowel Cancer
3. Rare Genetic Conditions

(Bowel Cancer Matepukupuku Puku Hamuti, 2009)

Identify traditional approaches to Hauora

1. Maori Models of health

1. The Medical Wheel (Stamler, 2003)
   1. Purpose: effectiveness of healthcare for Maori by delivering quality service.
      1. 4 themes
         1. Mental
         2. Emotional
         3. Spiritual
         4. Physical

2. Te Pae Mahutonga (Durie, 2011)
   1. Purpose: the star constellation focuses on modern health promotion
      1. 4 stars
         1. Mauriora – cultural identity
         2. Waiora – environmental protection
         3. Toiora – healthy lifestyle
         4. Te Oronga – participation in society

3. Te Wheke (Pere, 1984)
   1. Purpose: this is to link between the mind, spirit, human connection with the whanau and the physical world.
      1. 10 components
         1. Te whānau – the family
         2. Waiora – total wellbeing for the individual and family
         3. Wairuatanga – spirituality
         4. Hinengaro – the mind
         5. Taha tinana – physical wellbeing
         6. Whanaungatanga – extended family
         7. Mauri – life force in people and objects
         8. Mana ake – unique identity of individuals and family
         9. Hā a koro ma, a kui ma – breath of life from forbearers
         10. Whatumanawa – the open and healthy expression of emotion

4. Te Whare Tapa Wha (Durie, 1984)
   1. Purpose: is to set foundation for a holistic approach and to reflect on a way of being
      1. 4 components
         1. Wairua – spiritual
         2. Hinengaro – mind
         3. Tinana – body
         4. Whanau – family

Utilising of Maori medicine

Rongoa Māori – traditional Māori medicine

1. Rongoais the Māori term for medicines that are produced from native plants in New Zealand. Use of these medicines prevented many sicknesses, and provided remedies for the sick. In traditional Māori healing, diagnosis involved a holistic approach that included mind, body and spirit –mauri(spark or life force),wairua(spirit), andtapu(natural law).Whakapapaor genealogy was also considered. Tohunga, the medical practitioners of the Māori world, passed their knowledge down through the generations, and modern Māori healers still use many of the concepts and practices.(100% New Zealand, 1999)

Identify issues to primary and secondary health service

2. Discrimination
   1. The role of discrimination and racism in harming health is not new but has received increasing attention over the past 20 years. Doctors have been shown to be less likely to advocate for preventive measures for Maori patients than for non-Maori patients, and Maoris may be less likely than non-Maoris to be referred for surgical care. (Lis Ellison-Loschmann, 2006)

3. Accessibility
   1. Access has been defined in terms of both ‘access to’ and ‘access through’ health care, the latter concept taking into account the quality of the service being provided. Health care need and health care quality have been developed into framework for measuring disparities in access to care, a framework that includes broader environmental and societal factors like racism that may affect access.
   2. There is increasing evidence that Maoris and non-Maoris differ in terms of access to both primary and secondary health care services that Maoris are less likely to be referred for surgical care and specialist services, and that, given the disparities in mortality, they receive lower than expected levels of quality hospital care than non-Maoris. One survey showed that 38% of Maori adults reported problems in obtaining necessary care in their local area, as compared with 16% of non-Maoris. Maoris were almost twice as likely as non-Maoris (34% vs 18%) to have gone without health care in the past year because of the cost of such care. This adds to previous evidence that cost is a significant barrier to Maoris’ access to health services. (Lis Ellison-Loschmann, 2006)
4. Affordability
   1. Many of the Maori people are unemployed due to lack of qualifications for they did not have a chance to study. This results to not being able to avail the health services offered in Tamaki Makau Rau whether it is primary or secondary health services. Instead of seeking professional help from the doctors or health workers, they tend to self-medicate by buying over the counter medicines to have a relief on whatever symptoms they are experiencing.

5. The development of Maori health services
   1. At the beginning of the 20th century, Maori leadership played a key role in advancing health promotion and disease control activities within Maori communities.This approach was to be important throughout the century, and there are many examples of both national and local Maori-led initiatives committed to advancing Maori health. These initiatives occurred outside of the mainstream services being provided at the time, which made them vulnerable to changes in government and funding availability. An opportunity for the focused development of Maori provider services emerged with the introduction of the 1991 health reforms. However, this restructuring of health and social services also led to a widening gap in inequality, as evident in such key determinants of health as income, education, employment, and housing. Moreover, the reforms had direct effects on the health of Maoris, particularly that of children.
   2. What are the differences between health services provided by Maoris and those provided by non-Maoris? Crengle identified use of Maori models of health and promotion of positive Maori development as 2 key philosophies underpinning Maori primary health care services. Maori cultural processes used as a basis for developing and delivering contemporary health services that support self-sufficiency and Maori control are crucial to the success of these provider organizations. Maori provider services have specifically identified access issues as a key factor and have used a range of strategies to address these issues, including extensive mobile services and outreach clinics (alongside a health center service base), free or low-cost health care, employment of primarily Maori staff who are more likely to have access to Maori consumers in their communities,and active inclusion of the community in the planning and delivery of services.
   3. The number of Maori health providers increased from 13 in 1993 to 240 in 2004. However, these providers continue to face a number of difficulties. For example, a lack of good primary health data, such as ethnicity data, has limited the potential of many Maori health providers, and a small Maori health work-force has been quickly absorbed into the growing number of Maori provider organizations. Also, the short contract time frames in place require extensive renegotiations each year. In addition, because Maori providers work primarily with families at high levels of need in terms of health services, increased costs are inevitable if health gains are to be achieved, and funders must take this situation into account. Similar policy initiatives have recently been adopted in Canada and Australia to improve the health of indigenous peoples; however, the contractual environments in these countries lean toward single multiyear funding contracts for comprehensive primary health care, and there is early evidence that such systems are more efficient for providers and promote better outcomes among consumers.
   4. It is too soon to assess the effects that the Maori provider organizations are having on the health status of Maoris, and these organizations should be viewed as representing one of a package of necessary long-term measures. Although the evidence that such strategies are effective is not yet available, there is certainly evidence that the reverse is true; that is, health service provision with little Maori participation results in poor Maori outcomes. (Lis Ellison-Loschmann, 2006)

6. Government Health Policy i.e Whanau Ora
   1. It is when the family is empowered as a whole in facing the health problems instead of focusing individually with the whanau members. It encourages the family to help one another in dealing with sickness or any ailments by giving them health lectures, brochures and pamphlets with regards to the disease.

2. Explain the research methodology
   1. Result of consultation with local iwi and/or hapu
      1. Consultation helps develop a cooperative working relationship with local Iwi and Hapu. Te reo drives tikanga and kawa for each Iwi and Hapu. It is done usually before and during the research, for the researchers to advise them of the nature of the intended study and invite their comments and/ or involvement.
   2. Ethical and cultural considerations within a hauora context
      1. As a researcher, we should secure consent first. So that the subject will be aware on what is the scope of the research and on how he or she can participate. It is also given to secure his/her rights as a subject.
      2. The researcher should also consider his client’s cultural safety by not putting into risk his client’s cultural beliefs.
      3. The researcher should also work on establishing the relationship and set rapport or also known as whakapapa-kawakia.
      4. The researcher should allow his client to do their Karakia before and after their session.

3. Data collection and tikanga
   1. Data is collected for this unit standard by using different available resources which involves the three trends namely Lung Cancer, Gynaecological Cacer and Bowel Cancer. These are by utilizing books, journals, websites and notes from our lectures with respect to the Tikanga of the subject. It I important to observe their Tikanga for they will uphold each other’s culture and beliefs.

3. Describe the research methodology in accordance with research ethics and tikanga Maori, ensuring you cover the following areas:
   1. Complete literature review has been already submitted.
   2. Sourcing information

References:

• Bowel Cancer Matepukupuku Puku Hamuti. (2009) Cancer Society: Understanding Cancer, 7-10.
• Gynaecological Cancers Information for All Women. (2012) Cancer Society, 1-2
• Ministry of Health. (2014, January 23). Retrieved January 30,2014, from Ministry of Health, https://www.essaybishop.com/write-my-essay/health.govt.nz/your-health/condition-and-treatment/diseases-and-illnesses/cancer/cervical-cancer
• Te Puni Kokiri. (2012, March 6). Retrieved January 30, 2014, from Te Puni Kokiri: https://www.essaybishop.com/write-my-essay/tpk.govt.nz/
• Ministry of Health. (2010). Trends in Cancer Incidence by Ethics and Socioeconomic Group, New Zealand 1981-2004. Trends in Cancer Incidence by Ethics and Socioeconomic Group, New Zealand 1981-2004, 52-57
• The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company.
• The Free Dictionary. (n.d.) Retrieved January 30, 2014, from The Free Dictionary, https://www.essaybishop.com/write-my-essay/thefreedictionary.com/auckland

3. Procedures for recording and analysing information and presenting findings

Assessment Task 2

Analyse research regarding hauora Maori trends and paradigms from 1919 to the present day

The table above shows the cancer registration by tumour sites for Maori clients in year 2003-2006, Northern Region. There is a high significance rate which is 63% in Lung Cancer for Maori people. This is mainly because of the exposure to cigarette smoking and second hand smoke that the Maori people are experiencing.

Next is, Colorectal Cancer with 18%, which mainly caused by not eating enough vegetables high in fibre. The diet of the Maori people has a major impact in the second leading cancer. Most of the Maori people eats meat and processed food which contributes in acquiring colorectal cancer.

The next three types of cancer are under the umbrella of gynaecological cancer for women. These three has different contributing risk factors which are obesity, improper diet, number of pregnancy and genetics. It can be prevented by undergoing screening and regular check-up with their OB-Gyne. Most of the Maori women are getting pregnant with their first child at an early age which causes them to bear more children through their lifetime that may cause one of these cancers.

Assessment Task 3

Present your findings and explain a present day health priority for Maori

The leading five female cancer registrations were breast, colorectal, melanoma, lung and uterus in the Northern Region and nationally for the period 2003-2006, accounting for approximately 65% of all female cancers. The leading five male cancer registrations were cancers of the prostate, colorectal, melanoma, lung and non-Hodgkin’s cancer in the Northern Region and nationally for the period 2003-2006, accounting for approximately 65% of all male cancers.

Uterine cancer was the second most common cancer (12%) amongst Pacific women, both nationally and in the Northern Region. Cervical cancer was among the five most common female cancers in Maori, Pacific and Asian women but not in European/Other women in the Northern Region. Nationally, cervical cancer was in the top five female cancers for Asian women only.

In the early years, Maori people don’t have the enough knowledge with Cancer and they seek help with their local village doctor and instructed to take herbal medicines to relieve whatever symptoms they were experiencing that moment. And later on will be deceased due to different complications without knowing the real cause.

The present day health priority for Maori is early screening for cancers. For female Maoris, they can undergo mammography for breast cancer screening, and Pap smear for cervical cancer screening. For male Maoris, they can undergo Digital Rectal Examination to check if there are any tenderness and lumps in their prostate. Early prevention is important for there are many treatments that can be used like surgical removal of lumps or undergoing radiotherapy and chemotherapy treatments. The chance of survival is high when the cancer is diagnosed at the early stage.

Proper health education and having Maori representatives in public health care services is important for the Maori, for they will feel that they are safe and secured if they will speak to their co-Maori people in regards with their health concerns. The partnership of the Maori with The Crown will help the Maori people to avail the different health services offered by The Ministry of Health with respect to their culture and beliefs.