Maori & Wareware

Specific Cultural Issues/Factors that need to be considered!

In home and residential care Cultural Competence

Joseph Whanau Whanaungatanga Whakapapa

Whakapapa - Whanaungatanga

• 75 yr old Maori Female • Rest Home Care with Wareware • RN Withdrawn/Depressed • Pictures on the Wall Family Reunion in Cambridge • Daughter lived close by in Community working • 5 children • Tainui/Waikato Descent • 7th Day Adventist – loves her church

Whakawhanaungatanga • Missed the reunion in Cambridge • Anxiety attacks travelling in cars > 30 mins • Explored depression issues with her • Agreed to take medications SSRI • Anxiety improved somewhat after 1 month • Feeling better • Working on Travelling further • RN Surprised. 1st GP She had opened up to?! • Maori Doctor? By Maori for Maori? • Whakawhanaungatanga – Whakapapa?

Paratene Ngata

• Whakarongo – the act to listen • Rongo – to hear • Rongoa – Medicine

Maori & Wareware

• Introduction • Prevalence • Maori Models of Health • Aspects of Care for Maori & their Whanau

Figure 1: Age distribution of the Māori population, males and females, 2013

Figure 1: Age distribution of the Non-Māori population, males and females, 2013

Maori + Non Maori Population Distribution

• 80% Maori under 45 yrs • 61% Non Maori under 45 yrs • 4% Maori 65+ • 14% Non Maori 65+

Maori Population

• 15% Population • 24% of Under 5’s • 4.7% of Over 65+ • 2% of 80+

Dementia Prevalence 2011 • 2011 • Total Dementia Patients – 48182 • Maori with Dementia – 1970 or 4% • Maori 2% of Rest Home Clients • 2025 • Total Dementia Patients – 78267 • Maori with Dementia – 4493 or 5% • Maori as a proportion of dementia patients will continue to

climb! • 2050 estimated 7% • More Maori in Rest Homes!

Types of Dementia • Alzheimers • Vascular • Mixed • Lewy Body • Fronto-Temporal • Parkinsons • Wernicke-Korsakoff • Huntingtons • Creutzfeldt-Jakob • Normal Pressure Hydrocephalus • Downs Syndrome • Other

Maori - Risk Factors

• Depression • Trauma • Substance Abuse • Cardio/Cerebrovascular Disease – twice as

likely to be hospitalised for Stroke and IHD • Likely to be much higher prevalence then

what is evident currently! Why?

Whanau • 70yr old Male • Wareware • CVA • Dependent • Hemiplegia • Dysphasia • Im Taking Him Home!!!!!!!!!!! • Dont forget who I am? • Don’t forget who they are! • Reciprocal Care

Whanau/Reciprocal Care

• Whanau – Birth/Family • Hapu – Pregnant/Clan • Iwi – Bones/Tribe • Close Bonds? • Dementia – not well understood?

Dementia/Wareware

• Forgetful – Normal Aging? • Cantankerous/Hoha? • Diagnosis Dementia i. Mana – how dare you? ii. Stigma – Shock, Negative iii. Whakama – Makutu/Transgression of Tapu iv. Matakite – Communicating with Tupuna, gift

Dementia/Wareware

• Senior Colleagues – psychosis, Te Arai thinner and communicate with those on the other side!

• Whanau more likely to tolerate normal behaviours?

• Seek help from whanau and tohunga or ministers

• Present late with more severe pathology

Maori Models of Health

• Te Whare Tapawha • Te Whetu • Te Wheke • Putahi

• Biomedical Model • Holistic in their approach

Te Whare Tapa Wha/Whanau Ora

Taha Wairua

• Male 76 Maori • Whakawhanaungatanga • Depression/Anxiety • At home, withdrawn • SSRI months helped a little • Tinana/Hinengaro/Whanau • Wairua?

Taha Wairua

• Hadnt been to Church 15-20yrs • Same religion as me • Suggested go to Church • 2 months later Anxiety improved • Stopped taking SSRI • He & Whanau happier. More manageable!

Te Whetu

• Land/Whenua • Body/Tinana • Mind/Hinengaro • Social/Whanau • Spiritual/Wairua

He wahine, he whenua, e ngaro ai te tangata

Land

• Activities Land • Marae • Maori Health Provider – Programmes • Cultural Advisor • Cultural/Clinical Navigators

Dementia Care in New Zealand Barriers for Maori

• Fear of Western Institutions • Exclusion of Culture • Knowledge and Education • Communication of Information • Disjointed Services, Multiple Organisations

Screening Tools for Dementia

1. MMSE – Mini-Mental Status Examination 2. 3M or Modified MMSE 3. Mini-Cog 4. GPCOG - GP Cognitive Assessment 5. MoCA - Montreal Cognitive Assessment

Fear of Medical Facilities & Profession

• Cost • Older Whanau experiences of

Institutionalisation • Hospital – place you go to die • Bad Experiences with Medical Hospitals & GP

practices • Not referred when needed

Maori Principles

• Whakapapa • Whanaungatanga • Whakama • Whanau Ora • Manaaki • Aroha • Mana • Mauri • Pono

• Tapu • Noa • Ea • Aroha ki te tangata • etc

Communication

• Kanohi ki te kanohi • Whakawhanaungatanga • Whakapapa • English – Foreign Workers • Medical Jargon • Labelling • Use of Maori Terms • Tapu & Noa

Whakatauki

• Naku te rourou, nau te rourou, ka ora ai te iwi!