Maori Nursing - A Greater Knowledge of the Native Mind

Next year in 2008, we will celebrate one hundred years since Akenehi Hei became the first Maori nurse to qualify.

Of Te Whakatohea and Te Whanau-a-Apanui whakapapa, Nurse Akenehi Hei worked extensively in rural communities throughout Gisborne, Te Kao, Russell, Rotorua, New Plymouth and Jerusalem and Pipiriki on the Whanganui River.

Her motivation was clear – to work among Maori, in what we may now see as ‘by Maori, for Maori’ services. She advocated for local customs, and I quote:

“having kept the Maori race in vigorous health for many generations deserve consideration….A greater knowledge of the native mind will inspire a greater, and thereby a deeper sympathy for the Maori people”.

At the same time that Akenehi Hei was working in her communities, Maori leaders such as Ta Apirana Ngata, Te Rangi Hiroa; Sir Maui Pomare, were initiating a Maori Health Nursing Scheme.

In a thesis submitted last year by Lee Thompson, we learn that the appalling health status and population decline of tangata whenua had even attracted the interest of pioneer of modern nursing, Florence Nightingale. It seems Sir George Grey had commissioned a report from the ‘lady with the lamp’ in 1869.

Nightingale recommended that the diseases which Maori were suffering from could be remedied by improving diet, clothing, accommodation and education.

The report was never acted on.

Instead, an alternative set of recommendations from Dr Arthur Thompson was implemented.

These included that the Government should teach Maori Christianity and English, individualise property, build roads and English settlements, make the Queen’s law the land of the land, promote inter-marriage and prevent disease.

I wanted to share our history of Maori nursing because it reminds us that whether we are primary health care workers, mental health workers, hospital and health services workers – as Maori nurses we come from a proud tradition of being ‘efficient preachers of the gospel of health’ alongside the knowledge of the ‘native mind’.

Nurse Akenehi Hei was a pioneer in holding true to kaupapa and tikanga Maori in her pursuit of a framework of health.

The challenge of delivering health services in a culturally competent way, whilst also maintaining the highest clinical practice is one that still motivates and inspires us all today.

It is our greatest challenge to consider how the knowledge, skills and relationships we acquire – at Capital and Coast DHB and beyond – will achieve Maori health gains.

The path of history being as it is, just as a century ago the Native Health Service faced the onslaught of the coloniser’s agenda, no doubt there will be experiences in your own workforce story that bear the imprint of institutional racism.

It is my hope that the Maori Nurses Forum gathered here at Hongoeka, provides the space to unwind, debrief, unload and then together, work to ensure we are all on the same pathway towards improving health outcomes for whanau, hapu and iwi.

Maori Health Workforce

The critical success factor for any Maori health strategy is the quality of the workforce behind it.

The Maori health workforce profile released earlier this year, He Pa Harakeke, identified that 7% of all active registered nurses; and 6.7% of all active registered midwives are Maori.

In real numbers, that’s 2886 capable and competent Maori health workers who are best placed to reach and provide whanau.

That’s great – but it could be - and should be – much more.

Because as we know, Maori have a different pattern of health needs than the rest of the population, and are more likely to experience ill health than other population groups.

By 2011 it is anticipated that the proportion of hospitalisations for Maori is expected to increase from 13% to 17%.

And what we also know from that infamous study published in The Lancet last June, is that the hospital care received by Maori is poorer than for other New Zealanders.

The study, led by Professor Peter Davis, found that 14% of Maori hospital admissions were associated with health care mistakes. For the rest of the population the rate was 11%.

Most of the "adverse events" happened in hospitals, the rest in other health care settings like general practice or rest homes. About 1% were considered severe (causing death or long-term disability) and preventable.

The Maori population increase, the shortage of Maori nurses, the ongoing health disparities, the adverse events research, are all factors which the nation must address, in supporting the Maori health workforce as essential to our future progress.

A key way of doing this, might be to establish a Maori Health Workforce Commission to ensure there is sufficient support in place to sustain and develop a professional Maori health workforce to support Maori and non-Maori health needs, today and in the future.

There are practical initiatives that the DHBs can take, in promoting health as an excellent career option for Maori school leavers; in mentoring nursing students and new graduate nurses with good role models; in offering financial support or creating whanau friendly / flexible work environments that value Maori staff.

And there are questions we might well ask of the DHB, such as

What is the planned expenditure on Maori Health for the next ten years?


How will Capital and Coast DHB entrench the Treaty of Waitangi in all health contracts?


What will Capital and Coast DHB do to monitor the PHO’s responsiveness to Maori health needs?


And while we’re waiting for the answers, what better way to make a difference, then to focus on what we can do for each other.

The location for this korero is a wonderful example of how the workers, the weavers, the carvers, the cooks, the dreamers, the designers, the gatherers, the schemers have come together to build a wharenui and a marae complex – which in the process has created a vision, a history and a common story for them all.

The people of Hongoeka whanau wanted Ngati Toa Rangatira whakapapa and history to be presented in such a way as to both complement the matua whare Toa Rangatira at Takapuwahia, but to also depict the inter-tribal relationships they had with other iwi.

I have been privileged to hear the korero around the tukutuku panels, nga whakairo, and the kowhaiwhai that adorn the whare.

What came through resoundingly to me was that the process of agreeing on kaupapa that would symbolise their aspirations, was a process that was immersed in learning and relearning waiata, haka, whaikorero, tikanga and te reo Maori of this rohe.

There is as much here about cultural safety, about Te Tiriti o Waitangi, about hauora – as we might find in the competencies and standards of the Health Practitioners Competence Assurance Act 2003.

And that is the beauty of kawa whakaruruhau – we are all students in cultural safety education in every setting we encounter.

I am not the person to relay to you the stories behind the tukutuku panels, nga whakairo, and the kowhaiwhai – that pride belongs to the people of Hongoeka. But it does demonstrate the underpinning essence of cultural competency, that is:

to understand one’s self as a cultural bearer;
to recognise the historical, social and political influences on health;
to value and develop relationships that engender trust and respect.


If we were to be holding this wananga at Whangaehu Marae, of course, I would be more than happy to share the stories of our whanau, our marae, our heritage.

One of our leaders of the Ratana and Maramatanga movements, Mere Rikiriki, had a saying “E ringa kaha, e ringa poto, kaore e whakahoa”.

In saying so, she always reminds me to be true to ourselves, to be self-controlled without friend or favour. We do not stand alone, our connection to our whakapapa gives us the strength to stand.

It is this strength that we must draw on, this strength in knowing our own self as a cultural bearer, that gives us the drive to show leadership when culturally unsafe practices are witnessed.

People often talk about leadership as being something far away, an individual on a pedestal, leadership from on high.

We in the Maori Party challenge that view and say instead, that leadership resides in each and every one of us.

It is your ability to take up that leadership to utilise it in a way which will bring about change, that can be of the most benefit to our people when they are ill.

How can it be the case that 14% of Maori hospital admissions are associated with health care mistakes? We must not accept anything but the best quality of care for our whanau, hapu and iwi.

We must ask ourselves every day, have we got the courage to step outside of our comfort zones and be the most powerful advocates for our people?

Have we got the courage to speak out when we know our people are not getting appropriate access to the treatments they deserve; the treatments they are entitled to; the treatments that others get?

Have you ever contacted a Member of Parliament when concerns you have raised, are ignored or shoved on the backburner?

Some people just accept things happen, “it’s just the way things are”. Florence Nightingale didn’t. Akenehi Hei didn’t. Irihapeti Ramsden didn’t. I don’t and won’t accept second, third rate treatments, services, resources.

Leadership first begins with ourselves, with our whanau.

Last week was a very heavy week for our whanau, as a dearly loved father, husband, uncle, cousin, son passed away.

In the midst of our sorrow, I took great heart from a simple question from the medical practitioner who took me aside, and asked me, “Mrs Turia, was what I said, ok?”.

I replied to him that his compassion was appreciated, his honesty was needed, and his professionalism was valued.

That one question meant so much to me, in terms of the cultural competency he displayed in wanting to demonstrate trust and respect for our whanau.

He no doubt stepped outside his comfort zone, in opening himself up to the possibility of critical feedback.

We can all take heart from stories such as this – to be courageous in speaking out against any practice which serves to diminish, demean or dis-empower the cultural identity and wellbeing of another.

Cultural competency is about recognising the social realities of all people – whether or not they see their cultural identity as being at the background or the foreground of who they are.

Just as Akenehi Hei had a vision that Maori nurses could support the Maori race in vigorous health for many generations, so too, can we all show leadership in recognising that Maori health is a taonga that we must be all protect vigorously.