00-year dream for better health
Te Puea He¯rangi’s hopes for a Ma¯ori hospital in Waikato were thwarted by authorities. A century later, her vision may come to fruition under a Ma¯ori health authority, writes Florence Kerr.
As the sombre melody of a mo¯ teatea drifted through Te Paina pa¯ near Mercer, the bodies kept piling up. Te Puea He¯ rangi, an influential leader in the Kı¯ngitanga movement, also known as Princess Te Puea, was fighting an invisible enemy that was taking the lives of her people. She became their nurse, funeral director, and mother to those within the pa¯ .
It was 1918 and the influenza pandemic hit New Zealand hard, particularly Ma¯ ori communities who in some instances could not access the same healthcare as their Pa¯ keha¯ counterparts.
In that same year, in a letter to the Auckland Star, Aperatama Rupene described the devastation and inequalities Ma¯ ori faced during the pandemic.
He outlined the concern that many Ma¯ ori communities were being left to ‘‘rely upon their own knowledge of herbs and remedies to cope with the dread scourge’’.
The huge disparity in loss of life between Ma¯ ori and non-Ma¯ ori was the most striking feature of the 1918 flu pandemic, particularly the second wave. The largely rural Ma¯ ori population was seven or eight times more likely to die from the flu than non-Ma¯ ori. Ma¯ ori accounted for at least 2500 of the roughly 9000 fatalities.
He¯ rangi felt the ravages firsthand; she nursed many back to health using rongoa¯ Ma¯ ori (traditional medicine), but buried more. She took on the care of the many children left orphaned by the disease.
It was from the heartache caused by the pandemic that she created the plans for Tu¯ rangawaewae Marae in Nga¯ ruawa¯ hia, northwest of Hamilton.
At the heart of it was
Ma¯ hina¯ rangi wharenui, a hospital for Ma¯ ori that took a holistic approach incorporating tikanga (customs), rongoa¯ Ma¯ ori and Western medicine under one roof, designed aesthetically for Ma¯ ori. He¯ rangi saw firsthand the benefits of having Ma¯ ori surrounded by their culture, and having that infused in their wellbeing.
The survivors from Te Paina moved to Nga¯ rua¯ wahia in August 1921, and broke ground where
Tu¯ rangawaewae Marae is today.
Despite the project having support from Parliament with backing from Sir A¯ pirana Ngata – whose Nga¯ ti Porou iwi also donated £1300 towards Ma¯ hina¯ rangi – the local health authorities refused to license the premises and the dream never eventuated.
That was 100 years ago, and today He¯ rangi’s vision may come to life in the form of the Ma¯ ori Health Authority, a for-Ma¯ ori-by-Ma¯ ori health system.
Tu¯ rangawaewae trustee Glenda Raumati stands outside the wharenui today. She is also the general manager of Nga Miro Health, a Ma¯ ori health provider in
Nga¯ rua¯ wahia based at the marae.
Having worked in the health sector for 25 years, Raumati has seen how health inequities for Ma¯ ori can be fatal.
She believes that, had He¯ rangi’s vision been allowed to flourish 100 years ago, Ma¯ ori would not be suffering today.
‘‘Her vision was about caring for the people, all aspects of their life, physical wellbeing, spiritual, economical, mental health, everything,’’ Raumati says.
‘‘She built the community based on the social determinants of health which mean, to achieve wellness, it’s about treating illness, income impacts on the level of wellness you enjoy, education, access to transport. It’s not just access to doctors that keep you well.’’
Raumati recalls hearing the stories of the pandemic survivors forming work gangs to create an economic base for the people in the 1920s. A lot of the work involved breaking in land for Pa¯ keha¯ farmers – land that had been stolen through the confiscation process.
She says the descendants of those survivors are having to choose between paying their rent and seeing a doctor.
‘‘Our wha¯ nau have to anticipate being ill. They can’t get in to see a GP for a few weeks, so many have to choose between travelling to Hamilton if they have the money or hoping they get better on their own. That is the reality today.’’
And those descendants echo Raumati’s assessment of the health situation on the ground.
Stuff spoke to Nga¯ ruawa¯ hia locals who say getting in to see a GP in their town is impossible, with many having to pay $80 to get an appointment in Hamilton.
One local who did not want his name or image used said going to the doctor was a choice between not having a fever, and having kai and a roof over his family’s head.
‘‘You say wellness like medicine would cure everything. The chest infection is the least of my problems at the moment.’’
Those who spoke to Stuff unknowingly shared the same vision He¯ rangi had 100 years ago.
They hope that, once the Ma¯ ori Health Authority is established, it will mean a holistic approach to their wellbeing incorporating tikanga Ma¯ ori, rongoa¯ Ma¯ ori, and Western medicine in a Ma¯ ori setting, with Ma¯ ori doctors, nurses and administration staff.
They want to feel heard, feel safe and have culture integrated into their healthcare.
Waikato Tainui kauma¯ tua George Tukere hopes the authority will see the end of racism in the system. ‘‘When you get the actual treatment it’s good, but for Ma¯ ori we have to wait for it, so it’s not good,’’ he says.
‘‘They put you at the back and that’s the truth, I’ve been through it
. . . They tell you to go away and come back and Ma¯ ori will go away . . . That’s in the system, the hospital system, Ma¯ ori in the back. I experience it all the time.’’
Joe Fisher hopes that rongoa¯ Ma¯ ori is made a priority alongside Western medicine when the Ma¯ ori Health Authority is fully functioning. ‘‘I’ve gone to one of my koro’s doctors who is a traditional Ma¯ ori doctor . . . and I’ve found, depending on what it is, that it actually works better.’’
Nikita Nepia hopes for more Ma¯ ori doctors and nurses, while Jason Atutolu wants an environment that puts the patient first.
Atutolu says his experience of the health system has left him with the impression that, if he were Pa¯ keha¯ , he would have been treated better.
He was wheelchair-bound for three years, he says, after an ankle sprain was misdiagnosed as gout. Left untreated, the sprain developed into septic arthritis. Despite telling his doctor that he felt like it was something else, he wasn’t heard.
‘‘I’d like to feel that the nurses, the receptionist and the doctors care about us, you know, just take the time to listen and try and get you what you need.
‘‘It would be great to see that, and that everybody just gets treated as one, not only Ma¯ ori but everybody.’’
Hana Rawhiti Maipi-Clarke wants all aspects of Ma¯ ori wellbeing taken care of in the new system.
‘‘The system has never catered for Ma¯ ori, it doesn’t work for Ma¯ ori because we are put in a category where we have to fit the health system, when in fact it doesn’t fit us,’’ she says.
‘‘They have never attempted to try and help or to try and fix the
situation in moulding towards our culture, but now in a turn of events, it’s our opportunity to change and let Ma¯ ori take care of our own health.’’
Associate Health Minister Peeni Henare supports Maipi-Clarke’s views and expects a new Ma¯ ori health service would take a holistic approach to Ma¯ ori wellbeing.
As the minister responsible for housing, health, and Wha¯ nau Ora, Henare says these things could be included as part of Ma¯ ori wellbeing.
‘‘It’s hard to imagine something that you’ve never had. This is our opportunity to truly imagine what our ancestors imagined for us. The opportunity for carving out wellbeing for ourselves.
‘‘When I was at the Matatini draw, all the speakers said: ‘Peeni, look at our people doing the haka and singing, this is the Ma¯ ori health authority.’
‘‘That’s about our language, our customs, our wairua – that is the holistic approach I expect from a Ma¯ ori Health Authority. But I say that knowing that the detail is still yet to be led out by our experts, but that is an expectation I have, that it is holistic enough to include those things.
‘‘What Te Puea did was groundbreaking in her time, and we now have the opportunity to grow from that.’’
Back at Tu¯ rangawaewae, Raumati reflects on He¯ rangi’s legacy, and the direction Ma¯ ori health is taking. She is excited about what the authority could mean for Ma¯ ori.
‘‘When I first got into health 25 years ago I was optimistic, but I was naive to how the system actually works.
‘‘When [Health Minister Andrew Little] made that announcement I was shocked in a happy way because us Ma¯ ori who work in the health sector have felt the sense of optimism come back, and it has just grown exponentially since.
‘‘It’s got all the elements that we need – the ability to control the investment in Ma¯ ori health, the emphasis on prevention, ko¯ rero about localities being able to identify their own needs and drive how the service in their community will respond to that need – it’s amazing.’’
She hopes the authority will invest in iwi-operated and owned health services, which she says is the difference between replicating an old system and creating a more targeted service that knows the needs of the community and can meet that need.
She says that would look like facilities and availability of services in all rural communities, without the economic fear of being sent to Hamilton.
Outside Ma¯ hina¯ rangi wharenui, Raumati, who is versed in its rich history, says it is now used as a reception room for visiting dignitaries and guests.
She feels He¯ rangi would feel disappointed it has taken this long to form a Ma¯ ori health authority, but would be happy that it’s finally happening.
‘‘Despite not getting the hospital, she still carried on with her focus around health, she was a strong believer in preventative medicine.
‘‘There’s a statistic we read about in her book which said, by the 1940s, Ma¯ ori in Waikato’s health statistics equalled that of the non-Ma¯ ori population. Now if we think of the disparity and health statistics that currently exists for our people it suggests that, if leadership had taken more lead from her, we wouldn’t be in the situation we currently are.’’
‘‘Mehemea ka moemoea¯ ahau, ko ahau anake. Mehemea ka moemoea¯ ta¯tou, ka taea e ta¯ tou.’’
‘‘If I dream, I dream alone. If we dream as a collective we can achieve our dream.’’