The Taumata Rongoā team at Rawene Hospital viewing plans to boost Rongoā Māori in Northland. Photo / Tania Whyte
Covid-19, our biggest health crisis in a century, has thrust healthcare into the spotlight. Over the next five days, the Northern Advocate will explore the role the health system plays in communities across Northland. Today, Adam Pearse talks to the people who are at the heart of community-based healthcare.
In the Hokianga, there has always been a strong desire to tailor healthcare services to its community.
The Hokianga Health Enterprises Trust, formed in the early 90s, comprises a 20-member committee hailing from across the area which manages Rawene Hospital alongside nine satellite clinics dispersed across north and south Hokianga.
At its core, the trust's focus is providing bespoke, meaningful healthcare to its community – a key component of Heather Simpson's Health and Disability System Review released in March this year, which could inform the future of healthcare in New Zealand.
A prime example of this style of healthcare provision lies in the hospital's burgeoning Rongoā Māori programme – Taumata Rongoā, meaning Rongoā Potential.
Over the past few years, Taumata Rongoā has been providing traditional Māori healing practices and products using such plants as Kawakawa, matipo and mumarahou in topical ointments, analgesic balms, oils, soaps and tea.
However, Rongoā Māori has quickly gained traction over the past year after introducing an education programme alongside Ringa Atawhai Mātauranga (wananga training establishment) to bolster knowledge of Rongoā Māori within whānau, marae and community.
Suspected to be the only hospital in New Zealand running such a programme, almost 60 people will achieve level three Rongoā Māori certification by the end of the year, which included 20 hospital staff. The course, which would be added to by a level four certification next year, was run by Amy Bristow, a local, skilled Rongoā Māori practitioner.
During the first Covid-19 lockdown, Rongoā Māori became a valuable part of the support the trust provided to its community. In total, more than 2600 Rongoā Māori products were developed and given to vulnerable community members inside food parcels, which were distributed across the Hokianga.
"We put together the Rongoā packs really to provide purposeful, natural, easy ways of looking after yourself, but they also provided comfort for a lot of people, bringing back a lot of memories," Taumata Rongoā team member Faith Murray said.
"What we are doing in Hokianga is by Hokianga, from Hokianga, for Hokianga - we aren't taking things from outside."
Rawene Hospital services manager Christine Dorsey was a strong proponent of Rongoā Māori and saw how it could become a valuable part of Northland's medical landscape.
"Instead of looking all the time at illness and sickness, Rongoā is actually saying, this is a pathway to wellness, it's not about your disease, it's about how well you can be and not just physically well, also spiritually.
"It's not just about giving someone some cream, it's actually that someone went and harvested that and said karakia so there's a whole lot of spirituality gone into that, so when that cream goes to that person, they relate back to all of those things."
Since incorporating more Rongoā Māori as an option at the hospital, Dorsey said the reaction from some patients had been eye-opening.
"I gave [a patient] some Kawakawa balm for her legs and I just put it beside her and she cried, and that made me realise that it's more than just a cream."
Taumata Rongoā team lead Hone Taimona said plans had been formed to grow Rongoā Māori gardens and walkways on hospital grounds, cementing its future in healthcare provision in Hokianga.
Taimona said the value of Rongoā Māori in Hokianga was its connection to the community, which was 75 per cent Māori and more comfortable with healthcare they recognised.
"[Healthcare in Hokianga] can't be like coming from just down the road and you're looking at Whangārei, because straight away you're distancing yourself from the people," he said.
"We are able to deliver and serve our people in that way of using our cultural connectedness, using our whakapapa, using our knowledge and share it, the main thing is to share it."
Taimona hoped Rongoā Māori could soon become a mainstay of healthcare in Tai Tokerau, not just for Māori but for all Northlanders.
"If Hokianga can do it, why can't others do it?"
Trust chief executive John Wigglesworth, who has lived in the community for 35 years, saw the value of tapping into local resources to broaden healthcare provision.
"This idea of Rongoā is that the knowledge exists already in people in how to keep themselves well, why not tap into that?
"Let's go back to our roots of knowledge about how people used to look after themselves, particularly for Māori."
During the first Covid-19 lockdown, staff across the health sector in the Hokianga were repurposed as services were shut down or adapted. Wigglesworth said this prompted staff to come up with their own solutions to help their community.
"Staff started to do the things they thought was the right thing to do, so it was a bit loose around that and of course I allowed that because that's what we needed to do."
Similar measures were implemented in Kaitaia. With little direction from the DHB thanks to the extraordinary time pressure, Kaitaia Hospital acted swiftly to ensure the facility was safe.
"We had to work it out ourselves and then we did that quickly and turned the ward into the red zone [for Covid patients]," Kaitaia Hospital operational manager Neta Smith said.
Despite it being one of four Northland DHB secondary care hospitals, Smith said the facility was much more community focused. As a local herself, Smith said values of people first and respect were paramount.
"I'm embedded in my marae and community, so I know the contacts too, so I think that is different.
"The cleaner's job is just as important as the doctor trying to save someone's life."
She said the staff's links within the community saw more informed decisions being made around healthcare provision.
George Reilly from Te Rūnanga o Te Rarawa's social services division echoed Smith's thoughts, saying if services didn't match the need or culture of a community, whānau would suffer.
"When [people] get to those services, they are dissatisfied with many of the practitioners there, they don't seem to have an ability to form relationships with people that make them feel comfortable, so if they are not comfortable, they won't give best information about their afflictions and they won't necessarily return if there is a slight concern in their health," he said.
Reilly identified the runanga's programme Tūturu Tangata, which focused on developing innovative Māori health initiatives for youth, as a good example of tailored community healthcare.
"We put them on a marae, make them have fun, have experiences they wouldn't normally have, but all the time raise their knowledge of tikanga, whakapapa, their relationship to land."
He hoped similar initiatives would promote the prospects of whānau in the area.
"[Through these programmes], it will be normal for Māori to be healthy, to be educated and to be employed," he said.
"If you can concrete on these three things, the subsequent health aspirations would be much more improved."
Te Hau Ora O Ngāpuhi chief executive Te Ropu Poa said to provide health and social services for her whānau in the wider Kaikohe area, they had to be grounded in culture.
"For Māori, you have to base it on tikanga, the key things that matter to us as a people and it's quite different [to Pākehā], our world is different."
Poa believed more work needed to be done to consult with whānau to ensure services met their need.
"We need to include our whānau more and ask the right questions," she said.
"Let us work with our people, we know them, and we can have that influence which is required."
The need for extensive knowledge of communities was reinforced for Māori health and social service providers during the Covid-19 outbreak earlier this year.
With personal protective equipment deliveries late and little national guidance to work from, providers had to rely on their knowledge of what worked best for their community.
"There was an absence of best practice guidelines for Māori providers," Te Hiku Hauora chief executive Bill Halkyard said.
"There was no central or even regional body which spoke for Māori providers who are delivering community outreach, therefore most at risk."
Ngati Kahu social and health services chief executive Marihi Langford said while her team was put under immense pressure, she enjoyed seeing the restrictions of how they provided their services relax.
"The most exciting thing to come out of it was the contract criteria was loosened, so people got help," she said.
"We know who the community people were, we knew where the need was, and we just went and did it."
For Errol Murray, general manager of the country's northernmost healthcare provider Whakawhiti Ora Pai, working with little guidance and restricted resources was common.
"It's become the norm that we practice in, we will work with what we've got."
However, Halkyard, Langford and Murray all agreed the pandemic had brought them closer together as service providers. Prior to Covid-19, Langford said they might have congregated twice a year whereas during the outbreak, they were communicating twice a week.
"Because our community is quite separate, representation collectively makes us a lot stronger and we can be a lot more vocal."
Murray said it was vitally important Māori health providers collaborated in a pandemic environment, citing the high death rate for Māori during the 1918 flu pandemic.
"We're not going to lose people, we don't care what the Government says, we're going to work with what resources we've got, to protect our vulnerable."
Halkyard said the pandemic had recognised the invaluable role Māori health providers had in healthcare provision and reinforced the need for a holistic, whānau ora approach to healthcare.
"What it tells us is that a clinical response is never going to be sufficient, especially for Māori who are at the bottom of the heap."
Post-season monitoring recorded 50 individual tara iti, up from 33 last year.