Handover | Issue 31 — Autumn, July 2015

By Hinemoa Elder – Professorial Fellow, Eru Pomare Postdoctoral Fellow, Te Whare Wānanga o Awanuiārangi, FRANZCP, MBChB, PhD

While the concept “he tapu te ūpoko” (the head is sacred) is well known and something many of us have grown up with, I have been surprised that it had not previously been used as a spring board to explore the richness of mātauranga Māori about the brain, head and mind.

I have been privileged to meet and work alongside whānau who experienced traumatic brain injury (TBI) in my psychiatric training and work as a consultant psychiatrist, and it struck me that a comprehensive Māori cultural approach to TBI was needed. Part of this realisation stemmed from the absence of any established comprehensive cultural approach to such a circumstance and the observation that when I explored their tikanga understandings and needs with whānau I was encouraged by the positive responses. Questions arising from these observations work form the basis of my doctoral and post-doctoral studies.

I want to take the opportunity to encourage consideration of doctoral research for all health workers. We bring a wealth of applied hands-on experience that conveys a unique ability to contribute to the wider knowledge base. Building research skills also feeds back into improving our work with whānau as we hone our ability to critique information that might assist our collaborative journey – as well as driving creative approaches in what we offer.

The core findings of my research, determined by Rangahau Kaupapa Māori methodology and methods following 18 wānanga across the country are ngā pō e whitu, seven principles. First, wairua must be attended to as a priority. Why? The theory I have developed proposes that injury or indeed insult to the brain also causes a disturbance to wairua. This means there is a culturally determined insult that indicates a cultural response to that specific aspect. Second, the whānau is the unit of care and healing, in other words the TBI happens to the whole whānau. Whānau is the functional unit of healing.

This challenges the current rehabilitation paradigm that is individual and independence focused and these concepts that can be problematic where collectivist ways of being and knowing are privileged. Next, I found that whānau experience the clinical world as an alien culture. A salutary message and yet one worthy of putting into action in order to make the structures and spaces we work in safer for Māori in a number of structural and personal ways. This research identified that mātauranga Māori has a wealth of resources specific to traumatic brain injury. These include use of te reo me ōna tikanga, oriori, karakia, waiata, raranga, whakairo, mirimiri, romiromi. It also identified that part of our role is to support whānau who may not recognize they hold these latent resources within whakapapa to discover whānau members who can bring these forward.

The participants were also clear that Māori identity is about connection, this challenges us to look for ways to enhance a sense of place and to use pepeha to connect whānau with those places that reinforce a healing Māori identity. Places were also recognised as they have an important healing role because they define identity.

Finally, other trauma is remembered within whakapapa when traumatic brain injury discussion is invited. This invites an intergenerational approach to understanding and supporting healing for unresolved experiences as this is proposed to optimize outcomes (Elder, 2013a, 2013b).

While this work was developed in the context of TBI I am mindful that there is likely to be the possibility of wider application in the areas of mental health and addiction. Certainly, in presenting the work nationally and internationally this has been the reaction.

I am currently working through a robust validation process of a tool, based on these principles and theory for front line health workers that I hope to have ready for use in 2016. In closing I would like to acknowledge the Health Research Council for supporting my research.

References
Elder, H. (2013a). Indigenous theory building for Māori children and adolescents with traumatic brain injury and their extended family. Brain Impairment, 14(3), 406-414.
Elder, H. (2013b). Te Waka Oranga. An indigenous intervention for working with Māori children and adolescents with traumatic brain injury. Brain Impairment, 14(3), 415-424.