Tikanga

Helpful Tikanga

Māori health professionals who work outside their own rohe (region) will usually seek advice from local Māori about the correct tikanga to use in the host area. There are many variations in tikanga between iwi; what is important for one iwi may not be so important for another iwi, rohe-to-rohe – region-to-region. Tikanga may vary at different times and in different circumstances. Māori tūpuna were resilient and adaptable in times of difficulties and their descendants are the same. COVID-19 proved that Māori can mobilise in different ways at end of life to care for their ill and dying, albeit under difficult circumstances and in different situations. Being respectful of peoples’ cultural beliefs helps to keep everyone safe.

Tikanga are cultural customs that help to keep whānau safe. Tikanga are particularly helpful when caring for ill kaumātua and their whānau.

Examples of basic tikanga:

When visiting someone’s home it is appropriate to remove your shoes at the door and wait to be invited inside. Allow time for introductions. Instead of launching into your health care tasks, wait to see what format the kaumātua or whānau wish to use to begin the meeting. If you are unsure, ask them how they would like to start (they may want to say karakia or have a mihi (speech) before you continue.
Provide time and space for whakawhanaungatanga (establishing relationships) and karakia (prayers) and mihi (greetings).
Within all health care settings or in a home, avoid placing medications and hygiene products on tables or surfaces used for food.
Ensure curtains are closed if you the kaumātua is unclothed.
It is helpful to have colour coordinated face cloths (for example, white for faces and green for private parts).
It is important that you are aware that certain parts of the body may hold specific cultural meanings for kaumātua; avoid passing objects above someone’s head, for example. Be very respectful and discrete when you are touching someone’s private parts. There may be a whānau member present that the kaumātua would prefer to wash them, for example.

Local Tikanga

Māori health professionals who work outside their own rohe (region) will usually seek advice from local Māori about the correct tikanga to use in the host area. There are many variations in tikanga between iwi; what is important for one iwi may not be so important for another iwi and, rohe-to-rohe – region-to-region.

Tikanga may vary at different times and in different circumstances. COVID-19 for example, proved that Māori whānau mobilise in different ways at the end of life to care for their ill and dying, albeit under difficult circumstances and in different situations. Māori tūpuna were resilient and adaptable in times of difficulties and their descendants are the same. Being respectful of peoples’ cultural beliefs and customs helps to keep everyone safe.

Matua Hugh (hospice volunteer) would ask whānau/families if he could leave shoes on when entering someone’s home; this is a health and safety practice which is not aligned with Māori protocols. However, he explains it to each whānau he visits to provide a rationale for their behaviour:

We get to a Māori house, regardless of which house it is, the first question I ask, ‘Can we leave our shoes on?’ To us [workers] it’s a health and safety thing. I said, ‘I know it’s stepping over our kaupapa, but we also have responsibilities to ourselves, to our safety. And if we want to be performing what it is that we do, there are certain guidelines that we need to do’.

In her interview, Kui (health care assistant) explained how she works with Māori whānau staying in hospice. Kui emphasised that her role is to awhi the patient and the whānau to ensure they understand the caring process and to support their personal values and tikanga:

I feel that being Māori… they [patients] come closer… they put themselves closer to me… I’m one Māori in the whole of [Hospice]. I’m the only Māori that works there as a caregiving nurse - there’s no other Māori. So, when we have Māori family of course the nurses deal with what’s going down for the medication side because we don’t [do that]. All I do is make sure they’re okay… I could help shower him or her… and just let them know that’s what I’m there for. Its to help in any way I can. Let them understand… I will do anything to make things easier. But I ask them, ‘Are you okay with what’s happening? Can you give us permission to… would you like us to wash him?’ Because a lot of Māori are very whakamā [embarrassed, shy] and they will not, they don’t want just anybody washing their families.

A simple thoughtful act, like taking your shoes off at a person’s door before entering their home, can show respect and humbleness for people and their possessions. Kahu (hospice nurse) describes her experience of this:

I guess like one time I did go out [on a home visit]. Was quite interesting. I went out with [a non-Māori consultant] … And we went to this whānau’s home, and when I walked in, immediately I looked at the carpet and it was like, you know, very luscious. So, I thought ‘people do not wear their shoes here’. So anyway, I flicked my shoes off, and I walked down this carpet - beautiful carpet. Sit in the room and there’s the photos of all the whānau. Anyway, we get in there and this person turns around and goes, [said angrily] ‘It’s you again!’ like that. And then she sees me and goes [said nice and softly], ‘Oh, I didn’t know you were with her dear. Oh,’ and then sits down and goes, ‘how are you?’ Like that, right? After she’d like spun out at [name of non-Māori consultant who had their shoes on].

To help whānau uphold their traditions, GP K. said health services require flexibility, to allow whānau the space to be who they are, and to do what they need to do for themselves:

I guess I mean for those that know its time - space. Allowing, you know, not forcing another way upon [them], do you know what I mean?

Recommendations

For health and palliative care professionals, we recommend:

Familiarise yourself with the tikanga practices of whānau who use your services. If you are in doubt, ask whānau about their care practices and how you can best support them. Some hospices and district health boards have already implemented policies and guidelines to help their staff. Unfortunately, these are often ignored.
Familiarise yourself with organisational policies and guidelines that may already be in place relating to tikanga Māori. If you find that these are absent, be a champion for their development.
Grow your awareness of tikanga Māori (Māori customs) and implement practices that help to support them, especially when working with Māori whānau.
Build your knowledge of Te Tiriti o Waitangi (1840) (the Treaty of Waitangi) and its application within health and palliative care services.
Be aware that many Māori whānau today may feel culturally vulnerable having lost contact with their ancestral ties, language and customs. If you feel in need of expert cultural help (supervision, mentoring, and training), approach your employer to arrange this. Every health organisation has a responsibility to provide culturally safe care to ensure Māori feel protected accessing and receiving services.
Keep in mind that not all whānau may be culturally vulnerable. There are many whānau who have fluency in their Indigenous language, and they can also have a deep level of knowledge about their own tribal tikanga.
Participation in bicultural training is helpful for highlighting colonisation and its implications, along with the Crown’s responsibility towards Māori and the necessity of having genuine and sincere partnerships with Māori.

For health and palliative care services, we recommend:

Staff are supported to become familiar with tikanga Māori, Māori end of life care practices and Te Tiriti o Waitangi (1840.
Staff are supported to learn te reo Māori and tikanga Māori.
Provide access to cultural supervision for your staff.

Things to learn