See me as a whole I am more than my cancer. Te Whare Tapa Wha: A holistic model of well-being

Transcription

1

2 See me as a whole I am more than my cancer Te Whare Tapa Wha: A holistic model of well-being Lisa Cherrington, Clinical Psychologist/ Scriptwriter This workshop was orgiinally presented in 2012 in conjunction with CNN Equity Manger, Carol Wrathall, Pauline Wharerau (Maori Cancer co-ordinator Whakapai Hauora) Lorraine Searanke (Kaiawhina for Ward 23, Te Whare Rapuora) and Lizzy Kent, Cancer Psychology Service

3 Overview What is Te Whare Tapa Wha (TWTW)? What is Hua Oranga? Practical application: Case study Using Te Whare Tapa Wha as a stocktake, plan and reflection when working with Maori clients and whanau

4 WHAT IS TE WHARE TAPA WHA (TWTW)? A Maori model of health/ well-being developed by Mason Durie in 1980 s Holistic view of wellbeing that states in order to be at one s optimal health, all area s need to be in balance and working order Each dimension is integrated, intertwined

5 TE WHARE TAPA WHA

6 Te Taha Hinengaro The capacity to communicate, to think and to feel (Durie, 1998)

7 Te Taha Hinengaro Mind and body are inseparable Cultural/ clinical issues: Use of te reo to communicate Beliefs about cancer, what s causing it? Understanding/ comprehension about medical treatment process Feelings of isolation/ disconnection in medical system Beliefs about tikanga, tapu/ noa, wairua Whakama Pouri Lack of motivation to engage in treatment process

8 Te Taha Tinana (physical health and environment) The capacity for physical growth and development (Durie, 1998)

9 Good physical health is necessary for optimal development (Durie, 1998) Sacredness of the body - Tapu and noa emphasis Taha tinana is turning to nature for herbal compassion, utilising rituals for physical appeasement, keeping the soul and body intact (Te Roopu Awhina Tautoko, 1987) Practical issues income, housing, food

10 Te Taha Tinana Cultural/ clinical issues Western medicines AND rongoa/ karakia Sense of tapu about own body parts Hospital environment eating, washing, toileting in same place Shelter and food are priorities? Accessing medical system at a very late stage Urban vs rural/ turangawaewae

11 Te Taha Whanau (family and relationships) The capacity to belong, to care and to share (Durie, 1998)

12 Te Taha Whanau Refers to family, extended family and sense of belonging and connection with The capacity to belong, to care and to share (Durie, 1998) Individuals are part of wider social systems (Durie, 1998) Identity/ whakapapa/ connection Interdependence a strength

13 TE TAHA WHANAU Clinical/ cultural issues Identity as a Maori Tuakana/ teina Kuia/ kaumatua Obligations to whanau Whakapapa Whanau, hapu, iwi connections Whakawhanaungatanga sense of connection with family AND medical staff Whanau beliefs about cancer Support from whanau Is it appropriate? Expectations of whanau, ability of whanau to communicate with clinician s Involvement with other groups/ associates (gangs, sports, church, Maori)

14 Te taha wairua (spirituality) The capacity for faith and wider communion (Durie, 1998)

15 Te taha wairua (spirituality) Te taha wairua is probably the most difficult area to define, assess and understand yet it is the most important area and intertwined with every other taha - Refers to spiritual well-being, not just religion - Beliefs in a non-physical dimension or force (Kingi, 2002) - Health is related to unseen and unspoken energies (Durie, 1998) - A relationship also with the environment and ancestors - Intuition (which is also connected to hinengaro)

16 Taha Wairua is the unforgettable cry of birth the magical moment of natural death Taha wairua makes the intolerable, tolerable the biased, objective; despair, hopeful and man kind, God like It is the seed for world peace, the power for brotherly and sisterly love and the crucial element for the maturity of mankind (Te Roopu Awhina o Tokonui, 1987)

17 Wairua Na Heather Delamere Thomson Koro, what is wairua? the child asked, eyes wide Wairua, my moko is what gives us life Handed down to us from a time past At the moment of your beginning You shared with me the wairua of your tipuna: For I am your link with the past And you are my link to the future The aroha of the whanau has wairua And their words, their laughter, their tears The marae, tangi, waiata and whakapapa Have a wairua that strengthens us, gives us pride

18 So too the sunrise and sunset The soft summer rain, the raging storm, The song of the birds in the trees, The waves on the beach The mist rising from the bush The moonlight on the water And the embracing darkness of the night To sit quietly in the wharenui or the urupa And feel the presence of your tipuna is to feel wairua Your arms around my neck, your breath on my cheek, Fills me with a special wairua For there is wairua in all things that give meaning to life To love, to the future

19 So moko, open your mind, Let your heart love Your eyes see Your ears hear Your hands feel Give of yourself, my moko For in giving, you receive And the wairua grows. Na Heather Delamere Thomson

20 Te taha wairua Clinical/ cultural issues Beliefs and connection with spirituality and /or religion Tapu and noa Makutu, mate Maori what s causing cancer? Use of and beliefs in tohunga, rongoa, karakia, moemoea, purakau, taonga, tohu Tangihanga Life s purpose Connecting with spirituality how do they do this? What makes them feel centred, uplifted in some way (ie listening to music, going to the ocean, laughing with their children)

21 Rona s story:

22 26 year old Maori woman on Ward 29 who had just had her stomach removed as she had recently been diagnosed with stomach cancer and family had been identified as having stomach mutation gene. Other family members were being tested for the gene and cancer. Rona s mother had been diagnosed with stomach cancer. Rona had been living in Fiji with her 4 year old daughter and partner, but had come back to New Zealand with her daughter to be with her mother. Family members noticed that Rona had lost a significant amount of weight and Rona had reported stomach pains. Rona had been informed by her mother s own GP that her symptoms were all in her head and learned behaviour. However, family members advocated for Rona to be tested because of the mother s own cancer. On the day that Rona s mother died, Rona had been informed that her own stomach cancer was not terminal. However, she would need to have her stomach removed.

23 A family member who knew about the Cancer Psychology Service made the initial referral. The aunty was concerned for Rona s psychological well-being as Rona had a previous history of self-harm and bipolar disorder. In meeting with Rona on Ward 29, she identified frustration at only being able to eat small amounts of food and did not like that she was continuing to loose weight. I don t do skinny. I want my baby rolls back. I want to feel like a woman. She was trying to organise for family to bring her daughter up to hospital to see her and finding money to do so as her daughter was in Himatangi with whanau. Her partner in Fiji had broken up with her, telling her that he could not handle it anymore. Rona s focus at the initial meeting was on all that I have lost.

24 See me as a whole, I am more than my cancer Using Te Whare Tapa Wha form, stocktake what are the pumanawa (strengths) and kia ata titiro (area s of attention) What else would we want to learn about Rona?

25 How do we honour each taha when working with Maori diagnosed with cancer? Hua Oranga (Maori Mental Health Outcomes Measure) (Kingi, 2002) Developed a Maori mental health outcomes measure based on Te Whare Tapa Wha Through consultation/ hui with key stakeholders identified components within each taha as a way to evaluate outcomes of interventions Clinician, whanau and tangata whaiora forms Useful questions to ask ourselves when working with Maori cancer patients As a result of this intervention do you/ does your patient/ whanau member feel

26 Te taha hinengaro: Capacity to communicate, think and feel *Motivation As a result of the intervention are you more able to set goals for yourself? adherence to treatment regime engaging in healthy life style behaviours (exercising, food) disengaging in unhealthy life style behaviours (addictions) *Cognition and behaviour As a result of this intervention are you more able to think, feel and act in a positive manner - reaction to a cancer diagnosis, distress - sense of control over what is happening - behaviours/ attitudes/ communication with clinicians -attendance at appointments *(Kingi,2002)

27 Te taha hinengaro The capacity to communicate, think and feel *As a result of this intervention are you more able to manage your thoughts and feelings ways of expressing distress verbal, physical, anger, sadness whakama not asking questions or not wanting to be different * As a result of this intervention do you have a better knowledge and understanding of the problem? cultural beliefs around cause of cancer understanding of medical system treatment options, statistics

28 Te Taha Tinana Capacity for physical growth and development * Mobility and pain- ability to move around without pain and distress - need for 24hr nursing care -home environment * Opportunity for enhanced health- commitment to good physical health - accessibility of services - sense of control over cancer process - commitment to improving physical health diet, exercise, adherence to tx regime, life style factors

29 Te Taha Whanau The capacity to belong, to care and to share *Communication ability to communicate With medical staff about cancer process with whanau death and dying issues, tangihanga *Relationships confidence - state of relationships with whanau, staff, clinicians *Mutuality - whanau obligations - mai and atu - change in status from well to sick * social participation - participation in other groups within community Maori organisations, gangs, cancer community

30 Te Taha Wairua The capacity for faith and wider communion DIGNITY AND RESPECT feeling valued as a person As a result of this intervention do you feel more valued as a person? - treatment process CULTURAL IDENTITY strong as a Maori person As a result of this intervention do you feel stronger in yourself as a Maori person? -

31 Te taha wairua The capacity for faith and wider communion * Personal contentment As a result of this intervention do you feel more content within yourself? -identifying what might assist with feeling more content, more at peace * Spirituality As a result of this intervention do you feel healthier from a spiritual viewpoint? - spiritual practises - karakia, prayers, rituals of significance for client, church - creative processes singing, drawing, writing, building

32 Get into groups according to your professional background (4 groups) Using Te Whare Tapa Wha what pathways / plan would you recommend for this case? Feedback to whole group. Are there any similarities or differences?

33 Does the plan/ recommended pathways: 1. Enhance her capacity to communicate, think and feel? 2. Enhance her capacity for physical health and development? 3. Enhance her capacity to belong, to care and to share? 4. Enhance her capacity for faith and wider communion? In particular: Does she feel more valued as a person? Is she stronger in herself as a Maori person? Is she more content within herself? Healthier from a spiritual view point?

34 We connected We shared stories We laughed a lot when the time was right We gave each other a hard time We talked about rituals We talked about being in te po And that te ao marama will come We talked about strength and where hers came from We talked a lot about whanau We cried.

35 Te Taha Whanau Relationships with Maori health professionals Who are our Maori health professionals working specifically with Maori cancer patients and whanau? Maori cancer co-ordinators: Polly Marsters (Te Runanga o Raukawa Levin/Otaki) Doris Peeti (Te Kete Hauora Dannevirke) Chrissy Paul (Te Wakahuia, PN) Kathkeen Hollaway-Smith (Best Care Whakapai Hauora, PN) Te Whare Rapuora PN Hospital: Lorraine Searanke (Kaiawhina for Ward 23, Te Whare Rapuora)

36 HOW DO WE HONOUR TE WHARE TAPA WHA WHEN WORKING WITH MAORI CLIENTS DIANGOSED WITH CANCER?

37 1)Think holistically See me as a whole 2)Reflect using Te Whare Tapa Wha 3) Ask yourself the four outcome questions:

38 Will this enhance his/her/their: capacity to communicate, think and feel? capacity for physical health and development? capacity to belong, to care and to share? capacity for faith and wider communion?

39 I m a solo Mum Rona: I m a good parent I m a solo Mum I m a part time care assistant for the elderly I m the tuakana I m part of a whanau who has this gene I m a beneficiary I m a Maori woman I m a pain sufferer I m a good mate I m a listener to my Mum and Grandma I m an advocate (so give me a job ) I m more than my cancer