title: Desirable attributes for medical graduates: The health aspirations and needs of Maaori living in Te Rohe Pootae

authors: Maikuku, Victoria Louisa Wikitoria

abstract: Health disparities for Maaori, the tangata whenua of Aotearoa New Zealand, are prevalent when compared to the health of European New Zealanders, and even more so in remote and rural communities where access to health-care services is limited. Moreover, Maaori are underrepresented in the medical workforce in which there is a serious and escalating shortage of doctors and nurses.

In the context of the University of Waikato’s proposal to establish a Graduate Entry Medical School, Te Huataki Waiora School of Health has identified the need for a collaborative approach to ‘growing’ a fit-for-purpose health workforce with the skills and commitment to care for and work with Maaori (and Pacific peoples) living in remote and rural communities. This study thus explores the health perspectives, needs, and aspirations of Maaori living in and around the King Country rural service towns of Te Kuiti and OOtorohanga. Conducted by a Ngaati Maniapoto tribal member, the location for the study is known by Maaori as Te Rohe Pootae - the lands of Rereahu/Maniapoto, to which the Waikato people sort refuge after the invasion and confiscation of their lands in the 1860s. The perspectives, needs, and aspirations of Pacific peoples living in these communities have been explored in a ‘sister’ Masters study conducted by Janina Galewski.

The present exploratory study incorporates a co-design research process underpinned by an Indigenous health framework with Kaupapa Maaori values. Kanohi ki te kanohi (face to face) semi-structured interviews were conducted with 30 community members, 11 males and 19 females aged 18 years and over. The data analysis included a combination of values, verses and holistic, and provisional coding methods (focused, thematic, descriptive) (Saldana, 2021).

The findings reveal that these community members view themselves as either rural or remote based on distance, access to services, and geographic isolation, but not population numbers. In terms of services, they want a mobile health workforce including clinics, carers, doctors, nurses; mental health workers who are equipped with the resources and time needed to reach and serve their patients; and better access to dialysis and related services. The research also identifies three healthcare strategies. When ill or injured, one-third of the group go directly to their GP; one-third try other things before seeking medical assistance, including going home to their parents and/or to their marae for comfort and advice, ‘going bush’ to (re)connect with nature, and forms of pure (cleansing rituals); and although the remaining third are registered with medical centres they do everything they can to avoid seeing a doctor at all. Instead, they rely on rongoaa and other ‘complementary and alternative’ treatments such as physiotherapists, chiropractors, osteopaths, and other healers. 

Adopting and adapting a table created by Woolley et al. (2013), the findings also revealed three sets of desirable attributes for medical graduates (and other healthcare professionals): Skill-based attributes include quality care and communication skills, knowledge-based attributes include medical knowledge and culturally appropriate knowledge, while attitude-based attributes include personality and community engagement. This framework can be used to inform a medical education curriculum, with a specific emphasis on the health needs and aspirations of Maaori living in rural and remote communities.

text: Desirable attributes for medical graduates: The health aspirations and needs of Maaori living in Te Rohe Pootae Health disparities for Maaori, the tangata whenua of Aotearoa New Zealand, are prevalent when compared to the health of European New Zealanders, and even more so in remote and rural communities where access to health-care services is limited. Moreover, Maaori are underrepresented in the medical workforce in which there is a serious and escalating shortage of doctors and nurses.

In the context of the University of Waikato’s proposal to establish a Graduate Entry Medical School, Te Huataki Waiora School of Health has identified the need for a collaborative approach to ‘growing’ a fit-for-purpose health workforce with the skills and commitment to care for and work with Maaori (and Pacific peoples) living in remote and rural communities. This study thus explores the health perspectives, needs, and aspirations of Maaori living in and around the King Country rural service towns of Te Kuiti and OOtorohanga. Conducted by a Ngaati Maniapoto tribal member, the location for the study is known by Maaori as Te Rohe Pootae - the lands of Rereahu/Maniapoto, to which the Waikato people sort refuge after the invasion and confiscation of their lands in the 1860s. The perspectives, needs, and aspirations of Pacific peoples living in these communities have been explored in a ‘sister’ Masters study conducted by Janina Galewski.

The present exploratory study incorporates a co-design research process underpinned by an Indigenous health framework with Kaupapa Maaori values. Kanohi ki te kanohi (face to face) semi-structured interviews were conducted with 30 community members, 11 males and 19 females aged 18 years and over. The data analysis included a combination of values, verses and holistic, and provisional coding methods (focused, thematic, descriptive) (Saldana, 2021).

The findings reveal that these community members view themselves as either rural or remote based on distance, access to services, and geographic isolation, but not population numbers. In terms of services, they want a mobile health workforce including clinics, carers, doctors, nurses; mental health workers who are equipped with the resources and time needed to reach and serve their patients; and better access to dialysis and related services. The research also identifies three healthcare strategies. When ill or injured, one-third of the group go directly to their GP; one-third try other things before seeking medical assistance, including going home to their parents and/or to their marae for comfort and advice, ‘going bush’ to (re)connect with nature, and forms of pure (cleansing rituals); and although the remaining third are registered with medical centres they do everything they can to avoid seeing a doctor at all. Instead, they rely on rongoaa and other ‘complementary and alternative’ treatments such as physiotherapists, chiropractors, osteopaths, and other healers. 

Adopting and adapting a table created by Woolley et al. (2013), the findings also revealed three sets of desirable attributes for medical graduates (and other healthcare professionals): Skill-based attributes include quality care and communication skills, knowledge-based attributes include medical knowledge and culturally appropriate knowledge, while attitude-based attributes include personality and community engagement. This framework can be used to inform a medical education curriculum, with a specific emphasis on the health needs and aspirations of Maaori living in rural and remote communities.

year: 2022

title: Experiences from the past inform the journey ahead: ‘a way of being’ - culturally responsive and relational professional learning and development.

authors: Murray, Tracy Olive

subjects: Culturally responsive and relational angragogy

abstract: This thesis begins by contextualising the current reality for many Māori learners in Aotearoa New Zealand.  By reviewing the literature around the role of the provider in professional learning and development (PLD) in Aotearoa New Zealand, this thesis seeks to explain a new way of working that has not been well documented before.  Provided is the rationale for the methodology undertaken in the research to ensure the relationship with the participants remained at the heart of the process.  This thesis contends that applying culturally responsive and relational pedagogy across all levels of schooling is a unique way of being that requires deep critical self-reflection and conscious ongoing change in practice.  Learning what to stop doing and what to do differently is part of an ongoing cycle of inquiry that educational leaders at any level must engage in, to implement change in schools for Māori learners.

text: Experiences from the past inform the journey ahead: ‘a way of being’ - culturally responsive and relational professional learning and development. This thesis begins by contextualising the current reality for many Māori learners in Aotearoa New Zealand.  By reviewing the literature around the role of the provider in professional learning and development (PLD) in Aotearoa New Zealand, this thesis seeks to explain a new way of working that has not been well documented before.  Provided is the rationale for the methodology undertaken in the research to ensure the relationship with the participants remained at the heart of the process.  This thesis contends that applying culturally responsive and relational pedagogy across all levels of schooling is a unique way of being that requires deep critical self-reflection and conscious ongoing change in practice.  Learning what to stop doing and what to do differently is part of an ongoing cycle of inquiry that educational leaders at any level must engage in, to implement change in schools for Māori learners.

year: 2018

title: Historical anthropogenic heavy metal input to the south-eastern North Sea

authors: Boxberg, Florian

abstract: The Helgoland Mud Area (HMA) in the German Bight, covering an area of approximately 500 km2, is one of a few depocentres for finer sediments in the North Sea. Radiocarbon and 210Pb analyses revealed continuous sedimentation over the last several centuries. Zinc (Zn) and lead (Pb) contents in the sediments show a distinct increase towards the youngest most sediments with the thickness of the heavy metal enriched sediments ranging from 15 to 103 cm. Stratigraphic data indicate that the onset of heavy metal enrichment is diachronous progressing north-westward over the depocentre, paralleled by a decrease in the thickness of the enriched layer. Beginning already during medieval times, the enhanced input of Zn and Pb seemingly is related to silver and zinc mining in the Harz Mountains and the Erzgebirge, well-known mining areas since the Bronze Age. Both regions are directly connected to the HMA by the Elbe and Weser rivers. Zn and Pb enrichment began in the south-eastern HMA and progressed subsequently with an average of 10 m per year north-westward, most likely triggered by variations in river discharge and by the hydrodynamic setting. Quantitative assessments of the Zn and Pb content in the sediments suggest that since the onset of enhanced Zn and Pb deposition, the anthropic Zn and Pb input in the HMA amounts to ~ 12,000 t and ~ 4000 t, respectively.

text: Historical anthropogenic heavy metal input to the south-eastern North Sea The Helgoland Mud Area (HMA) in the German Bight, covering an area of approximately 500 km2, is one of a few depocentres for finer sediments in the North Sea. Radiocarbon and 210Pb analyses revealed continuous sedimentation over the last several centuries. Zinc (Zn) and lead (Pb) contents in the sediments show a distinct increase towards the youngest most sediments with the thickness of the heavy metal enriched sediments ranging from 15 to 103 cm. Stratigraphic data indicate that the onset of heavy metal enrichment is diachronous progressing north-westward over the depocentre, paralleled by a decrease in the thickness of the enriched layer. Beginning already during medieval times, the enhanced input of Zn and Pb seemingly is related to silver and zinc mining in the Harz Mountains and the Erzgebirge, well-known mining areas since the Bronze Age. Both regions are directly connected to the HMA by the Elbe and Weser rivers. Zn and Pb enrichment began in the south-eastern HMA and progressed subsequently with an average of 10 m per year north-westward, most likely triggered by variations in river discharge and by the hydrodynamic setting. Quantitative assessments of the Zn and Pb content in the sediments suggest that since the onset of enhanced Zn and Pb deposition, the anthropic Zn and Pb input in the HMA amounts to ~ 12,000 t and ~ 4000 t, respectively.

year: 2019