title: Māori men and the indirect procurement and sharing of prescription medications

authors: Hodgetts, Darrin

subjects: Māori men

abstract: Māori men have higher rates of many diseases and lower life expectancy than other population groups in New Zealand. The general consensus is that these health inequalities are due to the inequitable distribution of the social determinants of health; for example, education, employment, income and housing, and were largely driven by colonization and the social and economic marginalization of Māori. Health care factors, including reluctance to consult doctors or late presentation, are part of this equation, but do not fully explain the disparities in health between Māori men and other population groups. As part of our ongoing work in this area, we draw on a focus group discussion with seven Māori community health workers to provide a preliminary analysis of how some Māori people access and use medications. Particular attention is given to the emergent practice of Māori women presenting to general practitioners (GPs) with proxy symptoms to obtain medications for their male partners. This practice exemplifies a range of strategies that some whānau (family) have developed to navigate the health system and overcome the reluctance of some men to engage with the medical profession. The practice raises issues relating to the nature of “primary” and “whānau” care, accessibility of medical services and medications, adherence to medication regimes and the dynamics of doctor–patient relations.

text: Māori men and the indirect procurement and sharing of prescription medications Māori men have higher rates of many diseases and lower life expectancy than other population groups in New Zealand. The general consensus is that these health inequalities are due to the inequitable distribution of the social determinants of health; for example, education, employment, income and housing, and were largely driven by colonization and the social and economic marginalization of Māori. Health care factors, including reluctance to consult doctors or late presentation, are part of this equation, but do not fully explain the disparities in health between Māori men and other population groups. As part of our ongoing work in this area, we draw on a focus group discussion with seven Māori community health workers to provide a preliminary analysis of how some Māori people access and use medications. Particular attention is given to the emergent practice of Māori women presenting to general practitioners (GPs) with proxy symptoms to obtain medications for their male partners. This practice exemplifies a range of strategies that some whānau (family) have developed to navigate the health system and overcome the reluctance of some men to engage with the medical profession. The practice raises issues relating to the nature of “primary” and “whānau” care, accessibility of medical services and medications, adherence to medication regimes and the dynamics of doctor–patient relations.

year: 2011

title: Treaty People Recognising and Marking Pākehā Culture in Aotearoa New Zealand

authors: Black, Rosanne Marjory

subjects: Pakeha culture

abstract: The suggestion that all people are cultural and live in cultural worlds acts to challenge members of culturally dominant groups as they tend to see their way of life as normal rather than cultural. Dominant group members usually talk about themselves in relation to their national identity (New Zealander, Australian, or American) rather than name being part of a cultural group within their nation state. This study, located in Aotearoa New Zealand, explores with a particular group of New Zealanders, how Pākehā who are members of the dominant group, may come to recognise themselves as being cultural, to name themselves culturally, and to mark aspects of their culture. The contribution that recognising culture makes to a decolonisation agenda is also explored. This study of Pākehā culture is approached from both a realist and a social constructionist perspective. Culture, an abstract concept, is largely theorised as a constructed notion in a historically structured location. How culture is recognised, and the ways it is produced and enacted, through relationships and interactions in the broader structures of New Zealand society were explored using realist thematic methods of analysis. Treaty people are a network of mostly Pākehā activist educators who have engaged in promoting knowledge of and support for Māori claims for justice under Te Tiriti o Waitangi (the Treaty of Waitangi was the document signed by Settlers and Māori leaders in 1840 to establish settlement arrangements). Treaty people are practised in talking about cultural issues largely through their engagement with Māori - Pākehā relationships. The research focused on the situations and processes that stimulated a group of thirty four ‘Treaty people’ to start thinking about themselves as cultural; about what it meant to have a cultural identity; and what they recognised as markers of their culture. I have been a member of this Treaty People network for many years and carry the dual positioning of being the researcher, and a participant, both as a member of the group and as a Pākehā. Data was collected over an eighteen month period from two focus groups in 2003 and 2005. These sessions were video and audio-recorded and later transcribed. I meet with available participants in their own locations early in 2005 and audio-recorded the conversations. The transcriptions and notes form the data for this study. My findings from this study include: • Culture was often first recognised through encounters with different cultural groups and usually when a person is in a situation where they are in a minority. Although, dominant group members do not always see their own daily practices and values as cultural they often name as cultural the practices and values of people different from them. • Recognising and naming ourselves as cultural and marking our culture were difficult tasks that go against the grain of dominance. • Pākehā culture was recognised in a number of ways. Treaty people recognised that there were other forms of knowing about the world and that dominant group members valued being ‘right’ and in control of knowledge. Coming to recognise themselves as cultural unsettled a sense of certainty about their position in the world, and opened up possibilities for new ways to engage in intercultural relationships where participation rather than being in control was valued. • Accepting the name Pākehā implied having a position of responsibility to tangata whenua and to the land. In turn those who have accepted being Pākehā receive a sense of belonging to Aotearoa and a place to stand in justice alongside Māori and other people who are culturally different from them. • While this thesis does not make explicit links between ‘being cultural’ and a decolonisation agenda the Treaty People participants named strategies to support decolonisation and challenge Pākehā dominance which include: recognising practices and values that are perpetuated through colonisation, in particular egalitarianism, assimilation and superiority; recognising Māori as tangata whenua (first people of the land) and Te Tiriti o Waitangi relationships; taking up the challenge to seek justice through striving to deal with past wrongs and to engage in equitable relationships with Māori. This thesis contributes to the psychology and social science literature as it serves to address the question “We don’t have a culture … do we?” I posit that all psychologists do have a culture and provide some rich descriptions, for those who are Pākehā, of how their culture may be recognised, how it might be described and talked about. This is a core cultural competency requirement for psychologists. My thesis also contribute to a growing body of literature from members of dominant groups, who are developing a discourse to explore and make visible their cultural or raced (whiteness) positions of power and privilege.

text: Treaty People Recognising and Marking Pākehā Culture in Aotearoa New Zealand The suggestion that all people are cultural and live in cultural worlds acts to challenge members of culturally dominant groups as they tend to see their way of life as normal rather than cultural. Dominant group members usually talk about themselves in relation to their national identity (New Zealander, Australian, or American) rather than name being part of a cultural group within their nation state. This study, located in Aotearoa New Zealand, explores with a particular group of New Zealanders, how Pākehā who are members of the dominant group, may come to recognise themselves as being cultural, to name themselves culturally, and to mark aspects of their culture. The contribution that recognising culture makes to a decolonisation agenda is also explored. This study of Pākehā culture is approached from both a realist and a social constructionist perspective. Culture, an abstract concept, is largely theorised as a constructed notion in a historically structured location. How culture is recognised, and the ways it is produced and enacted, through relationships and interactions in the broader structures of New Zealand society were explored using realist thematic methods of analysis. Treaty people are a network of mostly Pākehā activist educators who have engaged in promoting knowledge of and support for Māori claims for justice under Te Tiriti o Waitangi (the Treaty of Waitangi was the document signed by Settlers and Māori leaders in 1840 to establish settlement arrangements). Treaty people are practised in talking about cultural issues largely through their engagement with Māori - Pākehā relationships. The research focused on the situations and processes that stimulated a group of thirty four ‘Treaty people’ to start thinking about themselves as cultural; about what it meant to have a cultural identity; and what they recognised as markers of their culture. I have been a member of this Treaty People network for many years and carry the dual positioning of being the researcher, and a participant, both as a member of the group and as a Pākehā. Data was collected over an eighteen month period from two focus groups in 2003 and 2005. These sessions were video and audio-recorded and later transcribed. I meet with available participants in their own locations early in 2005 and audio-recorded the conversations. The transcriptions and notes form the data for this study. My findings from this study include: • Culture was often first recognised through encounters with different cultural groups and usually when a person is in a situation where they are in a minority. Although, dominant group members do not always see their own daily practices and values as cultural they often name as cultural the practices and values of people different from them. • Recognising and naming ourselves as cultural and marking our culture were difficult tasks that go against the grain of dominance. • Pākehā culture was recognised in a number of ways. Treaty people recognised that there were other forms of knowing about the world and that dominant group members valued being ‘right’ and in control of knowledge. Coming to recognise themselves as cultural unsettled a sense of certainty about their position in the world, and opened up possibilities for new ways to engage in intercultural relationships where participation rather than being in control was valued. • Accepting the name Pākehā implied having a position of responsibility to tangata whenua and to the land. In turn those who have accepted being Pākehā receive a sense of belonging to Aotearoa and a place to stand in justice alongside Māori and other people who are culturally different from them. • While this thesis does not make explicit links between ‘being cultural’ and a decolonisation agenda the Treaty People participants named strategies to support decolonisation and challenge Pākehā dominance which include: recognising practices and values that are perpetuated through colonisation, in particular egalitarianism, assimilation and superiority; recognising Māori as tangata whenua (first people of the land) and Te Tiriti o Waitangi relationships; taking up the challenge to seek justice through striving to deal with past wrongs and to engage in equitable relationships with Māori. This thesis contributes to the psychology and social science literature as it serves to address the question “We don’t have a culture … do we?” I posit that all psychologists do have a culture and provide some rich descriptions, for those who are Pākehā, of how their culture may be recognised, how it might be described and talked about. This is a core cultural competency requirement for psychologists. My thesis also contribute to a growing body of literature from members of dominant groups, who are developing a discourse to explore and make visible their cultural or raced (whiteness) positions of power and privilege.

year: 2010

title: Disease surveillance and patient care in remote regions: an exploratory study of collaboration among healthcare professionals in Amazonia

authors: Luz, Saturnino

subjects: computer supported cooperative work

abstract: The development and deployment of information technology, particularly mobile tools, to support collaboration between different groups of healthcare professionals has been viewed as a promising way to improve disease surveillance and patient care in remote regions. The effects of global climate change combined with rapid changes to land cover and use in Amazonia are believed to be contributing to the spread of vector-borne emerging and neglected diseases. This makes empowering and providing support for local healthcare providers all the more important. We investigate the use of information technology in this context to support professionals whose activities range from diagnosing diseases and monitoring their spread to developing policies to deal with outbreaks. An analysis of stakeholders, their roles and requirements, is presented which encompasses results of fieldwork and of a process of design and prototyping complemented by questionnaires and targeted interviews. Findings are analysed with respect to the tasks of diagnosis, training of local healthcare professionals, and gathering, sharing and visualisation of data for purposes of epidemiological research and disease surveillance. Methodological issues regarding the elicitation of cooperation and collaboration requirements are discussed and implications are drawn with respect to the use of technology in tackling emerging and neglected diseases.

text: Disease surveillance and patient care in remote regions: an exploratory study of collaboration among healthcare professionals in Amazonia The development and deployment of information technology, particularly mobile tools, to support collaboration between different groups of healthcare professionals has been viewed as a promising way to improve disease surveillance and patient care in remote regions. The effects of global climate change combined with rapid changes to land cover and use in Amazonia are believed to be contributing to the spread of vector-borne emerging and neglected diseases. This makes empowering and providing support for local healthcare providers all the more important. We investigate the use of information technology in this context to support professionals whose activities range from diagnosing diseases and monitoring their spread to developing policies to deal with outbreaks. An analysis of stakeholders, their roles and requirements, is presented which encompasses results of fieldwork and of a process of design and prototyping complemented by questionnaires and targeted interviews. Findings are analysed with respect to the tasks of diagnosis, training of local healthcare professionals, and gathering, sharing and visualisation of data for purposes of epidemiological research and disease surveillance. Methodological issues regarding the elicitation of cooperation and collaboration requirements are discussed and implications are drawn with respect to the use of technology in tackling emerging and neglected diseases.

year: 2015