Mäori Rituals of Encounter: the Whanau Hui
by Dr Rees Tapsell
You will already have had the opportunity to experience a Virtual_Powhiri by way of the URL link provided on the main Rituals of Encounter page
Dr Rees Tapsell on the importance of
Rituals in Clinical Practice
"Mäori patients and their whänau see the doctor as having a position of power and influence within the mainstream hierarchy. Consequently, if that doctor is seen to be a positive, supportive, even active part of a whänau meeting involving the processes of mihimihi, whakawhanaungatanga, karakia and körero, then that can be very powerful in terms of engaging that patient and their family, and encouraging them to listen to what the doctor has to say, and to trust that it is said by someone who has approached the patient considering them from a total and holistic perspective, including their culture and spirituality. Alternatively, if the doctor is absent from such processes or clearly not supportive of them, then exactly the opposite is achieved."
Often, in the clinical context, a more informal process of welcome is undertaken yet some of essential elements of the powhiri and some of the more informal aspects of the mihimihi are utilised. These rituals will be important in whänau meetings, or in case conferences involving whänau or members of the local Mäori community. Other less directly clinical contexts where you may encounter these rituals might be meetings with local Mäori representatives about mental health services, or meetings with your own local Mäori cultural service providers.
Most often, a kaumätua (a wise elder) from the home people (the clinical team or hosts) will stand, recite special prayers for the purposes of blessing the proceedings and will welcome attendees (for example visiting whänau) and pose some questions and challenges for the purposes of the meeting. Traditionally, this will be followed by a waiata sung by members of the clinical team, so as to support their speaker.
Following this, a similar process is usually undertaken by one or more speakers from the visiting group (perhaps by a kaumätua from the whanau), again followed by a waiata. In the context of a whänau hui, the cultural worker or kaumätua leading the host clinical team may suggest further introductions, or may at this point indicate to the doctor that they can begin the clinical part of the meeting. It pays to remember that at such rituals of encounter the main speakers are expected to provide considerable information in a formal introduction. Such a formal speech is not expected of a non-Mäori doctor, but it is best to say more than just your name. Many families are not quite sure what a "registrar" is, so an explanation of your qualifications and role on the team, and some personal background, is appropriate. For example, you might say where you were born and raised, where you trained as a doctor and how long you have been practising, and how long you have been working for your current clinical team.
During the meeting, it pays to remember that while you have a special role and mana (prestige and power) as the responsible doctor, you are not "running" the meeting. Be alert for cues from your cultural adviser or local kaumätua as to the process. Whatever the purpose of the whänau hui, once all are agreed that the main goals have been achieved the host service's cultural worker or kaumätua will generally begin the ritual of closure. This may involve a short speech and/or a prayer or karakia.
Following the speeches, it would be usual at a powhiri for the group to seal friendship with the touching of noses (the hongi) followed by a traditional häkari (feast). In the clinical context, if non-Mäori seem uncertain about the hongi a kiss on the cheek is often substituted, and the final feast is more often represented by available refreshments such as tea and biscuits. Registrars and psychiatrists work under considerable time pressures, but it is extremely impolite to rush off at this point before participating in the final aspect of the ritual. To remain and socialise briefly will cement trust and rapport gained during the meeting. A whanau hui involving proper rituals of engagement and closure cannot be crammed into a short space of time, and can be invaluable in developing rapport and partnership with patients and their families.
It is sufficient for the non-Mäori psychiatrist or psychiatric registrar to have some sense of this process and how it might unfold. It is also important to remember that as the responsible doctor, the visitors will look to you as a person who holds mana and to whom they must listen and show respect. Accordingly, the success of a whänau hui using some variation on the processes of powhiri, mihimihi and whakawhanaungatanga depends on the responsible doctor being clearly seen to be an active and supportive part of the proceedings, if not directly involved in them.
As with all rituals of encounter, the quality and sustainability of the relationship which one is able to establish with the patient and their whänau can be greatly enhanced if the doctor is seen to acknowledge the importance of the process and is seen to be a positive and supportive participant. It is my experience that this is one of the ways in which a sense of trust can develop between the psychiatrist and their Mäori patient and family. It also provides a culturally safe and appropriate context for the airing of concerns and the sharing of information.
Participation in such processes can also serve to communicate to Mäori patients and their whänau the importance that the clinical team place upon culture, heritage and spirituality in the overall assessment and management of those presenting to psychiatric services. Given the perception of some in the community that doctors are "pill pushers" with a rigidly biological outlook, participation in these processes offers the opportunity to communicate a commitment to a truly holistic approach.
I recommend that psychiatrists or psychiatric registrars wanting to know more about how to participate in such processes consult kaumätua, kuia or cultural workers assigned to their services. A large whänau meeting (and they are often large gatherings) can be daunting at first, but learning how to take part in these rituals so as to work with Mäori patients and their whänau is vital if the best outcome is to be achieved, and is an important skill for a psychiatrist practising in New Zealand.
Now do this Protocol Quiz about how to behave in a whänau meeting