Southern junior doctors’ tikanga initiative a first for Aotearoa

A new tikanga initiative to ensure medical staff can access a kit of dedicated equipment for confirming deaths has been rolled out across hospitals in Otago and Southland by the Southern Māori House Officers’ Working Group.

In Te Ao Māori, when a person passes on, the body becomes tapu, (sacred or special). The separation of tapu from noa (ordinary) things is an important part of Māori protocol, or tikanga. So for some of our staff, using the same tools with the living and the dead wasn’t appropriate – but in a busy hospital, there was often no alternative.

The Working Group was established to support junior Māori medical staff, and they saw an opportunity to provide practical help. They worked with hospital leadership and Te Ara Hauora – Māori Liaison Services, and with North Dunedin MenzShed who made the wooden boxes to keep the tools in.

Each box contains medical tools (a stethoscope and pen torch), as well as karakia, and a wooden bowl for wai māori (water) for ritual cleansing. They’re adorned with a kowhaiwhai engraving, originally gifted to Dunedin Hospital NICU, that symbolises the cyclical and intertwined nature of life and death. The boxes have been named Ipu Mārie and have been placed in locations across the hospitals in Southland & Otago.

Registrar Dr Waimarama Matena (Ngāti Maniapoto, Ngāti Tūwharetoa, Te Ātihanunui-a-Pāpārangi) explains how important this is for Māori staff.

“At my previous hospital, a group of us got together to collect the equipment we need to confirm a death and tried to keep this as a special kit for that purpose. It helped us all feel much better but that was just something we did for ourselves. This project means that medical staff throughout our district will have access to that, if that is something culturally important for them or the patient’s whānau.”

The Working Group hope that the ipu mārie will also help promote cultural awareness and understanding of different beliefs and practices in our community.

“It’s important for staff to be able to maintain their own culture and traditions at work,” explains House Officer Dr Josh Solomon (Ngāti Kahungunu). “Equally, patients and whānau should feel comfortable talking to clinical teams about their own cultural needs. We need to create a respectful atmosphere where everyone is able to honour their own beliefs.”

“As senior doctors, we have a huge responsibility to our junior staff,” says Dr Kathryn Forwood, who is Southern’s Director of Prevocational Medical Training and chairs the Māori House Officers’ Working Group.

“We need to make sure that we offer an environment where they feel culturally safe and valued for who they are. It is so rewarding to be a part of this mahi and I’m so impressed with what the group has been able to achieve. We are the only place in Aotearoa to make dedicated equipment available to all staff in this way and we are enthusiastic to share this way of working with our colleagues across the country.”

Southern Chief Medical Officer Dr David Gow says he’s proud of the group and their initiative.

“I know they’ve worked hard over a long period of time to get this off the ground and it’s great to see this kind of leadership from our next generation of Māori doctors. The medical profession hasn’t always been good at understanding and embracing different cultural beliefs, but we know it makes a big difference to the way staff and patients experience healthcare. It’s fantastic to see our team leading the way with this work and I want to congratulate the Māori House Officers’ Working group on the success of the project.”