Maria Spears is a
4th year medical student at the University of Birmingham
My elective is currently underway in the idyllic
country of New Zealand. As someone who is interested in psychiatry
as a career, I decided to plan a placement within a unique aspect
of psychiatry. Luckily I found it at Hauora Waikato.
Steeped in Kaupapa Maori philosophy and
teaching, this elective placement has exposed me to transcultural
psychiatry involving the management, treatment and diagnosis of
mental health conditions, within a cultural and spiritual
The 3 'R's
Hauora Waikato is primarily a Maori,
community-based, independently-funded mental health organisation,
based in Hamilton city centre. It focuses on assessment, referral
and treatment, allocating patients to appropriate services where
their needs can be met. Hauora focuses on providing healthcare that
specifically meets the cultural and spiritual needs of individuals.
Patients do not have to be Maori to utilise the service; any
patient can choose to commit to treatment with Hauora.
In terms of the Kaupapa Maori principles, at the
most basic level it involves the 3 'R's:
- Respect for others
- Respect for yourself
- Respect for the environment
Every morning at Hauora there is a
‘whakamoemeti’, which literally means thanksgiving. It involves
singing of Maori hymns and prayers (‘karakia’) to start the day
positively. Karakia are also used during consultations with
patients if they request/accept it and in multidisciplinary
meetings called ‘whiriwhiris’.
The importance of ‘whanau’ (family) is a key
feature of the holistic approach at Hauora to helping patients with
their difficulties. Hauora strives to develop a good support
network for patients and has a variety of health professionals who
interlink within the team. The concept of the healthcare team being
like a family with elders who offer advice to other members, is a
very traditional Maori principle. It certainly helps that everyone
is in the same building and can communicate immediately.
I think this is one of the key factors which
stands out for me - how there is a strong emphasis on the social
and cultural aspects of the patient’s life and how everyone works
as a collective for the patient. No decisions are made without
consulting other members of the team first.
So far this elective has exposed me to a variety
of subspecialties in psychiatric medicine: child and adolescent,
early intervention, forensic, and maternal mental health. I've also
managed to go out on home visits in the country, to a forensic
rehabilitation hospital which focuses on Kaupapa Maori treatment,
as well as clinics based at the town centre.
There is certainly a stronger emphasis on the patient’s
cultural needs and background at Hauora
Although the underlying medical treatments for
mental illness are very similar to UK practice, there is certainly
a stronger emphasis on the patient’s cultural needs and background
at Hauora. For example, I sat in on a nurse's assessment where a
patient felt that she had been cursed with 'makutu' (evil spirits),
which had been present during a 'tangi' (funeral).
For anyone thinking of organising a psychiatry elective, hoping
to get more exposure and experience in sub-specialties with a
cultural focus, it's worth considering a placement in New
Many thanks to all at Hauora Waikato for
giving permission to use these photographs.