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Ngāti Ruanui CEO Debbie Ngarewa-Packer. (Image: supplied)
Ngāti Ruanui CEO Debbie Ngarewa-Packer. (Image: supplied)

ĀteaMarch 20, 2020

How marae and iwi are preparing for Covid-19

Ngāti Ruanui CEO Debbie Ngarewa-Packer. (Image: supplied)
Ngāti Ruanui CEO Debbie Ngarewa-Packer. (Image: supplied)

Māori authorities have acted swiftly on behalf of their people, but some say they’re concerned about the lack of communication from government.

Māori have not fared well in pandemics of times past. Health statistics remain grim compared with other demographics, and there are fears that should the Covid-19 coronavirus spread via community transmission, it’s Māori and Pacific communities that would be most at risk.

In response, many marae, iwi and other Māori authorities have acted quickly. Hongi and harirū have been phased out and a number of marae have closed their doors – a tough call for those for whom the marae is the centre of their daily lives.

The Iwi Chairs Forum, an iwi leaders collective created to engage directly with the Crown, set up a National Pandemic Response Group and spokesperson Mike Smith (Ngāpuhi, Ngāti Kahu) says that their advice to members has been to be discerning about the information they share.

“The anti-vaccination crowd are using this as an opportunity to get their message out, which is particularly irresponsible in my opinion.”

“One of the problems for our people as a result of colonisation is that there’s a high level of mistrust about government agencies,” he says. “We need to suspend our suspicion about what the relevant ministers are telling us at the moment and realise that that information is legitimate.”

As well as the ubiquitous hygiene advice, he advises whānau to do a risk assessment immediately. Identify the most vulnerable in the community and help them establish a social distancing routine. He emphasises that social distancing doesn’t mean being locked up inside. “You can still walk around the garden or go down to the river, you can still go to the ngahere and gather rongoā or take your kuri for a walk. It’s about close contact at this point, and I think it’s important to make that point for the sake of everyone’s mental health.”

“Keep yourself healthy. It’s a good time to stop smoking cigarettes; a good time to lay off the booze, a good time to smash the P pipe and address some of those baseline health issues,” he adds.

“Your whānau, friends and community are your first line of defence. Set up a neighbourhood support group.”

Ngāti Kahu’s chief executive Anahera Herbert Graves announced a two stage response via the iwi’s social media channels. Stage one included all of the usual hygiene and social distancing protocols, and stage two, to be enacted when the “first case of Covid north of Mangamuka is diagnosed”, included isolating, ordering groceries online and assigning one person to pick them up and deliver them, thoroughly washing fruits and veges, wiping down any packages or canned goods with a bleach solution, and wearing masks and gloves in public.

Ngā Whare Waatea, Māngere’s urban marae, is getting ready to deliver care packages but their food bank has been hit hard and they are welcoming donations.

Te Whānau ā Apanui have drawn their aukati line, closing the border of their traditional lands to fishing, tourism and travellers in order to protect kaumātua.

Meanwhile Ngāti Porou have hosted workshops on how to create soap and sanitiser using rongoā Māori, traditional methods and ingredients from nature.

Ngāti Ruanui CEO Debbie Ngarewa-Packer says they have identified a list of 1000 vulnerable people to keep an eye on in her catchment. “There’s varying degrees within that list, I’m not saying they’re all high risk. But we’re blessed with an abundance of kaumatua and have high diabetes and renal issues, like a lot of regions with high Māori populations. It only takes an hour to prepare 100 of our care packs, and our aim is to get those out before we end up on lock down.”

New Zealand’s director-general of health Ashley Bloomfield has said there hasn’t been any modelling done specifically for Māori, and some remain frustrated that the government hasn’t yet communicated directly with iwi. Ngāti Ruanui and other iwi have been working with the Iwi Chairs Forum on the most effective response, but Ngarewa-Packer says she is frustrated with the government’s response. She says weeks of calls and emails have been met with “a chasm of silence”.

“There’s probably a lot going on behind closed doors but the reality is their engagement and messaging with us as tangata whenua has been nil. We gave them some time and then went, you’ve taken a while, here’s our pandemic management plan. When we had no response over a week later we started to get a bit cross and stared pushing for a plan.”

When a meeting was finally scheduled on Tuesday with eight Taranaki iwi, the CEO and the chair of the Taranaki DHB, and the lead Civil Defence coordinator, she described the outcome as “completely benign”.

“Not one of them had a plan that included Māori.” she says.

“We had the mayors saying, ‘we want to make sure the water stays on and the infrastructure survives. Each sector needs to look after themselves’. I thought, iwi are a sector now?”

She says she’s not expecting the prime minister to get in contact personally, but expects Māori liaisons and the offices of Māori ministers to be engaging with marae, hapū and iwi right now.

“We’ve contacted the deputy director-general of Māori health. We have a Māori unit in DHBs, we have a liaison Māori unit in local council. We have representation in every bureaucracy across the agencies but not one of them has connected with us.”

“If it’s not in Taranaki now, it will be soon. I will eat my hat tomorrow if a case in Taranaki isn’t announced.”

On Thursday, the first case in Taranaki was announced.

Smith says the Iwi Chairs haven’t had a lot of communication from the Ministry of Health either but agrees with Ngarewa-Packer that by ignoring Māori, they’re missing out on what could be an essential resource in their response.

“Māori communities can provide relief and effective leadership in difficult situations, by mobilising volunteers and skilled health professionals, making some marae available in the event of emergencies, and information sharing though Māori networks. It’s really important that the government is inclusive in regard to Māori authorities, particularly tribal ones, because we have huge capacity to provide relief, support and facilities in the event of a disaster.

“We’ve seen that with the Kaikoura earthquake. Mark Solomon and Ngāi Tahu were able to provide aid and satellite phones and personnel faster than the Civil Defence and Red Cross and others. We have that capacity and the government would be foolish not to avail themselves of that.”

Keep going!
An influenza medicine depot in Christchurch for “poor” people. Taken by an unknown photographer 4 December 1918. (Image: Alexander Turnbull Library)
An influenza medicine depot in Christchurch for “poor” people. Taken by an unknown photographer 4 December 1918. (Image: Alexander Turnbull Library)

OPINIONĀteaMarch 18, 2020

Why equity for Māori must be prioritised during the Covid-19 response

An influenza medicine depot in Christchurch for “poor” people. Taken by an unknown photographer 4 December 1918. (Image: Alexander Turnbull Library)
An influenza medicine depot in Christchurch for “poor” people. Taken by an unknown photographer 4 December 1918. (Image: Alexander Turnbull Library)

Māori have fared worst in every pandemic New Zealand has seen. Measures must be taken to ensure equity during the Covid-19 outbreak or history will repeat, writes public health physician and senior lecturer Dr Rhys Jones. 

Covid-19 is about to hit Aotearoa in earnest. The New Zealand government’s response to date has generally been received positively, but we know the worst is yet to come. Our nation’s preparedness and ability to respond effectively will be sternly tested over the coming weeks and months.

Nowhere will this be brought into sharper focus than in relation to Māori whānau and communities. Many Māori health professionals are extremely concerned about the likely disproportionate impacts on Māori, and about the lack of an effective strategy from the government and health sector to deal with these impacts.

History paints a grim picture with regard to the impact of previous pandemics on Māori, providing a clear warning of what could lie ahead if we don’t take appropriate action. The 1918 influenza pandemic resulted in a death rate for Māori of 4.2%, approximately seven times as high as the non-Māori death rate. In the 2009 influenza A (H1N1) pandemic, rates of hospitalisation and death were also much higher for Māori than for other ethnic groups.

Why do Māori appear to be at greater risk from pandemics than many other ethnic groups in New Zealand? There are many different factors at play, including underlying social and economic disadvantage as a result of historical and contemporary colonisation, a greater burden of chronic diseases that increase the risk of more serious outcomes from infections such as influenza, and poorer access to and quality of health care.

But inequitable outcomes can also be attributed to the failure of the government to respond to pandemics in a way that adequately protects Māori communities.

One of the stated goals of the NZ Influenza pandemic plan is to “minimise the impact of the disease and to mitigate its effects on the people of NZ without increasing health inequalities.” However it is clear that the current pandemic response, if it continues under a business-as-usual model, will preferentially benefit Pākehā New Zealanders and fail to protect Māori from the worst outcomes.

How do we know this? We need only to look at the existing health system, which consistently delivers poorer quality care for Māori, to understand the default setting for health-related interventions in this country. The report of the first stage of the kaupapa inquiry into health services and outcomes found pervasive inequities that were inconsistent with the government’s obligations under the Treaty of Waitangi. It highlighted institutional racism, “anti-equity” funding arrangements and a lack of accountability for health entities in relation to equity for Māori.

There is a real danger that these systemic failures will be repeated in the current response to Covid-19. The Ministry of Health’s strategy lacks a Treaty partnership approach and has little to suggest it is appropriately addressing glaring equity issues. The government’s $12.1 bn package to support New Zealanders, while including a benefit increase and a doubling of the Winter Energy Payment, does not do enough to protect those in greatest need. Why, for example, is the government not using the funding boost to implement the recommendations of the Welfare Expert Advisory Group?

A pandemic strategy that relies on existing leadership and structures, and utilises conventional approaches, will fail to achieve equitable outcomes for Māori. It may work well for those it has been designed to work well for – predominantly middle-class, Pākehā New Zealanders – but will leave many others to fall through the cracks.

So how do we stop this happening? First and foremost, there must be Māori governance and leadership at all levels of the pandemic response – nationally and within DHBs, as well as across all other sectors. Iwi, hapū, whānau and Māori communities are mobilising, but this needs to be supported and linked to the appropriate information, resources and infrastructure.

Critically, every aspect of the pandemic response needs to have equity at its centre. It must ensure that all our communities have the resources to be able to carry out public health measures to prevent spread of the virus. For example, how do we make sure effective handwashing is possible among whānau in remote communities in Northland with severe water shortages after a summer of drought? What is being done to support Māori in precarious employment to be able to take time off work to self-isolate and still have enough money to put food on the table?

Every decision must be reviewed with respect to its impact on equity for Māori and adjusted accordingly. For example, what measures are in place to ensure essential supplies are available in the most vulnerable communities? As health care resources are diverted to manage Covid-19 cases, what existing services will be cut? Will Māori and Pacific peoples, once again, be hardest hit? If it comes to the point of hospitals having to prioritise people for intensive care beds or ventilators, how do we ensure that Māori are not disadvantaged?

It may seem like these are luxury considerations when we’re in the middle of a crisis. But if these issues are not addressed the process will default, once again, to inequity.

That leaves many of us with grave concerns about the response to Covid-19 – that it will reproduce racist outcomes and end up being another chapter in the long history of health-related Treaty breaches. We must not let that happen.

Dr Rhys Jones (Ngāti Kahungunu) is a public health physician and senior lecturer at Te Kupenga Hauora Māori, University of Auckland.