In some rural areas of Canterbury, mana whenua working alongside the University of Otago have created safe spaces for Māori to get vaccinated against Covid-19 on their own marae.
When you arrive at the Tuahiwi Marae, north of Christchurch, old-school pop hits greet visitors at the door. The sounds of laughter from the wharekai follow suit. It’s a very different vibe from the clinical white rooms of the traditional vaccination clinics dotted around the country.
Groups of whānau and friends walk through the open doors, all there to get vaccinated and many for their second dose. Familiar faces greet them at the door, like that of Amber Clarke (Ngāi Tahu, Ngāi Tūāhuriri), mana whenua and one of the organisers of the marae clinics, who shares jokes and hugs with almost everyone who walks in.
She’s taken the role of kaimanaaki, making sure everyone coming through the clinics feels welcome and liaising between Ngāi Tahu.
“It’s really just to make sure that all of our manuhiri and whānau are well looked after, that they have kai, that they have a hot drink, that they’re comfortable,” Clarke says.
This particular clinic is the fourth the MIHI (Māori/Indigenous Health Institute) team, University of Otago, Christchurch, have undertaken at various marae around Christchurch. It’s the second at Tuahiwi Marae, and most people coming through from the small town nestled between Kaiapoi and Rangiora are getting their second dose.
Dr Cameron Lacey (Te Atiawa), has been in charge of liaising with the Canterbury DHB throughout the process in the set-up of the marae clinics. He says MIHI was onboard right from the start, after being approached by local iwi wanting to protect their communities.
“The initiative for this came from mana whenua representatives who said ‘we want to be a part of supporting our communities to get the vaccine’.” he says.
Now, the team, which comprises MIHI team members as well as Māori nurses and administrators from the CDHB, have administered over 2,000 vaccines to Māori across the wider Christchurch area, and with more clinics in the pipeline, that number is set to multiply.
Lacey thinks these results can be put down to the Māori community-focused response. The marae clinics encapsulate a kaupapa Māori approach: Māori health in Māori hands, so they envelop Māori values within the service delivery.
“The mainstream approach is much more like a conveyor belt, so you sit there in a chair by yourself for 20 minutes to wait and they move you through quickly. However, as you can see in our clinics, whanaungatanga, manaakitanga and kaitiakitanga are embedded in how the service is delivered,” says Lacey.
Data from the Ministry of Health and Stats NZ showed Māori Covid-19 vaccination rates were almost half that of Pākehā and Asian populations as of last month. A 2019 report by the Health Quality and Safety Commission explains that “Māori face greater barriers to accessing healthcare, are less likely to receive the best-quality healthcare and are more likely to have a poor experience of care”, which all contribute to lower trust in the healthcare system.
Getting the correct information about the vaccine to the communities in rural parts of the country is important, and Clarke says the way that information is told makes all the difference.
“It’s the beauty of our people being in multiple spaces, the fact that we have long-term relationships across the board so that we could define what a Māori response looks like.”
For Dr Maira Patu (Ngāi Tahu, Te Arawa), GP and clinical senior lecturer at MIHI, University of Otago, Christchurch, and the clinical lead at these marae vaccination centres, a Māori response is important to close the gaps in healthcare for tangata whenua.
“One thing that’s been lovely about vaccinating on the marae is we’ve had a number of people tell us that they wouldn’t have got the vaccination otherwise because they don’t have a good relationship with current healthcare services,” she says.
By bringing the healthcare to a space where Māori feel comfortable, and having a full Māori staff made up of Māori doctors, Māori nurses, Māori psychologists, and Māori administration staff, there’s an extra level of trust between the patients, the administrative team and vaccinators.
“This health system has failed Māori for decades so we need to not only provide a service, but regain Māori trust in the health system.”
Importantly, that trust is not only beneficial for the patients, but also for the doctors and nurses on staff. One of the nurses who had been vaccinating at the marae told Patu she felt more comfortable doing her work on the marae than she ever had in a hospital.
“One of my staff said yesterday that it’s the first time in her very long career that she’s felt like she never had to justify herself… It’s really nice, there’s no questioning of who we are and our qualifications, it’s just a really safe space where we get to feel excellent.”
‘Protect the Pā’ was a slogan created by Dame Aroha Reiriti-Crofts, kaumatua of Tuahiwi Marae, when she agreed to host the very first of the MIHI Māori Mobile vaccine clinics in Christchurch. It was a concept that recognised the need for Māori to protect Māori from Covid-19 and has now underpinned the kaupapa of the clinics.
“Discussing the devastating impacts of past pandemics on Ngāi Tahu, she paused and said ‘we must protect our pā, because if we don’t, who will?’,” says MIHI Professor Suzanne Pitama (Ngāti Kahungunu).
“Her comment stuck with us all. It reminded us of when Māori health was not in Māori hands, and the implications of this. We are grateful that the partnership between our team, Canterbury DHB and Ngāi Tahu is assisting us support mana whenua aspirations.”
Once patients have filled in their vaccination forms with the administration team at Tuahiwi Marae, they’re taken through to the vaccination stations in the wharenui where they wait for one of Patu’s team to call on them. They’re offered time to ask any questions about the vaccine and talk to the nurses and doctors there.
Patients have to wait 20 minutes after they’re vaccinated, and so they’re sent back into the wharekai to have a cup of tea and a bite to eat, a contrast to other vaccine clinics, where patients wait in a quiet room on chairs placed one metre apart until they’re told they can leave.
Often, the groups at Tuahiwi Marae end up staying far longer than the 20-minute mark, using the opportunity to catch up with friends who’ve also come in for their vaccinations, says Lacey.
“Because it’s an environment where they feel comfortable, people stay so they can support other whānau and their community.”
For the communities involved, the clinics aren’t just about getting the vaccinations – they’re also a chance to slow down, talk with friends and be on the marae. That’s why Clarke says the kai is a necessary expense.
“It’s really important to us that there is kai for the whole day. I can’t mihi to our kairingawera enough, because that is significant for us, and that comes with a smile, that comes with a kōrero.”
The success of the approach for the community and whānau is apparent in the laughter that permeates through the hallways. It’s more than just a medical clinic. For these communities, these days are about coming together to protect each other. For Māori, the vaccination is about more than just protecting oneself, it’s about protecting the whole pā.
The opportunity to provide a potentially life-saving service to their communities is crucial for the MIHI team and Ngāi Tahu. In future, such models of co-design and partnership, like here at Tuahiwi Marae, might be the future of Māori health services with the new Māori Health Authority. Until then, this Māori-focused approach to vaccine clinics by MIHI and Ngāi Tahu will continue until December.