Indigenous womens health

MEREPEKA RAUKAWA-TAIT: A CHAMPION FOR CHANGE IN MAORI WOMENS HEALTH

Merepeka Raukawa-Tait is an outspoken and courageous leader in womens health in New Zealand. She has spent the better part of 20 years working to ensure that women, children and other disadvantaged communities have the opportunity to have input into decisions that will affect their lives directly.
Merepeka is best known throughout New Zealand for her work as the chief executive officer from 1999 to 2002 of the National Collective of Independent Womens Refuges, which represents New Zealands non-government volunteer services. She has earned many accolades for her views and work: North and South Magazines New Zealander of the Year in 2000, Toastmasters Internationals Communicator and Leadership Award in 2001 and the Peacebuilder Award of the United Nations Education, Science and Cultural Organisation (UNESCO). She is now a sought-after speaker for conferences, seminars and training workshops and spoke to delegates at the opening ceremony of the RANZCOGs fifth Annual Scientific Meeting in Auckland in September 2003. Merepekas father was Pakeha and her mother a full blood Maori. She was raised in a very Pakeha environment, and came to things Maori later in life. I think that has probably served me well, she says, I see things quite objectively and I have the privilege of being able to walk in both worlds. I sit comfortably in the marae (meeting house) and equally comfortably around the boardroom table. Being able to see both sides gives me an advantage when it comes to some of the crucial situations were confronting now in New Zealand. Merepeka spent the 1970s living and working in Switzerland, where she completed an MBA in International Management. She describes her time
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there as a formative experience because in Switzerland you rise and fall by your own merits. Switzerland brought home to me that we are responsible for ourselves, she elaborates. There are people in leadership who can help create the environment for all people to grow, but we also need to accept some responsibility for our own growth as well. Merepekas mother was also a powerful influence on her, exhorting her to always think for herself and ensuring that she and her sisters clearly heard the message daily that my girls can do anything.

a very popular person in the country. To move an organisation from the back streets of the nation to the front of the country, you have to be prepared to speak out in your position. Many, many hundreds of homes in this country are not safe for the women and children who are currently living in those homes and we have for many, many years turned a blind eye. Womens Refuge is dedicated to creating violence-free homes, and ultimately a violence-free society. When you go out and say to the general public and say to the New Zealand leadership, our Government and our Maori and Pacific Island leaders, You are killing your women and children, and ultimately you are killing your future, then you know that you are going to come up against it. And certainly that was the case. I cannot recall the number of times in my position as CEO that I was told to be more diplomatic. How do you couch these issues in a diplomatic way? How many women are going to be killed, viciously beaten or children assaulted while Im figuring out how to be diplomatic? I think thats been the problem in the past. I think weve been so concerned about what people would think of us as Maori that weve really neglected the message. I wasnt prepared to put out a sanitised version of the situation. I also know what the cost of domestic violence is to New Zealand, not just in terms of the family, but also in terms of hospitalisation. Its money down the drain because
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TALKING IN A FORTHRIGHT MANNER

Im known as a person who will speak in a forthright manner, Merepeka says of herself. When the Board of Womens Refuge asked me if I would take on the role as CEO, I wasnt sure if I would be

Merepeka Raukawa-Tait: A Champion For Change In Maori Womens Health

were not prepared to change behaviours. When she first joined Womens Refuge, one of Merepekas tasks was to repudiate the wider community view that women who were victims of violence as well as the volunteer refuge workers were second class citizens. That is a view that some sectors of New Zealand society still hold today, Merepeka remarks. Frankly, that work is not for the faint hearted and most people would run a mile rather than have to work in that area. I feel that changing the perception of the general public to violence in the home was my first big achievement. Most women dont want to be there, they dont want to be victims, they want to be in control of their lives just like we all do and live up to their potential. Merepeka is equally perplexed that wonderful organisations like Womens Refuge and Victim Support are not being funded by Government to be successful. You tend to be funded merely to hold the line and be the ambulance at the bottom of the cliff. To my way of thinking that is counterproductive and I would really go further to say that if you do not fund an organisation to be successful and make the necessary changes, then why fund it at all?

establish culturally appropriate services for Maori and Pacific Islander women. If you do not offer culturally appropriate services, there will be no uptake of your services by those two groups, Merepeka states outright. Maori like to see some of their values reflected in the program, and secondly they want to see programs offered and presented by Maori service providers. If Maori dont see themselves in the structure, be it in the operational area or indeed in the management and governance area now, then they just do not go there.

the community and they know some of the external factors that have impacted on the communities over the years and have contributed to some of the social decay and the economic downturn. My belief is that we should pick up those people and within three years, working alongside, delivering the same but in perhaps a more structured way, they will have gained those formal qualifications.

HOW CAN HEALTH PROFESSIONALS ASSIST ABUSED WOMEN?

Merepeka Raukawa-Tait argues that all medical practitioners must be able to identify the signs that indicate that their patients are being abused and if they cannot recognise them, undertake professional development to be able to do so. Knowledge of domestic violence should be built into the training of healthcare professionals, Merepeka recommends. Someone arriving at an appointment with a black eye or their arm in a sling is an obvious result of domestic violence, but domestic violence is far more than that - its the verbal and emotional abuse thats constantly going on in the home too. Health professionals need to be able to recognise domestic violence, know what to do and know whom in their community they can call on if they dont know what to do themselves, and then we will see more timely and proactive reporting of abuse. I had one healthcare professional say to me I dont know what questions to ask. If you want to help someone, you have to make sure that they feel comfortable talking to either yourself or someone working closely with you. The aim is really to ask non-threatening questions, rather than the Are you being beaten? kind of approach. For example, Are you safe at home? is not
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It needs to be recognised that if you dont have a well Maori woman, then you will not have a well family.
When youre talking about violence in the home, most Maori have an understanding of what goes on in Maori homes, and you dont want to have someone speaking to you, coming into your home or assisting you at the refuge who is going to be judgemental or who has absolutely no idea of how a dysfunctional whanau (family) operates. Anything that could be construed as judgemental will put the person off and they will walk. So its very, very important that Maori deliver to Maori these days though it must be a quality service as well. In terms of recruiting qualified Maori to deliver services, Merepeka says that there are ideal people within communities capable of doing an excellent job but who simply lack the formal tertiary qualifications. In every community you will find there is a small group of women, and indeed some men, she says, who have been working in this area for many, many years. They are well-known within their communities, they know their communities well, they know the dynamics of

THE IMPORTANCE OF CULTURALLY SPECIFIC SERVICES

Under Merepeka Raukawa-Taits leadership, Womens Refuge established the concept of parallel development, whereby culturally specific services are provided for victims of domestic violence of different ethnic populations. In all, it is estimated that 44 per cent of the women who presented to victim support services in New Zealand from 2000 to 2001 were Indigenous Maori women. Consequently, as they constituted a main part of its client base, Womens Refuge was compelled to
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a threatening question or I have someone on my staff who talks about safety in the home. Would you like to spend half an hour next week talking with that person? or Has there been a change in the family situation recently? If the husbands out of work and is now home then thats a major change in the home environment. Merepeka had the opportunity to convey this message to the Colleges members at its last Annual Scientific Meeting in Auckland in September 2003. She states that she was very encouraged by the feedback she received from the Colleges Fellows. My key message really was around communication and relationships and that they are the crux of any business today. If we dont get those two things right the ways in which we develop and nurture and grow relationships and the manner in which we communicate then we will be asking ourselves every few years What are we doing wrong? I really think how people communicate with each other and how they develop their relationships is critical. At the ASM I tried to say, Yes, you may have all the technical skills, but if you cant put your message across in a way that people can understand and will be prepared to take some action, then youll just have to go and repeat the cycle six or 12 months down the track. If were talking about womens health in particular, well, we dont really have six months, we need to get it absolutely right. Theres no reason why we should continue to make the same mistakes. We dont have time on our side, not where Maori womens health is concerned. Theres no reason why we cant get it right the first time and then continue to go on and grow from there. Part of that is the relationships that we consider important and go out of our way to develop, grow and nurture and
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also the manner in which we communicate upward, downward and across.

ACCESSIBILITY TO HEALTH SERVICES FOR MAORI WOMEN

The lack of culturally sensitive medical services for Maori may also discourage Maori women from presenting for both domestic violence issues and also for well-women checks. Merepeka believes that the changes to the New Zealand health system in the last eight to ten years have left people in New Zealand a little bit unsure about where they can access services and through whom they can access services. That has made many New Zealanders quite uncomfortable. She says these changes have accentuated the manner in which Maori women access health services anyway: late presentation and a reluctance to go altogether if they are unable to find someone of their choice. If you are a Maori woman needing to access maternal health services, then in the past it could have been someone in your community, perhaps someone youve already developed a rapport with such as a GP, but because there are less GPs now doing obstetrics in New Zealand, it can be difficult for a Maori woman to find services delivered in a culturally appropriate manner, with an understanding of her values. If youre living in your tribal area, because of the number of Maori women there, we can build up those kinds of services. But for the urban Maori woman, thats where the difficulty can arise and she may have to go to a mainstream provider, if at all. And if she does go it will usually be later on rather than earlier on.

health of Indigenous women in New Zealand is still at a disadvantage, due primarily to social and cultural factors. She argues that there needs to be recognition that if you dont have a well Maori woman, then you will not have a well family. I think because weve had such a long history of poor Maori womens health in this country, theres going to have to be heavy expenditure over quite some years to come, Merepeka predicts. We need to start specific targeting of areas, regions that we know are not good. What we try to do is put money into childrens health an obviously pressing issue because theyre very vulnerable, theyre young and they need to be able to grow. Merepeka also sees a need now to encourage self-sufficiency in Maori women, so that they develop some responsibility for their own health. We need to take some responsibility to keep ourselves informed. We can always point the finger and say that theres not enough being done either by the Government or by the agencies but at the same time I would say, Well, what are we doing ourselves? Surely were not so sick that we cant search out information that will make us stronger and well? As part of encouraging greater participation in health issues, Merepeka believes the strategy should be encouraging Maori women to work in the health arena. We have a lot of Maori

IMPROVING THE WELL-BEING OF MAORI WOMEN

Merepeka Raukawa-Tait speaks with conviction when she argues that the

Why should we be putting out a sanitised version of the impact of violence on Maori homes? How do you couch these issues diplomatically? I think weve been so concerned about what people would think of us as Maori that weve neglected the message.
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Merepeka Raukawa-Tait: A Champion For Change In Maori Womens Health

women working in education and Id like to start a drive to recruit Maori women for the health area, not just as counsellors and providers, but to work within the health system as policymakers as well. We need to assume more roles in mental health, the hospitals, the community, in developing policy, and in the Ministry itself. She feels that the Maori Health Action Plan for 2003 to 2005, which was developed by the Ministry of Health, is a step in the right direction, as it advocates major change in the next two to three years. It also supports her view of collective responsibility, that everybody that is publicly funded must accept some responsibility for improving Maori health, and that people are going to have to talk to each other. It isnt just the Ministry of Health deciding that this is what were going to do, its asking for that buy-in, particularly from community groups, she comments. They can say Right, this is the support thats supposed to come our way or These are the outcomes. Consumers are now becoming far more demanding and saying Yes, these are spot-on or No, they are below par. I always think that if you can get these documents into the hands of the people who will be the recipients of that service they will definitely give you a response and give you an idea of whether youre hitting the mark or not. The difficulty will be putting the entire Plan into effect. Everyone involved will look at the Plan and see that there are things that Maori already do, and there are definitely things that the Ministry of Health and the District Health

Boards can do. One of them could be around parallel development, to ensure that there are people there who will advocate on behalf of Maori when some issues come around the table.

CHALLENGING TE WHARE TANGATA

Another challenge for Maori women, which Merepeka Raukawa-Tait has spoken about often, is to persuade Maori tribal leaders to honour and preserve the concept of te whare tangata the nurturing place of future generations that in the past meant that women were acknowledged and honoured for that role, and were kept safe. Everyone had an interest in ensuring that you could go about safely bringing into the world future generations, explains Merepeka, and a place was ensured where future generations were loved, nurtured and encouraged in all ways. What were seeing now is that the home is not a place where Maori women feel valued or honoured, and it certainly isnt a place where they feel safe. And its not the women who have made the changes. Maori men have not lived up to their role of creating a nurturing place for future generations. They have abdicated their role in that area with tragic consequences. Maori men still want to be seen to be upholding the mana - their personal and political authority - by saying that women continue to hold the exalted position of te whare tangata and need to be protected. However, their actions say something quite different. They dont protect their women any more, and Maori women are most at risk in their own tribal areas, so why go through this big charade? Merepeka says she is still a great believer in te whare tangata, and in the value of bringing it back to centre stage.

I believe that we do have a collective responsibility as Maori to ensure that the woman thats bringing forth our future generations has a home environment that is safe, and knows that were whanau, were related and she is safe, she argues. And this, of course, is not the case today in New Zealand. If youre beating up on a Maori woman, youre beating up on her genealogy, her past, her present and youre prejudicing our future. The notion is still as strong as ever, but it means that Maori men must understand what it means for their own futures and for the future of our race.

CHANGING MAORI CONVENTIONS

Merepeka says that Maori are quite uncomfortable with a challenge, particularly if we are challenging some of the elders. I believe challenge is healthy if it is done in a respectful manner, she says. We must have the courage to speak out. There is a degree of acceptance in Maori society that violence in the home is no big deal, she says, and that attitude is not changing as quickly as it should. We have violence in Maori homes because people are not prepared to do anything about it and thats not just the person whose meting out the violence. For every abused child in this country, six adults know whats going on. As Maori women we all know in our families who are the people, and invariably they are men, we know the men in our families who do not keep their fists by their sides and their boots firmly planted on the ground. So until were actually prepared to do something about it, the massive change that we could make is not occurring. If Maori leaders were to say As of midnight tonight all violence towards women and children will stop, otherwise we will come down on the people who violate our women and children, then the violence would stop. But
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Good health to me, in Maori thinking, underpins a well society and by that I mean social wellness and economic wellness.
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theyre not prepared to say that and that to me is where the leadership has something to answer for. They must look to themselves and see what they are doing. We all have the opportunity to change, and they should be encouraged to if the behaviour of some leaders has in the past been less than desirable. Now is the time to show some leadership and some courage. Merepekas criticism of Maori ways have not always been well received by her own people either. We do these things behind closed doors, Merepeka, thats what I hear so often, but of course Ive kept on because what I say is that I know what happens behind closed doors, and nothing is ever sorted behind closed doors. If you really want to make a difference, shine a spotlight on it and do away with this ridiculous notion of family loyalty to the person who is the abuser. Make it clear: If youre an abuser, your number is up.

Maori men. Our Maori men keep these leadership roles very close to their chests and they promote other men. I want to see a leadership that is visionary, she elucidates, one that is inspiring and consists of compelling communicators, a generation of leaders who will be champions for change in New Zealand and provide a vision that all Maori can sign up to. They will say Yes, the ground is moving from under us all the time. Decisions are being made by the Government and others that will impact on us, but lets look at the extent of those changes and pull out the most positive things. Young Maori women, she says, can form an important part of this leadership group. Maori women know whats at stake, they know that theres no room for complacency. I believe that just as a butterfly needs two wings, Maori need to develop both their young women and men. I dont want to hear excuses that its not a Maori womans role to be the spokesperson. I think that if you get a Maori woman who is committed to being a critical and honest leader, and if we can get that groundswell, that critical mass of Maori women who see the leadership as there for their people and as having integrity and clear judgement, then youll see the gains that are to be made and they will happen in a very short time. I want to see Maori women promoted and thats basically been my work over the last 18 years. I get great enjoyment from that because, to be honest, I see more potential in Maori women than in Maori men. Ive been trying to develop in that area myself for many years, and I take with me now younger Maori women whenever I have the opportunity. Maori women leaders are coming through now: theyre culturally empowered, they know who they are. Merepeka argues that the future lies with young Maori women and to that

end, believes that young Maori women have to be persuaded that they should not see motherhood as the be all and end all of their lives. We are a young population a good 70 per cent of the population is under the age of 24 years and I think that what we should be saying is OK, motherhood can come further down the track, but lets look at you right now. What we should be doing is capturing the young Maori women as early as possible and saying to them Look, what is it that you would like to do with your future? We know that some years ahead you are going to be a mother and youre going to do a wonderful job in that area. But with ten years of working life ahead of you, how can we make sure that those years are most fulfilling for you? Lets steer them in that direction. We need to reach young women before they see motherhood as an option. I dont think were doing enough at this stage, convincing them that they have their whole lives still ahead of them. The fact is a lot of our young girls are leaving school without any educational qualifications so therefore their ability to get into well-paid jobs is severely limited and becoming a mother may well be an option that they entertain. But its not a desirable option. Theres no-one out there saying to them That is not an option for you.

EMPOWERING YOUNG MAORI WOMEN

Merepeka Raukawa-Tait sees the key to breaking the cycle of domestic violence in Maori society and the advancement of Maori people as a whole as better leadership. Maori suffer from poor leadership. Why dont Maori leaders say Surely this isnt as good as it gets? There are contributing social factors, to be sure, that limit our progress. For example, theres got to be more meaningful work available, there has to be an emphasis on improving Maori health, there has to be leadership that is articulating a well society in which Maori are making a contribution - but who is articulating that vision in the country right now? Merepeka is adamant that she is not anti-Maori men, but rather anti-poor leadership. It just so happens, she says, that most of our leadership positions in Maori organisations are taken up by
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Cassandra Humble Media/Executive Services Assistant Damian Christie Publications Co-ordinator

With thanks to Steve Williams, Executive Officer, New Zealand Committee for assistance with the preparation of this feature.

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