Health NZ Southern is the only place in New Zealand Aotearoa to provide dedicated equipment for confirming a death in hospital.
The Māori House Officers’ Working Group at Health New Zealand Southern is celebrating the success of their project to ensure medical staff can access a kit of dedicated equipment to confirm a death.
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 medical staff, and they saw an opportunity to provide practical help. They worked with clinical and operational leaders and Te Ara Hauora – Māori Liaison Services to test and socialise the idea of providing dedicated equipment, and with North Dunedin MenzShed who made the wooden boxes to keep the tools in.
The boxes contain equipment needed to confirm a death as well as some karakia and a bowl for wai māori.
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 the Southern district.
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 Health NZ Southern will have access to that, if it is something culturally important for them or the patient’s whānau.”
House Officer Dr Alec Heighway (Ngāti Tūwharetoa, Ngā Rua Hine) was one of the first to use the ipu mārie, and said it was good to be able to respect the significance of somebody passing on.
“I was glad I didn’t have to use my own stethoscope that I use with living patients, because that always felt wrong to me. And it was good to be able to use wai māori to cleanse before going back to ordinary life. But also, using the ipu mārie gave me some time and space to think about the fact that this person has died and it’s right to take time to acknowledge the magnitude of that, and to think about what I need to do and say to the 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.
Registrar Dr Waimarama Matena and House Officer Dr Josh Solomon hold an ipu mārie box outside Dunedin Hospital.
“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.”
Dr Kathryn Forwood is the Medical Director Prevocational Medical Education and Training and chairs the Māori House Officers’ Working Group. “As senior doctors, we have a huge responsibility to our junior staff,” she says. “We need to make sure that we offer an environment where they feel culturally safe and valued for who they are. And while we are teaching them clinical skills, we can also learn a lot from them about what younger generations expect from us as colleagues. 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.”
Health NZ Southern is the only place in New Zealand Aotearoa to make dedicated equipment available to all staff in this way, and the initiative was complimented during a recent audit. There are hopes that other areas will pick up the idea and provide similar kits.
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 Southern leading the way with this work and I want to congratuate the Māori House Officers’ Working group on the success of the project.”
