A seminar day of Maori Health, held in a marae

A "Wharehui", assembly hall

Here some important aspects of Maori health concepts:

Te Whare Tapa Wha - The Principle Understanding of Health in Maori Culture

In traditional Western understanding, health is in first place a physical entity, which then allows for emotional well-being and mental health (mens sana in corpore sano). In modern medicine, an effect in the other direction (emotional distress → damage to the body) is recognised, although health is still most commonly measured in physical parameters (BP, BG, Lipids, cardiovascular events). (Reflections of the author)

In Maori understanding, health consists of a system of interrelated components. The primary perspective is rather a spiritual than a physical one. „Taha wairua is generally felt by Mäori to be the most essential requirement for health. It implies a capacity to have faith and to be able to understand the links between the human situation and the environment. Without a spiritual awareness and a mauri (spirit or vitality, sometimes called the life-force) an individual cannot be healthy and is more prone to illness or misfortune”. (1)

Dr Mason Durie has framed this perspective into the concept of the four essential components of a house. This was published in the 1980ies and generally welcomed and supported by Maori.

These are the four components (taha) of the house (whare) of health:

Te taha wairua – Spiritual Health

As spirituality is not a part of the common Western understanding of health, this area remains unattended if not specifically and individually adressed. There are no own consentive concepts of spiritual health the Western society has to offer. It can be assumed that the perception and conceptualisation of spiritual health will vary widely between Maori individuals, depending on their anchouring within whanau, ancestry and personal experience and inclination. It may be wothwhile o ask, though, and to reflect on our own concepts. (Reflections of the author).

Te taha hinengaro – Psychological Health (Health of Thoughts and Feelings)

While Western thinking distinguishes between the spoken word and emotions (and generally encourages the word more than the feeling), Mäori do nor draw such a sharp distinction. Communication, especially face-to-face, depends on more than overt messages. Mäori may be more impressed by the unspoken signals conveyed through subtle gesture, eye movement, or bland expression, and in some situations regard words as superfluous, even demeaning. ... Health is viewed as an interrelated phenomenon rather than an intra-personal one, ...and poor health is typically regarded as a manifestation of a breakdown in harmony between the individual and the wider environment. (1)

Te taha tinana – Bodily Health

Taha tinana (bodily health) is a more familiar health dimension though the Mäori emphasis is different in that there is the clear separation of tapu and noa. Certain parts of the body and the head in particular, are regarded as special (tapu), and bodily functions such as sleeping, eating, drinking, and defecating are imbued with their own significance, reflecting various levels of importance and requiring quite different rituals. Food, for example, is a leveller which removes any vestige of sacredness or distance (as between people). ...

Slender body forms are not necessarily prized more than well-rounded shapes, nor does obesity provoke the same sense of disapproval encountered in society generally. Health workers report difficulties in trying to convince Mäori patients that they should lose weight. Their efforts might be better spent in appealing to health risks, especially for future generations, rather than to personal vanity. (1)

Te taha whanau – Family Health

Taha whanau acknowledges the relevance of the extended family to health. The family is the prime support system for Maori, providing care and nuturance, not only in physical terms but culturally and emotionally. Reported rises in the prevalence of family dysfunction including signs of abuse, do not lessen the point but underline its significance. Mäori still maintain that ill health in an individual is a reflection on the family and may well blame a family for allowing a person to become ill or to die, even when there is no direct causal link.

Taha whanau relates to identity and sense of purpose. The much-lauded state of self-sufficiency or self-realisation does not convey a sense of health to Maori. Inter-dependence rather than independence is the healthier goal. … Underlying the whare tapa wha model is the consistent theme of integration. Individual health is built into a wider system, the boundary between personal and family identity being frequently blurred. Similarly the divisions between temporal and spiritual, thoughts and feelings, mental and physical are not as clear-cut as they are have been in Western thinking.... Despite a century and a half of colonization, Mäori remained convinced that good health could not be gauged by simple measures such as weight or blood pressure... (1)

Source: (1) Mason Durie: Whaiora - Chapter Five TIROHANGA MAORI -MÄORI HEALTH PERSPECTIVES

The organisational structure of a GP practice in New Zealand and in Germany: A basic difference.

Now working in the third practice in New Zealand, I dare to make some generalisations:

A fundamental difference between a GP practice in Germany and one in New Zealand is the degree of applied hierarchy. This has cost me quite some effort to accept it and adapt. I am quite convinced that, in principle, this difference applies as well to other organisations and companies.

Now, my practice in Germany had a kind of pyramidal hierarchical and organisational structure. And I think this was quite typical. As the employer, I was the head, first alone, then with my colleages of the joint practice. Everyone else relied on me – or us - and trusted me/us. As the most experienced and long-standing owner my structure sort of coined the whole thing. On a second level, I had my „Ersthelferin“, the main „doctors helper“ (which is a literal translation from this professional term), who took my ideas and – importantly – checked them for practicability. Also, she added her own ideas. Only with her I was able to act as an organisational pillar. Another function of her was to act as a mediator between me and the other Arzthelferinnen, doctor's helper, and accommodate them. Apart from that, we held regular team sessions and on demand I discussed personal difficulties with staff especially if this was necessary. In Germany the GP is held responsible for everything his helpers do. Their, task, in turn, is to help the GP to work with more efficiency, but what they do are all his original tasks – like venosection, basic diagnostic measures like height, weight and BP, allergy tests, ECG, Doppler etc. They also do therapeutic measures (e.g. dressings, electrotherapy) and prevention, but everything it is in order to help the GP. Of course there is a range of non-delegable tasks like the most of the physical examination itself, ultrasound and others.

There is no such distinction between receptionist and nurse.

Now, in New Zealand the practice rests on three pillars. The profession „Arzthelferin“, doctor's helper, doesn't exist as such. On the first sight, her tasks seem to be done by the receptionists and the admin staff on the one hand and the nurses on the other. The GP is the third pillar. Everyone has his own tasks and day structure and is held responsible for this (as far as I understand until now). The GP is, in most or al least many cases, still owner of the practice. However, the NZ nurse has a different understanding of her role. She is not primarily there to help the doctor but has her own schedule, or template. The concept is that all constituents of an NZ GP practice are expected to „be happy to help“ each other but there is also the expectation that the „consumer“ or addressee of the helping hand is aware of that this is a friendly help and not the original task of the helping person. You can say that an invisible and unofficial „account“ exists that should, at least in the long run, be held in balance, and that the „withdrawals“ are done by either side. This, if it works well, is then called „team spirit“. This system can be visualised as a structure like one of these classicistic gates, where a roof, the team spirit, rests on three pillars. A New Zealand health professional might have difficulties believing that a team spirit can equally be percieved in the German model of a GP practice, which I would compare to a pyramid with the GP(s) at the top, then the main Arzthelferin (who often acts as the practice manager, a task done by admin staff in NZ), and „below“ the rest of the Arzthelferinnen. They might see their role as equally fulfilling. As an analogy someone might use the traditional, almost overcome European role model of a husband and his wife. Surprisingly, the cleaner seems not to be seen as a part of the team in NZ; this will also vary in Germany.

The task of the GP in Germany is now to create an atmosphere of generosity and courtesy that makes the employees feel appreciated. A further incentive for the Arzthelferin to feel comfortable in her role is that virtually all responsibility lies with the GP.

The basic difference of the structures is mirrored by the fact that the health centre in Germany traditionally carries the name of the GP, whereas in NZ it is often the name of the town.

This in turn lines up with my basic perception that simple institutional hierarchies are taken with much caution in New Zealand, but still based on a strong tradition in Germany.

Always a welcome interruption of everyday life and an occasion to see something else - my yearly GP conference!

Where the Rotorua GPCME conference is held - Rotorua from above

Surroundings of Rotorua

Deers - an animal imported by White settlers

One of the landmarks of Rotorua - the former hospital.

The venue - the Energy Event Centre in Rotorua

Entrance

Reception

Exhibition

Modern Architecture

In the lecture

My German colleague Eva

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Just beside the Events Centre: a beautiful geothermal scenery

After a long day: an opportunity to make use of the geothermal activity. At Polynesian Spa. 200 m from te Events Centre.

My Queen, I and our "Hausberg" in Thames

A queen in her realm ... a proud Elena in our original garden shed in it's newest version - created by her... and
well insulated, beautiful decoration - all at minimal (financial) cost!

Here she overlooks Thames from our "Hausberg", the hill behind our house.

Different winter views from our "Hausberg".

It's winter: time at home sweet home and with friends

Breakfast at friend's house, another German family here

Dining with Chinese friends

Staring at the new IPad

Typical scene: Lucas and Luis with a friend in our living room

I love it that all our kids are into music - and suprisingly I like their style...

Elena hairdressing Luis

Watching TV