, , , , ,

All of me meets here, an alchemy of parts – Negotiating my identities in New Zealand

Originally published in:  DeSouza, R. (2011). ‘All of me meets here, an alchemy of parts’ – Negotiating my identities in New Zealand. In P. Voci & J. Leckie (Eds.), Localizing Asia in Aotearoa (pp. 231-245). Wellington: Dunmore Publishing.

He could not see that i could be both … The body in front of him was already inscribed within the gendered social relations of the colonial sandwich. i could not just ‘be’. I had to name an identity, no matter that this naming rendered invisible all the other identities of gender, caste, religion, linguistic group, generation (Brah, 1996, p. 3).

Introduction

The title of this chapter comes from a poem by Chris Abani (2000) whom I met many years ago at the Poetics of exile conference. This line from the poem captures the intention of this chapter, to bring parts of myself together. I am often asked the question ‘where are you from?’ Depending on the person asking, it can imply that I have come from somewhere else, not here; that I am visibly and noticeably different; and sometimes reflects a desire on the part of the person asking to either connect, name or categorize. For the sake of economy, choosing one identity and keeping things simple inevitably backfires. answering Tanzania, the country of my birth, and that of my parents, or Goa, India, the place of my ancestors, results in more questions. The question has different nuances in the place of my ancestors and in the place where I choose to live: Aotearoa/New Zealand. Being asked where one is from more easily translates to ‘whom do you belong to?’ and the reference points are intimate, connecting me to a village and to a family. In Māori contexts, similar notions of belonging to place and people are invoked, where intimacy and connection rather than categorization are emphasized. such a question highlights issues of identity, difference and belonging. The process of active negotiation of identities in relation to oneself is the focus of my chapter. I centre on a little-known minority group within a larger indian umbrella identity – the Goan diaspora living in New Zealand. My aim is to provide a complex answer to the question of where I am from and, in doing so, provide a platform for further scholarship about the Goan diaspora in New Zealand.

 

/by
, , , , ,

People of colour decolonisation hui

The Decolonise Your Minds! Hui on February 5th in Tamaki Makaurau, Aotearoa provided a great opportunity to present my PhD work to awesome folks with similar theoretical and political commitments. Outside a professional or academic context and supported by fabulous vegan food and great korero and creativity, the radical space provided a great opportunity to not have to explain everything!

In my presentation, I talked about the ways in which the people who are supposed to care in institutions can engage in subtle coercions and “do” violence. This violence works through the reproduction of taken for granted norms and values, such that pressure is exerted on those whose personhood sits outside the accepted norms and values and reshapes their personhood. Reflecting an assimilatory process similar to the colonial process of moral improvement. Hardly a surprise considering that institutions like health and education are colonial, having been transplanted from the metropole to the colony and super-imposed over indigenous ways of learning and maintaining health.

Using the example of maternity I talked about the ways in which heath professionals draw on culturally and socially available repertoires of care that can be less than helpful when imposed on women of colour. This is because so often these repertoires are drawn on the basis of an implicit ideal user who tends to be cis-woman, heterosexual, white, middle class and one who takes up the ‘imperative of health’. That is the ideal neoliberal consumer who makes herself an expert through her consumption of self-help books and its acceptable accoutrements, who takes responsibility by attending ante-natal classes and who labours naturally with her loving and supportive partner present. She obeys the edicts of the health professional and makes reasonable requests that align with the dominant discourse of maternity as an empowering experience (if you are “informed” and “take responsibility”).

You can listen to the audio which is hosted by the Pride New Zealand website. I take the audience through the idea of discourses and how they shape subjectivity and practice.

Please note I have a tendency to swear when I am speaking passionately about something!

/by
, , ,

Adapting to New Zealand’s super-diversity

Originally published in  Contact: Newsletter for members of the Pharmacy Guild of New Zealand, December 2011-January 2012  (Issue 11), Pages 8-9.

New Zealand has earned the right to call itself super-diverse. this term refers to an unprecedented level and kind of complexity that surpasses anything previously experienced in a particular society. This super-diversity leads to new conjunctions and interactions, and outcomes that extend beyond the usual ways of understanding diversity.

Super-diversity is a relatively new phenomenon given the relative homogeneity of the New Zealand population. The arrival of super-diversity, its impacts and the relevance of super-diversity to pharmacy are the focus of this article.

Why is ethnic diversity and super-diversity relevant to pharmacy? And why is a nurse with a PhD writing about it? Perhaps it is because nurses and pharmacists have a lot in common. We see a lot of people and we tend to have very regular, intimate and long- term relationships with people (if we are doing something right). If we are not, people vote with their feet. Given this ubiquity, how can we ensure that we make a difference in the context of super-diversity?

New Zealand’s super-diversity kicked in with Asian migration in the 1990s. Prior to that, New Zealand had preferred particular “source countries” to select migrants from (Great Britain and Ireland). This homogeneity of migrants was altered by Polynesian Pacific migration from the 1960s, but it was the migration policy changes of 1987 that paved the way for skilled migrants from a range of countries to arrive, notably Asia.

These demographic changes led to a philosophical shift from assimilation to multiculturalism in the context of biculturalism. The expectation of newcomers to assimilate (give up their ways to fit into a new culture) was changed to reflect the notion of New Zealand as an inclusive society where the integration of newcomers was supported by “responsive services, a welcoming environment and a shared respect for diversity”.

But the effects of assimilation can be seen on the health of Maori and Pacific people who experience health inequalities and a lower life expectancy than Pakeha. We are beginning to see these same trends in Asian and MELAA (Middle-Eastern, Latin American and African) communities. It is easy to write-off the poor health of particular groups to their individual behaviour or their culture. But there is growing evidence that health professional behaviour contributes to creating and reproducing disparities as seen by the differential quality of healthcare different racial and ethnic groups receive.

Cultural competence is a strategy for reducing health disparities and activating health gain. The American Society of Health-System pharmacists (ASHP) suggests that medication therapy management is central to many health disparities including diabetes or end-stage renal disease which disproportionately affects particular groups (for example, Maori) that pharmacists are in a position to directly address these disparities or to change the language away from deficit to health benefit or gain.

The Health Practitioners Competence Assurance Act 2003 requires that all health professionals are competent and fit to practice. There are seven standards for New Zealand pharmacists that articulate the knowledge, skills, attitudes and behaviours necessary for competence. The standard that is most relevant to cultural competence is Standard One which requires that pharmacists practice pharmacy in a professional and culturally competent manner.

Cultural competence approaches require the health professional and the institutional system of health to adapt the ways in which they deliver services in order to accommodate difference. these require the health professional to focus on three main areas.

  • The first is to be aware of how the patient or client’s health beliefs, values and behaviours are shaped by their culture or religion.
  • The second is a focus on learning about what shapes health behaviours, disease epidemiology, ethno-pharmacology and complementary health practices located in different groups.
  • The final area is that of communication where the role of the health professional is to elicit the client’s health beliefs, develop a therapeutic alliance and utilise strategies that enhance communication such as working with professional interpreters (funded in some areas) or using the pharmacy translation Kit developed by the guild, for example.

New Zealand also has an indigenous strategy called cultural safety. The emphasis, here, is on the beliefs and attitudes of the health professional rather than that of the client. Careful reflection on the assumptions that underpin the culture of the profession or the service is required because these very assumptions can be assimilatory and disempowering for people who are not invested in them. Such assumptions as the belief that the individual is solely responsible for their own health, that Western medicine is the only valid mechanism for dealing with ill-health require conforming to the system, rather than the system adapting to the needs of the patient or client. These assumptions might pose a barrier to caring for someone who does not hold those beliefs.

Instead of doing what we’ve always done, we might be inspired to develop new ways of thinking and practicing that could benefit all people and communities in this super- diverse New Zealand.

 

/by
, , , , , ,

Are we there yet?

This piece was originally published at Tangatawhenua.com http://news.tangatawhenua.com/archives/14051

On October 3rd 2011 as part of the series: Are we there yet? These articles are being written as a prelude to the election in November, and focus on the ‘wish list’ of Generation Xers; their hopes, dreams, aspirations and vision for New Zealand society.

I have two enduring memories of arriving in New Zealand with my family in June 1975. On the drive to our new home from Mangere, I was stuck by two sights, the first were the abundant citrus trees, promising sweetness and growth in this new life and the second, the Blockhouse Bay Foodtown supermarket where we shopped for our first meal before it closed (and no I don’t remember what that was!).

The supermarket too represented abundance but the shopping trip was a portent of the self-reliance my family would need to develop to survive in this country. A marked contrast to the hospitality of home cooking that we might have expected as newcomers from the other side of the world. Later, I found out that Tom Ah Chee a New Zealand-born Chinese, was one of the three small business owners to invest in the Foodtown, New Zealand’s first American-style supermarket.

The neoliberal narrative of migration is that my family came to New Zealand (like other migrants) for a better life. Another explanation is that we were pulled to New Zealand as a result of the unevenness of life chances created by colonial capitalism. As South Asians in East Africa we were what Avtar Brah calls the filling in the colonial sandwich. Occupying a precarious uneasy place that had neither the imperial support of the British coloniser nor the entitled weight of indigeneity. Migration to New Zealand offered an escape from the colonial sandwich to maybe a liberal pizza, a place of equal footing, a safe haven, replete with economic and academic opportunities. “New Zealand has no ‘colour bar’” I remember my Mother proudly telling friends. Unfortunately, like the settler colony we’d left, the dynamic was the same but the nuances were different. In East Africa Asians had a symbiotic relationship with Africans and were understood (a checklist of some of the popular foods in Kenya, shows how our culinary destinies were interwoven despite the imminent exclusionary nationalist future: kachumbar, chapati, pilau, chai, samosa to name a few). In New Zealand, food provided an entry point in a different way. I sold Maori cookbooks to raise funds for the Hoani Waititi marae in Henderson.

The migrant’s new life is characterised by a delicate dance between preservation and hope. Treasuring a past that might never be retrieved while hoping to succeed and make good on the sacrifices that have been incurred. But other kinds of reconciliation are also necessary; requiring that migrants develop what Ghassan Hage calls an ethical relationship with the history of colonial capitalism/colonisation in which they are implicated. The narrative of migration as an individual choice framed by the desire for betterment must be considered against the collusive role of migrants in usurping the indigenous. As must being subsumed into larger stories of ethnic communities as uninvited foreign guests, in need of careful management and modernisation so as not to lower the cultural standards of the receiving society (“our way of life”).

Reckoning with a colonial history requires coming to terms with New Zealand’s history of racism. Knowing that anti-Chinese and anti-Indian sentiment has been evident since the arrival of these groups in the 1800s, where they represented the largest groups of migrants and refugees, and were viewed as threats to jobs, morals and sexuality. Chinese particularly were the targets of exclusionary immigration legislation through the 1881 Chinese Immigration Act, which exacted a poll tax of £10 from all Chinese arriving in Aotearoa/New Zealand. Indians, as British subjects were not exempt from hostility nor restrictive legislative practices despite their status. The 1899 Immigration Restriction Act restricted Indian and other Asian immigration and the formation of the White New Zealand League, in 1926 epitomised this hostility. The latter formed to counter the potential for contamination of bloodline, values and lifestyle posed by Chinese and Indian men. The introduction of the 1920 ‘permit system’ reflected demands for increasing prohibitions and excluding and/or repatriating Asian migrants.

The end of an unofficial White New Zealand migration policy was not brought about by a desire for equity or fairness. Economics was central to this policy shift, and the 1986 review of immigration was a response to a ‘brain drain’ and decreased immigration to New Zealand. Consequently migrant selection shifted from preferred source countries (largely European) to being skills based in the Immigration Act of 1987, whereby a points system was introduced. The introduction of the Business Immigration Policy and  ‘Family reunification’ and ‘Humanitarian/refugee’ categories plus the growth of a thriving export education market consolidated this long-term trend to diversity. Consequently Asians grew in number and became more visible and central to the national economy and the number of people from Middle Eastern, Latin American and African communities (MELAA) increased. However, the residue of the old attitudes and fears remains, migrants and refugees are held with great ambivalence- disadvantaged in the employment stakes but welcomed for the spice and innovation their presence adds.

I began this piece by talking about my family’s welcome to New Zealand through consumer capitalism at Foodtown. On reflection, the supermarket is an apt metaphor for migration, both for the visibility and promise of its products and for the invisibility of its processes. Neoliberal narratives of individualism and ‘choice’ render invisible both the dispossession of the local and indigenous and the economic imbalance necessary for the movement of goods and people to the West in order for capitalism to flourish. Yet if these two aspects of migration were made visible, in the same way that more ethical consumptive practices are becoming a feature of contemporary life then other kinds of relationships might be made possible. In the case of ethnic communities, direct negotiation with Maori for a space where indigenous Maori claims for tino rangatiratanga, sovereignty and authority are supported while the mana of newcomers to Aotearoa is upheld hold promise.

So, I close this piece with an alternative story of welcome. Two years ago we had a Refugee conference at AUT University, where Tainui, Refugee Services and a group of refugees talked about the powhiri process they had instituted as part of the orientation of newly resettled refugees in Hamilton. Their presentation included a powhiri during which a refugee participant delivered his mihi in Swahili. Much to his astonishment when he came to sing his Swahili waiata I joined in. It was a moving experience. In his korero he said that the original powhiri in Hamilton had helped him to stand tall and regain his mana after the dehumanising experiences of his refugee journey. On a larger scale, Maori King Tuheitia, invited ethnic communities members to a special powhiri during the 5th Koroneihana (Coronation) celebration at Turangawaewae marae in August this year. Isn’t this the kind of Aotearoa we want? Where standing tall is possible for all of us?

Ruth DeSouza
Are we there yet? Contributor


Footnote

The process of direct negotiation with Maori has already begun and there are many resources available.

/by
, , , , , , ,

A view from a Goan in Aotearoa/New Zealand

The ocean is what we have in common: Relationships between indigenous and migrant people.

This piece was previously published in the Goanet Reader: Mon, 30 Nov 2009

Legend has it that Lord Parashuram (Lord Vishnu’s sixth incarnation) shot an arrow into the Arabian Sea from a mountain peak. The arrow hit Baannaavali (Benaulim) and made the sea recede, reclaiming the land of Goa. A similar story about land being fished from the sea by a God is told in Aotearoa, New Zealand, where Maui dropped his magic fish hook over the side of his boat (waka) in the Pacific Ocean and pulled up Te Ika a Maui (the fish of Maui), the North Island of New Zealand.

The first story comes from the place of my ancestors, Goa, in India and the second story comes from the place I now call home, Aotearoa, New Zealand. Both stories highlight the divine origins of these lands and the significance of the sea, as my friend Karlo Mila says “The ocean is another source of sustenance, connection and identity…. It is the all encompassing and inclusive metaphor of the sea. No matter how much we try to divide her up and mark her territory, she eludes us with her ever-moving expansiveness. The ocean is what we have in common.”

This piece for Goanet Reader is an attempt to create some engagement and discussion among the Goan diaspora about the relationships we have with indigenous and settler communities in the countries we have migrated to, and to ask, what our responsibilities and positions are as a group implicated in colonial processes?

My life has been shaped by three versions of colonialism: German, Portuguese and British, and continues to be shaped by colonialism’s continuing effects in the white settler nation of Aotearoa/New Zealand. Diasporic Goans have frequently occupied what Pamila Gupta calls positions of “disquiet” or uneasiness within various colonial hierarchies. For me, this has involved trying to understand what being a Goan means, far away from Goa and to understand the impact of colonisation.

I was born in Tanzania, brought up in Kenya and am now resident of Aotearoa/New Zealand with a commitment to social justice and decolonising projects. What disquieting position do I occupy here?

Both sets of my grandparents migrated to Tanganyika in the early part of the 20th Century. Tanganyika was a German colony from 1880 to 1919, which became a British trust territory from 1919 to 1961. Tanganyika became Tanzania after forming a union with Zanzibar in 1964.

On my father’s side, my great-grandfather and grandfather had already worked in Burma because of the lack of employment opportunities in Goa. Then when my grandfather lost his job in the Great Depression, he took the opportunity to go to Tanzania and work.

Indians had been trading with Africa as far back as the first century AD. The British indentured labour scheme was operational and had replaced slave labour as a mechanism for accessing cheap and reliable labour for plantations and railway construction, contributing to the development of the Indian diaspora in the 19th and 20th century.

Large-scale migrations of Indians to Africa began with the construction of the great railway from Mombasa to Lake Victoria in Uganda in the late nineteenth century. Indians were recruited to run the railways after they were built, with Goans coming to dominate the colonial civil services.

Some 15,000 of the 16,000 men that worked on the railroads were Indian, recruited for their work ethic and competitiveness. Sadly, a quarter of them returned to India either dead or disabled. Asians who made up one percent of the total population originated from the Gujarat, Kutch, and Kathiawar regions of western India, Goa and Punjab and played significant roles as middlemen and skilled labourers in colonial Tanganyika.

During the Zanzibar Revolution of 1964, over 10,000 Asians were forced to migrate to the mainland as a result of violent attacks (also directed at Arabs), with many moving to Dar es Salaam. In the 1970s over 50,000 Asians left Tanzania.

President Nyerere issued the Arusha Declaration in February 1967, which called for egalitarianism, socialism, and self-reliance. He introduced a form of African socialism termed Ujamaa (“pulling together”). Factories and plantations were nationalized, and major investments were made in primary schools and health care.

My parents migrated to Kenya in 1966. The newly independent East African countries of Tanzania (1961), Uganda (1962), and Kenya (1963) moved toward Africanising their economies post-independence which led to many Asians finding themselves surplus to requirements and resulting in many Asians leaving East Africa, a period known as the ‘Exodus’.

A major crisis loomed for United Kingdom Prime Minister Harold Wilson’s government with legislation rushed through to prevent the entry into Britain of immigrants from East Africa. The Immigration Act of 1968 deprived Kenyan Asians of their automatic right to British citizenship and was retroactive, meaning that it deprived them of an already existing right.

Murad Rayani argues that the vulnerability of Asians was compounded by the ambiguity of their relationship with the sub-continent, and with Britain whose subjects Asians had become when brought to East Africa.

Enoch Powell’s now infamous speech followed where he asserted that letting immigrants into Britain would lead to “rivers of blood” flowing down British streets. The Immigration Act of 1971 further restricted citizenship to subjects of the Commonwealth who could trace their ancestry to the United Kingdom.

In 1972 Idi Amin gave Uganda’s 75,000 Asians 90 days to leave. My parents decided to migrate to New Zealand in 1975.

While ‘Asians’ (South Asians) were discriminated against in relationship to the British, they were relatively privileged in relationship to indigenous Africans. As Pamila Gupta says, Goans were viewed with uncertainty by both colonisers and the colonised. Yet, the Kenyan freedom struggle was supported by many Asians such as lawyers like A. Kapila and J.M. Nazareth, who represented detained people without trial provisions during the Mau Mau movement. Others like Pio Gama Pinto fought for Kenya’s freedom, and was assassinated. Joseph Zuzarte whose mother was Masai and father was from Goa rose to become Kenya’s Vice-President. There was Jawaharlal Rodrigues, a journalist and pro-independence fighter and many many more. In 1914, an East African Indian National Congress was established to encourage joint action with the indigenous African community against colonial powers.

In the two migrations I have described, Goans occupied a precarious position and much has been documented about this in the African context. However, what precarious place do Goans occupy now especially in white settler societies?

Sherene Razack describes a white settler society as: ” … one established by Europeans on non-European soil. Its origins lie in the dispossession and near extermination of Indigenous populations by the conquering Europeans. As it evolves, a white settler society continues to be structured by a racial hierarchy. In the national mythologies of such societies, it is believed that white people came first and that it is they who principally developed the land; Aboriginal peoples are presumed to be mostly dead or assimilated. European settlers thus become the original inhabitants and the group most entitled to the fruits of citizenship. A quintessential feature of white settler mythologies is therefore, the disavowal of conquest, genocide, slavery, and the exploitation of the labour of peoples of colour.”

I’d like to explore this issue in the context of Aotearoa/New Zealand where identities are hierarchically divided into three main social groups categories. First in the hierarchy are Pakeha New Zealanders or settlers of Anglo-Celtic background. The first European to arrive was Tasman in 1642, followed by Cook in 1769 with organised settlement following the signing of the Treaty of Waitangi in 1840. The second group are Maori, the indigenous people of New Zealand who are thought to have arrived from Hawaiki around 1300 AD and originated from South-East Asia. The third group are “migrants” visibly different Pacific Islanders or Asians make the largest groups within this category with growing numbers of Middle Eastern, Latin American and African communities. This latter group are not the first group that come to mind when the category of New Zealander is evoked and they are more likely to be thought of as “new” New Zealanders (especially Asians).

Increasingly, indigenous rights and increased migration from non-source countries have been seen as a threat to the white origins of the nation. While, the Maori translation of Te Tiriti o Waitangi may be acknowledged as the founding document of Aotearoa/New Zealand and enshrined in health and social policy, the extent to which policy ameliorates the harmful effects of colonisation remain minimal.

This can be seen in my field of health, where Maori ill health is directly correlated with colonisation. Maori nurses like Aroha Webby suggest that the Articles of the Treaty have been unfulfilled and the overall objective of the Treaty to protect Maori well-being therefore breached. This is evidenced in Article Two of the Treaty which guarantees tino rangatiratanga (self-determination) for Maori collectively and Article Three which guarantees equality and equity between Maori and other New Zealanders.

However, Maori don’t have autonomy in health policy and care delivery, and the disparities between Maori and non-Maori health status, point to neither equality nor equity being achieved for Maori. In addition, colonisation has led to the marginalising and dismantling of Maori mechanisms and processes for healing, educating, making laws, negotiating and meeting the everyday needs of whanau (family) and individuals.

So in addition to experiencing barriers to access and inclusion, Maori face threats to their sovereignty and self-determination. Issues such as legal ownership of resources, specific property rights and fiscal compensation are fundamental to Maori well being. Thus, the Treaty as a founding document has been poorly understood and adhered to by Pakeha or white settlers, in terms of recognising Maori sovereignty and land ownership.

Allen Bartley says that inter-cultural relationships have been traditionally shaped by New Zealand’s historical reliance on the United Kingdom and Ireland, leading to the foregrounding of Anglo-centric concerns. Discourses of a unified nation have been predicated on a core Pakeha New Zealand cultural group, with other groups existing outside the core such as Maori and migrants.

This monoculturalism began to be challenged by the increased prominence of Maori concerns during the 1970s over indigenous rights and the Treaty of Waitangi. The perception of a benign colonial history of New Zealand — an imperial exception to harsh rule — supplanted with a growing understanding that the Crown policies that were implemented with colonisation were not there to protect Maori interests despite the mythology of the unified nation with the best race relations in the world that attracted my family to New Zealand to settle.

So while countries such as Canada and Australia were developing multicultural policies, New Zealand was debating issues of indigeneity and the relationship with tangata whenua (Maori). More recently people from ethnic backgrounds have been asking whether a bicultural framework can contain multi-cultural aspirations. New Zealand has not developed a local response to cultural diversity (multiculturalism) that complements the bicultural (Maori and Pakeha) and Treaty of Waitangi initiatives that have occurred. However, many are worried that a multicultural agenda is a mechanism for silencing Maori and placating mainstream New Zealanders.

So is there a place/space for Goans in New Zealand? Or are we again occupying a disquieting space/place? According to Jacqui Leckie, one of the first Indians to arrive in New Zealand in 1853 was a Goan nicknamed ‘Black Peter’. Small numbers of Indians had been arriving since the 1800s, Lascars (Indian seamen) and Sepoys (Indian soldiers) arrived after deserting their British East India Company ships in the late 1800s.

The Indians that followed mainly came from Gujarat and Punjab, areas exposed to economic emigration. Indians were considered British subjects and could enter New Zealand freely until the Immigration Restriction Act (1899) came into being. Migration increased until 1920, when the New Zealand Government introduced restrictions under a “permit system”.

Later, in 1926, The White New Zealand League was formed as concern grew about the apparent threat that Chinese and Indian men appeared to present in terms of miscegenation and alien values and lifestyle. Discrimination against Indians took the form of being prevented from joining associations and accessing amenities such as barbers and movie theatres.

By 1945, families (mostly of shopkeepers and fruiterers) were getting established, and marriages of second-generation New Zealand Indians occurring. The profile of Indians changed after 1980, from the dominance of people born in or descended from Gujarat and Punjab. Indians began coming from Fiji, Africa, Malaysia, the Caribbean, North America, the United Kingdom and Western Europe.

Migrants are implicated in the ongoing colonial practices of the state and as Damien Riggs says the imposition of both colonisers and other migrants onto land traditionally owned by Maori maintains Maori disadvantage at the same time that economic, social and political advantage accrues to non-Maori.

But my friend Kumanan Rasanathan says that our accountabilities are different: “Some argue that we are on the Pakeha or coloniser side. Well I know I’m not Pakeha. I have a very specific knowledge of my own whakapapa, culture and ethnic identity and it’s not akeha. It also stretches the imagination to suggest we are part of the colonising culture, given that it’s not our cultural norms and institutions which dominate this country” (Rasanathan, 2005, p. 2).

Typically indigenous and migrant communities have been set up in opposition to one another as competitors for resources and recognition, which actually disguises the real issue which is monoculturalism, as Danny Butt suggests. My friend Donna Cormack adds that this construction of competing Others is a key technique in the (re)production of whiteness.

My conclusion is that until there is redress and justice for Maori as the indigenous people of New Zealand, there won’t be a place/space for me.

As Damien Riggs points out, the colonising intentions of Pakeha people continues as seen in the contemporary debates over Maori property rights of the foreshore and seabed which contradict the Treaty and highlight how Maori sovereignty remains denied or challenged by Pakeha.

My well being and belonging are tied up with that of Maori. Maori have paved the way for others to be here in Aotearoa/New Zealand, yet have a unique status that distinguishes them from migrant and settler groups. After all I can go to Goa to access my own culture but the only place for Maori is Aotearoa/New Zealand.

Increasingly, the longer I’ve lived in Aotearoa/New Zealand and spent time with Maori, the more I’ve begun to understand and value the basis of Maori relationships with the various other social groups living here as being underpinned by manaakitanga (hospitality), a concept that creates the possibility for creating a just society. Understanding and supporting Treaty of Waitangi claims for redress and Maori self-determination (tino rangatiratanga) allows for the possibility for the development of a social space that is better for all of us.

/by
, ,

Developing diversity in the workforce

Published in Kai Tiaki: Nursing New Zealand 1410.10 (Oct 2008): p23(1).

Identifying barriers, opportunities and strategies to integrate and develop a diverse health workforce was the aim of a workshop at the recent Diversity Forum in Auckland.

“Capitalising on a diverse health workforce” was hosted by the Centre for Asian and Migrant Health Research at the Auckland University of Technology (AUT) and opened by dean of the Faculty of Health and Environmental Sciences at AUT’s North Shore campus, Max Abbott. He recounted how pivotal overseas health professionals were to his recovery during a recent hospital stay.

Nurse consultant-recruitment at North Shore Hospital, Waitemata District Health Board (DHB), Carat Frankson, identified some bottlenecks to the registration of overseas nurses, in particular passing the International English Language Testing System (IETLS) exam, getting a job offer and finding employment opportunities for spouses. Other bottlenecks included organising passports and visas, selling and buying houses, finding schools, living costs, climate, separation from family, loss of familiar surroundings, religious practices, cultural backgrounds and the financial costs of moving from one country to another. Strategies the DHB provided in order to embrace a diverse nursing workforce included:

  • coaching, support, mentorship and supervision in the work environment;
  • introduction to the New Zealand cultural context and context of nursing at the DHB;
  • education in the principles of the Treaty of Waitangi; and
  • education in the values of the Waitemata DHB: integrity, compassion, openness, respect and customer focus.

The process could be mutually beneficial, Frankson said. “It is our responsibility to introduce and support new recruits into the New Zealand way of life, offering them cultural support. Incorporating and including immigrants into our communities is a responsibility we all share.” White these health professionals benefitted our workforce, they could also benefit other areas of society, eg schools, Libraries, universities, community centres, religious centres and the legal system, she said.

Auckland DHB clinical nurse educator, Roanne Crane’s presentation on integrating overseas-trained health professionals into the DHB identified some of the issues facing overseas registered nurses, such as Language, manoeuvring through the New Zealand registration process, socialisation, cultural differences, unprincipled agents and assumptions/racism.

Reducing health inequalities

Workforce development consultant at Counties Manukau DHB, Elizabeth Ryan, discussed the increasing demand for health services. The population was ageing, with the number of people over 65 projected to more than double between 2001 to 2021; a third of deaths occurring everyday in Counties Manukau were from potentially preventable conditions; and workforce demand would outstrip supply, with shortages nationally of up to 40 percent predicted by 2021, including in South Auckland. Having an ethnically diverse workforce was a key strategy in reducing inequalities in health, she said. The workforce needed to reflect the community being served in order to deliver quality health services in a culturally-appropriate manner. Ethnic matching was associated with greater patient satisfaction and better patient-reported outcomes.

She highlighted initiatives such as increasing the number of high school students studying health courses, with an emphasis on Maori and Pacific students, increasing numbers pursuing health at mid-career level, especially males/ Maori and Pacific people, collecting accurate demographic data, developing an affirmative action policy and the pilot programme which wilt see around 50 Pacific-Island trained nurses gain registration in New Zealand annually over the next three years.

Meeting the challenge of institutionalised racism was tackled by Auckland University researcher Nicola North. Of note was the complex and subtle set of skills that international medical graduates (IMGs) and international registered nurses(IRNs) needed to acquire, eg understanding cultural differences, familiarity with the culture of the new community of practice, fluency with the nuances of professional communication, and understanding the behaviour and values expected. To meet the challenge, North suggested several factors needed to be addressed: self-reflection as a society, a focus on immigration and settlement structures and processes, even-handed behaviour from registration councils, finding employment, smoothing the process of joining the new practice community and, lastly, getting real. “We need to acknowledge we need IMGs and IRNs more than they need us,” she said.

In the final part of the workshop, the group considered the question: What would a health system that capitalised on its diversity look like? Answers included:

  • recognising skills and supporting people financially;
  • ensuring the health workforce reflects the population demographics;
  • passing on success stories to the media;
  • rewarding and acknowledging cultural competence;
  • fostering diversity at all levels, including around decision-making, to develop new ideas and treatments;
  • consolidating, streamlining and integrating information systems to free up funding for initiatives;
  • growing the inter-cultural communication capacity of the entire workforce, eg educating people about how to deriver bad news to patients;
  • including diversity at art education levels;
  • focusing on areas of under-representation and targeting them specifically; and
  • ensuring support mechanisms are developed to take into account cultural differences, eg around employee disputes.

New York author Margaret Visser argues that change and diversity are necessary to human growth and evolution: “Machines like, demand, and produce uniformity. But nature loathes it: her strength lies in multiplicity and in differences. Sameness, in biology, means fewer possibilities and, therefore, weaknesses.” (1)

Reference

(1) Visser, M. (1999) Much depends on dinner:. The extraordinary history and mythology, allure and obsessions, perils and taboos, of an ordinary meal. New York: Grove Press.

/by
, ,

Indians in New Zealand and the story of my family’s arrival

The Indian community is a growing minority in New Zealand, making up the second largest group in the category ‘Asian’ after Chinese communities.

You can watch a short video (4.38), excerpted from the TV Series Here to Stay about Indians in New Zealand. by clicking on the link. I talk about my parents’ decision to migrate and the experience of arrival: Ruth DeSouza: Arriving in New Zealand.

I’ve also provided a very brief background of Indian migration to New Zealand from an article I wrote: DeSouza, R. (2006). Researching the health needs of elderly Indian migrants in New Zealand. Indian Journal of Gerontology, 20 (1&2), 159-170.

The 2006 Census found that European New Zealander’s make up 67.6% of the population of people in New Zealand, 14.6 % of people as Māori. Pacific Peoples make up 6.9% of the population, Asians 9.2% and Middle Eastern, Latin American & African people 0.9%. The Census also found that 11.1% of people identified themselves as New Zealanders (Statistics New Zealand, 2006). Within the Asian group, Indians had the highest percentage increase in population between 2001 and 2006  increasing from 62,190    to 104,583 a 68.2% increase. The previous Census of 2001, found that Indian-New Zealanders were highly qualified and more likely to receive income from wages and salaries than the total New Zealand population and as likely as the overall New Zealand population to receive income from self-employment thus Indians have the second highest median annual income among the Asian ethnic groups, are involved in white collar employment and, at 77%, had the highest labour force participation rate of all the Asian ethnic groups (Statistics New Zealand, 2002a).  A relatively high level of home ownership (41%) was also found. This profile of Indian New Zealanders is a recent development, early Indian migration was primarily derived from two rural areas of India, Gujarat and Punjab, and arrivals were mainly traders, farmers, artisans or small businessmen (Tiwari, 1980).

The Indian connection with New Zealand began in the late 1800s through Lascars (Indian seamen) and Sepoys (Indian soldiers) on British East India Company ships that brought supplies to the Australian convict settlements. The earliest Indian to arrive in New Zealand is thought to have jumped ship in 1810 to marry a Mâori woman. The Indians that followed came mainly from Gujarat and Punjab, areas of India which had been exposed to emigration, and were driven by economic factors. Initially Indians were considered British subjects and could enter New Zealand freely. This changed with the passing of the Immigration Restriction Act 1899.

Indian migration increased until 1920, when the New Zealand Government introduced restrictions under a ‘permit system’ (Museum of New Zealand: Te Papa Tongarewa, 2004). In 1926, the White New Zealand League was formed as concern grew about the apparent threat that Chinese and Indian men appeared to present in terms of miscegenation and alien values and lifestyle. Discrimination against Indians manifested in restrictions around joining associations and accessing amenities such as barbers and movie theatres. By 1945, families (mostly of shopkeepers and fruiterers) were getting established and marriages of second-generation New Zealand Indians were occurring. As well as Gujuratis and Punjabis, smaller numbers of Indians came from locations such as Fiji, Africa, Malaysia, the Caribbean, North America, the United Kingdom and Western Europe. The proportion of Fiji-born Indian immigrants to New Zealand rose significantly as a result of the Fijian coups of 1987 and 2000 (Swarbrick, 2004).

/by
, ,

How to conquer anxiety and even enjoy giving a presentation

Published in Kai Tiaki: Nursing New Zealand 13.10 (Nov 2007): p20(2).

It is 11 years since my first conference presentation and I remember that day vividly. I had prepared carefully for the presentation; friends and family came to support me; but a tricky question at the end of my presentation took me by surprise: “Ruth, thanks for that interesting presentation. How does what you say relate to postmodemism?” I was mortified and fudged an answer. It’s a wonder that anyone presents realty! Why would you expose yourself in this way and what is the purpose of a presentation?

In this article I attempt to summarise some of my learning and share some strategies and ideas, in the hope of prompting readers to consider embracing the performance that is presenting. I am going to ask you first to think about who was the best speaker you have ever heard and what was good about them. Now, think about what presenting might have to offer you. Why should nurses think about presenting or public speaking? It is a good career move. The pay off is personal satisfaction, peer esteem and building your career. It is a good skill to develop–you might need to present research at a conference, in-house or at an interview. These experiences help you become a better presenter and increase your visibility.

Conferences, for example, provide an important arena and opportunity for people to exchange views and communicate with each other. They are also useful for linking up with the people who are most interested in your work.

What makes a good speaker?

What makes a good speaker? In my view, a good speaker begins and ends their presentation strongly; you are hooked from the first word to the last, by their brilliance, humour, wisdom, provocation and ability to entertain. They also know how to tell good stories, but they never read from their speech. They capture your attention because, not only do they know their own work, they also have a clear message.

So how does one go about speaking? I have developed as a presenter over the years from being flustered and over-prepared, to having far too much to say, to now beginning to feel natural and comfortable when I present at a conference or gathering of peers.

When I was a group therapist and facilitator, I had to speak to several people at a time and this helped me grow in confidence as a speaker. Then I was asked to facilitate a function attended by 250 people. This prompted me to do a Toastmasters course, where I learned how to recover from mistakes in a presentation. I also realised that when I was anxious, I lost my ability to be natural and humorous, but if I could manage my anxiety, then all would be well

In terms of conference presentations, I prepared by reading previous papers and began networking, so I got to know other people in my research field, which helped me realise I had something to offer.

Preparation crucial

Preparation is crucial to presenting well Three aspects need to be addressed: the purpose, structure and content of your presentation. In considering purpose, it is important to know the key messages you want to convey. It might help to start at the end and work backwards–every presentation needs a destination. Then consider what you need to say to assist the listener to get those key messages. Is there a context you need to introduce? How much can you assume your audience will know already? So to the structure. I tend to work on the basis of four parts to a presentation: the introduction, the body, the guts and the conclusion.

The purpose of the introduction is to motivate the audience, which you can do by having a warm up or a question. I also use this part to introduce myself and define the problem or issue, and set the scene. Then you can introduce the context, such as terminology and earlier work. At this point, I would also emphasise what your work contributes to the topic or area, and provide a road map of where your presentation is going. This normally takes around five minutes. The next part of the presentation outlines some big picture results or themes and why they are important. This is followed by the “guts” of what you want to say, where you present one key result, carefully and in-depth.

The conclusion is where many presenters (including myself) run out of steam. The conclusion involves rounding off your presentation neatly and linking everything you’ve said. This can be a good time to mention the weaknesses of your work, and it can help manage questions at the end. It is good to find a way to indicate the presentation is over. I do this by thanking the audience and asking if there are any questions.

Now to the content. Many people use PowerPoint presentations. Use slides like make up–sparingly and simply: common advice is don’t have too much on them; and don’t have too many. (I’m still working on this one.) Six words per bullet point and a maximum of six bullet points per slide is recommended.

The slides are merely an adjunct to your talk, so please don’t read them word for word (my pet hate). The purpose is to highlight key points for the audience and to prompt the speaker. In considering the number of slides to have, keep in mind that each slide takes about a minute and a hail or two minutes to read and fully understand?? If you have 87 slides for a 25-minute talk, like someone I was on a panel with recently, you are likely to overwhelm your audience. Take care with formatting your slides and make sure the spelling is correct. Lastly, be sure you’ve saved your presentation to two types of media. Practise your presentation, ask for a second opinion and get some feedback. Practising helps fine tune your timing.

On the day itself, make sure you are prepared and took and feet good. Ensure you take the media you are going to use and take a hard copy of the presentation to refer to. Say your presentation out loud. At the venue expect nothing to work and scope the technology. Address your anxiety. I do this by practising my presentation, going for a brisk walk and taking deep breaths. I also like to get to the venue early and mingle with those attending the conference, so I can develop some allies in the audience. Focus on being yourself and focus on giving.

Connecting with the audience

Now to the actual presentation. Make sure you project your voice to the very back of the room. It is important to know the audience and pitch your message accordingly. Make eye contact if possible–this is easier if you had time to meet people beforehand. Find a way to involve the audience and make sure you have a good opening. Use repetition to reinforce your message: tell them what you are going to tell them; tell them; then tell them what you told them, but repeat it in different ways. Make sore you are standing in the right place so you aren’t blocking your slides or other visual aids.

Remember that once you get involved in what you have to say, then the nervousness will go away. Don’t be afraid to pause, and you can pause for emphasis. If you get stuck, just move on to the next part of your presentation (others won’t notice). Be spontaneous, considerate and inclusive. I like to move around and I tend to focus on entertaining. If you can generously link in with what previous speakers have said, or affirm later speakers for continuity and reinforcement, that is all to the good. Whatever you do, don’t go over time.

Congratulations, you’ve finished. Now, let’s talk about feedback and questions. Feedback is critical to Learning how to improve your talk and for future presentations. Solicit feedback, if it isn’t freely given, but be prepared for some negative comments! Ask for written feedback, if appropriate.

Managing questions is important. Repeat the question so everyone can hear. It is important to be both prepared and polite. Keep your answers short where possible. If you get drawn into a Long discussion with a questioner, for the sake of your audience, offer to discuss the issue tater. Don’t be afraid to say that you don’t know. Find a way to turn criticism into a positive statement, eg “thanks for mentioning that, it’s given me something to think about”, rather than being defensive.

Different types of questions

In my experience there are four types of question: the genuine request; the selfish question (which is realty about the questioner saying “Look at me”); the malicious question (which is designed to expose you); and the question that has absolutely nothing to do with your presentation and makes you wonder if you and the questioner were in the same venue!

Presenting requires a delicate balance–preparation is important but so is being yourself and being spontaneous. It is important to have content and structure, but the more you have of both, the less room you have for questions and spontaneity. It is important to be inclusive, but be careful with humour and jokes or your own stories, unless you can Link them with your talk well. Lastly, be entertaining, know your material, keep it simple, be prepared, be creative and have fun!

/by
, ,

Advice to a student nurse

My response to  a student nurse who was haunted by questions about becoming a nurse. Published in Kai Tiaki: Nursing New Zealand 13.1 (Feb 2007): p4(1).

I was pleased to see [x} letter, Questions haunt nursing student, in the December/ January 2006/2007 issue of Kai Tiaki Nursing New Zealand (p4). The questions she has reflected on indicate she is going to be an amazing nurse.

I believe nursing is both an art and a science, and our biggest tools are our heart and who we are as human beings. I was moved by her letter and thought I’d share my thoughts. The questions she posed were important because the minute we stop asking them, we risk losing what makes us compassionate and caring human beings.

Let me try to give my responses to some of the questions Lisa raised–I’ve been reflecting on them my whole career and continue to do so.

1) Can a nurse “care” too much?

Yes, when we use caring for others as a way of ignoring our own “issues”. No, when we are fully present in the moment when we are with a client.

2) Don’t patients deserve everything I can give them?

They deserve the best of your skills, compassion and knowledge. Sometimes we can’t give everything because of what is happening in our own lives, but we can do our best and remember we are part of a team, and collaborate and develop synergy with others, so we are resourced and can give our best.

3) How do I protect myself and still engage on a deeper level with the patient?

I think we have to look after our energy and maintain a balance in our personal lives, so we can do our work weft. We also need healthy boundaries so we can have therapeutic communication.

4) How do I avoid burnout?

Pace yourself, get your needs met outside work, have good colleagues and friends, find mentors who have walked the same road to support you. I’ve had breaks from nursing so I could replenish myself.

5) Why can’t I push practice boundaries, when I see there could be room for adjustment or improvement?

I think you can and should, but always find allies and justification for doing something. Sometimes you have to be a squeaky wheel

6) Isn’t it okay to feet emotionally connected to the patient?

Yes, it is okay to feel emotionally connected to the patient, but we also have to remember that this is a job and our feelings need transmutation into the ones we live with daily.

7) Don’t I need to continually ask questions, if nursing is to change, or will that just get me fired?

Yes, you do have to ask questions but it is a risky business. Things don’t change if we don’t have pioneers and change makers.

8) Finally, am I just being a laughable year-one student with hopes and dreams, and in need of a reality check?

No, your wisdom and promise are shining through already and we want more people like you. Kia Kaha!

/by
, , , , , , ,

Improving collaboration between nursing professionals and support workers in the New Zealand mental health system– A position paper

In 1998 I began teaching the first mental health support work cohorts in New Zealand at Unitec Institute of Technology. I had the privilege of working with Maori and Pacific mental health workers, peer support workers and consumer providers until 2005. I wrote this position paper for the Australian and New Zealand College of Mental Health Nurses way back in 2003. I have taken it out of the vault in case it is of use. I have listed more up to date references at the end of the document for those who might want to do some further reading.

EXECUTIVE SUMMARY

The Mental Health Commission (1997) states that mental health is the concern of all. Support workers are a reality of today’s mental health system in New Zealand and this paper looks at their relationship with community mental health nurses. This paper is a response to the major changes in mental health care in New Zealand over the last decade, which have dramatically altered the landscape of the mental health workforce. It seems timely to look at a way forward and to develop guidelines for nurses working with support workers in the community. In this paper “support workers” include community support workers and consumers as providers and the term “nurses” refers to community mental health nurses.

No one group can meet the needs of consumers. Together these two groups can provide complimentary services to improve client care but a model of cooperation is necessary and further clarification of roles and overlap is required. Effective teamwork between nurses and support workers in the mental health community in New Zealand must occur so that the care delivered is flexible and responsive to the needs of consumers and their families. The changes in the socio-political context of mental health care in New Zealand are challenging nurses to re-define their scope of practice. These developments and their implications are summarised and options for the nursing profession are discussed and recommendations given.

ISSUES

Competition for funding

The creation of the Regional Health Authorities (RHA) in 1991 was part of a new system of purchasing health services which replaced Area Health Boards (Yegdich & Quinn, 1996). This new funder /purchaser /provider system encouraged competition between providers and led to many new services entering the health sector. These included non-governmental services who were now able to compete directly with Crown Health Enterprises (CHE), previously there was an obligation for boards to concentrate funding on their own services (Yegdich & Quinn, 1996). In 1996 the new coalition government initiated another review of the health system leading to funding being centralised under the Transitional Health Authority (THA). Competition for central funding begs the question of whether competing services with different philosophies and types of workers can cooperate with each other. When community support services were established in Auckland there was antagonism from nurses as these new services were seen as better resourced, with lower caseloads and were seen to be eroding the role of the professional nurse.

Culturally appropriate parallel services

The changes in funding have also lead to the development of specialised Maori and Pacific Island support work services. In Auckland, the Maori community support work (CSW) service has dramatically reduced the rate of admission and re-admission for Maori . Previous statistics had shown that Maori were entering the mental health system at the same rates as non-Maori but required longer stays and more frequent re-admissions (Te Puni Kokiri, 1993). Increased numbers of immigrants and refugees from Africa, Asia and Eastern Europe have led to the formation of specialised mental health services, for example the Refugees As Survivors (RAS) centre. However, a disadvantage of parallel services is that nurses in main stream services lose the opportunity to develop specialised skills for working with cultures other than their own.

Case management

Case management originated in the United States in the 1980’s in the context of deinstitutionalisation, normalisation and the development of community mental health centres (Sledge, Astrachan, Thompson, Rakfeldt & Leaf, 1995; Willis & Morrow, 1995). It was seen as a way of improving the connections between services and linking both clinical and rehabilitation services together to ensure that “severely mental ill” clients received adequate services (Sledge, et al. 1995). Versions of case management are used in New Zealand although little has been written about the experience locally. Universal agreement has not been achieved regarding the scope of practice of case managers and the level of education required. The assumption that nurses are the most suitable group to provide case management services is being challenged by the emergence of support work services and parallel ethnic mental health teams.

Role change

Yegdich and Quinn (1996) have observed that the role of nurses has extended with the move from institution to community. Needs of clients now include housing, income, employment and social networks. However, an audit of community services in Auckland found that the dominant activity of nurses was crisis intervention (Yegdich & Quinn, 1996). Support work services have evolved in recognition of the gaps in community care provision. This movement to the community has also resulted in an increased emphasis on tertiary prevention, rehabilitation and recovery. New postgraduate training courses in mental health nursing have been developed as a result of a growing dissatisfaction with comprehensive nurse training and what is seen as inadequate preparation for working in this area (Ministry of Health, 1996). This is also important from a case management perspective particularly as broader skills are necessary for this role, for example knowledge of community resources.

Changing relationship with consumers

The consumer movement is influencing the movement of mental health service delivery from a medical to psychosocial rehabilitation model (Worley, 1997). New opportunities have arisen for consumers to interact with policy makers, professionals and others from a position of strength. Consumer operated programmes and initiatives have been developed due to the dissatisfaction with clinical mental health services. Consumers have found consumer-staffed organisations more empathetic, tolerant and understanding because of their own struggles with psychiatric disability (Worley, 1997). Consequently, guidelines have been developed as a result of increased consumer participation in professionally run mental health agencies (Ministry of Health, 1995). This has also led to changes in relationships between consumers and professionals. There is growing recognition on the part of professionals of the value of experiential knowledge and what consumers have to offer other consumers.

Safety and extended roles

  • Assessment by a nurse is required to detect changes in the mental state of a client. Where a support worker is the predominant contact, changes may be missed particularly if they have no clinical experience or assessment skills. In an article about extended roles, Rieu (1994) stated that discussion about accountability (“professional” and “legal”) and competency is needed. Other questions that need to be addressed include:
  • What preparation and training are support workers given?
  • What supervision do they get and how are they regulated?
  • How well are they resourced and supported?
  • Is their scope of practice clearly defined?

ADDRESSING THE ISSUES

Recognising the strengths of support workers

Support workers are seen as filling the gaps in community care, particularly in terms of work with clients with complex needs not met within the reductionist medical model (Davies, Harris, Roberts, Mannion, McCosker & Anderson, 1996). Other advantages include breaking the barrier of client-worker distance, providing a bridge between clients and mainstream staff and providing a role model for clients of similar background (Davies et al., 1996). Studies have shown that support workers are considered more effective than health professionals for several groups with varying mental health needs (Davies et al., 1996; Grant, Ernst, Streissgut, Phipps & Gendler, 1996). These include abused women, who have viewed the health system as sexist, fragmented and professionals as judgemental and insensitive (Davies et al., 1996). Other studies have shown that chronically drug-dependent women have become distrustful of “helping” agencies and in turn many professionals see these women as a hopeless population (Grant et al., 1996). They describe an advocacy model of case management using support workers, who worked intensively with women, who used drugs or alcohol heavily during their pregnancies and were alienated from community services. This alienation increased the risk of delivering children with serious medical, developmental and behavioural problems. It also prevented them from seeking assistance from agencies that were designed to help them. These ‘advocates’ were support workers experienced in social services with high-risk populations, had a variety of life experiences and came from a similar cultural background to their clients. They were seen as positive role models, providing hope and motivation. It was found after one year that clients now engaged with treatment agencies, decreased drug use, increased use of birth control and increased their involvement with supportive and skill building groups, such as parenting classes (Grant, et al., 1996).

Training and education of nurses

Nursing training must incorporate concepts such as recovery and consumer perspectives. Nurses need to be supported to work as case managers and build on their roles as more than adjuncts to the medical model. Mental health nurses working in the community must clarify their current roles and define what pathways they will follow.

Diversity in the workforce to provide culturally appropriate services

Reviews have shown that there are a paucity of culturally safe services for Maori and Pacific people (Ministry of Health, 1997). Furthermore, the provision of resources and devolution of resources have not supported other views of mental illness (Mental Health Commission, 1996). “Moving Forward” (Ministry of Health, 1997) national objectives states more trained mental health workers are needed before culturally appropriate services can be provided by mainstream and kaupapa Maori mental health services. A better partnership is needed between education and health sectors so that training can be specifically targeted to Maori. The Pacific Island objective also recommends that work be done so that mental health services become more responsive to the diverse needs of Pacific peoples. The national objectives recommend educating consumers as providers, community support workers and Maori and Pacific Island workers.

Better cooperation with ethnic support workers

In an Australian article, Fuller (1995) argued that health care practices by professionals continue to be predominantly monocultural despite recognition of the need to be responsive to the culturally diverse population. Fuller added that different ethnic groups practice illness prevention and health promotion differently. Some prefer direct, practical and immediate assistance from the Western care system rather than long term strategies. Fuller argued that nurses could not attain all the necessary cultural knowledge to provide total care to clients without a partnership with cultural intermediaries. According to Fuller, this expectation would result in lists of stereotypical traits being produced rather than an improved understanding of clients individual needs. Fuller added that the values and assumptions of primary nursing with contradictory notions of empowerment and autonomy have resulted in rigid professional boundaries which restrict multi-disciplinary team work, thereby increasing the need for an ethnic support worker.

Alternative structures and models

The Ministry of Health (1997) recommends that mental health promotion and prevention for Maori and Pacific Islanders be strengthened. They suggest using traditional (Pacific and New Zealand) structures to promote mental health including circulating Pacific language descriptions of key western mental illnesses. In addition, the Report of the National Working Party on Mental Health Workforce Development (Ministry of Health, 1996) suggested that Maori consumers become integrated into the provider culture of mental health services, so services reflect the wealth of Maori consumer experience. This is in line with the request by Maori consumers to have more Maori community support workers, patient advocates and crisis teams. This leads on to the next area for discussion about who can best provide services for those with mental health needs. Takeuchi, Mokuau & Chun (1992) found that the establishment of parallel services improved mental health for minorities and led to an increase in their use.

Multiskilled, multidisciplinary and comprehensive

According to Øvretveit (1993), it is rare that one profession alone is able to meet the needs of a person with a social or health need. Usually the skills and knowledge of a range of specialists are beneficial and coordination is crucial to prevent costs of duplication and staff frustration. This is echoed by the Report of the National Working Party on Mental Health Workforce Development (Ministry of Health, 1996). It suggests that the best way to deliver mental health services to consumers is by having a team of multi-skilled and multi disciplinary workers. This team would be able to address the many facets of care required by sufferers of mental illness and would include community support workers as well as Maori and Pacific Island workers. “Moving Forward’s” National objectives are to increase the Maori and Pacific Island mental health workforce. In addition, a flexible system is required where a case manager might need to spend more time with someone as the nature of mental illness changes rapidly.

A proposed model of cooperation

The mental health of consumers will be maximised if professionals and support workers are able to work in partnership and combine their skills, knowledge, life experience and expertise in a coordinated way. This would ensure that services are respectful, relevant, flexible, responsive and effective and that they are available to consumers to reduce the barriers that prevent them from achieving their full health potential. The framework for community service delivery for people with mental health problems needs to be comprehensive, health promoting and collaborative; a partnership that is committed to client empowerment and the elimination of barriers to access (Association of Ontario Health Centres, 1994).

RECOMMENDATIONS

Several recommendations are proposed:

Liaison

  • Adopt protocols for networking within all services so that inter-agency cooperation is maximised and clients receive a seamless service.
  • Improve the interface between clinical, cultural and psychosocial models to increase understanding and collaboration from both perspectives.

Training 

  • Educate support workers to understand the role of the nurse but not to the extent that traditional healing structures are negated in favour of psychotherapeutic methods.
  • Formalise traditional roles into the mental health system, for example the role of Kaumatua (Street & Walsh, 1996).
  • Train nurses in cultural and psychosocial models.

Role and Scope of practice

  • Develop job descriptions for support workers in cooperation with nurses to prevent role ambiguity, promote job satisfaction and decrease discontent.
  •  Support and safeguard support workers to ensure that their role does not compromise the safety of clients and staff or the role of the nurse.
  • Use nurses appropriately and ensure that they are not substituted by support workers for fiscal or political reasons.
  • Define core competencies for support workers at a national level and ensure on-going monitoring of standards.

Alternatives to the medical model

  • Recognise that the clinical model has limitations and cannot meet the needs of all clients.
  • Increase familiarity with alternative models of mental health amongst nurses, for example recovery and cultural models.
  • Review and clarify the role of nurses working in mental health.

Cultural safety 

  • Acknowledge the importance of spiritual issues, land rights, whanau reconstruction and physical health (Street & Walsh, 1996).
  • Resource nurses appropriately for the cultural component of their work.
  • Involve nurses in developing appropriate policy and healthcare services to Maori and ethnic minorities in New Zealand (Street & Walsh, 1996).
  • Familiarise nurses with the work of ethnic mental health workers and Maori support work services.

Consumer participation/consumer focused

  • Recognise the experiential and personal knowledge of consumers.
  • Ensure that consumers are key players in planning and accountability structures which are linked to outcome measures.

CONCLUSION

This paper has shown how support workers can reach clients who are lost to or fearful of the mental health system, whether this is because of social, ethnic or cultural reasons. In an evolving mental health system moving from institutionalisation to community-based care, these new roles provide a bridge between the clinician and the consumer. No one group can meet all the needs of consumers. Support workers can widen the focus of the mental health system in a way that better meets the needs of clients in the community at large, whatever their background. Friction has existed between nurses and support workers, the former often viewing the latter as eroding their role and of being unskilled. Alternatively support workers have sometimes viewed nurses as part of a system that they see as having failed them. Support workers are seen by some as being a political solution to eroded health care funding. Although there are several issues requiring on-going discussion, not least the legal and ethical requirements for support workers and their regulation, a synergy exists between nurses and support workers and together they can provide complimentary services to improve client care. For this to be successful a model of cooperation is necessary and further clarification of roles and overlap is required. Effective teamwork between nurses and support workers in the mental health community in New Zealand must occur so that the care delivered is flexible and responsive to the needs of consumers and their families. A guiding framework of principles for working in harmony should be developed.

REFERENCES

Association of Ontario Health Centres (1994). Response to: “Implementation Vision” – Mental Health Reform. Toronto: Association of Ontario Health Centres

Davies, J; Harris, M; Roberts, G; Mannion, J; McCosker, H & Anderson, D. (1996). Community health workers’ response to violence against women. Australian and New Zealand Journal of Mental Health Nursing,5, 20-31.

Fuller, J. (1995). Challenging old notions of professionalism: how can nurses work with paraprofessional ethnic health workers? Journal of Advanced nursing, 22, 465-472.

Grant, T.M.; Ernst, C.C.; Streissgut, A.P.; Phipps, P.& Gendler, B. (1996).When case management isn’t enough: a model of paraprofessional advocacy for drug and alcohol abusing mothers. Journal of Case Management, 5, 1, , 3-11.

Mental Health Commission (1997). Discrimination against people with experience of mental illness: Discussion paper for the mental health commission. Wellington: Mental health commission.

Ministry of Health (1995). A guide to effective consumer participation in mental health services. Wellington: Ministry of Health.

Ministry of Health (1996). Towards better mental health services: The report of the national working party on mental health workforce development. Wellington: Ministry of Health.

Ministry of Health (1997). Moving forward: The National Mental Health Plan for more and better services. Wellington: Ministry of Health.

Øvretveit, J. (1993). Coordinating community care. Open University press: Buckingham. Rieu, S. (1994). Error and trial: the extended role dilemma. British Journal of Nursing, 3, 4, 168-174.

Street, A & Walsh, C. (1996). Community nursing issues in Maori Mental Health. Australian and New Zealand Journal of Mental Health Nursing, 5, 54-62. Te Puni Kokiri (1993).

Nga Ia O Te Oranga Hinengaro Maori trends in Maori Mental Health: A discussion document. Wellington: Te Puni Kokiri. Worley, N. (1997). Mental health nursing in the community. .Mosby: St Louis.

Yegdich, T & Quinn, J. (1996). Community mental health nursing. In Clinton, M & Nelson, S (Ed), Mental health & Nursing practice, (p335-353). Sydney: Prentice Hall.

 

More recent references

Annadale, M., & Instone, A. (2004). Sei Tapu: Evaluation of the National Certificate in Mental Health Support Work. Wellington, New Zealand: Platform.

Barber, K. F. M. (2015). Realising Our Best Intentions: Vision, Values and Voice in Community Non-government Organisations of the Aotearoa$\backslash$ New Zealand Mental Health Sector. University of Waikato. Retrieved from https://waikato.researchgateway.ac.nz/handle/10289/9989

Cheng, R., & Smith, C. (2009). Engaging people with lived experience for better health outcomes: Collaboration with mental health and addiction service users in research, policy, and …. Toronto, Ontario: Minister’s Advisory Group,. Retrieved from https://www.researchgate.net/profile/Christopher_Smith27/publication/260589695_Engaging_People_with_Lived_Experience_for_Better_Health_Outcomes_Collaboration_with_Mental_Health_and_Addiction_Service_Users_in_Research_Policy_and_Treatment/links/0f317531a029393ce7000000.pdf

Hatcher, S., Mouly, S., Rasquinha, D., & Miles, W. (2005). Improving recruitment to the mental health workforce in New Zealand. Of New Zealand. Retrieved from http://www.tepou.co.nz/uploads/files/resource-assets/Improving-Recruitment-to-the-Mental-Health-Workforce-in-New-Zealand-2005.pdf

Hennessy, J. L., Smythe, L., Abbott, M., & Hughes, F. A. (2016). Mental Health Support Workers: An Evolving Workforce. Workforce Development Theory and Practice in the Mental Health Sector, 200.

 

Hennessy, J. L. (2015). The contribution of the mental health support worker to the mental health services in New Zealand: an Appreciative Inquiry approach. Auckland University of Technology. Retrieved from https://aut.researchgateway.ac.nz/handle/10292/9192

McMorland, J., Kukler, B., Murray, L., & Warriner, R. (2008). Partnerships in Development: developments in mental health service provision in New Zealand. A case study. New Zealand Journal of Employment Relations (Online), 33(1), 19.

Morrison, N., & Ronan, K. (2002). Assessment of Core Competency Status and Work Environment of Residential Mental Health Support Workers. The Australian Journal of Rehabilitation Counselling, 8(02), 114–126.

Morrison, N. (2000). Assessment of competency status of residential mental health support workers: a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University. Massey University. Retrieved from http://mro.massey.ac.nz/handle/10179/6018

 

O’Neil, P., Bryson, J., Cutforth, T., & Minogue, G. (2008). Mental health services in Northland. Industrial Relations Centre, Victoria University of Wellington, July, 2–3.

O’Hagan, M. (2001). Recovery Competencies for New Zealand Mental Health Workers. Retrieved from http://eric.ed.gov/?id=ED457512

Pace, B. (2009b). Organisational views of the mental health support worker role and function. Unpublished Paper. Waikato Institute of Technology, New Zealand. Retrieved from http://www.psychosocial.com/IJPR_14/Organizational_Views_Pace.html

Pace, B. (2009a). How New Zealand community mental health support workers perceive their role. Journal of Psychosocial Rehabilitation. Vol 13 (2). 5. Retrieved from http://www.psychosocial.com/IJPR_13/New_Zealand_Comm_Mental_Health_Pace.html

Pace, B. (2010). Exploring support work: Examining the role of mental health support workers in New Zealand (p. 159). Wellington, New Zealand: B. Pace.

Pace, B. (2009). A practical guide to mental health support work (p. 94). Wellington, New Zealand: B. Pace.

Reeves-Timms, H. (2011). Diploma in action: Making a difference when working with tangata whai ora. Retrieved from http://repository.digitalnz.org/system/uploads/record/attachment/508/diploma_in_action___making_a_difference_when_working_with_tangata_whai_ora.pdf

Rangiaho, A. (2003). Te Puawaitanga o Te Oranga Hinengaro-An evaluation of the Natioonal Certificate in Mental Health Support Work from a Maori perspective. Wellington, New Zealand: Mental Health Support Work.

Scott, A. (2015). Gaining acceptance: Discourses on training and qualifications in peer support. New Zealand Sociology, 30(4), 38.

Southwick, M., & Solomona, M. (2007). Improving Recruitment and Retention for the Pacific Mental Health Workforce. Auckland: The National Centre of Mental Health Research and Workforce Development. Retrieved from http://www.tepou.co.nz/uploads/files/resource-assets/improving-recruitment-and-retention-for-the-pacific-mental-health-workforce-feasibility-study.pdf

Sutcliffe, R. (2007). What is the meaning of supervision for mental health support workers? A critical hermeneutic inquiry. Retrieved from https://aut.researchgateway.ac.nz/handle/10292/88

Taylor, G. E. (2015). Who cares about carers? Experiences of community mental health support workers from a feminist perspective. University of Waikato. Retrieved from http://researchcommons.waikato.ac.nz/handle/10289/9649

 

Scott, A. L., Doughty, C., & Kahi, H. (2011). Peer Support Practice in Aotearoa New Zealand. Retrieved from http://ir.canterbury.ac.nz/handle/10092/5258

Te Ararau, K. P. (n.d.). Māori mental health workforce development. Networknorth.org.nz. Retrieved from http://www.networknorth.org.nz/file/NRWorkforceDevelopment/KeyDocsAndLinks/ktpabook.pdf

/by