A young Ngāti Porou geneticist is using DNA from her own people to fight Type 2 diabetes.
Māori suffer from the condition at nearly twice the rate as non-Māori.
Twenty-two-year-old Anezka Hoskin is part of a team at Otago University researching whether there is a gene that makes Māori and Pasifika people more prone to Type 2, or adult onset, diabetes.
The team previously found two genotypes that link Māori and Pasifika people with gout, which may account for their high prevalence of gout.
Now they want to know whether there is a similar genetic link between Māori and Type 2 diabetes.
The research is part of a decade-long partnership with Ngāti Porou Hauora and much of the DNA comes from Ngāti Porou people who donate a blood sample.
Anezka says it's a huge privilege and a big responsibility to handle the tapu specimens from her own iwi, including her own whānau.
The lab practices tikanga Māori when handling and disposing of Māori DNA samples.
Anezka’s interest in genetics began when her sister was diagnosed with Type 1 diabetes in childhood. Type 1 diabetes is known to be genetic while Type 2 diabetes is often linked with obesity and diet.
Anezka hopes that if they do find a genetic link to Type 2 diabetes it will help remove the blame and shame that people often feel.
She believes feeling whakamā often prevents people from seeking treatment.
Corrina Parata is currently the sole midwife for the East Coast, and after 18 years, says she still gets goosebumps when she recollects all the precious moments. Corrina believes that people who work on the wild and remote Coast build a specific set of skills that are different from urban health professionals. Corrina was inspired to be a midwife when she attended the birth of her niece. After a bad experience with the care at a large hospital, her sister decided to home birth despite complications. With the support of a midwife the baby was delivered safely. “The empowerment and healing for my sister to be able to take back control was so important for her. This experience and feeling the energy in the room that day made me want to become a midwife” Corrina said. Corrina decided to train though the Tihei Mauri Ora program under Becky Fox at Wintec. There weren’t many registered Māori midwives at that time, and Corrina remembers this kaupapa Māori based training being really powerful.
During her training she reflected on her own experiences having a child as a young Māori woman, and realised the lack of cultural safety practiced in the health system back then. She wanted to change this. It makes sense that Corrina then came to work for Ngāti Porou Hauora where Ngāti Poroutanga (the local culture) is recognised as a core value and vital for health and wellbeing. She says that Ngāti Porou Hauora supports her to run a midwifery service that works within her own culture. “When women give birth here they usually do so knowing that whānau who have gone before them were also born here. Through the practice of midwifery, you become a kaitiaki. Not just through supporting each child being born on their tūrangawaewae (cultural homeland), but in advocating to make sure we maintain a maternity service here on the Coast.” It isn’t just the midwifery service that works this way, it is across the whole service. “If there is family needing karakia or waiata.
All the staff drop tools and get in there to support. I feel like my wairua (spirit) is intact working this way.” Corrina believes that people who work on the Coast build a specific set of skills that are different from urban health professionals. Because it is wild and remote, it is even more vital to provide quality care and so the team have sharp and diverse skills. It can be consuming and overwhelming especially with the challenges of winter – no power, flooding, trees down over the roads, the water pump isn’t going. This is the reality of rural practice. You just need to carry on. It’s not for the faint hearted. Working this way over the years has made Corrina reflect on the bigger view of public health. She says that she never used to be political, but this work has developed her as a person. She is now a staunch feminist and advocate for social justice. “Why should Coast whānau not have access to quality care? Just because we choose to live rurally that shouldn’t be denied of us. It is this that gives me the burning flame to stick it out when so many say “oh I’d never work there”. Despite currently being the only midwife on the Coast, Corrina has regular contact with practitioners all over the country.
She remotely mentors five rural midwives in other areas of New Zealand, and meets regularly with a group of other rural midwives. This group shares ideas to improve their service and often have robust debates where they challenge each other on their practice and decisions. This online community of practitioners supporting each other is huge for preventing burn out – something we are seeing in the media as a concerning issue for midwives. Corrina also finds healing in the natural environment of the Coast. She loves fishing and the ocean. “I knew the local community had accepted me when they told me where the best fishing spots were” Corrina laughs. Twenty years and more than 500 babies later, Corrina says she still gets goosebumps when she recollects all the precious moments. “It is the highest calling and greatest honor to care for women and their families through the birth of a child. Women can feel quite vulnerable and frightened so you have to look after their wairua as well as the medical side. Being a midwife means whānau (families) place their trust in me and that trust means everything.” Looking forward, Corrina strongly believed that Ngāti Porou Hauora should continue to look at how we grow our own midwives, and is excited about the opportunities the learning institute will offer in moving forward with this goal.
This year Ngāti Porou Hauora opens the doors of the Te Rangawairua o Paratene Ngata Research Centre, based at Te Puia Springs Hospital. The name honours the vision of the late Dr Paratene Ngata: for Ngāti Porou Hauora to lead our own research developments, becoming “a tikanga and research based centre of excellence for Hauora Māori”. The name has been gifted to us by Dr Paratene’s whanau and in English translates to ‘The Inspiration of Paratene Ngata’. The centre will provide a basis for building on the research initiatives and relationships which Dr Paratene inspired Ngāti Porou Hauora, our communities and university researchers to build over the last 15 years+.
It is our intention that the centre will be a catalyst for growing sustainable research partnerships that enhance our work with local communities and scientists from a range of disciplines to generate new knowledge and better health outcomes that empower our people to live well and live longer. Initially, the centre will enhance research that has been focusing on increasing knowledge about factors, including genetics and nutrition, which contribute to the prevalence of the debilitating metabolic conditions which compromise many people’s lives: type-2 diabetes, gout, obesity, heart & kidney disease, and the impact of sugar. Through NPH’s newest research partnership, with the Maurice Wilkins Centre for Molecular Bio-discovery, an expanded collaborative network of scientists, health researchers and providers will work with us to further advance understandings about metabolic conditions - with the aim of informing significant improvements in treatment and prevention.
Teepa Wawatai, chairman of Ngāti Porou Hauora Charitable Trust Board, said diabetes, gout, heart and kidney disease were four important health issues affecting Ngāti Porou, and these will be a focus for initial research. “We are excited about the new Research Centre and believe the work that happens there result in better ways to prevent and treat these conditions while also delivering jobs and educational outcomes. This mechanism allow us to deliver these outcomes in a way that does not divert resources from our critical frontline healthcare roles.” Importantly, integral to all activities of the research centre will be regular opportunities for our communities (including schools), health professionals and scientists to meet with each other to share knowledge and co-define priorities, and for Ngāti Porou and other māori students, practitioners and researchers to develop skills in research of relevance to māori and rural health.
Four Ngāti Porou people participated this year in the week-long Summer internship for Indigenous peoples in Genomics - SING. The substantial advances in this field and the increasing focus on Māori populations and indigenous species have highlighted the urgent need for Māori to engage and understand enough about the technical, ethical and cultural issues that are being raised. SING is an initiative that emerged from the Te Waka O Tama - a recent project and is now a key activity within Genomics Aotearoa. SING is run by Assoc Prof Maui Hudson, Dr Phil Wilcox and Katharina Ruckstuhl, and is designed to develop our understanding of genomics alongside some of the best researchers in New Zealand.
Indigenous Genomics Aotearoa is a network of Māori with expertise across the fields of genomics, informatics technology, business and environmental stewardship. The network is being developed as part of a Vision Mātauranga Capability Fund project led by the University of Waikato, The University of Auckland, and the University of Otago with support from Ngā Pae o te Māramatanga Māori Centre of Research Excellence, and two National Science Challenges (Biological Heritage and Science for Technological Innovation). Some of the topics covered in SING were: Introduction to Māori research and ethics, introduction to genetics, epigenetics, ELSI research in tribal communities, bioinformatics, Māori perspectives and gene editing. A highlight of the internship was a presentation from Dr Joseph Yracheta, a faculty mentor from SING USA, bringing his experience working with American Indian and Alaskan Native interns. Four Nāti applied for the internship and gathered for a week in late January with fourteen other Māori participants. The Nāti interns were Ben Rangihuna, Anezka Hoskins, Matiu Bartlett and Huti Puketapu-Watson.
Ben Rangihuna is from Tikitiki and is currently studying medicine at Otago University. This year he will be studying quantitative genetics alongside Dr Phil Wilcox (Rakaipaaka). Anezka is an emerging young Ngāti Porou scientist, currently completing her Master’s degree. She aims to make a significant contribution to the field of genetics, and plans to proceed to a PhD in Human Genetics and to apply for entry to one of the top five programmes in the world (in the UK, USA, or continental Europe). Matiu Bartlett is from Wairoa Hawkes Bay and moved to Gisborne 6 months ago to work at Ngāti Porou Hauora in Te Hiringa Matua which is a new parenting support service working with hapu mama who are struggling with drugs and alcohol.
Huti Puketapu-Watson, Deputy Chair of Ngāti Porou Hauora (NPH), also participated in the SING internship to help build capacity in the emerging arena of genetics given that NPH has great potential to become a leading iwi health service provider in the movement towards precision or personalised medicine. This potential has been developing through NPH’s long-standing research programme with the University of Otago research teams led by Prof Merriman and Dr Te Morenga, and our contributions to the Te Mata Ira project led by Maui Hudson to develop Māori guidelines for genomic research and bio-banking. Also as Chair of the Ngāti Porou Miere Board, Huti learnt that the Honey Landscape research currently being carried out by Ngāti Porou Miere in collaboration with other iwi & Plant and Food and Landcare, had significant relevance in the discussions because that research focuses on DNA profiling of our manuka. Dr David Chagne presented an outline of the Honey Landscape research to demonstrate what was undertaken in the process of gene research and editing.
Veteran from all over the coast gathered together at Te Puia Hospital for a check up and a chat at the first Veterans Clinic. The initiative is a collaboration between Ngāti Porou Hauora, Veterans Affairs and Royal New Zealand Returned Services' Association to improve access to services for veterans living on the coast. A round-robin of services was set up so that each person who attended was able to have time with everyone, including a podiatrist, geriatrician, hearing specialist, rehabilitation specialist and a veterans affairs case manager. 13 veterans living on the Coast came on the day, some with whānau.
Janet Castell RSA District Support Advisor for the Wairarapa, East Coast, Hawkes bay District was part of the team running the Clinic on the day. She noted that “Getting all the health stuff sorted was great, but the nicest part was that it got a lot of chaps together and to just have a yarn. You could see how much they all enjoyed it. One of them commented that it was nice to be together for something other than a funeral.” The whole day was really successful and we had more numbers than expected. There are plans to try and run more clinics like this in the future and to expand the target group to reach more people. Janet is also in the process of setting up a network of regular information sessions for Veterans through the clinics.
Starting with Matakoa she plans to visit every second month to share information on what supports are available and help to link people up to the benefits they are eligible for. Recent changes in legislation mean that there are now more supports available, so we want to make sure whānau on the Coast have access to this.
A new pilates class has started in Te Araroa run by Ngāti Porou Hauora Physiotherapist Anne Hewetson. The weekly class is held at Hinerupe (the local marae) and has a growing mix of local people attending regularly, especially kaumātua (elders). The initiative has been started as a proactive way to keep people strong, mobile and to prevent falls, as well to boost recovery for those who have had injuries or operations. The exercises focus on increasing levels of strength, balance, flexibility, muscle tone, stamina, and well-being. The ability to modify exercises to meet differing needs makes it a great community activity. “People are commenting about how good it makes them feel.
There has been increased mobility in some members and it has given people a greater understanding of what their bodies are capable of and what it feels like to have a good stretch.” - Tracey Morris, Rural Health Nurse Because the Physiotherapist is only in the area once a week, the goal is to train a local person to take over the classes going forward. This will give people greater access to recovery and rehabilitation sessions. The team at Matakaoa Clinic are also wanting to start a regular walking group. The staff walk most mornings already but are keen to get more locals involved. The Huringa Pai movement in Gisborne has certainly helped inspire the idea.
These activities all fit in with Ngāti Porou Hauora’s bigger vision to transform the East Coast into one of the world’s Blue Zones. Blue Zones are a handful of small areas in the world where people live longer and live 'happier' than anywhere else on the planet. Two of the core ingredients that have been identified in the recipe for a Blue Zone are regular physical activity and coming together as a community.
A waiata (song) has recently been gifted to the mental health team at Ngāti Porou Hauora. Presented by John Coleman of Tokomaru Bay, this waiata is a special tribute to a woman and past consumer of the mental health service, who has since passed away. Waiata have long been an effective method for maintaining well-being for Māori. It is an expression of emotion and a traditional form of healing. Over the past few decades, Ngāti Porou Hauora have been privileged to have had support from John and over this time he has written the organisation hundreds of songs. John comes from a line of gifted Ngāti Porou composers including Tuini Ngawai and Ngoi Pewhairangi.
Through waiata John has recorded the history of hauora on the Coast. Whenever there has been a hui or significant moment, there has also been a waiata that helps us remember who was there and what the kaupapa (topic of discussion) was. Often visitors have been able to take away the gift of a song as a special reminder of their visit. This waiata, however, is slightly different. In his younger days, John worked in the NPH mental health service, and it was here that he came across this particular song. A woman who was battling mental illness at the time brought in the English version of the song and explained that when she heard it, she felt like it was singing about her. The lyrics resonated deeply. However, she asked that John translate it to Māori as she believed this would be more beautiful and useful to her in her healing journey. Years later, John was reminded of the song. With the Ngāti Porou Hauora team recently visiting and consulting with the community around our model of care, and the nationwide Government Inquiry into Mental Health and Addiction he decided it would be a useful tool to help people to understand the perspective of those suffering from mental health issues and addiction. Here is the song: Lace covered window
Original by New Faces / Nga kupu by J.T. Coleman I te reo
Tuatahi: Ka hikoi I tea o, anake,
O pumau, ka huri, muri new e.
Ka tangi roimata, maumahara,
Nga whakaaturanga matapihi.
Tuarua: Te marama e kore I kitea,
Na konei, ko te whiu, I tea o nei,
E pumau kia kume te aria e,
Tirohia te aria matapihi.
Chorus: Ka rapa noa nga mahara kei whea ra.
Ko wai e tau nei I a koe.
Me kume te aria kia mohio ano
Te aroha kei reira mo koe ra.
Tuatoru: Ka hikoi korua mo ake
Waihotia na pouri, mamaetanga,
Ka nga ra whiti-mai apopo,
Tu where te aria matapihi,
Whiti ra te aria matapihi.
Verse 1: When you walk through the world all alone,
And your dreams turn to ashes behind you,
Then the tears in your eyes will remind you,
Of a vein through a lace covered window.
Verse 2: Doesn’t seem very clear anymore,
In your world everything is uncertain,
How you wish you could pull back the curtain,
Just to see through that lace covered window.
Chorus: But you’ll never know what life has in store,
What’s waiting there to greet you.
So pull back the curtains and maybe once more,
True love is there to meet you.
Verse 3: So you walk side by side through the world,
No more times full of darkness & sorrow,
Every day is a bright new tomorrow,
When you open that lace covered window,
Let the sun through that lace covered window.
For centuries Te Puia Springs has been a sanctuary of cultural significance and healing for Māori. The site is particularly significant for Ngāti Porou, but was also known as a place of peace, where Māori from other tribes and people in conflict, could come to heal in safety. This historical context sits firmly beneath the recognition that redeveloping the hospital facilities at Te Puia is a key step to improving the health of our people within one generation.
This year, with support from New Zealand Lottery we have been able to have completed an independent Feasibility Study on the redevelopment of the facilities in Te Puia. The study has been carried out by Impact Consulting and looks at the potential not for a ‘bigger hospital’, but rather to redesign the existing infrastructure and unlock the potential for a more holistic facility which will better serve our community. The project is an invitation which seeks to draw other significant community stakeholders together in Te Puia to collaboratively improve health, social and economic outcomes for our region.
When we think of “health”, most people instantly think of preventing or curing physical sickness ie. a hospital. However, from a Māori perspective health is more about wellbeing. It encompasses much more than our bodies and is intrinsically linked to all we do, including our social interactions with others. It is fantastic to have a document which really unpacks the details of what this could look like and what is needed to bring it to reality. We believe this Feasibility Study will be a powerful tool in helping us move forward with this important project.
In partnership Vodafone New Zealand Foundation and Todd Foundation, we are excited to be developing innovative technology which will support parents on the Coast. This project is the first of its kind and has the potential to revolutionise parent’s engagement with children’s health development. The name Pēpi Ora came from a group of young whānau in Ngāti Porou. Pēpi means a baby in infancy and Ora is a state of wellbeing, to be healthy, fit and alive. The app will be an incentive-based programme for young families that takes the ‘Gold Card’ idea, but instead rewards parents for the important contribution they make to NZ society, and improves it by including a points collection and rewards program.
Young parents join our programme at their first antenatal appointment and once fully developed, will be able to collect points through activities such as attending health appointments, completing immunisations and developing and implementing a whānau ora plan. The potential to increase young parent’s active engagement in the health, development and education of their child is currently untapped in New Zealand. The physical Well Child/Tamariki Ora booklet is often forgotten by parents attending appointments, and very seldom looked at between appointments. Pēpi Ora will revolutionise these old systems by offering something that is engaging and culturally-sensitive. The interaction whanau will have with technology through the app, we believe will support actively engaged young parents and as a result, improve future outcomes for our next generation.
In October 2017 Ngāti Porou Hauora’s Frances King and Laine Tangaire a rangatahi (youth) from Rangitukia spent six weeks at the Vodafone NZ Foundation’s Change Accelerator Program surrounded by a team of tech experts from Dev Academy and Vodafone. This unique opportunity saw the concept of Pēpi Ora come to life through a prototype which we have now taken back to the Coast for development. This year we are undertaking a formal trial of the program with whānau on the coast and local businesses. Evaluation from this will inform the development of the next phase: a ‘native app’ that we can roll out across the whole community. This project is the first of its kind and has the potential to be scaled locally, nationally and internationally. Scaling the program will be dependent on the success of this pilot and the level of interest from key stakeholders including the Ministry of Health, NGOs such as Plunket, Māori health service providers and local businesses contributing to the rewards programme. Once trialed and refined into an attractive, functional app; this program has great potential.