Te Rohe o Te Wairoa, Hawke’s Bay, Ngāti Kahungunu and the response to COVID-19 between February and May 2020

3 Nov 2020 | Health Quality & Safety Commission

In a series of articles on Aotearoa New Zealand’s resilient health care during COVID-19, we hear about Te Rohe o Te Wairoa, Hawke’s Bay, Ngāti Kahungunu and the response to COVID-19 between February and May 2020.

Wairoa District in the east coast of the North Island comprises a large area stretching from Mahia through to Mohaka along the coast and inland to Waikaremoana, with multiple connections to the Tairāwhiti and Hawke’s Bay regions. Ngāti Kahungunu is the third largest iwi in Aotearoa and comprises six rohe (regions) from northern Wairoa to southern Wairarapa. During the rise of COVID-19 in Aotearoa in March 2020 numerous iwi and hapū entities, community organisations, government and local government departments mobilised to protect their entire community.

Networked, intergenerational community teamwork

‘Intergenerational community teamwork’ was the pre-eminent achievement of the response, according to Nigel How, chairman of Ngāti Kahungunu Wairoa Taiwhenua Incorporated, and Wairoa board member of Ngāti Kahungunu Iwi Incorporated. ‘The different groups involved in our response were made up primarily of people from our community. All have different experiences, knowledge, networks, relationships and skills. In time of crisis our community survives because we work together to be responsive to need, creative in approaches and adaptable to changes.’

One arm of the response was the Wairoa Community Welfare Food Hub. Between 31 March and 28 May 2020 (after the country moved down to level two lockdown), the Food Hub distributed 952 food parcels to households comprising 1,730 adults and more than a thousand tamariki. At its peak in April in the last days of level four lockdown the Food Hub distributed more than 300 food parcels to more than 700 people in less than a week.

The Food Hub was focused on delivering aid to kaumātua with little or no external support, as well as whānau with pre-existing health conditions, compromised immune systems and those experiencing financial hardship, and pregnant women. Assessment of need was accomplished via a networking of agencies from Kahungunu Executive, Te Whare Maire o Tapuwae, Enabled Wairoa, Wairoa Young Achiever’s Trust to local schools and Kahui Trusts, Civil Defence, government welfare agencies and Age Concern. It was a massive, networked and community-wide operation encompassing donations from the public, Whānau Ora, local businesses, farmers and the iwi organisations, delivering everything from handknitted socks to fruit, vegetables, baked goods, meat, fresh seafood, baby food, locally made honey, and Easter eggs over Easter 2020. Organisations from the district health board (DHB) to the Wairoa Museum provided money, transport, facilities, charge accounts, freezers and chilly bins, storage, laptops and, most crucially, a team of volunteers to make it all happen. The shared values of duty to community, responsiveness, creativity and adaptability extended much further than the food response.

‘Our local funeral director, the police, our local hospital, our local doctor practice, social clubs and the numerous church congregations to name a few all played a vital role in our entire community effort,’ Nigel said.

Denise Eaglesome-Karekare, chair of Te Wairoa Tapokorau Whanui Trust, Wairoa District councillor, previous deputy mayor for many years and past Hawke’s Bay DHB executive member, said, ‘What made our response outstanding, if I can use that word, was the natural ability of everyone to come together as a whole-of-community response. It didn't matter if prior to COVID-19 that some of us didn't have a relationship; this event made us think of those that were most vulnerable in our community and helped us put our differences aside and get on with the mahi that needed to be done.

‘The biggest challenge I saw was identifying the whānau that needed assistance because the hub had no control of that.

‘Our willingness to work together came out of, I believe, a shared passion for our community and its people. We all want to see our whānau flourish in all aspects of their lives – health, education, employment, housing, for example. The whanaungatanga that developed has stayed strong ever since and would probably never have happened had it not been for COVID.’

A values-based approach – manaaki, whānau and aroha

Leon Symes, chair of Tātau Tātau o Te Wairoa Trust, the post-settlement governance entity on behalf of the iwi and hapū of Te Rohe o Te Wairoa, reached the same conclusion from his trust’s perspective.

‘We have multiple entities in Wairoa at different levels, so the key question for our response to COVID-19 in the Wairoa rohe was how we get everyone together to get information shared. Māori did well in the COVID-19 response because we’ve got those strong networks within communities that we could then leverage off. We’ve got the strong connections with our marae and Māori entities on the ground like our kāhui groups.

‘Our key strength is that connection into those community groups where the need is the most. Council and other central agencies don’t have that connection. Having connection on the ground to identify whānau and talk to them and find out what those needs are and where help needs to be directed, even those who don’t put up their hands for support, is crucial.

‘The level of trust between Māori entities existed from the outset. In a Māori sense sometimes it fluctuates but in a crisis they all come together. The whānau know that in certain circumstances we put our differences to one side and get on with what we need to do. The trust is there to begin with and was definitely enhanced through the pandemic.’
For Leon, the Māori response and its success was because it was founded in the principles of te ao Māori, of manaaki, whānau and aroha, rather than the hard guardrails of legislation or regulation.

‘What we accomplished as Māori organisations was quite separate to Civil Defence Emergency Management (CDEM) and the rigid structure of civil defence, which is inflexible and hierarchical. We don’t have legislation and statutes, we have principles, values and mātauranga Māori that are not fixed in stone. That’s why we are more flexible. We operate on a values-based approach, not a traditional Western-based approach of authority. We are able to adapt and to quickly realise our roles and our abilities to provide support with what we could bring to the table.

‘That’s a progression of what we do, it’s how we were raised and how we were brought up. I was brought up to look after manaaki, whānau, aroha, these principles. It’s how we were raised from a young age: to make sure we look after those that are vulnerable, make sure we look after the needy, make sure that they’re cared for in all their requirements and needs. It’s not about the individualistic approach, that Western approach, It’s not about the “I” – it’s about the us.’

Calm leadership and effective communication is key – nationally and locally

Shayne Walker, chair of the Hawke’s Bay DHB, one of Aotearoa New Zealand’s five Māori DHB chairs, saw a similar picture of massive pan-community solidarity, the benefits of existing relationships and the community willingness to quickly develop new relationships, the collective, proactive approach and focus on the needy, including finding those the system hadn’t seen before.

‘We knew and we know that Māori have suffered greater inequalities in previous pandemics and other outbreaks and in general health outcomes, so we were really clear from the start that we have to focus on Māori and Pacific peoples and our other disadvantaged communities and that our response to Māori be appropriate,’ Shayne said. ‘We were fortunate that we have a good relationship here with Ngāti Kahungunu Iwi Incorporated, the pan-hapū, pan-tribal vehicle, but there are lots of Treaty partners in our region, so it’s important that we engage with all of them. So, what we had was all our Māori interests in the same conversation.’

Hawke’s Bay DHB and Ngāti Kahungunu Iwi Incorporated worked together to use their organisational structures to get resources out to people in the community from the central Tihei Mauri Ora Emergency Response Centre to the local Taiwhenua hubs, which then distributed the food and care packages directly to people.

‘Māori took a massive role in the response to COVID, distributing kai and health packs and even Easter eggs at Easter,’ said Shayne. ‘We really worked hard to reach out across our community to our business sector and elsewhere for donations of kai and other resources. Then we made those distributions directly to the door, particularly to our pākeke, to our elderly. We called them our whānau pounamu, our precious whānau, our vulnerable whānau.

‘The benefits that have spun off from this are the extra relationships and opportunities. The registrations of a lot of our whānau that weren’t engaged before with our Māori and our DHB approaches. Even things like our Pākehā pākeke receiving kai and health packs, saying, “I thought this was just for Māori” and us being able to say that’s not how we operate. It’s for everybody and it’s for our community,’ Shayne said.

The biggest challenge was effective communication.

‘At times it was quite hard because we had to explain to our whānau that we have to take an epidemiological approach to this as well as a cultural approach. Some of those epidemiological, scientific and public health communications were key.’

Austin King was part of the Wairoa Civil Defence response as a public information management representative. He has connections to nearly all marae and hapū of the Wairoa District and is a community development officer of the Wairoa District Council. His perspective: ‘The Wairoa COVID-19 response presented various inter-organisation challenges, but this community's “just do it if it's safe to do so” attitude really demonstrated the resilience of Wairoa and her people.

‘Our role as public information management reps entailed delivering and disseminating key messages to our people – around the national, regional and local COVID-19 response,’ he said.

‘Having strong whakapapa ties to this community – plus understanding intimately the fabric of the whānau who live in various smaller communities of Wairoa – our Civil Defence team was able to effectively communicate these messages between agency and people.

‘I agree that the structure of Civil Defence appears to be quite rigid and inflexible,’ said Austin, ‘however, the individuals involved in the Civil Defence response employed a “Wairoa-first” whakaaro from the outset, while still trying to navigate their way professionally and effectively through their legislative responsibilities as Civil Defence personnel. This was evident in the fact that Civil Defence was guided by local Māori NGOs [non-governmental organisations] and other agencies around what the “welfare” response looked like for Wairoa whānau.

‘One important key for any pandemic response is effective communication. Local agency and grassroots champions were key respondents in disseminating key messages throughout this response.

‘During a time of unrest and uncertainty, these grassroots champions played a critical role in communicating these messages to whānau. Ones that are able to get messages through to whānau on the ground.’

Tailored communications, localised solutions

Over the course of the lockdowns, as well as distributing food and care packs, Ngāti Kahungunu Iwi Incorporated developed its own messaging and communications to inform and reassure whānau over issues such as tangihanga processes for deceased whānau, gatherings of different sizes over phases of lockdown and accessible guidance on safe behaviours that do not violate tikanga, as lockdown levels changed and recommendations from government evolved quickly. Key messages were sent out via Facebook, email and the iwi website. These included placing a rāhui (or temporary prohibition) around yourself, your whānau and home, and more light-hearted strategies, such as using Te Mihi ā-Tukemata a Kahungunu, the ‘Kahungunu wave’ or raising of the eyebrows in lieu of hugs, hongi or handshakes. The messaging was designed to speak to community members and recalibrate tikanga for extraordinary times and requirements in accessible ways.

In Wairoa, Nigel How and the Wairoa Wellness Network pānui developed regular newsletters for a wide range of contacts including marae, iwi entities, government agencies, local businesses and the like. The newsletters emphasised community spirit and solidarity, and shared processes for tangihanga, the ‘tikanga of lockdown’, the details of food allocation on the basis of need, and regular stories of ‘The Nannies’ – two local personalities and relatives of Nigel’s aged 74 and 80. The Nannies’ adaptations to the tikanga of lockdown provided both light relief and examples in practice for the community to understand what was expected of them in terms of maintaining their bubbles while caring for kaumātua.

For Shayne Walker, from the view from the centre, effective governance and leadership were key to the district response. ‘We had really good collaborative and calm leadership around the region. Awesome leadership out of Wairoa. The Tihei Mauri Ora hub and non-Māori stakeholders throughout the Kahungunu rohe came up with localised solutions. The freedom for them to say what’s right for us was important and at the same time from a DHB perspective aligning an appropriate public health and epidemiological approach with this worked really well.

‘The key is we saw this amazing Māori leadership and this amazing New Zealand leadership and spirit coming to the fore. The steady leadership through remaining calm was very important. Trying to keep a cool head in an extremely stressful situation where emotions were extremely high and there was anger, people’s livelihoods and lives and villages were threatened. We came together when we needed to. It was like we were at war. Wartime conditions and events and it needed that level of leadership and collaboration. Leadership and collaboration was outstanding and it was tested and we should celebrate that it worked really well for us.’

COVID-19 showed digital inclusion and digital equity is possible and it remains vital for rural and remote communities

Leona Karauria is Wairoa born and bred. A founding member of the Hawke’s Bay DHB Consumer Council, she has a consumer health care advocacy background, and is owner of a local internet service provider.

One of the first priorities for Leona in the initial lockdown period was immediately contacting Sonya Smith, manager of the Wairoa Healthcare Centre.

‘We were facing immediate health challenges and there was an opportunity to put in place the best digital solutions,’ said Leona. ‘We immediately strengthened internet connectivity at the Rural Learning Health Centre and established remote and virtual environments in Tuai Lake Waikaremoana and Mahia Beach for online health consultations. We provided digital support and upgraded internet connectivity in the homes of clinicians and health workers to make sure they had reliable connections for virtual consultations. Our role was to repair and reconnect the relationship between the health consumer and the system that COVID-19 had fractured.

‘We have built internet infrastructure in some of the most remote communities in Aotearoa New Zealand,’ Leona said. ‘Places no one would touch. They are rural, remote, highly disconnected, and many are predominantly Māori communities. But COVID-19 has shown us that what was once digitally challenging doesn’t have to be. Big corporations only provide a “one size fits all” solution that excludes people in these communities. But we can fix the challenges and barriers of the system and provide digital equity. Local solutions can be better.

‘Digital inequity existed before COVID-19, yet digital connectivity was the most important source of effective communication for everyone across the world, not just in Aotearoa New Zealand. With an uncertain future ahead of us, our government needs to invest effectively to improve digital inclusion for all vulnerable families and communities. In recent years I have seen barriers put in place that prevent or delay consumers having reasonable access to receiving generic health care services. Post-lockdown, I now have greater concerns that the system is compounding the barriers, making it even more difficult for a consumer to get reasonable, basic health care attention.’

‘How do we not turn this off?’ Keeping what has been learned is part of the challenge

There were shared ideas of the learnings for and challenges of the future.

‘How do we not turn this off?’ asked Shayne Walker of the extra relationships and opportunities that developed during the response. ‘There are always ways we can learn to do things differently or better in parts but on the whole, I think everybody did an amazing job given the circumstances.’

The DHB board was challenged for funding an additional building outside the emergency department for COVID-19 triage purposes.

‘COVID-19 didn’t grip us so much that we needed to utilise the hospital as much as we possibly would have had to, so we were challenged that we didn’t need that building. But in actual fact our hospital is routinely at 90 percent capacity, so we need that building anyway. So, perception and communication and applying kindness while not rushing to assumptions but being prepared to have the conversations is what I’d say.’

Leon Symes of Tātau Tātau o Te Wairoa Trust agreed with the benefits of the additional relationships. ‘We need to be making sure we’ve got those connections with communities. Knowing what our neighbours are doing. Knowing our people down the road. The risk is we become too insular, too isolated. You can fall back into isolation and not communicate outside your own little island and not knowing how your neighbour’s doing.’

Leon saw an absence of closing the loop of the response as an opportunity for the future.

‘We’ve just been through a massive event. We need to pull together some of the learnings and put that within some kind of document or framework we can then pull out in the future. This is not a typical civil defence response. It is not a natural disaster, so the question is does it really fit within civil defence or is there some other kind of framework it would best fit within? We need something else that has a more values-based, caring approach. It was a unique situation that probably will be repeated again, and if we don’t learn from what we went through we’ll never truly provide a better response in the future.’

Last updated 05/11/2020