The social implications of medical practice among Maoris

Tu Tangata, Issue 7, 1 August 1982, Page 31

The social implications of medical practice among Maoris

R.J. Walker Centre for Continuing Education

Native knowledge of medicine may be described as non-existent in former times. No attempt was made to study it because it was believed that sickness and disease were caused by atua (evil spirits). This formed part of the belief that offenses against the gods are punished in this world not in the spirit world. As all complaints were so caused, inflicted by the gods then it would be highly absurd to administer human remedies. And so we see that the superstition-laden religion of the Maori blocked advancement in the science of medicine. The Maori when ill was in the truly unhappy position of being in the care of a priest instead of a doctor. He was dosed with charms and incantations and mummery until he died or recovered in spite of his friends.

(Best 1974 : 136)

Best’s dismissal of Maori medical practice as superstitious mummery failed to make the distinction which the Maori’s themselves made between illness with an observable physical cause and “mate Maori” illness with a spiritual or psychological cause. Buck (1949: 406) describes the treatment of minor ailments “obvious to the sight”. These included warts, boils, toothache, the use of heat to relieve pains after birth or difficult menstruation. Even the widespread remedy of bloodletting was practised to relieve pain. Captain Cook and Dr Deiffenbach of the New Zealand Company both recorded the use of steam rising from heated leaves for medicinal purposes. John Rutherford an English sailor who lived among the Maoris from 1816 to 1826 attested to first hand experience of Maori ability to operate on and heal battle wounds by the application of herbal remedies (Brooker and Cooper 1961:7).

However, there is no early recorded observation of the use of internal herbal remedies. It would appear that the development of oral medication was introduced to New Zealand by Europeans. The new science caught on with the Maori and they began to use medicines more freely and to try out native plants. This experimentation must have proceeded at a precipitous pace since Brooker and Cooper record over two hundred plants used by the Maori for medicinal purposes. Certain plants were believed to induce abortion, stave off pregnancy or cure the introduced venereal diseases.

Tapu

The social world of the Maori was governed by the laws of tapu. It was believed that man consisted of three parts, tinana (body), wairua (spirit) and mauri (life essence). Bodily well-being was dependent on support and protection of the mauri by the gods. Any transgression of the laws of tapu led to withdrawal of divine protection. The mauri was then exposed to the influ-

ence of malevolent spirits. Illness with no observable or known physical cause was attributed to an attack on the mauri by malevolent spirits. The remedy was to call in the tohunga (priestly expert) who would identify the offense and recite the necessary incantation to ward off its effect.

Early childhood socialisation practices implanted unquestioning belief in the power of tapu. Tapu was of three kinds, sacred, prohibited and unclean. Tapu in the unclean sense was associated with illness or death. However, transgressions against tapu prohibitions or sacred places could bring on a state of ill health which if not attended to by a tohunga could lead to death.

The belief that man could control natural processes by the power of incantation pervaded much of Maori medical practice and social usage. For instance, the Maori knew the mechanics of reproduction: “The seed of life is with man and that woman represents the sheltering or nurturing bed or receptacle for that seed” (Best 1975:11). This knowledge was supplemented by fertility rites known as whakato tamariki (planting children) to cause conception.

The Maori was also aware of the need for psychological or spiritual purging to absolve a woman ‘‘from the hampering effects of wrong acts, indiscretions (hara) that she may have committed”. So the tohunga practised a whakahoro (purification) rite (Best 1975:10). Tradition related that when Tutanekai’s mother went into prolonged labour at his birth the tohunga was called in to facilitate the delivery with appropriate incantations. When these failed to work the tohunga taxed the woman with having committed some hara (sin). She then confessed that her husband was not the child’s father. The incantations were then repeated with the insertion of the real father’s name in the genealogy. The child was then delivered with ease. Clearly, the Maoris believed in the idea

of confession being good for the soul, that physical disturbances may have psychological causes.

Cultural change

With the coming of the European the spiritual world of the Maori was largely replaced by Christian beliefs. But some elements of the old social order remained. Some Maoris still have a deeply ingrained antipathy when things tapu are brought into proximity with things noa (common). For instance hats, combs, scarves articles of toilet are all tapu by contagion. They must be kept separate from places where food is prepared or served. To place these items on a table where food is eaten is to give offense. Similarly to place one’s posterior on a table or pillows is an offense against the laws of tapu. Many Maoris still observe the custom of removing their shoes before entering a house.

A few traditionalists who still adhere to the customs of tapu even separate out their washing. Undergarments for instance should not be mixed with tea towels or table linen in the wash. Clearly, these taboos are more than mere superstition, they obviously have a sound basis in hygiene. Sick people and corpses were tapu. It was once customary to purify oneself at a stream after visiting the sick or attending a funeral. While many of these practices are still followed in rural areas they are gradually falling into disuse among urban dwellers.

Faith healing

The tohunga of old was more faithhealer than physician. With the introduction of European diseases which carried off large numbers of Maori population his role was called into question. By 1900 Maori numbers as a consequence of musket wars and introduced diseases fell from over 100,000 to 40,000.

In 1907 the “Tohunga Supression Act” instigated by Maui Pomare was passed. He and Buck then visited Maori communities and through the Maori Councils promoted health reforms in village life such as uncontaminated water supplies, through ventilation in meeting houses and so on. Gradually the Maori population recovered. But despite the suppression of faith healing belief in the tohunga flourished. In 1918 when the influenza epidemic swept away 226 in 10,000 Maoris compared with 49 in 10,000 Europeans, the stage was set for the emergence of Ratana the modern prophet and faith-healer of the Maori people (Ratana 1972:17). But unlike the tohunga of old, Ratana taught that cures would be wrought by belief in the One God. At the first Christmas gathering Ratana was reputed to have cured a hundred people

by faith in God. The press went so far as to dub him “the miracle man”. Belief in faith-healing persists today in both rural and urban areas. Certain people gain a reputation for faithhealing and are consulted for “mate Maori”. These are illnesses that a physician or a number of physicians have failed to cure. Maoris believe that if medical science cannot relieve them of their illness then it is a Maori sickness i.e. one with a spiritual or psychological cause. Since Maoris live in areas such as Porirua, Mangere or Otara which are not well served by doctors, it should not be wondered at that people resort to faith-healing. Society itself has created the social space for faithhealers. Meeting Maori needs For good or ill, we New Zealanders have placed doctors on a pedestal. Medicine is the prestigious profession because the public imagines its office holders hold the power of life and death over them. The profession adds to this mystique by a long process of rigorous training and certification. The corollary of this is that the incumbents tend to be drawn from elite WASP elements of society. The one saving grace is that we have a Maori Polynesian

preference system for entry into medical school. Even so we are a long way from having a medical system that is suited to the needs of a multicultural society. Much of medical diagnosis depends on how well the patient communicates with the doctor. Obviously, communication is a two-way problem. The question arises have we a medical profession that is capable of communicating not only across the whole range of the social spectrum but in the cross-cul-tural dimension as well? I doubt it. In Maori society for example the opening gambit is where are you from? Not what is your name? This is followed by do you know so and so? These are the social signals in Maori society that establish rapport and empathy. The prototypes and models for this kind of social behaviour are to be found in myth and tradition. But in an already over-crowded curriculum how can these things be taught at medical school? One of the consequences of professional demarcation of the medical field is less efficient medication for Maoris and Pacific Island people. The maldistribution of doctors in places like Otara has already been alluded to. We further exacerbate the situation by our failure to recognise the need for para-

medical personnel who would have responsibility for home visiting, ensuring correct medication i.e. that instructions are followed, changing dressings and identifying serious ailments that should be referred to specialists e.g. congenital defects. Even in an advanced society such as ours there is a place for the concept of a bare-foot doctor. Such a person should be drawn from within the community given elementary trainin 8 to carry out these minor functions thus freeing the doctor for more serious cases. Para-medical personnel who can identify with the people and communicate in a cross-cultural dimension are needed as mediators between highly trained specialists and people of different cultures. Some thought should also be given to establishing mobile clinics to serve deprived communities. For some people, making appointments is a daunting affair- For others the mechanics of getting to a doctor’s surgery are almost insurmountable when there is no family car an d public transport is inadequate, Families with a low per-capita income can bl afford to spend money on taxis, In conclusion might I say that medicine is so firmly established now as a science that some thought ought now be devoted to its application as a human

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