CONSIDERACIONES FINALES

Prior to Urbanisation Type 11 diabetes was absent

Part five explores and firmly establishes the status of tangata whenua Maaori health providing an important background and platform for this doctoral research thesis.

The Public Health Commission of New Zealand ( 1 99 1 ) claim that their statistics indicate Maaori health has declined considerable since colonisation and urbanisation with chronic non-communicable diseases developing that previously apparently non-existent. It has been since the 1 960s that diabetes mellitus Type II became proportionally higher in Maaori than the European counterpart, and diabetes mellitus Type I I four times more common in Maaori. However other lifestyle risk factors that contribute to Type II diabetes cannot be ignored such as:

• smoking • lack of exercise

• obesity (and food intake abuse)

• socio-economic factors of inappropriate housing, inadequate

education, high unemployment and a high rate of accidents

• alcohol and drug abuse illegally and legally prescribed (p. 23).

Goldie ( 1 903) was a western style medical practitioner who continually searched for the type of diseases that tangata whenua Maaori suffered and diabetes mellitus was not amongst them.

Goldie ( 1 903) stated, "karakia was extensively used with a specific karakia for whatever ailment afflicted them" (p. 46).

i. Diabetic Specialists authenticate statistics:

• Henschen ( 1 996) comments that New Zealand's national statistics indicate that

three per cent of the population is diagnosed as diabetic; however, Type II diabetes mellitus is four times more common in Maaori and Pacific Island

• Scragg, Baker, Dryson and Dryson ( 1 996) comment that there is a strong genetic

component in obesity and lack of exercise, which are two risk factors also contributing to the cause of Type II diabetes mellitus (p. 89).

• de Lore ( 1 993) says the onset of Type II diabetes for Maaori is approximately ten

years earlier than in Paakehaa (p. 60).

• Shillitoe ( 1 988) claims a link between a change in culture and diet contributes to

diabetes mellitus Type 11 (p. 1 5).

• Brown ( 1 992) says that Maaori display prevalence about four times that of

Paakehaa who are genetically relatively protected and that the onset of Type I I diabetes for Maaori is approximately ten years earlier than in Paakehaa p. (7).

• The New Zealand Herald (2002) claimed improved nutrition and physical activity

are key to halting the diabetes mellitus Type II crisis and New Zealanders' expanding waistlines are contributing to a diabetes epidemic, forecasted to affect more than 1 45,000 New Zealanders' in 20 1 1 - an increase of 77 per cent (p. A4).

ii. Diabetes absent in traditional knowledge search

Traditional knowledge verification has been obtained through the meticulous examination many of the old traditional hapuu karakia, waiata and pakiwaiatara from: the Tainui, the Arawa and the Mataatua waka hapuu of: Ngaati Tuuwharetoa, Ngaati Kahungunu, Kai Tahu, Ngaati Awa, Ngaa Puhi, Taranaki, and Ngaati Raukawa. Indeed my meticulous search found absolutely no reference to the distinctive diabetes mellitus symptoms particularly the excessive thirst and the sweet smell of the urine. Undoubtedly had these symptoms existed in our people they would have recorded them and woven them into the traditional stories known as pakiwaiatara? While at the same time they would have included the distinct symptoms in the karakia and ngaa mooteatea waiata. I say the absence provides conclusive evidence from a Maaori perspective that the disease did not exist, but then in the 1 960s the symptoms suddenly manifested. Thus because traditionally life was structured with particular rules and etiquette enforced from a hierarchical society but equally active, healthy and innovative people who sought answers; they would have recorded and existence symptoms of diabetes for subsequent generations.

Maintenance of physical fitness was recognised as a personal and national obligation. It was also part of the sacred duty of every single member of the community to maintain the body in perfect health. Physical fitness was thus an honourable thing, i ll-health was a disgrace, and physical unfitness not accepted. It was a religious duty for a man to keep himself fit and well; obviously therefore if he was unfit and unwell he had sinned and deserved to suffer, and should be made to suffer in such a way to cure himself and improve him. It was a crime against physical morality for a Maaori to fai l to acquire knowledge of the human body and its functions, or fail to improve his development or maintain his health. Disease and unfitness were the consequences of such sin. Some diseases were due to sins on the part of the individual, resulting from lack of exercise and from over-eating; others were inherited, and due to wrong-doing by the parent or ancestors. Cripples were not regarded as sinful in themselves, but as the unfortunate bearers of the sins of others. They were not blamed, but they were considered quite unfit to reproduce. On the other hand, those who neglected to exercise their minds and bodies were blamed for their physical defects, deprived of the privilege of reproduction, and degraded in rank (Rout, 1 926, p. 1 ).

Rout ( 1 926) says it was the personal duty of every Maaori to maintain the body in perfect health by means of diet and exercise. The care of the bowels was the secret of good health. Those who were unable or unwilling to be healthy should not be allowed to live, that is permanently unfit should be eliminated. The natural remedies or, rather, the preventives were clearly known to the Ancient Maaori. By diet and by exercise the Maaori kept their body physically fit and healthy. If the so called civilised nations of the present day could be persuaded to adopt the Maaori diet with an abundance of fruit and vegetables, coarse meals, with a little fish, eel or bird. There was no cancer among the New Zealand Maaori, or any other native race, so long as they lived their own natural life. As to the contagious diseases, the Maaori public health laws were obviously sufficient to eliminate these, and until the Maaori came under the control of European public health officers, acting as emissaries of civilisation, the spread of contagious diseases was impossible; the exercise and health parades were alone sufficient to ensure rigid prevention. They used sunlight as a preventative measure and the clothing worn was designed to prevent the spread of disease; that visitors were required to leave their own

bedding outside a visiting Paa because Maaori believed that disease was transferred in bedding (pp. 1 94- 1 96).

Rout ( 1 926) comments that Sir William Lane Bart, a Consulting Surgeon to Guy's Hospital in London comments that his long surgical experience has proved to him conclusively that there is something radically and fundamentally wrong with the civilise mode of life. And he believed in 1 926 that unless the present dietetic and health customs of the White nations ate reorganised social decay and race deterioration are inevitable. The New Zealand Maaori view that when the bowels are clean the whole body is clean is perfectly sound scientifically, and its ethical significance is far wider and greater than most of us imagine.

Sir William also noted that if the habit cultivated by the Europeans by regulating their diet and exercise in such a manner to ensure proper evacuation of the body' s waste matter) as was the Maaori habit of emptying the lower bowel would benefit public and personal health almost unbelievably. An obese and inflated abdomen is a truly hideous and unnatural sight, as unhealthy as it is unlovely; but an overloaded colon is much worse; it is the chief cause of our mental depression, pessimistic attitudes, marital unhappiness and social disorder. Finally, Sir Arthur Keith who was appointed the Senior Demonstrator of Anatomy at the London Hospital in 1 895 and was Head of the Department in 1 899 says that the lifestyle and methods used by the Maaori to prevent diseases were very effective as they did not suffer from any diseases (p. xiv).

Rout ( 1 926) comments that cleanliness of body was inculcated from childhood. Neither soap nor oil was known, but the body was cleansed every evening before the dances started. And in suitable weather there would be swimming, and on emerging from the water, the wet body was dusted all over with a fine powdery earth called one-puehu or sacred earth. A paste of the sacred earth was mixed in a calabash and used for washing the skin and hair. The Maaori diet was so healthy that the teeth needed very little cleaning, but a mixture of sacred earth with wood ashes was sometimes used as a toothpaste. Splinters of wood served as toothpicks and the children were taught to remove particles of food from between the teeth after each meal. From childhood every Maaori was taught the necessity of keeping the privy parts scrupulously clean with sacred earth

in the form of a paste. flax-waste which was soft and fluffy served as the toilet paper it was collected and stored for this special purpose. Dried moss was sometimes used when the supplies of flax-waste ran short (pp. 35-37).

iii. Traditional Maaori Health and Healing M ethods

Durie ( 1 994) comments that the systems for treating illness were sufficiently well­ established in traditional times to indicate that there was an awareness of basic anatomy, an understanding of physiological principles, recognition of the healing properties of flora. While traditional healing was largely symptomatic, aiming to provide rapid relief of symptoms, the physical remedies themselves were employed within a wider philosophical and theoretical context. Healers focused on two aspects of a health problem. The underlying aetiological hypothesis was based on the tapu/noa considerations, while the symptoms and signs were regarded as the outward manifestations of the problem (p. 1 5).

Durie ( 1 994) then comments that traditional Maaori healing encompassed several activities at spiritual, psychic, physical and ecological levels. The approach was an eclectic one, drawing on observations from a variety of sources but based on an understanding of human behaviour within the context of tribal survival, communal living, limited resources, and a temperate climate. A wide range of healing activities were practiced, many quite pragmatic, others derived from more complex understandings of religion, psychology, and philosophy. Five classes of activity were in common use, though more than one set of interventions at a time was the rule. A healing encounter could have included a ritualistic observations as well as poultice, bathing in a particular pool of water, and some action by the family as a whole (p. 1 7).

Durie (200 1 ) says traditional Maaori healing has not been rigidly defined, but there are a number of recognisable features that distinguish it from the treatment in a medical sense. Nor is it necessarily useful to attempt to understand traditional healing in terms of biomedical concepts and scientific proof. Though certain plants may have anti-bacterial or other therapeutic activity, and can be analysed scientifically, it is misleading to ascribe

health changes only to those properties and so dismiss (or fail to appreciate) other components of the healing process (p. 1 58).

Durie ( 1 994) comments that though the public health system in early times was impressive, all the more because of the limited access to other technologies, and healing systems were relatively well established, it would be misleading to presume that Maaori life was without serious health problems or that disease was only sporadic. Life was a struggle. Food gathering occupied much time and often required lengthy expeditions away from home. Even then, variety was not assured (p. 22).

Meat and fat were not regular dietary items, and cannibalism way has been part, at least, a consequence of that deficiency. With a climate far from tropical, protection from the elements was limited, clothing not always adequate, and the benefits of an open fire were diminished somewhat by excessively smoky surroundings. It is not known what effects a harsh environment had on longevity and wellness. Early explorers were impressed by the statute of the people they met and Cook concluded that Maaori in 1 769 were a healthy race (Durie, 1 994, p 22).

However, I do not totally agree with some of the comments made by Professor Durie particular the comment about meat and fat were not regular dietary items. This may have been pertinent for some hapuu or for specific geographic areas that lacked the natural resources that formed part of the regular staple diet for many hapuu, such as the eel/tuna. The eel/tuna formed the staple food for hapuu where because it was plentiful in the adjacent Waikato River and tributaries, and was preserved when the supply was excessive and able to be stored safely for a long time. However some hapuu did not have sustainable access to eel/tuna and may have suffered from a lack of dietary intake of meat and fat because of the lack of natural resources, but not all.

I also challenge the comments about serious health problems because no reference has ever been made through the traditional Maaori communication methods about any serious diseases as I have previously discussed. However the arrival and contact made with the European did introduce communicable infectious diseases, such as measles, influenza, gonorrhea, syphilis, tuberculosis, typhoid, scarlet fever, whooping cough and other and bacteria and viral infectious diseases. Because Maaori were isolated from other populations they had never been exposed to these contagious infectious they had no

resistance to them and as a consequence of the European contact was the introduction of diseases that devastated the Maaori population. Mortality rates were high where in some areas whole settlements of both children and adults were wiped out and as a result the Maaori population was drastically reduced through epidemics. In fact, serious health problems did arise secondary to the infectious diseases that left many Maaori communities with depleted numbers with many of its people with chronic systemic illnesses that also had a drastic economic consequence rendering poverty.

Rongoaa

Macdonald ( 1 973) comments that traditional Maaori Medicine known as Rongoaa was made from native flora and fauna with extensive knowledge acquired over the years, carefully analysing the effects by using various leaves, barks, moss, roots, berries, flowers and used externally, internally or as a vapour. These were made into poultices for sprains and boils, splints for broken bones from the Tootara tree, and charcoal for burns. The root of the Harakeke used to treat constipation, the Poohutukawa tree's inner bark was used to stop bleeding, as pain relief for toothache and made into a liquid to cure diarrhea. The Tootara tree bark was boiled with the Maanuka shrub to make a lotion that reduced fevers and smoke from the burning wood was used to treat paipai (p. 6 1 ).

Rongoaa knowledge was held in trust by the Tohu and other specially selected people (usually related and of a high rank) that included the type of foliage or natural resource and the time to gather as well as the method used to prepare as a medicinal preparation. The Tohunga played a dominant leadership role in all aspects and was treated with great respect and aura because of the power they (usually male but could be female) possessed and was demonstrated through challenge, as was the Maaori way.

Whilst Elsdon B est' s recording about many aspects of tangata whenua Maaori has been validated by contemporary Maaori there are some aspects of his writings that are challenged by many Maaori as being incorrect such as his comments about the use of Rongoaa. Indeed any knowledge about the medicinal uses derived from available resources such as barks, leaves, and roots and then modified through experimentation, trial and error was knowledge held by only a select few such as a Tohunga. Therefore to give or provide knowledge that had been accumulated over subsequent generations would

have been a breach of the tapu and noa concept that formed the basis any traditional or old-time Maaori health methodology or intervention.

van Urk et al. ( 1 992) comments Elsdon Best claimed that the Maaori of old relied principally upon his priest when attacked by sickness and that the priests did not deal in herbal remedies and there was no science of medicine in Maaoriland. And that he believed most of them to be based on the European method of treatment of the sick but acknowledged that Elsdon Best is the most widely accepted authority (regarding accounts of the day to day life). While at the same time disagrees with his comments about Maaori not having developed the rongoaa prior to the arrival of the E uropean. They substantiate their disagreement with Elsdon Best by claiming that the reports of Cook, Cruise, Rutherford, Dieffenbach and Colenso all evidence that the old-time Maaori used external remedies (p. 1 6).

van Urk et al. ( 1 992) says that Captain Cook observed the Maaori using a vapour bath and the use of extensive use of New Zealand plants. In 1 848 Reverend Richard Taylor of Whanganui published a Maaori vocabulary under the title A leaf from the natural history of New Zealand containing valuable notes on the medicinal use of native plants. He revised this information in a second edition published in 1 870. Dr O'Carroll, who was attached as a physician and surgeon to many expeditions against the Maaori insurgents during the 1 860s, published an article on Maaori Medicine in the Taranaki Almanac for 1 884. J Kerry-Nicholls, who explored the King Country in the 1 880s, compiled native pharmacopoeias which confirm and supplement the observations of other writers. Dr W. Goldie of Auckland published in 1 905 a full account of Maaori Medicinal Lore, in which they listed some 56 plants with medicinal uses (p. 20).

Wai

All populations rely on water for survival and most have incorporated the significance and appreciation of water into their culture and many used water for healing and cleansing purposes. Fresh water was consumed every morning from rising to the first meal of the day to ensure the body was cleansed internally and kept healthy, regular bathing in water was also part of the body cleansing and water was used as a ritual and

formed an integral part of spiritual healing and cleansing by the Tohunga of some ailments that were considered to be caused but usually in conjunction with karakia or chanting. The water was sprinkled by the Tohunga over the person or the person was immersed in a pool of water usually specially reserved for that purpose and because the water has some significance. It may be that the water was a spring from the ground or that it was somewhat different in purity from other water.

Walking or bathing the feet in certain water(s) was a method used with the belief that