Since 2009 the programme’s advisory group and project team have been designing initiatives to support Māori nurses and midwives. They have raised the profile of these professions by examining undergraduate programmes, improving access to professional development and providing clinical leadership training and support over the four-year contract with the Ministry of Health.

Ngā Manukura o Āpōpō project sponsor and Director of Nursing at Auckland DHB, Taima Campbell, said that as models of health care delivery change, clinical leadership by Māori nurses and midwives will be critical in creating and implementing changes to benefit whānau, hapū and iwi.

‘This is why we have been so pleased with the response to our clinical leadership training programme that we are offering in association with the Māori training organisation Digital Indigenous.com,’ said Taima.

‘Over four years we will have up to 160 Māori nurses and midwives take part in training designed to stimulate learning, discussion, debate and action on leadership and management, clinical competency, quality improvement, change management and people management. A critical part of the programme involves participants scoping, presenting and implementing a project that demonstrates leadership, has a clinical focus and makes a positive contribution to Māori health.’

Taima points to a number of other exciting initiatives that are growing and will be coming to fruition over the duration of the contract. 

‘We are involved in a collaborative project with the Tertiary Education Commission to produce an annual scorecard on the performance of nursing and midwifery education providers for their Māori students. The scorecard will acknowledge institutions and initiatives that address barriers to success through recruitment, retention and attainment and will be published annually.’

Addressing barriers to success is also a theme in another project sponsored by Ngā Manukura o Āpōpō. 

The project has analysed entry data and both current and emerging retention issues for Māori midwifery undergraduates.

‘This project has helped us identify retention activities that support Māori midwifery undergraduate students, addressing some of the barriers experienced by students to prepare future Māori midwives,’ Taima said.

In 2012 the Lakes and Northland DHBs are implementing ‘Poutama’, another initiative from Ngā Manukura o Āpōpō. 

‘Poutama’ is a 12-month structured workplace learning programme, using New Zealand Qualifications Authority (NZQA) unit standards.  A baseline for further learning programmes in nursing and nursing leadership, it aims to use existing programmes to achieve optimal learning and workplace application within a kaupapa Māori framework.

An e- portfolio project also began in 2012, led by Ngā Manukura o Āpōpō as part of its professional development workstream.

Taima said while there are a range of professional development opportunities available to registered nurses, a number of systemic and structural barriers restrict full access to education and training opportunities by all practitioners.

‘We have an opportunity to pilot e-portfolios with Māori registered nurses, who may not currently be associated with an active professional development and recognition programme. We’re looking forward to launching an accessible, purpose-designed, online option for professional development portfolio completion by Māori registered nurses.’

Ngā Manukura o Āpōpō has enjoyed the support of a committed advisory group and this has been another significant achievement by the programme. Ngā Manukura o Āpōpō has gathered an exceptionally talented, diverse and experienced group of women together to guide what is essentially succession planning – nurturing the leaders of tomorrow.

Ngā Manukura o Āpōpō is a national Māori nursing and midwifery workforce development programme. For more information, go to:  http://www.ngamanukura.co.nz

General Manager of Māori health at Counties-Manukau District Health Board (DHB), Bernard Te Paa, said Kia Ora Hauora was designed to improve the uptake and achievement levels of Māori students in secondary school science, as well as enhance the recruitment and retention of Māori tertiary students studying in health.

‘Initially Kia Ora Hauora aimed to have 1000 Māori recruits on to health career pathways by 2012,’ he said.

‘The target of 1000 Māori recruits was achieved well within a year of the March 2010 launch and the programme has really taken off, thanks to the enthusiasm and drive of our regional partners.’

Counties Manukau DHB, along with Māori workforce development organisation Te Rau Matatini, leads Kia Ora Hauora through the national coordination centre. This centre works closely with four regional coordination hubs; northern, midlands, central and Te Waipounamu.

Counties Manukau DHB programme manager Tuhakia Keepa said that to really appreciate the breadth of the programme, it’s worth taking a tour of the Kia Ora Hauora website with kaiwhakahaere Ben Mitchell. 

‘The site has a lot of information around what to study, where to study and how to get started as well as providing access to scholarships, and information about mentoring programmes,’ he said.

‘We have produced a series of short video clips where Māori health professionals share their passion for their health careers.  We also highlight the number of recruits who have signed on to Kia Ora Hauora by iwi and how to get closer to Kia Ora Hauora wherever you live in Aotearoa.’

Registering with Kia Ora Hauora is like joining a national club.  On Facebook members find like-minded friends and get alerts on scholarship availability and deadlines. And on YouTube there are more cool ambassadors for Kia Ora Hauora as well.

‘We have been consistent in our message that health careers are both exciting and rewarding,’ Tuhakia said.

‘The creation of strong promotional resources that engage Māori, coupled with a vibrant and growing regional and national presence has resulted in us doubling our target.  Today we have more than 2000 Māori considering and exploring health as a career.’

Kia Ora Hauora has also created a suite of support services to address the needs of those registered with the programme. These include science camps, study resources, career mapping tools, tertiary navigation guides. 

Tuhakia said that in 2012 Kia Ora Hauora would also offer an online mentoring programme and a science education programme. 

‘In addition to this, Kia Ora Hauora has pulled together a database of existing programmes, ensuring Māori are connected to local and national opportunities that exist within the health career sector,’ he said.

‘One of the greatest advantages of being connected to Kia Ora Hauora is having access to the most relevant supports available.’

Kia Ora Hauora is a national Māori workforce development programme designed to recruit, retain and revitalise the Māori health workforce. For more information on Kia Ora Hauora, go to: http://www.kiaorahauora.co.nz

This hugely successful programme won the trust a Whānau Ora Award in 2008. 

Te Hauora O Te Hiku O Te Ika Whānau Ora Clinical Nurse Manager, Angee Keung described the achievement as a reward that acknowledged the trust could bring the community together, empower people and make a difference for their tāne.

‘Until this project came along we were working in silos. But Hauora Tāne, ‘One Heart, Many Lives’ gave health promoters and clinicians alike, the opportunity to really work together to engage the community and successfully deliver the programme.’ 

Early and effective community engagement was crucial to its success. This began in 2007 with a series of tāne dinners.

‘The opportunity for a free dinner worked I suppose,’ said kaumātua Hohepa Stephens.   ‘But when we got them there, we gave them dinner and then asked them to stand and say why they’d come. A lot of them had genuine reasons, like ‘I came because my wife made me come’.  Others came because they had whānau who had died of heart attacks and they’d had problems themselves in their younger years, so they thought they’d better do something about their health.  A lot of them said ‘I’m doing it for my kids and mokopuna’.’

After dinner, local general practitioner Dr Lance O’Sullivan would cover the clinical aspects of cardiovascular disease in laymen’s terms before question time, when the kōrero really started. 

Little was left to chance when it came to making sure the tāne dinner contributed to the design and delivery of the programme.  The health promotion team ensured in advance that the questions were pertinent, the kōrero focused and that the ideas of all the tāne contributing to the kōrero were captured to inform the programme. 

Project manager Callie Corrigan said it was a privilege to be a wahine in the room, listening to the kōrero.

‘We were sitting in the back hearing some extremely valuable comments like, ‘I’ve gone and got all of the tests, but I haven’t gone and got the test results’;   ‘I don’t want to go and have the doctor tell me what needs to be done’; ‘I want to maybe go to a doctor who will help me on the path, not just tell me the kōrero’.

Health Promotion team manager Lisa McNab said it was through this early harnessing of ideas that they began to see what effective resources might look like.

‘When we started discussions with PHARMAC, the District Health Board and the Primary Health Organisation about implementing the programme, we took our tāne with us,’ she said.

‘From then on the basis for everything we developed, presented and delivered came from the tāne who attended those tāne dinners.  Our role was to take the ideas and make them work.’

Also critical to the success of the programme was the way in which it was delivered.  The issue of access came up early in the tāne dinners.

‘Why would I go to the doctor for a 10am appointment if I’m working up in the forestry and have to take a whole day off?,’ asked one attendee. The response was to have the nursing team go bush. 

‘For every barrier, we’d find a solution,’ said Callie. ‘For every question like “what would it take to get you going to a screening?” we’d find the answer.’

The style of communication was also exceptionally important to the tāne, who would grumble if their precise words were not used or their thoughts interpreted in a way they did not believe made sense.

Lisa said the Bro-Files started at the dinners as well. ‘Men would agree to become a Bro and we would record their kōrero, their own words about their health.  The Bros’ stories circulated in press and on radio and some of the Bros went on to become the Poster Boys.’

The Warrant of Fitness Health Heart Card with red, yellow and green lights indicating cardiovascular disease risk was another success. General practice clinics throughout Te Tai Tokerau knew if a tāne produced a Warrant of Fitness card, they were signalling a desire to take heart health seriously.

One of the Poster Boys, Manuera Riwai, believes families are closer as a result of the programme.

‘Our men have been able to communicate and be with each other,’ he said. ‘We’re not insular anymore because we’ve taken the opportunity to network with each other.’

Lisa agrees the programme strengthened relationships, especially among the men.

‘We had all this intense support in the whare. There were groups of bros supporting each other around their health.  There was a bro supporting another bro who had depression. There were all kinds of support systems that grew from this.’

Lance O’Sullivan said the programme gave space for men to talk. ‘The guy who did an article on heart health was hit up in the tea room at the mill because all of a sudden, he was an expert in his peers’ eyes.’

Lisa agrees with Lance about their men becoming megaphones for heart health.  ‘Our tāne did become the experts.  One of the current Bros is still on the back of a Toll transport truck that travels up and down State Highway 1 and 10 twice a day, seven days a week.  He’s become the expert and his whānau are still contacting him “oh, bro, I saw you sitting ten feet high…  What’s it all about, what do I need to do?  Where do I go?’

Lance also points out that a lot of people involved in the programme gave their time, stories and photos free.

‘The programme relied on the passion of our community and that passion really wasn’t valued. If I had a wish list now, it would be funding to properly support what we did at the time and funding to properly evaluate.’

Callie Corrigan is aware she is sitting on mountains of valuable data and material.

‘Collating the evaluation is the part that’s missing; we currently do not have the time or capacity. We have a wealth of learning here and it deserves to be published.’

In Northland, Te Hauora O Te Hiku O Te Ika is the largest Māori provider of general practice services and second largest Māori provider overall of health services.

For more information, go to: www.hauora.net.nz

During this time the trust moved from service provision in-group homes to providing residential services and community packages of care. It also became interested in becoming a social housing provider, believing that an integral aspect of recovery and wellness is in housing that people can afford and be proud of.

It was the new social housing component within its extensive portfolio of rehabilitation, accommodation and care packages that earned the trust a Whānau Ora Award in 2008.

Te Kotuku Ki Te Rangi Trust started its Social Housing Project with the support of Housing New Zealand’s ‘Housing Initiatives Fund’.

Within 12 months the trust had bought six two-bedroom units and was providing affordable long-term tenancies to tangata whaiora and low-income families challenged by a shortage of adequate housing in west Auckland.

The trust’s achievement was a reflection of its ability to develop sound support alliances and its commitment to involving tangata whaiora in planning wrap-around integrated services to maximise positive outcomes.

The social housing initiative offers tangata whaiora an alternative to shoddy boarding houses, inappropriate whānau environments, cripplingly expensive flats and isolated lifestyles that invariably led them straight back into the trust’s care.

Trust chief executive Josie Smith picked up the social housing initiative when she began working at Te Kotuku Ki Te Rangi. 

‘When I arrived, the initiative was moving through Housing New Zealand,’ she said.

‘We didn’t know what houses we were going to buy at that time; we just knew there was a Housing Innovation Fund that we were interested in.  The Trust’s then Chief Executive Michelle Cavanagh thankfully opened those doors positively for us and we took advantage of it.

‘We initially agreed to buy 50 houses over 10 years but the rules continued to change so we bought six in the first year and then we were not able to buy any more.’   

Josie said prospective tenants are referred by clinical teams.

‘When we know they’re well and about to exit services we’ll flag it to them that we have a vacancy. We then take them through a full tenancy interview and everything relating to the tenancy. We encourage the use of budgeters, or direct payments from WINZ, and we’ve never had a problem with tenants paying their rent. They know they have to pay, so they pay.  We also expect them to treat the house as their home, and they do.’

Josie is clearly proud of the ongoing success of the social housing project and what has been achieved.

‘Our service manager Natalia Kaihau did a project around gardening.  We started by giving them vegetables from one of our other sites and this encouraged them to change their diets.  They used to come down to the gardens she set up. She would teach them how to dig, how to use a spade – it was starting from scratch. Now they grow their own gardens.

’Our tenants stay well.  Whether it’s the house, whether it’s our follow up service, I don’t know – although our care stops at a certain point because they no longer need us.’

Josie said it was the tangata whaiora themselves who were most proud of winning a Whānau Ora Award.  She believes that what the trust delivers and how it delivers it is pure whānau ora. 

’Whānau ora should start with mental health because it’s with these individuals – our tangata whaiora – that you do everything from housing, budgeting, nutrition, clinical and non-clinical support, understanding and drawing on your community networks,’ she said.

‘We have navigators here who can navigate around anything to get whatever our tangata whaiora need – including the support that needs to be wrapped around the whānau.’

In 2011 the trust added a six-bed short-term respite service for tangata whaiora to is portfolio.

It also applied to the Social Housing Unit for funding support to purchase additional community housing and existing housing complexes to offer more options to clients facing multiple barriers in accessing and sustaining appropriate housing.

Te Kotuku Ki Te Rangi was established in 1992 to respond to increasingly community-based mental health solutions. It was one of the first Māori residential mental health providers.

For more information, go to:  http://www.tekotuku.co.nz

Project Karere, assisted by initial funding from the Ministry of Health, JR McKenzie Trust and the ASB Trust, had been in development and refinement since 2005 with an aim to use technology platforms that would help improve access to health services for whānau haua, whānau with disabilities.

This included enabling ‘real time’ access to interpreters for whānau turi in hauora hui and whānau ora activities and increasing the methods of communication and range of information available to whānau with various impairments. 

Three years after the win the trust’s chief executive Tania Kingi remembers the Whānau Ora Awards dinner as launch night for Project Karere.

‘It was the first time we’d “gone live” and learned what more we had to do technology-wise,’ she said.

‘The awards also gave us a chance to talk with other providers about how they were engaging whānau haua in the delivery of their services.’

Tania said the awards forum was also an opportunity to tell health providers that Te Roopu Waiora would work with anybody to ensure that their services were accurately targeted and appropriately delivered to whānau haua.

‘It doesn’t matter who the provider is, or what services they provide,’ she said.

‘We can play a role in enhancing services to a population that includes Māori with disabilities.  A very good example of this was ensuring sign language interpreting was present during the Christchurch earthquake and our ongoing support for whānau there.

‘Te Roopu Waiora is a kaupapa Māori service founded and governed by whānau haua.  Our communities are often hit with a double whammy. It is a population that identifies as Māori first. Then there is the additional struggle that impairment brings. “I’m also blind”, “I’m also deaf”, “I’m also a member of a whānau that need to be able to support me but simply doesn’t have the resources”. Our task is to hold agencies, government departments and providers accountable, helping them improve their response to our people, ensuring they feel valued, respected and in control.’ 

Project manager Sione Pasene said: ‘We’re at a point where we can say to the deaf community, wherever you are, whatever you need, choose which interpreter you want to use and we’ll make the service work for you.’

Yet over the eight years of development Project Karere has been through a huge technology evolution. The team’s own understanding of what is possible with Project Karere and what would work more effectively for Māori with disabilities has also evolved. 

‘What started as an initiative for Māori deaf now has application for Māori with different challenges,’ said Sione.

‘We have seven groups representative of the community.  We believe if it works for one, it will work for all.  Project Karere can work for those who are paraplegic, for the elderly …’

Another project started around the same time as Project Karere involved whānau with disabilities designing the ‘ideal marae’. 

‘The architectural plans for a fully inclusive marae emerged from the ideas of different whānau groups.  Now we can go to existing marae and share the ideas,’ said Tania.

Project Karere is a feature of it.  The waharoa entrance of the marae has a screen with sign language interpreted in real time telling the kaupapa of the hui and the current activities on at the marae. There is brail on different sized rails so that the kāpō community can feel which way to go to different buildings, and round tables for people who lip read.

Te Roopu Waiora has whānau steering groups on each of its project.

‘Project Karere had its own steering group made up of whānau and the marae concept had its own steering group made up of whānau. It’s through these processes that we get to become truly accountable to the communities we represent,’ Tania said.

‘We also run monthly whānau hui to inform anyone who wants to know what’s going on – and that can be a mix of providers and whānau.  It’s actually turned into a “this is what we want you to do” forum where whānau can talk directly to providers.’

Sione comments further on a voice for the trust’s community.

‘When Tania goes out to talk to select committees for example, she goes with a rōpu of six or seven, representative of all of the whānau, and they all speak. When we go out on our own we’re conscious that we’re able-bodied. Even though the concept of whānau haua encompasses all the whānau, there is the kōrero that we just don’t have. We can communicate articulately, but we don’t have the real authority of the consumer.’

Te Roopu Waiora Trust (www.teroopuwaiora.org.nz) is governed by whānau with physical, sensory and intellectual disabilities. It provides disability information and advice and assists whānau access Māori communities, providers, agencies and government. Large projects are jointly guided and evaluated by partners Tāmaki Ngāti Kāpō and Mana Tangata Turi.

Hei Oranga te Iwi o Whakawhiti Ora Pai was delivered into far north communities around Te Kao – on marae, in schools and online.

It used fresh produce as the basis for learning food preparation, preserves, recipes, traditional knowledge and values and encouraging whānau responsibility.

Whakawhiti Ora Pai general manager Errol Murray said getting whānau enthusiastic about gardening had not been successful in the past.

This, he said, was attributed to the fact that traditional Māori gardens covered huge areas. For many whānau, the thought of a garden seemed too big. A new approach was needed.

‘Our health promotion team talked to our kuia who reminded us that when they were young, they gathered food seasonally with their whānau and then preserved it,’ he said.

‘As the kuia told their stories they had the idea of gathering the stories into a book.’

This culminated in Preserving Kai, which was produced by the kuia.

‘The seemingly simple project involved hours of work and mobilised the whole community.  It went beyond preserving food and telling stories.  It was about community development and action,’ Errol said.

‘Sharing knowledge gave us a much greater appreciation of resources and resourcefulness.’

Errol said that the legacy of Hei Oranga te Iwi o Whakawhiti Ora Pai remains alive and well today. 

‘In any health promotion exercise, our kaimahi are always talking about the importance of good nutrition,’ he said.

‘It is threaded throughout all our communication at all age levels, whether we’re working in our kōhanga reo or with our kaumātua and kuia.’ 

Sharing knowledge was also a key aspect in the next Whānau Ora Award for Whakawhiti Ora Pai. 

In 2008 they were awarded for Kura Manaaki, a holiday programme designed to strengthen the sharing of tikanga and teaching of protocol and values to tamariki and taitamariki.

 Kura Manaaki was initially delivered on a number of Far North marae and now, more recently, at a camping ground on Ninety Mile Beach.

Kura Manaaki topics include rongoā (tradition Māori balms and remedies), mahi a rehia (weaponry), raranga (weaving), waka ama, marae kawa and tikanga, and kai oranga (healthy kai).  

‘We run up to four Kura Manaaki holiday programmes each year,’ said Errol.

‘We usually try to work with no more than a dozen kids, and we’re never short of helpers.  Some parents give us a day of their time or produce from their garden to help make the programme affordable for them.  We have some very talented mothers who bring their recipes and cooking skills. We also have a big elderly population who are more than willing to offer advice, guidance and tools.’

The programme highlights the health promotion team’s commitment to employing education and empowerment to prevent illness and showing how connectedness can restore, develop and maintain quality relationships within whānau, hapū and iwi.

‘We usually target our tamariki – our children – because they’re the most at risk … but in doing that we have to look at the whānau, and then at our kaumātua and kuia. 

They’re all linked, they’re all dependent on one another,’ he said. 

‘It’s a real bonus for us that we all live in the hearts of our communities, so we’re all involved with our schools and with our marae.’

By emphasising the key concepts of physical, emotional and spiritual health along with the importance of whānau in daily practice, Whakawhiti Ora Pai aims to improve total wellbeing and enhance cultural identity, through a range of clinical and health promotion services. For more information, go to: http://www.wop.co.nz

The project started in 2003 when Otago University researchers discovered the exceptionally high prevalence of glucose metabolism disorders in these communities.

Around 50 percent of those living in these communities were identified as having insulin resistance, impaired fasting glycaemia, impaired glucose tolerance or type 2 diabetes. 

Implementing a diabetes prevention community intervention began in 2004.  The focus on key risk factors resulted in a community awareness programme designed to improve nutrition, increase activity and reduce smoking and alcohol consumption.  Mobilising communities to take an active role in the design, set up and running of community initiatives was critical.

Programme manager during this time was Terry Ehau.  He describes the project as organic, evolving from the flax roots up, and reiterates that mobilising communities is as critical today as it was then when it comes to sustainable community interventions. 

‘The real triumph of the project was its effective use of champions,’ he said.

‘On the one hand we had the Ministry championing the project through funding, Otago University championing through knowledge and research and Ngāti Porou Hauora through our clinicians and coordination.  But equally important was having our kaiawhina as exceptional champions in the communities where they both lived and worked.  Then there were others in the community who stepped up, up-skilled and came on board as champions too – mums, dads, cousins, they became champions as well. We used local people to convey all the key messages. Our posters featured people we all knew.  We recruited local celebrities, mobilised gardening and cooking initiatives and got whānau to take ownership of these initiatives.

‘It was classic whānau ora.  We had experts and champions, at all levels of the project from whānau to community to clinicians and academics.’

The second-phase of the intervention sought to consolidate work already initiated and to embed the intervention into all parts of the community including workplaces and schools. A process and formative evaluation continues to this day, documenting the programme and gathering feedback from the communities and team to inform the programme.

An international diabetes conference in Wellington in 2008 heard that after the programme's first two years, the number of women aged 25-49 with insulin resistance, the first precursor to type-2 diabetes, dramatically dropped from 38 percent to 25 percent.

General practitioner Dr David Tipene-Leach told the conference that ‘the fact that there has been no increase in diabetes and a reduction in insulin resistance suggests such community-based programmes are effective and worthwhile tools. Marked improvements in levels of exercise and eating habits, and reductions in weight, body mass index and triglycerides, were also observed among women under 50 years’.

Dr Tipene-Leach also told the conference that the better results for women have been attributed to their higher level of participation in community intervention activities than men, something identified in an ongoing evaluation of the programme.

‘Women are braver and more insightful . . . they are more likely to do what is good for themselves and their family.’  (The Gisborne Herald 2 April, 2008)

Terry said that being part of the Whānau Ora Awards in 2006 was invaluable.

‘It was very important to be able to share projects and learn about other initiatives.  Taking the project into the mainstream Health Innovation Awards was also exciting.  It helped us understand that we were capable of succeeding on a global basis.’

He describes ‘Ngāti and Healthy’ as ‘common sense’ and notes that today it’s the model Ngāti Porou Hauora still uses to address population health issues and deliver primary health services. 

Like many remote, predominantly Māori communities health, education, housing and income are a significant part of the environment which impact both positively and negatively on whānau.  

Terry believes that effective service delivery to Māori in these environments requires a clear understanding on how continuity, connectivity, culture and change can influence whānau capacity to engage effectively and in ways that promote positive outcomes. 

‘The challenge for organisations and whānau is to determine a shared vision, based on high degrees of commitment,’ he said.

‘The challenge for Māori organisations is to recognise and embrace the potential of whānau and to support this by applying frameworks which resonate and appeal to them.  It is about shared intentions with whānau and the commitment to work from a platform which is positive and forward looking.  It is also about moving to an independence and interdependence model where all stakeholders have an opportunity to contribute and share power.’

Ngāti Porou Hauora is an integrated health, development and support services provider. It is owned by ngā whānau and hapu of Ngāti Porou to provide services, improve health status and increase the life expectancy of all its population. For more information go to: http://ngatiporouhauora.org.nz

This was an initiative designed to help clients who had completed a 12-week residential alcohol and drug programme by providing whānau opportunities to be part of the client’s journey of discovery in recovery.

Te Ara Hou was an independent Māori organisation established as a specialist drug and alcohol rehabilitation service in 1989.  In 1997 Te Ara Hou had merged with Raukura Hauora O Tainui, but retained its name and ‘brand’.

The service delivered by Te Ara Hou then, as it is today, was underpinned by Te Toi o te Mataariki, an ‘awakening model’ where successful recovery involves ascending to the highest point of the whare wānanga where the best view of the world is gained.  In Te Toi o te Mataariki, the journey of recovery starts in the darkness of the mind, Te Pō and triumphs in the world of light, Te Ao Marama.

Te Ara Hou general manager Wiremu Walmsley reiterates that Te Ao Mārama is the ultimate goal in the successful recovery of the men who join the residential programme. 

‘When the men come on to the programme, a facilitator helps them identify where they’re at.  Te Pō is total darkness and we do get men who really are in this place. But others may be at different stages on a journey to recovery and the facilitator helps each client identify where they are and how they can move to Te Ao Mārama.’

Te Aka a Tane acknowledged that recovery is a continual journey that can be supported by an informed whānau and community.  It was an important initiative that has subsequently been incorporated in different ways into both the residential and community alcohol and drug programmes delivered by Te Ara Hou.

The seven-day, 24/7 residential programme is provided for up to 20 Māori men aged 18 or more.  Wiremu describes whānau involvement as an important aspect of the programme.

‘It’s what Te Aka a Tane was about too, involving the whole whānau. There is no use having individuals come on to the programme, do a lot of work on themselves and then return to environments where there has been no change, or where they are unconnected to their whānau. A big part of our mahi is whānau integration.’

A number of mainstream drug and alcohol organisations have small Māori units attached to them, but Wiremu said Te Ara Hou is the only kaupapa Māori drug and alcohol programme for men.

‘While ‘addiction’ and ‘recovery’ are essentially the same anywhere, the way we deliver our service is different.  Our service is delivered from a kaupapa Māori perspective.  As we did in Te Aka a Tane we use the forest, the bush, the sea and rongoā as part of the recovery.  We also reconnect our men to their whakapapa, giving them the opportunity to research their families and go back to their kaumātua and kuia to get some of that history.  It’s all part of integrating them back into their whānau and wider communities,’ said Wiremu. 

‘Some of the men also wonder what learning to do the taiaha or the patu has to do with recovery.   But it’s about physical activity; it’s about coordination; it’s about team work; and it’s about pride and mana.  So they learn that on their journey as well because they’re learning in a kaupapa Māori environment.

‘We also have a whānau after-care service which gives our men the opportunity for group work once they have graduated from our service.  They can come together and kōrero.  Whānau are welcome to join this as well.  This service also does follow-ups with client and whānau, whether it’s a phone call or visit; just to see how they’re getting on.’

Raukura Hauora O Tainui offers a range of mental health and addictions services to individuals and whānau, incorporating a tikanga Māori approach.

For more information, go to: http://www.raukura.org.nz

Te Puna Hauora also won Te Tohu Kahukura, the Supreme Award for the model it began to articulate as early as 1997. That’s when it set up as a primary health provider addressing health inequalities for Māori, Pacific Island, immigrant and refugee people, and those with lower socio-economic status on Auckland’s North Shore. 

Just one year after the Whānau Ora Award achievement, Te Puna Primary Health Organisation (PHO) was established, with 5742 enrolled clients.

Today, Te Puna Hauora services are delivered from two Northcote clinics and a Birkdale clinic to over 12,000 enrolled clients. It has a childcare centre in Northcote, and mobile mental health iwi support services based in the Rodney area.

Te Puna Hauora was effectively built on its ‘Harakeke – I MAP’ model.  In this model, the heart of the flax is the individual and the whānau weave the harakeke into the shape it wants for its own health and wellbeing. Te Puna Hauora provides a service encompassing the individual and the whānau, helping them to set priorities for their health and social needs. Beyond Te Puna’s team are the external organisations that may be called upon in an integrated management plan.

‘I’ stands for individual, for interdisciplinary and for integrated.  The model is about giving individuals and whānau the ability to 'map' their own road toward health and well-being, putting them at the centre of the organisational kaupapa.

In 2004, ‘I’ also referred to innovation, which was evidenced for example in rent free reception and accommodation for lawyers, doctors, dentists and budget advisors at Te Puna Hauora who would, in turn, discount services to  Te Puna Hauora clients and support the complete delivery of the ‘Harakeke - I MAP’ model. 

Te Puna Hauora chief executive officer Lyvia Marsden said no one was more blown away than she when they won the Supreme Award. 

‘While for most it was a celebration, I experienced wehi – a reverent fear – because I knew how much there was still to do.

‘The essence was exactly as it is today. I had been a nurse working in mainstream for many years and that was all about control and us knowing best.  I was so systemised that I didn’t see my own culture and my own spiritual side. It took time for me to connect whanaungatanga with collective thinking and allowing whānau to take the real control and restore themselves.

‘At that stage we had Mason Durie’s Te Whare Tapa Wha framework.  We had Rose Pere’s Te Wheke.  What I wanted to do was to put together a proper practice system that worked from beginning to end for individuals and their whānau.  With the amount of experience I had in primary care, setting up a medical practice was not a problem.  But the real challenge was creating something that worked for Māori whānau. Early in 1997 I attended ‘The Dynamics of Whanaungatanga’, a two-day seminar designed and led by catholic priest Pa Henare Tate. The effect on me was profound and it was here the I MAP model began to be formulated in my mind.

‘At the time, once I started talking about it, I thought everyone at Te Puna Hauora was on the same page.  I was wrong about that and so one of the really important things for me was my daughter Lisa Chant’s ability to write.  As I talked and walked, she wrote, able to capture what I was meaning.

‘We worked together on it until we got it right.  We wanted to do things right, with integrity and compassion. We wanted to be able to help whānau to help themselves.  It was all about restoring the mana of people.  Essentially the values and principles are embedded in the constitution of the organisation and it is who we are today, but it has been a constant battle – in the clinical and non-clinical areas – to hold it true to its form.  We have worked really hard from board level through to whānau in our communities to ensure we are all on board and commit to transforming lives.

‘It has been a 15-year journey to go from paper, to computer to web-based.  The ‘I’ has become ‘WE’ because many in our organisation are practicing what we have learned, encouraged by witnessing the changes in the whānau we are serving.

‘Our people tell us that being heard, being respected, and being included in the process means they can begin to lead the transformation.  They are able to cope with things in life that have not changed, but they’ve changed.’

 Te Puna Hauora is still largely North Harbour based, and with a pharmacy also now incorporated into the service, clients up to 16 years old get a free medical service.  Livvy said that was another huge challenge, but getting children free access to doctors and medicines was worth it.

‘The model is based on relational values and focuses on joint efforts to get the best outcomes for all parties in an indigenous integrated care model while ensuring that the health of our children is not impacted negatively by poverty.

‘We’ve got dentists and physiotherapists in Te Puna using the same model to support whānau ora. But the bigger whānau ora picture goes deeper than that. Ultimately whānau ora is about transformational changes in a whānau.’

In 2012, Te Puna PHO is in the process of winding down to make way for the new Te Puna Whānau Ora Network Alliance, which will align Te Puna with New Zealand's largest network of qualified GPs and general practice teams, ProcCare. ProCare and Te Puna Hauora will work together to develop and deliver Whānau Ora services to ProCare’s patients.

Te Puna Hauora provides health and social services in the community of Te Raki Paewhenua, in Auckland's North Shore City. For more information, go to: http://www.tepuna.org.nz/

Lauren had decided to become a pharmacist after considering physical education and physiotherapy as careers. She was looking forward to completing her fourth year of study at the end of 2009, before doing a year-long internship as a requirement for registering as a pharmacist.

Lauren planned to be the first of her immediate family to complete university and said the scholarship meant a lot to her, given she was just getting through by spending her summer holidays working to offset her fees and then relying on a ‘very supportive mother and father’. The scholarship helped her with her fees, allowing her to focus more on her studies, without financial restraints.

The Whakatane High School old girl also praised her college in preparing her well for university life. She left Whakatane with numerous academic and sporting achievements, a love of science and a desire to make a difference in health.

Looking back on her Te Apa Māreikura achievement, Lauren said it was definitely an integral part in furthering her career development.

‘I completed my Bachelor of Pharmacy from the University of Otago, and successfully completed my internship to gain registration in the profession. I am now a registered clinical pharmacist currently working towards a post graduate certificate endorsed in medicines management.

‘Winning the tohu was an extremely memorable experience and certainly propelled me forward into my career. 

‘Financially it was a massive help, allowing me to complete my studies, find balance in my life and enter a career that is challenging but extremely rewarding. From here, I hope to further my skills in clinical pharmacy and use the knowledge to make a difference to our people.

‘It is with gratitude that I give recognition to the memory of Anne Delamere, Bill Katene, Denis Simpson and Rongowhakaata Wi Repa.  Their dedication and the lasting impression each left on Māori health serves as inspiration to us all.’

At the time ManuAroha was in her fourth year of dentistry.  She had a seven-year-old son Kaiawha, a four-year-old daughter Te Reremoana and was expecting her third child.

Her plans included graduating in 2009, and gaining experience before returning to the South Island to work.

ManuAroha has a passion to work for Māori and low-income people. ‘I come from a modest background and becoming a dentist allows me to provide foundations for my children and show them that hard work does pay off,’ she said.

After meeting the Wirepa, Delamere, Simpson and Katene whānau at the awards ceremony, ManuAroha said she felt massively honoured to carry the mana of people who did such a lot for Māori in health.

‘I also couldn’t do without the love and support of my whānau and the strength and encouragement they gave me throughout my studies.’

ManuAroha’s previous work background had been as a kohanga reo kaiawhina and at Te Wharekura o Arowhenua working with special needs children. She was first inspired towards a dental career while working with mentor Ann Fogarty as a Māori oral health promoter/ dental assistant at Te Wharekura o Arowhenua and the local kōhanga reo.

Her university career also saw ManuAroha help set up the local Māori Dental Students’ Association and serve as president of the New Zealand Māori Dental Students’ Association.

ManuAroha said the contribution of Te Apa Māreikura to her academic achievements is one for which she will be forever grateful. ‘I received the scholarship at a very busy time in my degree,’ she said. ‘Being presented with such an honourable award assisted me in finding the strength to push on and finish my degree.

‘Te Apa Māreikura greatly alleviated the pressure I had in my fourth and fifth years of dentistry. I was able to buy much-needed textbooks and a laptop so I didn’t need to leave the house as often. The greatest way the award influenced my studies, however, was by removing the need for me to work part-time to cover living expenses and the above costs. This allowed me to spend more time with my tamariki and my studies.’

ManuAroha graduated from the University of Otago with a Bachelor of Dental Surgery in December 2009 and was offered first choice of five locations to work in New South Wales, Australia.

‘I have since had another baby and am working full-time in the public health system servicing a range of patients from medically compromised, elderly to low income patients in a hospital and community-based clinics in Forster and Taree. I provide dental care from relief of pain to full comprehensive care, and am also beginning work in an aboriginal-based clinic in these towns. I want to gain as much experience here as I can and then return to Aotearoa with the knowledge and experience to be able to introduce and implement initiatives that will best serve our people.

‘Māori excel in whakawhanaungatanga and if we continue in supporting our people to pursue whatever they put their mind to, they can live the life they dreamed of, just as I am.’

The first physical education (PE) student to receive a John McLeod – a fact he still finds humbling – Hori believes PE has enormous potential benefits for Māori health.

‘When it comes to health, most people usually think of doctors,’ he said. ‘But there’s so much that can be done in the prevention area too, not just in curing and treating – steps that can be taken to avoid going to the doctor.’

Hori, who has always enjoyed outdoor activities and being active, is passionate about Māori and PE – ‘not so much telling people what to do, but inspiring them,’ he said

And he wants to work for the benefit of the community – not just a handful of people.

Hori attributes his achievements at university to hard work rather than ‘heaps of brains’.

He emphasises this with whānau members who think university is not for them.

‘I tell them I’ve come across people way less brainy than they are at university, and they’re doing fine. You just need to know how to work hard,’ he said.

He’s also had great support from whānau – the inspiration to pursue PE came from his father and an older cousin who both studied it at the University of Otago.

In 2010, Hori helped establish student-led Te Roopu Whakakaha Tinana - Physical Education Māori Association (PEMA). It encourages and supports Māori physical education students to achieve academic excellence. 

He is currently a member of the PEMA executive and was co-tumuaki with Renee Wikaire. Hori sees the roopu playing a major role in providing networking and mentoring opportunities for Māori physical education students in the future.

‘We’d like to encourage whakawhanaungatanga and bonding across the year levels, because university can be quite a scary place for Māori’ he said.

‘It’s the tuakana/teina philosophy really – the older students can give so much to the younger students because they’ve been through the system.’

Hori has lots of future goals.

He has completed his BPhEd degree and is now finishing his BA Māori (Hons) degree, aiming to graduate at the end of 2013

He’s keen to explore the health and well-being benefits of reconnecting with the environment (ngā atua Māori) through outdoor physical activities, rather than being locked in a concrete gym.

And he plans to work with rangatahi in his native Mataatua region, using the environment to create opportunities for them to experience some of the customs and practices of their ancestors such as mau rakau, waka ama, and kapa haka.

‘I love inspiring rangatahi – showing them that life’s not all about booze and x-boxes … Getting them on the natural highs through physical activity in the natural environments of our tīpuna,’ Hori said.

‘When I go home I see a lot of lost rangatahi. I used to dwell on that and get upset. But now I can use that as inspiration – fuel to climb the levels at university, so I can get in there and help them out.’

It’s a subject that is close to her heart. 'I am very passionate about working with Māori and Pacific communities and whatever specialty I decide on, one of my biggest commitments will be to improve the health of my own people.’

Winning the John McLeod Scholarship has further fuelled her determination to be the best doctor she can for Māori.

Doing this, she feels, helps honour and acknowledge the support she’s had from whānau and friends, as well as groups and organisations that have believed in her potential to help others.

It’s about giving back, she said.

Aroha was in her second year of study when – after a lot of encouragement from fellow Māori med students – she applied for a Hauora Māori Scholarship. She wasn’t confident she would get one and certainly didn’t dream she’d win the John McLeod.

She was at home studying when she got a phone call from the Ministry of Health, informing her of her success.

‘I was blown away. I was so shocked, I went silent. The person on the phone was like, ‘are you there?’ It was hard to get back to studying after that phone call.’

 Aroha said initially, she hadn’t realised how prestigious the scholarship was. When she did, she felt ‘so very grateful’ and humble.

She cites family and personal faith as key factors to her success throughout her studies.

Understandably, her whānau are very proud of her achievements, as are her friends. But she’s quick to point out that hard work is a determinant of success at medical school. ‘Pursuing a career in medicine involves perseverance and commitment – and a good memory helps,’ Aroha said.

Other sources of support have been Te Ohu Rata o Aotearoa – Māori Medical Practitioners’ Association, and Te Oranga – the Māori Medical Students’ Association.

‘Both groups provide so much support. The reo wānanga are fantastic; students from Auckland and Otago hang out together. The opportunity to talk to the ones who’ve been doing it for longer is amazing,’ Aroha said.

‘It helps to support your choice to pursue medicine. The encouragement and support is great – these are strong memories that will go with me from med school.’

While still formulating her plans for the future, Aroha has definite career interests. She likes the idea of working in the community and can see herself working with Māori and Pacific communities in South Auckland.

In the meantime, however, she is concentrating on graduating and her prevocational training years.

It’s advice and encouragement that has paid her handsome dividends.

Courtney was in her final trainee intern year of the Otago University Bachelor of Medicine and Bachelor of Surgery when she received the John McLeod Scholarship.

Having benefited from Hauora Māori scholarships in previous years, Courtney was aware there were separate excellence awards. But she never thought she would get one.

‘I was surprised when I got the John McLeod Scholarship. I didn’t even think I was in contention,’ she said.  ‘It felt good to be a recipient, quite an accomplishment. But it also comes with a responsibility as well.’

She’s also very pleased to have a Māori health-focused award, as she has a strong interest in Māori health and Māori health research.

Courtney has taken part in research on a number of topics, including stroke services for Māori, cognitive impairment, deep venous thrombosis prophylaxis and the resilience of indigenous health workforces in New Zealand and Canada. She was also a member of the clinical team for the Hauora Manawa Community Heart Study in Wairoa and Christchurch.

‘My focus is broad at present but I have a strong interest in both medical education and developing practice that is responsive to the needs of indigenous people,’ she said.

Currently working as a house officer at Christchurch Public Hospital, Courtney has developed a strong interest in anaesthetics.

‘You have to put so many years into specialising -- I want to get the right one for me and I want time for my family as well,’ she said.

‘I love anaesthetics and hands-on procedures. It has huge opportunities, is interesting work and other people working in the field have lots of positive things to say about it.’

Anaesthetics is an area in which few Māori specialise and Courtney acknowledges it could be difficult to have the same level of Māori collegial support as in other fields, such as general practice or public health.

However, she believes the relationships she has developed with other Māori health professionals and her ongoing association with Te Ohu Rata O Aotearoa - Māori Medical Practitioners Association will help provide her with that support.

Courtney said she enjoyed medical school and the challenges it offered. She sees a career path full of opportunities.

In the years ahead, she aims to complete her training and get practical experience overseas. But she expects to return to Christchurch to continue working and ‘then find some time to have some children’.

‘That’s why I can go into work day after day and put in all those long hours … being with patients, helping other people … it makes it all worthwhile,’ she said.

‘Getting to know these patients and their families is a privilege. You know how hard it is for them and you’re just trying to make things a little bit easier. I think that is a reward in itself.’

Maia was in her final year studying medicine and surgery at Auckland University when she was awarded the John McLeod Scholarship.

She was surprised and honoured by the accolade, never having considered herself ‘anything special’. 

Her whānau were `absolutely thrilled.’ 

‘They were possibly as surprised as I was – we keep each other grounded and level headed.  It was very much a team effort right from the very beginning. If it wasn’t for my whānau, I wouldn’t have been able to be there. So they were very honoured and proud as well.’

Maia was very thankful for the financial benefits of the award. ‘The reality was that it meant less stress and, more importantly, time with my children and whānau.’ 

She was also humbled to have external validation of her work and efforts.

‘I’ve always had a commitment to Māori health and about things being fair and just,’ she said.

‘There are disparities in all areas of health, but people are just so quick to judge and blame… often ignoring the upstream events that have influenced the health of groups of people, sometimes over many generations.

‘All you have to know about my daughter is that she’s Māori and that means almost 10 years off her life expectancy, and this stays true regardless of her socio-economic status or level of education. There has to be something wrong with that. It’s so unjust.’ 

Maia is currently working as a senior house officer at Auckland Hospital, rotating through different specialties. She hasn’t yet chosen her specialty, but likes getting to know her patients and the idea of continuity of care.

‘I believe it is important in trying to keep people well, preventing them from having to come back into hospital.’

She also believes that being able to relate to people from different walks of life in a non-judgemental way is very important in health.

‘One of my teachers once said that as doctors we all have personalities or a particular type of person that we struggle with. You just need to be aware and acknowledge it.   You have to keep yourself in-check and make sure you offer them the same opportunities as the next person. I think our health system would be a better place if it did work like that.’

The mother of three tells people thinking about a career in medicine that it will provide amazing opportunities.

‘But it’s not glamorous and it’s not beautiful and it’s not flash,’ she said.

‘It’s hard emotionally, but it also has its rewards. And those are huge …’

Maia acknowledges she has a lot to learn as she continues her career path and the work-life balancing act of being a wife, mother and daughter.

‘You have to keep learning and things change all the time in terms of management and treatments. So you have to keep up with those changes and continue educating yourself,’ she said.

‘But you also get to meet families and children, and children’s children. I can see it being fulfilling forever.’

She cites the photograph taken of her and son Tāmati at the John McLeod Scholarship ceremony as one of her favourites of them together.

‘He was six months old when I started my physiotherapy degree and 16 at the graduation ceremony for the Masters.

‘Before the photo he told me that he was proud of me, so whenever I see that photo I always remember how that made me feel. It still makes tears well up. I also really appreciated the opportunity to have my whānau with me at the ceremony. As a single parent I relied on many people to help me care for him while juggling the demands of study and full-time work. It was great that many of them were there on that day.’

On accepting her scholarship, Cath thanked her son in recognition of the family time that was given up to let her study, and that her achievements in higher education lays a path for others in the whānau to harness their potential and succeed at university.

She took her obligation to her whānau for their investment in her very seriously. However, at the scholarship ceremony she said she also heard the Ministry of Health challenge for her, to ‘step up’ and be a leader in Māori health. To this day, it’s a call to action she continues to strive for.

‘Learning more about Dr John McLeod and the Ngāti Hine connection with my whānau has made the award even more poignant,’ she said.

 ‘It also opened many doors for me. Until then I had worked as a clinician in generic ‘mainstream’ settings. The profiling that came with the award brought new opportunities. It opened up a network of Māori health professionals  – people that I have come to know, work with and learn from in an area of the health sector I had little experience.’

Cath initially trained to be a physiotherapist, going on to specialise in hand physiotherapy.  Then, when she started doing post-graduate Māori health papers, she realised why she was becoming disenchanted with her clinical work. Change was imminent.

‘I seized an opportunity to work with the Māori research team at the Auckland University of Technology and broaden my knowledge of Māori health.’

It was while completing her Master's degree in Health Science (specialising in Māori health and focusing on youth sexual health) that she became involved with Māori workforce development projects at Auckland District Health Board. There, Cath brought clinical and academic experience to her project management responsibilities for key Māori health workforce projects, starting with the Māori student-focused Rangatahi programme.

Cath is currently project manager of Ngā Manukura o Āpōpō – a national Māori nursing and midwifery workforce development programme.

‘In the last few years I’ve met a whole lot of likeminded people, been inspired by many wahine toa and have formed rich friendships within the Māori health network. I’ve found an area where I feel I am making a meaningful contribution, and that’s important to me,’ she said.

‘This experience has helped highlight the importance of working with people I admire and respect, and leading projects that reflect my values. It will also inform my decisions about where and what I work on in the future.

‘Do these people have the same underlying values as me? Are their intentions authentic? How will this mahi contribute to better outcomes for our whānau, hapū and iwi?’

Cath’s future challenges include finding a way to pay the mortgage and complete a PhD.  She said the topic is still being realised, but when she finally settles on it, it will be in Māori development.

‘I can’t see myself anywhere else.’

In fact, she represented Te Ohu Rata O Aotearoa - Māori Medical Practitioners Association on the award selection panel in 2001 and 2002.

But she never considered herself to be a John McLeod contender – as far as she was concerned, it was a scholarship that belonged to ‘bright sparks’.

Being awarded the John McLeod showed her that anyone could do it.

‘Having been on the other side and being in awe of the people receiving the scholarship – and then being recognised and finding myself among that group – has really added to my self-confidence,’ she said.

‘I knew other winners were brainy boxes, but they also had te reo, had been to kura kaupapa and were just beautiful all-round people. I didn’t see myself in that group. But actually, it’s also about recognising that we all have our own overall strengths and weaknesses.’

Matire worked in Hauora Māori, primary health and rehabilitation settings as a clinician and researcher after graduating from Auckland Medical School in 1994. She was two-thirds of the way through her PhD into stroke recovery when she received the scholarship.

At the time, the financial benefits were a huge bonus, helping to pay her student tuition fees.

But Matire believes it also helped highlight her clinical leadership potential, leading to appointments to numerous committees, boards and advisory groups.

In 2009, Matire was appointed to the Health Research Council – a career highlight she attributes in no small part to being a John McLeod Scholarship recipient.

She was recently appointed to the Auckland District Health Board Māori Health Committee.

Clinical leadership is one of her passions.

‘I think there’s a kaupapa Māori clinical leadership or governance space for us, which is about clinical excellence that gives good outcomes for Māori and their whānau. But we create that space based on Māori principles of whanaungatanga, respect, reducing inequalities and tikanga,’ she said.

 ‘I’m really keen to promote that through Māori providers – being excellent, but doing it in a kaupapa Māori way and achieving the outcomes we want.’

Over the years, Matire has worked in areas that combine her clinical and research interests.

This includes contributing to Hauora: Māori Health Standards 2000-2005 and being the principal investigator for the Māori and Pacific Stroke Study.

She also has an ongoing role providing commentary for the Māori Health Research Review –   a two-monthly online review of health research that may be of relevance to Māori.

Matire was clinical director at Te Hononga o Tamaki me Hoturoa, a Māori-led Primary Health Organisation, which is now part of the National Hauora Coalition.  Currently on maternity leave, she plans to return to general practice in the near future.

Matire doesn’t subscribe to the view that ‘you’re not a true researcher unless you do it fulltime’.

‘The clinical part keeps me grounded because I’m working with people, hearing their stories and being with them in their lives,’ she said.

‘And I like research, because you’re making a contribution at a different level that has more far-reaching consequences than just that one-on-one contact with people. As far as I’m concerned, one informs the other.’ 

Her future goals are many.

She’s looking forward to completing her PhD. She wants to more fully explore the concept of whānau ora clinical leadership. And she wants to continue to pursue her research and clinical interests.

‘Hopefully I will be able to take opportunities to be more innovative – looking at doing things a little bit differently and being a little bit more daring in the way I work,’ she said.

In her final year of studying midwifery, Ripeka was training in Hamilton while still living with her whānau in Hastings.

It was an arrangement that required a lot of planning, commitment and family support.

‘It involved sacrifices for so many people. When I went away for classes, it was a sacrifice not being at home with my whānau,’ she said.

‘And other people and extended family were also sacrificing their time, stepping in to support us all, my husband and my children.’

Because of this, Ripeka worked hard to ensure the time spent away from her whānau wasn’t wasted.

So when she learned she had won a John McLeod Scholarship, she saw it as a recognition not only of three years of dogged commitment to her studies, but also of the contribution, support and sacrifices made by her whānau and friends.

Midwifery was not an occupation Ripeka had ever considered. In fact, being a busy, fulltime mother, she thought she wouldn’t want to work with children. And having always being involved in sport, Ripeka considered that’s where she would naturally end up.

That all changed after being present when her sister gave birth - Ripeka decided she wanted to be a midwife.

Despite applications being closed at the time, Ripeka applied for the midwifery programme at Wintec (Waikato Institute of Technology) and was accepted.

‘The rest,’ she said, ‘is history’.

Ripeka loves being a midwife. Her job, she believes, puts her in a unique position that she views as an absolute privilege.

‘There are only a few important things in a woman’s life and giving birth is one of them,’ she said.

‘Getting my degree has allowed me to be present at one of the most important times in a woman’s life. That’s a huge thing. You step into this woman and her family’s life for a short period in one the most personal times ever, and then step out again. It’s amazing for me.’

 Her mahi in Hastings has allowed her to work alongside local iwi authority Te Taiwhenua o Heretaunga, complement their Hauora services, and network with other midwives. She particularly enjoys their wisdom and the collegial support, advice and guidance they willingly give.

Ripeka acknowledges the need for more Māori midwives. And she is delighted to have her daughter following in her footsteps – she is a recent graduate midwife.

‘There’s never enough Māori anything, including midwives,’ she said.

‘We work with people who come from places of struggle.  To be Māori is to walk into a place of struggle, understand that and work to empower them. And it’s about providing them with good networks through Taiwhenua o Heretaunga, being good examples in what we’re doing and supporting one another.’

Thinking back to the day she received her award in 2005, Ripeka is as amazed now as she was back then.

‘It’s a great achievement. For me, it’s still the same as when I first got it. It’s the personal satisfaction.’

While her focus may have changed along the way, her journey into medicine did not.

 Having received a Hauora Māori Scholarship each year as she studied for her Bachelor of Human Biology, Raewyn applied again in 2005 when she started her Bachelor of Medicine and Surgery.

She was aware of the John McLeod Scholarship but thought it was only for ‘the ones who really excelled in their field’.

So the award came as a big surprise.

‘It was always an honour to receive a Hauora Māori Scholarship,’ said Raewyn.

‘It’s an added bonus – you’re there because you love what you’re doing anyway.  But it’s neat when your hard work gets recognised, especially with an award like the John McLeod where you’re up against such talented people from a range of specialties.’ 

Raewyn puts much of her success down to whānau support, hard work and determination.

‘People think you have to be really intelligent to make it through med school, but it’s more about working hard, setting goals and sticking with it,’ she said.

Raewyn acknowledges the efforts of her parents, who encouraged all three of their children to go to university and supported them through the tough times.

And she said she was also lucky to have an extremely supportive husband, who ‘always provided a shoulder to lean on’ – both during her study years and now that she is working in the hospitals.

She’s grateful for the friends she made while studying, not only because of the support they provided at the time but because of the life-long friendships and collegial relationships that have developed. 

Born and raised in Wairoa, it was always Raewyn’s plan to return home to Hawke’s Bay after graduating in 2008. Which is exactly what she did.

Up until March 2011 she was a House Officer at Hawke’s Bay Hospital. After that she began working as a locum at Whakatane, Palmerston North and Hawke’s Bay hospitals.

‘After studying in Auckland, it was good being able to work at home, to see and treat your own people, and be a local again. That’s been a real highlight for me,’ she said.

 ‘I was brought up close to my marae and strongly identify as Māori. Coming from Wairoa, with its huge Māori population, you do see the burden that health and socio-economic problems have on our people.  I’ve always wanted to eventually come home and contribute to that – help address those problems.’

That’s part of the reason she wants to pursue a career in General Practice (GP) – she sees herself working more effectively with families at a community level rather than in a hospital setting.

Having recently given birth to her first baby, Raewyn is currently taking some time out to enjoy motherhood. 

Once she returns from maternity leave, she plans to apply for the General Practice Education Programme and continue towards her goal of working as a GP in Hawke’s Bay.

‘The GPs working in Wairoa are awesome role models. They work tirelessly and are so committed to achieving the best results for their patients and their community.  I want to get some more practical experience first, but that’s where I want to be.’

Working as a school nurse at Auckland’s James Cook High School gives Leah – the first nursing student to be awarded a John McLeod Scholarship – an enormous amount of satisfaction.

‘I love it there. You see all walks of life. Some kids struggle with day-to-day challenges and you do end up being like a mum to them. But I am working alongside our young people who will eventually become our future role models and leaders.’

Education is important to Leah. She sees herself as a good role model, because without it, she wouldn’t be where she is today. 

Leah was 26 when she was motivated by her children to return to study.

‘One day my kids asked me to help with their homework. But I couldn’t because I didn’t understand it. I felt stupid, and thought ‘what kind of mum am I if I can’t help my kids with their homework?’ My babies pushed me to go back to study.’

After completing a bridging course at Manukau Institute of Technology (MIT), Leah decided she wanted to train as a nurse.

‘I believed by becoming a nurse, I’d also become an educator. And if I could make even a slight difference to how Māori perceive their present health status, then that was a start.’

So she completed the Foundation Education Programme, and launched into a Bachelor of Health Science in Nursing at MIT.

Leah was in her second year of nursing when she applied for a Hauora Māori Scholarship.

She cried when she read the letter telling her she had won the John McLeod Scholarship.

‘Before studying, I felt like an underachiever. So when I got this award, it made me feel like I could do anything,’ she said.

‘Everyone has the potential to achieve their goals, but they may not see it at first. It wasn’t until I won the award that I realised this.’

Needless to say, her family were incredibly proud of her achievement. But Leah said the award acknowledges their support and hard work, too.

‘They put up with a lot. But having them there – my husband and children – was so important to me. My Nanny and kaitiaki were always there for me too, when times got tough.’

She is also grateful to tutors and lecturers Helen Scott, Angela Milsteed and Willem Fourie, who she said recognised her potential before she did, and who guided and supported her throughout her studies.

After graduating, Leah worked as a Plunket nurse for two years before going on maternity leave. On her return to work, she applied for a job as a school nurse at James Cook High School, and has been there now for more than three years, working as part of a multi-disciplinary team.

This work allows her to support young people at a time in their lives that can often be challenging and confusing, especially when living in an area of high economic deprivation.

Leah completed a Postgraduate Certificate in Primary Health Care (Speciality Nursing) in 2007, and a Postgraduate Diploma in Health Sciences in 2011.

She sees a future full of opportunities.

‘I would like to move into mental health because everyone experiences it, but not everybody wants to acknowledge it,’ she said.  Leah goes on to mention that like the wind, her choice may change, as she also finds adolescent health fascinating, and fulfilling.

‘I’d like to do my Masters as well. Colleagues and other health professionals are encouraging me to become a Nurse Practitioner too, so I’m thinking about that.

‘For me, it’s about helping people. My study has given me the confidence, skills and knowledge to do the best I can. People tell me to go to Australia for the money. But to me it’s not just about that – although of course, money does help.  I want to make a difference.’

That’s what two-times John McLeod Scholarship recipient Lincoln Nicholls tries to impress upon young Māori – it’s not all about brains or academic ability. That’s just part of the big picture.

Lincoln believes Māori have the ability to relate to New Zealanders in general, and Māori in particular. He’s ‘happy the med schools are slowly recognising that being Māori brings with it a set of natural skills - being able to relate to Māori and their whānau.’

Lincoln was in his health science year the first time he received the John McLeod Scholarship, and at medical school the second time.

He was surprised to get the scholarship because he thought it would go to someone further along their studies. But he felt extremely honoured. And it re-affirmed he was on the right track in his pursuit to be an active Māori doctor.

‘Receiving awards is an acknowledgement; recognition that all the sacrifices you make and the hard work you put in, the late nights, the assignments – that it all pays off. It’s really nice to get recognition for all that hard work.’

Lincoln said he owes a lot to his grandparents, who brought him up in Otaki.

‘Although they were Pakeha, it was important to them that I kept in touch with my Māori side. They made sure I spent time with my father’s whānau, my taha Māori.’

They also encouraged him to opt into the bilingual class at Otaki College.  Although hesitant at first, Lincoln saw it as an opportunity to learn te reo Māori and Māoritanga, which he knew would serve him well in the future.

Being a doctor wasn’t on Lincoln’s radar until much later in life. Initially, he trained in physical education (PE) before going on to teach at high school for six years. After a stint as a Head of Department, he decided he wanted another challenge.

Lincoln chose medicine because it built on his knowledge of human biology and his interests in health and well-being. He felt he could make a difference as a Māori doctor.

Once he entered medical school, he taught fellow students te reo Māori me ona tikanga because he was aware that having knowledge in things Māori would help doctors be more effective with Māori patients.  

He said one of the hardest aspects about studying medicine was the time spent away from his daughter, Awarangi, while living in Dunedin.

She was, he said, one of his biggest supporters. A special mention must also go out to Awarangi’s mother, Elizabeth, who provided the primary caring role for Awarangi. This enabled Lincoln to pursue his studies in medicine.

The tautoko and encouragement he received from whānau, friends, colleagues and tutors continues to motivate him in his work.

Lincoln is in his final year on the General Practice Education Programme and is currently working as a general practitioner for the New Zealand Army.

He is on the board of Te Ohu Rata O Aotearoa - Māori Medical Practitioners Association, learning to work at a more strategic level to develop and support Māori medical professionals.

He is also an ambassador for Kia Ora Hauora, a national Māori health workforce development programme. It’s a role that gives him greater scope to promote health as a career to Māori, especially rangatahi.

Looking to the future, Lincoln is considering several options – general practice, sports medicine or perhaps surgery or orthopaedics.

‘The beauty of medicine,’ he said, ‘is that it’s so open with many various specialties and you can do just about anything’.

It’s a maxim she learned from whānau mentors – influential Māori doctor, the late Paratene Ngata, and his wife Ngaroma.

Over the years, it’s helped modify her thinking and her career choices.

‘It all starts at home – that is where the passion is first,’ Lorraine said.

‘When I first started at university, the mantra was all about the mahi and our people. Even when I started Medical School it was about the mahi and our people. When Dr Pat (Paratene Ngata) became sick he counselled me further, teaching me a profound lesson. He helped me learn that whānau comes first, then friends, then networks.’

Lorraine already had a Bachelors Science and Masters of Science, and was in her third year studying medicine at Otago University when she was first awarded a John McLeod Scholarship.

‘I was shocked that what I had done in the past and what I wanted to do in the future had received such recognition,’ she said.

‘It was very humbling and an enormous honour receiving this award, because John McLeod was an amazing Māori medical doctor and researcher with national and international accolades.’

Lorraine was chosen for the John McLeod Scholarship two more times in the following years.

She said when she started studying medicine, she wanted to pursue general practice. She soon discovered, however, that she enjoyed other disciplines too.

‘I found comfort in doing pathology, I loved the intellectual challenge of medicine, the family interaction with paediatrics was fulfilling, and enjoyed the discipline and service I got from surgery,’ she said.

So she sought counsel from her uncle and aunty and in the end, set her sights on general practice and her own research.

‘Your journey does change as you go along, especially in medicine,’ Lorraine said.

‘General practice was always the place I thought I would end up, so the journey now is about accumulating essential skills, so that you are useful to our people.

‘As Māori, you never do things alone. I have had amazing support by many individuals, whom I consider to be part of my whānau. I will always be grateful for their awhi. People help you on your journey and in turn, you do the same, reciprocity – awhi them – that is whanaungatanga.’

She achieved a Health Research Council (HRC) Māori Health Research PhD scholarship and further HRC project funding for diabetes research. Lorraine was the principal investigator for He iti noa, na te aroha – Dietary Diabetes Prevention Study for Māori.

In May 2011, she became an Otago University Doctor of Philosophy.

Lorraine intends to focus on her clinical and research interests in coming years.

After working as a general practitioner (GP) in Gisborne with a special interest in diabetes management and care, Lorraine decided she needed more trauma experience, before heading back up the East Coast one day to follow the path laid by her uncle, Paratene Ngata.

To this end, in March this year she and her husband took their two daughters to Australia for a few years. Lorraine and her husband will both work as GPs in various locations. She will also continue her post-doctoral fellow work.

 While excited about the challenges ahead, she continues to keep her eyes firmly set on her goals.

‘I’d like to work with our whanau and support our Māori student doctors as Dr Pat and Aunty Ngaroma did,’ she said.

‘He humbly supported students’ acquisition of core clinical skills and knowledge. He showed by example how we as clinicians should keep our feet on the ground. She provided us with an open home full of love, support, and care needed to be successful throughout the years of training and work.’

Since his graduation in 2001, he has continued to maintain that original focus.

Being awarded the John McLeod Scholarship supported his belief that he had the potential to make a significant difference in Māori health.

‘Getting awarded scholarships brings monetary satisfaction, but I’ve always maintained the scholarships I’ve received have been about support – moral and cultural,’ he said.

‘Receiving the John McLeod Scholarship wouldn’t have meant as much if it hadn’t been a Māori scholarship.’

Lance decided early in his career that general practice was the best field for him.

‘I realised that emergency medicine was the ambulance at the bottom of the cliff. Hospital medicine in general was reactive instead of proactive, and the best fit for me was general practice, where I could do the preventative stuff,’ he said.

Lance and his wife Tracy went to Rotorua after he graduated. The five years he spent there as a Resident Medical Officer, General Practitioner (GP) trainee and then newly qualified GP were ‘wonderful’.

‘I wanted to work in a community with a high Māori population and needs. Rotorua was a good stepping stone because even though there’s high need among high numbers of Māori in the community, it was a well-supported environment where I could cut my teeth, in medicine terms.’

It was his whakapapa to the Far North and a recognition that the region lacked medical staff and had not had a Māori GP for more than 20 years which helped persuade Lance and his young family to move to Kaitaia.

They’ve now been there for about seven years, with Lance working four days a week in general practice and one day in the local hospital as a Medical Officer Special Scale.

He loves his work, the community he lives and works in and the satisfaction of knowing he’s living his dream of actively contributing to improving Māori health.

‘My involvement in my community is an extension of the work I am doing in the clinic – helping our people to make important and lifestyle changes and to also feel proud of who they are,’  he said.

‘Living in a close-knit community such as Kaitaia among people who are patients but also friends of mine or my whanau gives me the privilege of having an important role.  The patients I see in our resuscitation room I will be likely to see at a rugby game, where we are both watching our tamariki.’

Keen to widen his sphere of influence, Lance has also become involved in regional and national population health events. This includes helping promote the Pharmac One Heart Many Lives programme and the more recent drive to eradicate rheumatic fever in the region.

It’s work that provides him with significant job satisfaction and he feels very fortunate to be able to do this among his own iwi.

Lance can name a long list of people who have been key supporters of his efforts over the years, starting with his parents and whānau, and his wife Tracy.

Doctors David Gilgen and David Tipene-Leach have also been influential.

And his patients have had a huge impact too.

‘The ones you aren’t able to save, that you lose to illness you wish you could have prevented – those are really important things,’ Lance said.

‘It strengthens your resolve to get ahead, to stop that from happening again.

‘I know that I’m doing what I love, the right thing in the right place. And I would be happy if I could do this for the next 20-30 years – that’s my plan.’