Ko tainui te waka
Ko Waikato te waka
Ko Taupiri te maunga
Ko Poutetau te tangata
Ko Waihiapa te marae
Ko Ngāti Mahuta
Ko Mary-Kaye Wharakura tōku ingoa
Share some of your story with us …
My background is in the health and education sector. I was raising children and there was a shortage of good jobs that would allow me to earn extra money while I could be with my children. I worked in the education sector and started off as a teacher aid. Working for many years with special needs children, it was from there that I saw the need. For myself, I have 2 children, one of which is autistic. I had a greater need to further my education, so I went to university. I had a special interest in health- there are a lot of health needs that continue to affect education needs in our communities. Especially in our people, so I changed to health. I got a Bachelor in Health and major in health research. Being at that level of understanding young mums, I could see the need.
It was having a lot of whanau pass from smoking that got me into smoking cessation research. For many years it was quite acceptable in our culture to go to tangi that were related to smoking. Quite often cancer, illnesses, diseases, but the underlying cause was always smoking. I’ve always had more of an interest in prevention, I wanted to reduce that, because I’ve lost a lot of whanau. It’s more acceptable to talk about the disease rather than the underlying causes. It’s that packet of smokes that you buy each week, that you can’t afford. We need to educate our people, but it’s difficult.
What’s so difficult about it?
We have challenges with communicating in a way where we’re not bashing - especially if it’s something that makes us feel good. You can have all the wealth and knowledge in the world, but once we stick our feet in, we’re not going to move. Often it takes something unpleasant or sad to motivate change. We’ve changed in the last ten years where we go to a tangi and we know it’s because of smoking. There’s this new generation of people coming in who want to quit.
What kind of whanau are you supporting in your smoking cessation trials?
I’m really pleased because it’s the people coming through our doors- the stubborn ones who have been doing it for years. They have decided that enough is enough, they want to quit. It’s taken a hell of a long time. They’ve their friends and family and now through education and regulations like plain packaging, we have an awareness and an understanding of the harms.
Why do our wahine have higher rates of smoking compared to our tane?
When it comes to us wahine, we are the child-bearers, we were the ones that were chosen to carry the child. We’re not only carrying the baby, we’re carrying the family and we bear a lot more stressors than men do. We bear their stressors, so if it’s not a healthy and nurturing relationship, if you don’t care about your wahine and her health is not a priority for you, she will suffer.
Smoking is a way to temporarily relieve those stressors. Us wahine are tough; we hold a lot of responsibilities and sometimes when you’re on your own, you need something to help reduce the stress. But we’re realising through education that it’s not good for us, and whether you have one child or five children, we’re realising how we need to be there for them.
We look at a lot of the behaviors and patterns of smoking, like the inhale-exhale-inhale motion that you get from puffing, and we know that this controlled breathing is beneficial for calming your heart rate and reducing stress. But with all the added chemicals and endorphins that make you feel good, it’s tough to quit.
What are environmental triggers of smoking?
When one person smokes, many people around them smoke. If one person in your whanau smokes, it’s the whole whanau. I think there’s been a turnaround in education- the challenges of quitting around whanau who continue to smoke, the level of support needed for those trying to make a change. There’s clearly not enough support for our wahine.
In smoking- one of the biggest predictors of unsuccessful quit attempts is social support and who you have around to tautoko you. These are the factors that we’re trying to instill in our trials. We are a collective people, and ‘us’ people, we do things together, but we also do ‘not so healthy things’ together. So when I address these issues in my research, I make sure it’s done as a collective too.
As a researcher in an area that is still finding its feet in kaupapa Māori research, how do you change the way you work with Māori so it is mana-enhancing?
First and foremost, cultural safety. Fitting yourself around your participants. Understanding tikanga values. Bring yourself- be absolutely honest.
Integrity is the main thing to get you through the door and build trust. When I contact you about a clinical trial, I don’t just need your survey. I need you from the start to finish and our trials can go for up to 12 months.
I have to make sure when I get in touch with you in the first place that we can build a relationship and you trust me. Once we progress through the trial, I will tell you if things aren’t going right, I’m upfront in acknowledging that right away. Māori also don’t have a great track record with research, so we have to rewrite those wrongs in the work we do today.
What are the consequences for researchers doing work with Māori in a way that isn’t culturally safe?
You won’t get the participants, you won’t get the data, and if you do, it won’t be of a high quality. Moreover, if you have participants walking away from your study feeling uncomfortable, unhappy about their experience or culturally unsafe, they’ll tell everyone.
What are the challenges that you see with your Māori participants trying to quit?
As Māori we do things together, those trying to quit are still surrounded by whanau still smoking.
I have participants saying to me “Whaea... I might cave- I’ve got a tangi to go to”. That’s stressful in itself, and so there’s the craving to smoke. You’re around whanau, cuzzies you haven’t seen in a while, you awhi each other, you listen, you support. But often ciggies are in the centre of that awhi.
What are your thoughts on banning smoking on the marae?
I am biased because I work in smoking cessation, but when I walk around the marae, I do enjoy that there aren’t butts on the ground like there was when I was a child.
I remember years ago they put a ban on cards on the marae. That stopped three things- smoking, alcohol, and fights. That was an outrage, how dare they, it was another way of coming together, it was a social past time that we play. That seems to have been forgotten.
Can you talk about how you do work differently to benefit Māori even if you’re working in a mainstream institution?
This is my first clinical trial working as a researcher, and this means following the rules. Fortunately for me, I am in a trial where the target population is Māori. It’s not a Kaupapa Māori study per se, but that’s not to say that I don’t do it differently. I see this as a pilot study for introducing Kaupapa Māori methodology into future clinical trials at this organisation.
I’m lucky to be given the freedom by my team to do what I feel is best for our participants, but they’re lucky too. I follow the rules- I dot all my I’s and cross my t’s, however when it comes to how I work with our people - that’s how I do it differently. It’s a challenge for me to work within frameworks that are modern, westernised, within Pakeha frameworks but deliver it in a way that’s Māori.
Tikanga values are embedded at every opportunity. I integrate that into my practice. It’s vital that they [my colleagues] let me go with it, they assume I know best, but the feedback and responses they’re getting from participants tell us it’s working.
The trial we’re working on is in Rotorua, these guys don’t muck around. These are hearty Māori (laughs). So I’ve got to do it right. You as a researcher can’t come down there with the perspective of “I need this, I need that, this is how it needs to be done”. We’ve come in here, we’ve come into their whare, this is their motu. So we have to do to it in a way that’s culturally appropriate.
The information I’m getting, the data we’re seeing, is rich. It’s important to work in this way, to show others that this is how it needs to be done and these are the differences in data collection you’ll get because of it. It’s not that non- Māori researchers don’t see the value, it’s just about giving them the skills and education on how to do it with us.
Thoughts on whakawhanaungatanga …
That comes by being an effective communicator in research, but also bringing a lot of you, so bring yourself and your experiences in getting to know Māori as a people. If you are non-Māori, getting involved with a community, upfront about your past and what you do.
I’ve been fortunate enough to have been able to build rapport with our people. It’s changing and developing. We are finding ways to build trust with each other. Clearly state what your role is and expectations, as well as their responsibilities as participants. Clinical trials are clinical- they are supposed to be, but I remove that and make it personal.
Your quit journey is my quit journey, and it takes away those walls of it being clinical. They call me whaea, kare. They look forward to me calling, they make time for me, and I know in past trials that this has been difficult. It’s hard to maintain that, so that comes down to whakawhanaungatanga.
Manaakitanga is in there, I care about them and they know that. They trust me and I’m being genuinely honest with them. It’s a two-way relationship in the time they have me, their lows are my lows, their joys are my joys. My goal is to help them quit smoking and that’s the biggest joy of my job. It’s down to how you form relationships and engage with people.
I love working with our people- we’re funny, and smokers are especially funny. They’ll sit out in the pouring rain for hours smoking, it's hilarious, so it’s about understanding that- those personalities. These are the people that have had enough of that, who want to move on. They share those stories and it’s a privilege to hear those narratives. They’re talking about their goals, struggles, and it’s mokos- always mokos. They’re in their 50s, 60s and they always think it was too late.
They’re the ones that are knocking on me door. I’m so proud of them, because these are the ones who never thought quitting was possible and that they’d smoke themselves to death. We have a lot of our hapu mama, it’s a struggle for them too.
Thoughts on hapu mama …
When you ask a hapu mama why they smoke, it’s often “I don’t know” or “I just always have”. But when you ask questions around 'when you smoke', 'what happens before you smoke', 'when do you smoke more'. It becomes more clear.
After you’ve opened bills, after you’ve had a fight or a hard day. It would be a different picture if we took away those stressors that disproportionately affect not only Māori but women, such as financial stress, solo parenting, lack of social support or even domestic violence. It’d be a lot cheaper on the healthcare system.
How can qualitative research empower Māori?
I always ask one simple but profound question, “How long have you been a smoker?”.
They sit there, and you see them ticking it over. And I say “no judgement, take your time”. Sometimes they need a calculator because they’ve never thought of it. That’s the thing- when you’ve done something for so long, it’s easy to forget why you do it or enjoy it.
When you’ve been smoking so long, it’s like a relationship. Like a marriage. For our long term smokers, I’m up front about what to expect. A mourning process; some people don’t want to give that up.
Thoughts on supply reduction ...
I think that tax increases has been a good thing. From the many hundreds of people I’ve talked with, they've said it costs too much. There’s also push to only sell at certain, restricted outlets and they use the word “dispense” because it’s a health issue.
I only have an opinion, and while I agree with Hone Harawira that we need to get rid of tobacco, I would be concerned about the mental wellbeing and the added stress that complete supply elimination would create. I would hate to see the altercations that result from supply reduction.
Thoughts on vaping ...
We do have world leading cessation focused research. Being a nice little country, we can get good coverage. We know vaping is growing. I’m pro vaping, and it took me a while to get to this point. When you address the potential harms and benefits of vaping vs. tobacco cigarettes. It’s less harmful, it doesn’t have the nasty chemicals like carbon monoxide so no second hand smoking. You can also control the levels of nicotine, and it’s more affordable for our people. The e-juice is cheaper in comparison to cigarettes. Vaping was essentially created to help people quit, and I wouldn’t want non-smokers to take it on.