new zealand – Dr. Ruth De Souza

Postnatal depression in the Year of the Dragon

Women are more likely to develop emotional problems after childbirth than at any other time in their lives and the life time prevalence of major depression in women is almost twice that of men (Kohen, 2001). According to Lumley et al. (2004), one out of every six women experiences a depressive illness in the first year after giving birth. Thirty per cent of those women will still be depressed when their child is two years old. Of those women, 94% report experiencing a related health problem. Women who experience problems in the early stages of motherhood also report problems with their relationships, their own physical health and well-being. Women report that a lack of support, isolation, and exhaustion are common experiences.

Several years ago I was approached to develop a new brochure about Women’s perinatal mental health (given my expertise as as a clinician and educator in maternal mental health) for the New Zealand Mental Health Foundation who were partnering with EGG maternity a New Zealand company specialising in maternity wear. In developing the brochure, my partner and I consulted widely with consumer groups, mothers, fathers, health professionals in order to ascertain what would be the most important and clear information we could put inside the brochure. This was the end result:

The PND brochure has become widely available, it is included in information packs given to new mothers by Plunket, available from the resource centre at the Mental Health Foundation, the Foundation website and EGG maternity boutiques in New Zealand. It has been one of the most requested brochures ever with 33,800 sent out in 2011 alone.

Women who have a baby in a new country and are separated from their support networks and special perinatal customs (including special foods, nurturing, rest and household help) through migration can experience isolation and postnatal depression.

For the Year of the Dragon this brochure has been translated into Chinese by Kai Xin Xing Dong -a public education programme aimed at reducing the stigma and discrimination faced by Chinese people who experience mental illness. Funded by the Ministry of Health, the project aims to raise mental health awareness in the Chinese community and to counter stigma and discrimination.

See here for other PND resources

New mothers in a new land: Indian migrant mothers talk

Originally published in: DeSouza, R. (2010). New mothers in a new land: Indian migrant mothers talk. In S. Bandyopadhyay (Ed.), India in New Zealand: Local identities, global relations (pp. 207-217). Dunedin: Otago University Press.

Ethnic identity and acculturation become important issues in the transition to parenthood. The birth of a child presents parents with the opportunity to consider what values are important to them and whether they will look to the future or the past (or both) to determine what will sustain them in their role as parents and nurture their newborn to adulthood. This sifting process involves parents interpreting and accepting or rejecting the values, beliefs, and practices from both their heritage culture and their current community.

Migrant Indian mothers play a pivotal role in such negotiations. This chapter presents research findings from a study on the maternity experiences of Indian migrant women living in Auckland, New Zealand in late 20062. It begins with a brief discussion of the literature around the process of acculturation and its influence on Indian health and maternal health in particular. It then looks at the inherited beliefs and practices that shape the maternity experiences of Indian mothers, especially the centrality of motherhood to identity, and the idealisation and rewards of self-denial and good behaviour. Finally, the chapter discusses the study’s findings. These exemplify how motherhood is idealised and viewed as a socially powerful role among immigrant Indian mothers, and that these mothers have also taken on the messages of New Zealand models of motherhood (and parenting in general) where self-monitoring is required in order to be ‘a good mother’.

People of colour decolonisation hui

The Decolonise Your Minds! Hui on February 5th in Tamaki Makaurau, Aotearoa provided a great opportunity to present my PhD work to awesome folks with similar theoretical and political commitments. Outside a professional or academic context and supported by fabulous vegan food and great korero and creativity, the radical space provided a great opportunity to not have to explain everything!

In my presentation, I talked about the ways in which the people who are supposed to care in institutions can engage in subtle coercions and “do” violence. This violence works through the reproduction of taken for granted norms and values, such that pressure is exerted on those whose personhood sits outside the accepted norms and values and reshapes their personhood. Reflecting an assimilatory process similar to the colonial process of moral improvement. Hardly a surprise considering that institutions like health and education are colonial, having been transplanted from the metropole to the colony and super-imposed over indigenous ways of learning and maintaining health.

Using the example of maternity I talked about the ways in which heath professionals draw on culturally and socially available repertoires of care that can be less than helpful when imposed on women of colour. This is because so often these repertoires are drawn on the basis of an implicit ideal user who tends to be cis-woman, heterosexual, white, middle class and one who takes up the ‘imperative of health’. That is the ideal neoliberal consumer who makes herself an expert through her consumption of self-help books and its acceptable accoutrements, who takes responsibility by attending ante-natal classes and who labours naturally with her loving and supportive partner present. She obeys the edicts of the health professional and makes reasonable requests that align with the dominant discourse of maternity as an empowering experience (if you are “informed” and “take responsibility”).

You can listen to the audio which is hosted by the Pride New Zealand website. I take the audience through the idea of discourses and how they shape subjectivity and practice.

Please note I have a tendency to swear when I am speaking passionately about something!

Are we there yet?

This piece was originally published at Tangatawhenua.com http://news.tangatawhenua.com/archives/14051

On October 3rd 2011 as part of the series: Are we there yet? These articles are being written as a prelude to the election in November, and focus on the ‘wish list’ of Generation Xers; their hopes, dreams, aspirations and vision for New Zealand society.

I have two enduring memories of arriving in New Zealand with my family in June 1975. On the drive to our new home from Mangere, I was stuck by two sights, the first were the abundant citrus trees, promising sweetness and growth in this new life and the second, the Blockhouse Bay Foodtown supermarket where we shopped for our first meal before it closed (and no I don’t remember what that was!).

The supermarket too represented abundance but the shopping trip was a portent of the self-reliance my family would need to develop to survive in this country. A marked contrast to the hospitality of home cooking that we might have expected as newcomers from the other side of the world. Later, I found out that Tom Ah Chee a New Zealand-born Chinese, was one of the three small business owners to invest in the Foodtown, New Zealand’s first American-style supermarket.

The neoliberal narrative of migration is that my family came to New Zealand (like other migrants) for a better life. Another explanation is that we were pulled to New Zealand as a result of the unevenness of life chances created by colonial capitalism. As South Asians in East Africa we were what Avtar Brah calls the filling in the colonial sandwich. Occupying a precarious uneasy place that had neither the imperial support of the British coloniser nor the entitled weight of indigeneity. Migration to New Zealand offered an escape from the colonial sandwich to maybe a liberal pizza, a place of equal footing, a safe haven, replete with economic and academic opportunities. “New Zealand has no ‘colour bar’” I remember my Mother proudly telling friends. Unfortunately, like the settler colony we’d left, the dynamic was the same but the nuances were different. In East Africa Asians had a symbiotic relationship with Africans and were understood (a checklist of some of the popular foods in Kenya, shows how our culinary destinies were interwoven despite the imminent exclusionary nationalist future: kachumbar, chapati, pilau, chai, samosa to name a few). In New Zealand, food provided an entry point in a different way. I sold Maori cookbooks to raise funds for the Hoani Waititi marae in Henderson.

The migrant’s new life is characterised by a delicate dance between preservation and hope. Treasuring a past that might never be retrieved while hoping to succeed and make good on the sacrifices that have been incurred. But other kinds of reconciliation are also necessary; requiring that migrants develop what Ghassan Hage calls an ethical relationship with the history of colonial capitalism/colonisation in which they are implicated. The narrative of migration as an individual choice framed by the desire for betterment must be considered against the collusive role of migrants in usurping the indigenous. As must being subsumed into larger stories of ethnic communities as uninvited foreign guests, in need of careful management and modernisation so as not to lower the cultural standards of the receiving society (“our way of life”).

Reckoning with a colonial history requires coming to terms with New Zealand’s history of racism. Knowing that anti-Chinese and anti-Indian sentiment has been evident since the arrival of these groups in the 1800s, where they represented the largest groups of migrants and refugees, and were viewed as threats to jobs, morals and sexuality. Chinese particularly were the targets of exclusionary immigration legislation through the 1881 Chinese Immigration Act, which exacted a poll tax of £10 from all Chinese arriving in Aotearoa/New Zealand. Indians, as British subjects were not exempt from hostility nor restrictive legislative practices despite their status. The 1899 Immigration Restriction Act restricted Indian and other Asian immigration and the formation of the White New Zealand League, in 1926 epitomised this hostility. The latter formed to counter the potential for contamination of bloodline, values and lifestyle posed by Chinese and Indian men. The introduction of the 1920 ‘permit system’ reflected demands for increasing prohibitions and excluding and/or repatriating Asian migrants.

The end of an unofficial White New Zealand migration policy was not brought about by a desire for equity or fairness. Economics was central to this policy shift, and the 1986 review of immigration was a response to a ‘brain drain’ and decreased immigration to New Zealand. Consequently migrant selection shifted from preferred source countries (largely European) to being skills based in the Immigration Act of 1987, whereby a points system was introduced. The introduction of the Business Immigration Policy and ‘Family reunification’ and ‘Humanitarian/refugee’ categories plus the growth of a thriving export education market consolidated this long-term trend to diversity. Consequently Asians grew in number and became more visible and central to the national economy and the number of people from Middle Eastern, Latin American and African communities (MELAA) increased. However, the residue of the old attitudes and fears remains, migrants and refugees are held with great ambivalence- disadvantaged in the employment stakes but welcomed for the spice and innovation their presence adds.

I began this piece by talking about my family’s welcome to New Zealand through consumer capitalism at Foodtown. On reflection, the supermarket is an apt metaphor for migration, both for the visibility and promise of its products and for the invisibility of its processes. Neoliberal narratives of individualism and ‘choice’ render invisible both the dispossession of the local and indigenous and the economic imbalance necessary for the movement of goods and people to the West in order for capitalism to flourish. Yet if these two aspects of migration were made visible, in the same way that more ethical consumptive practices are becoming a feature of contemporary life then other kinds of relationships might be made possible. In the case of ethnic communities, direct negotiation with Maori for a space where indigenous Maori claims for tino rangatiratanga, sovereignty and authority are supported while the mana of newcomers to Aotearoa is upheld hold promise.

So, I close this piece with an alternative story of welcome. Two years ago we had a Refugee conference at AUT University, where Tainui, Refugee Services and a group of refugees talked about the powhiri process they had instituted as part of the orientation of newly resettled refugees in Hamilton. Their presentation included a powhiri during which a refugee participant delivered his mihi in Swahili. Much to his astonishment when he came to sing his Swahili waiata I joined in. It was a moving experience. In his korero he said that the original powhiri in Hamilton had helped him to stand tall and regain his mana after the dehumanising experiences of his refugee journey. On a larger scale, Maori King Tuheitia, invited ethnic communities members to a special powhiri during the 5th Koroneihana (Coronation) celebration at Turangawaewae marae in August this year. Isn’t this the kind of Aotearoa we want? Where standing tall is possible for all of us?

Ruth DeSouza
Are we there yet? Contributor

Footnote

The process of direct negotiation with Maori has already begun and there are many resources available.

The immigration guide to living in New Zealand, which includes the Maori (including translation) and English versions of the Treaty and an emphasis on the centrality of Te Tiriti.
A Treaty education resource for migrants called Tangata Tiriti has been developed.

A view from a Goan in Aotearoa/New Zealand

The ocean is what we have in common: Relationships between indigenous and migrant people.

This piece was previously published in the Goanet Reader: Mon, 30 Nov 2009

Legend has it that Lord Parashuram (Lord Vishnu’s sixth incarnation) shot an arrow into the Arabian Sea from a mountain peak. The arrow hit Baannaavali (Benaulim) and made the sea recede, reclaiming the land of Goa. A similar story about land being fished from the sea by a God is told in Aotearoa, New Zealand, where Maui dropped his magic fish hook over the side of his boat (waka) in the Pacific Ocean and pulled up Te Ika a Maui (the fish of Maui), the North Island of New Zealand.

The first story comes from the place of my ancestors, Goa, in India and the second story comes from the place I now call home, Aotearoa, New Zealand. Both stories highlight the divine origins of these lands and the significance of the sea, as my friend Karlo Mila says “The ocean is another source of sustenance, connection and identity…. It is the all encompassing and inclusive metaphor of the sea. No matter how much we try to divide her up and mark her territory, she eludes us with her ever-moving expansiveness. The ocean is what we have in common.”

This piece for Goanet Reader is an attempt to create some engagement and discussion among the Goan diaspora about the relationships we have with indigenous and settler communities in the countries we have migrated to, and to ask, what our responsibilities and positions are as a group implicated in colonial processes?

My life has been shaped by three versions of colonialism: German, Portuguese and British, and continues to be shaped by colonialism’s continuing effects in the white settler nation of Aotearoa/New Zealand. Diasporic Goans have frequently occupied what Pamila Gupta calls positions of “disquiet” or uneasiness within various colonial hierarchies. For me, this has involved trying to understand what being a Goan means, far away from Goa and to understand the impact of colonisation.

I was born in Tanzania, brought up in Kenya and am now resident of Aotearoa/New Zealand with a commitment to social justice and decolonising projects. What disquieting position do I occupy here?

Both sets of my grandparents migrated to Tanganyika in the early part of the 20th Century. Tanganyika was a German colony from 1880 to 1919, which became a British trust territory from 1919 to 1961. Tanganyika became Tanzania after forming a union with Zanzibar in 1964.

On my father’s side, my great-grandfather and grandfather had already worked in Burma because of the lack of employment opportunities in Goa. Then when my grandfather lost his job in the Great Depression, he took the opportunity to go to Tanzania and work.

Indians had been trading with Africa as far back as the first century AD. The British indentured labour scheme was operational and had replaced slave labour as a mechanism for accessing cheap and reliable labour for plantations and railway construction, contributing to the development of the Indian diaspora in the 19th and 20th century.

Large-scale migrations of Indians to Africa began with the construction of the great railway from Mombasa to Lake Victoria in Uganda in the late nineteenth century. Indians were recruited to run the railways after they were built, with Goans coming to dominate the colonial civil services.

Some 15,000 of the 16,000 men that worked on the railroads were Indian, recruited for their work ethic and competitiveness. Sadly, a quarter of them returned to India either dead or disabled. Asians who made up one percent of the total population originated from the Gujarat, Kutch, and Kathiawar regions of western India, Goa and Punjab and played significant roles as middlemen and skilled labourers in colonial Tanganyika.

During the Zanzibar Revolution of 1964, over 10,000 Asians were forced to migrate to the mainland as a result of violent attacks (also directed at Arabs), with many moving to Dar es Salaam. In the 1970s over 50,000 Asians left Tanzania.

President Nyerere issued the Arusha Declaration in February 1967, which called for egalitarianism, socialism, and self-reliance. He introduced a form of African socialism termed Ujamaa (“pulling together”). Factories and plantations were nationalized, and major investments were made in primary schools and health care.

My parents migrated to Kenya in 1966. The newly independent East African countries of Tanzania (1961), Uganda (1962), and Kenya (1963) moved toward Africanising their economies post-independence which led to many Asians finding themselves surplus to requirements and resulting in many Asians leaving East Africa, a period known as the ‘Exodus’.

A major crisis loomed for United Kingdom Prime Minister Harold Wilson’s government with legislation rushed through to prevent the entry into Britain of immigrants from East Africa. The Immigration Act of 1968 deprived Kenyan Asians of their automatic right to British citizenship and was retroactive, meaning that it deprived them of an already existing right.

Murad Rayani argues that the vulnerability of Asians was compounded by the ambiguity of their relationship with the sub-continent, and with Britain whose subjects Asians had become when brought to East Africa.

Enoch Powell’s now infamous speech followed where he asserted that letting immigrants into Britain would lead to “rivers of blood” flowing down British streets. The Immigration Act of 1971 further restricted citizenship to subjects of the Commonwealth who could trace their ancestry to the United Kingdom.

In 1972 Idi Amin gave Uganda’s 75,000 Asians 90 days to leave. My parents decided to migrate to New Zealand in 1975.

While ‘Asians’ (South Asians) were discriminated against in relationship to the British, they were relatively privileged in relationship to indigenous Africans. As Pamila Gupta says, Goans were viewed with uncertainty by both colonisers and the colonised. Yet, the Kenyan freedom struggle was supported by many Asians such as lawyers like A. Kapila and J.M. Nazareth, who represented detained people without trial provisions during the Mau Mau movement. Others like Pio Gama Pinto fought for Kenya’s freedom, and was assassinated. Joseph Zuzarte whose mother was Masai and father was from Goa rose to become Kenya’s Vice-President. There was Jawaharlal Rodrigues, a journalist and pro-independence fighter and many many more. In 1914, an East African Indian National Congress was established to encourage joint action with the indigenous African community against colonial powers.

In the two migrations I have described, Goans occupied a precarious position and much has been documented about this in the African context. However, what precarious place do Goans occupy now especially in white settler societies?

Sherene Razack describes a white settler society as: ” … one established by Europeans on non-European soil. Its origins lie in the dispossession and near extermination of Indigenous populations by the conquering Europeans. As it evolves, a white settler society continues to be structured by a racial hierarchy. In the national mythologies of such societies, it is believed that white people came first and that it is they who principally developed the land; Aboriginal peoples are presumed to be mostly dead or assimilated. European settlers thus become the original inhabitants and the group most entitled to the fruits of citizenship. A quintessential feature of white settler mythologies is therefore, the disavowal of conquest, genocide, slavery, and the exploitation of the labour of peoples of colour.”

I’d like to explore this issue in the context of Aotearoa/New Zealand where identities are hierarchically divided into three main social groups categories. First in the hierarchy are Pakeha New Zealanders or settlers of Anglo-Celtic background. The first European to arrive was Tasman in 1642, followed by Cook in 1769 with organised settlement following the signing of the Treaty of Waitangi in 1840. The second group are Maori, the indigenous people of New Zealand who are thought to have arrived from Hawaiki around 1300 AD and originated from South-East Asia. The third group are “migrants” visibly different Pacific Islanders or Asians make the largest groups within this category with growing numbers of Middle Eastern, Latin American and African communities. This latter group are not the first group that come to mind when the category of New Zealander is evoked and they are more likely to be thought of as “new” New Zealanders (especially Asians).

Increasingly, indigenous rights and increased migration from non-source countries have been seen as a threat to the white origins of the nation. While, the Maori translation of Te Tiriti o Waitangi may be acknowledged as the founding document of Aotearoa/New Zealand and enshrined in health and social policy, the extent to which policy ameliorates the harmful effects of colonisation remain minimal.

This can be seen in my field of health, where Maori ill health is directly correlated with colonisation. Maori nurses like Aroha Webby suggest that the Articles of the Treaty have been unfulfilled and the overall objective of the Treaty to protect Maori well-being therefore breached. This is evidenced in Article Two of the Treaty which guarantees tino rangatiratanga (self-determination) for Maori collectively and Article Three which guarantees equality and equity between Maori and other New Zealanders.

However, Maori don’t have autonomy in health policy and care delivery, and the disparities between Maori and non-Maori health status, point to neither equality nor equity being achieved for Maori. In addition, colonisation has led to the marginalising and dismantling of Maori mechanisms and processes for healing, educating, making laws, negotiating and meeting the everyday needs of whanau (family) and individuals.

So in addition to experiencing barriers to access and inclusion, Maori face threats to their sovereignty and self-determination. Issues such as legal ownership of resources, specific property rights and fiscal compensation are fundamental to Maori well being. Thus, the Treaty as a founding document has been poorly understood and adhered to by Pakeha or white settlers, in terms of recognising Maori sovereignty and land ownership.

Allen Bartley says that inter-cultural relationships have been traditionally shaped by New Zealand’s historical reliance on the United Kingdom and Ireland, leading to the foregrounding of Anglo-centric concerns. Discourses of a unified nation have been predicated on a core Pakeha New Zealand cultural group, with other groups existing outside the core such as Maori and migrants.

This monoculturalism began to be challenged by the increased prominence of Maori concerns during the 1970s over indigenous rights and the Treaty of Waitangi. The perception of a benign colonial history of New Zealand — an imperial exception to harsh rule — supplanted with a growing understanding that the Crown policies that were implemented with colonisation were not there to protect Maori interests despite the mythology of the unified nation with the best race relations in the world that attracted my family to New Zealand to settle.

So while countries such as Canada and Australia were developing multicultural policies, New Zealand was debating issues of indigeneity and the relationship with tangata whenua (Maori). More recently people from ethnic backgrounds have been asking whether a bicultural framework can contain multi-cultural aspirations. New Zealand has not developed a local response to cultural diversity (multiculturalism) that complements the bicultural (Maori and Pakeha) and Treaty of Waitangi initiatives that have occurred. However, many are worried that a multicultural agenda is a mechanism for silencing Maori and placating mainstream New Zealanders.

So is there a place/space for Goans in New Zealand? Or are we again occupying a disquieting space/place? According to Jacqui Leckie, one of the first Indians to arrive in New Zealand in 1853 was a Goan nicknamed ‘Black Peter’. Small numbers of Indians had been arriving since the 1800s, Lascars (Indian seamen) and Sepoys (Indian soldiers) arrived after deserting their British East India Company ships in the late 1800s.

The Indians that followed mainly came from Gujarat and Punjab, areas exposed to economic emigration. Indians were considered British subjects and could enter New Zealand freely until the Immigration Restriction Act (1899) came into being. Migration increased until 1920, when the New Zealand Government introduced restrictions under a “permit system”.

Later, in 1926, The White New Zealand League was formed as concern grew about the apparent threat that Chinese and Indian men appeared to present in terms of miscegenation and alien values and lifestyle. Discrimination against Indians took the form of being prevented from joining associations and accessing amenities such as barbers and movie theatres.

By 1945, families (mostly of shopkeepers and fruiterers) were getting established, and marriages of second-generation New Zealand Indians occurring. The profile of Indians changed after 1980, from the dominance of people born in or descended from Gujarat and Punjab. Indians began coming from Fiji, Africa, Malaysia, the Caribbean, North America, the United Kingdom and Western Europe.

Migrants are implicated in the ongoing colonial practices of the state and as Damien Riggs says the imposition of both colonisers and other migrants onto land traditionally owned by Maori maintains Maori disadvantage at the same time that economic, social and political advantage accrues to non-Maori.

But my friend Kumanan Rasanathan says that our accountabilities are different: “Some argue that we are on the Pakeha or coloniser side. Well I know I’m not Pakeha. I have a very specific knowledge of my own whakapapa, culture and ethnic identity and it’s not akeha. It also stretches the imagination to suggest we are part of the colonising culture, given that it’s not our cultural norms and institutions which dominate this country” (Rasanathan, 2005, p. 2).

Typically indigenous and migrant communities have been set up in opposition to one another as competitors for resources and recognition, which actually disguises the real issue which is monoculturalism, as Danny Butt suggests. My friend Donna Cormack adds that this construction of competing Others is a key technique in the (re)production of whiteness.

My conclusion is that until there is redress and justice for Maori as the indigenous people of New Zealand, there won’t be a place/space for me.

As Damien Riggs points out, the colonising intentions of Pakeha people continues as seen in the contemporary debates over Maori property rights of the foreshore and seabed which contradict the Treaty and highlight how Maori sovereignty remains denied or challenged by Pakeha.

My well being and belonging are tied up with that of Maori. Maori have paved the way for others to be here in Aotearoa/New Zealand, yet have a unique status that distinguishes them from migrant and settler groups. After all I can go to Goa to access my own culture but the only place for Maori is Aotearoa/New Zealand.

Increasingly, the longer I’ve lived in Aotearoa/New Zealand and spent time with Maori, the more I’ve begun to understand and value the basis of Maori relationships with the various other social groups living here as being underpinned by manaakitanga (hospitality), a concept that creates the possibility for creating a just society. Understanding and supporting Treaty of Waitangi claims for redress and Maori self-determination (tino rangatiratanga) allows for the possibility for the development of a social space that is better for all of us.

Developing diversity in the workforce

Published in Kai Tiaki: Nursing New Zealand 1410.10 (Oct 2008): p23(1).

Identifying barriers, opportunities and strategies to integrate and develop a diverse health workforce was the aim of a workshop at the recent Diversity Forum in Auckland.

“Capitalising on a diverse health workforce” was hosted by the Centre for Asian and Migrant Health Research at the Auckland University of Technology (AUT) and opened by dean of the Faculty of Health and Environmental Sciences at AUT’s North Shore campus, Max Abbott. He recounted how pivotal overseas health professionals were to his recovery during a recent hospital stay.

Nurse consultant-recruitment at North Shore Hospital, Waitemata District Health Board (DHB), Carat Frankson, identified some bottlenecks to the registration of overseas nurses, in particular passing the International English Language Testing System (IETLS) exam, getting a job offer and finding employment opportunities for spouses. Other bottlenecks included organising passports and visas, selling and buying houses, finding schools, living costs, climate, separation from family, loss of familiar surroundings, religious practices, cultural backgrounds and the financial costs of moving from one country to another. Strategies the DHB provided in order to embrace a diverse nursing workforce included:

coaching, support, mentorship and supervision in the work environment;
introduction to the New Zealand cultural context and context of nursing at the DHB;
education in the principles of the Treaty of Waitangi; and
education in the values of the Waitemata DHB: integrity, compassion, openness, respect and customer focus.

The process could be mutually beneficial, Frankson said. “It is our responsibility to introduce and support new recruits into the New Zealand way of life, offering them cultural support. Incorporating and including immigrants into our communities is a responsibility we all share.” White these health professionals benefitted our workforce, they could also benefit other areas of society, eg schools, Libraries, universities, community centres, religious centres and the legal system, she said.

Auckland DHB clinical nurse educator, Roanne Crane’s presentation on integrating overseas-trained health professionals into the DHB identified some of the issues facing overseas registered nurses, such as Language, manoeuvring through the New Zealand registration process, socialisation, cultural differences, unprincipled agents and assumptions/racism.

Reducing health inequalities

Workforce development consultant at Counties Manukau DHB, Elizabeth Ryan, discussed the increasing demand for health services. The population was ageing, with the number of people over 65 projected to more than double between 2001 to 2021; a third of deaths occurring everyday in Counties Manukau were from potentially preventable conditions; and workforce demand would outstrip supply, with shortages nationally of up to 40 percent predicted by 2021, including in South Auckland. Having an ethnically diverse workforce was a key strategy in reducing inequalities in health, she said. The workforce needed to reflect the community being served in order to deliver quality health services in a culturally-appropriate manner. Ethnic matching was associated with greater patient satisfaction and better patient-reported outcomes.

She highlighted initiatives such as increasing the number of high school students studying health courses, with an emphasis on Maori and Pacific students, increasing numbers pursuing health at mid-career level, especially males/ Maori and Pacific people, collecting accurate demographic data, developing an affirmative action policy and the pilot programme which wilt see around 50 Pacific-Island trained nurses gain registration in New Zealand annually over the next three years.

Meeting the challenge of institutionalised racism was tackled by Auckland University researcher Nicola North. Of note was the complex and subtle set of skills that international medical graduates (IMGs) and international registered nurses(IRNs) needed to acquire, eg understanding cultural differences, familiarity with the culture of the new community of practice, fluency with the nuances of professional communication, and understanding the behaviour and values expected. To meet the challenge, North suggested several factors needed to be addressed: self-reflection as a society, a focus on immigration and settlement structures and processes, even-handed behaviour from registration councils, finding employment, smoothing the process of joining the new practice community and, lastly, getting real. “We need to acknowledge we need IMGs and IRNs more than they need us,” she said.

In the final part of the workshop, the group considered the question: What would a health system that capitalised on its diversity look like? Answers included:

recognising skills and supporting people financially;
ensuring the health workforce reflects the population demographics;
passing on success stories to the media;
rewarding and acknowledging cultural competence;
fostering diversity at all levels, including around decision-making, to develop new ideas and treatments;
consolidating, streamlining and integrating information systems to free up funding for initiatives;
growing the inter-cultural communication capacity of the entire workforce, eg educating people about how to deriver bad news to patients;
including diversity at art education levels;
focusing on areas of under-representation and targeting them specifically; and
ensuring support mechanisms are developed to take into account cultural differences, eg around employee disputes.

New York author Margaret Visser argues that change and diversity are necessary to human growth and evolution: “Machines like, demand, and produce uniformity. But nature loathes it: her strength lies in multiplicity and in differences. Sameness, in biology, means fewer possibilities and, therefore, weaknesses.” (1)

Reference

(1) Visser, M. (1999) Much depends on dinner:. The extraordinary history and mythology, allure and obsessions, perils and taboos, of an ordinary meal. New York: Grove Press.

Indians in New Zealand and the story of my family’s arrival

The Indian community is a growing minority in New Zealand, making up the second largest group in the category ‘Asian’ after Chinese communities.

You can watch a short video (4.38), excerpted from the TV Series Here to Stay about Indians in New Zealand. by clicking on the link. I talk about my parents’ decision to migrate and the experience of arrival: Ruth DeSouza: Arriving in New Zealand.

I’ve also provided a very brief background of Indian migration to New Zealand from an article I wrote: DeSouza, R. (2006). Researching the health needs of elderly Indian migrants in New Zealand. Indian Journal of Gerontology, 20 (1&2), 159-170.

The 2006 Census found that European New Zealander’s make up 67.6% of the population of people in New Zealand, 14.6 % of people as Māori. Pacific Peoples make up 6.9% of the population, Asians 9.2% and Middle Eastern, Latin American & African people 0.9%. The Census also found that 11.1% of people identified themselves as New Zealanders (Statistics New Zealand, 2006). Within the Asian group, Indians had the highest percentage increase in population between 2001 and 2006 increasing from 62,190 to 104,583 a 68.2% increase. The previous Census of 2001, found that Indian-New Zealanders were highly qualified and more likely to receive income from wages and salaries than the total New Zealand population and as likely as the overall New Zealand population to receive income from self-employment thus Indians have the second highest median annual income among the Asian ethnic groups, are involved in white collar employment and, at 77%, had the highest labour force participation rate of all the Asian ethnic groups (Statistics New Zealand, 2002a). A relatively high level of home ownership (41%) was also found. This profile of Indian New Zealanders is a recent development, early Indian migration was primarily derived from two rural areas of India, Gujarat and Punjab, and arrivals were mainly traders, farmers, artisans or small businessmen (Tiwari, 1980).

The Indian connection with New Zealand began in the late 1800s through Lascars (Indian seamen) and Sepoys (Indian soldiers) on British East India Company ships that brought supplies to the Australian convict settlements. The earliest Indian to arrive in New Zealand is thought to have jumped ship in 1810 to marry a Mâori woman. The Indians that followed came mainly from Gujarat and Punjab, areas of India which had been exposed to emigration, and were driven by economic factors. Initially Indians were considered British subjects and could enter New Zealand freely. This changed with the passing of the Immigration Restriction Act 1899.

Indian migration increased until 1920, when the New Zealand Government introduced restrictions under a ‘permit system’ (Museum of New Zealand: Te Papa Tongarewa, 2004). In 1926, the White New Zealand League was formed as concern grew about the apparent threat that Chinese and Indian men appeared to present in terms of miscegenation and alien values and lifestyle. Discrimination against Indians manifested in restrictions around joining associations and accessing amenities such as barbers and movie theatres. By 1945, families (mostly of shopkeepers and fruiterers) were getting established and marriages of second-generation New Zealand Indians were occurring. As well as Gujuratis and Punjabis, smaller numbers of Indians came from locations such as Fiji, Africa, Malaysia, the Caribbean, North America, the United Kingdom and Western Europe. The proportion of Fiji-born Indian immigrants to New Zealand rose significantly as a result of the Fijian coups of 1987 and 2000 (Swarbrick, 2004).

Sailing In A New Direction

First published by: Australian Network for Promotion, Prevention and Early Intervention for Mental Health (Auseinet) – www.auseinet.com/journal and then republished in Mindnet Issue 11 – Spring 2007

Abstract

Migrants and refugees make up an increasingly significant number of Aotearoa/New Zealand’s population with one in five New Zealanders being born in another country compared with one in eight people in the United States and one in fifteen in Europe. Increasingly efforts are being made to ensure that settlement services are provided and that mental health service delivery is cognisant of their needs. This paper describes some of the efforts being undertaken in Aotearoa/New Zealand and the implications of such efforts; in particular the mental health of Asians, a growing group, is explored. The author suggests that there is a need to learn from Pacific people’s ventures, to broaden the bicultural dialogue and finally to expand the new focus from Asians, refugees and migrants to also include the needs of long term settled communities and international students.

Keywords

multicultural, bicultural, multicultural mental health, mental health policy, Māori, Pacific peoples, Asian people

Simply by sailing in a new direction You could enlarge the world. (Curnow, 1997, p.226)

A sailing metaphor seems apt as the focus of this paper is on the people who have crossed the ocean to reach Aotearoa/New Zealand. Around 1300 AD the ancestors of Māori used the stars and the winds to sail southward from Hawaiiki in their waka (canoes) to Aotearoa/New Zealand. Thousands of years earlier, the world’s first seafarers had set off from South-East Asia, sailing into the Pacific on rafts. Tasman’s arrival in 1642, followed by Cook in 1769 marked the arrival of Europeans. Organised settlement followed the signing of the Treaty of Waitangi in 1840. Pacific migration increased from a trickle after World War II as manufacturing and service industries grew. Asians too had been coming to New Zealand since the 1800s but their numbers were small until after 1987.

Young Chinese men from Guangdong province travelled to the goldfields of Otago in the 1860s (Ip, 2005) and Indian connections with New Zealand began in the late 1800s with Lascars (Indian seamen) and Sepoys (Indian soldiers) arriving after deserting their British East India Company ships (Swarbrick, 2005). The earliest refugees arrived between 1870-1890 and included Danes, Russian Jews and French Huguenots. Subsequently, refugees from Nazism (1933-39), Poland (1944), Hungary (1956-58), ‘handicapped’ refugees (1959), Chinese (1962-71), Russian Christians from China (1965), Asians from Uganda (1972-73), Chileans, Soviet Jews, Eastern Europeans, people from the Middle East, South-East Asia (Indo-Chinese), Somalia, Zimbabwe, Afghanistan, Bosnia, Ethiopia, Eritrea, Iran and the Sudan have resettled in New Zealand. More recently, Asian foreign fee-paying students have impacted on the education system, becoming important to the national economy and more visible in society (International Division & Data Management and Analysis, 2005).

It’s time to enlarge our world

Migrants to New Zealand are caught between two charged agendas: the colonial ideal of a homogeneous society, replicating Britain, and the desire of Māori for recognition as people of the land, or Tangata whenua, with specific rights. New Zealand’s founding document, The Treaty of Waitangi and the social policy principle of biculturalism have become an explicit template for relationships between indigenous Māori and subsequent migrants. The racialising and othering of migrant groups, along with past migration policy designed to keep the country white (Beaglehole, 2005), have implicitly shaped the treatment of migrants.

Changing migration patterns

The 2001 Census found that Europeans/Pākehā (Māori name for white New Zealanders) made up 79.6% of the population, followed by New Zealand Māori with 14.5%, people from the Pacific Islands 5.6%, and Asians 6.6% (adds to more than 100% because ethnicity is self-defined; people could select more than one ethnicity). Of the Asians, the largest groups are Chinese who make up 2.2% and Indians who make up 1.2% of the total New Zealand population (Statistics New Zealand, 2002b). Asians are the fastest growing ethnic group, increasing by around 140% over the last ten years and predicted to increase by 122% by 2021. In comparison, Pākehā will increase by 1%, Māori 28% and Pacific People 58%. This new diversity is in stark contrast to the previous assimilationist post-1945 migration policy which positioned the ideal migrant as ‘invisible’. Linguistic and religious diversity were also a hallmark of the 2001 Census which noted a 20% increase in the number of multilingual people and an increase in the percentage of people whose religion was non-Christian, including Hindu 56%, Buddhist 48% and Islam 74%.

Policy changes: From monocultural to bicultural to multicultural

Canada and Australia embraced multiculturalism during the 1960s, transforming the notion of settlement into a two way process; change was required by both migrants and the host society. New Zealand policy made this strategic move only as recently as 1986. The 1980s were a pivotal period in discussions of New Zealand identity, featuring biculturalism and its incorporation into social policy in New Zealand (Bartley & Spoonley, 2004). Discussions of multiculturalism began with the arrival of Pacific peoples in the 1970s and required Pākehā to cede the monopoly on power and decision making and the allocation of resources (Bartley & Spoonley, 2004). An attempt to address the bicultural/multicultural relationship came about with proposals that biculturalism should take precedence and subsequent arrivals to Aotearoa needed to negotiate a primary relationship with Māori (Bartley & Spoonley, 2004). Multi-culturalism would then be the outcome of a network of completed bicultural negotiations; however, no process was ever suggested for this to occur (Bartley & Spoonley, 2004). The bicultural/multicultural debate remains un-resolved and problematic (DeSouza, 2004a; Mohanram, 1998; Thakur, 1995; Walker, 1995; Wittman, 1998). However, rather that biculturalism being a barrier to multiculturalism, I believe that it has paved the way for the majority culture to consider cultural issues at large. The Immigration Act 1987 eased access into New Zealand from non-traditional source countries and replaced entry criteria based on nationality and culture with criteria initially based on skills. The policy changes led to unprecedented cultural diversity. In particular, Asians became a sizable majority of migrants, increasing from 18.7% of permanent and long term arrivals in 1987 to 48% in 1993 (Bartley & Spoonley, 2004).

A growing Asian population

‘Asian’ is a term that has differing definitions depending on the geographical context in which it is used. In New Zealand ‘Asian’ tends to refer to people from South East Asia and there are debates about whether an umbrella term such as ‘Asian’ is useful or merely an expedient construct that potentially provides benefits but disguises disparities within groups (Rasanathan, Craig & Perkins, 2004; Workshop Organising Team, 2005). In the 2001 Census, 44% of Asians identified with the Chinese ethnic group, 26% with the Indian ethnic group, 8% Korean, 5% Filipino, 4% Japanese, 3% Sri Lankan, 2% Cambodian, 2% Thai, and 8% with other Asian ethnic groups (note that people could give more than one response; therefore, these percentages do not add to 100) (Statistics New Zealand, 2002a). Asians in New Zealand are a relatively young population and are generally in good health. Most live in the Auckland region and over half are aged between 25 and 65 years, around 20% are aged 15 to 24 years and 20% are aged below 14 years (Asian Public Health Project Team, 2003). This age-distribution is similar to Māori and Pacific people, but Asians are younger (on average) than Europeans. The rapid growth of the Asian population has exposed a lack of policy and structures to evaluate and address their needs (Workshop Organising Team, 2005).

Access issues and underutilisation of mental health services

A survey examining health status in a large representative sample of Asian people (Scragg & Maitra, 2005) found that Asians underutilise health services:

Asian people were less likely than other New Zealanders, Māori and Pacific people to have visited a health practitioner (or service) when they were first unwell.
Asian people were less likely than Europeans to visit a health practitioner about a chronic disease (doctor, specialist, nurse or complementary healer).
Asian women were less likely than other New Zealand women to have had a mammogram or cervical screening test in the last three years.
Asians were less likely than all New Zealanders to use any type of telephone helpline in the last 12 months.
Asians also only wanted to see their general practitioner for a short term illness or a routine check up rather than visiting for an injury, poisoning, or for mental or emotional health reasons.

Another study found that barriers to accessing services for Chinese people included lack of language proficiency of respondents, lack of knowledge about civil rights and problems accessing general practitioners (DeSouza & Garrett, 2005).

This underutilisation is further reflected in mental health statistics. Of the 87,576 mental health clients seen by District Health Boards in 2002, only 1.9% were Asian despite making up over 6.5% of the population (New Zealand Health Information Service, 2005). This could in part be due to the bias of New Zealand’s migration policy which selects young and healthy migrants but it is clear that Asians underutilise mental health services and this does not necessarily mean that they are keeping well (Ho, Au, Bedford & Cooper, 2002). A study among recent Chinese migrants using the General Health Questionnaire found that 19% reported psychiatric morbidity (Abbott, Wong, Williams et al., 1999). A study of older Chinese migrants aged over 55 found that 26% showed depressive symptoms (Abbott, Wong, Giles et al., 2003). Lower emotional supports, greater number of visits to a doctor, difficulties in accessing health services and low understanding and engagement with New Zealand society increased the risk of developing depression. Interestingly, while participants with depressive symptoms consulted general practitioners more than their counterparts without such symptoms, they reported greater difficulty in accessing health services. Research with Asian migrants, refugees and student sojourners in New Zealand shows that social supports can assist newcomers to cope with the stresses of migration and reduce the risk of emotional disorder (Abbott et al., 1999). Conversely, research shows that language and cultural barriers can limit access to health services (Abbott et al., 1999; DeSouza & Garrett, 2005; Ngai, Latimer & Cheung, 2001).

Need for workforce development

The cultural competence of mental health staff for working with Asian consumers has not been researched. However, a recent project investigating the intercultural experiences of social workers in New Zealand found that contact with migrants, refugees or asylum seekers was infrequent, especially outside of Auckland (Nash & Trlin, 2004), but that the majority of social workers felt competent or better than competent in terms of working interculturally. Respondents recommended that further training in cross-cultural social work, staff training and better support services be available, in tandem with improvements in community services and the education of the host community to see new settlers as valuable additions to society. In another study, psychiatrists were surveyed by Johnstone and Read (2000), who found that out of 247 psychiatrists surveyed, only 40% believed that their training had prepared them to work effectively with Māori. Some of the suggested recommendations for improving how they worked with Māori included needing to understand Māori perspectives of well-being, and increasing the number of Māori professionals and Māori run services. Of psychiatrists who responded to the survey, 70% believed that there was a need to consult with Māori when working with Māori. A training package is being developed by University of Auckland, funded by the Health Research Council, to develop cultural competence in mental health staff working with Asians. Further development in this area is signalled in the next mental health action plan discussed later in this paper.

Omission in health research

Asian ethnic groups have been largely neglected by New Zealand health policies and research, despite their population growth (Duncan, Schofield, Duncan et al., 2004). Duncan et al. cite the example of the 2002 National Children’s Nutrition Survey, where both over-sampling and separate analysis of Māori and Pacific Island children occurred while Asian children were subsumed with New Zealand Europeans. Large-scale studies are needed to determine health risk across all major ethnic groups in New Zealand, which will in turn enable development of ethnic-specific data. Even more critical is the need for data concerning ethnic variation in other areas of health so that effective interventions can be developed and implemented (Duncan et al., 2004). This omission and exclusion is by no means a rare occurrence in national surveys and prevents the development of an understanding of the public health needs of Asian communities in New Zealand, necessary for the development of appropriate preventative health strategies.

Settlement issues

A report commissioned by the New Zealand Immigration service found that migrants had four areas of need: everyday needs, learning English, employment, and supportive connections (Ho, Cheung, Bedford & Leung, 2000). Factors such as unemployment or underemployment, having experienced discrimination in New Zealand, not having close friends, being unemployed and spending most of one’s time with one’s own ethnic group were predictors for poor adjustment among migrant groups (Pernice, Trlin, Henderson & North, 2000). In the last few years, a range of settlement programmes have been funded nationally with the development of an Immigration Settlement Strategy (New Zealand Immigration Service, 2003) for migrants, refugees and their families. The strategy’s six goals provide a broad base for enhancing wellbeing and include appropriate employment; confidence with using English or accessing appropriate language support; accessing appropriate information and responsive services; supportive social networks and sustainable community identity; expressing ethnic identity and acceptance and inclusion of the wider host community; and participation in activities.

Visible but invisible groups

The arrival of primarily Asian fee-paying students has had an impact on the education system, a greater importance to the national economy in terms of providing increased funding to educational institutions, and higher visibility in society in that most of the international students have come from China (International Division & Data Management and Analysis, 2005). Asian enrolment numbers rose by 318% over a five year period (1999-2003) to nearly 119,000, with an estimated economic value NZ$2.2 billion New Zealand dollars and providing 40,101 jobs (Infometrics, 2006). These numbers declined in the 2003-2004 period, leading to concern about the rapid development of the sector and raising the need for better quality assurance systems, which are now implemented through the Code of Practice for the Pastoral Care of Foreign Fee-Paying Students (Section 238H of the Education Act 1989). Levies paid by institutions with international students are used to support activities and projects relating to the export education industry such as promotion, communications, capability development, quality assurance, research and the administration of the Code (Ministry of Education, 2003). However, other than being able to use counselling services within their institutions, most international students are not entitled to access publicly funded (mental) health services while in New Zealand and are liable for the full costs of treatment unless they are sectioned under the Mental Health Act, and then only for the duration of that process. Once they are no longer under the Act, they are charged. Remaining voluntarily on an acute unit can incur a charge of approximately NZ$900 a day. International students are required to have appropriate and current medical and travel insurance while studying in New Zealand as a condition of enrolment (including mental health as long as it is not a pre-existing condition); however, insurance cover is capped at NZ$2,000 so if students need access to in-patient services they must cover their own costs.

The needs of long term settled communities have been brought into focus with the launch of the Asian Health Chart Book (Ministry of Health, 2006a) which demonstrates the need to focus not only on new migrants but also on longer-term settled migrant Asian communities. Major differences in health and health service use between recent migrants and longstanding migrants show that recent or first generation migrants have better health status than longstanding migrants or the New Zealand born, demonstrating the acculturative effects of the dominant culture.

Mental health services: Sailing in a new direction

Mental health services are responding to new migrant populations to varying degrees. Following on from a report on the mental health of Asians in New Zealand (Ho et al., 2002) has been an increased responsiveness to the needs of those communities (Yee, 2003). Research activity, information provision, collaboration and Asian-focused operational activities and policy are some of the strategies that are being used by government agencies (Yee, 2003). Other developments that will assist in meeting this gap include the New Zealand Mental Health Classification and Outcomes study (Gaines, Bower, Buckingham et al., 2003), which includes a small number of Asians, and a planned mental health epidemiological survey which will also assist but is currently limited to the two largest Asian communities, Indian and Chinese. This section briefly reviews national, regional and local developments and initiatives.

Developing visibility and responsiveness in mental health services

Asian researchers (Lim & Walker, 2006; Tse, Bhui, Thapliyal et al., 2005) have outlined the legislative and policy frameworks that support culturally sensitive mental health service provision. These include The Health and Disability Commissioner Act 1995 and the Health and Disability Code of Rights 1996 which require that services acknowledge the needs of people from a range of cultures and provide for these needs while also protecting culturally diverse people from coercion, discrimination and exploitation. A culturally sensitive approach and acknowledgement of the person’s cultural and ethnic identity, language, and religious or ethical beliefs is also advocated in the Mental Health (Compulsory Assessment and Treatment) Act 1992 and the 1999 amendments. In addition, one of the objectives of the New Zealand Public Health and Disability Act 2000 is that health outcomes be improved for Māori and other population groups through the reduction of health disparities. The Human Rights Act 1993 requires that mental health and addiction services do not unlawfully discriminate on the grounds of culture and ethnicity. Lastly, the Health Professional Competency Assurance Act 2003 requires practitioners to demonstrate cultural competence.

National mental health strategy and recovery

Te Tāhuhu – Improving Mental Health 2005-2015: The Second New Zealand Mental Health and Addiction Plan (Ministry of Health, 2005b) builds on the current Mental Health Strategy contained in

* Looking Forward: Strategic Directions for the Mental Health Services (Ministry of Health, 1994); * Moving Forward: The National Mental Health Plan for More and Better Services (Ministry of Health, 1997); and * The Mental Health Commission’s Blueprint for Mental Health Services in New Zealand: How Things Need to Be (Mental Health Commission, 1998).

Te Tāhuhu acknowledges that ‘there is no national strategy or policy to address the mental health issues of the full range of ethnic groups living in New Zealand. Building stronger relationships with people from diverse cultures and ethnic groups will be essential as we work towards developing strategies to address their particular needs’ (Ministry of Health, 2005b, p.37). Te Tāhuhu focuses on developing a comprehensive integrated mental health and addiction system that provides hope for developing a multicultural mental health agenda, compared to the other documents that make specific cultural mention of Māori and Pacific peoples but minimal reference to other groups. Te Tāhuhu emphasises early access to effective primary health care (a key entry point to mental health services for Asians), and an improved range and quality of specialist community based mental health and addiction services built on collaborative relationships (Ministry of Health, 2005b). It covers the spectrum of interventions from promotion/prevention to primary care to specialist services, and in particular the draft action plan (Ministry of Health, 2006b)

* acknowledges the presence not only of Asian peoples but also migrants and refugees, and the need for mental health services to be able to respond to the unique needs of all New Zealanders; * acknowledges the need for responsiveness to Asian peoples and other ethnic communities and refugee and migrant communities; * aims to build a quality mental health and addiction workforce that supports recovery, is person centered, and is culturally capable to deliver services for Asian peoples (that will require new skills and areas of specialised knowledge); * aims to strengthen the cultural capability of workers in mainstream services to work effectively with Asian, refugee and migrant populations through training programmes; * aims to increase the understanding of the mental health and addiction needs of Asian, ethnic, refugee and migrant communities through developing a profile of their mental health, and developing a mental health and addiction research agenda; * aims to implement national and local training for the mental health services workforce to work more effectively with them and use research evidence in service planning and delivery; and * aims to develop culturally responsive problem gambling intervention services for Asian peoples.

In addition, The Mental Health Commission’s Recovery Competencies for Mental Health Workers (O’Hagan, 2001) requires that a competent mental health worker acknowledges the different cultures of Aotearoa/New Zealand and knows how to provide a service in partnership with them. It suggests that every mental health and addiction service worker should demonstrate:

knowledge of diversity within Asian cultures;
knowledge of Asian culture, for example importance of family, religious traditions, duty, respect for authority, honour, shame and harmony;
the ability to articulate Asian views on health;
knowledge of traditional Asian treatments;
and the ability to involve Asian families, communities and service users in services.

In response to a report on Asian Public Health (Asian Public Health Project Team, 2003) the Mental Health Foundation have also created information sheets written in Chinese as a step towards meeting the mental health needs of Asians. They focus in particular on the mental health needs of Chinese adults and older Korean people. The emphasis on Chinese recognises that they comprise the largest of all Asian ethnic groups and the high number of Chinese international students in New Zealand, particularly in Auckland.

The potential of broader health policy

Developments in population based health policy offer promise in addressing barriers to accessing services by Asian communities. The New Zealand Health Strategy (NZHS) guides the development and provision of new services in the health and disability sector to improve the health of New Zealanders (Ministry of Health, 2000). Administered through District Health Boards (DHBs), the strategy aims to reduce inequalities in health status for Māori, Pacific peoples and people from lower socio-economic groups. It claims to focus on quality of service in order to ensure health outcomes are improved and health disparities reduced. There is scant reference to migrant health in the NZHS, other than a recommendation ‘to assess the health needs of refugees, asylum seekers and Asian immigrants’ (Ministry of Health, 2000, p.47) without any attempt to explain how this might be achieved.

A key strand of the NZHS involves improving responsiveness in the field of primary care. Primary Health Organisations (PHOs) have been established as ‘community-led’ organisations that guide the development of local services and their role defined in the Primary Health Care Strategy (Ministry of Health, 2001). The governance model is intended to involve local people in the planning and delivery of local primary health care services. This promotes the role of health workers as being to reduce health inequalities and address the causes of poor health status. Whilst accessibility, affordability and co-ordination are key, there is no mention of Asian and migrant populations in the strategy, which aligns with the NZHS focus on Māori, Pacific populations and lower socio-economic groups. The needs of Asian communities in New Zealand will need to be proactively considered given their projected population growth and evidence of different health needs to the wider population. Findings from the Asian Health Chart Book (Ministry of Health, 2006a) show that Asian people had positive health outcomes on a range of health indicators compared to the total New Zealand population. Of concern, however, was the lower usage of health services by the Asian population. The report provides a useful baseline on Asian health and it is hoped that it helps in identifying the health needs of Asian peoples in New Zealand and that it will be a tool for Asian communities themselves to advocate for appropriate health services.

Regional developments

The Northern Region Mental Health and Addictions Strategic Direction 2005-2010 (Northern DHB Support Agency & Network North Coalition, 2004) has two foci for its vision. The first is a specific focus on ‘equal opportunity to access quality services delivered in a culturally appropriate manner for refugee and recent Asian migrant clients and families’ and the second is ‘access to professionally trained and qualified interpreting services to meet the needs of migrant and refugees with experience of mental illness and their families’ (p.22). Recently a project was developed for training Asian interpreters and mental health practitioners who provide secondary mental health services for the diverse Asian immigrant population in the Auckland region, focussing on cultural competency and appropriate skills to work together effectively (Lim & Walker, 2006).

Local developments

At a local level, the twenty-one District Health Boards (DHBs) are responsible for deciding on the mix, level and quality of health and disability services to be provided for populations within government-set parameters. Some specialised mental health services, for example the ‘Refugees as Survivors’ (RAS) centres have been established, while others have developed ‘transcultural’ teams with clinicians who have an interest in the area or Asian mental health workers. Asian peer support workers are employed by consumer run organisations such as Mind and Body consultants to support Asian users of Auckland District Health Board Mental Health Services. There are also two Chinese consumers’ self-help groups: Bo Ai She and Yu Ai She. Community Alcohol and Drug services have two Chinese counsellors and non-governmental organisations (NGO) have begun responding to the needs of Asians by employing Chinese staff in community and family support roles such as Action for Mental Health Services, Supporting Families and Affinity. In the Auckland DHB there are two Asian community support workers with a focus on psychiatric rehabilitation. A great many of the developments have been in response to advocacy from ethnic community members and a desire to increase responsiveness to presenting clients.

Learning from the experience of Pacific peoples

There is much that newer migrant groups and mainstream services can learn from the experience of Pacific peoples, who are a diverse group representing over 20 different cultures. The largest group are Samoan making up 50% of Pacific peoples, followed by Cook Islanders (23%), Tongans (16%), Niueans (9%) Fijians (4%) and Tokelauans (2%) (self-identified; more than one response possible) (Mental Health Commission, 2001). A youthful population concentrated in the Auckland region with smaller numbers scattered throughout the country (Ministry of Health, 2005a), Pacific peoples make up 6% of the New Zealand population, which will rise to 12% by the year 2051. Pacific migration to New Zealand after the second world war increased as a result of growing industrialisation and demands for a manufacturing and service industry workforce (Spoonley, 2001). Large numbers of Pacific people migrated to urban areas of New Zealand, accelerating in the 1960s and early 1970s (Spoonley, 2001). The mid-1970s economic downturn led to many Pacific people losing their jobs. Unemployment, low income, poor housing, the breakdown of extended family networks, cultural fragmentation, and rising alcohol and drug problems have had a significant impact on the mental health of Pacific peoples, with rates of mental illness being generally higher among Pacific males and Pacific older people than the rest of the population (Ministry of Health, 2005a). However, Pacific peoples are a little less likely to use mental health services than any other group in New Zealand (Ministry of Health, 2005a).

Innovative health models such as the ‘Fonofale’ created by Fuimaono Karl Pulotu-Endemann (Crawley, Pulotu-Endemann, Stanley-Findlay & New Zealand Ministry of Health, 1995) have promoted holism and continuity. Similar to Durie’s (1994) Te Whare Tapa Wha, the Fonofale model uses the metaphor of a Pacific Island house and incorporates the values and beliefs of various Pacific Island groups. In addition, two key mechanisms have been advanced to improve social and economic outcomes for Pacific peoples. These are to improve ‘the responsiveness and accountability of public sector agencies to Pacific health needs and priorities, and to build the capacity of Pacific peoples, through provider, workforce and professional development, to deliver health and disability services and to develop their own solutions to health issues’ (Mental Health Commission, 2001, p.15). The key agencies in this task are The Ministry of Pacific Island Affairs, the Ministry of Health, District Health Boards and the Mental Health Commission. Other strategies are that services for Pacific peoples should: include Pacific views of mental health and wellbeing (which also includes all other aspects of health); take into account the relatively young Pacific population; acknowledge that there are isolated communities throughout New Zealand; consider the socioeconomic status of Pacific peoples; consider the diverse needs of New Zealand-born versus Island-born people and people of mixed ethnicity; and include the issue of alcohol and other drug use. In parallel, mainstream providers need to incorporate practices that properly address the above issues which will require building networks with Pacific organisations and groups able to advise on culturally acceptable methods of treatment (Mental Health Commission, 2001).

Conclusion: Exploring uncharted waters

Parts of the journey ahead are charted clearly. There are legislative and policy imperatives in place for mental health services to ensure that they are responsive in both policy and practice for ‘migrants, refugees and Asians’. How this is operationalised varies around the country but developments are promising, particularly in Auckland where the population of Asians is 12%. However, there are murky waters ahead that must be navigated. Further discussion is needed about the terms ‘migrants, refugees and Asians’ which are referred to in Te Tāhuhu and are an attempt at inclusion. The diversity contained within labels will have to be disentangled, so that the needs of the diverse people within labels such as ‘migrants, refugees and Asians’ are identified. Consideration must also be given to the needs of long term settled ethnic communities and international students, both of whom are neglected. Diving even deeper, the intersection of ethnicity, religion and socioeconomic status needs exploration. Consideration also needs to be given to how we work with the ‘buzz words’ such as cultural safety, cultural capability, cultural awareness and cultural competence and how they sit together (DeSouza, 2004b, 2006; Wood, Bradley & DeSouza, 2004).

Finally, a more strategic response to New Zealand’s changing demographics is required as until now the majority of developments have been ad hoc, reactive and operational, based on lobbying from ethnic community groups and non-governmental organisations such that responses are geared to our current situation rather than our future. It is necessary to address the place of the Treaty of Waitangi in the context of how multiculturalism is to be accommodated. Some see biculturalism as an obstacle to the acknowledgement of a more diverse society; however, I suggest that multiculturalism through biculturalism remains a possible solution that has been under-explored and under-operationalised. Future developments in Asian, migrant and refugee health need to heed the unique status of Māori and learn from the experiences of Pacific peoples, who have charted these waters already and know the currents and prevailing winds.

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How can nurses truly celebrate cultural diversity?

Editorial published in Kai Tiaki: Nursing New Zealand 13.4 (May 2007): p2(1).

American feminist psychologist and theorist Carol Gilligan once said that without voice there cannot be relationship, and without relationship there cannot be voice. (1) How do we have relationships with people who are different from us? How do we and the other person have a voice in the relationship, if we don’t know what our common ground is?

The 2006 Census reveals European New Zealanders make up 67.6 percent of the population, 14.6 percent of people self-identify as Maori, Pacific peoples make up 6.9 percent of the population, Asians 9.2 percent and Middle Eastern, Latin American and African people, 0.9 percent. (2) The Census also revealed that nearly 23 per cent of New Zealand’s population was born overseas, compared with 19.5 per cent in 2001. In terms of religious affiliation, 55 per cent said they were Christian, down from 60.6 per cent in 2001. And 1.3 million New Zealanders said they had no religion. The number of Hindus increased by 61.8 percent to 64,392, Muslims went up 52.6 percent to 36,072 people and the number of Sikhs was 9507, up 83 percent. (2)

This religious and cultural diversity has implications for nurses and those we care for. How do we have relationships with people of different cultures and religions? How can we, as nurses, cultivate relationships and ensure we have a voice, and ensure our colleagues and clients who are “diverse”, have a voice too? What does celebrating cultural diversity actually mean for nurses, other than taking part in a cultural festival or having friends from diverse backgrounds? What does it mean for systems that are primarily monocultural and are striving to be bicultural? And what does that mean for the increasing number of people from diverse ethno-religious communities?

New Zealand has a long history of migration, but the range and number of migrants in New Zealand has been on an unparalleled scale since 1987. With that have come demographic changes. I recently gave a two-hour talk about diversity, and afterwards a nurse asked “What about our (Pakeha) identity? What is going to happen to it?” She is not the only person worded about the loss of identity, as witnessed by the cry “What has happened to my country?” in letters to the editor and heard on talkback radio. For those of us who have migrated here, it is hard to understand why people from the dominant culture feel marginalised, when we are surrounded by Pakeha/white New Zealand culture, in terms of all the institutions and power bearers.

Interaction rather than co-existence

These concerns highlight a need for dialogue and I am reminded of the work of Lebanese-Australian anthropology professor, Ghassan Hage, who suggests the way forward is through interaction, rather than co-existence. (3) When we co-exist, we can idealise or demonise the other, but never really get to know them. But when we interact, it requires us to move forward in relationship, even when it is tough and frustrating. There are potential gifts of working from a place of interaction and these occur when we can say “Let’s take the best of both/many cultures and see what new and wonderful things we can create”.

Richard Florida has written about the creative class where new ideas and technologies have been developed in the United States as a result of attracting the best and the brightest from around the world and harnessing the creativity inherent in diversity. (4) This is where interaction comes in–we have to rub up against one another, experience conflict and find a way forward for creativity to kick in.

To harness such potential in health in New Zealand we need to address the political and policy Landscape of health. Nursing Council statistics show that migrant nurses made up 51 percent of new registrations in 2005-2006. (5) This percentage raises many questions: What do we have in place to assist the effective integration of new migrant nurses? What is good practice for those who employ migrant nurses? Who is responsible for ensuring that this happens well? What support mechanisms need to be in place to create innovation in health? How do receiving nurses create new spaces and places for cultural diversity?

Migration has always had an element of economic necessity, a tap which could be turned on and off, as and when we needed more labour. But, increasingly, receiving countries are beginning to realise people don’t just migrate for a job. They migrate for a life and for their dreams and aspirations. This means they put down roots and settle and want a home and a voice in their new country. In the short-term period of settlement, it is about such things as getting a job, financial independence, establishing a social network and adapting to various aspects of lifestyle. In the long-term period of integration, it is about career advancement, income parity, accessing institutions, redefining cultural identity, adapting or reassessing values, and participating in political parties and socio-political movements.

I have a number of suggestions about how we move forward with diversity: use it for our creative endeavours; see newcomers as a source of innovation; along with maintaining our obligations to Maori under Te Tiriti o Waitangi, ensure all who live in Aotearoa/New Zealand enjoy equitable access to services and enjoy equal rights, responsibilities and opportunities to participate in, contribute to and benefit from all aspects of life. Finally, recognise that we all share responsibility for the continuing development of Aotearoa New Zealand as a cohesive and harmonious society. Contributing to our own communities and venturing outside them, would be a great start.

References

(1) Gilligan, C. (1982) In a Different Voice: Psychological Theory and Women’s Development. Cambridge, Massachusetts: Harvard University Press.

(2) New Zealand’s 2006 Census of Populatino and Dwellings. (2006) 2006 Census Date. Statistics New Zealand. http://www.stats.govt.nz.ezproxy.aut.ac.nz/census/default/htm. Retrieved 20/04/07.

(3) Hage, G. (2002) Against Paranoid Nationalism: Searching for Hope in a Shrinking Society. Australia: Pluto Press.

(4) Florida, R. (2002) The Rise of the Creative Class and How it’s Transforming Work, Leisure, Community and Everyday Life. http://www.amazon.com/Rise-Creative-Class-Transforming-Community/dp/ 0465024769. Retrieved 20/04/07.

(5) Clark, M. and Ayling, B. (2006) Workforce Statistics 2006 Update. Presentation to Nursing Council Forums. http://www.nursingcouncil.org.nz/forum.html. Retrieved 20/04/07.

“How can nurses truly celebrate cultural diversity?” Kai Tiaki: Nursing New Zealand 13.4 (2007): 2.

The ultimate engagement of life: Being mentally healthy

Published in (2007) Asian Magazine, 4.

I came across a wonderful definition of health by Jesse Williams in 1928 the other day in a book that I was reading. Williams defines health as being “the optimal condition of being that allows for the ultimate engagement of life.” To me this is what being healthy is about, being in the best condition to fully take part in life. I have had a long passion in the issue of migration and settlement and in particular the impact on health and specifically mental health. We know that migration is a risky business that also has the potential to transform, so how can we maintain our mental health and go beyond maintenance to optimal health and engaging fully with life? What are the factors that help or hinder being ultimately engaged with life and what can we do about them? In this article I’d like to share my professional, personal and research findings with you from work I did with Goan women living in Auckland some years ago [1].

Migration offers the potential of a new and better life, otherwise why would anyone migrate for a worse life? Yet sometimes this is what unexpectedly happens. We are so focussed on the wonderful future and the leaving, but not so much on the arrival. Without our usual “soft places to fall” as Dr Phil terms it, our support networks, our fulfilling work, migrants can end up with migrant’s remorse!

It was the first time we had been on our own before, in Bombay you’ve always got family to help you and you’ve got everything ready made, so you never know what hardship is until you come here (Flora).

When there is a big gap between our hopes and expectations and the reality the disillusionment can be too much to bear. When the job that is going to be the foundation of the new life doesn’t materialise and the income doesn’t match the sacrifices, it can seem like things are going down hill fast. There is a cumulative impact of all these disappointments that can result in feeling overwhelmed and worn out. So when do ups and downs become something you should pay attention to? In my experience, it is best to ask for help from those around you when you feel like you are not coping and managing as well as you would like to be or know that you usually can. Help-seeking is something that many of us find difficult to do. Whether it is pride or the shame of admitting we cannot manage on our own. What I know for sure though is that when we have exhausted our own resources we should ask for help because things don’t tend to get better by themselves and sometimes they get worse when we do nothing. So start by talking to people that you trust, family or friends and keep talking and asking until you get what you need. If you have a faith community tap into its resources. Talk to your General Practitioner and ask for referral to a counsellor or mental health service. I remember talking to a man with a gambling problem that had become depressed, he said “what is the point of going to talk about my problems, I need financial help!” The answer is that there are a range of things that have contributed to how you feel and equally there are a range of things that will help, from going for a walk to talking to someone to getting budgetary advice. There is not going to be just one magical solution.

So what if you are reading this and thinking, I am fine, I just get down sometimes. Here are four strategies that Goan women used to help them maintain their mental health.

Developing a new support network New Zealand researchers [2] have found that support is one of four important factors for successful settlement. Support makes coping with daily living, acquiring language and employment (the three other factors) easier to acquire. Support also helps you manage stress by reducing how big you see the stress and helping to reduce the severity of your reaction to it [3]. Participants in my research study found that having contact with family, friends and other migrants was crucial and that by volunteering, joining their faith community and having access to support through e-mail the stresses of migration and settlement were minimised. It is important to make sure that you connect with people outside your faith or ethnic group too.

Having a “can do” attitude The term ‘pioneer spirit’ is often used to refer to migrants. The attitude of coping with things in the present because they will get better in the future if you make it work is part of the migrant dream. T some degree pragmatism and philosophical acceptance are necessary for survival and essential:

You just couldn’t pick a flight and go, you’ve resigned your job, you’ve spent half your savings to come here and you know there’s no turning back so you have to make the most of this. So it’s like there’s no turning back, but you think, ‘God what have I done’ (Flora).

As Arisaka says [4] “This almost non-negotiable drive for upward mobility requires diligent assimilation. Self-pity, victim consciousness, and separationist self-consciousness are deadly to the process towards success. Not only are they excessively self-indulgent, but they are also a waste of time and energy, and therefore not allowed”. I think that this can also be a trap and that again it is important to ask for help when you need it. You don’t get extra points at the end of your life for having done it the hard way!

Learning There are two ways of learning that assist with settlement one is the ‘culture learning approach’ where you adapt by overcoming every day cross-cultural problems by learning new culture specific skills that assist you to navigate the new cultural environment [5]and the other is by inoculation or anticipatory preparation [6, 7] which helps the transition experience , where a previous visit or some similar kind of preparation where you gain culturally specific knowledge and skills prior to migration can be a great help.

Lastly, maintaining cultural links was used to make sense of the migration and settlement experience and maintaining wellbeing. The loss and separation that can occur with migration can be lessened to some degree by holding on to familiar and trusted values and keeping ties [8]. Keeping a connection with ‘the familiar’ helps lessen the dislocation and challenges that resulted from being in ‘the unfamiliar”. This can be done by attending community events or even going back to the place of origin, for the benefit of children as well:

It’s important not to get carried away by the western thing, to keep taking them back to their roots if you can afford it because I think that priority has really made the difference for us (Sheila).

There are many ways to manage a new life in a new country. Each one of us has to find a combination of ways that are going to work for us. I hope this has give you some ideas about how you can not only survive the transition to life in a new country but thrive as well so that you can be in optimal condition to enjoy your new life fully.

References

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Arisaka, Y., Asian women: Invisibility, locations, and claims to philosophy, in Women of color and philosophy: A critical reader, N. Zack, Editor. 2000, Blackwell Publishers: Malden, Mas. p. 219-223.
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Vasta, E., Gender, class and ethnic relations: the domestic and work experiences of Italian migrant women in Australia, in Intersexions; gender, class, culture, ethnicity, G. Bottomley, M.D. Lepervanche, and J. Martin, Editors. 1991, Allen and Unwin: Sydney.