Kōrero mai: A Kaupapa Māori study exploring the experiences of whānau Māori caring for tamariki with atopic dermatitis

Abstract
Racism and colonisation have caused the systemic exclusion of Indigenous Māori populations in Aotearoa (New Zealand) and the perpetuation of health inequities. Atopic dermatitis, a chronic skin condition, is one such example where Māori tamariki (children) are disproportionately affected. International research highlights the challenges of caring for children with atopic dermatitis; however, there has been no such research in Aotearoa. This small qualitative study, using Kaupapa Māori (Indigenous Māori) methodology, aimed to explore the experiences of Māori parents caring for their tamariki with atopic dermatitis. Cultural engagement was paramount to the research using kaupapa kōrero (cultural narrative) through kanohi-ki-te-kanohi (face-to-face) interviews to explore the lived experiences of six whānau Māori (Māori families). Data were analysed thematically using a kaupapa Māori lens with five overarching themes: 1) the constant hard work of maintaining good skin health for tamariki; 2) the embarrassment is punishing for whānau; 3) courage is required to maintain vigilance; 4) constantly seeking solutions; and 5) whānau/people-focused solutions. Kōrero (conversations) illustrated that whānau Māori experience systemic racism across health, education, and social systems; implicit bias; and differential treatment within health services that impact caring for their tamariki. These findings reiterate the failure of mainstream primary healthcare institutions to enact Te Tiriti o Waitangi obligations and ensure health equity for whānau Māori. To survive and thrive within their contexts, Māori whānau drew on mātauranga Māori (Māori knowledge systems) in their everyday practices. Therefore, strategies to support whānau to reclaim and maintain Indigenous practices, alongside the responsibility of healthcare providers to improve health outcomes, are imperative to achieve health equity for Māori.

Ngā ariā matua
Nā te kaikiri, nā te tāmitanga kua hātepengia māriretia ngā taupori Iwi Taketake Māori o Aotearoa, ā, kua piki hoki ngā korenga e ōrite i roto i ngā whakatupuranga. Kua tino pāngia te tamariki Māori e te harehare kakā noa, hei tauira hoki tēnei mō tētahi mate he kino kē atu tōna pānga. Nā ngā rangahau ā-ao ka kitea wawetia ngā wero o te taurima i te tamaiti kua pāngia e te harehare kakā noa, ahakoa tērā, kāore anō tēnei āhua kia rangahaua i Aotearoa. Ko tā tēnei rangahau kounga iti, he kaupapa i whakamahi i ngā ritenga Kaupapa Māori, he whai kia tūhuratia ngā wheako o ngā mātua taurima i ā rātou tamariki kua pāngia e te harehare kakā noa. I noho ko te tūtaki i runga anō i ngā tikanga tētahi ara matua mō te rangahau, nā te whakamahi i ngā kaupapa kōrero, nā ngā uiuinga kanohi-ki-te-kanohi, hei tūhura i ngā wheako tūturu o ētahi whānau Māori e ono. I tātaritia ā-tāhuhutia ngā raraunga, nā te whakamahi aronga Māori, me ōna ariā matua e rima hei anga: 1) te mahi nui kia pūmau ai te hauora kiri mō te tamariki; 2) te taumaha o te whakamā mō te whānau; 3) te māia kia mataara tonu ki te mate nei; 4) te rapu haere tonu i ngā rongoā tika, me 5) ētahi rongoā hāngai ki te whānau/ki te tangata. Nā ngā kōrerorero ka kitea wawetia he rite tonu te tūpono o te Māori ki te kaikiri taketake, puta noa i ngā pūnaha hauora, kura, pāpori hoki, ki te makihuhunu hōhonu; me te korenga e ōrite o te tautiaki a ngā ratonga hauora ka pā ki ngā mahi tiaki i ā rātou tamariki. Hei whakapūmau ēnei kitenga i te ngoikore o ngā hinonga hauora taketake ki te hāpai i ngā herenga o Te Tiriti o Waitangi, ki te whakaū hoki i te ōritenga hauora mō ngā whānau Māori. Kia ora tonu, kia puāwai hoki i roto i ō rātou ao, kua tahuri ngā whānau Māori ki te mātauranga Māori i roto i ā rātou ritenga o ia rā. Nā reira, he mea taketake ngā rautaki tautoko i ngā whānau kia tīkina atu, kia whakapakaritia hoki ngā tikanga hauora iwi taketake mā rātou, i te taha hoki o ngā haepapa o ngā kaiwhakarato hauora kia whakapikia ngā putanga hauora, mō te whiwhinga ōrite ki te hauora o te iwi Māori.

Keywords / Ngā kupu matua
atopic dermatitis / harehare kakā noa; Indigenous / iwi taketake; inequity / ngā korenga e ōrite; Māori knowledge systems / mātauranga Māori; racism / kaikiri; children / tamariki; wellbeing / hauora