Original Research OPEN ACCESS Traditional medicine use in the Pacific community in Dunedin New Zealand
Evan WILSON,
1Ben GRANT,
1Rosa TOBIN-STICKINGS,
1Hanneke HEWTHWAITE,
1Gina FRANKLIN,
1Sarah OH,
1Simon GUAN,
1Thomas BOROWSKY,
1Kirsty THWAITES,
1Timothy LEAPER,
1Jun LEE,
1Susan JACK,
2Faafetai SOPOAGA
3*
ABSTRACT
Introduction: Traditional medicine (TM) has been practiced in the Pacific islands over many years, and Pacific peoples continue to use TM after migrating to New Zealand (NZ). There is limited published literature on Pacific TM use in NZ. This study explores the views, use of, and access to TM of Pacific peoples living in Dunedin, NZ. The information provides a valuable contribution in an important area where there is a paucity of information, and will also inform content development for the Pacific health curriculum for health professional courses at the University of Otago.
Methods: Cultural processes were used to inform and guide the recruitment of participants and data collection phases. Four focus groups were conducted with 15 Pacific Island community members.
Interviews were recorded, transcribed, and analysed using an inductive approach to identify main themes.
Results: Three main themes emerged from the data: Firstly, perspectives of TM from Pacific peoples, which were varied and included the importance of spirituality, the environment, and inherited knowledge. Secondly, the use of TM, which incorporated plants, massage, diet, family togetherness and other forms of healing. Reasons for the use and differences in uptake between groups were also identified.
The last main theme identified was barriers in accessing TM, which included the scarcity of traditional healers, resources, and cost.
Conclusions: The findings suggest Pacific peoples’ perspectives of TM encompassed a wide spectrum of views, knowledge, and techniques. There were identified barriers in access and substitution where traditional ingredients were not available. Some expressed concern that TM use may decline due to loss of exposure and availability of resources. Other challenges are fewer traditional healers and relevant plants in New Zealand. Assisting Western health professionals to engender discussion and openness to TM use in Pacific Peoples is likely to support patient care.
Keywords: Traditional medicine (TM), Pacific health, Pacific medicine, alternative medicine, complementary and alternative medicine (CAM).
INTRODUCTION
Traditional medicine (TM) incorporates a holistic approach which engages a patient’s mental, emotional, physical and spiritual well-being. TM is also known as ethno-medicine, indigenous or folk medicine, native healing, or complementary and alternative medicine, and could be considered the oldest form of health care.1, 2 According to the World Health Organization (WHO), TM can be defined as the “sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the
*Corresponding author: Faafetai Sopoaga [email protected]
1.Final year medical student, University of Otago, Dunedin, New Zealand
2. Senior Lecturer, Department of Preventive and Social Medicine, Dunedin School of Medicine
3 Associate Professor, Associate Dean (Pacific), Centre for Pacific Health, Va’a o Tautai, Division of Health Science Received: 08.12.2017; Accepted: 20.02.2018
Citation: Wilson E, et al. Traditional Medicine Use in the Dunedin Pacific Community in New Zealand. Pacific Health Dialog 2018;21(1):17-26. DOI: 10.26635/phd.2018.903.
Copyright: © 2018 Wilson E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
prevention, diagnosis, improvement or treatment of physical and mental illness”.3
There is growing public interest in the use of TM internationally. Despite this, there are significant gaps in the research. A key issue identified is the different terminology used for TM or different definitions about what constitutes TM. In NZ, there is sparse information on TM use, however, 23.4% of New Zealanders are reported to have used Complementary and Alternative Medicine (CAM).4 Another global trend is higher rates of TM use in low and middle countries. For example, use is reported in 71% of the population in Chile, and up to 80% in some African countries, where a number of bacterial and fungal infections are primarily managed through the use of TM.2, 5, 6 In high income countries, reported rates are lower, with 68.9% in Australia, 51.8% in the United Kingdom, 60% in Hong Kong, and 74.8% in South Korea.2, 7-9 There is a recognition of the need for health professionals to learn about TM, with the inclusion of teaching around TM practices in some medical school curricula.10
In the last decade, research has increasingly focused on exploring the patterns of use, as well as patient experiences of TM.11 The way TM is viewed by western healthcare professionals has also been explored. One study found that the practice of CAM by General Practitioners (GPs) in NZ had decreased over a 15-year period.
However, this study also found that the number of GPs referring to CAM professionals had increased, and researchers recommended that information around CAM should be included as part of medical education given to patients.12 In contrast, some medical providers in American Samoa believed the effects of CAM to be harmful, and advised patients to cease the use of CAM for breast and cervical cancer. Several key factors influence a provider’s likelihood to use CAM as part of their practice, including their gender, years of practice, and ethnicity.13
Pacific TM
Traditional medicine has long been practiced in many of the Pacific islands, and may include herbal medicine, the use of stones, faith healing, bone setting, and massage therapy.1 The practices and knowledge are usually passed on orally, with specific people in the community selected to continue the practice of TM. Consequently, written information about these TM practices is sparse.
Studies on TM use in Pacific Island countries found 60% of Nauru people and 80% of the Fijian population use traditional medicine.1 Traditional birth attendants deliver 40% of all births in Samoa. Pacific peoples continue to use TM when
they migrate to NZ14 with approximately 40% of Pacific peoples living in NZ having been born in the Pacific Islands.15
Although there is evidence in the use of TM in Pacific Island countries, the practice of TM is sometimes discouraged by individuals and Pacific organisations whose views are that these practices are redundant or ineffective.16 Areas identified that require further research include exploring the efficacy of TM, side effects, and access for Pacific Island communities in NZ.16 It is essential for healthcare professionals to understand more about Pacific TM, and the extent to which it is practiced by Pacific peoples in NZ. It can inform healthcare professionals about holistic and Pacific cultural approaches to healthcare, and how best to provide support for the users of TM in these communities.17
A group of final year medical students during their six-week public health attachment, supported by two supervisors, conducted this research. Our aim was to explore the views, use of, and access to TM among Pacific peoples living in Dunedin, New Zealand. The findings will be used in the development of the Health Sciences Pacific health curriculum at the University of Otago, and will also contribute new knowledge in an important area with limited information.
METHODS
Recruitment Process
Four focus groups from the local Dunedin Pacific community were organised with the assistance of the university Pacific Advisory Group (PAG) in collaboration with the Pacific Trust Otago (PTO), a local Pacific health provider. The Office of the Associate Dean (Pacific) (OADP) in Health Sciences worked closely with the researchers and the PAG/PTO to support the processes for engagement. A staff member from the OADP attended each focus group session to provide support and assist where required. Researchers followed due process according to the University of Otago Pacific Research Protocols. A small gift (koha) was provided for each participant at the conclusion of the focus group.
Focus Groups
Two ethnic-specific (Samoan, Tongan) and two mixed-ethnic focus groups were conducted.
Involvement was dependent on the availability of community participants on the specific week allocated for data collection. Each focus group had between 3-5 participants. The first two focus groups were held in the Office of the Associate Dean (Pacific). The last two focus groups were
held at local community venues specified by leaders of those communities.
Data Collection
Focus groups lasted on average 80 minutes. The semi-structured interviews were facilitated by two members of the research team using a pre- determined question set (see Table 1). Interviews were audio recorded and transcribed. These transcriptions were reviewed by the focus group facilitators for accuracy. The transcriptions were analysed using a thematic approach by six individual researchers. Emerging ideas from the initial analysis were collated and coded into sub- themes, and further analysed to identify the key themes.
Cultural Protocols and Context
Cultural processes were followed in the recruitment and data collections phases. The researchers were a group of eleven final year medical students. This research provided the training doctors with the opportunity to learn about how to engage with Pacific communities in research in a culturally appropriate manner. For example, there were formal cultural processes before starting and after completing the focus groups. These included prayers, acknowledgement of the journeys of both participants and the researchers, sharing of context, and exchange of gifts. The researchers received support for these processes through the Division of Health Sciences, Office of the Associate Dean (Pacific).
Inclusion Criteria
Pacific elders, leaders and adult community members of the Dunedin Pacific community who were identified as having expertise, experience, or knowledge of Pacific TM were endorsed by their ethnic communities to participate in a focus group for this study. Participants had at least conversational English, although two Samoan speaking participants received support for translation by a Samoan-speaking University staff member.
Exclusion Criteria
Children or adult community members who were not endorsed by the local community to participate in a focus group, or who did not have conversational English.
Ethics
Ethics approval was granted by the University of Otago Human Ethics Committee under Category B: Minimal Risk Research. The ethics committee reference number is D17/345.
Confidentiality
Data from the focus groups was kept confidential to the research team and any comments or quotes used were anonymised.
Table 1: Focus Group Questions
1. What are your experiences of traditional medicine in Dunedin?
- How does this differ from experiences elsewhere?
- What do you consider to be traditional medicine?
2. Traditional medicine can have lots of value and significance for people for different reasons. What are some of the reasons you use traditional medicine?
- Why not? (if that is the case)
- What situations is traditional medicine used in? What situations aren’t?
3. What are the ways that you access the traditional medicine?
- How does this differ to when in the Islands vs other places in NZ?
- What barriers exist to accessing traditional medicines?
- How has access to traditional medicines changed over time?
4. How do people in your community view traditional medicine?
- How have others responded to your use of traditional medicine?
- What is your experience of the health care professionals and traditional medicine?
- How has this changed the way you use traditional or NZ medical systems?
FINDINGS
Fifteen participants took part in this study (Table 2). Seven ethnic groups were represented. Most were from Tonga and Samoa, majority aged 60+, and more males were involved (60%).
Table 2: Participant demographics Characteristics N =
15 %
Gender Male Female
9 6
60 40 Age groups (years)
30-39 40-49 50-59 60+
2 2 4 7
13 13 27 47 Ethnicity
Tongan Samoan Fijian Tuvaluan Tokelauan Kiribati Cook Island
4 4 1 2 1 1 2
27 27 7 13
7 7 13
Three key themes were identified from the data, and each theme had a number of sub-themes (Table 3).
Table 3. Themes and Sub-themes 1. Perspectives of TM
a. Varied Definition of TM b. The Importance of Spirituality c. Relationship with the Environment d. Inheritance of Knowledge and Skills 2. Current practice and experiences with TM
a. TM practices in Dunedin b. Generational and Contextual
differences in TM use
c. Relationship between Traditional and Western Medicine
3. Barriers to accessing TM in Dunedin a. Scarcity of Traditional Healers b. Scarcity of Traditional Plants c. Cost of TM
d. Adaptation and substitution
The first theme outlines different perspectives on TM. What participants considered to be TM was varied and included plants, massage, dancing, food, music, and being connected. There was a strong belief in a higher power or God and its influence on health and the healing process. In addition, there was a connectedness between the environment and healing, and that there was a process for passing down traditional knowledge and skills through generations. The second theme focuses on current practices and experiences of the participants. Similar to the first theme, the TM practiced locally was varied and included plants,
massage, and prayers. There were generational differences in the confidence people had in using TM, with the older participants having more confidence. Most indicated that they would be comfortable to use either TM and/or western medicine, depending on its suitability for the condition being treated. The final theme focusses on barriers to accessing TM. The main barrier identified is a lack of available resources (e.g.
traditional plants) and skilled people who practice TM in Dunedin. The cost associated with accessing these ingredients can be prohibitive. As a result of this, in some situations, participants have trialed the use of substitutions with a similar product available in New Zealand.
The following section describes the three main themes and their sub-themes with quotations from the focus group participants.
Theme 1: Perspectives of TM
Sub-theme 1a: Varied Definition of TM
There is a wide spectrum of what can be considered TM by participants. Plants and herbal medicine were consistently discussed in all focus groups.
“[I think] traditional medicine is … herbal medicine or anything to do with plants.” (P7)
“Our leaves, our roots of our trees and our plants ...
the sap from our trees, our branches and those are traditional medicines, you know.” (P14)
Participants considered TM as natural and free from chemicals. Pills are seen as being an unknown with regards to their components, where they are manufactured, and who has made them.
“Traditional medicine to me means anything [that]
doesn't use drugs.” (P5)
“[I] think it's that leaning towards things natural … a pill, it's in the bottle you don't know where it's come from.” (P11)
Food was considered by some participants to be a form of TM, as diet itself can be a cause of disease and illness, or contribute to healing and good health.
“In the islands, food is medicine” (P11)
“We live on our environment, and we fish, the forest, the river, the sea, all of that is our food, food is our medicine, you can heal yourself with what you eat, or you can kill yourself with what you eat!”
(P14)
Emphasis was also placed on massage, dance, and family togetherness as TM.
“[At] our kava session ... we sit down and we talk, and it's a safe space where you can share things ...
getting together ... we have our therapy session.”
(P7)
“[A lady in the North Island] she's very good with broken like injuries … she knows how to put it back ... and massage, touch, people to recovery” (P6)
“...we sing a lot together, and we dance a lot together...that's very special, it's like a healing in itself, then you laugh together, and it does help.”
(P?)
Sub-theme 1b: The Importance of Spirituality Participants stated that belief in the involvement of a higher power in the healing process was important.
“[For] all those born on the island, it’s a belief system. Because we've seen it. We can't explain it, we don't have the chemistry knowledge or whatever, but that belief handed down that these things work. Not everything works obviously and I think that's really important that traditional medicine goes with that belief whether it's a spiritual belief [or] a belief in God but there is a belief there.” (P11)
“You used chants and you call on the gods … it's not just like physical … it’s the presence of, the presence that you can't see.” (P5)
Religion may influence the interpretation of this higher power. Christianity uses God as an explanation. The higher power was seen to work through either a person as a healer, or the TM itself.
“We do believe that our God gave us those plants and we can use it in whatever ways in sickness … God is working within those, medicines because every time we do those kinds of medicines we pray.
We pray that may God bless those medicines.”
(P12)
“The women who come to me … I tell them I'm not the healer, Jesus is. But He said I can do anything through Him who gives me this strength. It's not just the physical, but the spiritual side.” (P6) This higher power may come from ancestors, giving power to those in the present.
“... our ladies from Samoa who have the experience from bestowing their ancestors to them, they can do that, [heal] from a distance.” (P14)
“I believe, our fathers and ancestors passing onto us, that understanding ... because we want to use the fruit of our environments … it’s us, it’s our blood.” (P14)
A commonly held belief among Pacific peoples is that of spiritual illness, that may cause physical
manifestations. Pacific people consider that much of what has been called mental illness is likely to be a disturbance by a spirit. Healing may require removing ‘evil spirits’ which can arise from bad deeds or an unhappy spirit.
“...this will be the traditional healer speaking … and it’s often related to something that the spirit is unhappy about that, either this person … or somebody in the family of this person has done.”
(P8) (Translated)
“We do heal evil spirits as well in my culture ... we never treat people, like, they're mental, or they need psychiatric treatment … [there] is an evil spirit [that] is disturbing them” (P6)
“I wouldn't call anybody mentally sick .... a lot of the healing can be done [by] togetherness.” (P6) Additionally, the breakdown of the family unit, the foundation of the Fonofale Model of Health, was also highlighted as a cause for poor mental health.18
“I'm a strong believer that our Pacific way of being with our families is broken down … because we were chasing one thing called the dollar. And we don't have time to talk to each other and share.”
(P11)
Sub-theme 1c: Relationship with the Environment
Pacific people have a strong connectedness with the environment, linked with spirituality and making use of nature as a source of healing and wellbeing.
“We have a love of medicines, our traditional medicines. Samoan people are dependent on our bush, on our forest, on our sea and our river and all of our surroundings ... That’s why we experience any leaves, any herbs, any weed … and it’s turned into medicines.” (P14)
“People get sick [and] you get sent to stand in the saltwater… If you think about it, the saltwater’s full of minerals! It's full of all sorts of things!” (P11)
“It’s the circle of life … it’s really important that the placenta is buried, and then the leaves that you use for healing comes from the land.” (P15)
Sub-theme 1d: Inheritance of Knowledge and Skills
TM is provided by those specific community or family members who have been gifted the knowledge and experience through generational teaching. There are specific families who carry skills for different types of TM, and are trusted with specific roles.
“It’s a family thing, knowledge, so when you know a family that comes from a family of traditional healers, then they are the ones you go to, and you trust that what they will offer you is ... good.” (P5)
“The traditional Tohungas (Traditional Doctors) [are] the people in the community who have the knowledge that has been passed down through their families.” (P11)
“Even for massaging, different family have their own specialisation in massaging. Some for trauma cases, some for pregnancy.” (P9)
For some types of TM participants explained how they themselves had learned to use TM from their own parents and grandparents. These experiences continue to influence their use of TM.
“...my mum said why don’t you try bounding some ginger and then mix it with water, and I remember that’s what I used to take growing up back home.”
(P2)
“If you have stomach-ache … my mum told me go and chew … the guava leaves.” (P3)
Theme 2: Current practice and experiences with TM
Sub-theme 2a: TM practices in Dunedin
Among the Pacific peoples represented by the focus groups, there was a wide variety of TM practices. The most widely discussed was the use of traditional massage.
“But the massage is something that carries over because it is using your own knowledge of part, of the body parts, the organs...” (P5)
“We have masseurs, men and women and in the Tokelauan culture, men do not massage women, and women do not massage men.” (P6)
Massage was found to have multiple uses through the Pacific cultures, including in pregnancy, for newborns, for certain illness, and after injuries.
“Pregnancy isn't considered like an illness, but it's still a struggle with giving birth and she came in and she did a massage, and … the woman started going into labour easily and give birth.” (P6)
“And we start from birth. The massage starts from birth … the masseurs job is to encourage that body, that little body strength in that little body.” (P6)
“Even for massaging, different family have their own specialise in massaging. Some for trauma, some for pregnancy, some for different kinds of diseases, skin diseases and some for mens’ disease and for woman's disease.” (P9)
Use of the entire coconut tree in TM is also common among Pacific peoples. The leaves, husks, roots, green coconuts, their flesh, and
coconut oils are all used on the Pacific islands.
However only the oil is commonly used in Dunedin, primarily for use in massage therapy.
“Coconut tree is full of medicines ... the green coconut is used for particular medicine, [the] red one is used, [and] the roots are used for something else.” (P11)
“Like a coconut oil that's been bought from the island to massage children or ourselves.” (P10) In addition to coconuts, there was a wide range of other plants, herbs and spices used to treat a variety of ailments, including aloe vera for wounds and skin conditions, chilli leaves for boils, and ginger for fever.
She gave me a bottle of oil that she made with the cactus, aloe vera ... she boiled it and she blessed because she saw my grandson with the eczema kind of thing.” (P10)
“When somebody has a boil, we can use the chilli leaves.” (P7)
“She was having this um a little bit of a temperature … my mum said why don’t you try bounding some ginger and then mix it with water.”
(P2)
Spiritual faith and prayers are also used in conjunction with traditional practices.
Mum will change the wounds again, will go through the process again. And also prayers with that, is very important in that practice. Yeah, Mum always have a prayer.” (P10)
Sub-theme 2b: Generational and Contextual differences in TM use
Despite most participants having used TM, those born in the Islands displayed greater confidence in TM than NZ born Pacific peoples.
“I mean here in Dunedin, we still have those kind of plant, and massage and oil. And we still maintaining those, like we’re still using those kind of things. Our children, now in Dunedin, they, they don’t believe those things unless they go back home, and they see with their own eyes.” (P12)
“I think the younger people probably don't have the affinity [for] traditional medicine.” (P11)
This discrepancy was believed to stem from different experiences between the generations, whereby those born on the Islands had a far greater exposure to traditional practices.
“I guess for us we experienced it, we've seen it work!” (P11)
“So I'm from the generation who were born in the Islands, but I’ve grown up here all my life, so I've
never had this wonderful experience of being treated with traditional medicines.” (P13)
Participants expanded further, voicing concerns over the future of TM if this trend is to continue.
“I think maybe the generation, maybe 5 or 10 generation and then there is no more [TM use].”
P12
Sub-theme 2c: Relationship between Traditional and Western Medicine
The use of TM in Pacific populations did not preclude their use of western medicines. Most admitted to using both methods, sometimes concomitantly, or where one was trialed before changing to the other.
“They would still go to the hospital, but then on the side sometimes they also [use traditional medicine], it’s two types of approaches, so some they do it alongside.” (P5)
“This is more medicine in addition to the medication we get from doctor or sometimes before we go to see the doctor we use our traditional medicine first or sometimes we use after, when we use traditional medicine when western medicine doesn't work.” (P9)
Participants expanded further on this theme, explaining that certain illness can only be treated by TM, and vice versa.
“Cause some condition is not suitable for western medicines but is good for traditional medicine.
Some conditions is not good for traditional, but is good for their.” (P9)
When TM use was disclosed or discussed with western health professionals, a common reaction was to determine any drug interactions.
“I remember asking my GP if I could take ... like herbal [medicine], and I think he wanted to know exactly what I would be taking so it doesn't affect, have an impact on the other medication that I was on.” (P5)
However, occasionally when western health professionals would recommend against the use of TM, their advice was generally followed.
“And sometimes for us now, when the doctor say no you don't use a traditional medicine, that is one of the situations I don't use traditional medicine. If the doctor tells you not to use any other kind of medicine.” (P9)
Theme 3: Barriers to accessing TM in Dunedin Sub-theme 3a: Scarcity of Traditional Healers
In Dunedin, many TM are scarce, or simply not available. One cause for this scarcity is the lack of local traditional healers, with the inherited knowledge and skill to provide TM.
“I don't know about in New Zealand … but in Tuvalu, you have some certain families some certain people with the skills.” (P9)
“They know who to go to the village, whereas here, you don’t know who’s here eh? I mean, we don’t know who lives in Dunedin.” (P13)
Another challenge was limited information and ways of communicating, and reliance on word of mouth or chance meetings to inform people of the availability of TM.
“You have some certain families some certain people with the skills. So if you know someone like that here in New Zealand, if you have a chance [to]
meet them, then we will go for them or something.”
(P9)
Even amongst those who knew individuals practicing TM in NZ, there were further difficulties in access due to the dispersed nature of Pacific people across NZ, and the relatively small Pacific population in Dunedin.
“I haven't experienced anybody uh here. But up in the North Island, and Sydney, my family are all over there too, and they have been healing people.” (P6)
Sub-theme 3b: Scarcity of Traditional Plants Plants, herbs, and derived materials used in TM were often not available in Dunedin, this is likely to be due to the different climate and conditions compared to the Pacific Islands.
“Lots of trees and plants and herbs are useful but obviously there are quite different ones that come from the Island to here, that you don’t have those easily accessible here in Dunedin.” (P15) (Translated)
Of those plants which are available, or similar to those found in the Islands, many Pacific peoples are apprehensive about their use.
“For the fact that I wouldn’t know the plant and I wouldn’t trust that they are the same plants that we use in Tonga.” (P4)
“You go to the gardens there’s a lot of them [ferns].
It’s everywhere here. I wasn’t quite sure are they the same plant that we use in Tonga. So that’s what kinda put me to stop using some plant for traditional medicine.” (P1)
New Zealand’s strict border control further limits access to plant based medicines.
“Sometimes I wish I could bring some leaves back home but we're not allowed to you know through the customs.” (P10)
Regardless of availability, some participants believed that TM from NZ would not work due to the loss of connection with their ancestral land.
“This practices only gonna work on the island. It will never work when you leave off the island, and practice somewhere else.” (P10)
Sub-theme 3c: Cost of TM
Despite their availability, some TM are not frequently used due to their comparatively high cost in NZ compared to the Pacific islands.
“We do know that if we go back and eat our vegetables like we did in the island. Eat lots of fish!
It’s a medicine … but we can't do that here. Won't because it's too blimmin’ expensive.” (P11)
“We could make the coconut, we all know how to make coconut oil, but it’s 4 dollars for 1 coconut, you need 100. You know, so it's impractical.” (P11)
Sub-theme 3d: Adaptation and substitution Some Pacific peoples have adapted to the scarcity of TM by replacing unavailable ingredients with substitutes.
“If we don’t have the Samoan oil, we use the baby oil instead because it’s the equivalent of our Samoan oil.” (P14)
“I think that’s clover. White clover. I used to ‘cause it’s similar to type of plant called kehekehe.” (P1)
“So it's substituting or using an example of substituting coconut oil [with] virgin oil, olive oil … And that's what she uses for her massaging; olive oil. Because we can't put coconut oil in, it's too expensive.” (P11)
Some participants are looking for alternatives by learning and adopting local Māori TM.
“We don't even have the plants that we use at home over here because of different climate so we don't use traditional here but we want to learn how the Māori people use their herbal medicine.” (P9)
DISCUSSION Defining TM
Our study results are consistent with the literature which suggests no singular definition of TM. TM was perceived to be a treatment that is natural and free of chemicals; and diet was included as well as herbal and plant-based medicines, massage, and spiritual healing. TM
providers generally learnt through generational teaching, with specific knowledge and skills being passed down through families, and different families having special areas of expertise. The spiritual component was very important, and the belief in a higher power for healing was used in conjunction with other therapies. Mental health was not considered to be an illness and may be due to the breakdown down of the family, a key facet of the Fonofale model.18 The Fonofale is one Pacific model of health outlining components important in a holistic approach. These include physical, mental, spiritual, and culture as well as family, context, socio-economic, and the environment. In Dunedin, Pacific community members utilise different types of TM. The extent of use appears to be influenced by their context, background, where they were born, and their age.
This is consistent with the international literature on TM in other areas.1,14-18 In addition, external factors such as access to materials and availability of skilled providers influences use. This variation in the use of and perspective of TM may make it difficult for future research to quantify use of TM in NZ. However, this study has provided valuable information about Pacific peoples perspectives on TM.
Declining use of TM in Dunedin, NZ
The results from this study suggest a possible decline in the use of TM in Dunedin and it may be a similar trend nationwide. Participants born in the Pacific islands with exposure to TM had confidence and were more likely to continue use.
Most Pacific peoples (60%) now living in New Zealand were born here.14 Those born in NZ with less exposure to TM were more likely to prefer Western medicine as a first choice. In addition, using substitutions may reduce the authenticity and effectiveness of TM in NZ.
Improving accessibility
Several barriers were identified, including the availability of traditional healers and traditional plants. Methods such as use of social media or other networking techniques to advertise the availability to local healers, or investigation of safe importation of TM ingredients, could be explored. Provision of information and support regarding available local flora similar to Pacific plants, or different TM techniques, may introduce previously unused resources. Further research into methods of improving availability and evaluating their effectiveness is therefore needed.
Interaction of TM with Western medicine Local health professionals were generally accepting of TM use by the Pacific community.
This is consistent with NZ research with increased GP awareness of TM and CAM.12 It is possible that users of TM may seek out health professionals who are more open to its use. This varies, with the likelihood affected by the practitioner’s gender, age, and years of practice.13 Our study found that different patterns of TM use were identified. These included using TM as a substitute for western medicine, using TM concurrently with western medicine, and the use of TM prior or subsequent to western medicine.
The pattern of use depends on the confidence and knowledge of the user and at times, their interactions with western health professionals.
Some participants stated that if they were told explicitly not to use TM by a western health professional then they may respect this if done politely. In instances where an illness did not appear to respond to western treatments then participants would try TM and had faith that this would then work. Many TMs appear to involve spiritual care, and this may be an aspect of care that is useful to have alongside western treatments, and is aligned with the Fonofale model.18 Western health professionals need to create an accepting atmosphere around TM use in their patients. In this context, patients are more likely to disclose any TM use, allowing checks for possible contraindications whilst respecting cultural views.
Limitations
Time constraints were the major limitation of this study. The number of focus groups were restricted, and we may not have reached data saturation. We aimed to offset this by involving knowledgeable participants nominated by the PAG and PTO.
Additionally, no formal responder validation was undertaken. However, the researchers invited participants to the formal presentation of the project, with the aim that any major discrepancies between the participants’ meaning and researchers’ understanding were addressed.
Our researchers were not experts in the area of Pacific culture, which could have limited our ability to engage appropriately with participants and therefore limit the information gathered during the interviews. To facilitate better engagement and allow appropriate cultural processes to be followed, focus group interviewers were accompanied by a Pacific staff from the Office of Associate Dean (Pacific).
All participants were required to have conversational English to be included in the study, however, English was a second language for the majority of participants. Translations for two Samoan participants were given by a Samoan-speaking University staff member when this was needed for more complex explanations.
However, for participants of other ethnicities for whom translation was not available, we observed at times that language was a barrier.
A further limitation to the gathering of information at the focus groups was failure of recording technology. During one focus group, the dictaphone failed to record and so the majority of the discussion was not recorded.
Three interviewers were present, and with reference to field notes, were able to document what was remembered of the conversations. This may have resulted however in the loss of, or errors in, some discussion points.
CONCLUSION
This study has provided very useful information about the perspectives, use of, and access to TM by Pacific peoples in Dunedin. It has added to the limited literature on TM use by Pacific peoples in NZ. There was a wide variation in what Pacific peoples considered to be TM. The use of TM was influenced by a number of reasons including previous positive experiences, access to TM, and confidence in the ability of the traditional healers.
Pacific peoples born in the islands were much more inclined to use TM compared to NZ-born Pacific Islanders. With limited access in New Zealand, and substitutions for ingredients not available, some were concerned that TM may be lost for those who live in NZ. Better information systems may help share more widely the availability of traditional healers in NZ. Western health professionals can play an important role by facilitating positive and open discussions with patients who may choose to use TM.
ACKNOWLEDGEMENTS
The researchers would like to thank the University Pacific Advisory Group (PAG), Pacific Trust Otago (PTO), the Office of Associate Dean (Pacific) in Health Sciences, and especially the participants who contributed their time and shared their valuable knowledge. We would also like to acknowledge the Department of Preventive and Social Medicine at University of Otago, Alison Crossan, Kate Morgaine, and Talai Mapusua for their support for this project.
Conflict of Interest: None declared
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