Keeping Mothers Well - A Pacific Perspective. Sara ... - Hqsc.govt.nz

Sara Weeks Lotofale PIMHS

Pacific Migration to NZ Concepts of mental health Traditional beliefs around childbirth How big is the problem What can we do about it?

Lower SES High prevalence of domestic violence High rates of teenage pregnancy (48/1000 cf22/1000) High fertility rates

Fonofale model – four posts arising from the floorhold the roof The floor – Family The roof – Culture The posts Spiritual Physical Mental Other eg gender, socioeconomic status etcA problem in any of these will cause some sort ofhealth disturbanceFuimaono Karl Pulotu-Endemann 1984-95

Va is the space between, not the space thatseparates ... but space that relates Va diffusion Albert Wendt 2002

Problems are highly stigmatised Seen as a punishment for own or familytransgression Supernatural explanations Seen as similar to intellectual disability, withsimilar prognosis and management

50 Te Rau Hinengaro4540353025total NZPacific20151050mental disorder ever Mental disorder past year anxiety past year mood disorder past year substance

Even when these areadjusted for age,education, genderand householdincome, thedifferences remain,7060504030pacifictotal20100Serious mental IllnessModerate Mental Illness

The rates of mental illness amongst Pacificpeople are high They seek mental health treatment at a lowrate Therefore there is likely to be a lot ofsuffering which could be avoided

PIFS found increased rates in Pacific women(16.4%) with alarming rates in Tonganwomen (30%) and rather low rates inSamoan women (7.6%) Methodological flaws Behavioural problems in children ofdepressed Pacific women at 2 years oldPIF study Abbot et al ANZJPsych 2006,2007

Samoa Prohibitions during pregnancyBeing alone (aitu)ClothingEating Men not allowed round delivery (busy cooking!) Fofo Failele Gau

Tonga Taboo about shellfish Burial of placenta (fonua) Modesty Kita

Rarotonga High NZ assimilation Herbal laxative mixture Food restrictions while breast feeding Post partum illness

Niue Pica – soap, cigarettes, kerosene Change clothes every half hour during labour Faiava fanau “I think Niue is lost”

Support from extended family very important Feso’asoani Agalelei Whaangae Tamahiki Tamafai fa’ate’a

Huge financial strain Remittances to the islands

Alarmingly high rates in Samoa Virginity highly prized “Wedlock child” (Niue)

PND validation in Samoan and Tonganwomen Prevalence study Education and destigmatisation Pacific friendly services

There is no “I”, there is only “We” ... Sia Figiel Respect Body language Fa’amaa ‘drink’ the medication!