Dr Hana Tuisano
Pastor Pailate and the late Melitiana Tuisano raised Dr Hana in Invercargill. Her professional and academic experiences, combined with her Tokelauan cultural upbringing, helped her to adapt the Tokelauan concept of māopoopo to understand and manage patient care.
Her PhD explored the māopoopo theoretical framework to centre this worldview within the health sector.
Dr Tuisano has worked as an RN for more than 20 years. Clinical hospital nursing, public health, being a nurse advisor in Tokelau and lecturing at Massey University and Whitireia Community Polytechnic in the Bachelor of Nursing programmes add to her resumé. Also recently the RN liaison officer for Tokelauan patients coming from Tokelau in need of healthcare in Aotearoa New Zealand.
In her dissertation, Dr Tuisano identified the disconnection between Aotearoa New Zealand’s health system and the worldview of Tokelauan patients. The Tokelau Patient Referral Scheme (TPRS) operates a model of care which centres on the tauale (patient), the tauhi (caregiver) and te kaiga (host family).
The māopoopo framework and its potential relevance grew from these experiences, offering a more appropriate socio-cultural collective understanding for Pacific people in Aotearoa New Zealand.
“Māopoopo is a binding value that draws the different aspects of Tokelau social life in the entity we call the nuku, the people, interrelated to and interacting with themselves and their physical environments. It is the essence of a thriving community and best reflects the unique cultural values of Tokelau.
The goal is to educate people about māopoopo, a Tokelau worldview. Māopoopo, conceptually, serves as a cultural connector with people, a motivator of action, and an informant of principles that guide behaviour in practice,” Dr Tuisano says.
"Ko te role a te kāiga, e iei te kupu faka-Tokelau tōkaga, ko na kāiga ni tōkaga e o te nuku.
There is a Tokelau word that describes the family's role in the nuku (village)… it’s tokaga…the pillars. The families are the pillars of the village.”
Dr Tuisano’s PhD research involved 37 participants, comprised of intersectional communities within the Tokelauan collectivism structure.
“Tokelau elders, leaders and adults shared their views on Tokelau wellbeing, historical knowledge and perspectives on migration. These conversations also highlighted the unique position of Tokelau and its relationship with Aotearoa New Zealand.”
Her findings showed that Tokelauans rely heavily on relationships with one another, in contrast to a more individualistic view.Pacific health professionals were interviewed to shed light on the inequities built into our current health structures and systems. The interviews echoed health literature, which sees that equity can only be achieved through good data and policy design and implementation.
Dr Tuisano intends to use her research to help shape the future framing of health policies. “The framework facilitates the focus on collective action through effective cross-government and intersectional approaches. In this way, it could be utilised to ensure effective approaches of collaboration between the healthcare system and the social, housing, employment, and education sectors.”
Dr Tuisano sees the valuing of Pacific understandings of well-being as key to supporting and empowering communities through active inclusion in service design and implementation. “Greater, and better, reciprocity in relationships between government agencies and Pacific communities is needed,” she says.
She believes that health services need to be more closely aligned with the realities of Pacific communities. “This can be done by providing on-site multilingual health workers and incorporating cultural practices and concepts into service delivery for Pacific peoples.”
The revitalisation of Te Gagana Tokelau
“Throughout my PhD journey, it was important for me to use Te Gagana Tokelau (the Tokelau language) with my participants. Being able to speak in one's language adds nuance and richness to the conversations and knowledge learned, Dr Tuisano says.
In 2018, 8,000 Tokelauans were residing in Aotearoa New Zealand, compared to 1,400 in Tokelau. Of those living here, only 2,025 people of Tokelau descent can speak Gagana Tokelau.
Dr Tuisano says she is passionate about being part of the journey to revitalise Te Gagana Tokelau. “It is now an endangered language, listed by UNESCO World Atlas as the eighth most vulnerable in the world. In the diaspora, Te Gagana Tokelau is being used less and less within families. Therefore, second to fifth-generation Tokelauans now require urgent access and support in learning and maintaining their mother tongue to protect the language from extinction.”
Recently, the Tokelau Administrator Office within the Ministry of Foreign Affairs and Trade Manatu Aorere, the Council for the Ongoing Government of Tokelau, and retired anthropologist Associate Professor Judith Huntsmen collaborated on the reprint publication of the Tokelau Dictionary alongside the Tokelau Dictionary Project team.
Dr Tuisano and the Tokelau Dictionary Project team continue to vouch for more reprints to become accessible to Tokelauan households.
“Te gagana Tokelau ke olatia!”
The Tokelau Language is a thriving language
Future aspirations
Pacific identity remains front and centre of her academic career. She has aspirations to bring together Tokelauan academics to increase the positive impact of their knowledge on the Tokelauan community.
“I would envisage a positive outcome of knowledge sharing and encourage Tokelauans to embark on doing further postgraduate studies, in particular doctoral studies. This is a great opportunity for Tokelauans to share their insights on topics of interest and to contribute to the body of knowledge in the academic world.”
“I can foresee that māopoopo can help transform relationships between the Tokelau community and the health system that is more responsive, accessible and inclusive of the Tokelauan community and their needs and aspirations.”
Acknowledgements
Dr Tuisano acknowledges the participation of all involved in her PhD journey.
“I acknowledge all who shared their wealth of knowledge. Fakafetai lahi for the humorous, sad, and joyful accounts of your experiences and personal views that were shared in this study.
To my supervisors Dr Lis Ellison-Loshmann, Dr Anna Matheson, and Associate Professor Ridvan Tupa’iilevaililigi, for dedicating their time as my supervisors to get me through my PhD journey, to whom I am grateful on all levels.
Fakafetai lahi lele to my Tokelau academic cultural mentors Associate Professor Sania Faʻamaile Betty Ickes, Honourable Minister of Education in Tokelau Mr Kelihiano Kalolo, Mrs Vae Lopa who assisted and taught me how to translate te Gagana Tokelau and to Mr John Pedro who assisted with proofing.
A Special thank you to my praying parents Pastor Pailate and the late , my sisters Ruth, Mauosamoa, and Sitoga and their families.”