Module 11 Study Notes: Ka mua, ka muri

Module 11 Overview: Ka Mua, Ka Muri

Welcome to the final module of the course, Module $11$ . This module serves as a synthesis of the concepts explored throughout the semester, asking students to consider how these ideas connect to their future studies and professional health practice. The central, recurring theme that has underpinned every previous concept is relationships.

Thematic Foundations

Throughout the semester, the course has explored several key domains:

Social identities and positionality
Knowledge of place
Te Tiriti o Waitangi
Knowledge systems
Planetary health

Learning Objectives

By the end of this module, students should be able to:

Describe the interrelationships between the key concepts explored throughout the course.
Discuss why relationships are highly relevant in health practice.
Identify specific skills and knowledge from this course applicable to future university studies.
Identify specific skills and knowledge from this course applicable to future professional roles as health professionals.

Module Structure

$11.1$ : Kia whakatŉmuri te haere whakamua ( $10$ mins)
$11.2$ : Ka mua: Looking back across the course ( $30$ mins)
$11.3$ : Bringing ideas together
$11.4$ : Ka muri: Looking ahead

11.1 Kia Whakatŉmuri te Haere Whakamua: Perspectives on Time

The module begins with the whakataukĩ (proverb): "Kia whakatŉmuri te haere whakamua," which translates to "I walk backwards into the future with my eyes fixed on the past."

Contrasting Perspectives of Time

Western Perspectives: Time is often viewed as a linear progression moving forward in a straight line. The past is left behind, and the future is positioned in front of the individual. Progress is defined as moving away from historical events.
Te Ao Māori (The Māori World): Time is understood as a system where the past, present, and future are closely connected rather than separate (Rameka, $2016$ ). In this worldview, the past and present are known and visible, meaning they are positioned in front of the individual. The future is unseen and therefore positioned behind. Moving into the future involves carrying the past with you.

Significance for the Health Workforce

This perspective has profound implications for health practitioners:

Historical Context: Clinical places have histories that shape how services are currently structured and delivered.
Systemic Values: Health systems are formed by past decisions and specific value sets.
Human Histories: Both colleagues and patients bring their own unique histories, experiences, and relationships into health systems.
Integrated Practice: Understanding health practice requires responding to the immediate clinical situation while simultaneously engaging with the underlying contexts that contributed to it.

11.2 Ka Mua: Looking Back Across the Course

This section revisits the foundational knowledge and skills required to become a health professional in Aotearoa, centering on the idea that relationships are the heart of health practice.

The Breadth of Relationships in Health

Relationships in health extend far beyond the narrow clinical encounter between a practitioner and a patient. Drawing on the principles of whakawhanaungatanga (first introduced in Module $1$ ), this network includes relationships with:

Peers and colleagues
Whānau and communities
Place and history
Te Tiriti o Waitangi
Knowledge systems informing practice
The environment and the living world that sustains health

Challenging the "Blank Slate" Model of Learning

Learning is often erroneously framed as filling an "empty vessel." However, students arrive at their studies already shaped by:

Geographic upbringing
Lived experiences
Languages of thought
Interpretative frameworks used to make sense of the world

As shown in Module $2$ , these factors are intrinsically tied to social systems and patterns of power, privilege, and oppression. These systems dictate whose knowledge is valued and whose is marginalised. Health professionals are not neutral or objective; each practitioner brings their positionality into every interaction, shaping how care is delivered and received.

Review of Module Threads

Module $1$ : Relationships with peers and building a strong studio environment via whanaungatanga.
Modules $4$ and $5$ : Relationships with Te Tiriti o Waitangi and the responsibilities of FMHS graduates.
Modules $3$ and $6$ : Relationships with place and the impact of history on the present.
Modules $7$ and $8$ : Relationships between knowledge, power, and health practice.
Modules $9$ and $10$ : Relationships with the environment and planetary health responses.

11.3 Bringing Ideas Together: Knowledge Systems and Place

This section explores how different knowledge systems interact and how place influences health definitions.

What Counts as Knowledge?

Dominant Frameworks: Knowledge is often presented as objective and evidence-based, focusing on measuring outcomes and identifying causes. While central to research, this is only one perspective.
Relational Systems: Other systems emphasise the complex interaction of broader influences, such as the conditions in which people are born, live, and work. These highlight the role of place, historical processes, and socio-cultural relationships (Durie, $1998$ ; Krieger, $2011$ ).

How Place Changes Health Framing

Place is multi-dimensional (Module $3$ ), involving physical, social, cultural, and emotional dimensions. Knowledge of place involves recognizing the different needs across geographic locations and how history shapes outcomes in those specific environments.

Case Study: The Interconnectedness of People and Planet

This case study focuses on rongoā Māori (traditional Māori healing systems) as reported by Duff et al. ( $2020$ , pp. $472$ - $-$ 474).\n- **Practitioner:** Hone Moetara at Pirirakau Hauora Health Centre.\n- **Initiative:** Creating a garden of native plants and trees to preserve rongoā practices.\n- **Rongoā Practices:** Includes rongoā rakau (plant-based remedies) and mirimiri (massage).\n- **Holistic Health:** Rongoā treats the whole person, viewing emotional, mental, community, and spiritual problems as potential causes of physical illness. Hone Moetara notes that "Western culture commonly views people and planet as separate pillars," whereas Māori worldviews see them as related and whole.\n\n### Models of Health Compared\n- **Biomedical Model (Module 9 $):** Health is the absence of disease; illness results from body abnormalities and can be understood in isolation from context (Rocca \& Anjum,$ 2020).\n- **Te Whare Tapa Whā (Durie, 1985):** An integrated model involving four dimensions: te taha wairua (spiritual), te taha hinengaro (mental), te taha tinana (physical), and te taha whānau (family).\n- **Reciprocity:** "When the language of the country is sung or chanted, the plant is revived, the land replenished. The heart, head, spirit, there is no separation..." (Ahuriri-Driscoll et al., 2008 $, p.$ 33).\n\n# 11.4 Ka Muri: Looking Ahead\n\nThis section identifies future foundational challenges for health practitioners.\n\n### Challenge 1: A Changing Climate (Planetary Health)\nPractitioners will likely face frequent flooding, severe weather, mental health impacts on communities, new diseases, and acute food/water insecurity. \n**Practice Applications:**\n- Thinking about conditions that produce ill health, not just clinical illness.\n- Recognizing roles across the individual, community, system, and planet.\n\n### Challenge 2: Working Across Knowledge Systems\nEffective practice requires critical engagement with multiple systems (Indigenous and Western) without uncritical privileging.\n**Practice Applications:**\n- Recognizing the strengths and limits of different systems.\n- Listening to patients and whānau even when their understanding differs from clinical training.\n- Avoiding the impulse to "extract" from knowledge systems that are not one's own.\n\n### Challenge 3: Honouring Te Tiriti o Waitangi\nTe Tiriti is a living document establishing the Crown-Māori relationship.\n- **Article One:** Crown must provide good governance (healthcare provision; Reid, 2013).\n- **Article Two:** Guarantees tino rangatiratanga over land, resources, and taonga, including health (Sheridan et al., 2024).\n- **Article Three:** Guarantees Māori the same rights/privileges as British citizens, including the same standard of health (Sheridan et al., 2024).\n**Historical Context:** The WAI 2575$$ Hauora Report highlights the Crown's systematic failure to meet these obligations.

Conclusion: Professional Practice and Positionality

Graduates must understand their own positionality—the histories, advantages, and disadvantages they carry—and how these shape interactions. Being in "good relationship" involves respecting the histories of place (e.g., Ngāti Whātua ńrākei and Waipapa Taumata Rau) and acknowledging that human wellbeing is inseparable from the systems that sustain life.