Family Centred Healing

Ramona Tiatia

This doctoral study was funded by the New Zealand Health Research Council, through the Career Pacific Award. The study builds on Ramona’s Masters thesis on the exploration of Samoan traditional healers and the importance of the family household as a significant site for the cultural construction of health care provision. Ethics approval was obtained to interview two distinct participant groups of Samoan ethnicity in the Wellington Region who had undertaken official practices at home: renal (kidney) dialysis through a district health board; and a sentence of imprisonment by home detention through community probationary services. Fieldwork began in early August 2006 and was completed in June 2009. Samoan dialysis patients (n=5) and their carers (n=8) were recruited from the community by snow-ball technique through community networks. Samoan prisoners (n=2), their sponsors (n=1), prison officials (n=5) were recruited with the assistance of Corrections New Zealand. Key informants: Samoan elders (n=3), Advisors (n=6) from institutional and community networks in Aotearoa/New Zealand and Samoa.

An important component of the study was the exploratory use of a photographic method (Photovoice) to document the unique insider perspectives of patients’ and offenders’ day to day realities of managing Chronic Kidney Disease on Home Dialysis, and being Electronically Monitored under surveillance on Home Detention.

Rationale

Ramona’s PhD is a qualitative research study about housing, health and well-being. A central question focuses on the management of chronic disease and offender rehabilitation within the domestic household by state and civil control mechanisms. Investigation considers the extent to which the formal roles related to care giving, punishment and protection are affected by highly regulated health and offender services in the homes of Samoan families in Aotearoa/New Zealand.

Theoretical approach

The Samoan traditional built environment is inextricably embedded in natural landscapes and architectural motifs. Because of this, the analysis of visual data and in-depth interviews produced by participants relies on a range of complex Samoan epistemological paradigms (Aganu’u Samoa). Developing the epistemological framework of the study has involved in-depth discussions with Samoan elders and advisors.

Methods

Following the action participatory model, theoretical and historical considerations led to the use of photographs to document and analyse housing experiences and health inequalities amongst Samoan families. The methodological approach involved the distribution of disposable cameras as a means of producing photographs to document the families’ perspectives and stories of home and the impact of chronic disease and surveillance on their domestic lives. Once the photographs were developed, qualitative in-depth interviews were carried out with the participants; visual data and transcripts were then analysed thematically. The results and recommendations will be reported directly to the key governmental stakeholders supporting the study.

Summary

Because this study also focuses on families in their homes, it considers the suitability of the built environment in response to the high complex and sensitive realities posited by renal (kidney) failure and prison incarceration. If it is true, that “we shape our dwellings, and afterwards our dwellings shape us,”[1] then deciding on how to capture these complexities has required more than just a collection of visual stories through a range of multi-disciplinary approaches, it requires practical application of the findings that include a critique of power relations.

The photographic data and interview transcripts are generating many insights, for example about the inversion of gendered roles and responsibilities, the dynamics between regulated and private space, consent and compliance, storage of medical supplies and waste disposal, stigmatisation of chronic illness and imprisonment by electronic monitoring, transitional costs between state to civil society.

Lastly, the study also provides reflections about Photovoice, an innovative methodology, and the meaningfulness of visual narratives with respect to public health and offender management discourses about Pacific peoples in Aotearoa/New Zealand.

As part of the dissemination of the findings, a public exhibition of the photographs taken during the study is anticipated. The photographs exhibited will be chosen by a collaboration between Ramona and the participating families.

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[1] Pauline Barrett, J. P. (1998). The Joy of Home. London, England, Four Seasons Publishing Ltd. A quotation by Sir Winston Churchill.