Kōtuitui
New Zealand Journal of Social Sciences Online
He wahine tangi tikapa1…: statutory
investigative processes and the grieving of Maori families who have
lost a baby to SIDS
Eileen Clarke
The University of Auckland
Private Bag 92019
Auckland, New Zealand
Tim McCreanor
Te Ropu Whariki
Massey University
PO Box 6137
Auckland, New Zealand
Abstract Among Maori families, the loss of an infant
to SIDS is a terrible burden that reverberates through social networks
for years after the event. The statutory services that investigate the
death have a huge impact on such processes. This qualitative
investigation studied the experiences of whanau following a SIDS death
by reporting narrative data, gathered from families, police officers,
coroners, and pathologists. Thematic analyses revealed multiple domains
of high significance—police actions, post-mortem, and coronial
process—to bereaved whanau, and this paper considers their implications
for grieving, service provision, and social justice.
Keywords Maori; SIDS; whanau; grief; police; pathologist;
coroner
INTRODUCTION
For some time, research has indicated that the death of a child is
one of the most tragic events that can befall a family. The death of a
child is usually seen as traumatic and tragic because a child is the
last person in the family expected to die and thus it seems
inappropriate, unnatural, and unacceptable. Further, the death of a
child represents the loss of future dreams, relationships, and
experiences yet to be enjoyed and can affect families for the rest of
their lives with a tenacity that is difficult to comprehend (Raphael
1975; Knapp 1987; Nixon & Pearn 1997; Sheldon 1998; Biggs 2002). In
the case of Sudden Infant Death Syndrome (SIDS), family reactions are
compounded by the unexpectedness, the abruptness, and particularly the
absence of discernible cause. It is postulated that these factors lead
to more intense, disruptive, and intolerable grief (Friedman 1974;
Woolsey et al. 1978; Osterweiss et al. 1984; Zebal & Woolsey 1984;
Walker 1985; Carlson 1993; Arnold et al. 1997) and in some instances,
to forms of pathological bereavement outcomes (Raphael 1975; Mandell et
al. 1980).
This paper is drawn from a research project that investigated the
sequelae of SIDS among Maori families, and our analysis and conclusions
are confined to this group. We interviewed families, police,
pathologists, and coroners about the events surrounding the loss and
the grieving processes that ensued. A brief review of relevant
literatures on grieving is followed by an exploration of three key
themes from the data—police actions, post-mortem, and coronial
process—to create a dialogue around the impacts of statutory practices
from the different perspectives of those caught up in these tragedies.
We examine key issues around the investigation of SIDS deaths,
highlight their impact on grief processes, and underline the need for
changes in service provision to minimise the systemic damage to
indigenous wellbeing.
GRIEF
Grief processes are often conceptualised and described in terms of
“stages” or “tasks” to be achieved in an individualised manner through
an oscillating and overlapping mixture of emotions and responses
(Raphael 1983). Failure to successfully complete the tasks of grieving
can result in a range of individual health and mental health issues and
diverse social impacts as well (Worden 1991). Middleton et al. (1993)
postulated that grief may last for prolonged periods without
necessarily indicating pathology. Middleton et al. (1996) showed that
over a one year period following bereavement, while there is a general
and progressive decrease in grief phenomena over time, a small group
(9.2%) remain highly symptomatic at one year post-bereavement, and
Sheldon (1998) noted that up to one-third of bereaved people develop a
depressive illness.
These findings, however, do raise the question of what may be
perceived as acceptable or disordered grieving, judgements that need to
be contextualised carefully to have meaning. For instance, the pattern
that emerges from studies in Western societies of different intensity
and chronicity of response between men and women following the death of
a child (Dyregrov & Matthiesen 1987) is only one example of
intra-cultural difference. A further elaboration comes from Dyregrov
& Matthiesen (1991) in their study of parental grief over one year
following the death of an infant, which found differences between
working mothers and non-working mothers. Mothers occupied outside the
home reported less grief than women “at home” who are faced with a
situation where they are constantly reminded of their loss.
If such differences are apparent within cultures, then the
potential for intercultural difference is strong and cultural context
is a crucial dimension in attempting to understand grief. For
indigenous peoples, the issues of loss and grief at the death of a
child are compounded by the broader experiences they have of
colonisation and exploitation (McKendrick & Thorpe 1998; Swan 1998;
Weaver 1998; Smith 1999).
MAORI GRIEF
For Maori, the endemic losses of colonisation and the heightened
mortality resulting from ongoing alienation (Walker 1990; Pomare 1995;
Ajwani et al. 2003) have heightened the salience of already significant
cultural practices in regard to loss and death. In the contemporary
setting, a number of commentators have noted that gatherings around
death, be they tangihanga (grieving) or the unveilings of headstones,
retain a far stronger cultural significance for Maori than do funerals
in the non-Maori population. Life and death are closely interwoven in
the cultural fabric of the Maori world, with tipuna and those who have
passed away integrated into everyday existence (Tauroa & Tauroa
1986; Marsden 1992).
The specific format and sequence of cultural processes and
practices that attend a death, that is, the tikanga of tangihanga, are
widely understood and adhered to (Walker 1990; Marsden 1992; Mead
2003). In the contemporary setting, tangihanga is distinguished by
features such as the gathering of whanau, hapu, and iwi over a 3–5 day
period, and large scale provision of accommodation and meals (usually
on marae or other cultural facilities). These general features are
characterised by rituals of welcome and greeting, oratory, and
ceremonial exchange between the family and visitors. The deceased lies
in state with the coffin open, is the subject of direct greeting,
affection and sometimes challenges, and is always accompanied by family
members. Spiritual and religious blessings of the dead and the living
are carried out in both “public” and family settings. Burials in
whanau, hapu or iwi or public cemeteries are followed by a closing
session with food, speeches of thanks, and other cultural exchanges.
Within this frame, there are particular temporal and behavioural
patterns to grieving, and whanau involvement will endeavour to ensure
that these practices, adapted in form to fit the SIDS event, will be
swiftly and competently implemented following a death.
In the historical context, Sir Apirana Ngata’s comprehensive
collection Nga Moteatea (Ngata 1959) provides us with evidence
of expressions of grief and loss generally, and for our purposes
specifically, it includes also those expressions of grief and loss upon
the untimely death of a child or children. This body of evidence is
contained within the very particularistic Maori composition forms of
chanted narrative such as patere (chants), waiata tangi (laments),
waiata aroha (songs of love), and oriori (lullabies).
For example, a lament composed (probably in the late nineteenth
century) by the great grandfather of one of the authors (EC), refers to
the heartfelt grief he feels at the sudden unexpected death (from
fever) of two of his grandchildren.
…You stand apart quite severed from me;
Thus inflicting upon me this consuming grief. (Te Kaui 1959: 35)
And, as with the larger society, the loss of unfulfilled potential
is mourned and eulogised through the use of the specific cultural
mechanism of waiata tangi.
…I dreamt in the night you were both with me;
Awakening, there was only deep sorrow, bereft
Of the emblem of authority of your ancestors
…you will not mark the rolling years
of the future which stretched before you. (Te Kaui 1959: 35)
From a traditional Maori cultural perspective, the implications for
whakapapa and the transmission of culture arising from the death (or
dearth) of children are also noted and discussed by some contemporary
commentators. Mead (2003) put it this way:
What endures after death is the flaxbush, te pa harakeke, a
metaphor for the children who inherit part of the gene pools of the two
parents. A mother lives on in her children who may exhibit some of her
characteristics and may even look like her. Similarly the father is
reflected in the children. Where there is no pa harakeke, the family is
referred to as a whare ngaro, a lost house, in which the genes are lost
and have come to the end of a line that may have had great potential.
(Mead 2003: 149)
As Mikaere (2003) has written, the whare ngaro represents a
“terrible tragedy” not just for the entire whanau but for the wider
tribal grouping of the bereaved. These cultural imperatives undoubtedly
contribute to the complex mix of emotions and feeling that attend SIDS
in Maori families.
THE SIDS CONTEXT
The sudden unexpected death of an infant (SUDI) becomes classified
as Sudden Infant Death Syndrome (SIDS) if autopsy excludes any medical
reason for the death. In Western societies where child mortality rates
have been falling for more than 50 years and instances of child death
are relatively rare, SIDS accounted for a high proportion of perinatal
deaths. A huge research effort investigating a wide range of hypotheses
and risk factors has provided some very significant insights into the
behavioural aetiology of the phenomenon (Mitchell et al. 1992) and
since the early1990s, SIDS rates have fallen steeply (Mitchell et al.
1994). However, SIDS rates for some minority groups and particularly
for colonised indigenous peoples have remained disproportionately high
to the point where SIDS is currently regarded as primarily problematic
for such groups. For example, in the US, black and indigenous SIDS
rates are 2.5 and 3.5 times greater than those of whites (NICHHD 2001),
and Australian research presents similar findings with indigenous rates
estimated at three times that of the population as a whole (Panaretto
et al. 2002).
Since the early 1980s, Aotearoa New Zealand had a higher rate of
SIDS than other comparable Western countries (Mitchell 1990). A cot
death study from 1987 to 1990 identified a number of risk factors, and
a national SIDS prevention program followed in 1991. The campaign
significantly decreased the national SIDS rates but Maori SIDS rates
decreased only minimally (Mitchell et al. 1994). A Maori health
promotion programme (Tipene-Leach et al. 2000a) has achieved steadily
falling Maori SIDS rates (NZHIS 2004) but Maori deaths remain six times
the non-Maori rate and the loss of Maori babies to this condition
contributes to the grim catalogue of indicators of Maori health
disparities (Ajwani et al. 2003).
SIDS AND GRIEF
When a SIDS death occurs, families are immediately confronted by the
medico-legal system because the circumstances of the death of an
apparently healthy child require investigation (Raphael 1984). The fact
that enquiries are initiated by police on behalf of the coroner’s
office may, for some parents, imply criticism of their care practices.
The attitude of investigating officers and whether or not they regard
the household as a “scene of crime” is important. Unless police are
trained appropriately to handle the difficult task of balancing the
need for a thorough investigation with the needs of the family and
others involved, then there is a likelihood that unnecessarily
prolonged and disabling grief may ensue.
A common thread running through both research studies and personal
accounts of grief reactions following the sudden death of an infant, is
the attribution of blame and guilt, with a majority of parents
suffering personal guilt and self blame (De Frain & Ernst 1978;
Carlson 1993; Caddell 1998; Martin 1998), as well as societal suspicion
and condemnation (Green 1999; Emery et al. 2000).
The current reality is that 45 Maori families per year are left
struggling to grapple with devastating loss and ongoing reverberations
through their whanau networks. In reporting on SIDS prevention
strategies in Aotearoa New Zealand, the impact on parents and
communities can be very real and can lead to unemployment, poor work
attendance, mental ill health, criminal activity, and substance abuse
(Tipene-Leach et al. 2000b). Just as significantly, from a cultural
perspective, the implications for whakapapa and the transmission of
culture are also noted (Bell 1997). However, we could find no studies
that have attempted to examine the intensity or the chronic nature of
grief experienced by whanau, or to examine psychosocial outcomes.
Everard (1997) provides a profile of typical SIDS parents. They are
usually in their early to mid-twenties and often fairly new at
parenting with little experience of death. Few would have been in a
police investigation, come to grips with post-mortems, arranged a
funeral or tangihanga, or gone through an inquest. Most of these things
happen in the first week after baby dies, and coupled with the loss,
they make for a personally shattering experience (Everard 1997). In
addition, Everard suggests that the disproportionate levels of Maori
SIDS and the lack of appropriate grief resolution programmes mean that
the legacy of grief, self-blame, and anxiety in whanau was very high.
This is a prime example of the kind of situation that Ramsden (2005)
has argued should be covered by more diverse provision of care within a
framework of cultural safety.
A pilot study that preceded this project (McCreanor et al. 2004)
drew upon the combined knowledge of six SIDS care workers, highly
experienced professional counsellors who strongly articulated an
understanding of statutory authorities—police, pathologists,
coroners—as seriously impacting on the grief of Maori whanau. Findings
included the negative and inappropriate impacts of police behaviour at
the death scene, distress caused by the insensitivity of the autopsy
process, and the prolonged and regimented nature of the coronial
process.
The current study sought to elaborate these understandings by
gathering data about the SIDS event from whanau directly in a process
similar to that described by Edwards et al. (2005). By linking with
members of the National Maori SIDS Prevention team, we were able to
access and interview bereaved mothers and female relatives from three
whanau in northern, provincial Aotearoa New Zealand. Participants were
all interviewed between one and three years after the loss of their
baby, and the contact care worker or researcher was available for them
for follow-up if necessary. We were also able to interview various
statutory personnel, police, pathologists, and coroners, who regularly
work with SIDS cases.
METHOD
We framed our research within indigenous research theory known as
Kaupapa Maori research (Smith 1999), which regards articulated
experience in a variety of forms as legitimate and valuable data
(Connor 1994; Cram 2001). In essence, Kaupapa Maori as a methodology
has been described as “by Maori, for Maori” (Cram 2001) and seeks to
secure positive Maori development from research. It entails the valuing
and use of appropriate methods, including eclectic indigenous
approaches to building confirmatory and transformational knowledge for
Maori (Smith 1999). Connor, for instance, provides some commentary on
korero purakau—reciting stories as methodology:
Social reality is constructed by devising and passing on stories.
Interpretive structures are imposed on these stories according to
individual experience. The dominant social group’s narratives provide
their own reality and reinforce their superior position. In turn the
subordinate social group tell counter stories which again provide
another reality and set of interpretations which aim to subvert the
reality of the dominant group. (Connor 1994: 66)
A stated aim of the research project is an improvement and, if
necessary, change in policy, practice, and service delivery of those
statutory agencies involved in Sudden Infant Death events in Maori
whanau. A Kaupapa Maori approach is seen as providing an appropriate
and, because of its openness to existing theories and methodologies, an
encompassing, methodological framework in which to situate the
research. Timutimu (1995: 39) referred to this approach as “cultural
capital [which] has been developed into a set of identifiable icons
collectively known as Kaupapa Maori theory”. Moreover, she argued that
“the cultural capital of Maori people provides for a powerful critique
of Pakeha society”. The appeal of a Kaupapa Maori approach, however, is
not dependent solely on its explicitly critical approach and the
ability to expose the power relations that allow dominant group
constructions of “common sense” and “facts” to prevail, as fundamental
to the research endeavour as these understandings may be (Clarke 1998).
Our preference is based just as explicitly and indeed more
strategically, on the proactive and positive stance that a Kaupapa
Maori approach promotes. As Smith (2003) states:
In moving to transformative politics we need to understand the
history of colonisation but the bulk of our work and focus must be on
what it is we want, what it is that we are about and to ‘imagine’ our
future. (Smith 2003: 7)
DATA AND ANALYSIS
The data for the project consist of interviews conducted with four
groups: whanau, police, coroners, and pathologists. We gathered 11,
one-off interviews, three each from whanau, police and coroners, and
two from pathologists. All interviews, which were gathered under the
ethical standards of the Auckland University Human Ethics Committee,
were of between 1 and 3 hours duration and were transcribed
verbatim. Speakers were given appropriate pseudonyms, and critically
identifying features were masked. Together, the interviews comprise
some 140 pages of raw data.
The whanau interviews were all conducted with families whose
bereavements had subsequently been confirmed as SIDS by the post-mortem
and coronial processes. The interviews were with the mother of the
deceased infant and, in two instances, a third party (mother and sister
of the participant), and were of between 2 and 3½ hours
duration. We paid considerable attention to safe and ethical practices
of participant recruitment and engagement. Two of the families known to
the National Maori SIDS Prevention team were approached by careworkers
who had helped them through their bereavement. The third family was
recruited by a member of the research team who was known to them and
who also conducted the interview. All agreed to contribute to the
research. In two of the interviews, the Maori SIDS Prevention team
careworker was also present as a support person and facilitator.
Two of the interviewees were young solo mothers, while the third
was an older married woman. At the time of the SIDS event, one of the
younger women, Tracy, had no other children, Joanne had another
two-year-old child, and the older mother, Moana, had four other
children. The interviews do not carry the voices and views of any men.
While this is regrettable in some respects, it is also indicative of a
reality facing some women and whanau (McCreanor et al. 2004) that men
are often emotionally and materially absent from these settings.
The police data were drawn from three senior officers—pseudonyms
Awhitu, Barrett, and Conway—who had considerable direct experience of
working on SIDS cases. Two were Pakeha and one was Maori and all worked
in the greater Auckland area. The pathologist data were provided by two
male practitioners—Davis and Edwards—both of whom were Pakeha and based
in urban centres in the North Island. The coroner data came from three
coroners, one female and two male—Eruera, Foreman, and Graham—one
Maori, two Pakeha, and based in Auckland and a provincial city.
The data collected from these groups are experiential narratives.
We are not attempting to represent them as “factual” except inasmuch as
they are offered as understandings and interpretations of events
surrounding Maori SIDS encountered by our participants. The whanau
data, in particular, are nevertheless of significance to grief and
grieving since subjective, emotional reactions are lingua franca to
such processes. However, overall our interest is in the intersections
and divergences in the accounts of the different groups contributing to
the research.
Adaptations of a technique called discourse analysis (Potter &
Wetherell 1987; Wetherell et al. 2001), that has evolved within social
psychology, were used to evaluate and describe these data. Discourse
analysis is based upon multiple, detailed readings of the body of data
in order to develop a systematic and comprehensive description of the
patterns and variations in the talk on a topic, and the ways in which
language is deployed to establish and defend various discursive
positions (McCreanor & Nairn 2002; Cram et al. 2003; McCreanor et
al. 2004). As Braun & Clarke (2006) note, these approaches are of
great value in:
…[identifying] the underlying ideas, assumptions and
conceptualisations—the ideologies—that are theorised as shaping or
informing the semantic content of the data. (Braun & Clarke 2006:
13)
Like other forms of qualitative research, discourse analysis
operates outside of the protective cloak of objectivity. The
selections, interpretations, and descriptions the researcher makes in
working with data of the kind available here depend upon the
sensitivity, experience, and orientation of the researcher (Patton
1990; Taylor 2001). The rigour and discipline involved are complemented
by an openness of reporting, which allows readers to judge for
themselves the appropriateness of the descriptions that emerge.
Within each informant group, the transcripts were coded under
emerging themes as described above (more detailed accounts of method
and findings can be obtained in Clarke et al. 2005). The dataset under
each theme were then subjected to multiple readings as a basis for
developing descriptions of the general features of each. While the
study identified a number of themes within the talk of participants,
for the purposes of this paper, we have selected three of these themes
in order to illustrate the impacts and implications of processes and
practices upon grieving. These themes—police actions, post-mortem, and
coroner’s findings—are chosen for their likely impact on the grief
processes discussed above and because each in its own way represents a
modifiable influence on grieving. We have made linkages between the
current data and earlier publications we have produced in order to
provide a sense of the coherence of the experiences of parents with
those of the professional careworkers of the national Maori SIDS
Prevention team.
Police actions
The mere attendance of police officers in the settings of panic and
disbelief of the initial discovery of the death contributes to a
multi-faceted, multi-layered complex of blame and guilt that
characterises Maori SIDS grief. Although experienced police officers
may correctly assess such outpourings of grief for what they are, and
proceed in their assigned task with appropriate sensitivity and
restraint, the frame that they work within may confuse junior officers.
Barrett: In the case of a SIDS death we go in there and
clearly it’s a little kiddie that has died … while the circumstances
don’t present themselves as being suspicious we still have to start
from the beginning, without the rose-tinted glasses, to ensure that
there is no foul play involved, no infanticide.
In Moana’s case, the baby’s death actually occurred in the hospital,
which greatly complicated issues as hospital staff and the
investigating police officers were perceived as keen to blame her for
the tragedy, effectively exonerating the institution.
Moana: [My husband] felt that they were looking at me as
being the reason for Nathan’s death. As soon as the police were
mentioned he got on the defensive. That’s how he thought, that
everybody was looking at me … that everyone was pointing the finger at
me as the cause of Nathan’s death…
These perceptions heightened a critical understanding of the police
investigation. Moana’s perceptions of the youth and naivety of the
investigating officers and their muddled process compounded the
situation to the detriment of the whanau.
Moana: They were no older than my son … They were more
frightened … I feel for those cops being chucked in at the deep end.
That’s when things started to go all wrong. Inexperience. There was a
lot of fear.
The family decided in this instance that they needed a full
investigation and requested it, not just because of unjustified
suspicion falling on Moana, but more importantly for them, because of
their concerns over talk of possible negligence by hospital staff that
was emerging from the police investigation. Although the investigation
found that Moana’s loss was in fact from SIDS, it took a lot of
suffering and struggle to ensure that it delivered this judgement.
In Tracy’s case, her immediate reaction to the trauma of the
discovery of her baby’s death was vocal self-blame, but this is
prefaced by a kind of disclaimer that places her reactions, including
the apparent admissions of harming the child, within a frame of
emotional hyper-reality.
Tracy: I wasn’t thinking straight. All I wanted to do was
dong my head against the wall and make sure … I wanted to make sure
that it wasn’t my fault.
Cleo: Cos all you were saying was “I’m sorry for killing
you.” Something like that, along those lines. “I’m sorry son, I didn’t
mean to do it.”
Positioning herself as transformed from a normal psychological state
(that of “thinking straight”) allows both Tracey and Cleo to emphasise
the extreme stress of the situation by articulating what, on the
surface, are incriminating actions and statements, in order to
illustrate the fundamental flaws in the police response to the
situation. Tracy highlights the confusion and conflict faced by the
officers as evidence of their inexperience and lack of training to deal
with the traumatic situation they faced.
Tracy: The policeman that was there he was just a new cop
and so was the woman. They were just standing behind me and she was
saying to him, “Did she kill him?” I didn’t say anything to her, I just
thought, “What’s this woman on about, I didn’t kill my son.” They were
standing right there, she’s standing there saying to him plain as day,
“Did she kill him? Did she kill the baby?” The policeman was going,
“No, no.” Then they had to radio for a higher chief in the Police Force
to come out because they couldn’t cope.
The issue is not whether the policewoman’s questions were
understandable but rather their inappropriateness and their impact on
the family. In spite of her distressed state, Tracy recalled the words
of the officer with great clarity because of the undisguised suspicion
expressed. The whanau’s response to the police actions was feelings of
indignation and anger.
Int.: How did you feel about what she was saying?
Cleo: Very unprofessional.
Tracy: I wanted to smash her … And Michael [father], he had
actually just come in and he had found that really hard because of the
police being there. Then when she did that he just wanted to get up and
kill her.
This clumsy and insensitive approach by the police officer, while
inexcusable, should not be unexpected if SIDS cases are framed as a
crime scene investigation. As our Maori police informant noted, these
issues are compounded by the pressures on police to complete their task
quickly and the fact that their main tool is the post-mortem, which
requires the removal of the body, a requirement which conflicts sharply
with Maori practices of tangihanga.
Awhitu: …a lot of our police don’t know how to handle cot
death. They want to come in quick and take baby away and get it over
and done with. They don’t want to spend the time getting support
systems in place for the parents before they do their police work. They
want to do their police work and treat it as (1) suspicious or (2) as a
cot death. They want to come in and get it all over and done with.
Such pragmatic approaches can lead to distressing scenes such as
that reported by Tracy’s sister.
Cleo: …that was the hardest for me, seeing my sister
struggling with grown men and she was so strong. She didn’t want to let
her son go and it took so many people to get the baby off her.
The forced removal of the body for statutory purposes is probably
the most invasive of the police practices reported by our participants.
It results in trauma for whanau and reinforces the innuendos of
suspicion in the death scene investigation and the general impression
that it is wrongdoing rather than tragedy that is being investigated.
For Joanne’s whanau, the presence of the police was a matter of
concern, their appearance suggesting suspicion and blame and sending
unjustified messages of wrong-doing on the part of the whanau and/or
individual members to the wider community.
Joanne’s Mother: When my other daughter got here … she
thought something bad because of the police being here. But once Kaha
(police officer) … explained to us how when it’s a sudden death of any
type, they have to come in … and the ambulance driver did say that to
me that they have to call the police, so that we wouldn’t freak out
when we saw the police turn up.
In this instance, the interventions of a Maori liaison officer and a
sensitive ambulance driver offering a little contextual information
appears to have made a beneficial difference. The Maori police officer
that we interviewed saw the facilitation of such communication as a
vital contribution, particularly in his work with Maori families.
Awhitu: Well, I see my role as basically as a Maori face in
coming from the side of the police uniform you see, they see me as a
Maori first rather than a policeman, you know first and of course that
is good you know that’s the way I’ve always been. I am a Maori first
and a policeman second.
For each of these families, in different ways and to different
degrees, the actions of the police contributed to their sense of guilt
at the death and inevitably complicated their grieving processes. Even
with good quality police work, as evidenced in the positive reports
above, the paradox of police actions in the case of SIDS remains. One
of our police participants summarised the overall difficulties in this
way.
Conway: …fifteen minutes after a phone call, you found baby
being cuddled by mother in the lounge room, 14 or 15 members of the
family around, obviously very distressed and that’s not the basis
obviously that a forensic pathologist can have a proper investigation
to focus on. We have to dignify the scene as best we can, we have to do
the job that is required, which is a real juggling act, a real fly by,
and is something that is very difficult. Especially for young cops,
particularly for young cops who also have young families because they
themselves are reacting to what any other human would react to the
situation, but the job has to be done.
We note that these observations about police actions in relation to
Maori SIDS concur with what we have published elsewhere (McCreanor et
al. 2004; McManus et al. 2005) and thus that there is a definite
triangulation between the views of parents and the careworkers of the
national Maori SIDS Prevention team.
The careworkers said that unless the police behaved with exceptional
sensitivity, there were many points at which their activities could
have a profound negative impact. (McCreanor et al. 2004: 161)
While there was a clear acknowledgement of examples of good police
practice and optimism about the development of better routine practice,
there was also a need to ensure that experienced officers attended and
provide good training for those joining the service (Tipene-Leach et
al. 2000b; McCreanor et al. 2004).
Post-mortem
For whanau already reeling from the loss, the removal of the body
for often ill-defined investigative purposes may be seen as a
disruption to proper tangihanga process and akin to desecration.
Tracy: …having him taken away … not having him there with
us for that time … And not knowing, what are they doing … I can
remember saying to the funeral director, “Please I don’t want you to
take him, I want to know that he’s going to be safe.” And they got the
cocoon thing and wrapped him in his own blanket … That emptiness starts
right then, as soon as that baby’s out of your arms, that emptiness
starts right there.
The grief of the whanau is compounded by the inability to fulfil the
cultural imperative that demands that the tupapaku, especially in the
case of an infant, not be left alone, let alone in cold, impersonal,
clinical surroundings. Uncertainties about the timely return of the
body in an acceptable condition adds to whanau reluctance to surrender
care and responsibility of the tupapaku.
Tracy: I thought, “they’re going to take my son and stick
him in those silver rooms and he’s going to stay there by himself” … I
didn’t want him to be alone. I didn’t want them to take him and drop
him at the hospital and leave him at the morgue or wherever they take
them. I wanted them to take him, do their thing, dress him and bring
him back. But that’s obviously not what happened if it takes that many
hours and he’s left there for all those hours by himself ... that’s
hard to deal with.
While the return of the child reinforces the tragic reality of the
death, nevertheless the whanau are thus able to move out of an enforced
“limbo-like” state and continue the grieving process.
Tracy: As soon as I got my son back and they brought him in
and they took the lid off it was such a relief. It was like something
had come over me and it was like “Wow he’s home, sweet as, everything
is sweet as.” I laughed, I cried, I got angry, but he was there so it
didn’t matter.
For Tracy and her whanau, the trauma of the SIDS event is compounded
by the lack of care around the process and the protracted time taken to
perform the post-mortem and return of the tupapaku to the family.
Tracy: They should be able to take the body, do the
post-mortem, and bring it back within at least three hours … because
that’s a long time to grieve for someone that’s not actually there …
And the first night, wanting to be with your baby.
Pathologist participants were aware of these tensions and the
negative perceptions of their role. One reaction was to build
connections and share information with families.
Edwards: Their child has been cut up and they need
debriefing about that. To know that the guy that carried out the
post-mortem hasn’t got bloodstains on his shirt and all that sort of
thing. They can see him as just a very human person.
However, our metropolitan pathologist participant took a very
different line and argued that only in exceptional circumstances should
there be any direct contact with families at all.
In Moana’s case (as noted above), after deliberation, the whanau
actively sought the post-mortem for quite specific reasons.
Moana: My way of thinking was about the necessity.
Otherwise … if they didn’t find anything medically wrong with him and
they didn’t do an autopsy, we’ll be forever wondering “what happened”
until we go to our graves, and I wasn’t having that.
On this point, there is high concordance between pathologist and
family.
Davis: …the most important things from the point of view of
grieving is to know the cause of death. If you can for instance … tell
a family that this person’s death, this child’s death is not their
fault, if you can tell them “nothing you could have done or did not do
influenced death”, that’s a huge weight off their minds.
However, the self determination of such interventions is undermined
by the legal powers of the pathologist to mandatory investigation and
to pronounce the cause of death, as Moana discovered.
Moana: William and I gave our consent and it wasn’t until
after we’d given our consent that Dr Mullen came back and told us that
by law they had to do it anyway. But he couldn’t just do it. Tell us
that they could do an autopsy. He wanted us to talk about it. They
could very well have come in there and said “We’ve got to take your
baby there’s got to be an autopsy, like it or lump it.”
There was no blanket rejection of the practice of post-mortem by the
family but there was still profound ambivalence based in cultural
concerns.
Moana: …there were some members of our whanau saying, and
they were right too, I could see their point, they couldn’t imagine
them cutting up this little tiny baby. That was their concern. Also,
because it wasn’t so long ago when some coroner was keeping the body
parts and that sort of thing. That was also a worry and we discussed
that at the time.
The locating of the problem in the broader context of the coronial
process signals that these understandings were not limited to this
particular family but a part of the commonplace knowledge of the Maori
community.
Fortunately, along with the stories of trauma and conflict arising
from insensitive processes and personnel, are other accounts that
support the idea that good process makes a real difference. The actions
of suitably skilled and experienced staff, both investigative and
support workers, can in various ways mitigate the stress for whanau and
expedite processes in a timely, compassionate, but nevertheless
efficient manner.
Joanne’s Mother: It was good. Mereana … [SIDS care worker]
was really, really choice because we felt her aroha. We felt we could
relate with Mereana … to know someone we trusted, who could explain and
show the way. It was good it was really good for us.
Joanne: Mmm, and they just waited for us. I think we were
here for about three hours. I had him for three hours before they
started saying “Come on time to go.” The sooner we went, they could get
him [baby] back faster.
Mother: They [pathology staff] were really respectful.
Wiremu [Maori police liaison officer] explained to them what needed to
be done and they did it. He was excellent. He made it all sweet for us.
Not that they were bad people, but you’re still in awe at the clinical
side of it.
The approach taken in this instance worked for the whanau, with the
SIDS careworker and Maori police officers playing intermediary roles
between the family and the post-mortem processes and personnel.
Again, there is strong congruence between these data and the
conclusions available from our other research in this area.
While it is true that the autopsy findings can be a relief to
families, the uncertainty, alongside the unfamiliarity and
unpleasantness of the forensic protocols, can cause extreme distress.
(McCreanor et al. 2004: 162)
Based on SIDS careworker key informant data, we recommended that
attention was needed to prevent the perception among bereaved parents
that the post-mortem was a mechanism to establish their guilt over the
death of the baby.
Coronial process
Like the practice of post-mortem that informs it, the inquest
process itself is rationalised by coroners in terms of its contribution
to the grieving of families.
Eruera: I see it as part of the grieving process and
helping the family come to terms with it, that they did all they
possibly could. That there was nothing more that they could have
possibly done. That for some reason unknown to anyone this baby decided
it was time to go. So in that sense I see it as an important part of
the grieving process.
Some whanau will accept the SIDS finding as an absolution from blame
and as allowing a sense of closure that cannot be provided by any other
means.
Joanne’s Mother: For Joanne, she needed a closing, because
she felt maybe she’d done something wrong … until the letter came … “It
wasn’t my fault after all Mum.”
For others, it was even more intimately tied into their grieving
processes.
Moana: For me, that inquest was healing, it was part of my
healing. We had the autopsy report given to us by Sergeant Stephens,
but it wasn’t enough. You got all this ... but at the end of the day
there was no reason for his death. Now, you could very well go to an
inquest and hear all that, but it wasn’t ... it was different. It was
actually different from just having this piece of paper in your hand
and reading it and then you still couldn’t put it ... finish it off.
Int.: No closure?
Moana: No closure. And an inquest ... as far as I’m
concerned we had to have that inquest in order to move on. I don’t
think we would have been able to without it.
However, as with much of the rest of the statutory activities around
the SIDS death, process was of crucial importance to the outcome for
whanau. Coroners are clearly aware of the potential for their process
to impact negatively upon whanau, and our participants spoke of a need
for flexibility in how they do their work.
Foreman: Sometimes we have inquests in court and sometimes
we have them in all sorts of places and I know that helps the family. I
have had inquests in hotels, fire stations, police stations, in halls
in the country to save the people coming in.
The small details are also important. In Tracy’s case, the problem
was in the unannounced delivery of the coroner’s findings through the
post, at a time when she remained profoundly isolated and distressed as
a result of prolonged and unresolved grief.
Tracy: They just sent it out in the mail. To me it should
have been brought to us by either a policeman or a doctor. It should
have been given to you by someone who knew what was in it. Not posted
out in the mail.
Joanne’s family had almost the opposite experience largely through
the intervention of the Maori SIDS careworker.
Joanne’s Mother: He [coroner] got a hold of us and told us
it would be a long time because that’s the way things are.
Joanne: Then he sent a letter just to back it up.
Joanne’s Mother: It was awesome. We were really prepared so
nothing had shocked us.
Mereana: What happens there, the inquest officer will ring
me. He’ll ring me to tell me they’ll be sending the letter out to the
whanau. So I come and visit and say that the letter will be coming and
just to be aware.
Joanne: Yeah because I was feeling stink because I thought
it was my fault. I thought I had done something wrong. He [coroner]
said that it was ... what do they say ... they couldn’t ... there was
no reason for the investigation because there was no misconduct or
anything gone wrong. So I was glad.
With care, coroners can make use of the inquest as an educational
opportunity as well as a contribution to the grief resolution of
whanau, but coroners are aware of the risks this may pose to grieving
families.
Graham: It made me think that perhaps I should be having
more inquests for SIDS deaths just to get that message out. But
overlying or underpinning that is that you don’t want to put the
families through unnecessary further grief.
As with the actual post-mortem, the coronial process, when applied
sensitively, can be a definite contribution to the wellbeing of
bereaved families. The problems are particularly with the delays in
judgements, which leave the whanau in limbo often for months, and the
dependence on the goodwill and skills of particular individuals.
DISCUSSION
As this was a qualitative exploration of the features and influences
of Maori SIDS grief within a Kaupapa Maori framework, we were not
intending to gather data from a representative sample of informants.
Rather, we were keen to access experiences of a number of parties
involved in the unexpected death of a Maori baby and analyse them in
order to understand their implications for the grieving of the
bereaved. We acknowledge that the data so gathered do not represent
“reality” in the sense that scientific accounts conventionally claim,
but rather participants’ perceptions of events and their experiential
interpretations of them. It is our belief that these narrative,
experiential data are at least as important to the grieving process as
any objective account of the death and its consequences.
Although the numbers are small in each group of participants we
interviewed, accounts agree to a considerable degree despite marked
perspectival differences; the groups may be reporting different
experiences but they are talking about the same issues and
sensitivities. Police informants acknowledge shortcomings in their
practices, which were aired by parents; parents state their
appreciation for more appropriate ways of managing process introduced
by pathologists; coroners lament the impact of investigations on
families who highlight the importance of the judgement for closure. In
addition, we moderated our work against the experience of the National
Maori SIDS Prevention team careworkers by actively engaging them in the
design, implementation, and reporting of the research. At all stages,
their extensive professional experience (McCreanor et al. 2004)
provided the tuakana authority and a system of checks and balances
against which our analyses and interpretations had to stand up. On
balance, we argue that given such convergences, the data we have
gathered are likely to capture common experiences of these situations
rather than aberrant accounts of a discontented few.
The pattern of investigative practices that swings into force when
a Maori baby dies unexpectedly is dominated by a web of non-Maori power
and knowledge relationships involving coercive force (police),
scientific expertise (pathologists), and legal process (coroners).
While it could be argued that such enactments of power may be
acceptable in the rare situations in which parents or caregivers have
inflicted harm on a child, the numbers of such situations that might be
potentially confused with SIDS events is miniscule; the marks of such
assaults on tiny bodies are usually unmistakable and detected in the
earliest stages of investigation. As we have already noted, the
accounts of the impact of statutory processes we gathered from whanau
came from families whose babies were confirmed as SIDS cases.
Our data illustrate ways in which these interlocking, culturally
determined practices enmesh the bereaved whanau in bewildering, often
aversive and culturally unsafe processes that frequently exacerbate,
prolong, and disrupt their common, traditional practices around grief
and loss. Good outcomes depend on the strength of the whanau, and the
goodwill and cultural sensitivity of the professionals drawn into the
situation. Clearly, insensitive or inappropriate actions by police,
pathologists, and coroners, no matter how well-justified these may be
in investigative terms, impact profoundly and damagingly on the
grieving of Maori families.
The medico-legal apparatus itself lacks impetus (and in some
respects the capability, including police training, pathologist
availability, and coroner sensitivity) to work routinely for good
outcomes and the prevention of systemically generated harms to the
bereaved. Close to the heart of this incapacity lie the practices of
determination of the cause of death—the jewel in the crown of forensic
pathology and the keystone of coronial process. With the overt support
of the legal system, pathology is empowered to pronounce on
causation—the ultimate goal of scientific enterprise—which adds to the
sombre importance and moral significance in which the work is cloaked.
The deceased is maintained as an ultimate “docile body”—a term used by
Foucault (1995) to describe a controlled and compliant individual—by
physical separation from the bereaved and is thus available for the
expert as an object of research, to cut, to test, to diagnose.
Ironically, in the case of SIDS, the diagnosis is a default position
relating to the elimination of potential causes of
death—biophysiological problems, infection, trauma and so on—after
which Sudden Infant Death Syndrome is deployed as a residual, but
actually unaccountable, causality. Far from being able to give a
definitive cause of death, in Maori terms, the post-mortem often offers
little more than a bland assurance that parents cannot be accused of
having erred in their caregiving.
The actions and roles taken by various professionals clearly have a
major impact on the experiences of family members, and Maori personnel,
in particular, were of great significance to whanau participants in
facilitating statutory processes. Such processes were often not only
beneficial to whanau, however, but also to institutions for which they
tend to smooth the interface between Maori grieving and Pakeha
investigation.
While it is clear that post-mortem processes can be modified to
accommodate to some Maori needs and that there is no blanket rejection
of these investigations by Maori families, it is also the case that
there are extreme tensions evoked in their submission. Further, the
different approaches to the management of investigation of unexpected
death of an infant evident in our data remain unified around the
universal exclusion of families from the post-mortem itself.
We are not advocating the direct inclusion of family members in the
post-mortem, but we note that preventing lay people from having direct
insight into what are thoroughly interpretative processes, helps avoid
the development of commonplace perceptions that SIDS post-mortem is an
uncertain science. Any such conclusions would clearly give force to
calls for review of the status of post-mortem practices on the grounds
that the emotional and cultural cost of separation of the body from the
bereaved, and the distress caused by the realities of investigative
dissection, can not be justified in the absence of a definitive
diagnosis of cause of death.
However, a further key rationale supplements the scientific
justifications and is of far more popular and emotional appeal. Both
pathologist and coroners in our data claim that to be able to offer
families certainty on the cause of death is to enable them to commence
the processes of grieving and so the healing of the pain of loss that
is presumed to follow. The investigative process is thus justified in
legal, scientific, and human terms, making it virtually unassailable
despite the resistances and high emotions that surround it.
Potential challenges such as those that might be mounted from
positions of indigenous self-determination (Smith 1999), Kaupapa Maori
frameworks (Smith 2003), or cultural relativism (Ramsden 2005) are
pre-empted by the use of the universalising ideology of culture
blindness in the practice of medical science. In the case of Maori
SIDS, the pursuit of medical truth constitutes a series of
intercultural paradoxes whose resolution turns on issues of power,
agency, and respect. Post-mortem science, it seems, has little room for
diverse social realities, and Maori struggle to assert any influence
based in their distinct epistemological traditions. In Maori terms, it
is less a question of whether the investigation produces useful
knowledge than reducing the impacts of the discourses and practices of
investigation on the grieving of Maori families, on the living.
Our research therefore challenges the investigative process at all
levels of its application, asking perhaps what an indigenous
investigation of the cause of death might be like in this country.
Beyond such speculation, there are clear messages that if forensic
medicine is to attain its own ideals and do no harm, then there should
be serious revision of post-mortem protocols beginning with an
examination of the legal foundation of this tradition. It is
interesting to note that the entire coronial structure is currently
under review and is likely to institute entirely new processes in
relation to data gathering and the investigation of SIDS deaths
(Tipene-Leach pers comm 2006).
The literature is clear that grief costs run high at personal,
cultural, community, and national levels. Where, as in the case of
Maori SIDS, such costs are attached to strong disparities between
ethnic groups in a famously bicultural nation, the implications for
justice and equity are critical. If we cannot find solutions to the
burden of grief that is heaped upon Maori in so many different areas of
health and development, then we remain an inequitable society.
Re-orienting our investigative processes following the unexplained
death of a Maori infant are one component of what is required to change
this unacceptable state of affairs.
ACKNOWLEDGMENTS
Special thanks to Sally Abel and David Tipene-Leach who helped shape
this paper and gave invaluable feedback on earlier drafts. This work
would not have been possible without the key roles played by the
careworkers of the national Maori SIDS Prevention team.
The research that this paper draws upon was funded in part by HRC
grant 99/614.
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1“He wahine tangi tikapa me he ngaru
moana, taro ake kua paki” is a whakatauki that in this context can
describe normal grief; the wailing of the grieving woman is a surging
wave that eventually ebbs away. This contrasts with our participants’
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