at North Haven Hospice, Whangārei, New Zealand. Hospice New Zealand Communications Manager, Gretchen Leuthart sits down with Morgan McCaskill (Inpatient Unit Manager ) and Agnes Hermans (Spiritual Care Coordinator ) from North Haven Hospice in New Zealand to talk about the beautiful ritual of farewelling the deceased in their hospice.
Gretchen
What does the Māori word poroporoaki translate as?
Morgan
It’s difficult to translate so that the full meaning is expressed in English but it is a Māori ritual made up of an intentional sequence of farewell speeches to honor the dead and the bereaved that expresses people’s grief through beautiful language.
Gretchen
What did it take to make this formal practice and ritual ‘just part of what you do’ in caring for your patients and families?
Agnes
It was a combination of good collaborationand a shared vision to integrate Māori culture as well as offer best practice bereavement support in the time immediately after a death. We took time to learn about the spiritual and emotional depth of poroporoaki and receive advice about how we could offer it here while maintaining its cultural integrity.
Implementing the poroporoaki in a consistent and inclusive way requires a team approach. We are lucky to have the magic combination of Morgan as IPU Manager who also has Māori heritage ,plus our Māori Development Leader who is encouraging and provided cultural advice plus myself as a spiritual care coordinator who believes that our hospice philosophy of holistic care needs to be lived out and ‘structured in’ wherever possible.
Offering a ritual of farewell in the beautiful way we do it, offers guidance for a family at time they may need extra emotional support. In a way, we are sweetening the loss for the family with this added layer of care and ritual.
Morgan
Consistency is so important too. We practise the ritual each time someone dies in our IPU so it becomes something all our staff know to expect. Our clinical staff now expect and look forward to knowing these spiritual and cultural dimensions will come to the fore. They now have the confidence to speak and participate in the space too.
Gretchen
What’s the process to get families prepared for this ritual?
Agnes
Each family is unique and it is important to read the room to discern when it is appropriate to talk about what happens when the loved one is dead – even in a hospice. Normally we will have got to the know the family and together we talk about the family’s preferences for spiritual care when their loved one dies. We usually introduce the idea by saying , for example;
It is our practice to honour those we have cared for by saying a few words of acknowledgement, offering karakia / prayer / blessing. And as they leave, we can offer waiata (song) or be with you in silence. Would this be ok or is there any other support you would like in this moment of leaving?
Following the death, we practice further rituals. The family is invited to light a candle in the courtyard. This may be accompanied by blessing and song. The candle remains alight until the tupāpāku (deceased person) has departed hospice. Also, once the tupāpāku has left the building, we bless the room they died in.
Morgan
Communicating with our wider hospice team is essential too. We light a candle in the courtyard to indicate that a death has occurred and the tupāpāku is still present. Team members are notified that the tūpāpakuwill be farewelled, and when the funeral director is expected. Then we gather nearby and along hallway in readiness and silence.
Gretchen
What does the final blessing look like and then the departure?
Agnes
Once the tūpāpaku has been placed on the gurney, members of the clinical team (if invited by family) gather in the patient’s room. The person leading the ritual offers prayer, karakia, blessing, or words of honouring the person who has died. Members of the Hospice team may say a few words to acknowledge the person and the family may say a few words if they wish. We may sing a song or waiata or hymn. Then the funeral director escorts the tūpāpaku and family to the transport
Morgan
As the tūpāpaku is escorted to the transport, we follow slowly behind whilst singing, or in silence, as preferred by family. We gather quietly around the rear of the vehicle where goodbyes and condolences are offered, and the family may respond.
We close the ritual and the transport leaves slowly. A karanga (formal, ceremonial call) is offered, and the family are also invited to join us in blessing the room where the person died if they wish.
Gretchen
And you intentionally take time to pause, ground yourselves afterwards?
Agnes
Yes, taking time to make the transition from the sacred to the ordinary is an important part of the poroporoaki Often for staff, this ritual can stir up our own emotions, so we take a breather, sit down and pause, have a coffee or food and ground ourselves in our bodies. This allows time for us to settle, tune into our feelings and share experiences, reflect and absorb it all.
Gretchen
How are families responding to this offer of a goodbye ritual?
Morgan
We have had so much positive feedback. Families are telling us things like; “ it is beautiful, incredible and really made a difference to how we processed the grief of our loved one.”
Gretchen
And what about your hospice staff?
Morgan
Our team find it moving and special. As one of our IPU nurses said;
It is a very spiritual ritual. As a Pākehā(non-Māori) male it is different to the cultural upbringing I had as a child and earlier in my nursing career but the warmth, love and care it brings out is very heart-warming.”
Agnes
Staff and families can see we are holding true to our framework of holistic values and really living them out with this ritual.
Gretchen
Do other hospices in New Zealand carry out a similar ritual to farewell the deceased?
Agnes
Every hospice has its own rituals. Some would like to do more particularly of cultural significance like poroporoaki. However, many hospices may only have one Māori staff member and then it becomes an unfair burden placed on them trying to introduce and sustain every Māori custom.
Morgan
We have produced a Poroporoaki Booklet that incudes prayers, blessings, words of honouring and guidance for the process. We’ve made this available to all other hospices in New Zealand to help develop staff confidence and make it easier to develop their own tailored practice and make it their own.
https://www.northhavenhospice.org.nz/
I’m delighted to see this article highlighting this important aspect of palliative care. Since coming to Aotearoa New Zealand in the early 1990s I have been struck by how much we have to learn from Māori when caring for people who are dying and the grieving process. We are honoured to learn from and respect those cultures who were here before us
Every time I am fortunate enough to be part of this ritual, I get to witness Morgan lead the waiata and transcend between the living and the dead. Her final Karanga bids farewell to the tupuna and brings everyone back together .
As the wife of someone who died in the IPU and asked for all parts of the ritual, I am absolutely clear that this has been the foundation for a transformational bereavement. I am 100% certain that my husband rests well because of this.
This is a beautiful and meaningful way for hospice staff to live out the principles of Te Whare Tapa Wha in our every day practice. It also helps our families recognise that all four pou are important and integral to our care for their loved ones – and themselves in these sacred and special moments. These rituals give shape to the spiritual, particularly for those who struggle with the concept.