Initiating decolonization: from The Last Straw! to Whāriki

Abstract

The board game, The Last Straw!, is part of the Aotearoa (New Zealand) public health and medical curriculum at the University of Otago. An engaging and effective teaching tool about the social determinants of health, the game falls short by being silent about Indigenous experiences. A project is underway to adapt The Last Straw! for play following an Indigenous framework, kaupapa Māori (Māori (Indigenous people of Aotearoa) approach). The game board is being redesigned as Whāriki, a woven mat. The mat represents a metaphor for life as strands of thread are woven throughout the lifecourse, and the thread characteristics impact the strength and qualities of the mat. This brief commentary outlines the first stage of adapting this resource, illustrating decolonizing the public health and medical curriculum in a way that honours and embeds te ao Māori (the Māori worldview), making them visible and intentional.

Introduction

Understanding the social determinants of health (SDoH) is a crucial platform of public health and medical education; recognizing that health and disability systems are fundamentally unequal, with different groups receiving inequitable care (Yearby, 2020). A board game, The Last Straw! (TLS) was developed in 2004 to facilitate learning and discussion about the SDoH. The game is engaging and compelling (Rossiter & Reeve, 2008), and is played in the University of Otago (UoO) Medical Schools as part of the public health curriculum. The authors teach and research in tertiary health education, including at times within professional health programmes. Two of the authors are Māori (Indigenous people of Aotearoa (New Zealand)) and identify as tangata whenua (people born of the land), and the other author identifies as tangata tiriti (people of Aotearoa of non-Māori origin).

Māori have experienced persistent health disparities in contravention to the promises made by the British Crown in the 1840 Te Tiriti o Waitangi (The Treaty of Waitangi), a significant foundation document (Came et al., 2017). While a comparatively old document, its contemporary relevance has been validated by its inclusion in a myriad of legislation, including that which sets up the Aotearoa health and disability system (Durie, 2012). Medical and public health student education includes topics and content to develop a health workforce motivated to counter unfair treatment of particular populations. It includes learning about and working with Māori to ensure they graduate as effective, competent and culturally safe clinical doctors.

This short communication presents an early phase of a project adapting TLS to be more appropriate for medical education in Aotearoa. By framing the adaptation as decolonizing, our process to embed Indigenous perspectives and values in a public health module is strength-based and guided by Māori values and knowledge (Came, Warbrick, et al., 2020). More broadly, the game adaptation process illustrates a process of decolonizing (Smith, 2012) curriculum resources.

Background

TLS game is based on western conceptions of health, with red counters, labelled vitality chips, symbolizing well-being, with the winner being the player with the most chips at the end. The playing board represents an 80-year life, segmented into life course stages. A master player facilitates, following a game manual. Players roll a die to create individual profiles, establishing sex, socio-economic status and race at birth, modifying the profile at each life stage. Players move through life events that may increase or decrease the vitality chips, depending on the profile characteristics of the player (Rossiter & Reeve, 2008).

The game enables students to role-play the impact of different social determinants on the health of their character, with scenarios highlighting effects on both individuals and groups depending on their socio-economic status. Missing from the game for play in Aotearoa is recognition of the bicultural framework in the health and disability system that, guided by Te Tiriti o Waitangi articles and principles, was embedded in the systems and institutions of Aotearoa (Came, O’Sullivan, et al., 2020). The creators acknowledged the initial game’s limitations and noted that, by prioritizing playability over realism, the game did not sufficiently represent significant populations, such as Māori (Rossiter & Reeve, 2008). One of the critical tasks for players at the start of the game is to build their player profile by rolling the dice. Race is one of three profile characteristics. However, in Aotearoa, ethnicity as self-identity, not race, is used in all aspects of the health system. Thus, the early focus in adaptation was examining the race component of the game. This examination was published recently (Gilbert et al., 2021). This short report is about the broader project process of adapting TLS to prioritize a worldview that encompasses Māori perspectives. The study objectives were to

• (a) Formulate a partnership and process for collaboration with TLS game creators and

• (b) Redesign and revise the imagery and symbols of the game for play in Aotearoa.

This study was supported by a UoO Internal Curriculum Grant.

Method

A kaupapa Māori (Māori approach) prioritizes working in ways grounded in Māori worldview values and are used in this project. Cram (2001) presented these as respect for people: he kanohi kitea (a face seen); titiro, whakarongo, kōrero (see, listen, speak); manaaki ki te tangata (collaboration); kia tūpato (be politically astute); kaua e takahia te mana o te tangata (do not trample on the spirit and importance); and kaua e māhaki (do not flaunt knowledge). Hui, a form of meeting (O'Sullivan & Mills, 2009), was the mechanism to collaborate and gather, and participants were purposefully selected to meet the project objectives.

Results

This project commenced in mid-2020 as both Aotearoa and much of the wider world were coping with the pandemic caused by COVID-19. Our kaupapa Māori approach informed our interactions with the Canadian creators of TLS. Initial contact was undertaken through email, where we respectfully explained our interest and the reasons for considering adapting the game to suit the needs of the developing health workforce in Aotearoa. A hui on Zoom™ was used to talk about the project, with the project team able to share the background about the importance of the game being embedded in te ao Māori, the Māori worldview, for its play in Aotearoa. Similarly, the creators could share the development process, the practical and deliberate choices that had to be made to ensure the game was playable, and their reflections on those trade-offs. The creators could also speak about other game adaptations to reflect other nations and languages. The outcome of this project phase was that the creators supported the continuation of the project for a transformation of Aotearoa. All dissemination about this project acknowledges and respects their role as game creators.

The kaupapa Māori approach to achieving the second objective of redesigning and revising the imagery and symbols of the game was significant. An existing relationship between the first author and Kura Rēhia, a New Zealand Māori board game company, and their creative directors, was further developed to consider and rethink TLS. Kura Rēhia were engaged in presenting a redesign and revision of the imagery and symbols of the game. A face-to-face hui was undertaken in January 2021 between Kura Rēhia and the project team to explore the game basis, concepts and outcomes sought.

Kura Rēhia presented their concept back to the project team in March 2021. Kaupapa Māori guided their presentation, with the critical explanation of the imagery and redesign being given to the project as a hand-sketched concept of the woven mat and a video recording of the vital elements of the environment, close-up footage of kelp seaweed moving in the sea, which inspired the Whāriki (woven mat) design. The video, in particular, honoured the oral traditions of Māori rather than requiring a written report of the explanations as might be expected in other design work.

Crucial in the redesign and re-imagery of TLS was the incorporation of taiao (environment) and the presentation of the SDoH as Whāriki. Weaving is based on weft and warp thread. In te ao Māori, these strands are the whakapapa (lineage) of the weaving and are a metaphor for the life course and the SDoH. If a strand is missing or is a different size, it will affect the overall look, feel and strength of the whāriki. Also incorporated into the redesign of the board was an acknowledgement that for Māori, life does not start with being born, but we are part of our tīpuna (ancestors). Accordingly, the Whāriki board has an additional 10 squares in its life course, beginning with tīpuna, with the remaining segmentations similar to that of TLS but with the names and imagery showing the development of life and reflection of Māori worldviews. The new names are tīpuna, tipu (growth—was childhood), rangatahi (young shoot—adolescence), matua (more mature tree coming from initial tipu; adulthood) and kaumātua (mature tree; old age). The spiral symbol is used on the scenario cards, with its changing form showing the growth from the young shoot through to the mature tree.

Discussion and conclusion

This short communication provided an opportunity to present the framework and processes involved when decolonizing a useful and practical teaching instrument. Similarly, Ahuriri-Driscoll et al. (2021) proposed that the Indigenous voice and curriculum must be amplified within the public health academy. Adapting an existing and useful game to embed Māori content contributes valuable insight and illustration of the SDoH.

COVID-19 added extra to the process, ensuring that a face-to-face meeting with the Canadian creators was unlikely in the near future. Conversely, the normalization of online meetings simplified complicated meetings and negated unsustainable overseas travel that might have been needed to engage the creators. In a non-kaupapa Māori approach, the project team would have employed someone to represent the existing board with symbols reminiscent of Māori culture (Young, 2018). The kaupapa Māori framework was effective in making the connections and illustrations with mātauranga Māori (Māori knowledge) explicit and intentional, an approach also promoted by Smith et al. (2019). Engagement with Kura Rēhia has prioritized mātauranga Māori beyond merely symbolic changes, inviting educators and players to deepen their sense of decolonizing connections, across social, equity and environmental issues. Next is to examine the game content, representing the game challenges and scenarios so that the adapted game continues to facilitate learning about the SDoH but also honouring and making visible the commitment to health equity. Our kaupapa Māori process and values will continue to underpin the next stage. They will enable thinking more deeply about the SDoH, their definition and framing from a Māori worldview, and where there is acknowledgement and action around health and our foundational ecological, living and spiritual systems. The visual and conceptual re-presentation of Whāriki starts this process, as there is growth represented. There remains the opportunity to extend and explore concepts such as whenua as both land and placenta for the game to deepen thinking about what it is to be Indigenous, to be Māori, and the experiences and situations through the life course affect hauora (well-being) and health.