Tū te turuturu nō Hine-te-iwaiwa: Mana wahine geographies of birth in Aotearoa New Zealand

This thesis examines the embodied, spiritual and spatial experiences of maternity for Māori women. It reveals how colonial and patriarchal discourses are embedded and embodied in the spaces of childbirth in Aotearoa New Zealand. I use a mana wahine (Māori women’s) framework to critique discourses that continue to marginalise and isolate Māori women and their whānau (family group) during their maternity experiences. Importantly, this research highlights the possibilities of reclaiming and reconfiguring mana wahine in both theory and practice. In doing so, I conceptualise new geographies that account for, and celebrate, uniquely Māori understandings and expressions of maternity. Mana wahine provides a much needed theoretical framework that enables Māori women to (re)define and (re)present our lived realities on our own terms. A qualitative mixed method approach of interviews, solicited diary writing and a marae based wānanga is employed to examine the lived experiences of birth for ten first time mothers, five midwives and a wānanga of 17 women and their whānau. In total 32 women participated in various phases of the research. Empirical material is arranged around four key themes. The first considers the ways in which colonialism is lived and embodied in maternity experiences for many whānau. New formations of colonialism are evident in the silence that can surround the maternal body for women in this research. The second theme highlights how whakapapa (genealogy), wairua (spirituality), and whenua (land/placenta), can provide a powerful reconceptualisation of the maternal body that offers new possibilities for thinking about maternal embodiment, the spaces of birth (both material and discursive) and maternity policy and practice. Third, it is argued that many women and whānau occupy a number of in-between maternity spaces as a result of our colonised realities. As such, considerations of space from a mana wahine perspective can serve to destabilise the dualisms that dominate the spatial politics of birth in Aotearoa. Finally, this thesis posits that by reclaiming the collective and spiritual spaces of birth and afterbirth it is possible to transform and empower women and whānau in their maternity experiences. This thesis responds to a scarcity of academic scholarship on mana wahine maternities. It advances mana wahine and feminist geographical knowledges by providing a critical spatial perspective on Māori women’s maternal geographies. It is argued that reclaiming mana wahine maternities has the potential to transform women’s birthing experiences by (re)asserting the tino rangatiratanga (self-determination) of women, of their babies, and of their whānau, and thus the rangatiratanga of Māori communities, hapū (sub-tribe/sub-tribes) and iwi (tribe/tribes)

Mana Wahine Geographies: Spiritual, Spatial and Embodied Understandings of Papatūānuku

This thesis is a theoretical and empirical exploration of Māori women's knowledges and understandings of Papatūānuku in contemporary Aotearoa. The primary focus of this research is on the complexities, connections, and contradictions of Māori women's embodied relationships with the spaces of Papatūānuku - spaces that are simultaneously material, discursive, symbolic, and spiritual. In doing so, I displace the boundaries between coloniser/colonised, self/other, rational/irrational and scientific/spiritual. I demonstrate that Māori women's colonised realities produce multiple, complex and hybrid understandings of Papatūānuku. This thesis has three main strands. The first is theoretical. I offer mana wahine (Māori feminist discourses) as another perspective for geography that engages with the complex intersections of colonisation, race and gender. A mana wahine geography framework is a useful lens through which to explore the complexities of Māori women's relationships to space and place. This framework contributes to, and draws together, feminist geographies and Māori and indigenous academic scholarship. Autobiographical material is woven with joint and individual semi-structured in-depth interviews conducted with nine Māori women in the Waikato region. The second strand, woven into this thesis, is a critical examination of the colonisation of Māori women's spiritual and embodied relationships to Papatūānuku. The invisibility of Māori women's knowledges in dominant conceptualisations of mythology, tikanga and wairua discourses is not a harmless omission rather it contains a political imperative that maintains the hegemony of colonialism and patriarchy. I argue that to understand further Māori women's relationships to space and place an examination of wairua discourses is necessary. The third strand reconfigures embodied and spatial conceptualisations of Papatūānuku. Māori women's maternal bodies are intimately tied to Papatūānuku in a way that challenges the oppositional distinctions between mind/body and biology/social inscription. Māori women's maternal bodies (and the representation of them in te reo Māori) are constructed by, and in turn, construct Papatūānuku. Furthermore, women's spatial relationship to tūrangawaewae, home space and wider environmental concerns demonstrates the co-constitution of subjectivities, bodies and space/place. My hope is that this thesis will add to geographical literature by addressing previously ignored knowledges and that it will contribute to indigenous scholarship by providing a spatial perspective

Bacteraemia in patients admitted to an urban hospital in West Africa

BACKGROUND: Few studies on bacteraemia in Africa have been published. We aimed to prospectively identify the causative organisms of bacteraemia in The Gambia and their relation to clinical diagnoses, outcome and antimicrobial susceptibility. METHODS: Between November 2003 and February 2005 we studied those admitted to the Medical Research Council hospital who were suspected of having bacteraemia. We documented clinical features, outcome, pathogens identified and their susceptibility patterns, and searched for factors associated with bacteraemia. RESULTS: 871 patients were admitted and had a blood culture taken. The median age was 2 years (range 2 months to 80 years) and 36 of 119 tested were HIV positive; 54.5% were male. 297 (34%) had a positive result and 93 (10.7% overall) were considered a genuine pathogen. Those with bacteraemia were more likely to die in hospital (OR 2.79; 1.17–6.65, p = 0.017) and to have a high white cell count (WCC; OR 1.81;95% CI 1.09–3.02; p = 0.022). Three organisms accounted for 73% of bacteraemias: Streptococcus pneumoniae (45.2%), Staphylococcus aureus (18.3%) and Escherichia coli (9.7%) while non-typhoidal salmonellae (NTS) accounted for 8.6%. Antimicrobial susceptibility of S. pneumoniae was very high to penicillin (97.5%); high resistance was found to co-trimoxazole. S. aureus was generally highly susceptible to cloxacillin, gentamicin and chloramphenicol. E. coli and NTS were all susceptible to ciprofloxacin and mostly susceptible to gentamicin. Thirteen (33%) S. pneumoniae isolates were of serotypes contained in a 7-valent pneumococcal conjugate vaccine and 20 (51.3%) were of the same serogroup. CONCLUSION: In The Gambia, those with bacteraemia are more likely than those without to die in hospital and to have a raised peripheral blood WCC. S. pneumoniae is the most common organism isolated. Introduction of a pneumococcal conjugate vaccine can be expected to lead to a reduction in disease incidence