Fonofale Model

of Health

Overview

In this learning space we introduce Pacific health models discussing what they are and why they were created. The Fonofale Model of Health is one such model. A tool we have integrated into our Pacific health curriculum to help you engage and understand Pacific peoples as they present to you in your practice.

Pacific Health Models

Pacific Health models are tools that have been developed based on indigenous Pacific concepts, knowledge, values, and practices encompassing the cultural, values and beliefs of health to Pacific peoples. The health of Pacific peoples is viewed as a balance of different factors / dimensions, including spiritual, cultural, as well as environmental factors on health.

The Pacific Health models provide a cultural lens to understand the elements that influence the well-being of Pacific peoples which include dimensions that are often not included in the traditional biomedical health model like spiritual, family, culture, time context and the environment.

There are several Pacific Models of health, all developed for different spaces. Learn a little about some of them here.

Fonua Ola Model

This is a Tongan framework to health that comprises five dimensions of life that are independent and complementary to each other. This was developed initially in 2007 in the space of health promotion as the Fonua model and 10 years later after further research revamped to the Fonua ola model with the addition of two further dimensions, cultural and ecological).

The focus is around the dimensions of environment:

Community, Physical, Mental & Spiritual
Economic, Cultural & Ecological (added after further research)

To maintain harmony in life, health issues must be addressed at all dimensions. In addition to the dimensions, there are four phases in the natural order of Fonua/land and people but traditionally refers to the placenta as a symbol of birth and safety.

Kakala Model

Another Tongan model that focuses on the importance of relationships and social support in health.

It was developed in the space of education referring to the “communal process” of weaving together a string or lei of flowers.

Kakala being the tongan word for “garland made of flowers for special occasions” and describes a pacific process for collaboration and sharing and the passing of skills to the next generation.

Fa'afaletui Model

Fa’afaletui is a Samoan model developed in the space of mental health and it emphasizes the importance of relationships, family and community in health.

Used mainly in the research space. Fa’afaletui literally means “ways of”[fa’a] “weaving together” [tui] deliberations of different groups or ‘houses’ [fale].

It is often used in a space of sensitive conversations and bringing understanding and consensus.

Fa’afaletui is derived from the Pacific philosophy of connectedness and a collective holistic approach that enables culturally appropriate insight and intel finding. The different fale also embody the perspectives that are needed.

Tivaevae Model

A Cook Island model that focuses on the importance of relationships and community in health. Originally developed in the space of education but has been used in health research fostering the dimensions of collaboration. Respect, reciprocity, Shared vision and relationships.

There are other Pacific models of health and each providing some relevance and meaning to the different cultural practices of pacific communities and some more appropriately used in research while others used in reference to health in general.

Fonofale Model of Health

While developed by a senior Samoan health worker, having a name whose origins lie in the Samoan language, as well as taking the structure of a Samoan fale, or house, this model was developed with collaboration from six other Pacific ethnicities after a New Zealand wide consultation across 19 regions. Therefore, it is seen as one that embodies the cultural beliefs and values of the then, populace Pacific populations in Aotearoa.

It was initially developed in the space of mental health after a challenging time for Pacific peoples during the post overstayer / dawn raids of the 1970’s. It has since evolved to become a tool that is recognised for its holistic approach that acknowledges and embraces Pacific perspectives towards general health and well-being.

We encourage you to learn the Fonofale Model of Health to use as a tool in future engagement and collaboration with your Pacific patients, to better understand the context of their presentations to health services and how to work with them to address their health issues. Over the next five years, we will explore how you can do this in various situations and scenarios.

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Components of the Model

This model, deeply rooted in Pacific Islander cultures, provides a holistic perspective on health and wellbeing. Within this section, we delve into each element, including the spiritual, emotional, mental, physical, and social dimensions, offering a clear and insightful exploration of how they interconnect to shape one's overall health.

We provide detailed information and practical insights on how to nurture and maintain each aspect, recognizing that true health is a harmonious balance of these diverse elements. Our goal is to empower you with the knowledge and tools to cultivate a holistic sense of wellbeing, in line with the rich cultural traditions that inspire the Fonofale Model of Health.

Family

Traditionally, when Pacific peoples refer to their families, they generally mean their large extended families. With members spread across many villages and regions. In Western societies, a family often refers to two adults and two or three children. In the New Zealand context, Pacific peoples may refer to their families to include either the nuclear family, extended family, friends who have become family or their church family.

Churches. For many, have become like their families or represent for them the village context in New Zealand. There are sacred relationships within the Pacific world. This is referred to as “Le Va”, meaning the sacred place or sacred space. This sacred relationship governs the relationship between parents and children, between brothers and sisters.

It is important for health professionals to appreciate that the dynamics of families have changed when Pacific peoples migrated from the Pacific Islands to New Zealand. The dynamics of the traditional relationship between children and their parents have also changed. A health professional is expected to navigate the space sensitively where there are different expectations with respect to the rights of a young person in the New Zealand context and expectations of a young Pacific person within their own Pacific or ethnic specific cultural context.

"E lele le toloa ae ma'au i le vai" ~ Samoan Proverb

This proverb speaks of the Toloa, a bird, flying where it will, but always returning to where it belongs.

A person may explore what life has to offer, but will always return and know how and where it is connected to their family.

Physical

This component encapsulates things that can impact on specific people's physical well-being, such as the consumption of food, water, medications, as well as people's perception of what is physical wellness from their own beliefs. People's beliefs about their physical well-being may be at odds with the biological functions of the body. For example, a patient may say that they're feeling well, but the clinical signs would suggest otherwise.

What is considered to be a healthy body weight may also be viewed differently between Western and Pacific people's perspectives. Health professionals need to be mindful that navigating this space successfully with Pacific people is complex and requires sensitivity. There are many factors that impact on Pacific peoples physical well-being. Simply telling people to eat more healthy foods and exercise more is unlikely to be helpful if one does not understand the context of the patients.

For example, they may not be able to afford healthy foods or their work hours does not give them the flexibility to have regular exercise routine or perhaps go to the gym.

"Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have recieved from God? You are not your own; you were bought at a price. Therefore honor God with your body,"
~ 1 Corinthians 6:19-20

Pacific people have strong religious faith. Health promoters have linked in with this part of the health and wellbeing model to promote physical health.

For example, encouraging people to stop smoking so they can look after the physical body (the temple of the Holy Spirit).

Spiritual

This component relates to religious belief systems, which are, for most people, Christianity or to traditional spiritual beliefs linked to cultural customs and traditions. Christianity is seen as an important area in Pacific people's health and well-being since its introduction by missionaries in the 1800s. Many Pacific peoples incorporate praying and seeking spiritual help as part of the pathway to seeking health and well-being and as part of the process for healing.

The birth and dying processes have specific rituals and requirements. Families should be present when entering or departing this world. The umbilical cord has significant as a direct connection to the land and was buried on traditional land after birth or after delivery or all parts of the body are considered sacred, making it very hard for families to donate organs of their loved ones who have died.

Cremation is uncommon. Sometimes the burial site is relocated some years later or the birthing of the bones of a deceased person. There are customary protocols for undertaking these, and therefore cremation is often seen as at odds with these customary rituals. It is important for clinicians to be aware of spiritual beliefs of their patients and to provide the space for Pacific peoples where needed to receive spiritual support in the healing process.

In the hospital setting, this may mean giving space and time for families to pray before the patient is taken away for surgery or the offer for a church minister. A traditional healer to attend in critical moments for the dying or the critically ill. It is extremely important that patients do not die alone in hospital. Where, in your assessment, death is imminent.

The family should be alerted as soon as possible and given the opportunity to stay with their loved ones until they take their last breath. Ask the parents or family whether they wish to have the umbilical cord of their baby or regarding organ donation. Helping Pacific peoples to know they are contributing to the health of other people in the wider community and contributing to a community good that may help them in understanding why organ donation is important.

“In the Samoan indigenous religion the unity and harmony between the temporal and the divine, between time and space and all living things is God. Man’s purpose in life is to search for that unity and harmony, to search for God.”

Tui Atua Tupua Tamasese Taisi Tupuola Tufuga Efi (Former Head of State of the Independent state of Samoa) in a Paper for the Colloquium Organised by Pontifical Council for Interreligious Dialogue Vatican City, Rome, Italy 12 – 15 January 2005

Mental

This component relates to people's mental and emotional well-being. There is a deep connection between people's mental well-being, their journeys in life, and it includes a sense of belonging. The approach to Pacific people's wellness requires is an understanding and careful navigation of their journey to wellness. With the support of significant peoples in their lives and their connectedness to their cultural context, family, their roots, which could be their village, the region, the nation, including meaningful spaces and places in their past experiences.

While there are specific criteria for the diagnosis of different types of mental illness. Pacific people's personal beliefs can also contribute to mental illness. For example, a patient may believe that they had been coerced and the lifting of the curse will result in improving of their overall health. In this instance, involving the relevant experts such as a church minister would be helpful.

Some may believe that the breaking of cultural taboos can contribute to their mental or physical illness. In this case, seeking relevant cultural advice from cultural experts or traditional healers can assist in working out the best way forward. In supporting people's journey to wellness.

"I am not an individual;

I am an integral part of the cosmos.

I share divinity with my ancestors,

the land, the seas and the skies.

I am not an individual, because

I share a "tofi" (an inheritance) with my family,

my village and my nation.

I belong to my family and

my family belongs to me.

I belong to my village

and my village belongs to me.

I belong to my nation and

my nation belongs to me.

This is the essence of my sense of belonging."

Poem by Tupua Tamasese Meaole,

HRH, Samoa Head of State

Other

“Other” includes factors such as: Sexuality, Gender, Age, Literacy, Health Literacy and Socio-economic Status.

These are factors that are important to keep in the background of our thinking as Pacific peoples adjust to a new country, a new culture and a new way of life.

Culture

The roof of the house provides shelter from the external elements. It represents culture, cultural values and beliefs which link Pacific peoples to their identity, who they are, and affirms their sense of belonging.

The confidence gained from within the shelter and place of safety enables them to engage in meaningful way within society. Cultural practices may change with time, but the core values and beliefs of each culture remains.

As a health professional, having an understanding of the values and beliefs of your patients will help you better develop meaningful and trusting relationships with them. Pacific peoples are diverse, with many mixed ethnic backgrounds.

For example, Tongan-Irish or Samoan-Cook Island or Tahitian-European. Some may have been brought up in a strong Pacific cultural context, while others may not/ Take care, not to make assumptions and remember it is not a one size fits all.

"E sui faiga ae tumau fa'avae"
~ Samoan proverb

The way we practice culture may change, but it's roots and meaningfulness remain.

Time

Time takes on a different meaning in a Pacific cultural context. The timing of events and activities were determined by the seasons, the sun, the moon and the stars when people went to work on their plantations. This was often determined by the sunlight hours and not a specific time of the day, keeping to specific work hours and times as determined by the clock is traditionally a foreign concept.

It is important for health professionals to keep in mind that their idea of time may be different from that of their patients. The idea of being prompt for appointments may not be as important to the patient as it is for you as a health professional. Therefore, it is important to consider sending reminders to patients, perhaps using their mobiles.

The landline or mail can often assist in reminding patients about the specific times they need to attend clinic for an appointment. When you hold a health promotion event involving community leaders will often assist in ensuring people consider the event to be important. Otherwise, no one may turn up on time or no one may turn up at all.

Context

Pacific peoples are from many different ethnic groups, each with their own specific protocols and processes for navigating their unique spaces. Within these groups, there are specific hierarchical systems and specific values and customs are expected to be observed. It is important for you not to make assumptions about specific people and how you should engage with them or how they might relate to you.

Because of the diversity within these communities. The best way to approach a situation that you are unfamiliar with is simply to ask for help and guidance. Larger district health boards such as the Counties Manukau District Health Boards and other areas in New Zealand, particularly in Auckland and Wellington, have Pacific teams. These teams can assist you. There are also Pacific providers throughout the countries where you can seek help and advice from them also.

There are church groups and Pacific leaders in the communities who are very willing to support your work. So that you can support the health and wellbeing of their communities.

Environment

The current environment for Pacific peoples has changed since they moved to New Zealand. Most, however, still have very strong connections to this Pacific islands where they're from in the Pacific. Some Pacific patients, when they die or they're about to die, request their families to take them back to their land, to their islands, in the final stages of their journey.

If this is the case, ensuring a timely process for giving back the deceased to their family will ensure a smooth process to honor the wish of their loved one as soon as possible.

Pacific Health at Otago