Just decades ago, the gulf between health practitioners and the many Mäori (the indigenous people of New Zealand), impacted on the quality of health outcomes for Mäori. Bridging this gap is an engagement process.
This is the first of my engagement stories and it is close to home. My wife, Huria works as an educator for Te Poutokomanawa (Mäori Health Services) at Whangarei Hospital in northern New Zealand.
The enlightenment crossroad
My ancestors were European, Huria’s were Mäori and Polynesian. They both shared a world-view that accommodated both the material and spiritual. Both the spiritual and material influenced health practice. For example, monasteries often included a pharmacy. Both cultures relied heavily on herbal treatments.
the Maori herb kawakawa and European herb rosemary
When Europe entered the Age of Enlightenment in the 18th Century science displaced tradition. Scientific truth became synonymous with progress. Like teenagers discovering new capabilities, the followers of science viewed traditional medical knowledge as something to leave behind. Science became increasingly reductionist, and the only thing that mattered was what could be measured. Hopefully the “teenagers” will come to appreciate the wisdom of their elders.
Clash of cultures
Even as a Pakeha (New Zealander of European origins) the medical world seemed unwelcoming and sterile. I still avoid hospitals and medical clinics. Doctors seemed to treat people as objects rather than people, and some still do. To those from an indigenous tradition, the gulf is much wider. Medical practices were alien. People were separated from whanau (family), and hospital culture (individualism, medical jargon, cold and impersonal, command- control practices) clashed directly with Mäori cultural practice. Medical language was even less understandable than English for native Mäori speakers.
Legislative change
Prompted by poor health outcomes for Mäori, the government passed legislation in 1993 and 2000 to ensure that Mäori could, among other things, “contribute to decision-making on, and to participate in the delivery of health and disability services”. The two main changes were the development of Mäori Health providers and the development of Mäori Health Services with the public health system.
Bridging the gap
The Mäori Health Strategy is based on three principles articulated as Treaty of Waitangi principles:
- Partnership: Working together with iwi, hapū, whānau and Māori communities to develop strategies for Māori health gain and appropriate health and disability services.
- Participation: Involving Māori at all levels of the sector, in decision-making, planning, development and delivery of health and disability services.
- Protection: Working to ensure Māori have at least the same level of health as non-Māori and safeguarding Māori cultural concepts, values and practices.
To achieve this, in practice, where Huria works the main initiatives are:
- Having Mäori staff available in wards to facilitate engagement between Mäori patients and clinical staff.
- Ensuring Mäori voice is heard at all levels from the board to the ward.
- Promoting and educating in Mäori health and cultural concepts to hospital staff.
- Promoting health careers to Mäori in the region.
Cultural practices
For Huria, Mäori cultural practices happened from the start. The image below is from Huria’s powhiri (welcome) on her first day at work. The powhiri is a ritual of encounter. Huria was supported by Mäori elders and family members, some travelling for half a day to attend. The family handed her over to the new employer, with the understanding that they will care for her. The powhiri is an expression of both engagement and appreciation. It was heart-warming to hear people speak so warmly of Huria’s qualities – a great way to start any new job.
Other common cultural practices Maori bring that change the flavour of the work environment are karakia (prayer) and waiata (singing).
Dollars and sense
No doubt there are those who think that this is a waste of money, and it would be better to fund more operations. But ultimately these engagement processes will change both health practice and Mäori perceptions of health practice for the better. Surely, if Maori are more comfortable and at ease in the environment that is attempting their healing, the outcomes will be better.
Health models based purely on scientific practice are deficient. Mäori academics contribute to the engagement process. Mason Durie’s Te Whare Tapa Wha model, for example, positions health as a function of four interconnected dimensions:
- hinengaro – emotional and psychological
- wairua – spiritual
- tinana – physical
- whanau – family and extended family
Engagement principles – worldviews
Two engagement principles are illustrated here. The first is the benefit of sharing world-views. If any system of knowledge becomes too insular and too dependent on its own resources, its ability to adapt and develop is compromised. Western medical models can only benefit by learning from traditional and indigenous world-views and vice versa. The more engagement, the better the learning.
Engagement principles – diversity
The staff working for any organisation, should look like the communities they serve. Having a diverse staff is not just a nice idea. People are more likely to feel at home and want to use services if they see people working there who look like them, speak like them and dress like them.
Ultimately there will be no need for Mäori Health Services, because Mäori will be more represented at all levels of staff, and the two world-views will sit naturally beside one-another. Hopefully it won’t take too many years for this to happen.
Stakeholder Engagement 