The first inhabitants of New Zealand came from the islands nearby. The locals or what they call themselves, Maoris, travelled across the pacific some thousand years ago. It was also thought that the Maoris arrived in the island by groups. The initial meetings between the pakehas (the whites) and the Maori’s was recorded to have been in the 1700’s headed by James Cook, an expedition coming from Britain.
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In the middle of the 1800’s, an agreement was written between the British colony and the local settlers in the form of the Treaty of Waitangi. Agreed and signed by Maori chiefs and individuals that stood in behalf of the British crown. This agreement came about as the mediating factor between the foreigners and in particular the protection of the interests of Maori’s. The treaty gave way to more migrants from Britain up to a point where pakeha’s already outnumber the locals.
With new methods of living introduced by the whites, the locals were not able to adapt easily constituting the increase in Maori death rates. It was believed firearms and new contagious illnesses were among the top cause of mortality for the locals. Moreover, history is telling us that after New Zealand was colonized, locals were losing their lands which contributed much of the Maori’s health issues. It was noted that incidence of death was not as high as compared to those indigenous groups who were able to get hold and not surrender their lands as in the case of the Tongans and Samoans. (Kunitz, 1994)
The various challenges the Maori people faced were not limited to confiscation of their lands. This included putting restrictions with their rights and discouraging the use of Maori language in the area of study which paved way to adding more insult to the health of the Maori’s.
The signed Treaty of Waitangi has its main purpose which is to protect the rights of the locals of New Zealand particularly the Maori’s. However, realization of the main purpose of the treaty remained only in writing which resulted in disparities in health access between the whites and the Maori’s.
In this paper, I will be discussing the disparity and how it has put the Maori’s in the disadvantage which was clearly the opposite intention of the Treaty of Waitangi. The aim here is to better understand the Maori’s and where they are coming from so we, the future health care providers in this country, would be able to perform our duties properly.
Various studies have been done and scholars cited numerous reasons why there are inequalities particularly in health between the pakeha’s and the Maori’s. Genetic factors and environmental influences are among the suspects for the disparity but really does not play as the key variables when it comes to public health concerns.
For the purpose of this study, we try to dissect the “nongenetic” factors for the disparities in health between the pakeha’s and the Maoris. These include socioeconomic variables, lifestyle, discrimination, and accessibility to health care. Noting that, although, these may be four areas to consider, they are all somewhat correlated with each other.
The loss of land by most of the Maori’s constituted to their poor status. The locals have lost their ability to care for their lands which led to low production of fruit crops. Inability to rear animals such as pigs, sheep and cows due to lack of space also contributed to their lessening power to trade. Without much power in trade resulted to low income which forced them to live in the outskirts where there is limited supply of the basic needs. As a result, the Maori’s, being unable to acquire the necessities in life, were subjected to poor health conditions.
Tobacco use and alcohol consumption were introduced to the locals by the colonizers to help pass time or to keep them pre-occupied. However, with their poor state of life, Maori’s resorted more to these vices to combat depression. Unknowingly, it had grown in them and fell slave to these addictive elements. Excessive intake of these products created more problems for the Maori’s. They became more depressed and elicited unruly behaviours which certainly did not help in promoting good health practices.
The lack of knowledge with proper food preparations also added to the Maori health issues. Maori’s also believed that when an individual has gained weight that it is a sign of being healthy. Unfortunately, with the wrong perception, high rate of obesity and cardiovascular related diseases are not uncommon to them.
The locals or the Maoris have been long a subject to racism and have experienced discrimination at all levels for most of their lives. The incidence happening within the health care areas, may it be conscious and unintentional attitudes of people providing health care, have caused the Maoris to be doubtful when seeking medical assistance until it is already in its worst stage. Maoris also have encountered disempowerment coming from health care professionals. GP’s were reported to not likely support when it comes to measures to prevent health conditions to Maoris as compared to the non-Maoris.
Access to Health Care
Living in far flung areas not only inhibits the Maori’s accessibility to health care but it also limits them in getting proper assistance from any health care provider. Still in connection with the socioeconomic factor, some, if not most, of the Maori’s are still illiterate when it comes to using the internet due to either lack of service in the area or the lack of capability to get the service. Transportation also plays an important role when it comes to accessing health care. Most Maoris do not have the means for them to bring themselves to the nearest health care institution. Mostly happening, if a person coming from a specific cultural minority will seek medical assistance, one would want to find out if there is a medical staff of the same cultural background so it would be easy to convey their real condition. Being able to talk to an individual of the same culture will help ease the patient in opening his or her issues.
In recent time, a health disparity model has been formulated by the government under the Ministry of Health. This is to address the issues pertaining to inequalities in health for Maori’s. This model recognises the root of the disparities in a community and outlines procedures than can be performed to combat situations that cause the disparities. Areas that the model wants to achieve include finding ways on how to improve an individual/family income, the importance of employment, providing education and health access for the locals. In this model, it is also addresses Maori’s to have more control in the land/communities they are currently living in. It is also supported that health services including disability assistance be given when necessary. An example of this is when a local is disadvantaged due to sickness or disability will be provided sufficient income assistance and support against social, ethnic and racial discrimination. (Ministry of Health, 2002)
A case study was done about a Maori banker who sought medical attention as he was not feeling well. During consultation, the GP was not able to get the whole picture about the status of his patient. The GP tried to explain his thoughts about the situation and asked for further details. The patient started to get frustrated. The patient mentioned that she went to a urupa (graveyard) and smoked and thought it could be the reason of his condition. The GP, having no idea of the significance asked for its relevance. The banker revealed that graveyards are considered sacred and that by smoking in it is against their culture. The GP elicited if the patient had any idea on how to fix it. After a sigh, the patient replied that he needed a priest. For the GP, although he knew the act had nothing to do about his condition, out of respect of the individuals’ belief, he acknowledged about the violation of their culture and that he would be able to give medicine to take care of his breathlessness.
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In this case, the Maori patient really believed that the cause of his being unwell is rooted from him violating the Maori culture. Although the GP could have easily corrected the wrong notion, it would have been really difficult to have an argument especially if it contradicts ones cultural beliefs as it would mean for them as a sign of disrespect. The GP in this case was able to show signs that he respected their cultural system while presenting complementary solution from modern medicine which in turn helped hastens the intervention. The GP being comfortable with the disease attribution of the patient and by following the culture protocols while offering supportive assistance to deal with the patient’s breathlessness gave way for the Maori patient to be also comfortable in accepting treatment for both Maori and modern method of treating the condition.
Another case involving a 47 year old man of Maori descent who have encountered an injury from a crash at his work place as a driver. The health provider handling the patient had difficulty because the man is rude and unfriendly when they initially spoke on the phone. The issue was then brought up in a team meeting. Fortunately, one member is also a Maori who then suggested that a personal meeting is necessary between the health provider, his employer, client and his family.
The meeting was then set and everyone was present including the clients’ employer and whanau. During the meeting, the patient spoke that it was his first time to meet most who were in attendance. The patient also expressed his dismay about the different treatment plan suggested by different providers and that there was no clear information on when he is able to return to work. The patient is also concerned about the rehabilitation process as it might interfere with his duties in their cultural group. In this case, since all the variables that can be affected during the procedure were all present, it made easy to formulate a care plan. By doing this, a fast and significant recovery was experienced sooner than expected since everyone was motivated and at the same time very cooperative performing the planned care.
As a future health care provider in New Zealand, understanding the Maori’s is very critical in providing health service and somehow will help fulfil what the Treaty of Waitangi is really for. Our aim as health care practitioners is not to change an individuals’ beliefs or customs. We should be advocates particularly to the disadvantaged for them to have control of their lives and be able to improve their ways of living most specially with their health. We should then encourage Maori’s to look after their health and be able to support their own well-being.
Caring for them is not limited to those who are sick only but also to their whanau where making right choices about maintaining good health practices should be inculcated fully. In order to be successful with such model, the Maori’s and health care providers should be able to access the necessary resources. It should also be readily available, accepted and is in line with the maori culture.
As most of us do, it is a must that we trust our own health care provider to let them handle any of our health conditions. Same with the Maori’s, if they are satisfied and accept the treatment given then it gives them confidence that the health care provider understands where they are coming from and what they really need.
For this, it is a must for all health care providers to increase their knowledge about the history of the Maori culture and better understand what the real intentions of the Treaty of Waitangi. This move will definitely make the health care provider be culturally competent and be able to effectively communicate with Maori individuals and their whanau. In addition, this will also encourage patients to seek help early and be able to provide pertinent clinical details.
Kunitz, S. J. (1994). Disease and Social Diversity: The European Impact on the Health of Non-Europeans. New York: Oxford University Press Inc.
Mäuri Ora Associates. (2006, October). Best health outcomes for Maori: Practice Implications. Retrieved April 2, 2015, from Medical Council of New Zealand: https://www.mcnz.org.nz/assets/News-and-Publications/Statements/Best-health-outcomes-for-Maori.pdf
Ministry of Health. (2002). Reducing Inequalities in Health. Wellington: Ministry of Health.
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