Chona C. Ching
The Treaty of Waitangi and Maori Health
Maori landed in Aotearoa New Zealand from Hawaiiki, where Maori people originated. Maori people were Polynesians culture. They live 500 years in Aotearoa before the arrival of British Empire. In 18th century, Captain Cook explored New Zealand. In 1833, British government appointed James Busby, a British resident, to protect British trading and interest because there were a lot of settlers who came to New Zealand. Despite his presence, problems were never settled. In 1840, British government sent Captain William Hobson as a lieutenant-Governor with the mission to be able to sign a treaty with the Maori chiefs. The instruction was to acquire sovereignty over New Zealand. It was never easy for the native people to agree because Britain had earlier acknowledged Maori rights in the certificate signed in 1835 instigated by James Busby which were signed by 52 Maori chiefs. This paper states the “Declaration of Independence” which make the country an independent country and that all sovereign power and authority would go to the hereditary chiefs. It was not an easy road. The treaty was force to de settled. After a day of debate, dated 6th of February 1840, the treaty was signed by 43 northland leaders in the Bay of Islands and the next 8 months the treaty was signed at more than 40 places. A total of 532 Maori chiefs have signed but there were few important chiefs who refused to sign the treaty. The treaty was translated by an English missionary Henry Williams. The treaty contains three articles each with English and Maori version but has different meaning and interpretation. The first Article tackle about sovereignty, with the English version that states that Maori give up their sovereignty to British crown, where in Maori version implies a sharing of power, which means “kawanatanga”. The second article talks about the protection of property rights and the Maori version entails custody and preservation over cultural and social aspects. The third article guaranteed Maori the same citizenship rights as all British subjects. Both version are genuine and signed. Despite having a treaty, later the document was ignored. Maori rights were violated. Although Maori protested, it was never successful. Later, New Zealand dramatically grows due to immigration and Maori populations declined due to war, loss of land and illness.
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The New Zealand Health Strategy has established three principles obtain from the treaty that is significant to Maori health. The first principle is Partnership, which means working with the Maori society in all aspects to develop an action plan for the societies health care; Participation, which means encouraging Maori to be involved in the planning and delivery of healthcare services; and Protection, working to guarantee that Maori will have the same level of health with the non-Maori, and safeguarding the Maori norms and values and cultural beliefs. The Treaty of Waitangi can be enforce to the Maori health. In the Treaty, Maori should have their forest, fisheries and land. Addressing the problem regarding the land rights, social disruption and loss of language can help mitigate the factors affecting their health. In addition, In Maori version of the treaty, it ensures that “taonga” or precious possession should be retained and protected. In this point of view, health is considered as taonga. Furthermore, New Zealand Public Health and Disability Act 2000, acknowledge the Treaty of Waitangi, by compelling the DHB to address the Maori health and lessen the health disparities by improving the health outcomes of Maori and the non-Maori.
Cultural Practices among Maori
The native people of New Zealand which is Maori made up 15 percent of the population. Maori people has the lowest health status compared to the non-Maori group, higher illness rates and Infant mortality rate due to SIDS and low birth weight. The death rate among Maori is doubled compared to the non-Maori population. The reasons for this are lower rate of diagnosis and minor access to healthcare for adequate treatment. Overall, Maori are more ill for longer periods of time and have inadequate access to healthcare which results to death. These gaps in health among Maori are affected by the factors such as poverty, education and location, saying that culture is a determinant of health. These poor standard of health leads to substandard health outcomes which make the Maori group perception on health care delivery system negative.
Treatment studies about differential approaches have shown that some healthcare provider such as doctors treat Maori different from non-Maori. An example of this case is that a doctor was observe during a consultation with a Maori patient, where the doctor spent only 2 minutes rather than the normal consultation time which is 12 minutes. Due to this, Maori people often have fewer diagnostic exams, lesser treatment method and are referred to tertiary procedures at lower circumstances. With these events, there is a clear bias experience by the non-Maori group. The result is that Maori are unable to obtain sufficient care and understanding of the health information. This will affect the capability of the Maori people to follow treatment regimen and thus lessen the effectiveness of the healthcare plan.
The Maori people have a fundamental belief that understanding and being connected in the past is essential for the present and future. This is shown by the importance place on tupuna (ancestors) and whakapapa (genealogy over generations). Furthermore, a health environment is essential for it affects both the individual and community. Maori perspective on health is an integrated approach that adopt the four pillars of health: te taha hinengaro (the mental dimension), te taha wairua (the spiritual dimension), te taha whanau (the family dimension), and te taha tinana (the physical dimension). For Maori traditional perspective, the spiritual well-being or wairua thus not only provide connection with ones whanau but also the key to ones identity thus linking each one with the bigger society that sustain, safeguard and support. The mental (hinengaro) and physical (tinana) health is completely connected with the wairua and other component of a healthy life, which includes physical environment. The link between the environment (tea o turoa) and Maori is one of stewardship. The environment is the outflow of life and contributes an important component in the identity and integrity of people. There is a saying that states that “without the natural environment, the people cease to exist as Maori” (Royal Commission on Social Policy, 1988). Because of this concept towards health, understanding towards the type of disease and treatment priorities differs between Maori patients and non-Maori health care provider. The essential to health promotion is understanding their needs and work with them, assist the patient to obtain the best health state, within their culture, and to achieve the possible outcome. In Maori society, Whanau means family, which means directly parents and child, but sometimes in a broader relationship group with common ancestor. The fundamental unit in the Maori community is whanau which is organised and that the common good of each member is the concern of all. The degree to which a Maori belong to a traditional whanau depends on the experience in life, location, distance between families and relatives and communication. Maori culture is actively changing this is due to mobility, migration and reproduction. However, modern Maori family still give importance to connectedness, obligation, duty and benefit throughout their lives. Disrupted Maori families who have been influence by drugs, alcohol or sexual abuse is due to complicated connections, obligations and complex family bond. Interventions are needed to address this concern and should take place at the level of bigger whanau to be sustainable, efficient and acceptable before it multiplies through generations. Because of their connection, Maori patients often bring their family members during consultation and discuss with them whether to accept treatment proposal. Other Maori feels the need of another whanau who will serve as their spokesperson, with this longer consultation will take place and better decision will be made. Aside from greater comfort experience by the Maori patient, the presence of whanau will lead to improve care. For instance, they can add more about the patient’s background and medical history and help in convincing the patient to understand the medical instruction given and help in doing the treatment regimen. In order for the inequalities to be treated reliable and consistent data collection of ethnicity is important to achieve the finest clinical care. Without having this information which includes educational level, religious, socio-demographic date, affiliation, marital status, dietary habits and lifestyle, health care team will not be successful to provide the best care. Where the care is base on the understanding of the cultural background about the patient. Furthermore, it does not only benefit the patient but also the health system itself. Make it a habit to always ask the patient what their ethnic background is, and not to make assumption base on the colour of their skin or technically their physical features. By doing so, it shows your respect to the patient and also opens a discussion about their cultural choice. Ensure to give patient with thorough explanation on why, how, when will their given information be used. And assure them that it will be treated with strict confidentiality. And also make sure not to argue with them in term of their cultural view. There is what they called a central place of efficient communication. Improve communication is the utmost price of cultural competence. To make sure that the consultation period is worthy for both of you or maybe the whanau of the patient and the ultimate goal which refers to the health of the patient is achieved. It is common for Maori people to arrive in a consensus to prevent disruption over small matter. They may also seem to agree to the health authority but does not mean they totally agree. Harmony and respect is more important for them than. So make sure that during you presence they have totally said if yes that they will follow the treatment regimen or no if they don’t agree with the treatment regimen. In addition to this silence response of the Maori doesn’t mean that they totally agree but it is the opposite. In some instances, they just don’t care about it or doesn’t want to challenge the health authority. An improved way to approach a patient if he really understood or agree is by asking an open ended question, through this you are encouraging them to ask question and gauge how far does you patient understand you or the treatment plan, example asking if you have given them the necessary information that they need or ask them about what you just said. And also please take note that in giving health instruction, it can be done in many ways, so first you need to assess the level of understanding that your patient have, if he has sufficient or little or no background at all to what you are saying. This is the moment that the whanau will assist the patient to understand the instruction that is given by the health care provider. The task of the patient is to receive the treatment plan while the whanau will assist the patient and collaborate with the health authority. There are also situation where a Maori would like to tell things privately rather than with the presence of a whanau, so you can say that there are things that you want to talk privately with the patient or you can wait when you are alone with the patient or situation that is privately done like genital examination and you can ask question openly. With this matter the society and whanau support to assist the patient play an important role to Maori health. As discussed earlier, each Maori can be described in terms of relationship with their whanau, and in return, the whanau has the responsibility to look upon the individual. For this situation, health care provider should acknowledge that a Maori patient wants to involved a whanau to be included in the health regimen and decision making. As mentioned earlier, it can be done by choosing one of the whanau to speak on her behalf regarding all decision that is yet to be made regarding the patient situation like who is staying with the patient, the food and others things that is related to their culture. It is also specifically important that when a patient’s death is imminent or expected, a visit from a family member is permitted.
One of New Zealand’s pledge and obligation to the treaty of Waitangi is working towards a healthy Maori community in the future. Health promotion is the manner of enabling individual to increase control and make their health improve, by helping people declare their control regarding their health and encouraging them to decide on what is good for their own well-being and health and not by changing their own values and belief. Health promotion for Maori includes their whanau in helping them choose the right decision to recover and sustain their health. However, in order for the Maori to actively participate or to have the urge to enhance their health, necessary factors are needs which includes the health care provider itself, availability, accessibility and culturally acceptable to Maori. Maori values a trusting relationship with their health care authority just like any other culture. Mutual understanding can be seen when there is patient’s contentment and the patients go and agree with the treatment of choice. Improve knowledge of provider regarding Maori tradition will improve their cultural competence, thus making the communication with the Maori patient more effective. With this, Maori won’t hesitate to seek medical advice thus increasing the clinical information needed to better understand the Maori patient. Overall, it can guide to a increase patient/family/whanau contentment and compliance with the treatment plan.
Medical Council of New Zealand (October 2006). Best health outcomes for Maori: Practice implication. Retrieved on 19/05/2015 from https://www.mcnz.org.nz/assets/News-and-Publications/Statements/Best-health-outcomes-for-Maori.pdf
Nursing Council of New Zealand (March 2005). Guidelines for Cultural Safety, The Treaty of Waitangi and Maori Health in Nursing Education and Practice. Retrieved on 19/05/2015 from http://webcache.googleusercontent.com/search?q=cache:xfttamYlS8YJ:www.nursingcouncil.org.nz/index.php/content/download/721/2871/file/Guidelines%2520for%2520cultural%2520safety,%2520the%2520Treaty%2520of%2520Waitangi,%2520and%2520Maori%2520health%2520in%2520nursing%2520education%2520and%2520practice.pdf+&cd=1&hl=en&ct=clnk&gl=nz
Improving Access to Health Care Among New Zealand’s Maori Population. (n.d.).
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470538/
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