Serving Neglected Maori Needs

By TODD, Rebecca

Maori health providers have been operating for nearly 20 years. REBECCA TODD investigates how they make health services work for Maori. ——————–

Housed within an unassuming white weatherboard building on Gilberthorpes Road in Hei Hei is the Te Puawaitanga Ki Otautahi Trust. Its 30 or so staff are often not around as, like other Maori health providers, their focus is on care in the home.

The trust delivers the Tamariki Ora Well Child programme, outreach immunisation, chronic-disease services and education programmes. It deals with thousands of clients and everything is free.

Tamariki Ora community health workers Pani Ruwhiu and Pat Hetariki say it is all about gaining trust when dealing with Maori.

“You have to do a powhiri visit as part of a process to actually get into the house. A lot of young Maori mothers are quite closed to organisations or systems, so we can’t just barge in there,” Ruwhiu said.

Hetariki said face-to-face contact was essential, and having a brown face turn up at the door also helped.

Once inside, her primary focus was the newborn, but she also had the chance to look at the health and well-being of the whole whanau. She visited some high-need families up to three times a week, sometimes just to make an appointment if they had no phone or to accompany the mother on a visit to the doctor.

“Usually the baby’s health is fine, but parenting can be an issue because they have missed out on that nurturing themselves,” Hetariki said.

“These services are essential. Mainstream has always been there and hasn’t worked; that’s why programmes like ours came about.”

Ruwhiu said a big part of their role involved building a relationship and encouraging Maori to engage with mainstream services.

“It’s about breaking down the barriers,” she said.

“A lot of them get spoken to in a condescending manner. A lot of mainstream providers don’t understand their culture.”

Indications the programme was working included a 95 per cent immunisation rate for children enrolled with the service.

The Portrait of New Zealand health survey, released last week, highlighted well-known statistics, such as the extraordinarily high rates of diabetes, heart disease and some cancers among Maori.

Its most concerning finding was “the persistence of large disparities across a range of risk factors and health outcomes for Maori and Pacific peoples compared to the total population”.

Disparities such as these, along with a nationwide push towards Maori doing things for Maori, led to the first Maori health providers being set up in the early 1990s.

They now number 240 nationwide, with a focus on home-based services that are culturally sensitive to the needs of Maori.

Canterbury District Health Board’s executive director of Maori and Pacific health, Hector Matthews, said Maori health providers were working.

But statistics could look different according to your point of view, he said.

Maori rates of diabetes and obesity may not have changed over the past decade, but Maori were living longer today than they had at any time in history.

Maori smoking rates were still about double those of non- Maori, but only half of what they were 30 years ago, he said.

“There are definitely improvements being made. Some are incremental and will take a long time to show significant gains, but that’s not to say there are areas that could do with more improvements than others,” he said.

Maori health providers were particularly effective in dealing with people who would not otherwise use mainstream services.

“If we didn’t have them, many more people would slip through the cracks,” Matthews said.

“There’s enough evidence now in terms of measured outcomes to say it’s an effective way, but it’s important to remember that Maori people, like everyone, want choice and have the right to choice.”

After the release of the national survey, Maori Party health spokeswoman Tariana Turia said it was not an accurate reflection of indigenous health as Maori took a more holistic view of well-being.

Health was not simply the absence of disease but was part of a wider picture, including people’s connection to their culture. Maori health providers were achieving great results in this area, she said.

The director of Otago University’s Christchurch School of Medicine and Health Sciences’ Maori Indigenous Health Unit, Suzanne Pitama, said it was true that Maori viewed their health differently, but there was still a responsibility to work towards equity.

“Talking about holistic care sometimes distracts from current pressures on our health systems,” she said. “Maori providers are almost the ambulance at the bottom of the hill. When people haven’t been successful in other programmes, they are there to mop things up.”

Associate professor Tony Blakely, of Otago University’s Wellington School of Medicine and Health Sciences, said believing in Maori providers was an “article of faith”.

“It’s an article of faith that I subscribe to. I see them as an essential part of the landscape going forward indefinitely,” he said. “But they are only one part of the jigsaw, and providing firm quantitative evidence that it works is difficult.”

Healthcare for Maori by Maori was useful but should not have too much burden placed on it to fix deep-seated inequalities.

Most Maori still used mainstream care; therefore the onus was on those providers to improve their game, he said. For that to happen, researchers needed to better understand what was going wrong.

“We have flags saying something isn’t working, but we need better information so health services can respond. In the meantime, they have to move forward as best they can,” Blakely said.

Culture clashes and difficulties navigating the complex health system could become issues for Maori.

The real problem and the focus of many research projects was how to improve Maori health faster to end the disparities, he said.

Socio-economic differences accounted for about half of the disparities between Maori and non-Maori. “Increasingly, people are buying their own top- up health care, so addressing these inequalities is going to be an ongoing challenge for us.”

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(c) 2008 Press, The; Christchurch, New Zealand. Provided by ProQuest Information and Learning. All rights Reserved.