Podiatry Seminar: Culture and Related Issues

Saturday 9 June 2007; 9am

Jubilee Hall, Foundation for the Blind, Auckland

Tariana Turia; Co-leader of the Maori Party

'Happy Feet is not just for Penguins'

I was told a story the other day about a Man called Stan.

At his funeral earlier this year, there were many stories celebrating his large presence amongst the Samoan community; his service; his sacrifice; and the big shoes he had left behind.

And they were literally big shoes. Super-size in fact.

Stories flowed about Uncle Stan taking off his shoes in the middle of a busy crowd to help his nephew who was also blessed with an unconventional shoe size. One daughter spoke about the great joy her father had after she returned from an overseas trip, laden with shoes of all style and description; and like a modern day Cinderella, every single slipper fit neatly on his feet.

And then I started thinking about my six children, my twenty-six grandchildren; my nine great grandchildren. And how at the moment of their birth, we would caress their precious little bodies, and look for the connections.

“She has her Nanny’s dainty little toes”. “He’s got his feet from the Turia side”.

You see, ‘happy feet’ is not just a concept created by Warner Brothers; a comedy fantasy in the land of the Emperor Penguins.

‘Happy feet’ is something our families know and believe in, as part of our every day lives.

Indeed, we refer to waewae kura: precious feet as one of our proverbial sayings.

The challenge of cherishing, respecting, protecting our waewae kura, is a challenge that you in the podiatry profession are charged with.

I am pleased to be with you all today, to share my views on that challenge, particularly responding to your theme in considering the cultural competency required to meet this challenge.

When your President, Rangimarie Whatley, invited me to the seminar today, I was really happy to accept, for two reasons. One – as I’ve already mentioned – because the fascination with feet is something that many Maori and Pasifika families share from birth to death; waewae kura.

The other reason is because we in the Maori Party, know how very small the number of Maori practitioners are in the field of podiatry, and we are really keen to promote any developments which increase the presence of Maori both in the workforce, and in the cultural competency of the profession.

The Podiatry Workforce results from the 2006 health workforce annual survey revealed in fact that only 3.3% of the workforce who are actively practising as podiatrists are Maori. 1.3% of the podiatry workforce was Chinese; and Indian and other Asian ethnicities each constituted 0.7%. Pasifika podiatrists didn’t even rate a mention in the ethnic breakdown.

The Ministry of Health concluded that the fact that the majority of the workforce is European – a massive 87.5% - has been a consistent feature of this profession over previous years.

So perhaps this is the biggest challenge of all, how do we support a workforce which is predominantly European, to understand how best to meet the obligations, as a registered practitioner, to standards of cultural competence.

So what is Cultural Competency?

The concept of cultural competency is something that I absolutely believe in.

It was a concept that we began talking about when I was Associate Minister of Health; and it was introduced into the core business of podiatry and chiropody through the registration process.

As you will all know; any podiatrist who wishes to practice in Aotearoa, needs to register with the Podiatrists Board – which operates under the Health Practitioners Competence Assurance Act 2003.

In that Act, section 118 makes it quite clear, that “the functions of each authority appointed in respect of a health profession” include setting standards of cultural competence.

So what exactly does it mean to be competent in cultural matters?

In Te Ao Maori, we talk ofHe wae kai kapua: feet touching the clouds – those who indulge in impractical or impossible ideas; as opposed to He wae kai pakiaka : feet touching the tree roots – those who considered sound and practical ideas.

What I want to think about, is how to help us all be skilled and equipped with wae kai pakiaka, to be part of the stories of happy feet, rather than stories of neglect, of disease, of amputation.

The need for such competency has never been greater.

More than 500 lower limb amputations are done every year in New Zealand because of the ever accelerating pace of diabetes. 110-120 of these will be of Maori people; and their amputations will be at a much younger age, given the lower age of developing type two diabetes. Pacific people also experience more than double the average rate of amputations.

The majority of those amputations are avoidable – if there had been better foot care. In fact, diabetes specialist, Don Beaven describes amputations as “a failure of ordinary care”.

This surely then, is another major challenge for this workforce.

How is it that so many New Zealanders are suffering from a failure of ordinary care? And why is it that it is brown New Zealanders who appear to be suffering the failure more?

Undoubtedly, income and economics plays a huge role in looking at solutions.

We know that podiatrists are earning much better money in private practice than hospital care, so the shortage of health professionals is ending up in a loss of vital services.

Foot problems are the most common cause of the 7000 hospital admissions that this nation experiences, year in, year out.

It’s like that old negro spiritual: toe bone connected to de foot bone, foot bone connected to de ankle bone, ankle bone connected to de leg bone.

Diabetes causes a loss of blood supply and feeling to the feet, meaning injuries are undetected, leading to an increased risk of infection, ulceration and amputation.

Faced with these amputations; the growing impact of diabetes; the particularly severe and disproportionate effects which are felt upon Maori and Pasifika populations, we may be at a stage which our old people referred to as: He waewae täpeka ki te ara ripeka” : literally a foot turned crosswise.

This refers to something diverging from the right way, from pure to impure, from moral to immoral; from right to wrong.

So how do we get our feet both facing the right way again?

Well the Podiatrists Board has it set out there in the registration requirements in black and white:

• Consider the matters relating to gender, religion, ability, class and ethnicity including the Treaty of Waitangi;
•
• Podiatrists must be sensitive to social, ethnic and cultural safety;
•
• Health practitioners should provider services which are culturally appropriate and take account of Maori health needs and perspectives.
•
Competencies are written right throughout the minimum standards which demonstrate this.

To practice as a profession you must respect social and cultural values; or to demonstrate competency in communication; diagnosis and effect treatment, your interpersonal relationships are key.

Well – it’s all there in your code of practice, so I’m not going to go over ground that you must already be familiar with. But if I would say one thing, it is about the vital need of respecting social and cultural values.

Just as the Dem Bones spiritual reminds us, we can not treat feet in isolation from the rest of the body. In the Maori world our bodies are considered tapu – sacred and special. In this way, we hold a clear separation between the sacred and the common.

We believe that everyone holds their own unique sense of tapu – their own personal mana – and that should be respected.

In this sense, if someone was to step over another person – to jump over them as they had their legs outstretched would be both rude and demeaning of that person’s mana.

It is perhaps understood best in the concept Oku kainga waewae: the scope of my feet’s activity – the places my feet have trod, the places I am familiar with, the history and association with the land; my past, my genealogy that comes with me.

Toe clipping or removing a verruca is not just one of the tricks of the trade – you are actually treating the whole person – and the ancestors they bring with them.

The notion of holistic health of course also extends outwards into other areas of wellbeing outside of the physical.

I am really interested in the project that Auckland University of Technology is leading for Maori with diabetes related foot pathologies.

Their work in establishing Taupua Waiora Centre - a project funded by the Health Research Council in collaboration with WaiHealth, Raukura Hauora, Te Puna Hauora and the AUT School, of Podiatry, takes for granted that alongside dressing wounds and prescribing orthotics, their work may also involve connecting patients to wider social services.

And that, again, is part of the challenge of cultural competency.

In treating your clients with respect, you must also be constantly listening to other messages that may be coming out from the stories told.

Having empathy with your clients, establishing rapport, and looking for signs both verbal and non-verbal, which may lead you to appreciate other needs.

I am really impressed by the emphasis that the Podiatrists Board has given to cultural competence, and it is heartening to see that the specifications set in the Health Practitioners Competence Assurance Act are actually amounting for something in the real world.

And if I could leave one more message from our whakatauki, it would be to consider the message in : Na te waewae i kimi: by the feet it was sought .

By searching diligently, by being prepared to listen to the stories you are told, by taking time to look and listen and learn; one will find the desired goal.

ends

© Scoop Media