Turia Speech To Medical Council

Hon Tariana Turia

Associate Minister of Health

Medical Council of New Zealand, Wellington

Speaking notes

I am so pleased to be here with you today, to focus on the vital alliance that must be forged between cultural competence and health. It is a genuine pleasure to be in the company of a Council which has done so much to advance the debate around the concepts of cultural safety and competence in the health sector.

I want to congratulate you for your proactive and visionary approach in supporting health professionals to firstly understand themselves in order to ensure their practice is both safe and culturally competent.

Your own statement of cultural competence, published in August 2006, stands as a beacon for the health sector, illuminating the appropriate attitudes, awareness, knowledge and skills that are necessary to work successful with patients of diverse cultural backgrounds.

You have developed some excellent resources advocating best health outcomes for Maori and for Pacific peoples.

These are documents which encourage doctors to open their eyes and broaden their minds to the possibilities emerging from understanding the different views that Maori and Pacific peoples have with regards to their bodies, their health and all aspects of their lives.

The Medical Council has defined three key aspects as comprising a culturally competent doctor:

- That New Zealand has a culturally diverse population;

- That a doctor’s culture and belief systems influence their interactions with patients and accepts that this may impact on the doctor-patient relationship; and

- That a positive patient outcome is achieved when a doctor and patient have mutual respect and understanding.

The emphasis that comes through clearly from the Council is that doctors need to be able to respect and recognise different cultural perspectives of patients, in order to improve health outcomes.

In essence, it comes down to survival. Survival, at one level, is about physical fitness. We know of course that physical survival of Māori was in doubt in the 1890s when the population declined to the perilous level of just 42,000 having fallen 60 percent in the previous fifty years.

Fortunately the resilience of tangata whenua has meant that we now have a population of some 600,000 and physical survival seems to be assured; although the rising rates of conditions such as rheumatic fever remind us we can never be complacent.

Right at this moment, for instance, I am seeking solutions about how we can assure a coordinated, targeted and well-informed approach will be taken to prevention, screening and treatment of this third world disease.

While we must continue to be vigilant in ensuring the quality of care is universally received across our populations, I want to focus on the interpretation of survival which extends beyond the achievement of physical health.

All of us know that one of the key determinants in predicting health outcomes in New Zealand is ethnicity, with Maori and Pasifika peoples having poorer health outcomes across the board. What this tells us is that the one size fits all mentality is not meeting the needs of significant sections of our community.

Conventional – or perhaps more aptly – traditional western practices and philosophies – are simply not addressing the longstanding inequities which continue to reflect poorly on our health system.

Of course – none of this is a revelation to the people around this table. The health system has acknowledged the change that they believe is necessary to address the pervasive problems; the social and cultural injustices which are manifest in unequal outcomes.

Cultural safety/kawa whakaruruhau, emerged as a significant component of nursing education within New Zealand in the 1980s, thanks in no small part to the driving force and leadership of the late Irihapeti Ramsden.

Following on from her lead, the Health Practitioners Competence Assurance Act of 2003 requires the regulatory authorities to set standards of clinical competence, cultural competence and ethical conduct to be observed by health practitioners.

Furthermore, the Code of Rights from the Health and Disability Commissioner stipulates that every consumer has the right to be provided with services that take into account the needs, values and beliefs of different cultural, religious, social and ethnic groups including the needs, values and beliefs of Maori.

Both the HPCA Act and Code, therefore, provide us with a basic minimum threshold of cultural competence – an important guarantee of the quality of care we should be able to expect for all New Zealanders.

But I come back to the notion of survival.

The buy-in of health professionals on the frontline is essential to consolidating the transformation we need, for the people to endure in good health and optimal strength.

What does it all mean in practice?

I recall my sister in law, an Australian nurse, telling me about her experience in a ward in Wellington Hospital, some years ago now.

Des was nursing a Chinese woman, and found herself increasingly frustrated that as a nurse she was unable to communicate with her patient. What she noticed too, was that some of her colleagues would talk loudly or slowly around the woman, but neither the noise level or the pace did anything to enhance understanding.

So Des asked her seniors, would it be appropriate to consult a Chinese person in the community, to help the hospital staff in being able to communicate with her? An interpreter came in, and the family of the woman were also encouraged to be by her side, and there was the most immediate – and impressive transformation as suddenly understanding was achieved between the patient, her family and the health professionals.

Cultural competency is not just a matter of language. It is also about the way in which knowledge is gained – and how that knowledge is shared. The role that our families play in supporting and promoting lifestyle changes is absolutely critical.

We only need to think of diabetes management to appreciate the vital role families can play in life-changing behaviour. With all the best intentions in the world, we are missing an amazing opportunity if we only treat the individual and fail to think about who is feeding the family, what levels of physical activity are being encouraged, what other treatments are being undertaken - or how we take responsibility for the wellbeing of each other.

Legislation alone cannot create cultural competence – nor can the Medical Council’s resources- no matter how impressive.

It is about attitude; about enterprise, about entrepreneurship. And importantly, it’s about building the relationships so that trust will result.

We must be open to the broadest basis of social and cultural wellbeing, as integral to the capacity for people to be self-determining, to have control and responsibility over their own lives.

Matua Whatarangi Winiata always encourages us to consider that the survival of Māori as a people will be happening when a growing number of Māori are living according to values and practices that are distinctively Māori

Survival is therefore demonstrated in the capacity of the people to conceptualise and activate Maori worldviews in ways which are relevant and meaningful for today’s generations and tomorrows.

And I want to share an insight that Taima Campbell recorded in a special edition of Kai Tiaki Nursing New Zealand which paid tribute to Irihapeti Ramsden:

One of my favourite memories of Irihapeti is her seated and smiling during the karakia/ prayers and himine that were part of a powhiri in her honour.

Later, I asked her why she had remained sealed and she replied,