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Speech to University of Otago, Faculty of Medicine

Hon Tariana Turia

Associate Minister of Health

Monday 25 March 2013

University of Otago, Faculty of Medicine,

Annual Combined Heads of Department Meeting.

Tena tatou katoa. I was delighted to accept the invitation from Professor Peter Crampton and to know that gathered here in this forum would be Associate Deans in Research, Medical Education, Maori health, Pasifika health, finance managers and human resource managers – in essence – some of the key decision-makers around the concept of hauora.

As you will all no doubt be aware, hauora is a Maori philosophy of health unique to this land. Professor Sir Mason Durie has given particular expression to this concept – describing it in terms of the four walls of a whare – whare tapa wha.

Each wall represents a different dimension - taha wairua (the spiritual side); taha hinengaro (thoughts and feelings); taha tinana (the physical side); and taha whanau (family). All four dimensions are necessary for strength and symmetry.

Two years on from the Christchurch earthquakes, we have a particular understanding of how vulnerable our house can be – and we have become a lot more familiar with the concept of resilience and endurance as being essential to rebuilding our communities.

It is in this context, therefore, that I was so pleased to be asked to participate in the important discussions you are having around Maori health, iwi development and the role of the university.

I know that this university is doing a lot to strengthen its relationships with mana whenua, with Maori providers, and with whanau Maori.

The Ngai Tahu Maori Health Research Unit is a particularly exciting initiative - a partnership between Te Runanga o Ngai Tahu and the Dunedin School of Medicine which collects, collates, interprets and publishes information, data and statistics on Maori health issues. As I understand it, the research focuses are: hauora rangatahi (young people's health); hauora wahine (Maori women's health) and oranga niho (dental health) – and I want to make particular mention to Professor John Broughton here for the expertise and passion he has brought to this challenge.

I am aware of the various collaborations made with other iwi – such as with Ngati Porou Hauora.

And of course MIHI – the Māori/Indigenous Health Institute which provides a space for Māori-focused teaching and research at the University of Otago in Christchurch. That unit is dedicated to the memory of Dr Irihapeti Ramsden – and as such I would expect cultural competency to be a key driver in making the difference for both that unit – but more broadly across this university.

Irihapeti was instrumental in raising our awareness of the importance of cultural safety for both nursing staff and patients more than twenty years ago. Since then cultural safety programmes have been implemented in a variety of ways to address the culture of the health provider as much as the culture of the patient.

Training and recruiting culturally competent staff to work with Maori is also vital if we expect Maori to use health services and if we expect that Maori health and well-being will improve. The Maori Health Committee of the Medical Council has championed the vision that cultural competence must be a core competency for physicians and paediatricians and that clinical competence requires cultural competence. In other words cultural competence cannot be separated from clinical competence in achieving best Maori health outcomes.

Providing culturally appropriate services does not mean that health providers must know intricately the customs and practices of their clients - rather that they must provide care by firstly recognising and respecting the differences.

Dr Ramsden’s vision for health in this country asks that health professionals care for Māori and others regardful of those things that make them unique rather than regardless. That is the challenge ahead of us today.

And so if we pull together some of these strands – resilience and endurance; the model of holistic health; cultural competency – and then your core business – the business of medicine – today is a fantastic opportunity to look critically at how well equipped your students are when they leave this place; to face the health sector – and more importantly the patients and whanau that they will work with in the name of hauora.

I believe we are at a crucial phase in the development of our Maori health workforce – that is because the state of our Māori health and disability regulated workforce has remained static for nearly twenty years.

It sits at around 5 percent of the total regulated workforce. Coupled with that there is not only a shortage of Maori staff - but equally as alarming there is also a high turnover - as much as 39 percent.

We want all medical students leaving Otago to be qualified to respond effectively to Maori health and cultural needs and outcomes.

But in particular, I want to see more Maori who are trained, recruited and retained right across the range of health professions - both regulated and non-regulated.

We cannot underestimate the importance of the role of for example community health workers and caregivers who provide valuable support during clinical care by ensuring patients have access to appropriate health and social care. Yet we are not able to retain Maori community health workers or caregivers in the way that we need too.

While we have a range of programmes designed to increase the numbers of Maori working in the Maori health and disability workforce like Hauora Scholarships - we can, and should do more.

I am heartened to hear that the University of Otago has a 78 percent retention rate for Maori students from ‘Tu Kahika’ to the Health Sciences First Year and I am equally impressed by the 60 percent increase in the number of Maori students entering into the Second Year of the Medicine programme.

So I want to come back to the critical role that you play – not just in increasing the numbers of Maori students – as admirable as that is – but also in the quality and the competency of the training they are receiving.

And this is where you, the university, as trainers, educators and researchers of health and well-being, play a critical role in demonstrating the genuine commitment to partnership you are prepared to make in working with Maori.

Take for instance the positive outcomes we know the university will benefit from with collaborations such as with Ngati Porou Hauora on the East Coast.

How mutual are those benefits? What does Ngati Porou Hauora gain? Are they seeing large numbers of medical students graduating and choosing to work with their people in predominantly rural areas?

Are the costs shared equally by the health providers and the university?

What impact is the new knowledge having on the people at home?

Thinking about another aspect of your relationships with iwi, how strong are your relationships with whanau?

We cannot under estimate the importance of the role of the extended family in improving the health and well-being of our people. Whanau Ora is an approach that I am passionate about because it upholds the rights of the extended family to be involved in planning for their future.

At its simplest expression, whanau determine their needs whether it be to improve their own health or educational outcomes – with the help of an agency if required or with the assistance of a specialist Whanau Ora navigator who will help them develop a plan to address those needs and access a range of health and social services.

Whanau Ora is a whanau approach so rather than focusing on individuals within the whanau it empowers the whanau as a whole to take responsibility for their futures.

The role of agencies must be to enable this transformation to take place.

And so this is where I come back to the question about how the university contributes to the resilience, the endurance and the empowerment of whānau.

There is no question – the university must continue to lead the way in requiring courses on cultural safety and cultural competency to be universal within the courses taken in the Faculty of Medicine, and across other disciplines.

You must continue to think creatively about how to increase Maori participation in the health and disability sector.

And it is encouraging that universities are opting to collaborate more with Maori health providers.

But are you sure that you are doing it in a way that also benefits Maori health providers?

How confident are you that whanau can lead their own futures, once the health providers have returned to the office?

What is the difference you are making, that will enable whanau, hapu and iwi to manage their own development, informed and influenced by the leadership your graduates have inspired?

It takes great courage to speak out – to name issues – and then to work together to resolve them. I wish you all that courage and that vision, to put your minds to work, on laying the foundation for a health system that will truly transform outcomes for all peoples who call this land home.

Tena koutou katoa.


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