Flavell: Spring Seminar on Emergency Medicine 2013
Wednesday 25th September 2013
Spring Seminar on Emergency Medicine 2013
Skyline Redwoods Forest venue
Tuesday 24 September 2013; 7pm
Te Ururoa Flavell; Co-leader of the Māori Party
I want to thank Peter Freeman and Annabel Jeffery for inviting me to address your conference as the Co-leader of the Māori Party and the local member of parliament for this area of Waiariki.
At first glance, I wondered what the intimate connection would be between the Māori Party – the first indigenous party in Government throughout the world – and the Peripheral Hospitals Emergency Medicine Conference; the Australasian Society for Emergency Medicine, and the Australasian Society of Career Medical Officers.
So I browsed through your programme for a clue.
As I read, the reason for my invitation became even more of a mystery.
Haematology; orthopaedic injuries; wound care and sepsis appeared to have more in common with the after-match care following the exploits of the Parliamentary Rugby team than an average day in the House.
Although there were a couple of other plenary sessions that I could relate to – such as ‘ethical issues”; ‘what was I thinking” or even “places you can go with your probe”.
As I was about to give up, I re-read the riding instructions I had been given to help me in preparing my kōrero to you tonight.
And that’s when I hit rock bottom.
I was told that the Horizon lecture will be an inspiring family event with a strong Maori flavour.
Now I can do the strong Māori flavour alright – but as a father of five; aged 15 through to 21 – I have to say to you; not one of my adoring children would ever, in their wildest dreams, pretend that a lecture from their father would be an ‘inspiring family event’.
Perhaps we should all just stop while I’m ahead, and reassemble at the Gondola; where we can ride to the top of Maunga Ngongotaha and look in awe at the outstanding natural beauty of this area; gazing over the waters which are often described as the Crown Jewels of the nation, with their pristine waters, nestled in the exotic native bush, rich with the beautiful songs of our indigenous birdlife.
Failing that, we could all just luge our way down to dinner!
Seriously though, I want to warmly welcome you to Aotearoa.
I understand that this is the first time a PHEMC/ASEM conference has been held in New Zealand and we are very proud to be hosting it in Rotorua.
So I particularly welcome you, as mana whenua a descendant of the original people to settle this region, to the land of Te Arawa for your annual Spring Seminar.
In the traditions of Te Arawa, our ancestor Tamatekapua and his relatives set out from Hawaiki in a double-hulled canoe as much as seven hundred years ago.
And for those of you wondering what is it that gives New Zealand the critical edge in the international yachting spectacular called the America’s Cup, I would say look no further.
The impact of our waka – our travelling canoes - have shaped our landscape, our people and our talents.
Our ancestors were among the world's leading designers of their day; proving themselves also to be the global leaders in the field of sailing; earning a distinguished reputation as the sharpest navigators of the seas.
As descendants of Te Arawa, we trace our legacy back to these explorers of the sea; we associate with the places where they embarked on land and set up home.
The sharp vision; the determination and the courage of our ancestors knew no bounds when we came to this beautiful land. When visitors from other nations started to land on these shores; we established a competitive economy, based on trade and commerce.
By the1850s then we had purchased coastal vessels; we were trading in flax; pigs; potatoes and other produce; we had built flour mills; and we were establishing a reputation as a natural site for tourism.
We even traded to Australia back then sharing our expertise, as you know that continues today.
Across the globe, travellers were attracted to our thermal pools nestled amongst pumice, sulphur and manuka. Early European visitors as far back as 1839 have published accounts of their visits, describing the palliative and curative properties of the hot springs.
It is a distinctive feature of this rohe I hope you can experience in your time here.
I wanted to set the scene of this somewhat idyllic history; against the status of our people today, in 2013.
It is not such a good story.
In short, many health conditions are more common for Māori adults than other adults. These include heart disease, stroke, diabetes, medicated high blood pressure, chronic pain and arthritis.
Asthma affects nearly one in five Māori adults and children. Māori are also more likely than other people to have had a tooth removed due to poor oral health in the past year.
And it’s not just about health status and conditions. Access to health care is just as dismal.
Māori have a higher level of unmet need for health care than other populations. When you drill down to the detail, cost prevented 23% of Māori adults, and 8% of Māori children, from visiting a GP when they needed to, in the past 12 months.
So what happened between the time when our people were the architects of their own destiny; to a period when Māori life expectancy is on average, eight years less than Pākehā?
What we know is that many Māori communities were decimated by the toll of European diseases such as measles and influenza; typhoid fever; smallpox and tuberculosis. The impact was traumatic. The Māori population fell by up to 30% between 1769 and 1840.
The ongoing devastation of disease continued onto the twentieth century. In the 1918 influenza epidemic for instance, the Māori death rate was seven times higher than for Pākehā. Tangata whenua, the people of the land, were literally dying out with little acknowledgment by the state, of the dire situation we were in.
It took nearly a century since colonisation, before the first study of Māori living conditions was commissioned. The research undertaken in the 1930s found that many people were living in poor, overcrowded houses, without clean water. The loss of our land through confiscation; alienation and legislated theft had left our families with poor housing, dirty water supplies and an unhealthy diet.
And so we began the long slow journey, back towards regaining the optimal state of health and wellbeing we once knew.
Where would we find the change that we needed to reverse our fortunes; and improve outcomes?
Let me share some words of advice from the late Dr Manahi Paewai of Rangitāne and Ngāti Kahungunu. Dr Paewai was an innovative Kaikohe-based medical practitioner – as well as a former Māori All Black, and an outspoken local politician. In other words, he was at the top of his game in every respect.
His challenge was - Māu anō e rapu he oranga - Your livelihood in your own hands.
The answer to our transformation lay in our own solutions.
In te reo Māori, we might call this rangatiratanga – the potential to be self-determining; the power of our own autonomy.
Over our history, whether it be kōhanga reo language nest and kura kaupapa Māori language immersion schooling in education; Māori Television; iwi radio; or Māori business; the success in outcomes has always been associated with tangata whenua being in control of their own development.
In 1937, in this area for instance, the Women’s Health League was formed by district nurse Robina (Ruby) Cameron. Nurse Cameron gained the full support of Te Arawa chiefs to do what they could to improve Maori health and housing.
Last year we celebrated 75 years since the league was born and it was exciting to learn about some of the different initiatives they pioneered in those times – such as a guest house for Maori to stay in while whanau were in hospital, a milk in schools scheme and social security funding for those needing hospital care – many initiatives which are still relevant today.
So let me come back to the instructions for my talk tonight : an inspiring family event with a strong Maori flavour.
I don’t want to give anyone any illusion that Māori health is now scaling international heights, or that we are achieving the equivalent of the America’s Cup in emergency medicine for Māori whanau.
We are a nation confronted by ongoing disparities and an urgent need to improve Māori health outcomes if we are ever to achieve a marked difference in the health and wellbeing of our people – and that is in every sector; every sphere of medicine and the wider health system.
But we do have a master formula; the right flight path that will help us achieve the change we need.
And the Māori Party is immensely proud that it is our co-leader, Tariana Turia, who has been instrumental in launching this strategy – the strategy we call Whānau Ora. Whānau meaning family, Ora meaning wellbeing.
So this is where I finally get to the ‘inspiring family event with a strong Māori flavour’.
Because – just like our families came together to develop trade and commerce in the mid-1880s; just as our women in the 1930s pioneered a league firmly focused on the association between families and health; and later in the 1950s established our own Māori Women’s Welfare League; today our focus is on building capability for whānau to self-manage; to take the power back into their hands.
Whānau Ora was first conceived in 2010. At its core, Whānau Ora is an inclusive approach that involves collaboration and cooperation across agencies; to build the capacity of whānau – or the extended family.
Whānau Ora empowers whānau as a whole rather than focusing separately on individuals or even within that individual health conditions or social circumstances.
One of the really exciting markers of this approach – and tracing back to our early explorer traditions – is that whānau have a practitioner – or a navigator – to work with them, to identify their needs; to develop a plan to address their needs; and to broker their access, if required, to a range of health and social services.
The navigation role is a critical component of the change – they help to identify the strengths within the whānau; wrap around support; and help identify what are the skills needed to help achieve their aspirations.
So there is no confusion – this is not about an outsider doing to them, what the health sector or the state may have done in the past.
This is about whānau doing for themselves.
Whānau have the lead in determining what they want to achieve; and how they can move from a state of crisis or challenge; to making substantial changes in their lives.
It’s about reaching out to a fuller range of support services – while at the same time connecting with their own whānau, and across te Ao Māori. Breaking across all frontiers to improve cross-service engagement and encourage and embrace their wider family in the change.
For those who like the numbers; here is the detail:
• Whānau Ora is led by a national Governance Group comprising four community-based experts and the chief executives of three partner agencies – Te Puni Kōkiri and the Ministries of Social Development and Health – with support from two government departments: the Ministries of Education and Pacific Island Affairs.
• There are ten Regional Leadership Groups (RLGs) with a total of 85 community and partner agency representatives
• The initiative is steered by 34 collectives and two providers representing more than 180 independent Māori, Pasifika and general primary health and social services providers as well as tribal rūnanga, marae and Māori trust
• Budget 2011 invested another $30 million in Whānau Ora adding to the $134 million over four years in Budget 2010
And the impact has been enormous – encompassing more than 33,000 New Zealanders involved in setting their own direction. Common themes in whānau plans include better lives for children; employment; housing and home ownership; education and skills development; and health and cultural wellness.
While the outcomes are multi-sectoral, for the purposes of this conference I think it is important just to draw out some of the key achievements we have seen in the health sector with improving performance registered across a number of indicators in the year ended 31 March 2013.
As an example, a recent study released by the Ministry of Health about the progress seen from Whānau Ora collectives noted increased achievements against:
• the ‘Smoking
cessation advice’ indicator: up 27.3%;
• the ‘Cardiovascular disease risk recorded’ indicator: up 16.1%
• the ‘Flu vaccination 65+’ indicator: up 4.3%.
So, is it all good? Can we afford to just let the investment in whānau reap benefits and let the state leave things alone?
I think not – and this is the finale of my address – the invitation for you all to willingly be part of this inspiring family event!
I want to finish, outlining the reason why you all need to become involved in Whānau Ora – or indeed any other initiatives pioneered by indigenous communities across Australasia.
Just over twenty years ago, two of our leading Māori doctors, Dr Pat Ngata, and Professor Eru Pomare wrote an article, Cultural Factors in Medicine Taking which was published in New Ethicals in June 1992.
Here’s what they had to say.
“For Māori people health and sickness are inseparable from social encounter, economic endeavours, recreational pursuit, respect for the environment and the maintaining of traditional cultural beliefs and healing practices.
It should not be surprising to any medical practitioner in a multicultural society that people from different cultural groups may have different notions, views and beliefs about health, sickness and taking medicines and consequently may ‘see’ and ‘do’ these differently. Contemporary doctors in Aotearoa should at least develop some understanding and skills in working with Māori patients and acknowledge that cultural factors are very important in ensuring better compliance with modem medical therapies to achieve better health outcomes”.
This is where we come to another aspect of change that the Māori Party has pioneered in both health and education; and that is cultural competency.
Cultural competence training is about helping health practitioners to acquire the knowledge, skills and attitudes, to be more ‘in tune’ with their patients. At its essence it’s about finding ways to better communicate with people from different cultures who use health services; to understand health behaviours influenced by culture.
For Whānau Ora to be ultimately successful; for our families to achieve a radical transformation of health and wellbeing, we need health professionals to understand and promote the importance of health literacy and appreciating how what you all do, and how you can do it, can make a difference to outcomes.
When families are provided health information in a way they can understand, it helps them to be more active and engaged in decisions about their health. And you – and the way you interact with the families you work with at every aspect of care – are critical to the difference.
Finally, I read on your website, that these conferences are both at the forefront of scientific education and also relevant and accessible to all emergency medicine practitioners.
What I would hope my comments tonight might encourage you to see, is that to be at the forefront of emergency medicine, being relevant and accessible to all the families who access your service is ultimately the most powerful difference that you can make.
I wish you all a wonderful few days enjoying the luxury of the land and the lakes which are the jewel in the crown of Aotearoa.
Tēnā koutou katoa.