Observations by and Conversations with Health Workers and Hospital Personnel Involved in Transferring Māori Patients and Whānau to Waikato Hospital in Aotearoa New Zealand
2. Materials and Methods
3.1. Onerous Administrative Requirements
It all comes down to funding, so we could be taking them [patient] to one hospital because that is where [name] lives, that is their catchment. But if we think, clinically, they need treatment somewhere else…then we will take them there … sometimes you get stick from the hospital…it is all political. There are two factors hospitals get upset about—one is money and one is beds…I got stick for it…because Waikato had complained that the patients hadn’t gone [to them].
This week we had a family from [rural township] who went to [closest hospital] (The distance travelled here is 120 kilometres (one way), a journey of approx. two hours.) …Mum was pregnant and she went, Dad went, and another child, and they could all fit in that ambulance on the way over because there was only one patient…but to come back we had to go back down to the small one [ambulance] and when she was ready to come back [to her home township] with the baby and the baby had to be in an incubator we still had Mum, baby, Dad and a young child to fit in the ambulance…we probably didn’t have them in totally correct seating but how else do they get back from [the city]?…they had no money, no nothing, so it gets really tough.
I see that they give this [support] out to all the Pākehā whānau, but actually they don’t need it as much…they are giving less to this Māori whānau [staff] are having to fight for [Maori] whānau to get the same, even though they probably need a bit more.
A really good example [is] the transfer lounge…it had been made by professionals with no thought to the fact that you might have to sit in one of those really uncomfortable chairs looking at somebody, a complete stranger, for like four hours…A woman was there with a bag full of food and books and knitting and everything…she was sitting in outpatients just waiting for an injection for her [medical condition] which takes like ten minutes. So she had come from [a rural town] on the transport, so three hours in the most uncomfortable bus known to man, sat for half an hour waiting for that appointment, and then had to wait for the whole of the day before the bus went back…that is a model that is appalling. She was very good spirited about the fact that she brought her lunch and that she was actually alright but [the long day] is a toll.
For somebody who lives in [rural town] they may have to catch a bus and then get to a motel and then navigate a taxi to a service, have a service provided and have the same sort of difficult mechanism of getting back home again…if you are managing children or complexity within your life and you don’t have additional resource, it becomes the thing that topples people, it makes it too hard to adhere to the treatments.
Only one family member can go with a patient, and sometimes they can’t at all, they have to go up in their own car. We transfer patients from [Town A] to [Town B], we have scheduled runs…the ambulance can actually take up to 5 patients, if we’ve got 5 patients clearly we can’t take a family member or anything.
3.2. Communication Style
He [patient] had a key mental health worker who knew the social worker, who booked him a bus [seat]. The social worker got him from home onto the bus, he came up here to the transit lounge where he could have a cup of coffee and a sandwich. I met him there, we walked through to [service]…got him back on the bus and got him back down home.
If [staff] just give [Māori patients] the discharge letter and a pamphlet and they are sent home and there is not family who are aware that they’ve been sent home, or that they’ve been discharged, that is a big thing for me…It is not about giving them a pamphlet and hoping they’re going to read it, and then when they leave the pamphlet is left behind.
The people who are going to make the change are the people sitting in that room [whānau]…give them good information and say, this is your responsibility…there is a way to reach communities at risk who don’t necessarily mesh in with [the] standard approach to health care, which is posters.
3.3. Colonial Values Dominate Hospital Settings
From the clinical people’s perspective, the patient is the most important and getting them [the patient] to that end point…family is probably the after-thought…if it is a pediatric patient a parent must go with them, but only one, and so then the other parent has to get themselves there with the other children.
There is no real culturally safe space because [health organization] don’t really understand it … you’ve got a board of Pākehā that determine [work practice]. You’ve got a Pākehā looking at it from a Pākehā point of view and going ok how can we adopt this [Māori cultural practice] into this [Pākehā organizational culture] and it just doesn’t work…don’t get me wrong I don’t think it is down to any kind of viciousness but it is done through ignorance.
Doing the right thing [culturally] can actually bring you into conflict with colleagues…navigating the tension that might exist between what is expected professionally and what is expected culturally…how do you make sure you stay true to both and don’t compromise one over the other and keep everybody safe.
It is really hard for their colleagues around them to actually understand that whakawhanaungatanga at the start of the day and at the start of working with a [Māori] patient is really important … if you get whanaungatanga right, which they [Māori staff] do, it takes an extra ten to fifteen minutes to admit someone, however, on discharge it is absolutely seamless.
The organization has said they need to make a radical improvement to Māori health, but that means they are going to have to do radically different things and I don’t think that they are prepared or as open to it perhaps as they could be.
Conflicts of Interest
Glossary of Māori Terms
|Aotearoa||New Zealand; lit. “land of the long white cloud”|
|Kāi Tahu||tribal group of much of the South Island|
|Kaupapa Māori||collective vision, aspiration and purpose of Māori|
|Kāti Mamoe||tribal group of the South Island|
|Māori||Indigenous people of Aotearoa|
|Ngai te Rangi||Māori iwi, based in Tauranga, New Zealand|
|Pākehā||New Zealander of European descent|
|Ruapehu, Mt||Mount Ruapehu is an active stratovolcano at the southern end of the Taupo region (Central North Island)|
|Te Atiawa||Māori iwi with traditional bases in Taranaki, Wellington regions of NZ|
|Te Korowai||Specific model of health. A korowai is a type of cloak.|
|Te Rarawa||Māori iwi of Northland, New Zealand. The iwi is one of five Muriwhenua iwi of the far north of the North Island|
|Te taha whānau||family wellbeing component of the Whare Tapa Whā model|
|Te Wheke||model of Māori health developed by Rose Pere|
|Tiriti/Tiriti o Waitangi||Treaty first signed on 6 February 1840 by representatives of the British Crown and Māori chiefs|
|Tūwharetoa ki Kawerau||as are from the Kawerau and Matatā areas in the Bay of Plenty|
|Waihi||town in Hauraki District of NZ|
|Waikato||Waikato or Tainui is a group of iwi (tribal confederation) based in the Waikato region of NZ|
|Whānau||family, birth, kinship; the extended family structure|
|Whanaungatanga||the state of established relationships|
|Whare Tapa Whā||model of Māori health developed by Mason Durie|
- Pere, R.R. Te Wheke a Celebration of Infinite Wisdom; Ao Ako Global Learning: Gisborne, New Zealand, 1991. [Google Scholar]
- Durie, M. Whaiora: Māori Health Development, 2nd ed.; Oxford University Press: Oxford, UK, 1998. [Google Scholar]
- Kara, E.; Gibbons, V.; Kidd, J.; Blundell, R.; Turner, K.; Johnstone, W. Developing a Kaupapa Māori Framework for Whānau Ora. AlterNative Int. J. Indig. Peoples 2011, 7, 100–110. [Google Scholar] [CrossRef][Green Version]
- Fitzpatrick, K. Surgery, Imperial Rule and Colonial Societies (1800–1930): Technical, Institutional and Social Histories. In The Palgrave Handbook of the History of Surgery; Schlich, T., Ed.; Palgrave Macmillan: London, UK, 2017. [Google Scholar]
- Cram, F.; Smith, L.; Johnstone, W. Mapping the themes of Māori talk about health. N. Z. Med. J. 2003, 117–123. [Google Scholar]
- Waitangi Tribunal. The Napier Hospital and Health Services Report: Wai 692; Department of Justice, Ed.; Legislation Direct: Wellington, New Zealand, 2001. [Google Scholar]
- Harris, R.B.; Cormack, D.M.; Stanley, J. Experience of racism and associations with unmet need and healthcare satisfaction: The 2011/12 adult New Zealand Health Survey. Aust. N. Z. J. Public Health 2019, 43, 75–80. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Pitama, S.; Ahuriri-Driscoll, A.; Huria, T.; Lacey, C.; Robertson, P. The value of te reo in primary care. J. Prim Health Care 2011, 3, 123–127. [Google Scholar] [CrossRef] [PubMed]
- Davis, P.; Lay-Yee, R.; Dyall, L.; Briant, R.; Sporle, A.; Brunt, D.; Scott, A. Quality of hospital care for Māori patients in New Zealand: Retrospective cross-sectional assessment. Lancet 2006, 367, 1920–1925. [Google Scholar] [CrossRef]
- Jansen, P.; Smith, K. Māori experiences of primary health care: Breaking down the barriers. NZFP 2006, 33, 298–300. [Google Scholar]
- Robson, B.; Purdie, G.; Simmonds, S.; Waa, A.; Brownlee, G.; Rameka, R. Waikato District Health Board Māori Health Profile 2015; Te Rōpū Rangahau Hauora a Eru Pōmare: Wellington, New Zealand, 2015. [Google Scholar]
- Westbrooke, I.; Baxter, J.; Hogan, J. Are Māori under-served for cardiac interventions? N. Z. Med. J. 2001, 114, 484–487. [Google Scholar] [PubMed]
- Curtis, E.; Harwood, M.; Riddell, T.; Robson, B.; Harris, R.; Mills, C.; Reid, P. Access and Society as Determinants of Ischaemic Heart Disease in Indigenous Populations. Heart Lung Circ. 2010, 19, 316–324. [Google Scholar] [CrossRef]
- McKinny, C. Māori Experiences of Hospital Care in Auckland; University of Auckland: Auckland, New Zealand, 2006. [Google Scholar]
- Graham, R.; Masters-Awatere, B. Experiences of Māori of Aotearoa New Zealand’s public health system: A systematic review of two decades of published qualitative research. Aust. N. Z. J. Public Health 2020, 44, 193–200. [Google Scholar] [CrossRef] [PubMed]
- Bolitho, S.; Huntington, A. Experiences of Maori families accessing health care for their unwell children: A pilot study. Nurs. Prax. N. Z. 2006, 22, 23–32. [Google Scholar]
- Masters-Awatere, B.; Graham, R.; Scott, N.; Atatoa Carr, P. Meal Provision Needed for Caregivers Who Stay With a Child in Hospital. Int. Perspect. Psychol. Res. Pract. Consult. 2020, 9, 185–189. [Google Scholar] [CrossRef]
- Statistics New Zealand. 2018 Census: Usually Resident Population Count; Statistics New Zealand: Wellington, New Zealand, 2018. [Google Scholar]
- Mackie, B.; Kellett, U.; Mitchell, M.; Tonge, A. The experiences of rural and remote families involved in an inter-hospital transfer to a tertiary ICU: A hermeneutic study. Aust. Crit. Care 2014, 27, 177–182. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Brewer, N.; Pearce, N.; Day, P.; Borman, B. Travel time and distance to health care only partially account for the ethnic inequalities in cervical cancer stage at diagnosis and mortality in New Zealand. Aust. N. Z. J. Public Health 2012, 36, 335–342. [Google Scholar] [CrossRef][Green Version]
- Masters-Awatere, B.; Graham, R. Whānau Maori explain how the Harti Hauora Tool assists with better access to health services. Aust. J. Prim. Health 2019, 25, 471–477. [Google Scholar] [CrossRef]
- Ministry of Health. Waikato DHB Population Profile. Available online: https://www.health.govt.nz/new-zealand-health-system/my-dhb/waikato-dhb/population-waikato-dhb#:~:text=Population%20of%20Waikato%20DHB,people%20than%20the%20national%20average (accessed on 8 June 2020).
- Waikato District Health Board. Waikato District Health Board 2019/20 Annual Plan. 2019. Available online: https://www.waikatodhb.health.nz/assets/Docs/About-Us/Key-Publications/Plans/Waikato-DHB-Annual-Plan-2019-2020.pdf (accessed on 8 June 2020).
- Nikora, L.W.; Masters-Awatere, B.; Awekotuku, N.T. Final Arrangements Following Death: Maori Indigenous Decision Making and Tangi. J. Community Appl. Soc. Psychol. 2012, 22, 400–413. [Google Scholar] [CrossRef][Green Version]
- Jones, B.; Ingham, T.R.; Cram, F.; Dean, S.; Davies, C. An indigenous approach to explore health-related experiences among Maori parents: The Pukapuka Hauora asthma study. BMC Public Health 2013, 13, 228. [Google Scholar] [CrossRef][Green Version]
- Pihama, L.; Reynolds, P.; Smith, C.; Reid, J.; Tuhiwai Smith, L.; Te Nana, R. Positioning historical trauma theory within Aotearoa New Zealand. Alternative 2014, 10, 248–262. [Google Scholar] [CrossRef]
- Masters-Awatere, B.; Nikora, L.W. Indigenous programmes and evaluation: An excluded worldview. Eval. Matters—He Take Tō Te Araomatawai 2017, 3, 40–66. [Google Scholar] [CrossRef]
- Chin, M.H.; King, P.T.; Jones, R.G.; Jones, B.; Ameratunga, S.N.; Muramatsu, N.; Derrett, S. Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States. Health Policy 2018, 122, 837–853. [Google Scholar] [CrossRef]
- Reid, J.; Cormack, D.; Crowe, M. The significance of socially-assigned ethnicity for self-identified Māori accessing and engaging with primary healthcare in New Zealand. Health 2016, 20, 143–160. [Google Scholar] [CrossRef]
- Smith, L.T. Decolonizing Methodoloiges: Research and Indigenous Peoples, 2nd ed.; Zed Books Ltd.: London, UK, 2012. [Google Scholar]
- Chamberlain, K.; Hodgetts, D. Collecting qualitative data with hard-to-reach groups. In Sage Handbook of Qualitative Data Collection; Flick, U., Ed.; SAGE Publicaions Ltd.: London, UK, 2018; pp. 668–685. [Google Scholar] [CrossRef]
- Murray, M.; Chamberlain, K. Qualitative Research in Health Psychology: Developments and Directions. J. Health Psychol. 1998, 3, 291–295. [Google Scholar] [CrossRef] [PubMed]
- Braun, V.; Clarke, V. Thematic Analysis. In APA Handbook of Research Methods in Psychology. Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological; Cooper, H., Camic, P.M., Long, D.L., Panter, A.L., Rindskopf, D., Sher, K.J., Eds.; American Psychological Association: Washington, DC, USA, 2012; Volume 2, pp. 55–71. [Google Scholar]
- Wepa, D.; Wilson, D. Struggling to be involved: An interprofessional approach to examine Māori whānau engagement with healthcare services. J. Nurs. Res. Prac. 2019, 3, 1–5. [Google Scholar] [CrossRef]
- Mark, S.; Hagen, P. Co-Design in Aotearoa New Zealand: A Snapshot of the Literature; Auckland Co-design Lab, Auckland Council.: Auckland, New Zealand, 2020. [Google Scholar]
- Waitangi Tribunal. Health Services and Outcomes Inquiry: Wai 2575; Legislation Direct: Wellington, New Zealand, 2018. [Google Scholar]
- Gott, M.; Allen, R.; Moeke-Maxwell, T.; Gardiner, C.; Robinson, J. ‘No matter what the cost’: A qualitative study of the financial costs faced by family and whānau caregivers within a palliative care context. Palliat. Med. 2015, 29, 518–528. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Barnett, P.; Bagshaw, P. Neoliberalism: What it is, how it affects health and what to do about it. N. Z. Med. J. 2020, 133, 76–84. [Google Scholar]
- Stevenson, K.; Cram, F.; Filoche, S.; Lawton, B. The impact on whānau wellbeing: Transferring to secondary or tertiary hospitals following a disruption to the birthing journey. MAI J. N. Z. J. Indig. Scholarsh. 2020, 9, 121–132. [Google Scholar] [CrossRef]
- Masters-Awatere, B.; Cormack, D.; Brown, R.; Boulton, A.; Tangitu-Joseph, M.N.; Rata, A. The hospital transfer project: Supporting whānau engagement during hospitalisations. Te Arotahi 2019, 4, 4–14. [Google Scholar]
- Talamaivao, N.; Harris, R.; Cormack, D.; Paine, S.-J.; King, P. Racism and health in Aotearoa New Zealand: A systematic review of quantitative studies. N. Z. Med. J. 2020, 133, 55–68. [Google Scholar]
- Cooper, G. Gods and Kaupapa Māori research. In Critical Conversations in Kaupapa Māori; Hoskins, T.K., Jones, A., Eds.; Huia: Wellington, New Zealand, 2017; pp. 147–159. [Google Scholar]
- Harris, R.; Cormack, D.; Tobias, M.; Yeh, L.-C.; Talamaivao, N.; Minster, J.; Timutimu, R. The pervasive effects of racism: Experiences of racial discrimination in New Zealand over time and associations with multiple health domains. Soc. Sci. Med. 2012, 74, 408–415. [Google Scholar] [CrossRef]
- Cormack, D.; Reid, P.; Kukutai, T. Indigenous data and health: Critical approaches to ‘race’/ethnicity and Indigenous data governance. Public Health 2019, 172, 116–118. [Google Scholar] [CrossRef]
- Papps, E.; Ramsden, I. Cultural Safety in Nursing: The New Zealand Experience. Int. J. Qual. Health Care 1996, 8, 491–497. [Google Scholar] [CrossRef][Green Version]
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Masters-Awatere, B.; Cormack, D.; Graham, R.; Brown, R. Observations by and Conversations with Health Workers and Hospital Personnel Involved in Transferring Māori Patients and Whānau to Waikato Hospital in Aotearoa New Zealand. Int. J. Environ. Res. Public Health 2020, 17, 8833. https://doi.org/10.3390/ijerph17238833
Masters-Awatere B, Cormack D, Graham R, Brown R. Observations by and Conversations with Health Workers and Hospital Personnel Involved in Transferring Māori Patients and Whānau to Waikato Hospital in Aotearoa New Zealand. International Journal of Environmental Research and Public Health. 2020; 17(23):8833. https://doi.org/10.3390/ijerph17238833Chicago/Turabian Style
Masters-Awatere, Bridgette, Donna Cormack, Rebekah Graham, and Rachel Brown. 2020. "Observations by and Conversations with Health Workers and Hospital Personnel Involved in Transferring Māori Patients and Whānau to Waikato Hospital in Aotearoa New Zealand" International Journal of Environmental Research and Public Health 17, no. 23: 8833. https://doi.org/10.3390/ijerph17238833