Hospital services for Māori ‘hostile and racist’, review finds


A literature review led by Dr Emma Espiner (Ngāti Tukorehe, Ngāti Porou) has found Māori face systemic barriers to accessing hospital care. (file photo)

LAWRENCE SMITH/Stuff

A literature review led by Dr Emma Espiner (Ngāti Tukorehe, Ngāti Porou) has found Māori face systemic barriers to accessing hospital care. (file photo)

“To put it simply, there is no point solving someone’s transport barrier by giving them a taxi chit if the taxi drives them towards a racist health service,” Dr Emma Espiner writes.

It’s the line in her paper in Friday’s New Zealand Medical Journal a reviewer advised her to take out, because it didn’t sound “scholarly”.

But the former broadcaster, now a house officer at Middlemore Hospital, didn’t become a doctor to pontificate, she did so to make sure people understand why Māori have persistently s….. outcomes across every imaginable health indicator”, and help to fix it.

Espiner (Ngāti Tukorehe, Ngāti Porou) led researchers from Middlemore and the University of Auckland in a review on access to hospital services and found Māori experienced hostility, racism, poor communication, practical barriers to accessing care, and roadblocks to community-based care, including feeling culturally unsafe.

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The team reviewed a total of 23 papers, which landed on five ways to improve things – including basic relationship building – whakawhanaungatanga – with health providers, along with manākitanga (extending love and care), whānau involvement, cultural safety, and offering practical things like payment options and transport.

Espiner says removing barriers to hospital care for Māori would remove barriers for all New Zealanders. (file photo)

LAWRENCE SMITH

Espiner says removing barriers to hospital care for Māori would remove barriers for all New Zealanders. (file photo)

“It was important for us to look at papers that didn’t just state a problem but interrogated the issue,” Espiner said.

“You have to interrogate every part along the path of access to achieve change.”

The key was, barriers to hospital services should be understood as more than just lack of transport, she said.

Breakfast

The Whānau Ora Commissioning Agency has been battling the Ministry of Health for data on Covid-19 Māori vaccinations. (TVNZ)

“It’s all the stuff around Māori experience in healthcare. We share stories and there are stories of whānau members who have had bad experiences and that stuff really leaches into a whole whānau and whole community and creates that barrier – emotional, mental whatever. You’re already thinking, ‘oh God, this is going to be a bad experience’.”

This was reflected in the vaccine roll-out and vaccine hesitancy among Māori, she said.

The doctor was hopeful the incoming Māori Health Authority, set up as part of the Government’s health reforms, would pave the way for her list of solutions.

“You have to be optimistic. Any kind of change you have to think this is an opportunity … I think the right people are in the room.

“But the timing of doing research like this and then watching how Covid is being experienced by Māori is a perfect case study in how we get things wrong for our people.”

Treating healthcare like a one-size-fits-all slot machine would never work for people who were disenfranchised, Espiner said.

“That’s really important to help people understand it’s not about privileging one group over another, it’s about equity to improve the health outcomes for everyone.”

Removing barriers to hospitals for Māori would remove barriers for all New Zealanders, she said.

“Really responsive, joined up services with good communication, removing practical barriers will improve the experience for non-Māori as well. It’s just all the other stuff our people experience that makes us more vulnerable to those barriers than other people.”



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