Providing holistic care for Māori children and parents

I am the first Māori paediatrician in over 30 years in a region where more than a third of the children are Māori. My experience shows me that the healthcare system must invest in culturally appropriate care.

I recently had the privilege of reviewing a 3-year-old Indigenous Māori girl in the paediatric outpatient clinic at Waikato Hospital, New Zealand. Her mother, who was understandably anxious, had brought her to the clinic because she was complaining about abdominal pain. I exchanged greetings in Māori with the mother before switching to English, her main language.

However, I soon learned that the girl attended a Māori-language preschool and that her primary language was Māori. So I spoke to her in Māori. When I examined her, I gave simple instructions in Māori which she duly followed. Throughout the review, her mother kept commenting on how well I seemed to be getting on with her daughter; she marvelled at how relaxed she was, as the girl had previously been quite scared when assessed by doctors.

Towards the end of the review, as I recapped the management plan to the mother, the young girl walked towards me, looked up at me and hugged my leg. It was an unexpected and special moment. Her mother told me how much less stressful she had found it to receive care for her daughter from a clinician who spoke the Māori language and understood their cultural context. They hadn’t experienced this before.

This was not surprising, as I am the first Māori paediatrician in over 30 years to work in the paediatric department in Waikato region in the North Island of New Zealand – despite the fact that 37% of the region’s children are Māori ^[1]. In my work I see first hand the impact of health inequities on the Indigenous Māori population ^[2]; I have found that these children comprise about half of paediatric hospital admissions in the region.

Māori experience poorer health outcomes, compared to non-Māori, partly as an ongoing legacy of New Zealand’s colonial past, but also because health services need to provide more holistic care to Māori families ^[3][4][5]. Across the country, Māori make up approximately 17.4% of the population ^[6] but just 4.4% of doctors ^[7]. As non-Māori doctors often treat Māori patients ^[8], they need specific training in cultural safety and in Māori cultural concepts ^[9][10]. These include Te Whare Tapa Whā, a Māori health model which recognises four key components of wellbeing: taha tinana (physical health), taha wairua (spiritual health), taha hinengaro (mental health), and taha whānau (family health) ^[11].

The hui process is a structure for Māori medical assessments that focuses on whakawhanaungatanga – the building of relationships in a culturally appropriate way ^[12]. Also, the importance of correctly pronouncing patients’ names should not be underestimated to avoid patients feeling disrespected ^{[13] [14]}.

Why culture matters

Having a sick child is always stressful for caregivers. When the healthcare system adds to their stress rather than helping to alleviate it, the care they receive is less likely to be successful. Earlier this year, for example, I reviewed a Māori infant who had presented acutely to the emergency department for assessment. They were seen by a junior doctor initially and the plan was to complete several investigations including blood tests and a CT scan of the head.

However, after a period of observation, the family felt that their child was well and did not need further investigations. They wished to return home to look after their other children. The family was on the verge of self-discharging against medical advice when the junior doctor requested that I, as the paediatrician on call, see them.

In keeping with the hui process, I introduced myself and spent some time building connection through the process of whakawhanaungatanga by explaining to them where my iwi (tribe) was based and enquiring about where they were from ^[15]. At this point I asked the family if they would like to begin the assessment with a karakia (prayer in Māori). They assented and asked me to say the karakia, which I did (taha wairua).

I then completed my assessment and carefully explained to the family why the investigations were necessary and why they needed to stay in hospital to ensure the physical wellbeing (taha tinana) of their child. The discussion also included careful responses to the family’s questions so they could feel engaged in the process (taha hinengaro). In the end they agreed to the assessments, and a plan that included who would look after the other children at home (taha whānau).

It was crucial to listen to and consider the needs and worries of the parents, in a culturally appropriate way, so that I could provide the best care for their child. Understanding the range of Māori health perspectives and the diverse cultural needs of Māori is important in order to provide appropriate and effective healthcare and address the health inequities affecting Māori children ^[16][17].