Supporting Māori Patients And Whānau In Hospital Emergency Departments

Australasian College for Emergency Medicine | Tumu Whakarae | Te Ora Rata o Aotearoa

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He tangata, he tangata, he tangata. 1

The Australasian College for Emergency Medicine (ACEM), together with Tumu Whakarae, the National Reference Group for Māori Health Strategy Managers for District Health Boards and Te Ohu Rata o Aotearoa (Te ORA), New Zealand's Māori Medical Practitioners' Association, acknowledge the devastating threat and damaging generational impacts that COVID-19 presents to Māori communities, iwi, hapū and whānau.

Drawing on data from influenza pandemics in 1918 and 1957 and the H1N1 Swine Flu pandemic in 2009, we know that Māori suffered significantly compared to non-Māori /European populations, with death rates among Māori seven times more compared to non-Māori2. This reality is also acknowledged in the New Zealand Government’s worst-case scenario modelling on COVID-19 and potential health impacts report3.

We acknowledge Māori as tangata whenua in Aotearoa New Zealand and our obligations to Māori as Te Tiriti o Waitangi partners. Last year the Australasian College for Emergency Medicine launched Te Rautaki Manaaki Mana, the College’s Māori Health Equity Strategy. The whakatauki adopted for Manaaki Mana He tangata, he tangata he tangata focuses our attention on Te Rautaki Manaaki Mana’s focus.

Through Te Rautaki Manaaki Mana, ACEM’s wawata (vision) is that emergency departments in Aotearoa New Zealand will:

• Embody the holistic notion of Pae Ora (creating healthy futures for Māori).
• Provide excellent, culturally safe care to Māori in an environment where Māori patients, whānau and staff feel valued and where leaders actively seek to eliminate inequities.

This remains our commitment throughout the COVID-19 pandemic.

Partnership

ACEM is committed to a meaningful partnership with Tumu Whakarae and Te Ohu Rata o Aotearoa (Te ORA), New Zealand's Māori Medical Practitioners' Association, and other key Māori Health stakeholders and partners, to tautoko Manaaki Mana’s kaupapa to improve health equity for Māori throughout emergency departments in Aotearoa.

Supporting Māori health professionals in emergency medicine

We recognise that partnership and participation for Māori by Māori in emergency medicine supports an environment that is culturally safe and improves the delivery of quality health care for all patients. As part of our commitment to this, Manaaki Mana’s goals and actions include supporting and encouraging more Māori to take up emergency medicine as a vocation.

As the health sector and the country enters the unchartered waters of the COVID-19 pandemic, it is now more important than ever to ensure that emergency departments across Aotearoa New Zealand and Australia strive to achieve equitable access to care and fair treatment for Māori and all indigenous and other at-risk groups.

Hold Fast to Manaakitanga
We know that inequities are magnified during pandemics. These are challenging times for whānau from all cultures and backgrounds. It is more important than ever to show each other manaakiitanga, aroha, kindness and care, and uphold the values that underpin ACEM’s Manaaki Mana Strategy.

We know that Māori are at greater risk of increased severity of disease and death from COVID-19. This is due to:

• higher exposure to the social determinants of poor health
• higher rates of respiratory diseases, diabetes, obesity and cancer
• differential access to care at all levels due to institutional racism and implicit bias.

Emergency Departments are the gateway to the hospital for acute care. We support the following:

• ACEM working with St Johns and other pre-hospital and ambulance services including primary care providers to ensure that those that need hospital level care reach us.
• Emergency Departments consulting with Māori in the preparation and running of the department and hospitals to care for unwell COVID-19 patients, as well as patients experiencing health issues not related to COVID-19.
• Emergency Departments ensuring equitable access for Māori by addressing fears about safety, separation from whānau and care of tūpāpaku (the deceased). Information addressing these fears must reach Māori.
• Working with Māori and colleagues in Intensive care and other specialties to ensure a transparent and robust process that aims to eliminate bias in treatment decisions, especially those which place limits on care (such as whether intensive care admission and/or mechanical ventilation is offered).
• Acknowledging that personal bias is likely to be accentuated under stress when making decisions in an overwhelmed health service. Offer clinicians guidance and processes to mitigate this.
• Collection of data and analysis to ensure equitable outcomes.
• Providing care that is culturally safe to Māori which upholds tikanga as far as is possible under the relevant alert level, in accordance with NZ Ministry of Health and Government direction.
• Recognise that our Kaumātua and Kuia (Elders) are taonga (treasures). Every effort must be made to protect them as much as possible from COVID-19.

Te Ohu Rata o Aotearoa (Te ORA), New Zealand's Māori Medical Practitioners' Association understands that the transition to cultural safety and the journey towards equitable outcomes for Māori, which are accentuated by the COVID-19 pandemic, are fraught with layers of difficulty and challenge. We have partnered with the Australasian College for Emergency Medicine in their journey so far.

We support this COVID-19 Pandemic: Supporting Māori Patients and Whānau in Hospital declaration in its entirety. We are committed to the ACEM vision of having Māori-centric Emergency Departments and ACEM training large numbers of Māori doctors in Emergency Medicine.

Tumu Whakarae, the National Reference Group of Māori Health Strategy Managers for District Health Boards in New Zealand, acknowledges the commitment shown by the Australasian College for Emergency Medicine in this statement. We are heartened at the commitment shown to te Tiriti o Waitangi and to addressing health equity for Māori. We hope this also inspires other Colleges to openly communicate their commitment.

Tumu Whakarae looks forward to continued and meaningful engagement with ACEM to implement the Manaaki Mana Strategy4 in Aotearoa’s Emergency Departments.

Mā te aroha, ka manaaki
Mā te manaaki, ka ora
Mā te ora, ka puāwai
Aue, Manaaki Mana e5

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