Hon Tariana Turia
Associate Minister of Health

1.50pm Sunday 29 July 2012 SPEECH

Inaugural Auckland University Medical Student Association Conference
‘Sowing the Seed, Growing New Zealand’s Future Doctors’
University of Auckland Grafton Campus

E kore au e ngaro, he kākano i ruia mai i Rangiātea.

I will never be lost, for I am the seed which was sown from Rangiātea.

This Conference – ‘sowing the seed, growing New Zealand’s future doctors’ – draws from the inspiration of this whakatauaki passed down throughout the generations as the voice of our ancestors.

The whakatauaki tells us that no matter where we go, or what we do – our historical, cultural and spiritual links to the past define us and help to refine us in knowing who we are.

I will never be lost – the waters of te awa tupua, the Whanganui River – always lead me home. Koro Ruapehu will be my marker; Whangaehu Marae will call me back to the whare from whence I have come.

I can never be lost for my connections to Ngati Apa, Nga Wairiki, Nga Rauru, Tuwharetoa, and Whanganui give me a sense of location no matter how far I stray.

The proverb, E kore au e ngaro, is an affirmation that, no matter what happens, our identity as a people will remain strong because we know who we are and where we are from.

And so when I saw that this inaugural Auckland University Medical Students Association conference was entitled Sowing the Seed, I’d have to say that it gave me a sense of optimism about the state of our future health system.

By now, you will no doubt be aware that the New Zealand health care system has not succeeded in achieving equal outcomes for all members of our population.

Poor health is disproportionately greater amongst those whose cultural background differs from the majority population.

For evidence of these ongoing disparities one doesn’t have to look far.

Just two days ago I was up here, at Rongomai School in South Auckland, launching the Rheumatic Fever Prevention Programme. As you will all be aware, New Zealand is faced with alarmingly high rates of rheumatic fever.

But what you might not know is that Māori are twenty times more likely to be hospitalised with acute rheumatic fever and Pasifika forty times more likely that Pākehā or Palagi.
Why do we have such massive disparities in a 21st century health system – and more importantly what will you, as future doctors, do about this?
This is where we come to the concept of cultural competence.
Cultural competence is an essential skill for all health professionals to help them to better understand their patients and whānau. For those of you who have not yet come across this term in your training I’d encourage you to visit www.mauriora.co.nz where we have loaded the first online foundation course on cultural competency designed specifically for health workforce professionals.
But before you head for the search engine, let me perhaps tell you a story which comes from the cultural context of tangata tiriti – those New Zealanders who come to this land by right of the Treaty of Waitangi. It is the story of an oak tree.
“They say that an oak tree is brought into creation by two forces at the same time. Obviously, there is the acorn from which it all begins, the seed which holds all the promise and potential which grows into a tree. Everybody can see that.
But only a few can recognise that there is another force operating here as well – the future tree itself, which wants so badly to exist that it pulls the acorn into being, drawing the seedling forth with longing out of the void, guiding the evolution from nothingness to maturity. In this respect, say the Zens, it is the oak tree that creates the very acorn from which it was born”.
I heard that story from the Be Institute – a social change campaign and movement driven by the call for a 100% accessible country for us all. Their drive is to improve physical and social access so that disabled peoples can contribute fully to society.

The story of the oak tree relates as strongly to you as medical students – as it does to those in the disability community; to Māori and Pasifika communities; indeed to us all as members of whānau, of families, of aiga.

For all of us have potential – the key is in how we harness that potential to be the best that we can be. Even more – to become an oak tree of such stature that all can shelter under it, we need the optimum environment to thrive.
If there is one document I would like you all to read it is a paper by Kira Bacal, Peter Jansen and Kathleena Smith – Developing cultural competency in accordance with the health practitioners competence assurance act.

In that paper the authors run through an inventory of errors and omissions which characterise the experience that Māori all too frequently endure in the health system.

“Māori receive fewer referrals, fewer diagnostic tests and less effective treatment plans from their doctors than do non-Māori patients. They are interviewed for less time by their doctors and are offered treatments at substantially decreased rates. They are also prescribed fewer secondary services such as physiotherapy, chiropractors and rehabilitation. All this, despite the fact that compared to non-Māori, Maori are on average sicker, for longer periods, during their shorter lives”.

Is it any wonder then, that the disparities in Māori health remain unchecked and persistent?

So let’s go back to our rheumatic fever example.

In some research presented last year, University of Otago researchers at the School of Pharmacy, Professor Pauline Norris and Dr Simon Horsburgh obtained information on all medicines dispensed in a single year in Te Tai Rāwhiti.

Over the course of the year 51% of the population received a prescription for one or more antibiotic. Yet amongst children six years or under only 43% of rural Māori children received antibiotics during the year whereas 68% of rural non-Māori and over 80% of urban children received them.

The research suggests that issues relating to access of health services such as poverty, geographical isolation and lack of reliable transport to pick up medicines or visit a doctor are all likely reasons for low levels of anti-biotic use by rural Māori.

But other more worrying reasons are that Māori are being prescribed antibiotics less frequently; or are not having their prescriptions filled.

Why is this such a concern? Well when one considers that antibiotics are actually very cheap; and that there are high rates of acute rheumatic fever in this area, one would think that proactive steps would be taken to reduce the impact of the disease in Māori communities.

It is these type of questions that I hope will exercise your mind as you continue in your training. How will you resolve them?

And this is where Whānau Ora comes into its own.

Because the days of treating individual illnesses in isolation of the wider family – or in the context of a holistic approach to health and wellbeing are now well and truly in the past.

We now realise the importance of collaboration across the health sector; integration across all sectors; and the value of taking a comprehensive approach to the wellness of whānau.

Finally, I want to end with one more story.

But before I do that I want to explain why the art of story-telling can be so important to your training as a medical student.

What we know by now is that culture can influence the expectations and the perceptions of the healthcare system; as well as impact on a whole range of factors associated with effective communication.

The ability to read body language; to understand traditions or beliefs; to appreciate different cultural contexts can all play a role in achieving a better understanding of people from cultures different to your own.

Being able to be receptive to other cultural frameworks can improve and enhance your communication and ultimately impact on clinical outcomes.

It is about sowing the seed for a stronger relationship.

And so I want to end with a story my cousin, the late Rangitihi Tahuparae once shared with us.
“Let us return to our origins.

Since the time we as Māori were immersed in the knowledge streams of tauiwi, we have become like a branch grafted to a foreign tree, producing fruit of a different quality and somewhat unpalatable. It Is time that we returned to the rootstock of our ancestors”.

From this story we recognise the significant part that cultural identity plays in determining outcomes for whānau. The tree represents the growth of whānau wellbeing.

We have our own root system, developing a strong value system of tikanga and kawa; a system that is the foundation for growth as long as we have all the essential ingredients for optimum wellbeing – the skills and attributes; the support strategies and just the right balance of creativity and innovation.

As the Māori population grows it is increasingly important that health practitioners have the skills to integrate cultural understandings with clinical care.

Te Ohu Rata o Aotearoa – the Māori Medical Practitioners Association is committed to increasing the numbers of Māori doctors becoming specialists.

Indeed I am proud to announce that there is currently sixty Māori doctor mentors and mentees in the Te Ao Auahatanga Hauora Māori Health Innovation fund programme.

But we must never assume that only Māori need to possess the clinical expertise and cultural knowledge to work with whānau, hapū and iwi.

That is where cultural competence training is so effective in helping to update and enhance the knowledge, skills and attitudes of all health professionals. It is training which all can benefit from – both as professionals and those you are working with and supporting.

My greatest hope for you all as the health experts and health leaders of our future is that your training; your learning; your experience both at Auckland University but even more importantly in the health settings of our everyday communities, sows the seed to recognise the value and the strength that culture brings to health. Tēnā tātou katoa

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