Last week, the interim Māori Health Authority announced its first round of funding, saying it was aimed at embedding te ao Māori (the Māori worldview) in the health system for the benefit of both Māori and non-Māori. Jem Traylen explores what the approach could mean in practice.

It’s early on a warm Waitangi Day weekend morning and a group of older pākehā are out on a walk when a Māori man in his forties strolls past.

One of the group recognises associate health minister Peeni Henare and stops him to tell a story that the politician is sure to be delighted to hear.

They proudly report they’ve all received their three covid shots through the local Māori health provider.

They tell Henare how much they prefer the Māori provider over other GP services in the region, where doctors approaching retirement are cutting back their hours and it can take a month to get an appointment.

Henare told BusinessDesk that although they’re primarily funded to target Māori communities, these providers also open the door to non-Māori.

“If that's a platform we can build upon into the future for the way Māori health care provision is in communities, then I think that's a win for all of us,” Henare said.

Solution makers

The chief executive of the Whanau Ora Commissioning Agency, John Tamihere, agrees. He told BusinessDesk that 80% of people served at covid testing and vaccination sites funded by his agency were non-Māori.

He says he’s delighted that during the difficulties of the covid pandemic so many non-Māori had the experience of being served by Māori staff.

“We’re not bludgers. We’re not always at the bottom end of society, creating the country’s problems. We’re actually solution-makers,” Tamihere said.

Ngāti Toa chief executive Helmut Modlik has heard similar sentiments from a nurse working in the iwi’s chain of Ora Toa medical centres: non-Māori saying they’ve travelled over the hill from Wainuiomata or the Hutt Valley into Porirua because they love how it feels to be looked after by the iwi provider.

The five Ora Toa clinics are in poorer, high-needs communities with large numbers of Māori and Pasifika – but non-Māori are still in the majority.

The people they serve carry a disproportionate burden of chronic health problems. Modlik says his team fights to have a far longer and more complex conversation than primary healthcare typically allows.

“Recently, I was advised by my team that someone had turned up with covid concerns, and they did have respiratory concerns.

“But when that was layered on with all of the other health problems they were suffering from, it ended up being a two-hour consult.”

In some mainstream general practices, he says, “you’ll get your seven delivered minutes slot, and then you'll be moved on. That's generally not the experience in our Māori health provider clinics.”

Trusted faces

Modlik welcomes the language used in last week’s announcement, saying it was important that a broader and more holistic perspective is reflected in the way care is designed and delivered.

“The recognition and investment by Māori for Māori to provide a degree of intimacy – of familiarity, of relationship, of trusted voices, trusted faces, trusted places. That kind of addition to the mix is profoundly therapeutic.”

All sorts of people like to be looked after by the iwi provider, says Ngāti Toa chief executive Helmut Modlik (Image: Kāinga Ora) Tamihere says establishing a trusted connection is what a kaupapa Māori health service is all about.

“75% to 80% of all clinical success is sorted out in the first five minutes of consultation. Can you make connection with this person? Do they make connection with you?

“And once a trusting relationship is built, you can explore a range of options very quickly – somebody who’s not telling you what you want to hear, but is actually trusting of you. [Then patients are] able to divulge the difficulties they’re under and the way they’d want to see those addressed.”

Henare hopes that such approaches will encourage Māori to get the care they need earlier, instead of finding themselves only going to the doctor when it's too late.

Monocultural thinking

National Party health spokesperson Shane Reti agrees that timeliness is important, and has raised concerns that these new programmes are diverting resources away from addressing the growing waiting lists for specialist appointments.

But he does not oppose in principle taking a more holistic approach to healthcare. (Last week’s announcement included millions of dollars for Māori approaches to health, including for traditional healing.)

As a Western-trained medical doctor of Māori descent, Reti is used to crossing cultural boundaries. These days, he says, professional bodies provide guidance on where complementary and alternative medicines might fit with standard practice.

“Sometimes I see benefits that my colleagues and I can't explain. We need to understand that better – to see how we can absorb that knowledge more into our mainstream thinking.”

Rob Campbell, who chairs the interim Health NZ agency that will take over NZ’s 20 district health boards, says the system has been too dominated by monocultural thinking.

The system has not worked for Māori for many decades, and solutions that best work for Māori must come from Māori, he said at last week’s announcement.

“The privilege that we have in this country is that Māori as tangata whenua are willing to share these solutions with us, so that we all can benefit.

“I am reminded constantly … that what is good for Māori is good for everyone.”

Campbell said he looks forward to a time when people in this country felt respected, cared for and treated well by a health system no matter their race, gender or age.

“We have a lot of work to do to reach this lofty goal. As the old rock and roll song goes, you ain’t seen nothing yet.”

Read BusinessDesk's interview with Riana Manuel, CE of the new Māori Health Authority.