Better outcomes for wāhine
Gynaecologist Dr Angela Beard, Ngāti-Haunui-a-Pāpārangi, Ngāi Tahu, wants to see a fusion of cultural competencies with clinical know-how from medical professionals.
The increasing enrollment in her courses, offered by MIHI (Māori/Indigenous Health Innovation) at the University of Otago, Christchurch, demonstrates progress. During her medical training, Dr Beard learned everything about taking a patient’s history. Yet there was no consideration back then about the unintentional barriers that might be created for Māori in asking those questions.
Now, through her teaching work with MIHI, Dr Beard ensures medical professionals and trainees can create better connections with all patients and, ultimately, support Māori health equity.
“We still take a history, do an examination, and make a plan of management,” says Dr Beard. “But we do it differently from the usual Calgary-Cambridge model taught in medical school. We do it in a safe way for Māori.”
This approach involves applying two mental models when assessing patients: the hui process and the Meihana model. Authors, including Dr Suzanne Pitama, now Dean of Otago University’s Christchurch medical school, developed these frameworks based on Māori principles of hauora for practical use. It is based on the understanding that clinicians are in the best position to impact on health inequities – if given the right tools.
Participants in the gynaecology-specific MIHI courses learn about cultural safety and practise the conversations that researchers know make a difference.
“That’s making sure we use te reo in our consultation, that we acknowledge decision-making around health includes family – and that can be whakapapa family, or anybody that turns up with a patient, that we accept that a patient may be using rongoā (traditional Māori medicine), and normalise it,” she says. “We definitely need to understand the importance of tīkanga.”
It is essential learning, both for those who trained here and for the population of our health workforce – nearly half – who trained overseas. Increasingly, doctors new to Aotearoa want a deeper understanding of the cultural context here.
Dr Beard’s goal is for Māori to receive evidence-based best practice at the same rate as non-Māori. She sees fewer wāhine Māori referred for investigation of endometrial cancer, for example, despite a higher rate of diagnosis among the population.
“This is why we teach the epidemiology of disease – so health practitioners can identify risk factors more quickly when they confirm a patient’s whakapapa.”
“Wāhine Māori are less likely to be referred for specialist tests and, therefore, less likely to receive the most appropriate care. We also know they experience higher levels of disadvantage and can be more likely to forgo their own needs. They might have more mouths to feed, have fewer transport options, or have experienced racism in the health system previously.”
These are the ‘social determinants of health’ – the circumstances in which people are born, grow up, live, learn, work, and age, and they strongly affect a person’s health and quality of life.
Dr Beard teaches how to take a wider view of social determinants when making a patient assessment, to understand the barriers that prevent Māori women from accessing best practice healthcare and respond better.
“Often in gynaecology, we see a one-size-fits-all approach. We’ve heard from wāhine Māori that they often don’t feel heard or understand all the options in abortion care or contraception, for example. It needs to change.”