Issue 18 May 2005
General points
- Effective treatment and rehabilitation is built upon successful communication with claimants/patients and their whänau/family
- Acknowledging the impact of different cultural backgrounds by providers is the basis for effective communication
- The key to culturally competent care for Mäori claimants/patients is for providers to seek a better understanding of Mäori world-views and culture, and to apply this in practice with Mäori claimants/patients
- Mäori claimant/patient satisfaction with care, and the acceptability of treatment, is associated with providers’ ability to develop and display an understanding of Mäori communication needs.
Introduction
Effective treatment and rehabilitation for Mäori is built upon successful communication with Mäori claimants/patients and their whänau (family). Successful communication involves a commitment to continued learning about tikanga Mäori (the cultural values and customs of Mäori) and understanding how a Mäori world-view affects Mäori preferences for communication. This is the second ACC Review on Mäori Cultural Competencies for Providers. It summarises the key messages from the ACC Summary Guideline (1) on communication with Mäori claimants, and includes anecdotes and quotations from the Guideline (in italics).
Tikanga Mäori – A Mäori World-view
Many Mäori have a world-view that values connections to ancestors, the family, the physical environment and incorporates tikanga Mäori. This world-view focuses on connections from the past through to the present. It may affect the way treatment is approached. For example, a stressful event such as surgery may be undertaken more confidently if there is the opportunity to include karakia (prayers) and a whänau conference.
Kia mau ki te kupu a tou mätua
Adhere to the advice of your parents and ancestors.
How does Culture Impact on Consultations?
People respond differently to illness and injury because of social, cultural and psychological factors. Adherence by Mäori to Mäori cultural norms and practices varies widely. Understanding and appreciating the significance of particular events or means of communicating will enhance communication and the ongoing relationship. A positive relationship is likely to improve adherence to treatment plans and health outcomes for Mäori claimants/patients.
First Meeting
When Mäori have initial contact with a provider, getting to know each other is important, particularly if health issues are long term or serious. Allow sufficient time for introductions with all staff and time to meet whänau if present. The provider should lead the way into each room of the health premises, indicate where to sit, introduce themselves, and then allow time for the claimant/patient to make their own introduction.
The Importance of Whänau/Family
For many Mäori, an individual’s health problems are considered the problem of the whänau. Mäori often bring whänau to support them and this should be encouraged as a way to improve communication. In many cases the whänau will have a designated person to lead discussions with the provider and whänau. Involvement may be vital to a claimant’s adherence to treatment. Where whänau involvement cannot be accommodated, it is important to give an explanation.
Mr H.H. (15 years of age) was undergoing an MRI to assess his injury. Family/whänau members had travelled 90 kms with him to the appointment, but were told after the scan was complete that the results would be made available only through his doctor. The family/whänau was upset as some had taken time off work, expecting a discussion of the findings with the radiologist. They had not been told about the policies and reporting processes of the MRI unit. (1)
Ways of Communicating
The Summary Guideline contains information on ways of communicating that will enhance the relationship between provider and claimant/patient.
Face to face contact
In general, personal contact is preferred, with the aim of seeing the face, hearing the voice and observing the body language. Direct eye contact can be taken as a sign of disrespect, especially when directed towards authority figures. Mäori may prefer to look at a neutral point in the room rather than having sustained eye contact.
Communicating treatment plans
Silence does not mean Mäori agree with treatment or rehabilitation proposals. It is best to check understanding and concerns with open questions. For example you could ask, “I want to be sure that I have given you all the information you need. Can you tell me what you understand will happen to you, from what I have said.”
Correct pronunciation of te reo Mäori
Incorrect pronunciation implies a lack of respect and can cause offence.
Mr Ngawharau took his daughter, Pounamu, to a busy accident and medical clinic. The clinic triage nurse explained that she found it hard to pronounce the child’s name and suggested she call the injured child Jade, as that was much easier for her. Jade is the English equivalent of Pounamu (or greenstone). The father and daughter left without receiving further care, but presented later to a hospital emergency department. (1)
Taking care with medical language
Medical phrases in common use may mean something very different to claimants/patients. Taking care with language can be critical to the on-going relationship.
The family/whänau of Mrs K is very reluctant to go to the hospital or see medical specialists because “they don’t believe what you tell them, and they treat Mäori badly”.
This came about after the referral of their kuia to a specialist for assessment after a fall causing injury. During talks with the family/whänau members the specialist asked if the kuia was taking any medication. The family/whänau were clear that their kuia was not on any medicines, so they were very upset when the correspondence from the specialist stated that “the family/whänau denies the patient is on any medication”. (1)
Claimant/patient satisfaction with care and acceptability of treatment are associated with the ability of providers to show they understand their claimants/patients and are understood by them.
He tao rakau, e taea te karo; he tao ki, e kore e taea te karo
A wooden spear can be parried, but a verbal spear cannot be parried.