‘Institutional racism’ is blocking Pacific and Māori access to health care, doctor says

 

A doctor believes “institutional racism” in the health system is leading to worse outcomes for Pacific Island patients.

Invercargill-based general surgeon Dr George Ngaei​ said Pasifika people weren’t getting the same access to treatment once bowel cancer gets past the first stage of basic treatment.

Ngaei, an advocate for Pasifika health, is the chairman of the Pacific Advisory and Cultural Trust, which is a community health service.

The state of Māori health, described as a humanitarian crisis by one expert, is already under investigation by the Waitangi Tribunal.

Ngaei believes access to care is restricted due to the health system ignoring the cultural needs of Pacific peoples.

“Once a Pacific person gets bowel cancer, and they need advanced treatment, they are less likely to get it, and a lot of it comes down to what you call unconscious bias.”

Unconscious bias was hard to detect but attitudes needed to change, he said.

Ngaei is not the only voice raising concerns about access to health care, as a survey conducted by the New Zealand Māori Council says Māori also have a lack of faith in the New Zealand health system when it came to accessing care.

This survey was presented to Health and Disabilities Services Review this month.

The survey says that 83 per cent of Māori surveyed did not feel comfortable accessing services provided by District Health Boards and 79 per cent believed the current model for health and disability services was not fit for purpose.

Māori Council executive director Matthew Tukaki said the health system was failing because Maori were less likely to access care but it was not a cultural issue rather a trust issue.

Māori might only end up at the hospital when they know they might die because past experiences meant they did not trust the health system, he said.

Geographical location was a major contributing factor as health care was often centralised to major centres while the majority of Māori live in the regions, he said.

Campaigning to see more “brown faces” on health would be important to get more Māori and Pacific people accessing health care and having that campaigned where Maori socialise was crucial, he said.

Yet, for Ngaei he says for Pacific Island people the issue is a lack of understanding about culture.

Pacific Island people need more time in a medical environment to trust a person and open up, and they look at life and health from a holistic approach.

This means that a doctor may be unable to gather all the information they need to make an informed decision about treatment.

“If someone comes with a physical ailment, their mental and family relationships are all interconnected but from a western view that is too difficult.

“GP’s are under pressure, patients have five-minute appointments, and doctors don’t want the whole family in the waiting room.”

The level of access to treatment was not equal because cultural differences prevent clear communication, he said.

Cultural competence courses are available to assist medical professionals but it would take at least another generation to resolve the problem, Ngaei said.

The PIPER Project report published in the New Zealand Medical Journal in June, 2018 says outcomes for Pacific patients with bowel cancer are worse.

The study found that the five-year risk of death from bowel cancer was highest in Pacific patients at 59 per cent, Māori at 47 per cent and Non-Māori-non-Pacific at 38 per cent.

Auckland University of Technology associate professor Jacquie Kidd supports claims that cultural differences prevent clear diagnosis for Pacific and Māori people.

“In health, we have a built a system with one group in mind and that is European,” she said.

Pacific people needed to visit the doctor several times before they were comfortable talking about personal and sensitive topics which could not be done in short appointments, she said.

Kidd believes in adopting Māori and Pacific mentalities to health would be beneficial to the health system overall.

“Health strategies for Māori and Pacific people are complex and amazing; you have to stop and listen,” Kidd said.

Whilst cultural competence were good programmes Kidd said participation was flawed.

It was flawed because the courses were often only attended by individuals who were willing to attend, she said.

A spokesperson for Leva, which runs a Pasifika competence course, said participants from all DHB’s had attended its courses.

A Southern DHB spokesperson said the cultural courses were not compulsory but were highly attended.

Stuff asked the Ministry of Health if institutional racism prevents minority groups, in particular Pasifika and Maori, from receiving the same level of bowel cancer treatment in New Zealand.

Ministry of Health Pacific health chief advisor Matafanua Hilda Fa’asalele​, in an emailed response, says “achieving health equity for all New Zealanders is a priority for this government and for the Ministry of Health.”

Fa’asalele​ said inequitable health outcomes remained despite its best efforts.

“We accept that despite efforts, inequitable health outcomes remain pervasive. Pacific peoples experience long standing inequities across a range of health and socio-economic indicators. These in equities are complex and multi-faceted and can result from the relative poorer economic status of Pacific peoples.”

“We want the health and disability system to perform for pacific people,” she​ said.

Māori, Pacific and those living in areas of deprivation were groups of focus for programmes such as the national bowel cancer screening programme, she said.

​The national bowel cancer screening programme provides free bowl cancer testing for everyone aged between 60 and 74 and is currently available at eight DHB’s.

​The programme will gradually be rolled out nationally and is expected to be completed by June 2021.