Best health outcomes for Maori - Medical Council of New Zealand

way of reducing the risk of infection; or the tapu nature of a
pataka (a storehouse for food) – a way of ensuring that food
supplies will be protected and nutritional standards therefore
maintained during winter. The application of tapu to parts
of the body such as the head was also a warning to avoid
unnecessary injury to the particular region or organ. Treating
nesting birds as tapu was a way of increasing the potential
number of birds for food, rather than risking the loss of a
whole brood.
Many Mäori feel that keeping tapu items separate from
noa items is very important and find it distressing when
the division is not observed. For example, in the case of a
patient’s death the whänau will likely wish to spend time in
the room with their loved one. The presence of the dead
body (tüpäpaku) makes the room tapu, and therefore
food cannot be brought in. It is easy to imagine how a
well-intentioned member of the hospital staff might bring tea
into the room, thinking the family would prefer a cup of tea
“in private”. Unfortunately, this would create a violation of the
tapu/noa separation and be seen as offensive.
As described by Dr Mason Durie:
“The degree of comfort individuals feel with seeking health
services impacts on their use of services and, in turn, health
outcomes… The delivery of care in a culturally appropriate
manner is an important element in determining both the
willingness of people to access services and the success of
any treatment or care then delivered.” 46
2 Best health outcomes for Mäori: Practice implications
Identifying issues and behaviours that will make Mäori
patients more comfortable in the healthcare setting
will result in a mutually beneficial situation, where both
patient and practitioner satisfaction increase and clinical
outcomes improve. 31,37,47-49
Mäori culture emphasises familial and community ties.
Its world view acknowledges the wisdom of the past as
well as its connections to the present, through historic
places, ancestors, community ties, and the physical world. 6
Keeping this in mind may assist non-Mäori practitioners in
understanding Mäori patients’ behaviours, such as bringing
family members to medical visits and consulting with
them before approving treatment, preferring face-to-face
interactions with their practitioners, and expecting that first
meetings (with any and all members of the medical team)
will be handled formally and at an unhurried pace until a
relationship is established.
Some areas where cultural differences may arise with a
Mäori patient include: establishing (and maintaining) a
therapeutic relationship, interpreting (and sending) nonverbal
signals, expressing agreement and disagreement,
communicating medical information, allowing (and including)
family members in medical settings, and praying. Although
some or all of these areas may be important to an individual
patient, you must remember that, like all other ethnic groups,
Mäori demonstrate great diversity within their community. 6
However, in common with other New Zealanders, Mäori
patients are generally happy to educate a provider who
demonstrates concern and respect for their wishes by
asking about areas that may be unfamiliar or confusing.