Best health outcomes for Maori - Medical Council of New Zealand

Case studies continued...
CASE THREE:
“We Are Family”
The whänau factor
A 47 year old Mäori woman presented to her GP and was
diagnosed with diabetes. The GP, through her conversation
with the patient about ethnicity, realised that for this
woman, like many Mäori, the whänau formed the basic unit
of her society, and thus it needed to be the basic unit for
medical intervention. The GP made sure that rather than
educating only the patient about the disease, she worked
with the family as well. It is unlikely that the patient would
change her diet unless her whänau was also brought
into the consultation, so the doctor sat down with several
members of the family and explained to everyone about
diabetes, the pancreas, insulin, glucose levels, finger prick
testing, pharmaceutical interventions, diet and exercise,
complications and preventing complications. Since the
patient was one of the family’s main cooks, she would not
change her diet or have a refrigerator full of healthy salads
and diet food while cooking all night for the rest of her
family. It was also important for other family members,
such as her daughters-in-law who also did some cooking,
to understand how her diet needed to change.
The GP also recognised that, with the incidence of diabetes
and obesity disproportionately high in the Mäori population,
it was likely that other members of the whänau would
develop diabetes in the future. She knew that by educating
2 Best health outcomes for Mäori: Case studies
the entire community and encouraging healthy changes in
everyone’s diet and exercise habits, she had the opportunity
to prevent or delay those cases. Accordingly, when talking
about the importance of exercise in keeping diabetics
healthy, she led a discussion on whänau-based exercises
in which the entire community could participate regularly.
She also referred the patient (and her whänau) to a Mäori
dietician who could use her knowledge of foods commonly
used in Mäori cooking to help the patient substitute healthier,
but still culturally acceptable foods, for example, using
karengo (seaweed) in salads. The dietician also explained
portion sizes in appropriate ways and discussed how the
patient and other whänau cooks might handle hui and other
events where food will be provided.
Although this educational session took a bit longer than the
average consultation, the GP felt that it was an excellent
investment of time and energy. Over the next 12 months,
she was proven correct, as she found that not only was
her patient’s diabetes well controlled and her borderline
hypertension dramatically improved, but several other
members of the whänau also lost weight and adopted
exercise patterns because of their improved understanding
of diabetes as well as the different diet options now available
to them. Basing treatment decisions on the goal of having
the patient remain healthy and active in her role as mother
and grandmother to future generations allowed the GP, the
patient, and the whänau to achieve the best possible results.