ABSTRACT
Background: Maori, Indigenous peoples of New Zealand (NZ) are twice as likely to die after a diagnosis of cancer compared to non-Maori. Cancer pathways are not designed for Maori health gain and are not pandemic resilient. Maori receive delayed poorer quality treatment and those with comorbidities are undertreated [1]. Existing inequities from time of referral to cancer services through to treatment were exacerbated by the COVID-19 response in Aotearoa NZ. Coordination of care is crucial for Maori patients and whanau (family), but poorly developed along this early part of the cancer pathway. In addition, care quality is not well monitored, and the current pathway is vulnerable to changes created by pandemic conditions. Aims: This study seeks to co-design, implement and evaluate a holistic cultural and clinical cancer service that is patient and whanau centred;the Whanau Hauora Integrated Response Initiative (WHIRI) programme. This comprehensive, pandemic resilient, racism-free, hauora (wellbeing) enhancing and responsive model of care will be designed for the early part of the secondary care cancer pathway. Design and Method: The WHIRI programme includes navigation, a holistic whanau/family hauora assessment tool, proactive management by a team of clinicians and a team responsible for making systems changes. WHIRI was launched mid-pandemic (early 2020) for kaumatua (elderly Maori) with long-term conditions and ran for 3 months. During COVID we found that WHIRI had the potential to change hospital systems and improve experiences for patients and whanau. WHIRI ensures the provision of best-practice timely treatment for Maori patients and could make large gains in closing the survival gap between Maori and non-Maori in the short- to medium-term, leading to reductions in Maori cancer deaths. We plan to redesign WHIRI into a cancer programme that functions effectively in all COVID levels using qualitative Kaupapa Maori methodology. Key to this methodology is partnerships with patients, whanau, cancer clinicians, Maori navigators and The Cancer Control Agency New Zealand. We will present our methods and co-design model of cancer care. We will outline the potential to expand the model nationally with reach from primary care all the way through to palliative care. It will also provide a platform for future research to measure the impact of WHIRI on cancer and whanau care. 1. Hill S, Sarfati D, Blakely T, Robson B, Purdie G, Chen J, et al. Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service.
ABSTRACT
Background: Iwi Maori (Maori people) are the Indigenous people of Aotearoa. Some estimates predict that Maori have been occupying the lands of Aotearoa for more than 1000 years. After claiming sovereignty in 1835 with He Whakaputanga (Declaration of Independence) following annexing international interests, Maori signed the Treaty of Waitangi (Te Tiriti o Waitangi) 5 years later to ensure independence, protection, ongoing prosperity and justice. Maori were prosperous, trading, had a strong economy and thriving in all areas of life. Maori knowledge systems and language were mainstream and many Pakeha who settled embraced all aspects of Maori culture including te reo Maori. Our history tells us that Te Tiriti was not honoured and this had catastrophic effects on Maori existence. By the late 1890s the Maori population had nearly been wiped out by infectious illnesses, loss of lands and the encroaching effects of assimilation, colonial shift in power and the disempowerment of Maori. Access to health care is a human right and was protected under treaty rights but successive governments have failed to address inequities. Moving forward to 2021, the Ministry of Health recently announced a new health structure and the establishment of a Maori Health Authority (MHA) to independently advise, commission health services for iwi Maori. Many see this change as transformative and a true act of Tino Rangatiratanga (self-determination). The act of re-Indigenising our health systems landscape may find the solutions to restoring equity. Objectives: To provide a personal reflection of the proposed new health care system reforms with a particular focus of the historical socio-cultural context of Aotearoa and illustrate why these reforms are important and transformative. I want to demystify the ideas and rationale for de-colonisation. I also want to consider the implications for Maori health and the enormous expectations others may have towards Maori solutions and the anticipated critics of the new system. Methods: I will briefly review the historical context of Maori in Aotearoa, the causes of poor mental health (MH) outcomes, why equity is important and why things need to change. I will discuss the most recent independent health reviews, which provides the basis of the new health reforms. Understanding Indigenous concepts like Tino Rangatiratanga and Mana Motuhake will be articulated. Understanding the concept of health and wellness from a Maori perspective will be discussed. Findings: Maori MH incidence and prevalence rates for most health conditions continue to be disproportionately higher than the dominant culture. Like Indigenous Australians, youth suicide rates for Maori remain the highest in the modern world, and other health crises such as COVID-19 can perpetuate these outcomes. Healthcare systems (in Australia and New Zealand), health structures and those in the positions of influence continue to underperform. The new proposed health reforms put Maori health leaders in the frontline in decision-backing processes and delivery: 'Ma Maori, mo Maori - By Maori, for Maori'. Conclusion: The enduring effects of colonisation continue to create inequitable health outcomes for Maori in Aotearoa. The new health reforms proposed may generate needed ideological, philosophical and culturally mandated shifts which align with the intent of Te Tiriti o Waitangi and the achievement of Tino Rangatiratanga and Mana Motuhake. There is now a process to re-empower Maori to find their own solutions to poor health outcomes, to rediscover lost knowledge and indigenise our healthcare system. The effects of the new system should be given time to make a difference.
ABSTRACT
Background: The COVID-19 vaccine has been recommended for pregnant people in Aotearoa since June 2021. People birthing in November 2021 were eligible for vaccination while pregnant. Despite recommendations, pregnant people may have lower rates of COVID vaccination than the general population. We aimed to assess vaccination rates during pregnancy in Wellington and contributors to vaccination status. Methods: For three weeks from November 2021, people birthing at Wellington Hospital were surveyed regarding their vaccination status and reasons for this. Results: 191/206 eligible people (92.7%) consented to participate. 142 (74.4%) were fully vaccinated, 20 (10.5%) had one dose and 29 (15.2%) were unvaccinated. Main motivators for vaccination were to transfer antibodies to their baby and protection against COVID-19. In contrast, unvaccinated participants' reasons were vaccine safety and delaying until post-natal. Both groups expressed concerns regarding changing official advice without well communicated reasons for the change. Maori participants were less likely to be vaccinated (11/18;61.1%) than non- Maori (131/173;75.7%) (p = 0.06). Conclusion: Pregnant people were less likely to be vaccinated than the general population;the milestone of 90% of eligible people being vaccinated was achieved in Wellington in November 2021. Ethnicity inequities in the population rollout are reflected in our data. Both vaccinated and unvaccinated participants' decisions were influenced by wanting the best for their baby. Messaging to pregnant people must include the benefits of vaccination during pregnancy for babies. As ongoing COVID boosters are likely, we must ensure that inevitable changes in vaccine policy are accompanied by explanation of reasons for changes.