My time as a kiwi apothecary (part 4): Cultural awareness

Kia ora, Drug Topics readers,

A few months ago, I had the privilege of attending a cultural awareness workshop in the Manawatu region of New Zealand. This experience allowed me the opportunity to visit some members of the local Maori community at their marae (a communal or sacred place which serves both religious and social purposes) and to learn more about some of their customs and practices. Our group of 12 pharmacists and students was welcomed to the marae in the traditional Maori manner, including the touching of noses and sharing of breath (hongi). While there, we took the opportunity to discuss some of the special considerations that we need to respect when working with Maori patients.

A little history

For those unfamiliar with the Maori people, I will provide a little background information. It is believed that New Zealand was first settled by Polynesian sailors some time in the last millennium. The descendants of these original settlers became known as the Maori, forming a distinct culture. Leadership was based on a system of chieftainship. The most important units of Maori society are the whanau (extended family), and the hapu (group of whanau). Traditional Maori society preserved history orally through narratives, songs, and chants, and experts could recite their tribal genealogies going back hundreds of years. Cultural arts include storytelling, song composition, dance forms such as haka, weaving, highly developed wood carving, and elaborate tattoos.

The first Europeans known to reach New Zealand were the crew of Dutch explorer Abel Tasman, who arrived in December 1642. British naval captain James Cook visited the islands near Christmas of 1769. Cook returned to New Zealand on his subsequent voyages and his explorations paved the way for future European settlement.

Contacts between European settlers and the Māori had varying effects. In some locations life changed only slightly at first, while in other parts of the country the usual way of life was radically altered. As the 19th century unfolded, European technologies and practices further modified the Maori way of life. Now, more than 100 years later, while traditional customs are still observed and adhered to by a large number of Maori, many aspects of their previous way of life are relegated to history books and museums.

Considerations in practice

Maori individuals have a life expectancy that is nearly 8 years shorter than that of non-Maori New Zealanders. This is probably attributable to a higher incidence of conditions such as heart disease, hypertension, diabetes, and hyperlipidemia.

While there are several possible explanations for these higher rates, one element that we as healthcare providers can influence directly has to do with the attitudes and knowledge we employ when working with clients whose backgrounds are different from our own. Our failure to observe basic social customs often appears disrespectful and alienates patients. Dissatisfied with the treatment they receive, they are more likely not to follow up with their providers.

One of the most important considerations in Maori treatment is the inclusion of the extended family. Therapy options which may strike the individual patient at first glance as strange or unnecessary will often make more sense after they have been discussed with other family members. When the family is included in healthcare decisions, it is more likely that the patient will develop trust and faith in the healthcare team.

When a provider is first meeting with a Maori patient, it is important not to rush the encounter. It is necessary to take the time to properly introduce oneself. In order to properly engage with the patient, it is preferable to perform any discussion or counseling (when possible) face to face. Avoidance of eye contact on the part of the patient typically indicates respect, not lack of interest, as we may initially conclude. The Maori saying “we listen with our ears, not our eyes” is quite fitting in this regard.

While it may seem like common sense, proper pronunciation of Maori names is essential to building a respectful relationship. When in doubt, it is always important to ask. Maori names are often connections to the past, and pronouncing them correctly is a show of respect.

Conclusion

At the end of the day, it is essential that we, as pharmacists and healthcare providers, interact with our patients in a manner that optimizes health outcomes.

I feel that by taking the time to learn a little bit more about Maori customs, at the very least I can communicate information about medications in a way that will make more sense to the patient.

If I am able to demonstrate an ability to understand my patient’s needs as well as convey information in a manner that is patient-friendly, it becomes much easier to form the bonds necessary to a positive patient-pharmacist relationship. It’s a good feeling when a young Maori girl reassures her mother that she can trust the “medicine man” to give her correct, safe information about an over-the-counter remedy.

This is the final installment in a four-part series written by Joel Claycomb, PharmD, who has been serving as a visiting community pharmacist in Manawatu, New Zealand. His account of volunteering in Haiti after the earthquake appeared in the June 2011 issue of Drug Topics and can be found in the magazine’s online archives at DrugTopics.com. He can be reached at jcclaycomb@gmail.com.