Māori and Pacific practitioners have always been significantly under-represented in the medical workforce compared to their proportion of the general population. This remains the case in the 21st century, though there have been increases since the 1990s. Māori and Pacific workers tend to be concentrated in support roles like caregiving, which require fewer qualifications.
Māori and Pacific people have long signalled a need for more Māori and Pacific health practitioners. It is considered that a more culturally appropriate service is likely to be available from someone who shares the same cultural values and beliefs. One response has been the establishment of Māori and Pacific health providers.
The first Māori medical doctor was Māui Pōmare, who graduated from the American Medical Missionary College at Chicago in 1899 and returned to New Zealand to practise. He was followed by Peter Buck in 1904, and Tūtere Wī Repa in 1908. Both Buck and Wī Repa had been inspired as Te Aute College students to enter medicine when Apirana Ngata spoke about the need for Māori practitioners during a conference there in 1897.
The first Māori woman doctor was Rina Ropiha, who graduated in 1948. She specialised in psychiatry and established a private clinic at her home. During her medical training she got married and had four children.
In 2015, 2.7% of doctors identified themselves as Māori and 1.8% as Pasifika. This was a small increase from 2.5% and 0.8% respectively in 1997. Medical schools have set aside places for Māori and Pacific students to encourage their recruitment. The University of Auckland established the first Department of Māori and Pacific Health in 1996.
Nurses and midwives
In response to the toll infectious diseases and poor living conditions took on Māori health, the first Māori nurses were registered in 1909. Māori nurses became an important element of district nursing schemes in rural areas.
Māori midwives assisted women in childbirth in traditional communities, and after European settlement. Māori district nurses began to attend deliveries in the 20th century.
Māori and Pacific nurses and midwives are under-represented in their profession compared to their proportion of the general population, though Māori are better represented than their Pacific counterparts, particularly in midwifery. In 2015, 6.5% of nurses and 9% of midwives identified themselves as Māori and 2.6% of nurses as Pasifika – in the 2013 census 14.9% of the population identified themselves as Māori and 7.4% as Pasifika.
Educational institutions have developed programmes to encourage Māori and Pacific people to work in these fields. Waikato Institute of Technology pioneered a nursing programme called Tihei Mauri Ora which supports Māori students to learn in culturally appropriate ways.
In 2009 the first undergraduate nursing programme for Māori was approved. It was devised by Te Whare Wānanga o Awanuiarangi in Wellington. Whitireia New Zealand in Porirua offers Māori and Pacific nursing degrees.
Cultural safety definition
The Nursing Council of New Zealand’s definition of cultural safety is: ‘The effective nursing practice of a person or family/whānau from another culture, and is determined by that person or family. Culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socio-economic status; ethnic origin or migrant experience; religious or spiritual beliefs; and disability.’1
The term ‘cultural safety’ (kawa whakaruruhau) used within many health professions was first developed within nursing and midwifery to indicate practitioners’ responsibilities when working with Māori. It emerged from a nursing education leadership hui held in Christchurch in 1989. Irihapeti Ramsden led the development of its incorporation in nursing and midwifery training in 1992.
Since the inclusion of cultural safety in education programmes, there have been periods of controversy where some students or their parents have resisted course content. By the early 2000s this was rare. While some health practitioners might not use the term cultural safety, most have been exposed to it through education and professional organisations.