Clive Bibby: Finding a cure is more difficult than identifying the cause

Frustrations with the failure of the Public Health System to deliver for Maori have reached boiling point across the nation- in some areas more than others.

Understandably, some Iwi leaders are saying "Enough!"

Are they right?

The evidence that was presented mainly by Maori Health professionals to the Waitangi Tribunal Health Services and Outcomes Hearing at Ngaruawahia recently left those in attendance in no doubt that, according to them, the root cause of this failure is the institutionalised and individually practiced racism within the system.

Some of you will be reacting to these claims with scepticism based on a developed mistrust of "so called evidence" describing similar deficiencies in other public institutions and l must confess that my own first response to these emotive disclosures is to regard them as probably the work of radical revisionists with alterior motives and as such, not something to be taken seriously.

Some would say even that reaction is evidence of a racist flaw in my own character but frankly,  l don't "give a monkeys" what others think. 

While l may not agree with the emphasis they place on racism as the main cause of this failure, l identify with their general concerns and have had enough personal experiences with the system both as a patient and as an administrator to understand their frustrations.

If the national health system that should be looking after our Maori cousins is as broken as is being suggested, then surely we all have a responsibility to ensure it is functioning properly.

I can't imagine the ethnic european section of society tolerating such a situation for longer than it takes to ring up the Prime Minister and inform her that her government is in danger of being consigned to history if she doesn't fix it before she feeds the baby.

However, trying to adapt a Pakeha" designed health system into one delivering  health services to Maori populations requires skills and creativity that only Maori can provide and it is probably fair to reflect that Maori themselves haven't always supported some of the brightest ideas coming from their own people that could have made a difference.  Entrenched racism may well influence outcomes but it isn't the only reason for the failure to get runs on the board throughout the whole country.

There are many high profile cases of Maori health professionals and leading Iwi politicians ( previous Minister of Health Dame Tariana Turia and Dr Lance O'Sullivan - naming but two) who have developed systems that can deliver the much needed health care needs for their people but far too many of these acceptable outcomes are isolated and as a consequence, have had little impact on the system as it delivers for Maori as a whole.

A question!

Would we not be more likely to obtain better results building on the successes of the Maori Health trail-blazers l referred to earlier and introducing delivery systems across the country that are known to suit the people for which they were designed - something we have clearly not done enough of in the past?

You see, my understanding and experiences of the public health system, particularly in delivery mode, is that each region has to deal with its own specific problems as best they can and we have to match our local geographic and demographic variables with the resources we have on hand in order to try and provide adequate care for all residents, no matter where they live or who they are on the social scale within their community. Consequently what works for some may not work for others.

It also usually means that the delivery of health services to the more isolated patients will be relatively much more expensive and less efficient than for those in the more densely populated areas. In that context, the type and quality of health services delivered will have little to do with the racism discussed at the Ngaruawahia summit.

And so, even if we were able to completely stamp out the racism plaguing the system, the problems related to cultural acceptance and adoption of prevention methods and sickness treatment will remain as a shadow over the whole damned lot.

My own personal opinion is that we would be much better off fast tracking and expanding delivery services based on the Whanau Ora philosophy which is " to take the services to the patient " and deal with them in an environment that is likely to extract the maximum amount of cooperation .

We are right to acknowledge that our Health System has failed Maori but l don't believe it will be resurrected to a more acceptable service for them simply by focusing on a problem such as "racism" which, no matter how debilitating, is for most, a perceived impediment. You can talk about it all you want but you can't remove it unless there is a quantum shift in the attitudes of us all towards one another, irrespective of whether we are Maori or Pakeha.

Much better to concentrate on providing a service that fits with the cultural limitations of isolation, poor housing, nutrition and adequate numbers of affordable aged care facilities.

We already have the ability and resources to do that nationwide so we should start rolling it out immediately. We can't afford to be side-tracked by another red herring.

Clive Bibby is a commentator, consultant, farmer and community leader, who lives in Tolaga Bay.