The Hawke's Bay District Health Board has been called racist following an internal review into how it treats Māori and Pasifika patients.
Doctors thought a Pasifika woman who was in Hawke's Bay Hospital for a fall injury had "limited English" when she actually had hearing problems. Photo: RNZ / Tom Kitchin
Board members were told about the patients' experiences at their last ever meeting this week.
The internal review was a "proactive piece of work" by the DHB, which partnered with Māori cultural communication agency Tātou and strategy advisers Rutherford Consulting to improve its referral process.
About 40 people were interviewed such as whānau and GPs as well as hospital clinicians and administrators.
The experiences
Patient one - 17-year-old tamaiti tāne, or boy, experiencing drug induced psychosis
The boy's māma wanted to get a mental health referral for her son after a police incident.
But she found because his diagnosis was assessed as mild-moderate, he could not receive much support until he did something to "trigger the system", for example, commit a crime.
After several days, the tamaiti had not heard anything and his māmā was at her "wits' end".
She went in to see the DHB's Child, Adolescent and Family Services, because she wanted to speak to them kanohi ki te kanohi (face-to-face).
She was told her son's case needed to be triaged and it was not as severe as others. This concerned the māmā.
Finally, her tamaiti tāne was seen, but they found the experience cold and impersonal.
Before any greetings or introductions, the details of the boy's case were read out loud in verbatim - that he was found unlawfully on a property with his taiaha (long wooden weapon) experiencing schizophrenia.
The māmā said she wanted to be treated with more respect for tikanga and aroha.
Patient two - a Pasifika māmā, about 90 years old
This woman had been in hospital for two months due to a fall. She had been labelled as having "limited English".
Pasifika Health were called to a hui on day 37 of the woman's stay, to help develop a discharge plan.
When the Pasifika health navigators met her, they discovered she could not hear them well.
A social worker gave her a hearing amplifier to try and she became very engaged in conversation - even in English.
The team learned the patient had been incorrectly labelled as having "limited English" when in fact they found she had limited hearing.
When Pasifika Health spoke to the physicians about the hearing problem, they were told it was not an issue and they should only focus on her discharge.
Pasifika Health eventually decided to go around the official processes and create their own "referral", approaching the audiology department themselves. The woman was eventually given hearing aids.
More allegations of racism
These stories come to light just days after the Hawke's Bay DHB released another internal review into its "cultural responsiveness" of maternity services for whānau Māori.
For this, 80 people were interviewed.
Many wāhine and whānau said they were discriminated against at the region's main hospital in Hastings.
They spoke of targeted harassment and some have been fearful of falling pregnant again, due to past traumas.
One wanted a muka tie, which is used by many whānau to secure the umbilical cord after birth but was asked "what the hell is that"?
"I had multiple midwives come in, so I never saw the same face because I was struggling with breast-feeding, I was taught 10 different ways. I didn't even have time to adjust to one," another new māmā said.
There was also stereotyping of Māori whānau.
"They might have gang connections and tatts, but they love their wāhine and their babies. That aroha is not different - but they get judged the minute they walk in the door as bad parents," one interviewee said.
Māori midwives said the DHB's attempts at tikanga were tokenistic, and many staff were from overseas and did not know anything about Te Titiri o Waitangi.
"All the images on the wall are Pākehā interpretation of what Māori looks like," one said.
"There's a karakia on the wall - but it is never used or offered to ngā wāhine,'' another said.
What next?
Tātou chief executive Skye Kimura told the outgoing health board: "One of the key findings for us was the big R word - the racism word - was really really evident in a lot of the stuff, particularly for our Māori whānau who are experiencing these experiences."
The consultants provided the DHB with a roadmap of what patient experiences could look like in the future.
This could come down to welcoming someone with a simple "kia ora", involving a kaitakawaenga (mediator) earlier in the process, allowing users to type in te reo and Pacific languages into computer systems, with the appropriate tohutō (macrons), without errors and autocorrect and providing good digital communication such as using apps or e-mails.
But come Friday, the DHB will no longer exist, as it becomes part of Health NZ and the Māori Health Authority.
The DHB's head of business information Aaron Turpin said the work aligned with the Health NZ and Māori Health Authority's focus on Te Tiriti o Waitangi to co-create new models of care.
In light of the maternity services' review, the DHB said it needed "organisational-wide change".
It was working through the more than 40 recommendations and developing a work plan to address them in a "timely manner".