Super-Māori or Super-Doctor - future indigenous medical graduates Papaarangi Reid LIME Connection II September 2007

Super-Māori or Super-Doctor When we envisage future indigenous doctors, who do we see?

Super-Māori or Super-Doctor When we envisage future indigenous doctors, who do we see? Super-Doctor or Super-Māori?

Super-Māori or Super-Doctor When we envisage future indigenous doctors, who do we see? Super-Doctor or Super-Māori? Or do we expect them to be both?

Super-Māori or Super-Doctor When we envisage future indigenous doctors, who do we see? Super-Doctor or Super-Māori? Or do we expect them to be both? Who qualifies as indigenous in our affirmative action admissions programmes?

Super-Māori or Super-Doctor When we envisage future indigenous doctors, who do we see? Super-Doctor or Super-Māori? Or do we expect them to be both? Who qualifies as indigenous in our affirmative action admissions programmes? Are the pathways into our programmes decolonised or liberated from our baggage?

Super-Māori or Super-Doctor When we envisage future indigenous doctors, who do we see? clinically safe

Super-Māori or Super-Doctor What do we mean by clinically safe? Do grades matter? “C”s get degrees Grades and engagement What do our communities need/deserve? Practice or practise.

Super-Māori or Super-Doctor When we envisage future indigenous doctors, who do we see? clinically safe culturally safe

Super-Māori or Super-Doctor What do we mean by culturally safe? Noted a variety of words used Noted a variety of definitions How are we going to move forward? Cultural safety from kawa whakaruruhau

Super-Māori or Super-Doctor What do we mean by culturally safe? Recognises cultures – including the medical or nursing culture Acknowledges who has power Therefore who is the “agent of change” What needs to change? “Negotiate a space for the indigenous patient to heal or die peacefully” Communicate with patient, establish relationship, ask, listen, negotiate.

Super-Māori or Super-Doctor What do we mean by culturally safe? “Negotiate a space where the indigenous patient can heal or die peacefully” Communicate with patient, establish relationship, ask, listen, negotiate, act Depends on mature sense of self, understanding of power & professionalism Depends on ability to be reflexive

Super-Māori or Super-Doctor However in a system An agent of change is perceived as very powerful and potentially very dangerous Especially one working to reduce systemic inequalities acting out on indigenous peoples That is, a health worker who intentionally intervenes in the accrual of white privilege

Super-Māori or Super-Doctor Therefore a system that is designed and finely tuned to create and maintain white privilege, will not welcome cultural safety. Understandably cultural safety is being colonised and sanitised by health systems [including those we work for] to neutralise its ability to shift power. Colonised by name [competence, sensitivity], nature [self-reflexive] and intent

Super-Māori or Super-Doctor Therefore it remains important to hold fast to the vision of cultural safety and define only what our institution can cope with [rather than re-defining cultural safety] And ….

Super-Māori or Super-Doctor And ….. train graduates to Negotiate a space for their indigenous patients to heal or die peacefully Communicate with patient, establish relationship, ask, listen, negotiate, act Develop a mature sense of self, an understanding of power & professionalism Develop the ability to be reflexive

Super-Māori or Super-Doctor When we envisage future indigenous doctors, who do we see? clinically safe  culturally safe  Cultural competency has raised the expectation that indigenous doctors be capable of leading and responding appropriately in a variety of indigenous cultural settings. Is this reasonable?

Super-Māori or Super-Doctor It will be difficult to achieve: 1.Student pathways into medical science 2.Difficult to do a conjoint degree Is there evidence of better health outcomes? [warm fuzzies are not enough]

Super-Māori or Super-Doctor Why do we want this outcome? - are we credentialing? - is it a hang-up from “real-Māori” racism? - are we being romantic – time-warped? Try to understand individual histories within colonial histories, judge the histories not individuals, promote rights and provide supportive pathways to re-engage Changing entry criteria at FMHS UoA

Super-Māori or Super-Doctor Finally Indigenous graduate, or Indigenous graduates Thinking beyond [super] individuals to cohorts of indigenous graduates who will have travelled important roads together, who will network through different regions and different specialities. Differences will be good.

Super-Māori or Super-Doctor So – of course it’s both [if possible] Otherwise a committed indigenous person who is fascinated with science, passionate about learning, engaged with their community and their own personal development, can reflect constructively on colonial events [macro and micro] and cope with stress. Commitment not involvement.