You have featured two articles on “Cultural Competence” in the last two Best Practice Journals. BPJ13 had
several articles on Maori issues and BPJ14 had the byline “Cultural Competence Series” above the article
on Maori Mental Health.
I have been concerned that “Cultural Competence” is seen by many to be about Maori issues. The RNZCGP fuelled
this concern by delegating its material on “Cultural Competence” to the Maori faculty and produced a document
about “Cultural Competence” that made no mention of the use of interpreters. Of all the issues surrounding
the care of people from other cultures, inability to communicate due to lack of shared language, surely has to go at
the top of the list.
I have no problem at all with focussing on Maori health and really appreciated the focus on this. My problem is two-fold.
The first is the invisibility of other cultural groups in this discourse; in fact many Maori view the issue as being
about “Biculturalism”: Maori and the rest as if all of us who are not Maori are in some way the same.
The second, which is more subtle, is that I am a supporter of Irihapeti Ramsden’s thesis around Cultural Safety
that argues that the best way to learn about the culture of a patient is to ask them and that attempts to learn about “Maori” from
sources other than the patient in front of you, risks stereotyping and compounding the problem of cross cultural care.
Language Line is now able to be used by GPs needing interpreting services at a cost of $22 per consultation. An article
about the dangers of using “Ad hoc” interpreters and how to use professional ones might be a useful addition
to this series.
Dr Ben Gray,
Department of Primary Health Care and General Practice, Wellington School of Medicine and Health Sciences
When discussing cultural competence we have deliberately focused on Māori given that this is where the greatest
health inequalities exist and therefore where the greatest gains can be made. This focus is relevant given the New Zealand
context and provides examples to which all clinicians can relate.
This is not to imply that all non-Māori are the same. We have emphasised that even within one ethnic group there
may be different world views and beliefs and agree that clinicians must not generalise and stereotype patients. As New
Zealand becomes more culturally diverse, clinicians need to develop increased sensitivity to the influence of different
cultures on health care beliefs and practices.
The evidence of disparities in health care is significant and the responsibility for achieving better outcomes is
clearly shared broadly across society. Bpac will continue to contribute through education, analysis and advice.