Ma¯ori nurses paid less
The Waitangi Tribunal is to hear claims of institutional racism in Ma¯ori health funding and the pay of Ma¯ori nurses. Carmen Parahi reports.
‘My kids think I’m a joke. They say, ‘oh mum why didn’t you just drive a grader?’ I think I’m a joke too.’’
Beneath Mairi Lucas’ humour lies a serious issue.
Lucas is part of a Waitangi Tribunal claim alleging Ma¯ ori nurses experience racism and pay disparity in the health system. They also witness the struggle Ma¯ ori patients deal with trying to access and receive proper care.
‘‘Ma¯ ori nurses just don’t turn off. Sometimes it’s a burden, we want to do it but you feel so burdened with responsibility,’’ she says.
Lucas has worked as a nurse and practice manager for 34 years. She’s a registered nurse, has a masters degree and postgraduate diploma.
Neither of her two digger driver sons has any formal qualifications. Her 31-year-old earns the same hourly rate as she does, while the 24-year old gets $2 less.
‘‘A lot of our nurses are struggling financially,’’ says Lucas. ‘‘I’m a really high-paid nurse in primary health care; I’m on the top level.’’
Lucas earns $36.60 an hour, which equates to $76,000 a year, while new nurses start at $25. The New Zealand Nurses Organisation (NZNO) website says senior nurses with more than five years’ experience earn $68,000-$114,000 depending on responsibility.
It’s estimated Ma¯ ori nurses who work in Ma¯ ori health organisations earn up to 25 per cent less than those working in hospitals.
‘‘If you ask any Ma¯ ori nurse, they become a nurse because they want to be able to help their own.
‘‘They want to work in kaupapa Ma¯ ori providers but because they can’t afford to, a lot are forced out,’’ says Lucas.
‘‘We’re not able to hang on to the best of the best, which is what we want. Many go into DHBs because they’re getting paid better.’’
Lucas works for Te Manu Toroa, the biggest Ma¯ ori health provider in Tauranga, part of Nga¯ Matapuna Oranga, a primary health organisation (PHO).
Nga¯ Matapuna Oranga will be leading stage one of the Health Services and Outcomes Inquiry before the Waitangi Tribunal.
Lucas is one of two community nurses working under a contract set by the Bay of Plenty District Health Board (DHB) to manage 135 patients each.
New Zealand’s 20 DHBs govern all health organisations and services within their districts and manage funding allocations.
‘‘The targets are set by people who don’t understand the community,’’ says Lucas.
‘‘It frustrates me we’re so busy trying to tick the boxes to reach these targets. It often gets in the way of caring for people, especially in Ma¯ ori health.’’
Lucas is refusing to add more to the 78 patients she has now. Many of them are sickness beneficiaries.
She says the contract terms are difficult because all of her clients have two or more chronic conditions. When Lucas visits them she often takes care of more than just their illness.
She manages her clients’ prescriptions, what they need, can go without and can afford.
‘‘I treat, I educate, I advise, I support wha¯ nau,’’ she says. ‘‘I buy medication for people when I have to, take care of them after hours. Lots of work outside of the contract.’’
Te Manu Toroa is a low-cost, high-needs access service with three GP clinics. No-one pays more than $18.50 for a consultation. Lucas says the government subsidy isn’t enough.
‘‘Very low-cost access is really beneficial to the patient but the organisation carries a huge financial burden. You will find most low-cost access providers are Ma¯ ori.’’
Eighty per cent of their clients are Ma¯ ori and dealing with more than health concerns; poverty, poor housing, unemployment.
The organisation has its own small foodbank for patients who need it. ‘‘People are struggling,’’ she says. ‘‘I saw someone who had $1 left to last until he gets paid again. Luckily there was kai in his cupboard. But that’s the type of thing I would help him with if he didn’t have kai there.’’
Fewer than 4000 of the 52,000 nurses from the Nurses Organisation are Ma¯ ori – about 7 per cent. NZNO kaiwhakahaere (executive) Kerri Nuku says more nurses are needed to help meet the needs of Ma¯ ori struggling with serious disparities in the health system.
‘‘The Government talks about initiatives to increase the amount of
Ma¯ ori nurses,’’ says Nuku, ‘‘but no funding follows so at the moment it’s just lipservice.’’
Nuku says all nurses have to pass the same, annual competencies, whether they work in a hospital or small community clinic. Yet Ma¯ ori nurses working for Ma¯ ori community health organisations continue to be paid less than everyone else. She doesn’t blame the providers but points to the DHBs which hold the purse strings.
As a percentage of Vote Health, funding to Ma¯ ori health providers by the Ministry of Health and DHBs was less than 2 per cent between 2011 and 2016. Many claimants in the tribunal’s Health Services and Outcomes Inquiry argue the funding mechanism for Ma¯ ori services is unnecessarily confusing and complex.
In her evidence, Nuku says the disproportionate funding, the disparity in the health outcomes of Ma¯ ori and the low pay of Ma¯ ori nurses are examples of institutional racism. ‘‘Systemic inequities in social, educational and health outcomes can be an indication of the presence of institutional racism,’’ she says.
‘‘Racism can also be present in policies, practices and the racial climate within an organisation, or in how safe or comfortable it feels to be Ma¯ ori in a workplace.’’ Practice nurse Waiharakeke Winiata was one of the first to graduate with a Bachelor of Nursing Ma¯ ori in 2012.
She says the students were made to feel the Ma¯ ori-focused degree and her cultural values
were of lesser value than the general nursing degree.
‘‘We used to get frustrated always explaining our degree. It was the same curriculum as other nursing degrees and we sat the same exam as our counterparts.
‘‘We were fighting to prove we were the same, we were equal to them. It was hard, we were always discriminated against.’’
She says it wasn’t only the students who struggled. ‘‘We also saw racism against our tutors.
‘‘Our tutors were Ma¯ ori, we had a 100 per cent turnover of our Ma¯ ori staff. It wasn’t verbalised but we saw it. We saw how staff were treated, spoken to and managed out. It’s subtle but we saw it as students.’’
Winiata says she was lucky and managed to get a job after graduating. She’s currently nursing in a general practice clinic in Palmerston North. At a previous job she was told to cover up her ta¯ moko, a traditional Ma¯ ori tattoo.
‘‘To me it was hurtful, it is part of my identity, that’s who I am, I’m Ma¯ ori. And to be spoken to like that was hard for me. Whakaiti te mana.’’
She got into an argument with a non-Ma¯ ori colleague once who thought it was rude when a Ma¯ ori patient spoke in te reo Ma¯ ori to her children. When challenged by Winiata, her workmate believed it was OK if migrants spoke in their language but not Ma¯ ori.
Winiata says she’s heard other health professionals make disparaging comments about Ma¯ ori patients.
‘‘They’re like ‘Oh, those Ma¯ oris this, Ma¯ oris don’t want to come in, Ma¯ oris, no wonder they’re all sick,’’ she says.
‘‘They don’t actually take into consideration the holistic world view of what’s happening to that patient, their wha¯ nau, what else is going on.’’
Winiata says Ma¯ ori nurses will take a holistic approach when treating a patient. They’ll consider every factor in their lives, not just the illness.
Ma¯ ori do present late when they’re sick, whereas non-Ma¯ ori will go in for regular checkups, she says. ‘‘A lot of our people have socio-economic problems and they want to deal with that before their physical health. The majority of them will only come in when they’re really bad.
‘‘It’s hard to see Ma¯ ori patients being discriminated against like that, it is hard. Especially when you’re the only Ma¯ ori in the workplace and you try to explain but they can’t understand.’’
Nuku says they’ve spent years working with Ma¯ ori nurses, telling them it’s OK to use their cultural practices in nursing. ‘‘Just because you’re going to work within a structure that doesn’t actually allow you to be Ma¯ ori, it doesn’t mean to say you have to lose who you are at the door and pick it up on the way home.’’
She’s already taken their case to the United Nations committee on the elimination of racial discrimination, telling the panel about Ma¯ ori health inequities and the racist health system that has marginalised Ma¯ ori either using or working inside it.
Nuku will present her evidence to the Waitangi Tribunal next Thursday. Its deliberations started on Monday.