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Chinese medicine in New Zealand Systems, Cultures and Communications


In this essay I will be discussing the effect the Treaty of Waitangi in relation to the provision of health care in New Zealand from a bicultural perspective; demonstrate an understanding of New Zealand health legislation and explain how health related codes of practice would influence TCM practice; discuss therapeutic communication and ways stereotyping, stigma and diversity can influence health care delivery in New Zealand; and finally demonstrate an understanding of cultural safety and the application of cultural safety principles in practice.

1. The effect the Treaty of Waitangi

The Ministry of Healths documents highlight the seriousness of the health status of Maori and the real need to address the disparities and inequalities that exists. The Hon. Annette King, Minister of Health stated: (nursing council) Improvements in Maori health status are critical, given that Maori, on average, have the poorest health status of any group in New Zealand. The Government has acknowledged the importance of prioritizing Maori health gain and development by identifying a need to reduce and eventually eliminate health in equalities that negatively affect Maori. There are three main principles in the Treaty in relation to health, namely partnership, protection and participation. Partnership refers to an ongoing relationship between the Crown, its agencies and Iwi. It means that Maori need to share in decision making about the nature of their health services, with this leading to increased Maori control over their own health. This means during TCM practice, we must work in partnership with Maori clients and their families, we are working together with iwi, hap, whnau and Maori communities to develop strategies for Maori health gain and appropriate health and disability services.

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Protection creates an obligation for the Crown to actively protect Maori and their interests. In health, this is about health promotion and preventive strategies, and it implies the State will seek out opportunities to enhance Maori health. To protect Maori cultural value, a practitioner shall respect the patients own cultural traditions, such as asking people for guidance and asking if they have any special needs when caring them. A healthcare provider also need to remain aware of cultural differences, like in Maori culture head is consisted sacredly, so we need asking the patients permission before the treatment or care given that may need touch the head. Participation is about equality of opportunity and outcomes, and emphasizes positive Maori involvement in health care services at all levels. In TCM practice, we must encourage Maori to participate in all aspect and areas relating to their health. However, we need to look at these three principles as a whole, as it cannot be applied without thinking how each principle effect the other, hence I agree with the statement made by Kingi, T.R. (2007), These principles are not discrete or mutually exclusive, therefore in a TCM setting, we need to ensure we work closely with Maori community, such as provide information in Maori language, offer free seminars in Maori communities etc.. And even have Maori TCM practitioner or nurses will improve the probability of getting the message through. Further to TCM practice, Maori are required to involve in different healthcare systems, such as district health board, for decision making etc... This will further improve the healthcare status of Maori, broader issues are also needed to be considered such as Maori employment, education, social and cultural well-being.

2. Health legislation and health related codes of practice

I am going to discuss three Acts and health related codes of practice would influence TCM practice. Firstly, The Health Practitioner Competence Assurance Act 2003, this act provides a framework for regulating health professionals,

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therefore in a TCM setting, TCM practitioners are required to have ongoing education in order to renew their annual practicing certificate, this ensure the quality of TCM practitioners and hence provide a better and safer environment for the patients. Secondly we will look at The Health and Disability Commissioner Act 1994, this Act provides patients to make any complaint against persons or bodies that provide health care or disability services, a Health and Disability Commissioner is appointed to carry out the investigation, in a TCM practice, our client should have complain/feedback forms available and patient should be informed that they have right to complain. Patient may make a complaint in any form appropriate to them. Patient should be advised of their provider's complaints and be kept informed about the progress and outcome of the complaint Patient should be advised of the availability of advocates and the Health and Disability Commissioner to assist with the complaint. And the patient should not be adversely affected by complaining. The third act we are looking at would be The Privacy Act 1993, this is an important act as it safe guards the patients privacy, in a TCM practice, such as the clients identity will be protected when the clients information is used for other purpose like training. And all records must be stored in safekeeping and must not be accessible to the public. Lastly, in the current health legislation of New Zealand, every person in New Zealand has rights under the Code of Health and Disability Services Consumers' Rights. The New Zealand Public Health & Disability Act 2000, now incorporates number of significant references in relation to Maori Health. The New Zealand Public Health & Disability Act 2000 requires District Health Boards to establish and maintain processes to enable Maori to participate in and contribute to strategies for Maori health improvement. These, and related requirements, are imposed in order to recognize and respect the Treaty principles and to improve the health status of Maori.

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In order to achieve Maori health and cultural values protection in TCM practice, NZRA code of practices has given the further details based on the Code of Health and Disability Services Consumers' Right. I will focus on two consumers rights out of ten.
The right to be fully informed.

The patient should always receive the following information: an explanation of their condition; the options including the expected risks, side-effects, benefits and costs; an estimate of when patient will receive a service; the advice of any possible involvement in teaching or research; the results of tests or procedures and the information which patient need to make a decision. At the same time the patient also should be given honest answers to their questions relating to services. This may include questions about: the identity or qualifications of a provider; provider's recommendations; how to get another opinion; results of research which the patient were involved in and probably a written summary of information.
The right to make choices and decisions.

Patient should receive a service only when the patient have made an informed choice and given their informed consent. Patient should be presumed to be competent to make choices and give consent unless there are reasonable grounds for a provider to conclude otherwise. If patient have diminished competence (for example, a child) the patient should be allowed to make choices and give consent to the level of their ability. In circumstances where services have to be delivered without the patients consent, the TCM practitioner should be in the patients best interests. Steps should be taken to discover whether services would be consistent with clients wishes, including discussing the matter with available family and close friends. Patient also make a decision in advance, in accordance with common law and their consent should be obtained in writing when they will be involved in research, an experimental procedure, a general anesthetic or where there are possible

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significant adverse effects. Patient may refuse survives and withdraw the consent. Patient may change to another provider where it is practicable to do so. Patient may make decisions about body parts or bodily substances.
3. Therapeutic communication

Through our language we are able to communicate our understandings, our values and our thinking to those around us. We use non-verbal means such as gestures, body movement, clothes, paralanguage both consciously and unconsciously to signal our intentions. In a situation where people are being judged in a simplified and superficial manner, i.e. gender, race etc It often leads to stereotyping. In stereotyping, we hold a set attitude positive or negative towards a person purely on the basis of the group they belong to, where as stigma are always seen as negative. New Zealand has a diverse culture, hence stereotyping and stigma can lead to biased/unfair treatment in the healthcare system. Therefore it is important to treat all patients equally without prejudice on their background. According to (Medical dictionary, 2011), therapeutic communication is defined as a process in which the nurse consciously influences a client or helps the client to a better understanding through verbal or nonverbal communication. Therapeutic communication involves the use of specific strategies that encourage the patient to express feelings and ideas and that convey acceptance and respect. Therefore in a TCM setting, we need to ensure getting our message across, strategies include encouraging the client and family to ask questions, because sometimes they feel embarrassed to ask question, and using other forms of communication such as Braille, posters, information sheets, internet etc.

4. Cultural safety

TCM practioner has to work with people from a range of cultures and circumstances. To be able to understand and work with people of other cultures, it is important to be aware of our own culture. Also it is about being aware of the difference between the patient and TCM practioner. It is about being aware of the

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impact that your life experience may have on others or impact on the way you deliver care to a client from a different culture to your own. That brings us to the importance of cultural safety. Wepa, D. (Ed.). (2005) defines cultural safety as a way of being with another person, which encourages and celebrates difference. It is not about seeing others as different from you; rather you are different from others. It is also about you accepting others difference and acknowledging your own background and culture (p.91). So how can we be culturally safe? We should try to set aside our existing patterns of behavior and understandings, so that we can be as open and receptive as possible to the patterns and thought processes of others. For instance, asking people for guidance when caring for them, or ask if they have any special needs, acknowledge the importance of religious practices and the role of extended family as well as recognize there could be conflict between traditional vs. western health care practices.

In conclusion, the effect of treaty of Waitangi on TCM practice was discussed and their three main principles, partnership, protection and participation were explained as well, and also giving examples on how these principles are not discrete, they need to work with each other. we then moved onto three different acts and a code of right, they are The Health Practitioner Competence Assurance Act 2003, The Health and Disability Commissioner Act 1994, The Privacy Act 1993 and Code of Health and Disability Services Consumers Rights respectively, influence of these acts and code of right on TCM practice was discussed; the concept of therapeutic communication was demonstrated in the essay as well as how stereotyping, stigma and diversity influenced healthcare in New Zealand. And finally we have defined cultural safety and how to provide a cultural safe environment in TCM setting.

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REFERENCES
Nursing Council of New Zealand (2011). Guidelines for Cultural Safety, the Treaty of Waitangi and Maori Health in Nursing Education and Practice. Wellington, New Zealand Durie, M. (2001). Mauri Ora: The Dynamics of Maori Health. Auckland: Oxford University Press Jones, R., Pitama, S., Huria, T., Poole, P., McKimm, J., Pinnock, R., & Reid, P. (2010). Medical education to improve Maori health. The New Zealand Medical Journal Kingi, T. R. (2007). The Treaty of Waitangi: A framework for Maori health development. New Zealand journal of Occupational Therapy, 54(1), 4-10 Link, B. G., & Phelan, J. (2001). Conceptualizing Stigma, Annual Review of Sociology Medical Dictionary. (2011.) therapeutic communication. Retrieved from http://medical-dictionary. hefreedictionary.com/therapeutic+communication Walker, T., Signal, L., Russell, M., Smiler, K., & Tuhiwai, R. (2008). The road we travel: Marori experience of cancer. The New Zealand Medical Journal Wepa, D. (Ed.). (2005). Cultural Safety in Aotearoa New Zealand. Albany, NZ: Pearson Ed. North, N. (2008). Immigrant Doctors Practising Non-Western Medicine: A Study of Self-Employed Immigrant Chinese and Indian Doctors Practising NonBiomedical Traditions of Medicine Occasional Publication #19 Massey University

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J.R.R.McKimm PitamaT. S.Huria 2010 T.R.(2007 ) , 54(1), 4-10 G.B. J.2001 2011 http://medical-dictionary hefreedictionary.com/therapeutic+communication K.M.SmilerL.T. & TuhiwaiR.2008 Marori D.(Ed)2005 NZ N.2008 # 19

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