Something very special about working in NZ is it’s unique cultural landscape. Just like any country around the world there are local cultures to understand and respect, not just to be a good human but so you can be a competent and effective health professional.

Māori communities first paddled their waka (canoes) across the Pacific Ocean to Aotearoa over 1000 years ago and still have a huge influence on life in NZ today. Most people know them nowadays by their fierce haka performances and tribal tattoos, but there are many more traditional rituals, beliefs and practices that make up the Māori experience of the world beyond these tokenistic displays.

You may have also come across the term “Pasifika” which refers to people from other Pacific Islands who live in NZ, such as Samoans, Tongans and the Cook Islanders, each nation bringing their own distinct culture.

Pākehā is the Te Reo Māori term referring to someone who is “white European” and this is the perspective from which I write this article.

Now, rather than writing your 1000 word referenced report on the Treaty of Waitangi or 500 word reflection on cultural competence for you (which you need for your Overseas Registration Application), I thought I’d take this opportunity to give you some quick snippets demonstrating how you might practically implement culturally sensitive practices into the clinical setting while in NZ.

• Pronouncing names correctly: one of the easiest ways to show respect, ask your patient for their help first rather than having a go and embarrassing them. If you’re new it’s unlikely you’ll be correct and you could cause offence – not an ideal way to start your therapeutic relationship.
• Whanau: simply translated as “family”, but means so much more than the nuclear family that Pākehā might understand. It’s about connectedness and belonging in the community, and is so integral that responsibilities to Whanau are often prioritised over physical health (like medical appointments). It may also mean having multiple people in the room (I never experienced this…), so just ask if your patient would like everyone to stay or go – again don’t assume, and check who they want present and how much they’d like to share.
• Faith/religion/church: often Christian and a huge part of life, so just a note to say be considerate.
• Traditional medicine/views of health: traditional beliefs might suggest that illness occurs when the balance of body, mind, emotions and spirit get out of whack. This is not to say Māori and Pasifika don’t engage with modern health systems at all, but there are likely to be senior whanau members supporting a holistic view of your patient behind the scenes.
• The appointment process: your patient might expect an initial greeting and introductions, then to make a make a connection (traditionally this might be a description of where you’re from so they can make connections with people they know from your area), then the consultation (with informed consent), followed finally by a conclusion of the encounter – seems pretty straight forward right? But reflect a little on whether you do this with every single appointment…
• It is forbidden to touch the head without permission. The head is considered sacred, and this is the reason for example that when “summitting” Aoraki (New Zealand’s highest peak), mountaineers will only go to the “shoulder” or second highest peak as a sign of respect for his head. Very relevant for cervical mobilisations and manips.
• Similar to the last point, not sitting on eating/head contact surfaces as a respect and hygiene practice. How often do you perch on the head end of your plinth? I realised I do it a lot…
• Returning blood: my colleague told me about this one in relation to dry needling/acupuncture. If you take something from someone’s body it’s technically theirs, so you should offer it back rather than just chucking it in the bin.
• You can make eye contact, but if prolonged this can be a sign of disrespect
• Try to use some Te Reo Māori words: kia ora, whanau, email sign offs… like any new language it can initially feel a bit awakward, but it is now recognised as an official language of Aotearoa New Zealand and increasingly being taught in schools and adult language courses.
• Finally, you can absolutely ask things like “I’m concerned I may be doing or saying something to make you feel uncomfortable. Can you tell me what you are thinking?” Easiest way to clear up any uncertainty!

I’ll conclude by saying this is absolutely not a comprehensive list and as with most experiences, after 1 year of working in New Zealand I realised how much more there is to learn! There are plenty of online courses nowadays and your employer may point you in the direction of some further training if you’re interested. My main reference point while writing this article was the PNZ Māori and Pasifika resource pages.

As long as you are open and a little vulnerable with your patient about your limited knowledge of their culture, but do your best to ask questions and show respect, then you should find you’ll be able establish good rapport and have significantly better opportunity to guide them to better health.

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