As a Samoan doctor, born, bred and trained in New Zealand practicing medicine in a predominantly pacific population in South Auckland for almost 10 years now, I have seen my fair share of acute and chronic medical issues that are plaguing our Maori and Pacific communities. I say Maori as well having worked in a predominantly Maori clinic provider for a few years and working up north in our rural communities. There are important questions we as
Anae Dr Neru Leavasa | BHB MBChB FRNZCGP PGDipHsc (Sports Medicine)General Practitioner | Sports Doctor
Spirituality is defined as ‘The quality of being concerned with the human spirit or soul as opposed to material or physical things’. (1) Religion is also defined as ‘The belief in and worship of a superhuman controlling power, especially a personal God or gods’. (1) Maori and Pacific people are very religious people. According to the 2013 census over seven in ten Pacific peoples (72.8%) affiliated with one or more Christian religions (compared with 43.8% of the total New Zealand population) (2). Maori also had 53.8% stating they were affiliated to some form of religious group. (2) As always these statistics are more of a guideline as there are many variables that can affect the data such as people not completing their forms and people not wanting to document their religious affiliations for personal reasons.
However, it will be very interesting to see the most recent statistics taken in March this year to see the religious trend of our population as it helps us understand ideologies, theologies and therefore philosophies of how people behave the way they do.
questions of life. These are origin, meaning, morality and destiny. Where did we come from? What is the meaning of life? How should we live this life and where will we go when we die? These are the major questions everyone grapples with and it is in this worldview lens that one lives their life based on the resulting answers. Are there poor health behaviours based on the idea that it doesn't matter what you do as good or bad health is in the hands of your creator? Or are there good behaviours that suggest that the responsibility is in one’s hand to improve or sustain good health in order to minister God's purpose and plans in your life? Whatever the behaviour there may be a religious origin that is influencing that person's decision.
There is a deep sense of importance placed on spirituality as it navigates an individual and their ideas about the world. There are many spiritual and religious world views one has in regards to their philosophy of living. Whether you are an atheist as well, your world view tries to deal with the major
I have seen many uncontrolled diabetics with chronic medical conditions often say that if it is their time to go (pass away), they will happily go to meet their maker. Others have said that if they have poor health habits then they’re poor stewards of what God has given them. To understand our patients and their religious worldview it is good for us clinicians to understand what our own religious or non-religious worldview may be. I myself am a born again christian and my worldview means that I have satisfied my subscription to this belief using objective evidence to live my life the way it has answered those big four questions - origin, meaning, morality and destiny. Now that I have an understanding of my belief, I can now try to understand the philosophy of other people and how they live their life. Having an insight into their worldview will help reveal the motivations that stems from their core beliefs. Like the uncontrolled diabetic, who doesn’t take their medications at times because of their belief that God will heal them regardless of their effort. Or the patient who is unable to afford their medications as they are giving most of their income to the church as they feel condemned if they don't. Obviously there may be other issues to deal with in the socio-economic and cultural context but their main belief may stem from a theological idea that may be contributing to poor health. So what you may ask, well this can open up a dialogue to suggest talking to their pastors or church elders about doctrines in healing, wisdom and being good stewards. They might receive prayer, guidance and sound doctrine that may lead into healthier behaviours. If the hospitals have chaplains and a chapel onsite to help patients then why not have them in primary care to do the same.
There is a growing body of evidence that says that spirituality has an impact on mental health which therefore leads to either positive or negative behaviours. One paper suggested that research showed that religion and spirituality can be damaging to mental health by means of negative religious coping, misunderstanding and miscommunication, and negative beliefs. (3) Another review article confirmed that clinicians need to be aware of the ‘religious and spiritual activities of their patients, appreciate their value as a resource for healthy mental and social functioning, and recognize when those beliefs are distorted, limiting, and contribute to pathology rather than alleviate it’. (4) If we or their religious elders were better able to address these beliefs then health behaviours may improve and lead to better health outcomes.
So where do we start? Well first of all I think we clinicians need to answer the question if spiritual health is important in the first place. I think it is as it may be the most important belief your patient has that affects every facet of their life including their health. We need to step back and take a look at our patients holistically and address the underlying issues they may have. I can hear clinicians say ‘Well we can't address everything in a 15 minute consult’ or ‘I’m not trained in that area to address that in the first place’ which I totally understand. The current practice model with appointments in primary care, staff shortages, lack of integrative care and other constraints play a huge role in patient care. But maybe if we continue with the same practice then why do we expect different results. Let's at least ask the question whether our patients consider spiritual or religious beliefs important to them. If so, then we can delve deeper into that relationship and their health. We may be surprised that this area may be the key to unlocking good health behaviours.
clinicians have to ask ourselves and those involved with delivering health care. These are just some of them. Why are our Maori and Pacific people still over represented in health statistics? Has the health system or the traditional western health models failed us? Is it time for new innovative health programmes or systems be implemented to reduce the burden of disease in our people? Spiritual health might be the key in unlocking the benefits of health overall.
clinicians have to ask ourselves and those involved with delivering health care. These are just some of them. Why are our Maori and Pacific people still over represented in health statistics? Has the health system or the traditional western health models
Why are our Maori and Pacific people still over represented in health statistics?
There is a deep sense of importance placed on spirituality as it navigates an individual and their ideas about the world.
We need to step back and take a look at our patients holistically and address the underlying issues they may have.
failed us? Is it time for new innovative health programmes or systems be implemented to reduce the burden of disease in our people? Spiritual health might be the key in unlocking the benefits of health overall.
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