Hungry for cultural safety and cultural competency? Don't just reach for the 'karakia sandwich' says Associate Professor Elana Curtis, speaking on the importance of being culturally safe, pro-equity and antiracist in the health sector during the Grand Round session in June.

A record crowd of over 170 people attended the online symposium, which can be viewed on-demand at this webpage, to hear Dr Curtis discuss her groundbreaking work with the Medical Council of New Zealand to establish cultural safety and competence standards in that organisation.

Dr Curtis told attendees that the journey toward cultural safety and cultural competency — two different concepts with different meanings — was dynamic and difficult, but too important to ignore.

"Everybody's using a different term. And in fact, everyone is using language in a different way; saying cultural safety but meaning something different than another person talking about cultural safety," says Dr Curtis.

"Some of the confusion is also there because of things like 'oh you need to be culturally aware or culturally sensitive' or have cultural humility etcetera. So, it's quite a hard dynamic in which to manoeuvre around.

"But what is important is that cultural safety and cultural competence apply to all marginalised identities, and this goes beyond just ethnicity and indigeneity.

"However, in Aotearoa New Zealand, we have a Treaty based and Indigenous rights base argument behind why we must focus on Hauora Māori in its own right —which is why this must also be its own area of focus above and beyond cultural safety and cultural competency."

Dr Nina Scott, who works to promote kaupapa Māori approaches to research in her role of Manager of Hauora Māori Research at Health New Zealand Te Whatu Ora, hosted the June symposium and agreed the issue was complex.

"This is a messy, complex tangle of a situation where everybody was getting a little bit confused, so Elana's work is going to be really helpful. It's quite a vulnerable space for many people," says Dr Scott. This problem is compounded by assigning stereotypes to someone's culture, a misplaced sense of cultural authenticity, and organisational reluctance to genuinely address cultural safety and competency.

"We make assumptions about people who belong to a certain cultural group, and then promote ideas about cultural authenticity that you have to have certain traits to belong to a particular ethnic group," says Dr Curtis.

"In other words —you must speak te reo Māori, you must know your whakapapa, you must visit your marae. These notions are problematic, we shouldn't be stereotyping.

"The other key challenge is that cultural competency becomes about the 'nice to do' stuff. It's quite nice to go to a marae, get fed, learn a waiata. You get to take on those skill sets, but it's actually a lot harder to do the work of looking at your own self, your own culture, your own bias, your own prejudice." This is where, according to Dr Curtis, the 'karakia sandwich' metaphor comes in.

"[The sandwich] is a bit of a representation of what I'm meaning here. People are learning to do a karakia at the beginning of a hui — some people can't even pronounce them or understand its meaning — and a karakia at the end.

"But the middle of the middle of the 'sandwich, or the guts of what we're supposed to be discussing, stays racist, stays uncritical, stays actually dangerous for Maori. The 'safety' for pakeha isn't about a karakia at either end of the hui, it really is about what's happening in the middle of that hui."

The way forward is for individuals and organisations in the health sector to be conscious and critical of their own assumptions and actions.

"Cultural safety actually requires us to assess our privilege and power and then we need to disrupt the effects of social inequities and power imbalances on hauora outcomes. You have to acknowledge you have privilege and power to start with and that's a challenge for many of us," says Dr Curtis.

Held on the first Monday of every month 12:00 —1:00pm, (or the following Monday if there's a holiday), the Grand Round provides lively and thought-provoking lunchtime discussion and allows researchers to share and discuss their work with people in the health and wellbeing sector.

The view the on-demand recording of the June Grand Round, please click here.