Belinda (Bee) Westenra – Whitireia, Te Pūkenga: A recent master’s thesis is the first research study to invite Māori paramedics in Aotearoa New Zealand to share their experiences of working in paramedicine.

The research by Bee Westenra, Programme Manager Paramedicine at Whitireia, Te Pūkenga, aims to inform improved cultural responsiveness within paramedicine organisations, and encourage recruitment strategies to entice more Māori into the profession.

Westenra was inspired by her own observations working as a paramedic in Newtown, Wellington.

“It’s a community that is diverse ethnically and socio-economically,” she explains. “Most of my patients were not Pākehā, but the vast majority of the paramedics were. And, when I joined the Wellington Free Ambulance Service in 2004, it was more than 80% male and I was one of just two openly Queer people who worked there.”

Westenra wanted to complete Master’s research that focused on improving the diversity of ambulance services.

“When I undertook my literature review, I saw that nobody had interviewed Māori paramedics about their experiences,” she says, “and Māori continue to be under-represented in tertiary health care education and in the health care workforce in Aotearoa New Zealand.”

Through social media posts and snowball sampling, Westenra found five participants who identified as Māori and who were working as paramedics in Aotearoa. Three were based in the North Island, and two in the South Island.

Westenra conducted, recorded and transcribed a one-on-one, in-depth semi-structured interview with each participant. 

"As tauiwi myself, it was a huge privilege to be entrusted with these experiences," she says.

Through thematic analysis, she identified two complex main themes. The first was balancing the best job in the world with navigating a complex space. This included two subthemes: Māori patients benefit from Māori paramedics; and enablers can be barriers, and barriers can be enablers.

“All the participants said it was a privilege to help people on the worst day of their lives,” she says. “They all loved their jobs and loved helping the community – especially their own Māori communities. They had an innate understanding of the privilege of walking into somebody's house and the need for people to feel respected and safe in their homes.”

She says this sense of purpose helped the participants balance the challenge and complexity of working in predominantly white, middle-class, patriarchal workplaces.

The second main theme was that Māori paramedic identity is not homogenous, acknowledging the fluidity and complexity of Māori identity in Aotearoa New Zealand in the 21st Century.

“The participants had different backgrounds and stories about how they got into paramedicine. I should have known – but didn’t – how different their experiences would be,” she says. “Unfortunately, those experiences were often related to ‘how Māori’ they looked.”

She says the participant who encountered the most overt racism in their role described themselves as the “most Māori-looking” paramedic in their workplace.

“A second participant described themselves as ‘undercover’ and moved quite comfortably between the Māori and Pākehā worlds,” she says. “The third participant felt similarly, reporting that they were unable to ‘find their tribe’ at work and would instead put on a work persona.”

Another called themselves ‘a non-practising Māori’: “For them, it didn’t feel safe to be overtly Māori. They could draw on their cultural knowledge when it made a difference for their patients, but otherwise tried to protect themselves in a very white, patriarchal workplace.”

The remaining participant had been adopted by a Pākehā family.

“In Māori settings, there was often an expectation they would be able to speak te reo or understand all of the tikanga, but they couldn’t. This could be uncomfortable for them.”

Westenra concludes that the complexity of Māori identity suggests that there is not a single simple solution to increase the numbers of Māori entering the paramedic profession. She makes several recommendations to remove barriers to entry.

“There are gaps in the delivery of cultural safety education to paramedic ākonga,” she says. “Greater inclusion of tikanga, te reo Māori and Te Tiriti o Waitangi cultural competencies in the curriculum could better prepare the next generation of paramedics for working with Māori in the community.”

Westenra recommends targeted sponsorship for Māori in paramedicine and other health care programmes.

She also suggests both ambulance services – Hato Hone St John and Wellington Free Ambulance – implement targeted recruitment initiatives to attract Māori paramedics, and work to improve cultural safety in their workplaces.

“When I did this research, one of the ambulance services didn't even record the ethnicity of their staff,” she says.

She notes that both organisations have actively recruited Māori liaison staff, and St John has a senior Māori manager.

“This is a positive step at the higher levels of these organisations, but the impact this will have for Māori paramedics working in local communities across the country remains unclear.”

Westenra is encouraged that paramedicine has recently become a registered health profession.

“There’s now scope for Māori paramedics to be able to work at local GP practices, which would mean having community-based paramedics who are connected to and understand the local community,” she says. “That future is not too far off, and provides a welcome opportunity for delivering culturally-appropriate care to more of our communities.”

Belinda Westenra (she/her) (MProfPrac (Ed), BSc (Comp Sci), PASM) is Programme Manager Paramedicine at Whitireia,Te Pūkenga which is located on Ngāti Toa whenua in Porirua, Aotearoa. She identifies as tauiwi (foreigner, European, non-Māori, colonist), queer and autistic. She is a vocationally-trained registered paramedic with research interests in teaching cultural safety, anti-racism praxis, neurodiversity and LGBTIA+/rainbow-inclusive care. https://orcid.org/0000-0002-5973-8443

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