Claims of Māori and Pacific patients being called names like "coconut" while being roughly handled by health professionals are being uncovered in a University of Auckland study.

Research funded by the Ministry of Health which aimed to address increases in rheumatic fever (RF) in Māori and Pacific people revealed an ethical gap in their treatment by health professionals.

The study involved 113 participants who suffered rheumatic fever and rheumatic heart disease between 2015 and 2016. Participants were from seven North Island District Health Board (DHB) areas including Northland, Waitematā, Auckland, Counties Manukau, Waikato, Hutt Valley and Capital and Coast.

The study's lead author, Dr Anneka Anderson, of the university's Te Kupenga Hauora Department of Māori Health, said one of the largest complaints from the whānau who participated involved claims of racism and a lack of cultural safety and understanding.

"Participants were subjected to verbal racism — such as being called 'coconuts' — and to being treated differently by medical professionals because of their socially assigned ethnicity."


Participants also described when being washed or showered being given quick, painful bicillin injections or, as one person described them, "jab and go" injections. One caregiver was particularly concerned that bicillin was being delivered into the patient's buttock while he was asleep.

Anderson said some people even said they preferred to inject their own doses of bicillin, a long-acting formulation commonly used for the secondary prevention of RF, rather than go through the pain of receiving it from a health professional.

Other complaints included nurses touching the heads of Māori patients without their permission and male doctors asking young Pacific girls to expose their bare chests for medical examinations.

From 1996 to 2005, RF rates significantly increased for Māori and Pacific children, but decreased among New Zealand European children.

Between 2005 and 2010, the rate of RF doubled from 1.9 reported cases per 100,000 to 3.8 per 100,000.

The majority of cases occur in the northern and central North Island and in pockets around the Wellington region.

Rates among Māori and Pacific children between 5 and 14 years of age are disproportionately high.

Anderson said there was no evidence to support Māori and Pacific people having an increased genetic susceptibility to RF.

"The figures reflect social, political and economic influences that result in socioeconomic deprivation, overcrowded conditions, an increased incidence of streptococcal infections and differing opportunities for appropriate and effective health care."

She said the increases in RF among the Māori and Pacific people was concerning given the disease had largely disappeared from developed countries.

In addition to the 120 to 170 patients admitted to hospital with a new diagnosis of RF each year, a further 50 patients are hospitalised with recurrences of ARF and another 50 are admitted with an unexpected diagnosis of RHD.

Financial pressures associated with the complex living contexts of many whānau created barriers to accessing both primary and secondary health care services for their RF.

Common barriers were securing transport and meeting the costs of health care and medical prescription fees.

Many parents and caregivers also described experiencing anxiety and guilt as they felt they were at fault for their child's illnesses.

Whānau blamed themselves for not realising how sick their children were, for not seeking medical attention soon enough for their children and for not pushing HCPs and services "hard enough" for the medical treatment of their children.