A study has found that many Māori and Pacific whanau have experienced racism in hospitals, including Pacific people being referred to as 'coconuts' by staff.
The University of Auckland study reviewed whānau experiences of healthcare from the onset of rheumatic fever (RF) and rheumatic heart disease (RHD) symptoms to the diagnosis stage.
It found "systemic failures" within the health system when providing care to Māori and Pacific patients, including instances of racism and a lack of "cultural safety".
Whānau described negative health care experiences that demonstrated a lack of cultural awareness. This included nurses touching the heads of Māori patients without permission and male doctors asking young Pacific girls to expose their bare chests for medical examinations.
"Participants explained how such experiences left them feeling scared, vulnerable and disrespected in the sense that their social values and sense of security had been compromised," the study reports.
A hospital-based paediatrician told the research team there is clear racism directed towards Māori and Pacific whānau in parts of the health system.
"I think you have to be deaf, daft and blind not to spot it on a regular basis in our particular hospitals. It's all around us I'm afraid; it's rather endemic, that's very sad," he said.
Losa, an adult Samoan woman, told the research team she felt uncomfortable receiving injections from a male nurse. She wanted to have the option of saying no, and to have the option of requesting a female nurse.
Whānau reported feeling dehumanised and receiving rough and inappropriate care in hospital.
One mother was so worried about the rough treatment of her daughter that she decided to stay in the hospital and care for her herself.
Rheumatic fever rates are decreasing in most developed countries, but it's still a significant problem in New Zealand and Māori and Pacific people have the highest rates and recurrences of rheumatic fever (RF) and incidences of rheumatic heart disease (RHD).
Pacific children are over 50 times more likely to get acute rheumatic fever than New Zealand European children, while Māori children are over 30 times more likely.
While rheumatic fever rates for New Zealand European children significantly decreased from 1996 to 2005, during the same period rates dramatically increased for Pacific and Māori children.
Most cases occur in low socioeconomic communities in the northern and central North Island and in pockets around Wellington.
"There is no evidence to support Māori and Pacific people having an increased genetic susceptibility to RF," the study said.
"Therefore, the increased burden reflects social, political and economic influences that result in socioeconomic deprivation, overcrowded conditions, an increased incidence of GAS (Group A Streptococcus bacteria) infection and differing opportunities for appropriate and effective health care."