Emma spends lockdown at Auckland hospital, and sees how government action on COVID-19 underlines the lack of urgency when it comes to Māori health.

Emma spends lockdown at Auckland hospital, and sees how government action on COVID-19 underlines the lack of urgency when it comes to Māori health.

By Gabrielle Baker

Getting Better consulting producer Gabrielle Baker (Ngāpuhi, Ngāti Kuri) is a public policy and Māori health expert whose focus is on creating a just and effective health system. Here she reflects on hope, worry, and the prospect of a "new normal" after COVID-19.

During alert level four, most of us were unsettled in some way. And for many of us, the Covid-19 pandemic brought with it the added worry that Māori would be left irreparably harmed.

The worry was built on whānau stories of the 1918 Influenza pandemic, which saw the death rate for Māori approximately seven times as high as it was for non-Māori and decades of research on health inequity in Aotearoa which show across almost every health and disability indicator the health system does less well for Māori than it does for Pākehā.

Recently, Dr Melissa McLeod wrote, with a group of other leading Māori health researchers about the increased risks of Covid for Māori. This includes an increased risk of getting Covid and worse outcomes from Covid, not to mention the wider reaching consequences beyond the virus itself, like rising unemployment. All of these concerns were occupying many of our thoughts during alert level four and, in my case at least, driving us to distraction.

"Whatever it is, coronavirus has made the mighty kneel and brought the world to a halt like nothing else could. Our minds are still racing back and forth, longing for a return to "normality", trying to stitch our future to our past and refusing to acknowledge the rupture. But the rupture exists. And in the midst of this terrible despair, it offers us a chance to rethink the doomsday machine we have built for ourselves. Nothing could be worse than a return to normality."

When I read these words from Arundhati Roy's in April, I got to take a moment out of the worries to be a little hopeful. At some point beyond the state of emergency, would we have a once-in-a-generation chance to create a new normal and leave behind the stale ideas in the health system that disproportionately impact Māori whānau, people with lived experience of disability, takatāpui and rainbow communities, refugee and migrant families, and many poorer communities? …

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Emma travels home to Tukorehe for her tā moko, and gets some advice from Dr Glenn Colquhoun.

In this episode of Getting Better we drove to Levin to pay a visit to poet, doctor and youth worker Glenn Colquhoun. But we started that day down the road in Kuku where Emma got her tā moko.

By Emma Espiner and Noelle McCarthy

On a road trip to her ancestral home of Tukorehe, in Horowhenua, on State Highway One Emma explained why the time feels right to get her tā moko: "It's not always been obvious, I think, to Māori when I meet them in a hospital or primary care setting, that I'm also Māori and I think people are surprised when I say that, because most people would look at me and know that, but I think it just reflects that power differential, and the fact that there aren't still aren't that many of us. And so I just wanted to enable them to know. To be visible, and to be safe for them."

Emma's Uncle Tipi Wehipeihana is a well known tā moko artist who lives a few hundred metres from Tukorehe at Kuku. His studio is at the back of the whare, with a comfy sofa and kete and taonga all over the walls. Emma's cousin Courtney ("the favourite moko") also came for the morning. The tikanga is different from tattoos - Emma didn't come with a design for example. So she had no idea what she was going to come away with, but she knew Tipi would understand the whakawhanaungatanga side of it and also the whakapapa she wanted to represent: "I'm a Wehipeihana on my Dad's side, same as Tipi and Courts. My Pākehā side is my Mum's, she's one of 12 kids from Takaka. Her mum was Ethel Smith, a strong woman in an entirely different mould from my Dad's mum Kura."

Sitting down on the stool opposite Tipi, Emma explained: "I was just thinking last night, about Mum and Dad's wedding, it was the first time that Pākehā and Māori whānau met... and I wasn't there. But, you know, these two are intensely Catholic whānau. And then Nanny insisted on bringing her own priest and then Nana had her priest... So it was a two priest wedding! But they came together - and it was awesome." Tipi drew a design freehand across the diagonal of Emma's arm "If you're looking at both sides, your Nanny's side and that connection, we will have something that represents your Māori side there, and the interweaving in the connection with your Pākeha side down here." The whole conversation only took a couple of minutes, which surprised Noelle, but it's a different thing to get your head around if you're not Māori. Tipi explained that part of the design represents "the pools of lineage in which you swim."…

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Why do so few indigenous doctors end up becoming surgeons? And why does it matter?

For this episode, we travelled to the Leaders in Indigenous Medical Education - LIME - Conference in Ōtautahi, to meet trailblazing surgeons, doctors and medical educators from indigenous populations in Canada, USA, Australia, the Pacific Islands, and Aotearoa.

Before that, we spent an evening with Dr Maxine Ronald (Ngāti Wai, Ngāpuhi) who works as a general and oncoplastic surgeon in Whāngerei.

By Emma Espiner and Noelle McCarthy

There's an old joke - what's the difference between god and a surgeon?

God doesn't think he's a surgeon...

That long-standing association of surgery with type A personalities - highly driven, confident (did someone say arrogant?) - exists because the profession draws in people who are comfortable operating in life or death situations - the sorts of situations that also underline their own status, and the power of surgery. So why do so few indigenous doctors end up becoming surgeons? And why does it matter?

In this episode of Getting Better, we meet some doctors who are breaking down that white, male Type- A cliche of a surgeon. But although things are changing, they're changing very slowly. If the number of Māori doctors is proportionally small, the number of Māori surgeons is tiny.

There are 14 consultant surgeons who identify as Māori. This is out of an overall pool of hundreds - if this figure was proportionally balanced in terms of population, it would be closer to 130. If you're Māori looking to get into surgery, you're not only contending with the intense competition to do surgical training, you're also reckoning with expectations about the best thing you can do with your medical degree, as Maxine Ronald ( Ngāpuhi, Ngātiwai) explains over dinner in Whāngerei: "historically, Māori health has been positioned in primary health care, and public health... with good reason, and in specialities it wasn't well understood where you could make an impact."

But even so, Maxine always knew surgery was where she wanted to be: "If you're a Māori doctor, you're expected to contribute, to improve Māori health. And I I wanted to do that, but I just love surgery. And I couldn't not love it and I couldn't do anything else... It still blows me away, this neat feeling - just that immense privilege of, seeing it, of being in theatre, of operating on a real person, with real family and being able to remove disease or pathology... That really seemed like real medicine to me."

Maxine is now a general and oncoplastic breast surgeon, working in Whangārei hospital…

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Emma's in Tairāwhiti, where "by Māori for Māori" has the potential to be more than just a slogan in healthcare.

For this episode of Getting Better, we've stepped outside of day to day medical school training to go to Tairāwhiti where there's a higher proportion of Māori than anywhere else in Aotearoa. With Māori making up 48% of the population, it's one of the strongholds of our language. It also has one of the lowest life expectancy rates for Māori at just 69 years of age compared with 81 years for the general population. Suicide rates here are about double the national average. But with four Māori providers active in the rohe, "by Māori, for Māori" has the potential to be more than just a slogan here. The innovative approaches to mental health in particular singles this region out as the home of some of the most promising indigenous-led services to address our most intractable issues.

By Emma Espiner and Noelle McCarthy

On a winter's day last year, we visited Te Kura Huna, a whare wānanga in downtown Gisborne where Ngāti Pōrou psychiatrist Dr Di Kopua introduced us to Mahi a Atua, the mātauranga Māori-based approach to mental health, based on Pūraku that she's developed with her husband, tohunga tā moko Mark Kopua. Dr Kopua explains: "First and foremost, my identity is as a Ngāti Pōrou woman. But that will never take away the fact that I'm a psychiatrist. I worked really hard to get that tohu, and create change. I can always be a psychiatrist, whether I work in the DHB whether I continue to diagnose or prescribe or seclude, or put people under the Mental Health Act, none of those behaviours or behaviours that any psychiatrist wants to do, but the system has perpetuated it for so long. So all of these things that I'm saying don't make me less of a psychiatrist, but they do speak from a Ngāti Porou woman's voice."

Speaking from that voice has led to Mahi a Atua, a way of looking at family dynamics through a wholly indigenous lens, with a broader workforce supporting whānau than you'd be able to find in traditional western models. The Mahi a Atua approach was a tool in the kete of many kaimahi working in Te Kūwatawata, the kaupapa Māori mental health programme that was running when we visited Tairāwhiti. …

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Dr Vaaiga Autagavaia takes Emma to meet the Rugby League team he coaches in Sir Edmund Hillary Collegiate, a training programme that goes far beyond sport and into the development of life skills.

Dr Vaaiga Autagavaia is a Samoan doctor who grew up in Mangere East. Here he explains how two Māori doctors drew him into a High School rugby programme at Sir Edmund Hillary Collegiate in Ōtara that now uses sport as an innovative way of learning, and outlines the next steps for the programme.

By Dr Vaaiga Autogavaia

Coaching High School rugby league at Sir Edmund Hillary Collegiate is a hook that two Māori doctors have found hard to shake. Dr Wiremu and Hoani MacFater (Ngā Rauru, Te Ātihaunui a Papārangi), brothers who grew up in Penrose started coaching the boys' teams four years ago.

In the school of predominantly Māori and Pacific students they saw a bit of themselves when boys would often miss some (or all) of their classes but still turn up to training and that this motivation could be used as a strength that, with additional support could help them to fully realise their education potential. From this was born the idea of a school Rugby League programme where sport is used as a context to engage students in their education.

Since then, I've joined them to coach, and work alongside the school to develop the idea. We've worked closely with Senior School Principal, Kiri Turketo (Ngāti Whatua,Ngāpuhi), and a passionate and enthusiastic group of senior staff led by Caragh Doherty (Physical Education and Health Head of Department) and Shauna Eldridge (Senior School Deputy Principal).

In Term One of this year the programme started as 'Sport In Education' (SIE) with its first Year 9 class that incorporates all sport, not just rugby league, and includes male and female students. The SIE program will progress to involve classes across each year group including delivering NCEA credits from Year 11 onwards. The programme is taught across all subjects (Maths, English, Science, Social Studies, Physical Education/Health) incorporating active pedagogy, sport contextualised curriculum and pastoral support that uses students' strengths as a starting point to motivate them to thrive in the classroom and on the sports field.

The ultimate and primary aim of the programme is that educational achievement for students will ensure greater success and wellbeing for their families and communities - if along the way they become international representatives in their sport, it is a sweet bonus…

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For her GP placement, Emma asked to go to Northland. She's on the road with rural doctor Kyle Eggleton, whose weekly clinic is in the remote outpost of Tuparehuia.

Emma went to Northland for her GP placement in order to work alongside Dr Kyle Eggleton. He describes what's involved in working as a doctor for a Māori health provider.

By Dr Kyle Eggleton

I am a general practitioner, but I am not a general practitioner, I am not allowed to be. It is a bit confusing trying to explain this contradiction to patients. I end up saying that the contract that I work under doesn't fund full general practice services. Patients still don't understand this and when they are asked who their GP is, they say that it is me. I don't argue with this pronouncement, but do feel that my profession is something else, something undefined in Pākehā words.

For a start I don't think that the work that I do is typical general practice work. I don't have a single clinic, but work in a different place every day. It might be a freezing room bolted to the outside of a community hall, or a rural first aid post where faded handwritten posters lists the telephone numbers of volunteers, or it could be in the back of a van where patients and I perform an elaborate dance negotiating the plinth and desk bolted to the floor. Despite the diversity in location the clinics are bound together in the amazing beauty of their surroundings, the warmth and community spirit of the patients that attend them and the whakapapa links to Ngātiwai.

There are other things that make the work I do less typical of general practice. My standard consultation is 20 minutes, a little longer than the 15 minutes I used to do when I worked in my own practice. Partially the longer times reflect the need to unpack the complexities in a patient's life. Psychological, social and economic issues are intertwined with the biological and are often best dealt with a whānau ora approach and the expertise of other colleagues. On other days I feel like I am an agnostic minister of religion as I tease out spiritual influences that cause a patient's mouth to quiver and their eyes to dull. I often can't solve these problems, but asking and knowing sometimes helps a patient to find solutions themselves. These intertwined aspects of a person is more than health, it relates to wellness…

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Emma Espiner goes to Porirua to meet the Wallace whānau and hear about a night in ED that changed their lives.

Clarification: Kōkiri Marae is in Lower Hutt, not in Porirua as stated in the podcast

Trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) introduces her new podcast and recalls the experience of being thrown in at the deep end while recording the very first interview.

By Emma Espiner

When you set out to do anything in Te Ao Māori you have to be prepared that it'll turn into something else. You are required to show up in an entirely different way, and to be open to challenging your views. This is how it was for us with this podcast. Our producer, seasoned broadcaster and podcast-maker Noelle McCarthy of Bird of Paradise Productions, sketched out themes for each episode right at the beginning of this journey. There would be a global Indigenous health piece, something about colonisation, maybe an ep of 'real life' in the hospital with the bleeps and whirrs of medical equipment and a voiceover from a clinician teacher elucidating the finer points of clinical examinations to their students.

All of that went out the window on day one. We met the Wallace whānau at their home in Porirua to talk about their experience of navigating the health system after Colin had a stroke while still in his fifties, six years ago. Listening to their story, it was like the world stopped turning. All the theoretical structure of our podcast conceived in our heads and drafted out on our laptops at Noelle's dining table in Auckland drifted away as we walked through each step in the Wallace's long and lonely pathway back to the present day. We saw every point at which our health system had let them down.

After that first morning, we stopped trying so hard to force the podcast into our structure. We followed the stories and drew on our relationships with people working on the front lines of health equity, allowing us to mine ideas more deeply and reflect on people's experiences in a more authentic way. This approach took us all over Aotearoa and left me promising everyone that I'd come back one day, wanting to stay with everyone we met and join them in whatever it was that they were doing - the midwife at Te Puia Hospital, the psychiatrist in Gisborne, the surgeon in Northland, the GP in Levin, my own whānau at home in Kuku…

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Trainee doctor Emma Espiner introduces her new podcast Getting Better - A Year in the Life of a Māori Medical Student.

Trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) travels to the front lines of healthcare in New Zealand, where life and death decisions are made every day and where the statistics clearly show Māori are suffering: Māori die younger, get chronic illnesses earlier and receive less care than non-Māori.

We'll hear from whānau whose experiences are the real-life stories behind the statistics and doctors who see first-hand the racism that has led to our acceptance of "unequal outcomes"- in the real world, "unequal outcomes" means sickness and death.

Finally, we'll look at the COVID-19 crisis, which underlined the governments' ability to act when it's not just Māori at risk of dying too soon. Does that mean that Māori dying early is just business as usual?

Go to this episode on rnz.co.nz for more details