Speech: Maori Medical Students Wananga Reo

One hundred years ago, this year, Tutere Wi Repa of Ngati Porou graduated – our first Maori GP.

Alongside Maui Pomare (our first Maori graduate); Te Rangihiroa, (the first Maori to graduate from Otago Medical School) and Pohau Ellison they formed the Maori Medical Practitioners Association and began working together, to lift the health and wellbeing of tangata whenua.

They later joined up with James Carroll and Apirana Ngata and formed the Young Maori Party - the foundation of the Maori renaissance at the onset of the 20th century.

As we gather here tonight, a century later, I think back to that whakapapa of incredible Maori medical enterprise and it fills me with great pride that we can stand strong in our foundations.

There may well be another Maui Pomare in this group; another Tutere Wi Repa. There most certainly is another Maori Party. And we have every reason to believe the future is in our hands.

It is a future that is enormously challenging.

This day in history will be marked by the research published in the New Zealand Medical Journal by a trio of researchers from Canterbury University.

It is a day when the very basis of a universal healthcare system seems under threat.

The research argues that the changing social and political environment has disadvantaged poor people, Maori and Pasifika peoples.

Healthcare reforms have impacted adversely on housing, health and education. The neoliberal economic and social agenda pushed first by the Rogernomics movement of a Labour Government, and then reinforced by a National Government driven by market forces, has resulted in increasing inequalities between the rich and poor.

But the healthcare system you are entering is also plagued by the swollen abscess of institutional racism which is seeping throughout the health system.

Dr Gay Keating of the Public Health Association says the fact that Maori are receiving fewer elective surgical operations than other New Zealanders is systematic discrimination against Maori which she defines as racism.

Data received by Capital and Coast Health Board’s Maori Advisory Committee revealed Maori had more preventable admissions to hospital, childhood asthma, diabetes, cancer rates and a whole host of other factors. In particular, the two to threefold higher death rates for Maori compared to European remains unacceptably high.

Professor Tony Blakely stated just over a year ago that, and I quote,

“Racism – both institutional and personal – is likely to be a factor in poorer outcomes for Maori. Somehow the system is more advantageous to Pakeha”.

What would Wi Repa have done? Pomare? Te Rangihiroa? What will you do?

This is the fundamental challenge of the 21st century.

We have a moral obligation to be bold enough, and brave enough, to say what we see; to name it, to confront it, to challenge.

How many more experts need to diagnose the problem? How much more analysis in medical journals and government reports needs to be published before we say, enough?

It will take hard work. It will take sacrifice. But most of all, it will take a belief that we are worth it.

A belief that we can work together to mould our future into the shape of our ideals.

A belief that health is a taonga, something to be treated with respect.

A belief that through Te Tiriti o Waitangi, our taonga must be protected through the actions of health purchasers and providers.

We want to see an accessible and affordable system of public and primary health for all people who call Aotearoa home.

If this is a vision that you ascribe to, then now is the time to act.

The Maori Party is ready and raring to act, to see your vision realised.

We will be placing pressure where pressure is due, to ensure the recruitment, retention and professional development of a culturally competent health workforce.

I have been thinking about some of our contemporary challenges – the invasive virus of institutional racism; the poverty of spirit; the impact of economic violence – and how it relates to cultural competency.

And one of the issues that keeps coming up is the threat posed to whanau ora by the challenge of confidentiality and informed consent.

In the Maori Party we fought valiantly in the context of the legislation around human tissue organ donation for whanau to be fully involved in the process of informed consent.

We argued that in a tikanga context, any issues relating to human body parts should enable the collective wishes of the whanau to be taken into account alongside that of the individual.

Allowing individuals to be the sole decision-makers regarding whakapapa material is entirely contrary to our tikanga and the preference for collective involvement. It is a breach of whanau rangatiratanga, placing at risk the protection of whakapapa.

Similarly, we see the issue of confidentiality in a cultural context.

In a previous life I was involved with Te Oranganui Iwi Health Authority, the longest and largest Maori Health Service provider in the Central Region. We were intimately involved in primary, medical, community and mental disability support services, and extremely committed to whanau oranga.

We sought, as a principle of practice, to engage the whole whanau, to promote healthy living across all spheres of influence.

We know that family violence, drug and alcohol abuse, smoking, stress, overwork, poverty, poor housing, employment insecurity, and social isolation are all significant barriers to the attainment of optimum health.

And so our commitment was that none of us stand separate from the fullness of whanau.

But there were some issues where our doctors, dedicated as they were to their professional ethics, really struggled. One such dilemma was with the situation of abortion.

To our medical specialists, the orientation was clearly around an individual’s right to healthcare.

And yet there was an ironic twist to this.

Whilst there was a reluctance to act outside of a code of confidentiality to the individual patient, it was not unknown for our doctors to want to contact Child, Youth and Family when a young girl was under the age of sixteen.

My challenge was always, how could one reconcile the fact of refusing to allow whanau to be part of the decision-making process on the basis of confidentiality, when that same confidentiality didn’t seem to apply in the referral to CYFS.

Over time at Te Oranganui we were able to involve our kuia in the decision-making process, so that at least the young woman in question, received information about the consequences of her choice, the other resources she might be able to access, the connection to whanau, to whakapapa, to cultural support.

Throughout the course of your medical training, you will no doubt have come into contact with a complex menu of pharmaceutical remedies; alternative treatment plans, surgical options, service specifications which contribute to achieving healthy outcomes.

Does your training invest just as much priority in cultural authenticity? Do you understand the whanau, hapu and iwi contexts that your healthcare is played out in? Do you treat your families with respect, with diligence, with care?

How strong is your commitment to the agenda for Maori primary and public health? Is whanau ora something you model in your own life?

As I thought about these questions, and how well I met my own checklist, I reflected on the inspiration of a man who was recently honoured with a distinguished fellowship from the Royal New Zealand College of General Practitioners.

I am of course talking about Dr Paratene Ngata.

I first came into contact with Dr Pat when I was a young nurse at Whanganui Hospital. I remember being so profoundly proud of this young Maori doctor – a rare thing in those days - and that pride has remained with me all my life.

As some of you might know, Dr Pat is dying and he is openly talking about his impending death and the celebration he intends people to have at his tangihanga. In a brave "out of the box" move, Dr Pat is asking that all who attend his tangihanga wear a white ribbon to signify their opposition to violence. If people are not prepared to wear the ribbon as a symbol of their commitment to peace and a caring environment they will not be able to celebrate the occasion.

Dr Pat, over twenty years ago recognised his own violence and vowed he would raise his sons to be ‘gentle men’ and gentle men they are. Dr Pat's stand is a wonderful example of a person who in the process of dying is helping to generate a debate of huge importance to this nation.

That to me is the essence of whanau ora. It is about a demonstration of what one really believes in, it is about pushing boundaries and it is about not accepting oppressive institutions and behaviours. It is about living out our commitment.

It is about holding on to the hope that we can restore our whanau to ensure every home is a site of safety; every child knows they are loved; every person is treated with respect.

We must believe that we can achieve our aspirations. We are at a new dawning of opportunity, and we must make it happen, for our children and their children after them.