A Lot Of Harm To Put Right

By August 26, 2021October 29th, 2021Feature Article, North&South

A Lot Of Harm
To Put Right

Emma Espiner is a recently graduated Māori doctor. Dame Naida Glavish has been fighting for Māori in the health system for 30 years. They talk about what’s changed and the inequities that remain.

Dame Naida Glavish is one of the most famous Māori women alive today. She came to the attention of mainstream New Zealand when she insisted on using “Kia ora” as a greeting in her job as a toll operator at the national telephone exchange in the 1980s. The move led to reprimands from her supervisor, but after consulting with Professor Ranginui Walker, who told her it was racist for anyone to suppress an indigenous greeting, she persisted.

This might seem unremarkable now, as Māori greetings are ubiquitous, but at the time her supervisor said she would be fired from her job if she kept using te reo Māori. I say that she came to the attention of mainstream New Zealand, because she was well-known in Māori communities already, having been a staunch activist for Māori rights and te reo Māori during the 1970s. She was at Waitangi every year, protesting, and marched against the Springbok Tour. Today she is the chief advisor tikanga Māori with He Kāmaka Waiora, Māori Health, for the Waitematā and Auckland District Health Boards.

It was a surprise to me, a recently graduated Māori doctor, to find that Dame Naida Glavish — holder of many prestigious titles, jobs and honours — is still unknown to some. Most notably, to the woman behind the desk on the day I went to interview her at her Waitakere Hospital office. I arrived early, nervous, sweating slightly. “Excuse me, could you please tell me where Dame Naida Glavish’s office&nbspis?”

This woman looked at me like I was an idiot. “WHO?” Dame Naida Glavish, I said. “Do they work here? Never heard of them.” She sighed heavily. Asked me to spell the name out, and shoved the phone at me once the line connected. I thanked her and returned the phone, she eyeballed her computer screen furiously, wiping the receiver down with an antibacterial wipe as I walked away.

I’d called around a bit, asked some mates what the general consensus of Dame Naida was. I heard she was a hard-arse, that she spoke her mind, and didn’t suffer fools. I work part-time for a Māori public health organisation, starting in 2015 on a three-month summer internship that I just forgot to leave. I called my boss, Selah Hart, CEO of Hāpai Te Hauora. She told me that Dame Naida was responsible for getting her an entry-level job more than a decade ago, and that she played a significant role in getting her to where she is today. Broadcaster Stacey Morrison told me Dame Naida was an extraordinary woman, and that I was lucky to get to spend some time with her. My husband Guyon had interviewed her during Māori language week a couple of years ago, and his eyes got this glazed look when I asked him what she was like: “Amazing.” None of these anecdotes reassured me — I have a strongly developed sense of intimidation about older Māori women, they’re the people I least want to look like a fool in front of.

Why put myself through this torture at all? This year, along with my friends Noelle McCarthy and Gabrielle Baker, I made a podcast about Māori health inequity. Well, we dressed it up as a journey narrative about my experience as a Māori medical student, but that was just the Trojan horse to bring people inside the experiences of whānau Māori and the health professionals who are committed to making things better for us. All the science communicators I look up to — the physician-writers like Siddharta Mukherjee, the GP-poets like Glenn Colquhoun, the public-health physicians and researchers who teach at the University of Auckland like Professor Papaarangi Reid and Associate Professor Elana Curtis, the researchers like neuroscientist Sir Richard Faull and psychiatrist Dr Hinemoa Elder — they all know that storytelling links the mind to the heart, brings the evidence alive, makes people care.

I had a feeling that people didn’t care, because the bad outcomes and awful statistics were around long before Dame Naida chained herself to a bridge at Waitangi in the 1970s, when she was hanging out with the likes of Professor Ranginui Walker, one of our most influential Māori academics and Māori rights activists. So my curiosity overcame my whakamā about meeting this wahine toa — I wanted to know what things looked like from her position at the top, leading, advocating, educating and agitating for more than 30 years in health. I also knew that she was deeply immersed in our mātauranga Māori, something we get very little teaching on at medical school. There are differing opinions among our leading Māori health experts about whether mātauranga Māori is the answer at all — some propose that it’s not our culture that’s the problem, it’s structural racism, so let’s work on fixing that rather than trying to get people to learn their pepeha or do a karakia. Others believe we should have both, and yet more think that actually, tikanga Māori could be a positive framework in health for all New Zealanders, not just Māori. I also wanted to know where her steel comes from. How she’s held her head up all these years, maintained her courage, facing racism so overt that you would blush to hear it now. So, we had a lot to discuss.

Emma Espiner: I’ve been thinking a lot about how the life expectancy difference between Māori and non-Māori is still seven years. That’s a lot of missing years with our kuia and koroua when you add it all up. You were talking about all the stories that we lose when we lose our old people too early, the library of knowledge&nbspdies.

Whakamā –
embarrassment
Mātauranga –
wisdom

Dame Naida: Yes. That’s true. That is true. And, people like myself, who were raised by two grandmothers — every now and again, when required, those grandmothers come back. Being raised by grandmothers is like being raised two generations ahead of yourself. Of course, when the grandmothers die, you become the grandmothers. For instance, both grandmothers had words of wisdom to pass on, and the Māori grandmother . . . Inā kite koe i tētahi mea hē, hakatikangia. Inā kore ka rite koe ki taua hē. You see something wrong in front of you, fix it, because if you don’t, you’re going to become like it. That didn’t make me popular. The things that people would do, I’d have to do something. I’d have to say something about it. I honoured the grandmother in those.

Has it got easier to call out the wrongs?

There’s some who are grateful for it, and some who are absolutely opposed to it. In one of my weakest moments during the Kia Ora tolls era, my supervisor gave me the time off to go to a tangi. I was thinking, you’ve got to back off a bit, because he’d been a good supervisor. I was driving over the Harbour Bridge, and thinking, I better be kind. And this voice came into my head. Nui ake tēnei take i a koe. I thought it was the wind blowing so I wound the window up.

But it came back. Nui ake tēnei take i a koe. I went into work and I had to honour the grandmother. I said to him, “Thank you for the time off, I will honour what you need to do as my supervisor. But I will do what I need to do to honour the wisdom of my grandmother.” I went back on the board: “Kia ora, tolls here.”

I guess lots of us come into health because there’s either been mamae in our family, or some experience where we’ve seen the health system not work. We’re really living those inequities in our whānau — all the things we learn about in lectures: dying younger, getting sicker, receiving poorer quality treatment, how Māori get less time with their GPs compared to non-Māori, how we don’t get the prescriptions we need, how we’re labelled as non-compliant and difficult, but the evidence shows doctors take less time to explain things to Māori patients. That’s a lot of harm to put right.

Tikanga –
custom or practice
Mamae –
pain

One of the areas the health system didn’t pay a hell of a lot of attention to, in my respectful opinion, is the fact that for Māori, we come in here for health, right? However, we come in here with an inheritance of distrust. And that distrust is based on a whole range of things in which Māori have had negative experiences in the world of living, basically. Whether it be education, whether it be justice, whether it be police, whether it be prisons. The health system did not take into account the fact that people do die in the health system, in the wellness system.

One of the things that I ensured was the pathway of tūpāpaku in the new build of Auckland Hospital, and also in North Shore Hospital and Waitakere, the hospitals that I’m responsible for. That tūpāpaku would be treated with the height of tapu and respect. Because whānau’s grieving, the length of it, is dependent upon how they see their loved one treated. If you’re in hospital, you’ve got a whole range of areas one could enter into if you have a complaint. But in tūpāpaku, the whānau are left with the grief trying to deal with that.

So, the pathway hadn’t been a smooth pathway. As a living being we understand that we have a sacredness about us. For instance, the tapu of women, the womb of women, is the house of the generations, the house of the genealogy. Total, absolute tapu of women. There’s a tapu about men who hold the tewhatewha, to be the provider and the protector of that sacredness of women. If there was a true understanding of that, then we wouldn’t have the domestic violence that we have today.

With the rebuild of Auckland Hospital, the whare āwhina works, and it worked in Greenlane when Greenlane was Greenlane. Te kainga atawhai. People travelled to Greenlane and to National Women’s. Just before I started working, in 1989, my mother had a stroke and she was in Greenlane, and we travelled from Helensville to Greenlane to sit around the bed with my mother. Twelve of us were there within one hour when she had her stroke. We slept in our cars and used the public toilets and washed in there, and stayed by our mother. So, when I got the job, the first thing I wanted to do was to develop a kainga atawhai to make sure people can stay.

What that proved was that having whānau close by led to shorter bed stays.

Yes. Yes. That’s a thing! We are rongoā to our own whānau when we’re given space to support them.

The shorter bed stays was in the interest of the organisation. It had an economic benefit for them, as well as for the whānau. Now, in Auckland Hospital, every ward has a whānau room, because of the policy of two visitors per patient. If that patient is me, there’s no way that they’re going to hold back my whānau, let alone the tribe. And they’re doing the same thing at the moment at North Shore Hospital.

I read a research paper recently that showed that we act as whānau for other Māori. There’s an example of a teenage boy who was on his own, and, basically, someone was visiting someone else and she acted like an auntie for him. She was asking the questions of the nurses, making sure he was getting what he needed and all that sort of thing.

Yeah. The establishment of kaiatawhai teams and kaimanaaki teams in the hospitals. It definitely leads to short bed stays, because that’s healing for the wairua as well as for the physical, and the doctor is trained, absolutely, in the physical. And, that’s all they’re trained in. Whereas the oranga hinengaro leads to just as much physical wellness.

And it breaks that transmission of that trauma of bad experiences in health, too, so the whole whānau benefits from seeing a positive interaction.

Absolutely it does. We’ve come a long way. One of the long ways we’ve come is that Māori mothers are able to claim their whenua, the afterbirth, and take the afterbirth . . .

We take that for granted now but it wasn’t a thing.

Tūpāpaku –
the deceased
Tewhatewha –
axe-like weapon made
from wood or bone
Āwhina –
to assist
Rongoā –
medicine
Atawhai –
to care for
Manaaki –
to support

Hell no, it wasn’t. Matrons in the maternity buildings would incinerate, and it wasn’t understood that the Māori word for placenta is whenua. The baby lays in the whenua while in the womb of their mother, so it’s a whenua-to-whenua relationship with Papatūānuku. You know, it’s just a bit of dirt to some people.

There are now two designated lifts from the top to the bottom of Auckland Hospital. And those two designated lifts are for tūpāpaku. No food, no dirty linen, no dirty anything. Staff can use it, patients can use it. Just no food. And that acknowledges the tapu of the tūpāpaku, but also the tapu of the whānau of the tūpāpaku.

One of the ways we achieved that was that the DHBs are agents of the Crown, and as agents of the Crown, they have a Tiriti o Waitangi obligation. So we were able to apply that.

It’s a powerful symbol, too, because I did my final med school year at Auckland, and you see it. Everyone around here has just adjusted to that being how it is. I didn’t see anyone ever take food or drink into those lifts.

Well, there were a few mavericks, and one of them was a doctor. I was in the lift and she was standing there with her cup of coffee and I said, “Well, you can’t come in here with that.” And as I’m talking, I’m pushing the button, and the door closed. She must have pushed the button and the door opened.

I said, “You and I can stand here all day, because I’m telling you, you are not coming in here with that. It is a policy, and this lift is a tūpāpaku lift. There’s three other lifts over there.”

Or the stairs.

Anyway, I shut the door and she wrote a letter of complaint against me to the CEO. “I’m not Māori. I don’t have to abide by those Māori rules”, is what she said.

How long ago was that?

It was about 2014.

Not that long ago. A senior doctor?

Yeah.

Because my generation and the ones just above us, they’ve come through the medical school. They get the teaching from Papaarangi [Reid], so they’re very pro-equity, my colleagues. Even the non-Māori ones. The rangatahi, my younger friends, now, are really hungry to connect with our mātauranga. It’s that generational thing.

You’ve talked about your grandmothers in interviews, and you had that privilege of having that knowledge. Lots of us didn’t get it growing up, and they’re really hungry for it now. Do you think, especially with mental health, that’s been a real thing for us?

Oranga –
welfare
Hinengaro –
mind
Whenua –
land
Papatūānuku –
earth mother
Rangatahi –
young

I do a presentation, and that presentation’s usually called Jacky Nohi, because Jacky is a gender neutral name. So, we’re not talking about male or female. I spoke one time to prisoners and Jacky became triplets. There was a Haki Nohi, a Hemi Nohi and a Hine Nohi. Haki and Hemi were in two different gangs, and Hine was their sister, and she was the one trying to keep the whānau together and all of that.

So, the presentation was on the triplets and where they were at in each other’s lives, and the impacts on each other, and the impact on their school, and their whānau.

But all of it is centred around the hinengaro wairua, and the stuff that we trap in our daily lives, we trap in our life’s experiences.

The trauma.

Yeah. The trauma. And it sticks in our hinengaro wairua aura. And it impacts the hinengaro wairua, because no one will know what’s trapped in there unless it’s disclosed by us. Only we know what’s trapped in there.

Fathers, for instance — I know that Māori men did not know that they are automatically, as a Māori, born with a tewhatewha. And that tewhatewha doesn’t have to be in the physical. It’s a tewhatewha of knowledge that you are the provider and the protector of the whare tangata of your whakapapa. The tapu of women.

As a result of that, they come through living in the gutter, basically. Their minds are in the gutter. They haven’t had a chance to feel good about themselves. So we talk about our men that are in prisons —what our men need is someone or someones to talk to them about who they are in their skin. Not about the impositions on them through education, through justice, through whatever. Who are you in your skin?

And if you don’t know, let’s go on a journey and see which pathway you like in terms of who you are. We get these overseas psychiatrists who don’t understand us and they do more damage to us.

They pathologise us.

Wairua –
spirit
Karakia –
prayer
Manuhiri –
visitor or guest
Karanga –
ceremonial call
Mihi –
acknowledge
Hongi –
greet and share air

Oh, they do. I’ll tell the story about the 43-year-old Māori man who was in Hearty Towers at Greenlane Hospital. The psychiatrist came over and said “There’s a 43-year-old man next door, and he’s ready for discharge. He has had a lung transplant, and medically, clinically, it was a perfect transplant. But, now he refuses to discharge. What’s the matter? Can you go and talk to him?”

I did go over and I said to this man, whose wife was with him, “What’s the matter with you?” And, he goes, “Well, I don’t know.” And I go, “Medically it was a success, so why don’t you want to go home?” And he goes, “I don’t know, but I’ll tell you what I do know. I know I would’ve died with my old lungs, but I can’t live with these new ones.”

I looked at him and looked at his wife, and I said to him, “Well, before you went into theatre, did you give thanks to your mother and father for the life you had from birth with those lungs all the way from birth before going into theatre? Did you set them free when you went into theatre? Did you karakia and say thank you for the life you gave me, now I’m happy to let you go?” He goes, “No.”

And I go, “So when you got out of theatre, when you came to, in recovery, did you give thanks to the point of origin of those new lungs?” And he just looked blank at me and I said, “You know, when we have a manuhiri, we karanga them, and we karakia them, and then we mihi them, then we hongi them, sharing our life force with them, and then we feed them. So, then, by the time we finish doing all of that, they lose their manuhiri status. They, then, become one of us.

“The same thing for those lungs you’ve got. Did you karanga them? Give thanks to the point of origin? How we are with manuhiri, our bodies are like our marae. So did you mihi to that new lung, and did you introduce your new lung to all the other organs in your body and tell your organs, hey he manuhiri kei te haere mai, tiākina. Our life depends on it. Did you?”

And he goes, “No.” And I said, “Well, would you like to?” His wife said, “Yes.”

So I went to histology in Greenlane, got those lungs out, and we had the karakia to set the old lungs free. And he sobbed and sobbed and sobbed for his mother, for his father, for a brother that he was mean to, and sobbed.

I said, “No, mihi ā, mihi ā.” So, we began the process of introducing the new lung, haere mai, haere mai, haere mai. Then, introducing the new lung to all the organs in his body: Tiākina, ko tai mai hine manuhiri te awhi mai ia tai tatou. Hei orana kei to. Tiākina.

He went home that afternoon. And I know that he’s well, because he sends a Christmas card to Greenlane every year.

What do you make of the plans for the Māori Health Authority and getting rid of the DHBs? You know, reducing the numbers. Do you think it will help us with what we want to do?

No. For as long as we are going to report to Pākehā for our wellness, it’ll never help us. Not ever help us. I went down to Wellington last week with the Family Court judges, and our agreement with the Family Court judges about the uplifts of [Māori children] was, and has been, sanctioned now. [Chief District Court Judge] Heemi Taumaunu has made a release that we are co-designers and co-deciders. So the advisory committees are gone. We’re not there to advise [just for] someone to disregard our advice.

That’s great. Getting rid of that consultation stuff. But this is the thing with health. You can’t fix health without being in corrections, without being in social development.

I’m in Heritage New Zealand, I’m in the police commissioner’s office. There’s only one thing I’m not in, and that’s tourism.

That’ll be alright on its own. One of the things that we struggle with is convincing people to care about health equity. We made a podcast about it and what Pākehā said made the biggest difference to them was hearing whānau stories.

Some of my friends who are doctors, they’re on alert when they have whānau in hospital, because they know that they have to advocate, potentially, for them. And that their whānau might experience racism.

I’d have to say — and maybe it’s because I’m so well known — but most Māori who go into hospital, I’m advised about it, because the whānau rings me. And the whānau go, “Auntie, so-and-so is in hospital”, and I tell them it’s okay, I’ll send the te kaiatawhai team up.

I don’t think Pākehā realise that, about how interconnected we are. I read that the main thing with your tolls experience was that nek minit it’s Ranginui [Walker] on the phone. We’re always conscious of who we’re talking to because they’ll be related to someone. To us.

They haven’t got a clue about our reach.

But that’s our strength. I put my two grandmothers on my arm because our Māori patients, they don’t always assume that there’s a relationship between us, as Māori — not just the doctor/patient dynamic which can be a bit intimidating.

It is a privilege to be of service. It is. I say to a lot of professional people, be privileged that you’ve got a client and give them the best of your skill.

What would you say to my class? We’ll probably have about 40-odd Māori and Pacific doctors graduating this year. What would you say to us?

I would say the same thing. All the skills that you’ve achieved, you have achieved because there’s sick people out there. It is a privilege to be of service to those people who have a need.

Rangi Walker said things like, I find it difficult to deal with the privileged who use their privilege to undermine the underprivileged. Rangi was an amazing leader, an amazing teacher.

When our people ask, I don’t even know I’ve got the knowledge until they ask me. And then I think, I remember my grandmother talking about things like that. I don’t really understand what I have unless someone asks me and then I know.

Emma Espiner (Ngāti Tukorehe, Ngāti Porou) won Opinion Writer of the Year at the 2020 Voyager Media Awards.

This story appeared in the January 2021 issue of North & South.