‘If we give up now, nothing is going to change’

 

Te Kōhao Health in Hamilton this week celebrates 30 years of providing kaupapa Māori health services to whānau.

Te Kōhao is led by Lady Tureiti Moxon, who recently received an honorary doctorate from the University of Waikato for her services to Māori health. She’s been at the forefront of fighting for health equity in this country, including championing Te Aka Whai Ora, the now disestablished Māori Health Authority.

She says such celebrations are bittersweet — marking decades of hard slog to arrive at a national Māori health service, only to have a new government kill it at birth.

Still, as Lady Tureiti tells Siena Yates, giving up hasn’t crossed her mind.

 

I truly thought we were advancing as a nation with Te Aka Whai Ora. The change to our health system could have been transformational. It was supposed to give us a different way of doing things, a different way of operating on the ground.

But it became a scapegoat for this government.

They dismantled 30-plus years of hard slog, where we’d been inching along trying to secure some gains, so they can go back to what they know — which is doing the same thing over and over again, and somehow expecting a different result for the problems we see in this country.

They’ve taken us back a hundred years. Because it’s not just the policy. What they’re doing more widely is emboldening regressive attitudes, where we start to see things like the instruction to speak only English in Waikato Hospital.

There’s been no consultation about the health system changes whatsoever, which is appalling behaviour by one so-called partner to another. The only way to fix that is to do something about our constitution and put the Treaty right where it’s meant to be, as the foundation document of this country — as our top priority.

But that’s the trouble. Te Aka Whai Ora was never going to be given a chance by this government. They’re not interested in evidence. All they want is to eradicate any reference to the Treaty of Waitangi. Just look at what they’re doing now — they’re combing through 28 different pieces of legislation with clauses that refer to the Treaty, so they can pull them all out.

It’s a blatant disregard for, and breach of, the Treaty. But you know what? This government doesn’t care. Because it doesn’t suit them. What suits them is being sovereign and wielding power. So the false interpretations of the Treaty, and of history, suit them, too, because they serve to perpetuate a whole conspiracy theory that Māori don’t deserve anything that allows us to uphold our sovereignty.

In health services, we didn’t ask for anything more than anybody else. But we didn’t ask for anything less, either. We didn’t ask for bad health, or not being diagnosed in time. We didn’t ask to die young or from preventable diseases. But here we are.

And the worst of it is, a lot of the decisions about our health have been made based on the government’s greed for power and control, and their agenda to get rid of any semblance that Māori are here and have ideas about how to live our own lives.

What they don’t see is that we’re going to be here forever. And so, what they do today won’t destroy what we’ll be doing tomorrow. That’s why I keep doing this work. Because if we don’t exercise rangatiratanga over our health, we’re always going to be at the beck and call of successive governments.

Sure, they’ve got the resources, and they’ve got the decision-making power to say where those resources should go and who should get them. But what they don’t have is our resilience and knowledge. We know what is best for us. And that’s what I keep chipping away at. It’s work that progresses what we can do ourselves, for our whānau, and requires us to be brave and innovative.

In April this year, for example, Te Kōhao Health opened our new diagnostic clinic, Taakiri Tuu. We partnered with Pacific Radiology to bring in X-ray machines so that people can be seen and diagnosed without having to wait at the hospital. We’ve also got mammogram, ultrasound and CT machines. And we’ve partnered with specialists who come and run their outpatient clinics from Taakiri Tuu. We’re also about to start working with Te Whatu Ora to open more specialist clinics on our premises.

The purpose of all this work is to help whānau get diagnosed, and get diagnosed early, so that we can start to tackle health in a preventative way.

Often, the reason why our people don’t get the right diagnosis, or don’t get it until something’s gone really wrong, is to do with clinicians and the way they view people. It’s the lens through which they see Māori and judge whether or not they deserve to have this treatment or that operation, over somebody else. Clinicians are making those kinds of subjective decisions all the time, and often there’s a refusal to admit that Māori have a different experience in healthcare than Pākehā.

There’s lots of evidence around that. One example is asthma pumps. There’s a blue one, which is for when someone is having an episode and trouble breathing, and there’s a red one, which is the preventative one. One study showed that nine times out of 10, doctors were prescribing our people the blue one. Very few were giving Māori the preventative medicine, because a lot of them thought: “If I give it to them, they won’t take it properly.” So many assumptions like that are made in medicine.

A lot of what we need in healthcare is to put the focus back on the patient, to care about them as people, and also as people with different needs. The basic, fundamental act of caring about somebody, not just seeing them, makes such a big difference. But at the moment, the focus is more on the clinician and their availability. For a lot of clinicians, it’s become just a job. A job where they have to move people through and push them out, like getting meat through a grinder. Just in and out, as fast as you can.

Lots of families tell me they’ll never leave their people up at the hospital on their own because the staff don’t look after them in the way they should be looked after. And it’s an indictment on the hospitals too.

That’s why Te Aka Whai Ora was so important. It opened the way for a health service where we could get to know somebody because we’re a relational people. We could get to know who they are, where they come from, and what’s going on in their life, and build rapport, for better outcomes. These things are often disregarded because time is limited, but if you do these things from the start, you get a fuller picture that informs everything about that patient’s future care.

The experience with our doctors at Te Kōhao, I would hope, is one in which they’re inquiring. They’ll go through your whole history, all the notes, and check where things are with various ailments, particularly recurring things. And they’ll start the process of investigating those properly, with the full picture in mind. And then they can send you to a specialist for follow-through. It’s the kind of care a lot of our whānau miss out on because clinicians only have time to look at the isolated problem at hand and provide the go-to remedy: “Here, take a pill for that.”

That’s the system we have. And that’s why we have to really take the bull by the horns and start creating new pathways to do things our way.

Another major focus for us now is getting our people into health career paths through scholarships and training programmes. Creating pathways for our people to become doctors, nurses, technicians, support systems and, importantly, decision-makers. That’s the only way we’re going to be able to move and shape things in a different way, and change things to be more responsive to our own.

Part of developing those professionals is creating spaces for them too. So yes, we do want a Māori hospital — we should absolutely be thinking that way. We should always be thinking about providing for our people at every step of the pipeline, right from when they visit their GP, through to being placed in hospital if need to be. Right from when they’re born to when they die.

The majority of health funds go into existing public hospitals, so we’re not going to be able to just start up a hospital next week, but it’s certainly doable. And in the meantime, we can get to work creating our own spaces in other ways.

At Taakiri Tuu, we have free clinics coming up next month, and on the first of November, we’re going to be signing the memorandum of understanding with Te Whatu Ora to get more clinics running here and make sure Māori are being put on lists to come through those clinics. That’s one way of working in partnership for the betterment of the community.

It’s exciting because, if we get this right, it can be something of a blueprint for others. We’ll be able to demonstrate how this can work and support others to do it in their own areas.

We worked so hard for Te Aka Whai Ora. Truly, we did. To have it taken away is hard. But we can’t stop here. Because if we give up now, nothing’s going to change. So I think of what Tā Hemi Henare said:

Kua tawhiti kē tō haerenga mai, kia kore e haere tonu. He tino nui rawa āu mahi, kia kore e mahi nui tonu.

We have come too far to not go further. We have done too much to not do more.

We’re not going to fix everything tomorrow, but we’ll keep chipping away. And as much as we might be pushed back, it’s never going to stop us from continuing to move forward.

 

Lady Tureiti Moxon (Ngāti Pāhauwera, Kahungunu, Ngāi Tahu) is chairwoman of the National Urban Māori Authority and managing director of primary health provider Te Kōhao Health. She has worked as a barrister and solicitor focusing on Māori land law and Treaty jurisprudence, and has served as a member of the Waitangi Tribunal as well as being involved in numerous Waitangi Tribunal claims related to health, Oranga Tamariki and ACC. She was also a member of the establishment board of Te Aka Whai Ora, the Māori Health Authority.

 As told to Siena Yates with the support of the Public Interest Journalism Fund.

E-Tangata, 2024