Nobody knows much more than Collin Tukuitonga about how our communities, especially Pasifika, can hang on to good health. Collin, who was born in Niue, has been a leading figure in New Zealand, the Pacific, and internationally — and not just in health, as Director of Public Health at our health ministry some years back, or at the World Health Organisation in Switzerland, where he led work on non-communicable diseases and child health, but also heading the Ministry of Pacific Island Affairs in Wellington, and, more recently, the Pacific Community (SPC) in New Caledonia.
Sometime ago, he was also at the forefront of moves to increase the number of Māori and Pacific students at Auckland’s medical school. And now he’s back there, as its first Associate Dean Pacific, to see what can be done to lift the numbers of Pacific students graduating from med school.
Here he is talking to Dale.
Fakaalofa lahi atu, Colin. Or should I say Collin, with a double “l”? Because I see your name has been spelled both ways.
Kia ora, Dale. It’s a pleasure to talk with you. And first, let’s deal with that confusion about the spelling. For many years, I spelled my first name with only one “l”. But, when I joined the staff of Auckland University in March this year, they insisted on reverting to my original double “l”. So I’m in the process of advising everyone that that’s how it is now, although the situation is a bit messy.
My middle name, a family name, is Fonotau. That’s Niuean for a big hui or fono, one planning for a war or a battle. That came from a grandfather in Niue.
And Tukuitonga is our surname. That signifies that we were migrants from Tonga. Niue was populated by two or three waves from Tonga, one from Sāmoa, and a smaller one from the Cook Islands in the early days. So that’s a little bit about all my names.
Were you born in Niue, Collin?
Yes, I was born at home in Niue. And my pito, or umbilical cord — we have the same word as in Māoridom — and my fonua, or placenta, is buried in Niue. I grew up on Niue, too.
So I’m wholly Niuean. The whānau, the village, the environment. They all shape you. I was actually raised by my grandparents, Misihe and Soveleni, along with my cousins, whom I regard as brothers and sisters.
My grandfather Misihe had a huge influence. It was pretty much his influence that shaped me. He was self-taught. He had very little schooling but he learned to read the Bible. And he built the fale that we grew up in. He was a very good fisherman and planter, too.
And what about the religious beliefs of your neighbours and family?
Niue was largely populated by Christians who followed the teaching of the London Missionary Society. The LMS had gone around the Pacific and their teaching became the predominant religion on our island. But my grandfather and his cousin played a big part in establishing the Roman Catholic Church on Niue.
The rest of the whānau weren’t too happy about that. But my grandfather was pretty much his own man and he wasn’t bothered by the criticism. He had 15 offspring and one of them was my mother, Saipipi. She and the rest of the family all became Catholics — and that was another big influence on me in those early days.
Did you ever have cause to feel that the richness of Niuean history was shortchanged, even subsumed, by Christianity? Perhaps there was something lost in the narrative?
People talk about Tonga as a community where the Tongan culture has become so much influenced by Christianity — and particularly the Wesleyan orientation — that you can’t tell what was Tongan culture and what was religion.
But I’ve never felt that way in Niue. I always felt that, if anything, the Niuean culture had a big influence on the church as it was practised on our island. For example, the hymns introduced through the church were all sung in Niuean. And the mass was in Niuean. So there was a strong Niuean influence on the way we practised Catholicism.
Obviously, the Catholic Church has prescribed a number of things — and people might say they were harsh in some areas, like their attitudes to abortion and marriage. But I never felt the church took over our lives and our culture. We shaped the way the faith was practised. My mother was one of the interpreters who translated the Catholic material into the Niuean language.
New Zealand looms large in Niuean life nowadays. But did it for you, as a young man? Did it play a big role in your understanding of the big wide world?
Oh yes. It was big. Really big. Huge, in fact. Even though I grew up on Niue, the New Zealand influence was huge. For example, in those days, the State Services Commission ran the public service on the island and my teachers at high school were mainly Pākehā, and the odd Māori, who’d come from Aotearoa.
And what we were taught was very much influenced not just by the teachers, but by the New Zealand curriculum and by the way the public service was organised. I mean, even the plumbers, electricians and the builders were all New Zealanders who’d come over as public servants.
It was very pronounced. But it’s different now. It’s a much more Niuean school system these days. But I remember being punished for speaking Niuean and being made to sit outside the classroom because I was speaking in Niuean when we weren’t supposed to. We were expected to speak in English.
It was pretty strict, although I don’t regret it. Overall, I think it had a positive impact on me.
As you know very well, of course, we’re trying to reclaim the reo Māori we lost over the generations for the same reason. And I’m led to believe that the Niuean language is in an even more precarious state.
Yes. The Niuean reo is in dire straits. We call it vagahau Niue and I’m involved with a number of people doing our best to save it. But the language is losing ground every year. It’s in extremis. So few people are now speaking the language that it’s in real danger. In fact, it’s listed by UNESCO as one of the languages at risk of extinction.
The other problem is that, as you know, most of the Niuean people (some 30,000) now live in Aotearoa and only 1,700 or 1,800 live on the island.
I’m lucky that, for me, and for others in my generation, Niuean was our first language, although we learned English at school. But most of the Niueans here in Aotearoa don’t speak the language at all. And their babies don’t learn it. So there’s a real danger of the language being lost completely.
We’re doing our best, trying to lobby the various ministries to work with the communities and churches. But it’s a big, big mountain that we may never be able to climb. It’s a sad situation — and I’m very concerned about it.
Despite those concerns, Collin, I’m sure that, in the course of your mahi over the years, you’ve been proud of Niue’s achievements. Does any one thing stand out in your mind?
Well, despite our struggles with our language, it can still provide enormous pleasure. For instance, when there’s a Niuean hui, or fono as we call it, I’m pleased and proud to be able to address the people in our first language — and to be respected for that. There’s something magical about being able to use your language when you’re speaking with your leaders.
As you know, language is such a critical part of the expression of our culture. So, when I find myself in Ghana or Costa Rica or other distant parts of the world, through my language, I still feel closely connected to my little motu in the middle of the Pacific. That’s how powerful I think the language is. It has a way of maintaining the culture and supporting who you are as a person.
One significant aspect of your work has been as an advocate of affirmative action to get more Māori and Pasifika people becoming doctors and nurses. But we’d be doing you a disservice if we didn’t make more mention of your overseas experience.
There’s been an international focus in your academic studies, hasn’t there? There’s your medical degree in Fiji, your master’s studies in public health in Sydney, as well as your research qualifications in San Francisco. I imagine all that experience has helped shape your thinking about the best moves to make with Pasifika health programmes.
Yes. I’ve been fortunate to have been able to study in different parts of the world — and also to have worked for the World Health Organisation in Geneva, which gave me a chance to do a lot of travel overseas.
And it’s clear that, at one level, Niue people are fortunate, because they’ve had free healthcare as a result of the generosity of New Zealand. But, in many ways, it’s also been clear that the experiences of Māori and Niuean people are similar to many others around the world, in that they’re often not in privileged positions and have to work extra hard in order to be heard and recognised.
I see that all around the world. And I suppose there’s a little bit of comfort in that we’re faring a little bit better than some of the other indigenous groups around the world. We still have a long way to go, but we’re making progress and I’m encouraged with what’s happening.
I understand that you’re back at the varsity now and that you’re now pushing ahead with measures to have more Māori and Pasifika delivering healthcare in New Zealand and around the Pacific. How’s that going?
When I was here at the Auckland University medical school with Professor Colin Mantell 20 years ago, we were able to set up the Māori and Pasifika programme, which has paid off, especially for young Māori students. The number graduating in medicine in Auckland has been really encouraging. But the story isn’t the same for Pasifika students. So I’m back to see what we can do to change that.
There can be a number of challenges for Pasifika students. Problems at home, challenges at school, and young ones not knowing what they’re in for when they embark on tertiary study. So they come to medical school not well-informed about the needs here. And, of course, medical school itself is a tough, tough place to survive.
I’m very impressed with what’s happening with the Māori students. But I’m concerned that the number of Pasifika students isn’t growing. We have to look at why that is and introduce similar measures that have worked for Māori.
It’s a big ask, as you know, because there are often complaints from Pākehā parents. Like: “You’re taking more Māori and Island students and my boy and my daughter are missing out.” These are the inevitable comments that come up when we try to address the chronic inequities in our communities.
Māori are still counting on the Treaty to help bring a little more justice to Aotearoa. Our people have been shouting from the rooftops about the Treaty failings ever since it was signed. But at least there’s a treaty. Pasifika people don’t have that comfort though. Our Pasifika cousins are out of the mix. What can we do about the challenges because of that?
I was a firm believer in keeping Māori and Pasifika together at medical school because, indirectly, Pasifika students were able to access some of the pūtea and resources supporting Māori students. But we’re finding it more and more difficult for that sharing to take place because expectations have changed and there are many who want Pasifika to be more visible.
While we share the responsibilities here at the medical school, we now need to look at the needs of the Pasifika students more carefully. But it’s not all to do with what happens here at the medical school. It’s also what happens at home.
There are Pasifika families who want their daughter to succeed in medicine but she still has to teach Sunday school, cook food for their family, and look after the young ones — and those expectations aren’t realistic, in my view. So we have to address some of these issues in Pasifika families.
I guess there was a time when Māori and Pacific Islanders weren’t so close here in Aotearoa. But we’re becoming increasingly intertwined through marriage and, one way or another, we’re often reminded that our genetic trail points to our shared Pacific origins.
Well, we are intrinsically, or inevitably, connected. I don’t know what the intertwining statistics are these days but, in my family, I had four uncles who had Māori wives. My siblings and cousins are all a mixture of Niuean and Māori. And I’m aware that there’s a growing number of Pasifika-Māori marriages.
You’ve had the advantage of seeing for yourself how health programmes have been operating in many parts of the world. And you’ve done a fair bit of research as well. So you’re in a good position to identify the biggest challenges to good health among Māori and Pasifika communities.
One major problem is that there’s a liberal view that encourages and promotes economic development, often at the expense of the environment or cultural values. That’s the thing that concerns me the most because economic development promotes more individualism and private good, with little regard to the benefits for the wider whānau.
I say that because a lot of the health problems among Māori and Pasifika people have their origins in the commercialisation of the food system — what we eat and what we drink. It’s all a reflection of the drive for economic success.
In fact, my public health colleagues are talking increasingly about the commercial determinants of health. Food systems that promote distributing and consuming highly salted, highly processed food with soft drinks and all that stuff that we know aren’t good for us.
But that’s the predominant food supply chain we all face. We need to tone that down and go back to growing more kumara ourselves and eating more fresh fish. And, unless we do, there’ll be no holding back the tsunami of diabetes and heart disease affecting both Māori and Pasifika families at rates greater than anywhere else in the world.
Last month, there was a health report compiled by Heather Simpson, an influential Pākehā ally of Helen Clark. What did you make of that review?
I’ve written a number of articles for Newsroom on it. Overall, I think there are some good things in the report, but the word that we’ve used, and organised a submission around, is that we’re “disappointed”. Here we are, with an opportunity to redesign the system that better meets the needs of our people, both Māori and Pasifika, and I think they’ve dropped the ball.
There was no mention whatsoever of the needs of Pasifika people. If you keep pushing ahead with more of the same, you’re going to keep seeing the same inequities that have existed for decades. So the report has been a lost opportunity to redesign the system and deal with these issues. We’ve written to the Minister of Health to express our “disappointment” and to point out the weaknesses in the review.
There are clearly some positive elements in the review. For example, there’s a greater focus on the resources for health and wellbeing, on keeping people healthy, and on improving diets rather than trying to treat people once they’re sick. These are some good points.
But, overall, it’s a disappointing report and we’d like Wellington to look at it again.
What about this unwelcome visit from Covid-19, Collin? What are we learning from that?
One reminder we’re getting is how fragile our system is. Here we were, going along quite nicely as if there were no great threats, and a virus comes along and knocks everything over.
And it’s not just an issue of protecting people’s health because the virus has other consequences — like people losing their jobs. This is a vicious circle because people without jobs generally have trouble with health.
I’m worried, too, and annoyed, about people who’re pushing to open up our borders especially to a so-called trans-Tasman bubble, when we know there’s huge concern about community transmission in Australia.
The real need is to keep protecting the health of New Zealanders. And I rather like what Helen Clark said: “Economies can recover. The dead can’t.” It might take a bit of time but it can recover. If you’re dead from Covid-19, that’s it.
So I’m unimpressed by the people who keep pushing the government to open up our borders. I understand the economic consequences, but right at the moment, my view is that the public health objectives are still our priority. We need to look after our people.
Another reality is that this isn’t going to go away in a hurry. This pandemic could go on for some extended period. We have to accept that we may well get some clusters here in Aotearoa until such time, if we’re lucky enough, to get a safe and effective vaccine.
That’s looking at the national scene and beyond. But what of your personal goals?
Two goals, Dale. One is to learn te reo Māori properly. The other is to do a PhD. I’m still hopeful that could happen sooner rather than later.
I’ve met quite a few Niuean people and they all can sing. I’m assuming you can belt out a few tunes, too.
The unfortunate thing is that I can’t play the guitar all that well. Not as good as you, anyway. But that doesn’t stop me from singing a Niuean song.
And, looking back, I’m sure you’ve got plenty to sing about. For instance?
What comes to mind is the enormous pleasure I had in helping to set up the Hauora Ngāti Hine all those years ago with the late Erima Henare, Kevin Prime, and the late Rob Cooper and others. They all went on to do amazing things. But I was very happy with what we achieved. That’s a memory I treasure. So, too, with helping the whānau in Hokianga to set up Hauora Hokianga. This is a while ago now.
There are things like this that have been really rewarding. Like helping set up a number of Pasifika clinics here in Auckland as well. Those projects are very important in our communities. And they’re reminders that we have to stop thinking someone else is going to deliver healthcare for us. We have to do it ourselves.
(This interview has been edited for length and clarity.)
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