Dianne Sika-Paotonu: The duty to act

It’s likely you’ll be seeing a lot more of Dr Dianne Sika-Paotonu, the associate dean (Pacific) at Otago University in Wellington — especially with Covid dominating the news. She’s an immunologist and biomedical scientist who’s been taking on two major scourges that, for generations, have been robbing many of us and our whānau of health and life. One is cancer in its many forms. Another is rheumatic heart disease.

In this talanoa with Dale, Dianne explains why and how she embarked on this work — and what progress is being made.

 

Mālō e lelei, Dianne. I hope you’ll be kind enough to share some kōrero about your whakapapa lines and your names.

Of course. Both my parents are Tongan. My father, Tevita Sika, comes from Vava’u, and my mother, Teisa (nee Latu), comes from Ha’apai. They met in Tonga and my father, who used to play rugby for Tonga, gave up his rugby career to marry my mother. They came here to New Zealand in the 1960s and then had me and my younger brother, Joseph (Joey).

Paotonu is from my husband, Reno, who is Sāmoan-Niuean.

That means our daughter, Alisha, is a bit of a fruit salad. She’s a very special part of our family, partly because we nearly lost her when she was little. I was quite unwell when I was pregnant with her, so we look on her as a miracle child. She’s recently finished university.

What was the story when your mum and dad arrived here? What did they end up doing?

Both my parents worked hard to support me and Joey, and to make sure that we had an education and everything we needed. My father worked for Todd Motors, as it was called back in the day, and that turned into Mitsubishi Motors.

My mother, who’d been a secretary in Tonga, worked in a cake shop and juggled multiple other jobs. We also had my aunt Olivia Tonga living with us, and she helped look after Joey and me.

Your family’s experience is the familiar story of the sacrifices made by our Pasifika people when they arrive here, isn’t it?

My parents sacrificed so much for their children that there’s nothing that Joey or I could ever do that could even begin to pay them back for what they’ve done for us. Any successes that we may have had along the way are a result of all their hard work, prayers, time, love and care.

I understand that a teacher at high school encouraged you into science and then you went on to biomedical studies.

I had some amazing teachers who encouraged me along the way and fostered my interest in science. Jake Ormsby was my teacher back at the Wellington Seventh Day Adventist primary school and he was one of the first who helped to shape my journey.

Then there was Ms Robins at Wellington Girls’. She was very committed to her students and was quite influential in supporting my pathway into science at the tertiary level.

Apparently, you were a bright kid, an A-student. But faith looms large in your life too, doesn’t it?

Faith has always been a strong part of our family — and also, of course, the notion of service that goes along with that.

As my parents were settling here in New Zealand, there were some very kind people who helped support them — and so Mum and Dad, in turn, looked to what they could do to help and support others.

Being part of a faith community remains important to me, and over the years I’ve had the opportunity to contribute in different ways, including mentoring and working with Pacific young people.

What drew you into studying biomedicine?

When I was quite young, we had a family friend who passed away from cancer and this upset me a great deal. So, I made this really big promise to my mum, that I was going to grow up and cure cancer.

I gravitated towards science and was determined that, in some way, I’d try to keep my promise to Mum. And, as a result, the subjects that I took in high school, and the degree pathways that I followed, were health science-focused and science-based.

Were there many other Polynesian students with you?

No, there weren’t. I came through the education system at a time when there were very few Pacific students taking science subjects, so there weren’t many of us. In college, I was often the only Pacific student in my classes. When I got to university, there were a few more Pacific students around, but most of the time, I was still the only one.

You have a focus in your work on rheumatic fever, and you’ve mentioned cancer, too. Do you think we’re any closer to understanding why cancer is so prevalent among Māori and Pasifika people?

We’re learning new information all the time, but there are still knowledge gaps in this area. A lot of work is currently being undertaken not only to develop better treatments to help people, but also to understand more about why cancers arise in the first place — and especially to know why some people get better and why others don’t. We do know that there are certain cancers that are more commonly found in Pacific peoples.

I had an opportunity to work on developing better cancer treatments when I started my PhD at the Malaghan Institute of Medical Research in Wellington, where I was a member of the team cancer vaccines team.

The type of cancer vaccines we designed weren’t the sort that would be given to children to prevent them getting cancer later on in life. They were the sort that would be given to people who already had cancer — to strengthen their immune system to fight against the disease.

My work showed that these cancer vaccines could make strong cancer-killing immune cells when the vaccines contained a sea sponge extract and bacterial compound together.

The cancer vaccine work was really important, but I was aware that most people around the world wouldn’t have access to this type of expensive cancer treatment.

I then started looking at cancer diagnosis and exploring ways to pick up cancer sooner rather than later. The focus was to find a simple method to detect cancer early, when it would be more likely to be successfully treated. For example, a straightforward blood-test method for picking up early cancers could be used in many parts of the world — even in developing countries where treating cancer with the available approaches could work much better.

It’s a fascinating area and, although no one is going to cure cancer on their own, even a slight discovery that pushes towards the goal has got to be encouraging. What satisfies you most about this mahi and this area of research?

You’re right. Everyone contributing in this setting has a part to play, and the work and the mahi that we all do is much needed. There’s still quite a long way to go because of the knowledge gaps, but it’s important to just keep moving forward. And even though progress may be slow, it’s still progress.

We still don’t have as many of our Pacific or our Māori researchers heading into these research areas. Over the past decade, there’s been a lot of work to encourage our young people to consider science and the health sciences — to help in finding Pacific and Māori solutions for our people and communities.

Although more Pacific students are now undertaking STEM (science, technology, engineering, maths) subjects compared to when I was a student, we still have much more work to do here to increase numbers at secondary school and university.

You’ve also focused on rheumatic fever, its impact on Polynesian people, and the use of penicillin. Can you tell us a little more about why you wanted to try and find some answers in this area?

Yes, of course. Currently we have high rates of rheumatic fever and rheumatic heart disease in our Pacific and Māori communities here in Aotearoa New Zealand — and we also have high rates in the Pacific region.

What we call acute rheumatic fever is the body’s reaction, or the body’s auto-immune response, to an untreated infection by a particular type of bacteria. This particular type of bacteria is known as Group A streptococcal bacteria, or GAS bacteria for short.

And what the GAS bacteria can do is cause infection in the throat and in the skin. If those infections of the throat or the skin aren’t treated — and they can normally be treated just with antibiotics — the GAS infection can turn into acute rheumatic fever.

Acute rheumatic fever involves inflammation that occurs in the body. So, you get high fevers and inflammation of the heart, joints, the skin, and the brain — it’s really unpleasant.

It usually occurs in our younger people, our children and youth. They typically end up in hospital until they get better. If untreated acute rheumatic fever keeps happening, or, if there’s a severe episode, this can lead to something more dangerous known as rheumatic heart disease. That’s when the heart becomes permanently damaged.

Penicillin comes into the story as we currently don’t have a vaccine to prevent GAS infections. This means once a child or a young person has been diagnosed with acute rheumatic fever, they are immediately given monthly injections of a type of penicillin known as Benzathine Penicillin G (or BPG for short).

These painful BPG injections are given once a month for at least 10 years, or sometimes for the rest of someone’s life — and this is called secondary prophylaxis.

The reason for the BPG injections is to keep long-lasting penicillin in the body to stop GAS bacterial infections from happening in the first place. Currently, the penicillin is given by injection into the upper thigh or bottom once a month. And it’s a really nasty drug to be given this way.

What we’re trying to do is make a new penicillin that is longer lasting and hurts less when it’s given — in order to prevent acute rheumatic fever and rheumatic heart disease in our children and youth.

As you can imagine, our little ones and our young people hate having these injections — and it’s about time that we made something better for them. So, we’re working very hard on that.

This research work is also extending into the Pacific region in partnership with Pacific researchers and collaborators based in Oceania, Australia and the US.

We’ve seen campaigns about strep throat and swabbing in schools, but I guess the onus is on us to connect the dots for our people so that we all understand the danger. And we also need to factor in a distrust of western systems, be it health, education or politics because of colonisation. How do we get our people to trust scientists like yourself to come up with solutions to the challenges?

Yes, there are barriers for both our Pacific and Māori communities within health — and, on top of that, there are health inequities that, sadly, have persisted for decades and generations.

If we look at the current Covid-19 situation, the pandemic has highlighted some of the health inequities for our people, and we’ve seen some of the responses that have arisen as a result. I’m thinking in particular about the repeated calls to have Pacific-led and Māori-led efforts that are tailored and targeted specifically for our people. Particularly around the prevention, testing and vaccination efforts for Covid-19.

Over the past couple of weeks, we’ve seen an acceleration in more of the community-driven, Pacific and Māori led efforts to try and get people vaccinated. These approaches work because they reduce the barriers that get in the way of delivering the care that’s needed for our people, in a way that suits them and builds trust.

It was also helpful to have the government respond by resourcing these particular efforts in a way that acknowledged the importance and need for Pacific and Māori to lead, drive and provide solutions for our own communities. It’d be great to have more examples like this — and also to have more support and resourcing for these approaches in other health areas.

For a long time, we’ve had more of a focus on equality in health, where the approach has been “one size fits all”. But we know that this doesn’t work for our Pacific and Māori communities.

What’s needed is an equity focus, which means doing what’s needed to get people the help and healthcare they need. This includes reducing barriers, and engaging and communicating with our communities in a way that’s respectful, that incorporates reciprocity, and that acknowledges the importance of relationships.

Our Pacific health workforce is critical for responding effectively to the needs of our communities, and more Pacific health staff are needed.

It’s so important that we have figureheads, role models and experts who can stand and kōrero to allay anxieties about this “unseen stuff” inside our bodies. What would you say about that responsibility to be a voice that can straddle the scientific and the cultural dimensions, Dianne?

As a Pacific immunologist and biomedical scientist, I consider it a privilege to have been provided with opportunities to share and to help others, and also communicate information that may be useful to people.

There’s an Einstein quote that I carry with me: “Those who have the privilege to know, have the duty to act.”

Thankfully, there’s also a growing understanding of the need for scientists and researchers to become more closely connected, and to engage appropriately and respectfully, with Māori and Pacific communities and other groups across different settings. We need to support effective and appropriate dialogue and outreach efforts, and scientific knowledge sharing and translation activities.

I’m grateful for opportunities to make a meaningful contribution using my training and the skills I have. Whenever I’m asked to speak, or if ever I’m offered the opportunity to share, I accept the invitation, no matter what the forum or the context may be. I consider it my responsibility to give back, share and be helpful to others around me.

I’m also appreciative of any opportunity to help draw attention to some of the health issues and needs that are important and relevant to our Pacific communities here, not forgetting our Māori brothers and sisters as well. I’m most willing to continue doing more of this.

You’ve been over to Harvard in the States. Not too many Pasifika scientists get invited to such a prestigious forum. But you may see a special value in our mātauranga and age-old thinking being able to complement western science.

I’m indeed encouraged by the increased awareness and the recognition of the need for more Pacific and Māori scientists and researchers to be included in the western science framework.

We have so much to contribute, and we add strength and value to scientific work that’s being done.

I’ve also had the chance to mentor and support students, researchers and young people, many of whom have been of Pacific heritage. Helping them grow, develop and succeed is important to me. It’s a privilege to have the opportunity to support our next generation of scientists and researchers.

I’m encouraged also that we’re at a point in time where there’s an increasing awareness and recognition of the need for us to lead contributions to find solutions for our people, rather than having other people bringing their solutions to us.

As Pacific peoples, it’s also important we’re there at the discussion tables, being part of the talanoa and the kōrero, to ensure that we’re included and that our people are represented. We’ve still got a long way to go in this respect, but there has been some progress.

What has been the most satisfying for you when you look back on your career and life, Dianne?

No one ever gets to where they want to be by themselves. With any success or achievements, there’ll be a number of people who’ve contributed and supported in some way.

For me, any successes represent the contributions of my family, my faith communities, and also friends and colleagues who’ve all helped along the way. So, I don’t hold on alone to any achievement.

What further goals have you set for yourself?

I’m always goal setting. I have long-term goals and I have short-term goals, and sometimes I get there quickly and sometimes things take much longer. Often it can be quite a journey to get where you need to be, but I’ve learned to never give up, no matter what happens.

If there’s one thing I’d like to see, it’s for the next generation of our young people to become equipped and supported to be leaders within their areas of expertise.

And not just to lead but also to ensure they’re contributing to their communities and to society in a way that’s going to bring about positive change in Aotearoa New Zealand, and in the Pacific region and beyond as well.

What a pleasure your kōrero has been, Dianne. Thanks again, and keep up the good work.

(This interview has been edited for length and clarity.)

© E-Tangata, 2021