Dr Api Talemaitoga: A GP’s talanoa

Bula vinaka, Api. Can we start with your background and how you became a doctor?

It’s a complicated story because a medical career was never my first choice. I wanted to be a school teacher like my parents Makelesi and Wapole Talemaitoga, who were schoolteachers in Fiji. Second, I wanted to be an airline pilot. Medicine was my third choice.

I’m from a big family, and I’m also the eldest of the grandchildren on both sides. On my mother’s side, I had eight aunts — and one of my favourites was Sokoveti Nailati who often talked to me about becoming a doctor.

Then in the sixth form in Fiji, I passed my exams, but my marks weren’t good enough to be a pilot or to be accepted into the University of South Pacific to do medicine. But I was accepted into Fulton College, a Seventh Day Adventist teachers’ college.

And I did three days there, but then my parents persuaded me to go back to school and repeat the sixth form, so that I could pass with high enough marks to get into medical school.

Which is what I did, and I ended up really enjoying that year because it was kind of revising. In fact, I got such good marks that I won a scholarship to the University of South Pacific to do what was called foundation medical. It’s kind of the first year of Fiji Medical School.

Then, after the mid-semester exams, I was one of three people from the class who were offered scholarships to go and study overseas.

That’s how I ended up doing medicine at the University of Otago in Dunedin.

I have a younger brother, Josateki, and a sister, Laitipa — and we’ve all been students in our parents’ classrooms. I love that ability to explain things to people. Especially when English is a second language, like it is for me.

I had to learn that, and learn the medical terminology, which is almost its own language, then find ways to translate it into everyday language. And that’s been really important in our Covid work.

Api in his Otago uni days, in 1981. (Photo supplied)

I imagine Dunedin would’ve been quite an experience for you.

It was a shock. Culturally, and the weather. I don’t think people realise that you just have no concept of what cold is if you’ve only ever lived in Fiji.

But I was really lucky. I was in Knox College, which was a hostel in Dunedin. The camaraderie with other university students was amazing, and so too was being in an environment where you know everyone is there to learn.

That first year taught me about New Zealand life, in an immersion kind of way. Of course, I’m still learning, but that was a great start for me. There’s nothing quite like being put right in the middle of things — and the friends I made from that first year remain.

Not too long after you went to Dunedin, there was the 1987 military coup in Fiji.

I’d actually just finished med school in 1986 and was working as a house surgeon in Christchurch when it happened.

I was intending to go back to Fiji. It was just the timing. I’d got my New Zealand registration but I was wondering if I should get more experience. I was interested in respiratory health because there were still a lot of chest infections and TB in Fiji.

But when the coup happened, there was a huge drain of professionals who left Fiji to go overseas, so all of us who were on government scholarships were asked to go back home.

I arrived back in Fiji in February 1989. The medical superintendent at the time was an Auckland-trained radiologist, Dr Joe Taka, and he asked me what I’d like to do. “Medicine, obstetrics and gynaecology, or surgery?”

Things were really on a shoestring, and the few of us who were there did just about everything.

Those were also the days of 24-hour call. If you started at 8 in the morning, you didn’t finish until 8am the next day. But then you just carried on with your work and finished at 5pm. I don’t know how we did it.

Anyway, I ended up doing medicine for five years Fiji in the hospital and I enjoyed that. But I had to learn a lot of the practical stuff and you depended on your clinical practise to diagnose because the lab was quite basic. It could do kidney function, liver function, maybe a full blood count, but not much more than that.

And Fiji didn’t have bucket-loads of money, so I learned a lot. Before I got there, I’d never put a chest drain into someone who had a collapsed lung or had an effusion of fluid in the lung from TB. One of the interns, who was my junior, taught me how to do that. Because, practically, that’s what they learned in Fiji.

And, though I don’t do much practical stuff now, during my career it helped me especially when I came back to New Zealand.

Api (back row, far right) in Suva with extended family on the Talemaitoga side. (Photo supplied)

What brought you back to New Zealand? 

There wasn’t just one thing. I’d kind of stagnated, professionally. That’s the thing I like about New Zealand — there’s ongoing, continuing medical education programmes. You’re exposed to conferences and gatherings where you go to listen to people and keep learning things.

I remember talking to my colleagues, ex-classmates in Christchurch, and they were talking about tests. CT scans, in fact, and the possibility of something called MRI coming in. I had no idea what they were talking about. In Fiji, we just had basic x-rays to do that.

I thought I’d come back to New Zealand and work, maybe just for a couple of years, to refresh and train. Or maybe come and do a specialty.

But I stayed on in Fiji partly because the Fijian government said they needed me.  And I also had another important job.

In addition to working at the hospital, I was the physician to the president of Fiji, the late Ratu Sir Penaia Ganilau. He had a blood disorder that was flaring up in his old age.

So, I would finish work at the hospital, and then the Crown car would pull up to pick me up. And I’d be taken to Government House, where I’d spend an hour talking to him about his latest blood results — which I would send to Washington DC because his haematologist was at the Walter Reed military hospital there.

I also travelled with him for the last two years of his life. I moved to Christchurch only after he died in 1995.

And you went back to Christchurch hospital, where you’d started out?

Yes, but after a few years there I was able to focus on general practice, which had been my original preference.

I paid my way through the GP training programme and then joined the Elmwood practice of two friends from med school, Kris Yee and Helen Wood.

It wasn’t easy. I had to build up my patient base from scratch because I wasn’t buying somebody else’s practice. But after a few years, between the three of us, we had a great mix of people who came to see us.

That included a lot of Pacific patients who were coming from Aranui, Hornby and other parts of Christchurch, to see me. And that was humbling, because I understood what it’s like when English isn’t your first language. Like, how can I tell this Sāmoan man that he has diabetes, and then get him to understand how to take care of himself?

But that’s what I like about general practice. It gives you the option to bring people back, extend their consultation. Don’t charge them for it, but access this pool of funding if you can, just to make sure they know how they can change their lifestyle if possible.

On the personal side, there was another important reason for me to come back to New Zealand — and that was the question of my sexuality. I had strong feelings of being gay, but in Fiji it was shunned. It’s very conservative — and that was my upbringing. Conservative Christian church.

Very quickly I realised it was going to be difficult to have a gay relationship in Fiji. And one of the hardest things was telling my parents.

But they came over to New Zealand for a visit and I just introduced Alastair as my friend. Then we went on holiday to the South Island together, and Mum and Dad just said: “Oh, you two really like each other don’t you?”

And, although I never said “I’m gay” or ”I’m coming out”, when I went home for Christmas, Mum and Dad just said Alaistair would be very welcome to come.

That was 28 or so years ago, and Alastair and I are still together today.

Api’s parents on a visit to New Zealand in 1995. (Photo supplied)

Api and Alastair in Russell. (Photo supplied)

Thank you for sharing that. It’s cool to hear about what moving back to New Zealand represented all those years ago. You’ve explained how you got into general practice, but I understand that you have other roles too.

Yeah. I’m part of the Pasifika Medical Association, which started around 2000. That’s been a good way to keep in touch with other Pasifika doctors, but it’s also allowed us to make a more effective push for Pacific health.

I also worked on a contract with New Zealand Aid and six Pacific Island countries involving agreements around the medical aid scheme between New Zealand and  Sāmoa, Vanuatu, Fiji, Tonga, Kiribati, and Tuvalu.

And I’ve been on committees, helping review policy papers and things like that.

All that kept me busy, but I made sure I could still have a day at the practice in Christchurch. I need to keep my hand in with clinical work because that keeps me grounded and gives me credibility with my colleagues. I didn’t want to be spouting off on health stuff without hands-on current experience

And now you’re in South Auckland.

We’ve been here for 12 years. And one of the pluses is that Auckland is warmer than Dunedin or Christchurch. Auckland is also the centre of so much of the work in Pacific health.

Our current GP practice is Cavendish Doctors in Papatoetoe. Initially, I just thought: “No, I don’t want to start a practice again. I’ve done it before and once was hard enough.”

But we looked at what was happening in the area, the number of businesses and people needing health services — and that was how Cavendish started.

Saying that, I’m still working at the clinic in Christchurch. When the borders allow it, I do a few days there every fortnight.

Api, left, and his colleagues on the executive of the Pacific chapter of the Royal New Zealand College of General Practitioners. From left, Dr Monica Liva (chairperson), Dr L’Ondine Tukuitoga and Dr Vanisi Prescott. (Photo supplied)

You’ve touched on some of the barriers Pasifika often face in getting proper healthcare, like language. We also hear a lot about the inequities in the system for Māori and Pasifika. In many ways, Covid has exacerbated serious shortcomings in the system.

But there’ve also been pockets of progress — although they sound hard-earned. What’s your feeling about how the last few years have gone?

We’ve had a lot of challenges, but it’s been fantastic to show what Pasifika people can do. Together, Pasifika providers and the Pasifika community have shown that, when the information is made available, and explained in your own language by someone who looks like you and sounds like you, they step up and lead the way.

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

As told to Teuila Fuatai. This piece was made possible by NZ On Air through the Public Interest Journalism Fund.

© E-Tangata, 2022