Canaan Aumua is still in his early 30s, but he’s already making a significant impact in medicine. For a start, there’s been his warm professional touch at Starship hospital and as a GP in Māngere. But he’s seen how limited conventional medical practice can be when the patients are from high-needs communities. So he’s turning his attention to the battles being fought to ensure that Māori and Pasifika voices are well and truly heard in the course of reforming the public health system.
And then there’s the chatbot technology that he and a couple of mates have created. It’s an easy, digital way for patients to have access to medical advice — and it’s also a relief for doctors frustrated by the reality that they can see only so many patients, face to face, each working day. Here’s Canaan, catching up with Dale.
Kia ora, Canaan. I’m told that if I paid more attention to the Bible, I’d be well aware of the name Canaan. But I’m not. You’re the first person I’ve met who’s called Canaan.
Yes, it is biblical. Canaan was the Promised Land, the original name for Israel. My full name is Canaan Tai Pepe Aumua. Tai is from a Fijian uncle on my mother’s side — and Pepe comes from my grandfather on my Sāmoan side. Aumua is a Sāmoan matai title.
I’m a bit of a fruit salad, in addition to my Sāmoan and Fijian heritage, my other grandfather (Mum’s dad) comes from Kent in England. But it’s my Pacific whakapapa that resonates strongest with me.
You’re also a Westie, aren’t you?
Yes. I’m a born and raised Westie, and I still live there today in the Waitakere Ranges. Mum and Dad were both born in New Zealand, but raised back in the islands. Mum’s side comes from Noveicovatu in Fiji, and she grew up in Nadi for most of her early life before coming to New Zealand and going to Rutherford College in Te Atatu.
Dad, Joseph Aumua, was born in New Zealand, but he was raised in our village Afega, in Upolu, Sāmoa. Then he came over to New Zealand and became an Avondale and MAGS (Mt Albert Grammar School) boy. Like many couples back then, he and Mum were married in their early twenties. Dad joined the police force soon after, and he’s still a detective sergeant.
Mum, Linda Aumua, has spent most of her life working in education, both in New Zealand and in Fiji. She’s now the head of Healthcare and Social Practice at Unitec Waitakere.
And where do you fit in your family?
I’m well looked after between my older sister Sharnell and my younger sister Taylor. Shar is an artist, interior designer and everything in between. And Taylor is a freelance journalist who’s done a lot of work for Tagata Pasifika on TVNZ.
What can you tell us about your growing up?
We lived in the wop-wops, in the Waitakere Ranges.
Hardly a bastion of Pasifika people.
Very true. We moved from Oratia when us kids were very young. It was actually by chance that our parents ended up here. Our house was owned by a wealthy Chinese businessman, and he was selling it for what was considered a lot of money back then.
Mum and Dad didn’t have much, but he saw that we were a young family trying to get a start. So he gave it to us at a bargain price. That’s how we ended up here, and it’s been our family home ever since.
But then, when you were getting on to high school age, your mum was looking further afield from west Auckland for you to get your secondary education. And, somehow, you landed at St Peter’s, right in the city.
Yes. And St Peter’s changed the course of my life. I love that school, and often think back to my time there. And it’s interesting how I came to be a St Peter’s boy.
When I was young, I was fairly quick on the rugby field and I played on the wing. I was lucky enough to get into a few representative teams which helped my cause when I was trying to get into a city school, even though I was out of zone.
In the course of checking out various schools, we went to an interview at AGS (Auckland Grammar). But I freaked out there because I didn’t see anyone like me. There weren’t as many Māori and Pacific boys there at that time, and I remember telling Mum: “I can’t go here. Not with no other brown kids. No. I don’t want to go here.”
We ended up walking down the road from AGS to St Peter’s and it was such a mix of cultures with plenty of brown skin. Māori, Pasifika, Indonesian, everything. So I said: “Yeah, this is where I want to be. There’s kids here who look like me, speak like me. Kids I can relate to.” That’s how I ended up there and it was fantastic.
How did you get on at St Peter’s?
The school was great. But I can’t say I was a great student. I was that kid whose report card said: “Canaan could do better if he applied himself.” In my sixth form year, I failed every subject except English. Education is an important thing in our family, so I was freaking out and thinking that I wasn’t going to finish high school, or ever get to university.
But there were a few teachers who sat me down, gave me a good talking to, and became mentors. They helped me change the direction I was heading in. One was Brett McMurdoch. He was the head soccer coach and a maths teacher.
He told me that hard work would always prevail over talent. He’d tell me: “Always ask if you don’t understand. Practise questions so many times that you know the answer before you’ve finished reading it.” Best of all, he’d say: “Enjoy exams. Let it be a time to show the examiners how much you know.”
That’s what did it for me. I took his advice on board, and I worked my guts out. I didn’t play any sport that final year. I stayed in the classroom every break and lunchtime doing maths and sciences, to try making it into university. I just managed that on the basis of that one year’s work. And, to this day, I continue to work exactly how he instructed me — and it’s never let me down.
I’ve never forgotten the work ethic and the human values that the school instilled into me. Our school motto was “to love and to serve”. I can’t speak highly enough of that school and what it’s done for me.
What became of your rugby aspirations?
Well, even though I’d entered St Peter’s as a rugby hopeful, I ended up throwing it all in. I never played rugby there. Instead, I played 1st XI hockey. And, since leaving school, I’ve never played any regular hockey or rugby. So I suppose I’ve been a disappointment to those counting on me becoming a great rugby player. Hopefully, though, I’ve been making up for that through my work.
I’m sure you have. The first step into that line of work, for a number of students, has been MAPAS, the Māori and Pacific admissions scheme. Was that the stepping stone for you?
I did the Certificate of Health Sciences at Auckland University in my first year before I tried competing for a place in the Auckland medical school. It’s a programme designed for Māori and Pasifika students wanting to get into the health sector, but who might’ve been lacking in the sciences, maths or English.
Papaarangi Reid and Elana Curtis were the programme leaders when I was there. It was a fantastic foundation before competing for a place at medical school, which I entered through MAPAS.
There’s been an ongoing perception that the scheme provides an entry into medicine for “brown students with poor grades”, but I can testify that the calibre of MAPAS students are just as good as, if not better than, most other candidates. Everyone these days is a straight-A student. It’s a competitive programme.
It was a great environment for us students. Brilliant, bright, brown teachers who understood our cultural values and how we learn — and who helped us use that information as we went on into our work life.
Lately, as there’ve been discussions about strengthening DHBs and having a Māori Health Authority, we’ve had a reminder that it’s important to have a cultural input to the way we deliver health to our people.
There’s no doubt at all that there’s a need not only for Māori and Pasifika practitioners, but also for Māori and Pasifika leadership in healthcare, if we’re ever going to reduce the health inequities in New Zealand.
It’s true for every sector, whether it be health, education, justice or welfare. If we’re going to see any improvement, and see that gap close, having Māori and Pasifika leaders at the forefront is a necessity.
Papaarangi, Elana, and also Rhys Jones and Colin Tukuitonga are a few of the many who’ve helped advance Māori and Pacific health. They’ve been fighting a long, hard battle, and they’ve paved the way for many of us younger ones to follow.
There are many others as well who’ve added their weight to this fight because they’ve had a strong sense of social justice, underpinned by an understanding of our cultural values, the way we live, the way we work and play.
When you’re out in Māngere, or other deprived areas in the country, you can soon appreciate that good medicine isn’t about textbook information and how high a test score you can get. If you can’t communicate with your patients and your community, then your education can’t be put to good practice.
It must be frustrating for you as a doctor because health can’t be removed from societal influences — such as education, housing and jobs. You’re working in the medical side, but do you sometimes lament that there’s so much to do in order to improve overall health?
Absolutely. The crux of improving health isn’t medicine as we often imagine it. It’s in addressing the social determinants you just mentioned. All of them combined are what drive the health outcomes. Also, the impacts of colonisation on Māori play a significant role in our health outcomes.
Before I was in general practice, I was a paediatric surgical registrar at Starship hospital. Then I turned to working as a GP for 15 months in Māngere, and I soon realised that medicine wasn’t the solution I was looking for. These people were coming in with problems that medicine, and my textbooks, couldn’t solve.
My tablets or plasters were just a temporary fix to get that person through another week or two. It was the leaky, cold, damp homes that were the problem. Or it was the domestic violence, the drug and alcohol abuse, child welfare issues, or poor health literacy.
For example, it’s really easy for doctors to complain about poor medicine compliance, because we feel like that’s a waste of both the patients’ and our own time. But people can’t take their medication on time because they’ve got mokopuna to feed first. And they can’t come to the pharmacy when they don’t have access to a car, or they have no money for petrol.
Sitting across from my desk when I’m practising, the patients may seem like they’re the problem because, for instance, they aren’t taking their medicine or they didn’t bother getting that blood test because they’re lazy or don’t care. But, actually, I can’t think of one person who doesn’t want to be healthy, who purposely wants to be unhealthy and spend what little money they have on advice they don’t want to listen to.
After a year working in South Auckland, I personally felt that most of the health problems affecting my people don’t get fixed in a medical centre. So I’ve started training in public health to try and follow the lead of Papaarangi and all those other public health superstars, because I believe the answers lie at that higher level.
I should acknowledge that I’ve seen you in your doctor-patient setting and I immediately warmed to your style. And I’m assuming that most patients who attend the Turuki Health clinic feel the same way. It’s very down-home but there’s magic occurring there as well. I’m sure you’ve had opportunities to join one of the flash surgeries. But I imagine there’s a lot to learn from working in the lower socio-economic scene.
I loved my time at Turuki — it’s a special place working for a special community. I’d recommend Turuki to anyone who wants an insight into the health of New Zealanders, and who wants to learn “real” medicine. It taught me to think on my feet and adjust best clinical practice to fit the social realities of our communities.
As doctors, we’re trying to do things by the book as much as we can. We don’t like to veer outside the lines. But working in a highly deprived community means that, to be effective, you have to be outside the lines. You have to think outside the box.
Instead of making the patient conform to my best practice and change their life to how I want them to live, I need to change the way I practise medicine to fit in with their lifestyle. That’s the number one thing I took away from Māngere.
I appreciate the time I spent there before I started studying public health. It taught me to be much more flexible — and not set such rigid boundaries about how the patient must conform to what I’m offering.
And it taught me that, even though it was hard, I should keep trying to make sure that what I was offering was going to be useful for that patient, that family, and their community.
There’s more to Canaan Aumua than the lessons you’ve learned as a GP and your interest now in public health. You and your colleagues have developed a chatbot as a digital way to spread some worthwhile medical advice. I note that, with Sanjeev Krishna and Cole Rudolph, you came up with this idea last year when the measles epidemic was doing so much damage in Sāmoa.
Our people in high-need, low socio-economic communities were already struggling with access to health services. So to then have something highly infectious like measles break out was devastating. It exacerbated the existing difficulties so, for us, the question was how we might provide better access to worthwhile advice.
And that’s how we hit on the idea of using chatbot technology. If we were to stick with conventional practice, I’d see one patient at a time, and, if I tried my hardest, I’d probably see 40 or so patients in one day.
Whereas, deploying my medical knowledge into this technology, my chatbot can talk to an infinite number of people whenever that’s convenient for the users. It was a fantastic way for us to give access to sound, accurate health information.
Mītara, our measles chatbot, was the first bot in the world to be launched in an infectious disease epidemic. We were easily able to apply what we learned from that to create Āmio, our latest Covid-19 chatbot which has already exchanged over 250,000 messages across Aotearoa via Facebook.
With advancing technology, I think it’s extremely important that history doesn’t repeat itself by leaving Māori and Pacific Island people behind again. We want our peoples at the forefront of not only accessing these digital solutions, but also designing them so they’re suited to our communities’ needs.
(This interview has been edited for length and clarity.)
ARK is a New Zealand based social enterprise that uses technology to combat issues of health inequity. Its team of creative and innovative thinkers combine their skills and knowledge in medicine and public health with technology and communications to create sustainable solutions to some of health’s biggest problems. www.thisisark.co.nz
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