We’re still falling a long way short of a health system that fairly serves tangata whenua. And the anguish continues for the tens of thousands who haven’t yet found a way to recover the reo Māori that their whānau have lost through recent generations.

But we do have inspiring advocates and role models in those fields. And here Dale meets one of them — Dr Lillian Angeline Fraser. She’s a southern woman (Kāi Tahu, Kāti Māmoe, Waitaha) who’s been making her mark as a GP and teacher through Turuki Health Care in Māngere over the last 10 years.

 

Kia ora, Lily. I understand that your name — and Lillian, the formal version — go all the way back to a pretty special great-grandmother who was based at Pūrākaunui, just north of Dunedin.

Kia ora, Dale. Yes. Nana Lil was a really important person in my mum’s whānau. There were seven tamariki in her whānau, and every time a new baby was born, Nana Lil was there for that first year or so.

As a schoolgirl, she was one of those who was hit for speaking Māori — and we still carry that mamae with us. She was the last one in our whānau who had the reo. Until me.

Pūrākaunui is where our whakapapa Māori is from. I consider that to be my tūrangawaewae. It’s where we went as kids for holidays and I have a whare there now. I call it paradise. It’s beautiful.

Tell us about your old man and your mum.

My parents were together only briefly. My dad is Ray Millard and my mum Jacqueline Fraser. They married and lived out at Ōtākou, one of my marae on the Otago Peninsula. I was born at that marae and took my first steps along that beach.

Mum had grown up not knowing that was her marae. She moved out there purely because it was a beautiful place. Then, in talking to the locals, they found out that her nana was Nana Lil. And they were like: “Oh, yep. This is your marae.”

My mum left my dad when she was pregnant with my brother Rata, who’s two years younger than me, and we came up to Auckland. We went back home to Dunedin most holidays, though, so I felt connected.

Mum had seen the state of the reo on our marae at Ōtākou in the early 1980s. In those days, we just didn’t have te reo. Our paepae was rote-learned mihi, and then the rest of the whaikōrero was in English. Same with our tāua (kuia) for our karanga and waiata. Those were all learned by rote.

But when we moved up to Auckland in 1982, the kōhanga reo movement had just kicked off and Mum saw that as an opportunity to have the reo in our life.

So we were kōhanga babies. My brother Rata was born into kōhanga reo. We went pretty much through the whole of our education in te reo Māori — right through to high school at Te Wharekura o Hoani Waititi Marae.

Did you guys move out to west Auckland? Or did your mum travel a lot to get you there?

We lived in central Auckland. We went to kōhanga reo in Freeman’s Bay and then we went to Grey Lynn primary which had a strong total immersion unit. Same again at intermediate, but the local high school was Western Springs which wasn’t strong with their reo at that time.

Then Mum bumped into Victor Mokaraka who was the tumuaki at the Hoani Waititi wharekura, which had been open for one year at that stage. And Mum had a bit of a moan to him about the options for me. And he said: “Oh well. Send her up to us. We need more students.” So that’s how I ended up at Waititi for high school.

I went as a third former and caught the train out there. I thought I wouldn’t know anybody, but as it turned out, some of my kōhanga reo mates were in my class.

Your mum sounds like a very committed person. Did she end up working in te reo Māori mahi?

She’s an artist. She does collage at the moment but she’s had many different mediums over the years.

While we were at kōhanga reo, she went to university to study te reo Māori. She just saw so many opportunities for us by speaking Māori.

She can understand reo pretty well and she can manage our kids up to the age when they start school and then she struggles a bit. But she is committed to te reo and tikanga Māori.

Without her, perhaps your life would’ve turned out much different?

When we were little, she was into homeopathy and naturopathy and lots of clean eating which has followed me through my life.

She had a big vegetable garden and she became connected with different tohunga Māori during my late childhood and into my teenage years. She turned to rongoā Māori, so we were drinking kūmarahou, kawakawa, and all those sorts of things.

I don’t think I had a single course of antibiotics in my whole childhood. But she was the one who directed me towards medicine. Your parents know your āhua and what your strengths are.

Because we didn’t have doctors in our lives, I’d never considered being a doctor. But she read an article in a Mana magazine about the MAPAS programme — which is the Māori and Pacific admissions scheme at Auckland University’s medical school.

She cut the article out and said to me: “Take this to school. Do you think your mates would be interested in this? And how about you have a read as well?”

It immediately resonated with me. I think there were two parts to that. One was the manaakitanga side of things, which is my nature. I’m quite a mothering person. At kura, I was always the one brushing the kids’ hair or looking after the little ones.

But I also enjoyed the academic side of school, and that came easily to me.

People had told Mum that kura kaupapa would ruin my opportunities to go to university — that it was all very nice to learn te reo and tikanga and kapa haka but, educationally, I was going to suffer.

So there was always that side of me that wanted to prove those people wrong.  Medical school appealed to me because the perception of med school is that you’ve got to be brainy and it’s difficult.

But the thing about kura kaupapa is that, if you have a dream, they’ll figure out a way to make it happen. And so I said to my principal, Whaea Bev Manahi: “I might want to go to med school.”

And it felt like, just the next week, she had this med student come in and tell me all about it. And that set me on that path.

In your practice at Turuki Health Care in Māngere, you try to factor in aspects other than just the ailment. You have an understanding of lifestyle pressures, employment, unemployment, housing — and you approach things in a holistic way, don’t you?

I grew up in Grey Lynn and Western Springs in the ‘80s when life there was similar to what Māngere is now.

My mum was a full-time artist, and the reality of being a full-time artist is that you often can’t sell enough to live on — and so most of my childhood was spent on a benefit.

Still, I had an amazing childhood, and I was privileged in many ways. But financial privilege wasn’t one of them.

My firsthand knowledge of being poor and having to struggle means it’s easy for me to understand what patients are talking about.

The advantage of primary care is that, as a GP, you have a lot of autonomy, provided you’re practising safely, to have your own special interests and things that you want to focus on.

At Turuki, we do low-carb, ketogenic and fasting diets, and we support whānau with health coaches to make lifestyle changes.

We’ve also developed our Aronui wellbeing service which includes Wairua Practitioners and many group wānanga from maramataka to Māori meditation orokoroa and whatu kākahu. You can’t just do one aspect. You can’t just do tinana (physical health) because, if you just do tinana, you’re never going to support people to a place where they are thriving.

I feel fortunate that the kaupapa of Turuki is so in synch with the way that I see the world. It’s a fantastic organisation to work for.

Many people may not realise that you have this taha Māori? Did you ever feel uncomfortable at kura or have occasions when people underestimate your reo Māori?

I look Pākehā and a lot of fair Māori go on that journey of needing to accept that they are Māori because they have whakapapa Māori and that’s their birthright.

But I haven’t really struggled with that. I think that’s because of the education system that I’ve grown up in. If you’re in kōhanga reo and kura, everybody knows your whakapapa and there’s no questioning that.

Often, when I see patients, they don’t know I’m Māori when they first meet me. And I get the comment all the time: “Oh, I didn’t realise you were Māori.” But I don’t get offended by that, because I wouldn’t know I was Māori.

But with patients, before we even get into “Why are you here?”, I think it’s important that we have that kōrero about who we are first. “Ko wai koe?” “Ko wai ahau?”

With new people, you need to start with whakawhanaungatanga. You take that step back and say: “I’d just like to learn more about who you are and where you’re from. And this is who I am and this is where I’m from.” And that makes it easier.

I do have patients who come specifically to me so they can have their consult in Māori. Or they bring their kids who are in kura so their doctor can speak Māori to them.

I had one parent say that their son was especially happy that his doctor could speak Māori. That was really important for them to model to him that te reo Māori can be everywhere and can be used in te ao hurihuri (everyday life) because sometimes it can feel like it’s limited to kura.

That’s the coolest thing. I still buzz out when I do a whole consult in Māori.

Who would you describe as your biggest influence as a med student? And how do you respond to those critics of the Māori-Pasifika scheme to get more brown students into med school?

 When there’s a small group, you stick together. We were fortunate as medical students that there were so few Māori doctors that we knew everybody.

The doctor who I loved and admired was Dr Paratene Ngata, who passed away in 2009. He was a GP in Uawa (Tolaga Bay) and he was our kaumātua. If things got quite heated in hui, he had a way of settling everybody with an “All right then?” and a laugh.

I did three placements with him in Uawa — and the way he served his whānau, because he was from there, was lovely. He just had a beautiful āhua. He was Dr Pat. “Panadol Pat” they used to call him because Panadol was his most prescribed medication, as it is for me.

Then we have our mana wāhine. Papaarangi Reid, who’s a leader for us, Matire Harwood, and Sue Crengle. And Rachel Thompson down in Te Kaha who I also had a couple of placements with. I just loved having that rural GP experience with both her and Pat.

What I loved was how committed they were to their whānau. There was always a way to achieve what they needed to achieve. The quality of care was amazing — and still is for Rachel who’s carried on working in Te Kaha.

In terms of the admissions scheme? We were at med school when Don Brash did his speech in 2004 about wanting to abolish admissions schemes. That’s just happened again and it goes around and around in circles and feels like nothing’s changed.

We were the first big group of Māori and Pacific students to go into Auckland medical school. There might’ve been 34 in our class — whereas, previously, there might have been 10 to 15.

When there’s a good many of you together, you can kind of just stick it out.

When things were getting tough, we got together and had a wānanga with Moana Jackson. He reassured us that, as long as there are inequities in the health workforce, then this system is needed.

We will happily give up the admissions scheme when the percentage of Māori doctors is proportional to the Māori population — and when we have equity for Māori health. When Māori are achieving academically and getting into medical school without any extra support, then we’ll walk away from it.

But until that happens, it’s needed.

What do you think of the idea of a Māori health authority?

At Turuki, we’re pushing to do more than just te taha tinana and te taha hinengaro. They are the two things that health is focused on: the body and mind.

Mainstream health hasn’t done wairua well, or whānau well. So we’ve developed our own Māori model of health care.

Plus, we need added support to compensate for how disadvantaged we are in the current health system. That costs money. We can’t expect to spend the same amount that non-Māori spend and get a better outcome, or to lift our outcomes to that level.

That’s because we’re so far behind. We require a lot more resource — and that resource is money. To have more kaimahi, to have the different model, requires more pūtea.

I’m hopeful that the Māori Health Authority is one of the avenues to show that we can do this for ourselves, and we can do it in a way that achieves equity.

Take a person who has a problem and needs to get a certain test that’s free in our health system. That sounds good on the surface. But even though it’s free, there are all these barriers in front of them.

It might be that they don’t have a car. It might be that they work long hours. Or that they’re a caregiver for somebody and can’t leave that person alone. Or they don’t have a phone. There are all these barriers to get that free test.

To support somebody to get that test, you have to be able to do things differently. You have to take the time to develop a relationship so that whānau trust you enough to tell you what’s going on for them. And that requires more time, so you can’t see so many people a day.

It’s not just about doctors and nurses. It’s Whānau Ora navigators, health coaches, social workers, wairua practitioners. You want to be able to support people to do the things they need for their health.

What added pressures do lower income communities face, and what are our most pressing health priorities?

I think having a lower income makes everything harder. Many of your choices around basics are severely restricted — warm housing, nutritious food, transport, education, jobs, all of it.

The impacts of colonisation are ongoing, as is racism — in our health system, towards us as a people, and, sadly, sometimes even our own view of ourselves can be negative. That creates so much stress which in turn creates disease and feeling unbalanced. It affects you and your whānau.

I think ultimately you’ve got to go back to first principles and look at self-worth and identity.

At Turuki, we’re learning how to reconnect with mātauranga Māori — through connecting to the environment with maramataka and pure, through karakia, takutaku, and being together in wānanga. We do a lot of teaching in our practice, and we’re upskilling staff all the time to ensure that we’re doing the best by our whānau and providing high-quality care.

You’re a proud māmā. How has being a parent changed the way that you work, Lily? And is your kōtiro a kura kid as well?

The best thing in my life is being a mum. I was born to be a mother. I would happily have been a mother at a much, much younger age, and so, looking after a child has been easy for me.

My daughter Tui is nine now and she goes to Te Kura Māori o Ngā Tapuwae which is our local kura in Māngere.

It has amazing leadership from Arihia Stirling, Ma Stirling. I’m so happy that Tui is in kura and can speak Māori.

But I’ve come to appreciate how difficult it is to raise a child speaking Māori.

Even with all the amazing resources that we have now, with Māori TV and so many opportunities to hear te reo Māori, she still wants to watch Pākehā YouTube.

When I was at kōhanga, my mum and the other parents were getting English storybooks and putting white masking tape over the words and re-writing the books with a vivid pen in te reo Māori. Those were our books because there were almost no resources out there yet.

So I can see how far we’ve come in 40 years, but also that we haven’t come far enough. I hear that over and over from so many whānau who can’t access good quality Māori medium education in their area.

The parents who make it happen are the ones who are prepared to fight, to drive, to make sure that their kids get te reo Māori. But they’re struggling. Their battles are nothing compared to the 1980s and ‘90s, but they’re still finding it tough.

I’m guessing that you don’t have much spare time — and not much room for pastimes. 

Well, I’m a big reader. I read every day. My other new interest is making kākahu (feathered cloaks). I made a small one first which I gave to my friend and now I’m making an adult-sized one for my partner’s three nephews. The first of them will graduate at the end of this year.

I’ve finished the tāniko and I’m about to start on the feathers. I’m spending probably on average about an hour a day and have been working for the last two months on this one.

I’m obsessed with it. I just think it’s beautiful and there’s lots of time to do things while you’re making kākahu. Just thinking, or listening to music or podcasts.

You have to have a little bit of a creative outlet. So that’s my biggest passion at the moment.

 

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

© E-Tangata, 2021