Dr Siro Fuata‘i has been a GP in Māngere for more than 30 years. He’s also been involved, along with other Pacific doctors, in the push to get the health system to be more responsive to the health needs of Pacific people.
In this kōrero with Dale, he looks at the challenges of working in an area with high social needs, the continuing need for many more Pacific and Māori doctors, and why the overall state of Pacific health is no better than it was when he opened his practice in the Māngere Town Centre more than 30 years ago.
Mālō, Siro. Let’s start our kōrero with you telling us about your whānau, and then we’ll talk about your pathway through school and the studies that led to your long career in Pasifika health.
Kia ora, Dale. I’m Sāmoan, but I was born in Port Moresby in Papua New Guinea when my parents were missionaries there for the LMS (the London Missionary Society).
And my name, Sirovai, comes from the large river near the place they worked. My parents were there for six years before returning to Sāmoa.
My father, Fuata‘i Tuautu, was a church minister. His mother’s family is from Lauli‘i and his father’s family is from Apia. His father was Lofipo Vasa Seumanutafa, but he was informally adopted by a great aunt from Lauli‘i. He’d stay with his adopted family in the weekends and go back to his parents during the week so he could go to the Marist school in Apia. And he has kept his adopted name Tuautu despite his father’s family asking him to change it.
My mother Lusa’s family are from Moata‘a. Her parents Iupati and Mauinu‘uese Imo trace their roots to Sapapali‘i and Iva in Savai‘i. Our family have a strong presence in Moata‘a where my older brother holds the title of Tofaeono and a younger brother has the title Asi Leulua‘iali‘i.
After my parents completed their mission in PNG, they returned to Sāmoa and my father took over as the church minister in Vaiala where I grew up. That’s where I did most of my schooling. I went to Apia Primary, then Sāmoa College. And then I spent a year at USP (the University of the South Pacific) in Suva before going to Dunedin to do medicine.
I met my wife Rosaline in Dunedin where she was studying law, and we got married in Apia. Both of us had come to Aotearoa as part of the Sāmoa Government scholarship programme. We intended to do a couple of years work and then return home. But our first baby, Saleima, had a difficult birth and had cerebral palsy. We stayed here to make sure that she had the care she needed.
She passed away when she was 14 and we buried her here in Tāmaki Makaurau. We decided then to not go back to Sāmoa to live, since she was going to be here all the time.
Our two other children are Teuila and Fa‘asi‘u. Teuila, as you know, is a journalist here in Tāmaki Makaurau, and Fa‘asi‘u is currently playing rugby in the US. His club is Rugby New York, which is part of the Major League Rugby competition.
When I graduated from the Otago med school, I spent five years working at Wellington Hospital. Then another two years in Rotorua — and finally to Auckland where I am now.
What have you specialised in through those years?
Initially, I focused on obstetrics, but during the holidays, when I did some locums, I found that general practice was especially interesting, so I gravitated towards becoming a GP.
I started a practice in Onehunga-Royal Oak in 1986, with a colleague of mine, Leone Dillon, another Sāmoan doctor. We rented an old house there, and many of our patients came from across the bridge — from Māngere, Ōtāhuhu, Papatoetoe, as well as west Auckland.
Eventually, we decided to sell that practice, and I relocated to the Māngere Town Centre in 1990. And that’s where I’ve been ever since. The clinics operate under the name of Bader Drive Doctors and we have a branch in Manurewa. I also started another GP clinic in Manukau 2013 with a friend, Dr Api Talemaitoga, called Cavendish Doctors.
How was your English when you first arrived in Dunedin?
It was okay because, like a lot of us in my era who went to Sāmoa College, we weren’t allowed to speak Sāmoan at school. If we did, we were put on detention. So my English wasn’t too bad.
But the cultural change was a challenge. It wasn’t a shock but it was an eye-opener in many ways. The way of life, the way people did things. Student life had lots of liberal aspects to it and few restrictions. Things like alcohol, partying and junk food were freely available — and that was a big change for me.
For many years, there’s been a strong push to get more Māori trained and working in medicine. Were you aware of those efforts when you were in Dunedin?
Yes, I knew about the moves to increase the number of Māori and Pacific and minority ethnic groups getting into the training schemes for medicine and dentistry.
I think it was a good move to encourage those students to believe in themselves and say: “Look. I can do this type of work.”
And that’s been really valuable in addressing health and social issues that Pacific tend to be overrepresented in. For example, Sāmoan and Pacific health professionals have been essential to engaging local families around diabetes management, smoke cessation — and, of course, Covid.
But we need to keep looking at the pathways into the health workforce for young Pacific people. There are a lot of scholarships and grants available but many people and families don’t know they exist, or don’t how to access them. It’s important to connect young Māori and Pacific people to them, otherwise our numbers will never improve.
As it is, the Māori and Pacific workforce doesn’t meet the demand — which is a bit sad. So, we need to work harder.
One of my interests when I started as a GP was to encourage young Pacific medical students to go into general practice, and I was given funding for that. It’s still something that I’d like to develop more. We need many more Pacific GPs in our communities to address the issues that we have.
And helping the Pacific workforce to have an identity and develop lobby groups is important, too. There’s a tendency for health policy to lump minority groups together, and then come up with generic solutions which don’t necessarily work for us. So we need to lobby for ourselves because we know what our needs are — not just in terms of being patients but also in developing workforce and social support. It means we’re more likely to get solutions that work well for Pacific families and communities.
That’s why I and some colleagues (Alec Ekeroma, Teuila Percival, Debbie Ryan) started the Pasefika Medical Association a few years back. Now we also have the Pacific GP Network and the College of GP Pacific Chapter.
You can see the value of having our own people in the health workforce if you look at how we met the Covid challenge and at the way our Māori and Pasifika doctors have been able to connect with our communities.
And that also includes having people in senior policy-making roles. For example, Debbie Ryan and Api Talemaitoga have both been advisors to the Minister of Health on Pacific health.
Some might say that one doctor is pretty much the same as another. But it’s clear that our people prefer to see a reflection of ourselves when we visit our GPs and other medical facilities. What would you say of that preference — and that brown faces in medicine are important if we are to improve the health of our people?
It’s a very real thing. Brown people much prefer to see a brown doctor. And to be honest, most Pālagi are the same. Naturally, there’s a sense of connection and engagement when you see somebody who is like you. I have to say that, personally, I find it comforting being seen by a Māori or Pasifika doctor.
And, over the years as a GP, I’ve realised it’s not just the brown patient who’s more comfortable with a brown doctor. Doctors who have similar backgrounds with their patients often connect better with them. It’s a kind of familiarity that makes it easier to understand what’s worrying someone, or the issues they’ve come in with.
Are you saying that there’s an important role for a GP as a confidant, a counsellor or a caring uncle or aunty which shouldn’t be understated?
That’s right. What I found is that many of the Pacific and Māori patients came with quite simple issues that they might be reluctant to share with a Pālagi doctor.
If you didn’t have a cultural connection and an understanding of their background and their situation, you wouldn’t appreciate their anxiety about their ailment. It might be something quite minor, but the fact that you do understand what they’re talking about is important.
It could be that somebody mightn’t want to go to the local medical centre because they’ve got no money. And, of course, they’re whakamā about that. So they’ll sit on the problem for days or even weeks — and, in that time, possibly become really unwell.
But if they find out that there’s a brown face in the medical centre, maybe they’ll try to get an appointment despite their discomfort about the money. And they’ll be reassured and encouraged in the future to come as soon as they have a problem.
I suspect there’s a number of whānau who don’t get the help they need when they need it because they can’t afford it. How can we deal with that problem?
What we and other clinics in South Auckland have done is use some of the funding streams from the DHB to help people who really need health assistance but can’t afford it. The same goes for those who may not have primary health issues but who do have social problems. When they come into our clinics, it’s usually because the doctors are the only way they can access help.
We say to people: “Look, we don’t want you to feel that you have to pay that. There’s some funding that we can put you on and you don’t have to worry about it.”
For example, certain forms of contraception for women are funded by the DHB. A lot of women also qualify for free cervical smears, and there’s also certain mental health counselling and treatments which are funded.
If patients don’t qualify for any of the funded services, then we try to find another way of helping them without making them feel anxious about payment. It’s important that people know there are pathways which make it easier for medical doctors and practices in the community to help those who need it.
We know that there are social determinants for health — including rent, incomes, access to quality kai — that a GP can’t resolve. What do you say when you talk to young GPs? We can do so much, but we can’t do it all, can we?
The majority of health problems tend to come out of those social inequities, and in the medical profession we’ve changed our attitude. We help our patients with their medical problems, but we also work hard to refer them to agencies that can help them with other things that inevitably impact their health.
Many medical practices are now associated with social services that provide support with housing, transport, food, looking for jobs. It’s a wraparound approach that works well for Pacific and Māori.
We often refer to Sir Mason Durie and Te Whare Tapa Whā. It’s the need to align the spiritual with the physical, the mental and the emotional. These are all determinants of health. Is it a model you advocate for those training to be frontline Pasifika doctors?
A lot of Pasifika and Māori whānau place a strong emphasis on the spiritual part of their wellbeing, so we certainly encourage younger doctors to recognise that.
What makes a good GP?
I think it’s important to be part of the community where you work. In my case, I’ve worked in South Auckland for more than 30 years. Before I set up my own GP practice here in 1990, I spent five years as a locum in the area. And although I don’t live in Māngere, I’ve been part of various community groups like Sāmoa Atia’e, a social support group in Māngere. And Te Puaha Oti Ora, a Counties Manukau disability support organisation which became part of Taikura Trust when it was established by the Ministry of Health in 2002.
I also think it’s important to work with younger doctors — it’s not just about getting them into the workforce. They also need to understand everything else that goes into being a Pacific GP. The relationships I’ve built within the community, which includes many of the local churches and congregations, takes time to develop. And they’re an invaluable connection to the families and people we look after.
That’s really come out during Covid. And it’s been great to see how our younger health professionals have stepped up. Many have run community events like vaccine drives or information sessions for groups in South Auckland — and, through that, the communities have felt a special sense of belonging and connection with them.
I’d also say a key part of our work is being able to speak a Pacific language. Most of our patients are Pacific and they may not speak English as well as their native language. If you can speak their first language, it’s much easier to understand what they’re trying to explain to you, and it’s easier for them to understand what you have to say.
We have people on staff who speak Sāmoan, Cook Island Māori, Niuean, Tongan, Tokelau, Fijian, Hindi, Sri Lankan — and, of course, English.
Although our focus is Pacific, we do have a lot of Māori patients as well — and for those who prefer Māori input into their health, we refer them to Turuki Health Care across the road. We also have a relationship with Pūkuaki marae.
What have been the successes in your time here? You mentioned the way Covid galvanised the Māngere health providers and community groups. Are there any other successes you can point to?
The meningococcal campaign which was run through local schools and general practices made a huge difference.
About 20 years ago, meningitis was widespread in the South Auckland community. The Ministry of Health started a national campaign to specifically vaccinate and eradicate the disease — and it began in South Auckland. We were involved in delivering the vaccine and education around it.
And in the last 10 years, it’s been rare to get cases in the community.
Would you say things have improved in terms of access to primary healthcare for Pacific and other low-income people generally, in the time you’ve been in South Auckland?
I don’t think so. The main barrier to primary healthcare is still cost and having access to a GP of your choice. There aren’t enough GPs and our population continues to grow. Overall, the health standard of Pacific people is no better than it was 30 years ago — in fact, there are a lot more people with serious medical issues.
There also aren’t enough services to meet that demand, which means it’s harder to get help when you need it. And the cost of going to the doctor and getting medication is still a major barrier for many people.
What’s the change you’d most like to see as a South Auckland GP?
I think free GP visits and free medication from the pharmacy would make a major difference to a lot of people in South Auckland. It would take away the stress of seeking help and getting medication for so many families.
And, as we touched on before, better social support for people with serious health issues would also make a big difference. This includes a good home, a job, and enough money to live.
Too many families don’t have access to affordable quality homes, which affects their overall health and quality of life. And benefit rates that actually cover the cost of living would also make a difference to the people who need that support.
What is it about Māngere that keeps you there?
The people of Māngere are proud of their community. There’s a sense of ownership. In a way, it’s like a village. There’s a mix of ethnicities and all sorts of religious groups, and they all tend to work together. They’re proud of what takes place here, especially with the difficult social issues a lot of people face.
They say: “Well, you know, this is Māngere. And this is how we do things.”
(This interview has been edited for length and clarity.)
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