Suzanne Marie Crengle has more than made good of her childhood dreams of becoming a doctor. There was med school (1980–85), a stint as a junior doctor, next as a GP, and then many years working in public health, the academic world, and doing research on what she sees as the big health priorities for Māori — especially cardiovascular disease, asthma (especially in our kids) and lung cancer.
Not surprisingly, she sees colonisation and the racism that’s come from that as significant factors in the sub-standard treatment that Māori have often received.
But the research that she and her colleagues have been doing has been helping deliver solutions. Here she is talking with Dale about her lifetime of work and her focus on Māori health.
Tēnā koe, Sue. Seeing that you’re a bit of a rockstar in our Māori medical scene, it’s time we got to know more about your career. Can you tell us about your names, your whānau, and where you grew up?
My first name is Suzanne but, when I was a child, I was only ever called Suzanne if I was in deep trouble. My whānau used to call me Suzie, and in my adult life I’m known as Sue. My middle name is Marie.
I was born in Waiouru, because my dad was in the navy, and there was a communication station there that he was posted to. I grew up in Wellington and Auckland. Dad worked at the defence department in Wellington and the navy base in Auckland.
For most of my childhood we lived in Cannons Creek in Porirua, and Elsdon and Titahi Bay, and that was where I did most of my schooling.
I went to Mana College in Elsdon until the end of sixth form, and I did pretty well at school. But I remember, before I started at Mana College, Mum and Dad had to fight for me to be able to do te reo Māori and be in the top class.
In those days, we were “streamed” so that students taking French were in the top class and those taking Māori were in the bottom classes. Mum and Dad ended up going to Whetu Tirakatene-Sullivan and Gerry Wall (who was the MP for Porirua at the time) and had the streaming system changed so I could do Māori and be in the top class.
We moved to Auckland for the last time when I was just about to start the seventh form, and I went to Pakuranga College.
Your Māori connections are all south-based, right?
Through your mum?
My whakapapa is through Dad. I’m from the Ōraka Aparima rūnaka, and our marae is at Ōraka, or Colac Bay, right on Foveaux Strait, or Te Ara a Kiwa. It’s beautiful.
Did you go straight from school to varsity?
One of my earliest recollections was Dad saying to me: “When you grow up, you’re going to be a doctor.” He had high aspirations for my sister Hana and me. He wanted us both to go to university and to get that type of education.
My mother was a primary school teacher, and she was very keen to support us in whatever we did. Having had that message from Dad when I was really young, at about 9 or 10, I kind of decided that I wanted to be a doctor — and I stuck to that aspiration.
I got into med school under what was then called the Polynesian Preference Scheme. These days it’s called the Māori and Pasifika Admission Scheme.
Did you feel that some people looked down their noses at you and others who came in through that scheme, or something similar?
There were some students who thought it wasn’t fair, but they didn’t understand that the reason those schemes are in place is because our education system, and our secondary school system in particular, isn’t a level playing field. Those schemes are there to help address some of the inequities in our secondary schools.
I knew that I’d got into med school with one of the lowest marks in the class, but I finished med school in the top 20 per cent, which I think goes to show that supporting Māori into med school is important, especially given what we see in the workforce, where we’ve got so few Māori doctors.
You teach a cultural component with aspiring health professionals now, but what was it like in those early days when you were at med school? Was it a one-size-fits-all sort of model that was operating then?
Pretty much. There were individual teachers and staff who were aware of the importance of supporting the Māori students and who were thinking about Māori health outcomes in a different way. But, in general, it was one-size-fits-all.
I was at med school from 1980 to 1985. In the policy world, we were only just starting to do biculturalism in those times. It’s vastly different today, and I think we should celebrate that. We’ve still got a way to go, of course, but it’s vastly different from what it was in the early 1980s.
So, you studied for six years and became Dr Sue. Where did life take you then? What were your first appointments?
I did five years in hospitals — all in Auckland. Two years as a junior doc and then three years training to be a psychiatrist. I changed my mind after those three years and left to go into general practice. I did a couple of years in a so-called “mainstream” practice in west Auckland.
Then, in 1991-92, the National government announced a set of health reforms. What those reforms did was allow a lot of the Māori providers that we see today enter the health sector.
Te Whānau o Waipareira Trust in West Auckland was interested in doing that, and so, when those health reforms came into place, I and Nikki Turner and Marion Hakaraia worked together and set up Te Whānau o Waipareira Health Services.
That included a general practice at that time, and we had some really innovative — for those days — community-based programmes.
We had a mobile home that was decked out as a clinic, and I used to go to all the kōhanga and the kura. And then, when the whare kura was set up at Hoani Waititi marae, I used to go there three times a year and do health checks on the kids.
We used to do women’s health checks out in the community, and there were kaumātua programmes. We had a great time doing good mahi out there in the Waipareira rohe.
The thing about providers like Waipareira — the Māori providers — is that they have a high proportion of what the government calls “high needs patients” (Māori and Pasifika) using their services.
These are people who live in the more deprived areas. And we know that people who live in more deprived areas have higher health needs and health problems. So, there’s a health burden, if you like, and a higher complexity of patients who use these providers.
That’s great if you’re a doctor, because it makes you feel like you’re making important contributions and have the opportunity to support patients and whānau to make significant decisions with their lives. And that’s really rewarding, as a doctor.
I read somewhere that you went into bat for a colleague, and I’m assuming it was Nikki, after her GP trainer said that hugging your patients when they arrive at a consultation was sexually inappropriate.
That seemed to rile you, because this is very natural behaviour for our people. What affected you so much about the way that trainer responded?
Because they were totally wrong. It was a kaumātua — it was a kuia who’d come into Nikki’s office. In those days you needed to do videotape consultations — with the patient’s consent, of course — and then they were reviewed by trainers. So, quite naturally, Nikki gave this kuia a hug when she walked in the door. And then she got this feedback.
I was infuriated, because it was an attack on a totally culturally appropriate thing to do. The College of General Practitioners were having their conference in Auckland that year, and they used to have this evening where you could go along and talk to the board. So, off I trotted to the board, in a highly indignant state, and said the feedback had been inappropriate.
I think there were one or two board members who didn’t agree with me, which shows that even in the 1990s there were people whose cultural competence was lacking.
But there were others on the board who acknowledged that the feedback may not have been appropriate in the context of where we were working.
Let’s also note the whakawhanaungatanga in these medical settings. We often are exposed to the negative statistics of Māori health. Can you touch on the warmth of the workplace, and the people, and the appreciation they show when you’re kind to them?
Yeah, without a doubt, the whanaungatanga of working in Māori providers is fantastic. Recently, the early staff from Whānau o Waipareira all got together and had dinner, and we hadn’t been together like that for a very long time, and it felt like a whānau reunion. We’re bound together by tikanga, and those core values that we have that you don’t necessarily find in the so-called mainstream practices.
With the people who use the services, you often develop relationships based on humour and whanaungatanga, because I think people have a greater sense of trust in you, because you’re Māori. When we know that so often people’s experience in mainstream health services hasn’t been great, for them to then have that extra trust in you, because you’re Māori as well as a doctor, is a privilege.
I noticed that your thesis is on the Well Child services and was written from your experience at Waipareira. Why did you choose that kaupapa, and what were you able to share that obviously impressed those who were helping you through that part of your academic study?
That was my master’s in public health thesis, and I was interested in how health services were designed and how they operated. There wasn’t much information in the public sphere about Māori services in those days, so I wanted to describe the Whānau o Waipareira Tamariki Ora service, and also to identify what some of the challenges for that service were, so that Waipareira could use that when they were engaging with funders and other organisations.
After that, you opted to help train others to be contributors to our health sector, and to factor in these cultural components that perhaps were missing. There are many shortcomings in the delivery of health services to Māori —institutionalised bias, racism, and so on. Why is it so, and what needs to be done about it?
In my opinion, the underlying problems associated with hauora Māori outcomes arise from colonisation, because the underlying ideology in Aotearoa’s case is that the European people and their culture and their ways were superior to Māori — and that still permeates the institutions that were established, and that includes the health system and other societal structures.
Racism is a component of that, and institutional racism reflects those inequalities in power, and we see that play out in the way social economic status is unevenly distributed between Māori and non-Māori. That has a huge impact on health.
We’re starting to get to grips with this in medicine. We’re starting to get to grips with the role of implicit bias, and the way it can affect how we, as individual doctors, interact with people, and how we investigate and treat and manage different people’s illnesses.
We all have implicit biases, because we all have stereotypes, but those stereotypes can affect the way you engage with people, and how you treat and manage them. That’s when it gets us into serious trouble, and we become contributors to inequity.
Your academic work has been prolific, with nearly 140 published articles and 40 papers, including annual reports into perinatal and maternity mortality, Pharmac, and so on.
Moana Jackson spoke and wrote about the differences between Māori and mainstream research methodology, and how important it is to acknowledge the role of colonisation in the research space. What are your thoughts on that?
It’s 100 per cent important to acknowledge the role of colonisation in the research space, and the kind of harms that research has done in the past.
I do a good deal of kaupapa Māori research, because I try to focus on health services and the contribution that health services make to Māori health outcomes primarily. I do some research in other areas such as rangatahi health as well, but primarily my interest is in identifying inequities and then trying to make sure that our health services and programmes are equitable, that they’re culturally safe, and that Māori get good outcomes.
You mentioned harm done in the past by research. Could you flesh that out for a moment?
One of the ways that research has been unhelpful or harmful is that researchers would drop into communities, do the piece of research that they were interested in, and then bugger off again.
What was the impact of that research? Were there positive impacts of that research for Māori? Who knew?
What typically happened is that researchers wouldn’t engage in whanaungatanga or anything that might make people want to participate or feel safe and valued in participating.
Another problem was that, in some research, the participants reflected the total population, which meant that the number of Māori participants was really small, and so we could never work out whether those research findings reflected our experience.
If you have research findings that are based primarily on non-Māori people’s experiences or data, then what’s done with that finding may not benefit Māori if our experiences are different. And that’s potentially harmful.
Today we have research questions that are important to us, we have appropriate tikanga, we have the Māori community involved in the design of the research, and we make sure that there are enough Māori participants.
Lung cancer and asthma research loom large in some of your research. Why so, and what would you regard as the major and most pressing health need that our people face in 2023?
I like to do research on things that I see are big health priorities for us — cardiovascular disease, asthma, particularly in kids, and lung cancer, which is the biggest cancer killer for us. I think that, if we can design a lung cancer screening programme which works for Māori, we’ll be able to make a good contribution to the terrible inequities in lung cancer that we experience.
If I put my public health hat on, I think a major challenge that we face for hauora Māori is about the social determinants of health. If we look more specifically in terms of health problems, I think the health and wellbeing of rangatahi, as the up-and-coming generation, is really important. Then you’ve got all of the usual candidates in terms of adult health: heart attacks, strokes, various types of cancer.
You’ve had many accolades across your career. What tohu do you hold most dear?
I’ll give you two examples. A few years ago, I was sitting in a café in Kingsland, and a man came up to me, and he said: “Sue Crengle?” I said: “Yeah.” He said: “My name is so and so.” I looked at him and I said the name of a patient, who was his mother. I’d looked after her during her final illness. She passed away at home. He was very kind to me in what he said, about how much he had appreciated that care, and it really touched me.
Recently, there was someone who was going to participate in the lung cancer screening research that we’ve got going in Auckland, and she saw my name at the bottom of the participant information list and shared a similar story. I’d looked after her mother during her final illness as well, and the daughter said some very nice things about that to the research nurse they were talking to, who passed it on to me. Those things make me feel honoured.
Then, at another level, I’d have to say that the Maarire Goodall award last year was pretty special. Maarire was a fantastic man, and it was a great privilege to be given that award in his memory.
I love that what you’ve mentioned is not just the academic recognition, but personal stories from people who noted your tautoko for their family members. I suppose we should look at the new crop of emerging talent, and whether they, too, will carry the challenge of delivering better access to health.
I’m just so thrilled at the people who are coming through med school now. In terms of their taha Māori, they’re fantastic, and they’re much more critical in terms of critiquing the services and the systems, and they’re already exercising their ability to speak up where they see things that aren’t right.
I’m full of hope for the future with all these young people.
At the end of a conversation, I like to ask what else a person does apart from their work life. What is it for you?
Well, I grow vegetables. My father was a keen gardener, but I never started growing vegetables until about six years ago, and he’d already passed away. But I love getting dirt under my fingernails.
I also do CrossFit, and I like to go to countries in eastern and southern Africa for holidays and hang out with the wildlife there.
Any particular country?
I tend to do these trips with my mum. It’s one of the things we do together. We’ve been to Rwanda, Botswana, Zimbabwe, Zambia, Tanzania and Kenya. I think our favourite place is Botswana.
(This interview has been edited for length and clarity.)
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