Fa’afetai Sopoaga: Connecting communities in Dunedin

Last month, Otago University’s Faumuinā Fa’afetai Sopoaga took out the Prime Minister’s Supreme Award for Excellence in Tertiary Teaching. The Sāmoan-born Associate Professor at Dunedin’s School of Medicine has played a key role in getting Pacific health into the medical curriculum in New Zealand. Here she talks to Dale about an innovative programme she created to teach medical students how to better understand and treat their Pacific Island patients.

 

Talofa, Tai. If we were in the habit of conducting more formal interviews here at E-Tangata, I might be addressing you as Faumuinā Fa’afetai Sopoaga. But I understand you’re comfortable with the short version, even though, like a number of names from the Pacific, it got trimmed in Aotearoa because Pālagi had trouble pronouncing Fa’afetai.

That’s true. In Sāmoan, fa’afetai means thank you. So that’s where my name comes from. For the last three years, I’ve also been called Faumuinā. That’s a high chief title from Fagaloa in Sāmoa.

I was born there. My parents, Rev Nomeneta and Lili Sopoaga, were church ministers, so I grew up in a Christian environment — and one deeply rooted in fa’a-Sāmoa. Sāmoan is my mother tongue. I learned to speak English when I went to school.

So you came out to New Zealand on your own to study medicine? Or did your ‘āiga move across?

There was a group of us who came out from Sāmoa on a government scholarship in 1984. We were placed at Timaru Girls’ High School for a year. Then I came down here to Dunedin with the hope of studying medicine. My aim was to go back home to Sāmoa after I graduated. But after I came to Dunedin, I was diagnosed with Lupus.

After graduation, I went back to Sāmoa to work, but I became rather unwell and started to develop complications. Then I returned to Dunedin to do post-graduate training, and I was advised that if I wanted to live longer, I’d better stay here in New Zealand rather than live in Sāmoa and have to come back here for treatment.

Have you been able to contribute to health development initiatives in Sāmoa, even though, as a result of your lupus, you call Aotearoa home?

Yes, I have. As a result of living here in Dunedin, I ended up working for the Otago Medical School. So when Sāmoa asked New Zealand for help to develop its own medical school, I was able to organise support from the University of Otago to help with that.

For me, it was very hard realising that I couldn’t go back to Sāmoa to live — my parents and close family were still there. However, I do have the opportunity to contribute to developments back home.

I guess I have a strong faith and belief that things do happen for a reason.

The School of Medicine in Sāmoa has been going now for around five years and is embedded within the National University of Sāmoa. It’s still very new and needs a lot of support from New Zealand and other countries.

The Otago Medical School has been running now for a long time, almost 150 years. It has around 600 staff members contributing to the teaching of its medical programme. The medical school in Sāmoa, by comparison, has around five full-time staff.

Well, we have to start somewhere. And, after all, when the Otago Medical School started, it had only one professor, one student, one classroom, and one cadaver.

Would it be fair to say that there has, at times, been a patronising western view of medicine and that it hasn’t paid much attention to other cultural approaches? There’s been a “we know what’s right” assumption — although that attitude is being challenged now.

As far as I can recollect, when I started my medical training at Otago, there was no teaching at all about Māori kawa. But we’ve now moved on to where there’s an excellent established Hauora Māori programme for learning and teaching — and the students really appreciate it.

They’re wanting to learn because of the need to understand cultural issues and approaches when they’re working with patients. And there’s a lot of knowledge about traditional medicine that’s been lost over the years, and we need to learn more about that.

I must credit our Māori colleagues for the progress made with Hauora Māori. They’ve made it easier for me, as someone who is Pacific coming into this teaching space, to utilise opportunities to provide Pacific teaching.

I’m also looking at opportunities to link in with Pacific health in the region. There’s a lot to learn and appreciate. For example, if measles or some other infectious disease was to emerge in one of the Pacific Island countries, it would arrive in New Zealand within 24 hours. The reverse is also true.

There’s a keen interest to contribute to the Pacific from our Otago staff. When we provided the opportunity for them to help in the development of the medical school in Sāmoa, they were all vying for that chance. There were more staff offering to help than opportunities available.

You’re satisfied then that there’s a way for Sāmoan rongoā and Māori rongoā to complement western medicine without people thinking that this rongoā is ancient and perhaps not effective?

Well, the World Health Organisation is recognising traditional medicine as important in the provision of universal health care, and I believe there’s a role for us to be working together.

In Sāmoa, the clinicians and the Ministry of Health are looking at how to bring the traditional healers to work alongside western-trained doctors in healthcare. When I was growing up, I was treated with traditional medicine that was effective. So I’ve experienced its impact.

Healing can occur without giving people medication. It may be just the connectedness with the healer or the reassurance from the doctor that a patient needs.

Now, coming here and learning in a western system, I can see there’s a need for both to come together, share the knowledge, and pass that on to the next generation of health professionals.

What do you think of the whare tapawhā model advanced by Mason Durie and others? That’s the idea that you can’t just have bodily health because, in order to get that, you also need to look at the mind, and even the spirit. Is it important that these things are in alignment and that true health is achieved by having these parts of us synchronised?

When I did my training, there was a strong focus just on the physical ailments. But now, with Hauora Māori and Pacific teaching, we’re trying to help the students understand the need for a holistic approach to health. For example, we need to appreciate the spiritual and mental health side, and incorporate the important role of whānau.

When I’ve taken students into the community, they’ve learned just by observing the different components of health and seeing the things that are important to our communities. Like the sense of community itself.

And they’ve also come to understand that time can have a different meaning. Time, in many communities in the Pacific, is determined not by the clock but by when the sun comes up and when it goes down.

So, if you’re a GP and you have 15-minute appointments and a patient is late, you’ll be stressed. It’s often helpful to appreciate the context and see beyond what’s presented in front of you. There may be a whole lot of reasons why they haven’t turned up. Maybe they had no transport to get there, or someone else was unwell and they were the main caregiver for the family. Or maybe they don’t have a phone or enough credit to contact you.

Do you think our peoples are working closely together enough, Māori and Pasifika? Are we being as effective as we could be?

I think we’ve come a long way, but there’s still a long way to go. What is encouraging, though, is that we’ve got an increasing number of Māori and Pacific medical students in the class. We’ve come from a place where there was one or two brown faces, to where there are more brown faces, and the numbers are increasing.

That, in itself, changes the dynamic in the medical class. It changes the way in which medical students engage with one another in an inclusive way.

Let’s turn for a moment, Tai, to your own teaching role — and where you get your satisfaction.

When I was a student in the medical programme, I didn’t always enjoy my learning because, at times, I felt intimidated by my teachers. I always wondered whether there was a better way of learning than being intimidated or growled into learning something.

So when I had an opportunity to teach, I tried to focus on inspiring students to learn.

And then I’ve been a patient myself. I’ve been on the receiving end. So I‘ve reflected on what it would be like to have a doctor who can relate to me and engage with me in a way that’s helpful. Being a patient, even with medical knowledge, I still felt very vulnerable and in need of care and reassurance from the health professionals looking after me.

I’ve had some really inspiring teachers over time. Fantastic role models like Sir David Skegg and Charlotte Paul and Peter Crampton. People who’ve restored my faith in medicine and in the ability of the profession to be a healing profession.

But, when I was a fifth-year medical student, I almost pulled out after a difficult teaching session with a neurologist. I didn’t want to go into a health profession that wasn’t caring of its people.

Fortunately, I had an outstanding dean at the time who provided support during the journey, and encouraged me to keep going.

And now, as a teacher, I’m in a position to support students’ learning and I want to inspire them. I think our students can learn really well when they feel they can make a significant contribution and difference to society.

Picking up the prime ministerial award for excellence in tertiary teaching this year has been a lovely acknowledgment that you made a good call when you decided to carry on with your studies. What did that award mean to you?

Well, I work in a team. Although I received the award and was recognised as an individual, I received it as part of our team. I teach within the Centre for Pacific Health, located within Va’a o Tautai, with Dr Rose Richards as the director.

Va’a is the Sāmoan word for waka. Tautai is the skilled navigator. In Sāmoan, the word tautai is not given to any fisherman or any navigator, but one who is highly skilled.

We’re very similar to Māori in that we work in communities. We’re part of the wider connectedness.

We have a saying in Sāmoan: O le ala i le pule o le tautua. It means the pathway to leadership is through serving. My father, as a church minister, ingrained in me and my four siblings the importance of achieving our best and serving. Life is about service. So, wherever you work, you make sure you go into that space to serve.

In our culture, we have systems for providing service. I’ve been given the chiefly Faumuinā title — and this is really about service. It’s about serving my family and my community and conducting myself in a way that honours the integrity of my family.

So what I say, what I do, and how I conduct myself must always honour my parents and my family — and also honour my local community that has placed their trust in me by becoming involved, for example, in the Pacific immersion programme at the Otago Medical School.

I’m glad you’ve mentioned the Pacific immersion programme. I understand that it involves medical students spending the weekend with a Pasifika family as a way of teaching Pacific health to the next generation of doctors in New Zealand. It’s a neat idea. How has it worked out?

I’ve been inspired by what the students have learned through the programme.

Some students who’ve gone into our communities, on their return, when they’ve reflected on that experience, have said: “Oh, I was scared to go to your community because of all I’ve heard about Pacific communities from the news, and it often wasn’t good. So I was afraid.

“But now I’m learning about the strengths and the connectedness in your community. The strong relationships, and the important place of faith. And the way they draw strength from their traditional culture.”

When the students come back, they also reflect on their own journeys.

Some of them feel that the families they’ve been immersed in are very rich families in important ways — and that they, themselves, are the ones who are poor, because often they come from families that are not as connected.

Some come from families who are very busy in their own world — who have mums and dads travelling around the world. Some students feel their families don’t have the depth of relationships they’ve just seen in the Pacific communities. Families who, materially, may have very little but have a richness of culture and connectedness — things money can’t buy.

We teach students using a positive approach, focussing on the strengths in these communities, and how, as a healer or as a health professional, a doctor can use these strengths.

We challenge students to think about their own perceptions and prejudices and how these impact on the provision of healthcare. They’re welcomed, embraced and treated as whānau by their host families — and when they come back, I encourage them to reflect on how this experience might help them in the future to be more effective doctors.

Sometimes the experience moves them to tears, when they reflect on what they’ve seen. Some of them say they didn’t know this was happening “in my country”, particularly the poverty.

Yet, amidst all of this, they’re seeing a community that is resilient, positive, happy, welcoming, and keen to share with them whatever resources they have.

Many get gifts from the families and they feel really uncomfortable receiving these because they can see some families aren’t well off. However, generosity is part of Pacific culture. So the students learn about humility, humanity, and about being kind and taking care not to making assumptions about people.

They’re going in there to learn about how to best serve these communities as health professionals, and they come back with life lessons.

Some of the medical students continue to engage with their host families where there are opportunities, for example, birthday invitations.

And some of them, in their sixth-year medical elective where they can spend three months anywhere around the world, have gone to the Cook Islands, Sāmoa, and different islands in the Pacific to increase their knowledge and understanding.

They’re lifting their eyes from a clinical perspective and a focus on just getting a medical degree to including humanity in their approach. I feel very privileged to be in a position to support their learning journey.

You started the Pacific immersion programme in 2010, I understand, and it’s now a required part of the medical programme in Dunedin — congratulations on that mahi. You must have put through a few medical students in that time?

At least 600 medical students have had placements with a Pacific family since we started. And around 100 families in Dunedin are involved in the programme. Each family is involved once a year, and a family may be allocated up to two students at a time.

The Otago Medical School has three campuses — Dunedin, Christchurch and Wellington. This year, for the first time, students in our Christchurch campus had the opportunity to do the programme. There are now discussions for the Wellington campus to start its programme in 2019.

If the programme is run across all campuses, around 250–300 families will be involved each year, as there are 300 students in each year of the programme.

It’s not easy to run the programme because it requires mutual trust and respect.

The students often feel vulnerable going to a stranger’s home. And our communities are also vulnerable because they’re opening up their homes to these young students who they know very little about.

The programme is made possible through the close working relationship between the university and our local Pacific communities — the Tongan, Cook Island, Sāmoan, and Fijian communities who have put their trust in us by becoming involved in the programme.

Some of our community have reported that when they come to the hospital, these students are engaging with them in a way that makes them feel really comfortable.

I feel privileged to be nurturing those relationships between the medical school and Pacific communities because tertiary institutions are foreign environments to our people.

I believe the university benefits a lot from our Māori and Pacific whānau coming into this space. And our communities will not enter if it’s not welcoming, so I try to make this space welcoming.

For example, carvers from Fagaloa travelled to Dunedin to carve an outrigger waka which now sits just outside our Pacific office. It’s a reminder of where we belong and where we come from. A reminder of our connectedness to our Pacific islands and our people.

Thank you, Tai. Thank you very much. You’ve come all the way from your home in Fagaloa. And you’ve been making an impact on the lives of many people. I wonder if your successes have resulted in others in your whānau following in your footsteps now that you and others have helped pave the way for them.

I’m one of the first in my family to come to university. My sister Luisa and I came out together. She’s a scientist and a quality assurance manager for the dairy industry. Now we’re encouraging the next generation to think about higher education.

Tai, I thank you for sharing that with us. You’ve seen many changes since you made Aotearoa your home. Many of our PI people arrived to fuel the factories decades ago. But now, like yourself, they’re taking very prominent positions in academia and business and all the other walks of life. And there’s now an increasing respect for the major contribution that Pasifika people are making to the wider New Zealand.

I feel really humbled when I learn about what our families did when they came to New Zealand. Some of them were actively recruited during the time when there was the economic boom in New Zealand. And then, later on, there was the economic downturn which resulted in a very difficult time, including the Dawn Raids.

So I teach the students about those events because a lot of them don’t know this history and aren’t aware of New Zealand’s relationship with the Pacific. For instance, during the time of the Spanish influenza epidemic in 1918, the ship Talune arrived in Sāmoa and wasn’t quarantined by the New Zealand administration — and, as a result, a quarter of Sāmoa’s population died.

It’s important for students to know about this history — and know of our people’s contribution to New Zealand, whether it be in forestry or the factories or whatever.

I’m grateful to New Zealand and the opportunities it has provided for me, and heartened by the support that New Zealand continues to offer our people.

For instance, when the tsunami hit Sāmoa, there were many from New Zealand who offered help. I’ve also seen many of my medical colleagues helping to improve the health not only of our whānau here but also of those in the Pacific.

As a society, if we continue to work together, we can progress things forward and achieve our aspirations as a community in New Zealand.

 

This interview has been condensed and edited for clarity.

© E-Tangata, 2018