Fuimaono Karl Pulotu-Endemann receiving an honorary doctorate in health from Massey University. (Photo supplied)

Anyone who knows Fuimaono Karl Pulotu-Endemann knows he’s not a wallflower. Growing up in west Auckland in the 1960s, he stood out as a proud Sāmoan and fa’afafine. 

Fuimaono went on to become one of the first openly fa’afafine employees in the public service, and Aotearoa’s first Pacific registered psychiatric nurse. And last month, his work in Pacific health over more than 35 years was recognised with an honorary doctorate in health from Massey University.

He talks to Teuila about his life and his long career in mental health. 


Mālō le soifua, Fuimaono. Thank you for speaking with us. Can we start with a bit of your background, please? 

Mālō lava, Teuila. My name is Fuimaono Karl Pulotu-Endemann. I was born in Sāmoa in 1950 — and, for the first nine years of my life, I was raised by my maternal grandparents, Pulotu Tivoli and Fonofale McCarthy. 

You’ll see one of my surnames is from my grandfather. When he was alive, it was the matai title he held. It then passed to my mother, and after she died, my sister was bestowed with it. 

My title Fuimaono is an ali’i title, a high chief title, from my grandmother Fonofale’s family in Salani in the Falealili district in Upolu. My dad’s name is Endemann, which is German, and he’s from Fagamalo in Savai‘i. 

I understand your family was part of that early wave of Pacific migrants who settled in inner-city Auckland in the 1950s. 

That’s right. My parents and other family came to New Zealand in the early ‘50s, but my grandparents and I didn’t come over until 1959. My sole purpose for being here was to be educated. 

When we first arrived, we all lived with Mum’s sister and her family in a house in Eden Terrace, Newton. Then, in 1960, our family shifted to Te Atatū South, in west Auckland. This was the time when Pacific families were being encouraged to move out of central Auckland and into South Auckland — but my parents wanted to go west.

Interestingly, some of the most expensives houses now in Eden Terrace, Ponsonby and Grey Lynn are where some of my relatives once lived.

My mum was a qualified shorthand typist, and initially she worked in the Department of Island Territories. But once the children arrived, she stopped working until about the 1960s, when she started at Waitakere Hospital as a nurse aide and then in the Post Office mailroom. 

My dad worked several jobs but then became a full-time carpenter for Neil Housing, where he stayed until he retired. It was a family business, and I still remember the fun times we had at their Christmas parties and family picnics. 

And the friends that my parents made during that time — their neighbours and workmates — are very much part of our extended family today. 

So you grew up out west and went to school in Te Atatū? 

Yes. I went to Edmonton Primary School and then Rutherford High. And it was at high school that I got rheumatic fever and had to take six months off school. Back then, the treatment was bed rest, so I was always in catch-up mode at school. I had to sit School Certificate twice but I managed to get five subjects, which at that time was quite good.

I think that was when I developed my absolute love of reading. I became quite a fast reader — and if I put my mind to it, I can read four to five books in one week.

I wonder what it was like for you, being young, Sāmoan and openly fa’afafine in the 1960s.

I always say my saving grace was the first nine years of my life when I was with my grandparents in Sāmoa. I was treated in a positive way, and they encouraged my interest in dancing and singing. They gave me the confidence to be myself.

And then I came to New Zealand, and it was totally different. It wasn’t okay to be Sāmoan and it wasn’t okay to be fa’afafine. I was this queer little boy running around in the ‘60s, and it just blew some of the teachers and students away. Because you weren’t supposed to be okay with those things, let alone proud of them. 

I remember my Mum saying: “In New Zealand, boys don’t walk, talk or laugh like you.” Years later, I saw the movie Birdcage. There’s a scene where one of the most flamboyant characters is coached to talk and walk like a man. I burst into tears when I saw that because I realised what Mum had been trying to tell me, in the nicest way. 

I’ve been called names like p**fter, n**ger, coconut, bunga. They’re just words to me. I’d think: “Okay, that’s what they think, and this is what I think.” And I’d carry on. 

I was always a proud fa’afafine and a proud Sāmoan. And, actually, being Sāmoan and fa’afafine are the most powerful things about me. Because I believe that if you can survive the anti-Sāmoan and anti-fa’afafine things that come from the schools, come from the churches, and sometimes come from your own family, then you are a very strong and powerful person.

In saying that, I don’t want to minimise how hurtful and damaging homophoic and racist attitudes can be. I know this from my work in mental health.

One of the most upsetting things in my work is that the incidence of self-damage and suicide among gays, lesbians, and transgender young people has remained the same in the last 20 years. Despite all the changes in law and policy, there’s still a high percentage of my community who harm themselves. 

In 2001, Karl was appointed a member of the New Zealand Order of Merit for services to public health. He developed the Fonofale model of Pacific mental health, accepted by the Mental Health Commission as the standard for treating Pacific mental health. And he has represented Pacific people on numerous bodies, including the Parole Board, Psychologists Board, NZ Aids Foundation, Hutt Valley and Capital and Coast DHBs, and Alcohol and Liquor Advisory Council, among many others. Pictured, from left: Karl (centre) with his aunt Barbara Endemann, mother Pulotu Faileaso (Alice), sister Pulotu Elvira Sheffield, and his partner Ian Harris. (Photo supplied)

How did you come to specialise in mental health?

By sheer chance. I left school in the sixth form because I wanted to get a job. Mum wasn’t keen on that, especially because I was on track to get UE. But I had 10 younger siblings and I knew that working would be a big help.  

I got a job as a clerical cadet at the Ministry of Works in downtown Auckland. I was absolutely terrible at it. But in those days, it was the kind of job Sāmoan parents thought you should have because a lot of them worked in factories or as labourers. 

One day, I saw there was a shortage of psychiatric nurses in the paper. I applied and got into the training course in 1971. It was based at Oakley Hospital in Point Chevalier — a dedicated psychiatric hospital which became Carrington Psychiatric Hospital before closing in the early ‘90s.

When I graduated in 1974, I was the first registered Pacific psychiatric nurse. There were other Pacific trainees, but I was the only one who finished that year. 

I also went on to be a registered general nurse, and a registered obstetrics nurse. Male nurses were only able to specialise in obstetrics after 1978, so I was one of the first male registered obstetric nurses in New Zealand. 

But my number one love has always been mental health. 

I became a charge nurse at Carrington, and that was another first — they’d never had a Pacific person in that role before. And I remember vividly when I was a student nurse, and one of the Pālagi students had said to me: “You can come and work for me as a staff nurse when I’m in charge.” He assumed I’d never get far because I’m Sāmoan. 

Well, he ended up working under me as a staff nurse. And I don’t mind saying that his arrogant, belittling attitude was a motivation for me. 

There are awful stories about the practices that occurred in psychiatric hospitals in the 1970s and ‘80s. And you worked at Lake Alice, too. How did you find it?

One of the things that really affected me were the Pacific patients who’d come straight from the islands. 

In the ‘50s and ‘60s, cargo boats like the Mātua, Tofua and Taveuni would go to Sāmoa, Tonga, the Cook Islands and Niue. They’d pick up copra and bananas, and psychiatric patients, and bring them to New Zealand. 

It was a harsh system. The patients were taken away from everything they knew and basically deposited at Oakley Hopsital. No family. Totally isolated. Staff often wouldn’t use their names because they struggled with pronunciation. Instead, they’d become “Anne” or “Mary”. Some weren’t even asked about their ethnicity and simply labelled “Islander”. 

There was also a clear disparity in the treatment of patients. Pacific males were deemed as dangerous and placed in a locked ward, even if they were an informal or voluntary patient. They were also more likely to be diagnosed with a more serious psychotic illness, even if the doctor couldn’t really communicate with them. 

One of the things I asked a lot was: “How did they come up with this diagnosis when the patient can’t speak English and the psychiatrist can’t speak Sāmoan?” I’d get told that a cleaner had interpreted the conversation. But how do you translate something like schizophrenia in Sāmoan unless you understand the full context? 

In mental health, psychiatrists and health professionals have a lot of power because patients can legally be treated against their will. And, too often, poor communication and ignorance leads to bad treatment decisions and a fundamental misuse of power.  

Have things improved over the years for Māori and Pacific people needing mental health care?

It’s still hit and miss. What’s changed is we have more Pacific and Māori health professionals, and more people who understand our worldview — though we’re still very much in the minority. 

I do a lot of work with Leota Dr Lisi Kalisi Petaia, who’s a consultant forensic psychiatrist in forensic services. It’s where some of our most acutely unwell patients are — and one in four of them is Pacific.

Leota grew up in Sāmoa and also has Tongan heritage through her grandmother. We met in the early 2000s when she was training to be a doctor, and then we worked together in Sāmoa in 2009, helping in the aftermath of the tsunami.

We’re good friends, and as mental health practitioners and Sāmoan matai, we also speak the same language — although her knowledge and spoken Sāmoan language is far greater than mine. 

What is it that distinguishes Pacific approaches to mental health?

For Pacific, it’s family. We know with Pacific patients, family involvement is essential to any treatment and wellbeing plan. That’s at the heart of the Fonofale model of health that I developed in 1985. It recognises how fundamental family is to our identities, and promotes a holistic understanding of health and wellbeing. 

For example, Leota and I held a camp for Sāmoan youth earlier in the year. They wanted a youth-only camp, but Leota and I insisted that parents and other family members be included, because we don’t come as individuals. We belong to our families and they belong to us. Our young people are deeply affected by the issues their parents face, and their behaviour, and it makes sense to address those things together.   

But even now the idea of involving family in a patient’s care — even just asking patients about their family — still doesn’t happen automatically. A lot of the time, we have to explicitly point out that “this man is Sāmoan, so we need to understand who his family is”. Otherwise, it gets left off the list. 

The system is still inherently Eurocentric, and most of the doctors working in it come from that world. But there are more young people coming through the workforce who get it. They see the Fonofale model, and other culturally-focused models, like Mason Durie’s Te Whare Tapa Whā, and they understand why a different approach is better for Pacific and Māori. 

Karl with friends Valita and Dr Lesieli Tongati’o, Leota Dr Lisi Kalisi Petaia, and Dame Luamanuvao Winnie Laban, after receiving his honorary doctorate in health from Massey University. (Photo supplied)

A lot of people would say you’ve helped paved the way for other Pacific people. When you were awarded an honorary doctorate in health from Massey University last month, you were described as a trailblazer and an advocate and role model for fa’afafine in New Zealand and around the world. 

Well, I don’t believe in role models — and I’ve never considered myself to be a hero. I can only be myself and hope to do the very best for myself. It’s unrealistic to put someone on a pedestal, especially because we all look up to different people for different reasons.

I remember at Oakley, the head cook was a wonderful Sāmoan woman by the name of Mrs Erolia Amos. She was the one I looked up to. So my so-called role models or people of influence were people like the cleaners and nurse aides.

And role modelling is hard. You can only be yourself. And that’s also very hard, because it’s hard to be yourself when you have all these other influences, like the churches, telling you you’re not okay.

Another thing your Massey citation said is that you were one of the first to be openly fa’afafine in the public service. I’m guessing it wasn’t that easy in the 1970s or even the ‘80s, to be you, but would you say there’s been a significant shift?

Yes, definitely. There’s been a real change in attitudes around sexuality since the late ‘80s and ‘90s — and that’s been helped by legislative changes like the 1986 homosexual law reform. I did a lot of work around HIV and AIDs with people like Louisa Crawley, Eti Laufiso, and Brenda Heather. And in the late ‘90s, we started the Pacific Island AIDs Trust. Until then, everything had been focused on white gay men, and we wanted it for our own communities.   

Certainly, we’ve had progress on gay marriage, adoption, and legal rights to property, but there are still areas that need improving — for example, the statistics around self-harm and suicide among Rainbow youth haven’t improved since the 1990s.

And I have to say I find the current discussions on transgender and sexuality to be dominated by a Eurocentric worldview and based on a medical model. When you talk about Sāmoan and other Pacific transgenders, you not only need to include the people but also the worldview they come from. 

For me, my fa’avae or foundation as a fa’afafine is that, firstly, a fa’afafine is Sāmoan. I belong to my ‘āiga, my nu’u, my district, and my country — and they belong to me. My sexuality is within that cultural frame. 

So, a fa’afafine, as I define it, is a Sāmoan, born physically male, with the spirit of a woman — a powerful woman.

Thank you for that. And what about the racism in the health system, which you would’ve seen up close since the 1970s?

I remember in the late 1970s, overstayers were being targeted and there was a lot of anti-Pacific sentiment. We were seeing that in the hospitals. Even at National Women’s Hospital, the immigration police would turn up and question women. I’d seen them separate a Tongan mother and her newborn — and deport her without her baby. It was totally immoral. 

And they’d come and ask me: “They said they were Māori, but they couldn’t speak English. Do you know if they’re really Māori?”

I just thought: “Bugger that, they’ve just given birth.” So I’d tell them the women were exactly who they said they were. I knew the consequences.

Karl and Ian. (Photo supplied)

Are things better now? Is there more awareness about the impact of racism in the health system?

You know, Teuila, I wish I could say yes. It’s probably less overt, but that doesn’t make it any less harmful or pervasive.  

My own recent experience is a good example. I’m living in Christchurch now — I’ve abandoned my place in Wellington to come and look after my partner of 38 years. Ian is Pālagi and he had a stroke about three years ago. He also has Parkinsons, so we’ve had some ups and downs. 

When we went to Christchurch Hospital after his stroke, it was like I didn’t exist. I was basically sidelined from being informed about my partner’s health. It wasn’t until I asked to see the charge nurse and told them I was a registered nurse that they spoke to me. 

It’s the most blatant racism I’ve experienced in the 60-odd years I’ve been in New Zealand. I’m not surprised that happened. You ask any Pacific people who live here, they’ll tell you about the racism. But you can see why that kind of treatment would be a huge issue for many Pacific people, who won’t necesarily speak up — and how that would affect the quality of care they get.

What are you working on now? 

My main work right now is different from anything I’ve done before.

Over the years, Leota and I have looked at different ideas, and we always come back to the fact that we’re often the ambulance at the bottom of the cliff. People are already so unwell when we see them — and particularly when they see Leota who works a lot in prisons and in forensic services. 

Covid has made things tough for many families, and a lot of young Pacific people have asked for help with their mental health. We’ve found that children who drop out of school without qualifications are more likely to start using drugs and alcohol, and that can lead to violence and offending and ultimately ending up in prisons and other institutions.

So, we’re working with schools in South Auckland, including students and teachers at McAuley High School and Manurewa High School, as well as youth groups and community groups to identify early signs of mental health distress. And just this week, we launched a new model called Kalisi, which focuses unashamedly on Pacific women, specifically mothers, and their role in the lives of all Pacific peoples. 

It’s about preventing mental health issues in our families. So we don’t end up at the bottom of the cliff.

It’s been a great talanoa. Fa’afetai tele lava, Fuimaono. 


This interview was made possible by NZ On Air through the Public Interest Journalism Fund. It’s been edited for length and clarity.

© E-Tangata, 2022

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