Lupe Taumoepeau and her life-changing surgeries

She’s New Zealand’s first female vascular surgeon, yet Lupe Taumoepeau can count in the dozens the number of times she’s been mistaken for a cleaner. It’s a reminder that there are still too few Māori and Pacific in medicine, especially in its more elite specialties. Here, Dr Lupe — as she’s known at Wellington Hospital where she works as a consultant surgeon, and at the private clinic that she co-founded — talks to Dale about her trailblazing path.

 

Mālō e lelei, Lupe. I understand that your full name is Tapukitea Tokilupe Taumoepeau — which no doubt has often been beyond some of your Pālagi teachers and schoolmates through the years. What can you tell us about those names?

Well, my first two names were given to me by my aunt. A tradition in Tongan culture is that, when you have a child, the naming rights usually go to your father’s sister or a female relative on your father’s side. 

But I was never called by my first name, which is my aunty’s name. Instead, I’ve been known as Tokilupe because that was my grandmother’s second name and none of her grandchildren had been given that name. 

In Tongan, Tokilupe means young dove. Apparently, Lupe is a common name in Spanish, too, where it means wolf. And in Sāmoan, where it means pigeon. So, I guess I can use any of those three personas. 

There’s a strong matriarchal element in Tongan communities, isn’t there? There’s no doubting the mana of wāhine, especially of men’s sisters.

That’s right. From a very early age, I had lots of strong female role models in my family around me. My mum, Elisapeta Taumoepeau, was a solo mother for most of my early life. She and my dad Paula separated when I was two, and then they reunited when I was 15. Mum was the first strong female role model that my sister, Nanise, and I had. 

You’re right, though. Because of that culture, and because I had these strong women around me, I never felt that anything was out of my reach. 

We went to an all-girls Catholic school where they celebrated women. It was just a part of our upbringing — and that had a lot to do with Nanise and me realising that, if we put in the mahi, we’d get the treats at the end, in terms of career and life goals.

Your grandad, Samiu Taumoepeau, was an eye surgeon in Tonga, so you already had a strong link with the medical profession. I suspect he had a big influence on you.

Yes. There’s no doubt about that. He went through his medical training in Fiji. And then he did his surgical training in Australia before going back to Tonga. I used to love hearing all these stories about his work — and loved looking at his surgical textbooks and then getting out some of his surgical gear. I was amazed that he could restore somebody’s sight. 

There was also this sense of community and this strong Tongan ethos of looking after one another. I think pursuing a career in medicine was a very practical way of putting those things together.

Can you speak Tongan?

I understand everything, but I wouldn’t say I’m fluent. If I spend time in Tonga or around Tongan families, I can pick up things really quickly. But there’s always been my regret that, although my parents tried hard to push us to speak Tongan, we were lazy about it. 

Now, being a mother, I do try to speak Tongan to my nephews, my niece and my son. Thankfully, my parents are around and they also speak to their grandchildren in Tongan. So I’m trying to expose the children to the language. But I can definitely do better.

Can we talk about Baradene College now? It’s a pretty prestigious Catholic school. I hear you were head girl there, too. Were you the first Tongan in that role?

There had been another Tongan head girl, several years ahead of me. So there was some Pasifika history there, I suppose. My sister was head girl two years after me. But what it definitely had was a culture of nurturing and encouraging young women to achieve their potential. 

So I was lucky and blessed to be in a position to go to Baradene. And that came about because, although my mother was a solo mum for most of my upbringing, and although she was one of 11 children, she was the only sibling in New Zealand. 

She had plenty of requests from her brothers and sisters and my grandmother, who lived in Australia, to join them there, where she would’ve had more help with us two girls. But she was in Remuera and she wanted to keep us in that area, rather than moving us from New Zealand, or to South Auckland where we had lots of extended family. 

So she sacrificed a lot, working at cleaning and administrative jobs to give my sister and me the best start in life. I owe a great deal to my mum. 

Like a host of Māori and other Pasifika kids you, I suspect, have had your name butchered along the way. Did that make you squirm sometimes?

It was funny to me at the time, but now I think back and cringe actually. My sister and I were one of two Tongan families at St Michael’s primary school in Remuera. But, at first, our surname, Taumoepeau, was pronounced, jokingly, as “Tummy-power”. And we just went along with it.

And Tokilupe, when I was at school, got shortened by the kids to Toki, pronounced “Toe-key”. So, at primary and high school, that’s what I was known as. I tolerated it, I think, because it was better than people looking at my name and going: “T . . .” And then just giving up. At least it was a name that I could use.  

Then, when I went to medical school, I decided that I wanted people to understand that my Pacific background and heritage was really important, and “Toe-key” is clearly not a very Tongan name. So I reverted back to Lupe, the other half of my name. That’s what most of my family call me — and it’s the name that I use now.  

I understand that you went to med school as a Pasifika student on an affirmative action scheme — the Māori and Pacific Admission Scheme (MAPAS) — which was a way of helping to get more Māori and Pasifika people into the medical profession. But although that made good sense, the scheme didn’t always find favour with some of your medical colleagues. 

From day one, there were comments and criticisms from non-Pasifika and non-Māori medical students about the supposed easy ride that MAPAS students had into medical school. Sometimes it was in your face. Sometimes it was something mentioned under their breath as they were walking past you. 

But we had the good fortune to have a meeting place, a whare, where the small number of us at med school at the time could congregate for study groups, or lunch and things like that. And we used to talk about that perception of us. 

We had a strong, almost family-like connection to each other — and we were just there, trying to do the mahi together. As you know, there’s plenty of research showing that when the health workforce reflects the population they serve, their patients are 100 percent more engaged and they feel empowered to take ownership of their health. That can only lead to improved outcomes for our people.

I think these programmes and affirmative action schemes are vital because it’s the only way we can close the significant gap in health equity and outcomes between Māori and Pacific Islanders in New Zealand and the rest of the population.

You left med school and went as a junior doctor into the wards. That must’ve been a harrowing experience, given the hours and conditions. And you did that for six or seven years before specialising in vascular surgery. How were those early years as an experience?

I did my junior doctor time at Waikato Hospital in Hamilton. That was my first time living away from home and I look back on it as a very formative time in my life. I moved to Hamilton with five of my closest Māori and Pacific Island friends from medical school. We had a great time putting into practice all of the stuff we’d been learning at university.

It was exciting. It was busy. And it was a vulnerable time in our lives as well because you have a lot of pressure on you as a junior doctor. When you were on call, you didn’t always have help immediately available. You’d sometimes make significant decisions that could have various consequences for patients. 

But we had this group of amazing women with a strong bond between us that we’d developed at university, and that helped us all through some pretty stressful times.

There you were, only just out of med school and you’re on the frontline making life and death decisions. Can you tell us something about how you felt when you got it right and also when you didn’t?

At the moment, one of my roles is as an educational supervisor for first- and second-year doctors. Part of that role involves pastoral care. We often have meetings and they bring up near-miss situations or times when there’s been some breakdown in communication with patients.  

All of those stories bring back memories for me. Every clinician has been in that situation. As a surgeon, despite our very best planning and desire for a good outcome, sometimes, because we’re only human, we can’t fix things. Unfortunately, we can’t fix everything.

It’s really stressful when you have near misses or bad outcomes, despite all your hard work. What I try to do is encourage these young doctors to realise that they’re part of a much bigger support network. It’s not just their immediate supervisor or senior colleagues. There’s always someone like me who they can talk to. And they need to learn to treat every mistake as something to try to improve on the situation next time.

If you don’t acknowledge complications, you’re either not doing enough operating or you’re just not telling the truth. It’s inevitable that we have complications and bad outcomes. But the more we can share these stories and incidents, the better equipped we are to deal with the fallout and to move on.

In becoming a vascular surgeon, Lupe, you’ve broken through the glass ceiling. Not so long ago that was the preserve of male surgeons. Can you tell us something about that specialty? I understand it’s delicate surgery in very intense situations?

One of the most rewarding operations that I do is kidney transplants. These are life-changing for people on dialysis. There’s been a real push by the Ministry of Health to try and do more pre-emptive transplants to prevent people from going on dialysis because we know that, once people are on dialysis, it shortens their life. 

Diabetes is the leading cause of renal failure in New Zealand and both Māori and Pacific Island patients are over represented in this risk group. So this is an opportunity where, through an amazing network of transplant physicians throughout New Zealand, donor surgeons and recipient surgeons have the power to change someone’s life. 

The process of dialysis often involves a patient being hooked up to a dialysis machine where they’re completely immobilised for six to eight hours, three times a week. There are plenty of dialysis patients who are still working, but obviously it can be extremely restrictive on people’s lifestyle and family life, their ability to travel and so on. 

Patients who receive a cadaveric kidney — it’s amazing to see their excitement. There’s a bit of apprehension, too. I’ve had more than one patient tell me it was like winning lotto when they had a phone call to tell them their name was on the transplant list and there was a kidney arriving for them. I find that incredibly rewarding.

A transplant involves sewing the donor kidney artery on to the recipient artery in the pelvis so the blood flow gets to the kidney. Then we have to sew the vein from the kidney into the vein in the recipient’s pelvis alongside the artery. 

When I take the clamps off the vessels and see the shrivelled-up grey kidney become purple and then pink and then pulsate with blood, nothing else I do beats that. It’s amazing to see and, when the kidney starts working and the patient is off dialysis, it’s incredibly rewarding. I feel blessed to be part of that.

You must also have a sense of humour to cope with those who ask if you’re the cleaner when you go into the operating theatre.

When I was a junior doctor and was moving every year to different hospitals for training, that query was common in the first three months of arriving at a new hospital. The first few times, I’d laugh it off. But I’d never challenge anybody because I didn’t want to make the person uncomfortable. They were simply projecting an unconscious bias. I’d just say no, and carry on.

Over time, I’ve been more prepared to call that out. I’d say: “No, I’m the surgeon.” Most people are extremely apologetic and embarrassed. There’s the odd very surprised look and a quick check of my ID badge to make sure I am who I say I am. It happens rarely now. But you have to laugh sometimes. Otherwise you’d cry.

You have every right to feel proud of being part of a Tongan wave of academic and professional achievement and, as a wāhine, drawing even more attention to the reality that any goal is possible — and that young people are confidently following in your footsteps.

I feel privileged to be in this position. I didn’t go into surgery or, in particular, vascular surgery, to be a trailblazer. I just followed my passion and this is where I ended up. When I went through, there were very few female role models I could look to for guidance. In fact, my main mentors were male surgeons.

There’s an old saying: “You can’t be what you can’t see.” For me, that’s real and rings true. So I make a conscious effort to put myself out there when I can. I don’t like being in the limelight but I do feel that having visible role models is important in encouraging the younger generation of Pacific Island and Māori students to pursue careers in medicine.

There’s not enough of us. Pacific Islanders make up almost 7 percent of the population. The number of Pacific doctors would have to increase from 295 to 1082 to reflect the make-up of our population. Māori are 15 percent of the population but are only 3.5 percent of doctors. So we’ve got a long way to go. And we’re not going to get there without more of us stepping up to be role models, sponsors, and mentors for the younger generation.

I love that you have a young son, Lupe. I’m sure that it can be difficult to juggle work and family. But you seem to have found the right mix.

The mix is definitely not balanced, Dale. I was so focused on my career early on. I went from high school straight to med school and fast-tracked my way through, almost convincing myself I didn’t want children. I was quite happy being the cool aunty. That was it for me.

It’s hard for any working woman to find the right time to have children. Once I’d finished my training, I changed my mind. And I’m really happy that I did. I think becoming a mum filled a gap in my life that I hadn’t even realised was there.

There’s no way I could do what I do without my husband, Alan Douglas. He’s my 100-percent support person. He’s the home executive and the main caregiver of our five-year-old son Lachlan. Lachlan’s middle name, Samiu, comes from my eye surgeon grandfather. 

Alan is such a supportive husband and amazing father that I’ve been free to pursue this dream career that I have. I’d love to be able to spend more time with the family. It’s a real struggle because I feel torn, like every working mother does. I give my time to my patients but I also want to be part of my family life as well. So I’d never pretend that my life is anywhere near balanced. It’s a constant struggle.

Apart from your work and family are there some things or hobbies you love?

I wish I had the time. I grew up around music. Flute and violin. And I play the piano. I’ve never had a piano of my own. When I left home, I loved going back to my parents who did have a piano. For Christmas last year, Alan bought me a piano. That’s a special thing for me. 

My son is now learning to play the drums. I don’t know if my husband has been taking lessons on the sly but he’s very good on the drums — and he’s an ex-piano player. You never know, Dale, there might be a family band around the corner.

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

 

© E-Tangata, 2020