Dr Owen Sinclair is one of only six Māori paediatricians in the country. He works in the emergency department of Waitākere Hospital in Auckland, where he sees all too often the evidence of systemic racism in our health system. 

Not surprisingly, he doesn’t have much patience for the idea that we’re making progress in that department. As he makes clear in this kōrero with Dale, real progress won’t happen unless and until Pākehā New Zealand understands and comes to terms with how racism was built into our health system.

 

Kia ora, Owen. Before we get into your work and the way the health system treats Māori in particular, could you tell us a little bit about yourself?

Sure. I have a Māori father and a Pākehā mother, but I didn’t meet my father until I was in my early 20s. I grew up in West Auckland with my mother, so I was raised by my Pākehā family. We were pretty poor, but we had a very loving household.

My grandparents actually lived, at that stage, on Waiheke Island. That was before it was the glamorous, rich suburb of Auckland it is now. I spent a lot of my holidays and childhood running around there. It was a pretty privileged upbringing when I look at it. I didn’t have much money, but I had a fishing rod and a bike and all that sort of stuff.

When I was about 10, I went to Dilworth School in Auckland. It’s a boarding school, and you had to be poor and have just one parent to go there.

My iwi is Te Rarawa. I think I was about 18 or 19, maybe a bit younger than that, when I decided I wanted to get in touch with my Māori whānau. It just seemed to be the right thing to do at the time.

I’d written this letter, which was quite hard to write, to my grandmother, my father’s mother. They actually came to our house — my father’s sister and her daughter. They came to visit me, with gifts. They were very welcoming and very friendly.

My father has nine children to six mothers — and we were all known to his family. That was no secret. So they came down to see me, and then I went up to them.

Since meeting my father, I’ve had very regular contact with him. I’m not the oldest. There are a few younger than me. I know them quite well. Interestingly, I’ve just got in contact with a half-sibling who I’d never met before.

So that’s how it went. It was an amazing journey for me. It put all the pieces in place in my life. I know where my marae is. I can recite my whakapapa, and I have regular contact with my Māori family, although I never grew up with them.

My father’s name is Owen Tatana. He was married once, and he named his son, from that marriage, Owen. It’s funny when we’re all in the same room and the phone goes and they say: “Is Owen here?” Or when we go on the marae together and it’s Owen, Owen and Owen.

And your mum? You say she raised you on her own — let’s celebrate her a bit. What else might you say of her?

My mum is Suzanne Sinclair, and she did really well for herself. She was a poor solo mum who had a brief liaison with a Māori man at a time when it wasn’t thought to be good to do that sort of thing. But she had good support from her parents, who were amazing.

She always had a job and she worked very hard. She was a teacher, and she was always very dedicated to politics and the Labour Party. Our whole Pākehā family was heavily involved with the Labour Party. So I was very conversant with how to place pamphlets in letterboxes.

She got elected to the Auckland City Council before the super-city merger and was a three-term independent councillor.

And then the natural progression was for her to become an MP. She was elected to parliament in 1993 in an Auckland seat (Titirangi). And then that electorate was abolished and we got MMP in 1996. She was a list candidate, but Labour didn’t win enough seats, so that was her one term.

How did you get in to medicine? Did you always want to be a doctor?

I left school with pretty good grades and became an engineering cadet. I did that for a while and then did an engineering degree. But I didn’t really like that. I was made redundant, but I’d already decided that I was going to become a doctor — or try to become a doctor.

I was able to get into medical school under the Māori and Pacific entry scheme. And, after I was qualified, I decided to become a paediatrician.

I’m currently working in Waitākere Hospital as a general paediatrician. There are only six Māori paediatricians in New Zealand. We’re all pretty busy. We don’t have a network or anything, but we all sort of know each other.

I also give lectures on Māori health to fifth-year medical students at Auckland University.

It’s hard to work out what to do to help Māori when you first become a doctor, and even in my job now. We’re quite reactive, for want of a better word. We tend to sit in hospital and wait for people to come to us.

So I decided to do a couple of things. One of them was a diploma in public health. That evolved into a master’s thesis on equality in health.

It was on pertussis, which is whooping cough — and it identified a mass of inequalities between Māori and non-Māori.

Māori rates of pertussis are 1.6 to 2.6 times higher than non-Māori. Specific data for Māori has been recorded only since 1989, and over that period, Māori have always had higher rates.

In my thesis, I tried to identify all of the reasons for why that should be — which is related to the system, poverty, and care, and all that sort of stuff.

The inequality in pertussis is actually related to all of the inequalities in New Zealand society that Māori have. So it’s everywhere.

I’m trying, through a number of mechanisms, to work out a way forward to raise the awareness of Māori health and equality. I think everyone knows about the inequalities, but it’s what do you do about it that matters.

That’s one of the things we struggle with — there are very few meaningful ways to address the inequalities. And, even if you step out and try to do it, you become swamped with the enormity of the problem because it’s so pervasive.

The inequalities in our health system are well documented. So are the historical contributions to that inequality. But more of us need to understand why Māori and Pasifika — in fact, any people who are doing it tough financially — seem to be less well-served by our medical system than others in different demographics around the country.

You gave a speech last November at the NZ Anaesthesia Annual Scientific Meeting in Auckland, about how systemic racism is to blame for our glaring health inequalities.

How hard is it to get that message across? Even using the racism word, as you did in your speech, can be challenging. I’m not uncomfortable with the word, but others seem to be. What’s been the reaction and in what context were you using the r-word?

You do have to be a little bit careful in using that. When I give this talk, I don’t use the word “racism” until near the end of the presentation.

I think a lot of people don’t realise that the formation of New Zealand was inherently racist and that the process of colonisation is based on racist theories. The people who were colonising believed quite firmly — and were very explicit about their belief — that their race was superior to other races.

That was how they justified moving to another land and conquering, or assimilating, as it happened in New Zealand, another people, and then appropriating all of their assets.

If you broaden that and you look at all of the Māori health indicators in New Zealand, and extend that out even further to include all of the socio-economic markers, all of them are inferior for Māori.

Māori are more likely to be poor and under-educated, to be arrested and in prison, to live in poorer housing, to suffer from poor health, and to die younger than non-Māori.

If you look at that broader picture — at health and inequality and all these other things — you can’t help but conclude that the system in New Zealand is inherently racist. And that Māori are getting inferior treatment and essentially being discriminated against by the system and the law.

And there is only one thing that can explain all of these things — health, justice, education and housing, and so on. All of those things have individual explanations. But if you tie them all together, there’s only one thing that can explain everything. It’s racism. And that racism has been in New Zealand since the time of colonisation.

The trouble we have is that Pākehā New Zealand doesn’t confront its racist heritage, or see that ethnicity in itself is a factor in New Zealand for everything negative

So you get Māori being blamed for their negative statistics. They’re actually blamed for it. And not only do they get blamed, Māori — and Pacific — get much less care, much less everything from all of the systems in New Zealand.

And, although we know that Māori have needs in all of these areas, the really racist thing is that no one does anything about it. There’s just a complete ambivalence to it — so that it’s now accepted as the normal way.

A prime example is the contrast between Rangitoto College and Māngere College.

Rangitoto College is the largest school in New Zealand. It’s on the very wealthy North Shore. If you go to that school, you have a choice of three gyms. In your senior year, you might go for a trip to Europe. They’re able to fundraise almost $3 million a year from their community to fund all those glamorous things.

Then there’s Māngere College, which is not too far from where I live. It’s decile 1. They’re able to fundraise around $7,000. They might be able to treat a few children to a trip to Sāmoa, where they’re basically sent to live in a village. They have half a gym, and the thing is falling down.

If you get into a car on a Sunday evening, you could get between those schools in 23 minutes. But, in reality, it’s night and day.

The other thing you’ll notice is, if you go to those schools and look through the gate in school time, at Māngere College, you’re unlikely to find a child with light skin. But if you got to Rangitoto College, you’ll struggle to find a child with brown skin.

And, again, there’s only one thing that explains all of the variables and the relative value of the property of people in those areas and the education standards. Racism.

So it’s really unfair to say that New Zealand is a fair society.

A Māori child who was born into a poor household and goes to Māngere College doesn’t have the same opportunities or the same lifestyle as the child that lives in a wealthy household, whose family has three European cars and goes to Rangitoto College.

Now, everyone knows this. This is not a surprise to anyone. But the racist thing is no one does anything about it, because that’s considered to be the way it is.

When I give this talk, I don’t introduce the racism word at the beginning of the talk. I have to put it in context, discuss it, and give lots of examples. It’s not hard to give examples. The problem is giving the right examples at the right time and saying the right thing, without being confronting.

The only way Māori and Pacific outcomes are going to improve is if European New Zealand actually confronts its racist heritage and acknowledges that that racism is alive and well — and that ethnicity in New Zealand is an absolute variable on your health and life outcome.

It’s a delicate kaupapa to raise. I respect the need to talk about it, but also to preface and contextualise it in the way that you did. You’re helping to share some kōrero about this dynamic and dimension with emerging doctors.

Some parts of Auckland, as you say, have got bugger-all brown people in them, so some of your colleagues in the medical field may have no experience of the hardships that Māori and Pasifika patients face through our medical system. Some of them working in South Auckland would have studied in Otago and grown up on the North Shore.

How important is it that those working in the medical profession understand what’s actually going on in the hood, so to speak?

It’s critical. I try to break it down, and I use my own DHB as an example. Let’s say a child comes into my ED with symptoms of pneumonia. If they came to me in Browns Bay and they’re European, I’d send them home. If they came from Ranui, I’m doing an X-ray and admitting them to hospital. That’s the reality.

You can’t decide on their medical condition, their medical outcomes, or what diseases they might have without an intimate knowledge of their socio-economic background.

Ethnicity is a vital part of the equation when you’re assessing whether a child has a disease. Māori children are much more likely to have a serious disease when they come in front of you. They have to be able to access better healthcare in a meaningful way.

You can’t assume that the family will be able to follow up with a GP — you have to tailor your treatment and observations. Quite often in paediatrics, we’ll send children home and say: “If you get worse, seek help.” You’ve really got to be cautious with that with Māori and Pacific people who may live in crowded households without any resource. You’ve got to essentially admit those children to hospital and make sure they get better.

So ethnicity and its corresponding socio-economic variables are vital to how you’re going to treat your patient.

I don’t actually give the racism talk to fifth-year medical students. We talk about bias. So, it’s code. I think they do realise I’m talking about racism, but it can get quite confronting in that sort of circumstance.

Most of them are from a white background, many of them are privileged. Your views of bias are usually given to you by those around you, so they’re not necessarily your fault.

The focus is really that ethnicity is an absolute proxy for poor health.

Also, I try to hammer home the fact that Māori and Pacific receive much less healthcare than Pākehā New Zealand, and you need to tailor your care to that. That’s how that teaching goes.

The teaching itself is guided by the University of Auckland, so I don’t give them the fire-breathing speech that I gave to the anaesthetists conference. But those are the themes that we go through to try and get them to understand. And most people are pretty receptive to the whole idea.

I do give them tips on how they might interact with Māori families. I insist that they have to go in and introduce themselves to everyone in the room. Then pull out a chair and sit down. And I encourage them, quite strongly, to start off a kōrero by telling their patient and their whānau something about themselves. I might have a picture on my phone of my children, or my wife’s dog, or talk about something that happened to me in the weekend, just to start off the kōrero.

But I also tell them that that’s what I do with all my patients. I don’t just do it with the Māori and Pacific patients, I do it with everyone. It’s sort of a vital part of medicine.

I think that’s really interesting. It’s just establishing a relationship before you get down to the nuts and bolts. Maybe it’s just politeness and good manners, irrespective of whether they’re Māori, Pacific, or any other culture.

When we look at the whole health system, would it be fair to say that there’s been piecemeal approaches to cultural expectations? And, even though the Treaty implies equity and fairness, it seems to be sort of filtered? Is that fair? Do you sense that there’s a lot of well-meaning people trying to head in the right direction, but at the moment, it seems to be being advanced in a piecemeal way?

I think you’re being a bit too positive, eh? The outcomes haven’t changed at all in any way, shape or form.

Don’t get me wrong. I think that culture’s important, but it beggars belief to expect that, if you have enough cultural workers, and if you come into hospital and they come and greet you, that things will change. It’s not true.

What Māori need is high-quality healthcare. Their health problems aren’t going to go away unless we take their health problems seriously, give them enough treatment, and get them through it.

There’s also the macro problem as well, but there’s only so much we can do in the health system. If you’ve got a whole ethnicity who are poor and living in crap housing, their health isn’t going to get better.

No amount of Europeans learning how to pronounce Māori names is going to help that. Those things are important. I don’t have any problem with it. And I think it’s part of the wave of addressing the racism that European people should pronounce Māori names correctly and take Māori seriously and that sort of stuff.

But unless it’s backed up with a commitment to proper housing, a commitment to the living wage, a commitment to the elimination of health inequalities in our society based on racism, there will be no real change.

I hear what you’re saying about culturally appropriate health services, and I get all that.

But when it comes down to it, there’s only six of us. You’re going to have to help us with this. We’re going to have to fight for healthcare.

People need to realise that Māori need more healthcare, that they can’t do anything to change that on their own. So just give them the high-quality healthcare. Give them the house. Don’t give tax cuts to the rich.

Unless you get all that in place, it’s just going to go on. There hasn’t been any change. In fact, the expectancies have got worse.

An example of this from my research is the broadening of the gap in immunisation uptake in Māori infants. Although overall immunisation has increased, the gap between Māori and non-Māori hasn’t narrowed. In fact, it starts to get wider from six months.

Another paediatric example is rheumatic fever, a third world disease that’s increasing in New Zealand and occurs almost exclusively in Māori and Pacific peoples.

I’m doing a Level 2 te reo course. It’s vital to me and vital to New Zealand. But we’ve really got to get serious about this. It’s the time game. Prancing around pronouncing names right and detailing all the problems — it’s not enough. It’s time for intervention. It’s time to get in and fix it. We know what the problem is. We’ve just got to get in there and do it.

I’m liking it, mate. But has it come at some cost? When you use the r-word, do your colleagues get a bit offside because they feel like it’s a veiled criticism of them, whereas it might be just looking at the historical realities?

My work is very supportive of this. I actually practised the talk on them before I did it. Everyone in the paediatric field is down with ethnic equalities, and the fact that racism has been a common denominator is now relatively well accepted. They get it. In other fields, not so much.

I suppose one of the things that I’ve been a little bit afraid of is that it will all be left to me, where I am, to try and sort out and fix the problem, which is just not going to work. We’ve all just got to do it together.

So, no. I haven’t had any direct backlash, but I wasn’t surprised at that. I’m a fairly forthright character. I don’t know whether people are avoiding me, or they just don’t want to talk to me about it because they know that they’ll get a robust response. I don’t apologise for that.

It’s been nice meeting you. Would you like to share some things about yourself that maybe we don’t know? I see that you’re a fisherman and a gardener.

I do enjoy fishing and gardening. I’m an incessant cook — I get a bit carried away with that. But I suppose the biggest thing I’d like to be known for is being a good father and a good husband. I have two children: James (11) and Lucy (8). My wife Jo is a doctor — she’s an anaesthetist.

And, also, I like to contribute to things. I’m the chairman of the board of my children’s school. Our school’s going great. Its achievement data is off the charts because the school is so good. I coach my children’s sports teams. Cricket, rugby and hockey. I enjoy that. I’ve got a vintage car that I potter around with. It hasn’t had much attention because of all the other things.

And I love travelling. I went to Rapanui — it was great seeing all the statues. And Chile after that. And I go camping on Great Barrier every year. I enjoy life.

And a good life. Thanks for sharing some kōrero today, Owen. And congratulations, especially on your mahi with the kids.

 

© E-Tangata, 2019