Dr Rawiri McKree Jansen GP was one of those kids inclined to land in trouble in his schooldays. And his teachers weren’t predicting great accomplishments from him. But his well-informed, widely-known, unafraid voice on the need for reform in the health system has meant that he’s now a force for significant good, especially in seeing that there’s progress in meeting Māori and Pasifika needs. He’s dreaming about that — and pushing for it, too — as he explains to Dale.
Thanks for joining us on E-Tangata, Rawiri. That’s the name I know you by, but a good many people know you as David, don’t they?
Well, I’ve changed my name over the years. Starting from when I was deeply involved with Te Ataarangi, the Māori language movement, I was known for a long time as Rawiri. But, when I went to med school and became a GP, I had half of my world calling me David.
So, about 18 months ago, I felt I should settle on one, and I did that. And I also took my wife’s surname McKree into my surname.
The Jansen part of it comes from a Danish connection on my father’s side. A great-great Danish grandfather migrated here and, from him, I have relatives in in Whanganui and Wairarapa. My dad Ross, trained as a lawyer and, one summer, he, his brother and a mate were travelling around performing as a band. One night they had a gig in Ngongotahā, where he met my mum Rhyl.
And, in due course, she and and Dad had six kids and raised us in Hamilton. Mum’s whānau links are to Ngāti Raukawa and Ngāti Hinerangi.
Tell us about your schooling. Was it there that you developed a love for our reo?
Mum’s dad Charlie lived with us, and he spoke Māori with me, so I grew up having that as part of my life experience. When I was 18, I bumped into Te Ataarangi, and that movement nurtured te reo in me.
My impression is that Te Ataarangi has been a wonderful taonga for a great many people. What would you say of its role in revitalising te reo?
It’s had a powerful contribution. It linked people who wanted to learn with people who were fluent, and it created a beautiful space for people to learn. It provided a structure and a safe place to do that.
You’d go through these different whiti and you’d work with a small number of words, master those, and then add some more. I remember Ruakere Hond saying that it created fluency in a limited vocabulary, but it created that fluency really quickly. And it gave you confidence to speak even while you’re growing the vocab.
Another plus was that it happened in so many places. It carried on in somebody’s home or at a kōhanga reo, or at a factory cafeteria at lunchtime, or after work. It’s very portable, and whoever feels like doing it can set it up very quickly and then just bring in people who’re interested.
And what about your desire to be a doctor?
I always wanted to be a GP. I can remember when I was nine years old, talking to my grandmother about that. She didn’t seem so certain that I’d achieve my dream. And, through high school (Fairfield College), I had experiences with teachers who told me: “No, you’ll never make it.”
I was a bit of a mischief bugger at school and ended up being invited to leave Fairfield College. So I went to Hillcrest High School after that. But that gave me an opportunity at the right time to get some academic momentum.
I got into Otago med school on the Polynesian preference scheme. This was at a complex time in New Zealand’s history. There was the 1981 Springbok Tour. We’d had Whina Cooper’s land march. And we had the nuclear-free independent Pacific movement.
Med school was a tough time for me because a lot of mainstream white New Zealand society was reacting against these moves. I joined the student protests, and my studies began to suffer. In the end, I dropped out and trained as a teacher instead.
But, in my mid-30s, I decided to have another crack at medicine. I applied to the Auckland med school and was accepted, and I graduated in 2000.
What sort of reception was there for your attitudes towards te reo and other Māori perspectives during your student days?
It was a hostile reception at Otago University in those years. Although I was young and up for it, I lost that battle and had to leave. And I wasn’t the only one. I can remember one Māori medical student “dropping out” every year. But then I can contrast that with the situation when I came back to Auckland in the late 1990s.
At the Auckland med school, Professor Colin Mantell had the support of Professor Peter Gluckman, and they started encouraging lots of applications from Māori and Pacific students. They were creating five and six and then 10 Māori medical student positions a year. That was just amazing.
Those were the years when Elana Curtis and Donna Clarke called for Māori doctors to come together with Māori medical students, and that was the start of the Māori Medical Practitioners Association, which has been a fantastic way to support each other.
And it has provided a forum where Māori medical students can present some of their research all across the spectrum, from neurology to geriatrics to public health to general practice to surgery. To every field in medicine.
What was the reaction of non-Māori students to the effort to have more Māori and Pacific people in the medical ranks?
Back in the 1980s, you had Pākehā students who’d tell you that their mate had better marks than you and should be there — and that you were stealing a place from that mate. But compare that to where we are now, when both Auckland and Otago have these impressive cohorts of young Māori heading for graduation. Many of them are fluent in te reo and many of them are also fluent in cultural expression and are well connected with their whānau and communities. That’s such a different situation now.
When I came back to Auckland med school, I had two lecturers who encouraged me to speak Māori with Māori patients in the wards — and, for me, that was enough sustenance from higher-up. But, for decades, we’ve had Māori students who haven’t had that support.
I can see that you’ve become confident enough to be calling a spade a spade when you’ve seen faults in the system. I’ve heard you call it a racist system that disadvantages Māori. You keep putting your head above the parapet which, I suspect, can come at a cost for you. Has that been the case?
I’m not sure. Many Māori academics and researchers call out the system. They do it in academic journals and in public lectures. And I take a lot of inspiration from them. But there are other ways of going about your work.
I remember years ago we were working on a project of bringing Māori clinicians, nurses and allied health professionals together and trying to give them a formal academic qualification in clinical teaching. And there was this Māori nurse on the orthopaedic ward at Middlemore, and she said: “Nah. I don’t want to do that. Yes, I’m Maori, but I just want to be a nurse.”
And I totally respect that. She doesn’t have to take on all this other mantle of responsibility, of trying to fix the whole system. She’s gonna be a really good Māori nurse looking after all of her patients in that ward — which is a good thing because that’s our whānau, isn’t it?
That’s the diversity of Māori, and it ought to be accepted. People are in all sorts of places in their political journey. Or in their career. And we’ve gotta love and accept that, and be with our whānau through it all.
So I don’t think I’ve paid a price for being outspoken. Maybe there are things that I don’t get invited to do, or there are certain committees that I’m not appointed to. Things like that. But I do get fantastic opportunities to work with our people in clinical settings like the Papakura marae. Or for Raukura Hauora o Tainui. Or up at Ōrākei for Ngāti Whātua. That’s been an incredible privilege.
A major problem is that, unless there’s an acceptance politically, there’s an imbalance. And, unless there’s a commitment to deal with that inequity, then we’re going to stay where we are. What needs to happen politically to ensure that there’s health equity in the future?
That’s a critical question for us to understand and respond to. If we want to see better Māori health outcomes for Māori, then we must see that the health system responds to Māori health needs inside the clinic, the hospital, the general practice, and everywhere within the health service.
That’s a big piece of work. But about 80 percent of what influences health for Māori are things that happen outside the clinic. They’re housing and employment and income and education and risk factors, right?
So we have to challenge the corrections and justice systems, which impose huge inequity upon Māori families. We have to change that. We have to imagine a society where fewer Māori are getting arrested — and where there’s equity in engagement with police and with judges and all through that system.
Imagine, too, if we had equity in housing and if we had much less overcrowding. And if we had equity in the education system from primary and secondary school through to apprenticeships.
In terms of health outcomes, all of those contributions to equity would be immense. They’d be a bigger contribution than what we do inside the health system.
That said, I’m not going to take any responsibility off the health system. It has to change its game. It has to stop being racist and become a pro-equity, pro-Treaty system.
That’s the change we have to see in Aotearoa now. We have to get busy now so that in 2040 — all these years after the signing of the Treaty, we’ll have something to celebrate. So the question is whether, 20 years from now, we’ll be celebrating or protesting.
If we don’t get this job done, we’ll be protesting. But you gotta believe that this job can be done and that an equitable Aotearoa is possible.
Well, it’s not as if we haven’t been making progress, is it?
That’s true. Take te reo for example. We’ve come from a time when te reo was officially suppressed and, as a people, we’d almost lost our language. And then we’ve had this renaissance of te reo Māori, and what a beautiful thing that is. What a power that is for us. And, from that, let’s keep building and making progress across all the other fields.
We can already see the progress with so many young Māori running businesses, for example. Or, succeeding academically or making a mark in the media. We see it, we live it, and we can tell that that’s our future.
Here’s the thing. There are more of us now than ever, right? My granddad was born in 1900, and that was the low point in the Māori population. There were only 47,000 in the 1901 census. Look at us now — more than 750,000 and soon to be knocking on the door of a million people. And we have these rights. And it seems to me that we have the capacity to act on them and to get a whole lot of this going in our favour.
Good kōrero. But in our political system we’ve got two major parties who tend to opt for a universality in health delivery rather than targeted intervention. It’s a one-size-fits-all approach and I guess, out of fear of losing the middle ground, they don’t want to be seen as pandering to Māori demands. And then perhaps our iwi aren’t being as proactive in health as we could be? Or do you think we need to step it up?
Yeah, we do. And one of my dreams is that we develop a Māori health provider network that reaches up to 400,000 Māori and delivers comprehensive care. And it’s not wrong to imagine that we could do more than that, because we have Māori clinical capacity across all of the specialities.
When you see the number of Māori doctors and nurses coming through, it feels like there’s huge momentum towards a tino rangatiratanga moment. It’s a wonderful time to be alive and to be imagining how much further we can go. It feels like we’ve got so much of the raw material that we need to build that future, and to fulfil the vision of mana motuhake.
Let’s touch on GP work, because this is often the first point of contact for most of our people with the medical system. What strengths do you derive from working in that intimate way with our people?
The only medical field that I ever wanted to work in is general practice, and I love it. It’s the privilege of being with people in their ordinary everyday lives. Sometimes we’re there at the beginning when newborn babies join a whānau, and sometimes we’re at the end when we get to hold somebody’s hand in their final hours. And each of those experiences, and everything in between, is such a privilege. We get to be with people when the challenges are immense, and we get to be with them when their successes are achieved.
It’s important that we can serve our community as they come to us. Let’s accept them for who they are, let’s work with them for who they want to be, and let’s serve them. That’s the joy of doing this job.
I recommend it, but, on the other hand, it’s clear that we need Māori nurses, we need Māori science teachers, we need Māori lawyers. And so on. We need Māori influence in all parts of society. And that’s one of the beautiful things about the way our urban marae are organising all of the services that support our whānau and our communities.
Would you like to make a comment about the coronavirus? Have we, for instance, featured as prominently as we should have as Treaty partners?
Yes, I’ve got a few thoughts on coronavirus. And, yes, I do think we should’ve been involved as Treaty partners in organising the lockdown. And I thought the tangihanga regulations should’ve been more respectful of our culture, so that we can do those things that we need to do when a family’s grieving and is sending somebody on their way.
I’m also worried about the palliative care for those who’re really unwell and for their whānau who’re having to deal with restrictions in being part of that journey with them. I think we can do that better — and we should do better. The Crown has a Treaty obligation to work in partnership with Māori, but the system hasn’t quite got there yet.
I don’t want to finish up without giving you the chance to talk about any other things on your mind — whatever gets you up in the morning and drives you along.
For me, it’s really predictable. It’s whānau, eh? I’m really blessed to have a beautiful woman in my life. My wife, Alvie, is the most intelligent person I know. And it’s my privilege to be on life’s journey with her. And we have this beautiful whānau. We’ve got lots of kids and we’ve got grandchildren and so all of that is just a joy.
I’m very grateful to have Alvie in my life because I mess up and I make mistakes and I have somebody there who picks me up and corrects me and directs me and loves me. To be loved is a really powerful thing in life, and I’m grateful for that. I’m well loved, Dale.
And, while I’m on the subject of love, I love your Waatea show, Dale, and the work that you do. That’s a beautiful contribution that you make.
(This interview has been edited for length and clarity.)
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