The Māori Health Authority that’s being set up — and that Riana Manuel is heading — has been the target of some criticism. Especially from opposition politicians.

Well, they would oppose it, wouldn’t they? It wasn’t their idea. And whenever there’s any hint of supporting the rangatiratanga agreed to in the Treaty, there’s scope for labelling it apartheid no matter how nonsensical or wide of the mark that is.

That’s not much of a concern for Riana who’s done such a substantial apprenticeship in health work that she knows how effective it can be when Māori health workers are designing and providing the care for Māori patients.

So, this revolutionary step in the delivery of healthcare in Aotearoa is not giving off risky vibes. Nor is Riana in this conversation with Dale.

 

Kia ora, Riana. Not long ago, here on E-Tangata, we heard from Margie Apa, a good mate of yours, who, like you, now has some extra sway in the health world. Margie’s background is Sāmoa and Ōtara. Yours, I understand, is the Coromandel.

Yes, I’m from Manaia, on the Coromandel Peninsula — and my first name, Riana, comes from one of my nannies, who passed away just before I was born in 1972.

We’re from Ngāti Maru, and also Ngāti Pukenga and Ngāti Kahungunu. My māmā is Ruth (nee Davey), a Pākehā woman who met my dad, Harry Haerengarangi Mikaere, when he was in the forestry workers’ school in Kaingaroa. Mum was a first-year nurse at Rotorua at that time.

My husband is Hone Manuel. He’s from Ruatōrea, but he grew up in Gisborne. And then I wrestled him away, nearly 30 years ago.

Your schooling was in the Coromandel?

I started at Hauraki House, which was a small primary school right in the heart of Coromandel, but it closed down and became Coromandel Area School. That‘s where we spent the rest of our primary school years.

My dad had petitioned for te reo Māori to be taught at Coromandel Area School but got refused, so we were trucked off to Turakina Māori Girls‘ College. Then, because Māori girls’ boarding schools back then didn‘t have a seventh form, I was transferred to Auckland Girls’ Grammar to do my final year.

It‘s neat to see your dad pushing for reo Māori. Was he a speaker himself? 

No. He was part of the lost generation. But his mum and dad were both native speakers. I remember growing up with Nanny and Grandpop, and sometimes they’d talk to each other in te reo so nobody else could understand what they were saying. It was like a secret language.

But that didn’t happen often. That‘s because my grandfather and grandmother thought, as did many of our people, that their children and mokopuna would suffer if they taught them te reo Māori. They remembered the problems they’d had at school for speaking Māori and they feared that their children would be smacked and strapped. So, they only spoke te reo Pākehā.

I think Dad pushed for te reo at school because he knew he couldn‘t teach us. By then, my grandparents had both passed. So, he lobbied for it. He was the chairperson of the school board at the time. And when they wouldn’t teach it as a subject, we were sent to boarding school.

Have you raised your kids speaking te reo Māori?

Absolutely. If Dad’s generation were the lost generation, then Hone and I were part of a generation where we got bits and pieces of the language. You did School Cert Māori and Sixth Form Certificate and Bursary Māori. Then you went on and did courses at uni or wherever.

But we made a conscious decision that our children should be reo Māori speakers, and go to kōhanga reo and kura. All of our children have been educated through to Year 13 in te reo Māori, and they’ve been able to do it in the kura in Manaia.

Do you all love mussels?

You know what? I don‘t. Dad was one of the first mussel farmers in our rohe, and he‘s been an aquaculture guru for at least half of his career.

As a kid, I remember him being distraught that none of us seven kids were eating what he was farming. So, he put mussels into our minced stew for dinner one night — and, needless to say, I got a bit sick and never ate mussels again. All of the other kids have come around to eating them. Not me, though.

I‘m assuming you went on to study nursing when you left school.

Well, no. When I left school, I applied for teachers’ college, because I thought I might like to be a teacher. But then I had second thoughts, joined a group called Kahurangi, and we travelled around overseas.

That must’ve been some experience.

Kapa haka was what we learned at kura. So, I made the cut when I tried out for the group. We did a summer school in Hastings and then we performed all over Canada. I just loved performing.

We were part of a First Nations pow-wow circuit. It was fabulous. It wasn‘t just the travel. It was living on the reservation, being part of that kaupapa, recognising that, as an Indigenous person, we had so much in common. All of us with a story, all of us with a history, all of us having experienced loss in so many different ways.

When I got home, I started working as a carer at my mum’s rest home. I watched the nurses, and I’d watched how my mum had gone from being the Plunket nurse to the public health nurse to the district health nurse — and I remember thinking: “I could do that.” So that’s what I did. I was about 21.

Nursing often means tough working conditions and pay inequity, certainly through the last couple of years. The government wants to build up the nursing workforce, particularly in mental health, and particularly with Māori and Pasifika nurses. But I wonder why people would be attracted to such stressful work.

For us nurses, it’s always been a profession of nurturing and caring. But you can hardly compare what the nursing workforce looks like nowadays with pre-Covid times, because the pandemic has made things so much more difficult.

That‘s not to say that pay equity and other issues weren’t there before the pandemic, because they were. But, if you look at any female-dominated industry, you‘re going to find that there are problems with pay equity. So, I‘m not surprised that nurses are pushing that big drive for changes.

But it’s a fabulous career and it‘s one that I‘ve loved to be a part of. I think Māori are, inherently, a people of service. It’s suited my desire to serve my people, the way I problem-solve and care for people. But it also allows us to grow health literacy for our own people.

Sometimes we don‘t think laterally enough about what it means to empower people to understand how to own their own health care. Covid has given us a great opportunity in that regard.

You were the CEO of Te Korowai Hauora o Hauraki before taking up this new mahi. What’s the best aspect of that localised, iwi-driven healthcare?

For me, one of the best parts is that it was grown locally. It came from the aspirations of our own people. When something has its genesis in that kind of thinking, you nurture and take care of it.

You don‘t limit yourself to thinking that Te Korowai is just a healthcare provider. No, Te Korowai is whānau ora, Te Korowai is mokopuna ora, it’s rangatahi ora, it‘s kaumātua ora. It’s every ora wrapped into one. Everything you need to create oranga for your people sits inside that kaupapa and is supported by iwi.

I know you‘ve got a high-backed chair in a flash office, because you’re a CEO, but I’ve rung before and you‘ve been out on the frontlines doing vaccinations. How important is it to keep a hands-on approach in frontline work, even though you‘re the boss?

For me, this is about modelling. I‘ve grown up on my marae and in my village, and I‘ve spent all my life with people who modelled good behaviour, good values, and good service.

So, for me, being out on the frontline is about making sure that my kaimahi feel supported. If I go out on the frontline as a registered nurse with my scope of practice, I can take four or five of my kaiawhina with me and we can do a whole lot more work.

It’s also about making sure that I stay relevant with my people. And, of course, keeping my practising certificate up. You‘ve got to have so many practice hours to hold a legitimate practising certificate.

And every time I go out on the frontline with our kaimahi, we have the best day. It‘s hard work, but we get awesome feedback from our people. It‘s a great way to stay in touch.

We‘re on the cusp of some wonderful opportunities in all sorts of areas, but change won‘t happen overnight. We all know that. How frustrating has it been for you that we’re constantly reminded about our people‘s poor health stats?

It‘s hugely frustrating. One of the things that motivated me to go for this job was because reforms tend to happen only once every 30 years or so — and in 30 years’ time, I probably won‘t be a big part of the workforce.

This time around, I thought to myself: “We‘ve got to do something to move this waka.” One of the ways we’re doing that is making sure that, within our hapori, our marae, our whānau, and in our urban settings, we create a system that empowers our people to help us turn the waka, because they’re the best navigators that we have.

Better than any clinicians we have, and better than any system, are the people who use it. They’re the ones who should be doing the navigation.

What did you think when it was announced that the Māori Health Authority was to become a reality?

I nearly shed a few tears because, in my career, I hadn‘t ever seen a moment when a Treaty partnership was actually turned into a functional and operating reality.

I know we‘ve got a long way to go and these are just the beginnings, but I feel heartened that we may be able to make a difference this time. We may be able to create an enduring partnership.

And, if we could do it here, what would be the imaginings for the rest of society? This could be a model for many different sectors.

We tend to be humble as Māori people, and sometimes when you’re going for a gig or standing for public office, you’re required to talk yourself up. Your CV speaks for itself, I know. But what made you want to apply to lead this new entity?

It was the opportunity to make an important change. When I saw the opportunity come up, I thought: “This is something I’d love to be a part of, and I‘m going to apply. And, if I‘m fortunate enough to get it, I’ll throw myself at it 150 percent.”

I know that what we‘ve done at home has been a model of care for our people, because we designed it and we’ve grown our workforce. We’ve put our local people back into it. We run it by Māori, for Māori — but we take everyone with us.

And I figured, if we could do that locally, what if we could pull it off nationally?

What if we could encourage and inspire and provide the opportunity for all of our providers to do that very thing? Because we have 170-odd Māori providers throughout the motu, all of whom have had differing opportunities and experiences with different healthcare models.

And this isn’t just about health. It’s about the social determinants that affect our people’s wellbeing. What if we could turn the tide on things like providing better housing that would drive down the respiratory disease in our people?

It’s making sure that our people have high levels of health literacy education, that we‘re creating pipelines and opportunities for our workforce. And that workforce then becomes a mechanism for a better economy, and that better economy leads inevitably to better outcomes for our people.

Health can‘t just sit on its own like an island. It‘s something I plan to spend a lot of time on, to get the rest of those sectors playing the game for us, and with us, because what I‘ve noted in my own community is when we do that, when we‘ve got a service that encompasses all of those other social determinants, we can actually make change.

What was the reaction from the people back home when you landed the job?

Before I applied for the job, I went back to our people and alerted them, because the last thing I wanted to do was go without the blessing of my people. They were like: “Yep. Come on. Let’s go. Let’s give it a good try.”

When I announced that I‘d been given the job, there was a mixture of elation and a bit of concern because, moving away from home and away from my provider means change. But we‘re so lucky because I had Taima Campbell all geared up to step in as our interim CEO, and she‘s fabulous.

But you never want to leave any of your organisations in a place where they won‘t be well if you’re not there. If that‘s the kind of organisation you run, then it‘s not healthy, because every operation has to exist with or without you.

We‘ve been very lucky. I‘ve been able to work between Wellington and Tāmaki and also go home on the weekends to see my family. I‘m so lucky to have my mum and dad still alive at home, and my husband and my children and mokopuna all living in the Manaia village. Going home grounds me.

What will your early priorities be in the new mahi?

Getting as much resource out to our people as possible at a provider level and at an iwi, hapū and whānau level. One of the best things we can do is give the resources back to our people so that they can start doing the things that they know, instinctively, how to do.

Every bit of resource that we find, we’ll put back to our people, because our iwi providers, our kaupapa providers, are not organisations that have grown up overnight. These are organisations that are 30-plus years old. They‘re well-oiled machines. And those that aren‘t as well-oiled as others, simply haven’t had enough resourcing.

What I want is for our people to have access and choice about the services they get. And I want them to be able to feel a great sense of pride and trust and hope in those services that they have access to — services that reflect their worldview and their realities.

A priority is working in strong partnership with Health New Zealand. Margie Apa and I are committed to making sure that our leadership reflects a true Treaty partnership that we’ve talked about for many years. Margie and I have very similar values and it‘s lovely to work with her and her team.

Fifty years ago, this position would have gone to a man, almost without question, but now we have wāhine Māori and Pasifika leading tribally and politically in the health sector. What would you say about that? Motherhood, leadership, and seeking out our potential?

I remember, as a child, learning very quickly that there were responsibilities and roles that my mother and my nannies and aunties had, not to mention my pāpās and my koros. And when I think back to how I must have appeared to my children, a lot of it was modelled on that. They grew up in the same village, so they grew up with the same sort of growlings and warnings.

I do think about the kind of leader that I want to be, about being a good tupuna. If I make a decision now, how will it affect my mokopuna? I‘ve got 12 mokopuna now, so I feel a responsibility to make sure that whatever I do has a positive impact on their lives, including the structures and legacies I leave behind for them.

Nobody was more fiery than my nannies. They were fierce. They would speak their mind, sometimes to their own detriment. And they were ladies who would hold themselves to a really high account.

That‘s what I‘ve tried to do. I believe it has made me a better leader, conscious of the footsteps that I leave behind. I remember thinking as a manager that when you’ve had several children — I gave birth to three children and have had four whāngai as well — you really have a deep sense of when someone‘s telling you something that‘s not quite right. I can smell BS a mile off. And I put that down, largely, to having raised my children.

So yeah, it‘s been a great ground to cut my teeth on, and I‘m grateful to those wonderful human beings who made me accountable.

I guess we‘re used to seeing decisions coming down from on high, but you’re talking about more of a ground-up approach to make sure you make the right moves early on. How are you going to gauge this effort?

In my experience, people tell you really quickly when you‘re not doing the best job you could. Our people may be many things, but having a light touch when it comes to letting you know you‘re not doing a great job isn’t one of them.

I feel confident that if we‘re not making the grade, if we‘re not doing something in a way that’s tika, pono, and doesn‘t uphold those values that we as Māori people seek to have within our lives, someone‘s going to tell me about it really quickly. And that’d probably be my own people. In fact, they‘d be at the front of the line.

I can already detect that you’re an assertive wahine, and you’re gonna have to be, aren’t you, because apart from your health background, this position almost asks you to have a political focus, too.

I keep going back to the fact that this isn‘t about a top-down. It isn’t even from the centre out. It is literally that we have to have faith and trust in each other to do this job.

Yes, there was always going to be a political aspect about the job. There‘s no getting away from that. Not for the Māori Health Authority, not for any place in this country of ours, because in a democracy we all have to be prepared to have a voice.

We know what‘s not working. We know that there’s so much evidence that our people are not getting the health services they deserve. It‘s just not right that we die seven years younger than everybody else. These are basic things that shouldn’t be happening.

It’s time to get busy and stop that. And whatever it takes for us to get that in place, that‘s what we should be doing. And, at the same time, bringing back some of the esoteric knowledge that has been lost, because one of the things we don‘t account for in colonised nations is that there is so much that we‘ve lost that would be valuable in this current day.

So, you know, restoring our own mātauranga, our reo, our tikanga, our kawa, our rongoā, our maramataka. All of these things can help us and guide us on the way forward.

For me, it’s about facing those issues and then it‘s about making sure that, within our partners, we identify where racism sits.

Our institutions are inherently racist. It‘s just a thing. It‘s not something we all have to be affronted by. It‘s something we just have to acknowledge. And, once we acknowledge it, then we start moving toward solutions.

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