Over the last 50 years, Māori and Pasifika students with their eyes on a career in medicine have had the chance of getting a hand from MAPAS at the University of Auckland’s School of Medicine.
MAPAS is the Māori and Pacific Admissions Scheme which was set up to help ensure that New Zealand’s doctors would, bit by bit, get to the point where they’re reflecting the ethnic mix of the country’s population.
Here, Chloe Fergusson-Tibble tells how MAPAS has helped her along the way.
When I was very young, I told Mum I wanted to be a doctor, and she said “Go for it” in the same way she might have said: Yes, go and get fish and chips from the corner shop.
Her attitude was this: If you want to do that, then do it. It didn’t seem to occur to her that I could get lost on the way, or that someone might give me wrong directions.
By high school, I still hoped to be a doctor. I was fairly studious and loved human biology, as well as reading and writing stories. I was a natural at English, history and classics. To me, being a doctor would be about listening to people’s stories.
But when I went to the careers advisor, I was told I hadn’t selected the right subjects and should reconsider. I wasn’t strong in science or maths, and she also mentioned that I “didn’t really have the right support” to pursue medicine.
When I reflect on what that meant, I think it was probably code for “you aren’t from the doctor-type of family.”
True, there were no doctors at home and our university degrees were limited, at that time, to one aunty. Nor was there a lump sum of money lying around our house to get me to medical school in Auckland or Dunedin. I knew nothing about scholarships, and no one told me about them.
As a 16-year-old who thought about work as a way to pay for ciggies and a car that might pass a warrant, I rearranged my flimsy plans trusting that the school knew what was best.
I finished school and embarked on what became a mostly extramural degree in psychology and English. I also realised that I very much wanted to become a mum. Staying home to study and look after my own child at 19 felt natural to me.
Then, as a 24 year-old mother of two, I started working for a Māori mental health service in Gisborne. During this time, I was able to connect with my own whakapapa and I started to learn the absolute value of using Māori approaches in healthcare.
I saw first-hand how Māori are more likely to die from suicide, or to be restrained and placed in solitary confinement.
I also saw psychiatrists coming from all over the world to try and help. Very few had the ability or confidence to work in the tikanga-based way that I was now seeing as crucial for people in distress.
Then, one day, in strutted Dr Diana Kopua. I’d met Māori doctors before but, with Di, I was star-struck. Here was this wahine Māori, who’d gone to medical school later in life, rocking a moko kauae, talking about Mahi a Atua, equity, and using pūrākau as a way to heal our people.
I hadn’t ever heard a doctor speak in ways that resonated so deeply with me. It turned out she was a Te Ora doctor. That’s the professional body representing Māori medical students and doctors.
In that moment, I knew I’d follow this woman and this kaupapa to wherever it took me. So, being something of a stalker, I rang her that night to tell her I was considering going to medical school.
It was Dr Di who first told me about the Māori and Pacific Admission Scheme, or MAPAS.
I wasn’t even aware at that point that I had to actually “get into the medical programme”. I still thought that, like fetching fish and chips, you just went and got medical education if you wanted to.
No wonder the MAPAS advisor, Will Nepia, laughed when I called him the next day. Let’s also not forget that I hadn’t studied science in over 10 years at that point.
Will arranged a MAPAS interview for me — and I did that, only to be told (with love, but also very matter-of-factly) that I’d failed. I aced the English test but definitely not the maths.
In order to succeed, I would need to complete a foundation programme, called Hikitia Te Ora. Then I could apply to first year Health Sciences and, only after completing that could I then apply to medical school.
Just like that, my plans to study to be a doctor stretched out from five to seven years.
It was clear that I had so much to learn. I still thought that you graduated as a specialist in everything and then changed your title from cardiologist to psychiatrist, or whatever, depending on which part of the hospital you chose to work in.
Still, I decided to push ahead and, at the end of 2015, I left Gisborne to start my studies. When I said goodbye to Di, she reminded me that to truly become a Māori doctor I needed to continue working in a whānau manner, and show pride in my whakapapa and in the values handed to us from our ancestors.
She warned me that medical school would, at times, feel like it stands in total opposition to all that.
She also told me to hold fast to my MAPAS and Te Ora whānau. To ask them for help and support, every single time I needed it.
I spent much of that next year crying.
Right before my first MAPAS wānanga, and the start of my journey at the University of Auckland, my mother died of cancer. She was 48.
The care that she received during her illness assumed that she and her whānau understood the seriousness of her diagnosis, her prognosis, and the value of palliative care. We didn’t.
What I would learn that year, in the Hikitia Te Ora programme, gave me the language I needed to understand and explain her death and the deaths of so many other Māori.
I learned about the health inequities that our people experience. About epidemiology, institutional racism, cultural safety and Te Tiriti-based healthcare. Despite not being a maths genius, nor having an affinity for physics, I started to realise that being on this path was exactly where I was meant to be.
I finally had a bird’s eye view of healthcare that proved my bone-marrow deep sense that our whānau Māori are missing out on what we need to thrive.
But not all of the crying that year was of the grieving and healing variety.
I remember watching my children playing in the yard in Auckland, while I sat slumped over our dinner table with my weekly maths homework sheet sobbing to my devoted husband, asking him why mathematicians are so bloody obsessed with finding the value of x?
I thought back to Di’s advice, and leaned hard on all the MAPAS resources — the Hikitia Te Ora lecturers, open office hours, tutorials, advisors and study sessions with our tuākana. I worked until my neck ached, consumed chocolate at an unapproved rate and came through with grades higher than expected in maths, physics and chemistry to gain entry to first year Health Sciences.
The thing about that Hikitia Te Ora foundation year is that it’s designed for us to thrive.
They know that many of us are from non-medical, non-academic families and they know that some of us come from backgrounds where surviving is more pressing than thriving.
They understand the deeply entrenched racist structures that keep our people “below”, and so they know how to help us.
It was the most beautiful thing to learn not only the language of maths and chemistry, but also the language I so desperately needed to explain why our whānau are dying before their time.
As a MAPAS student, you are, from the very beginning of your studies, equipped with an evidence-based understanding of the health inequities that our whānau Māori face.
I learned that it wasn’t our fault that we didn’t understand what was happening with Mum. Health literacy is not simply how much patients and whānau understand about hauora. Rather, it’s about the ability of the system to shift to meet us. It’s the health system’s responsibility to present information to patients and whānau in a way that makes sense, so that we can make informed decisions.
I also remember sobbing in a Hikitia Te Ora lecture about land confiscation. The colourful pictures of Māori land diminishing over the decades since colonisation released a pōuri that I’d locked away. I learned to articulate how land confiscation and language dispossession resulted in my people dying earlier than non-Māori. It filled me with a deep sense of pride to be able to locate our health statistics within those historical injustices.
I cry less about those things now because the knowledge was deeply healing. Now I can look ahead to my own role in our recovery.
In 2017, I started first year Health Sciences alongside more than 1500 others in our year group.
I looked around at the mostly 18-year-olds and wondered how the heck I was going to make it through another year of chemistry among high-school leavers who were backed by impressive grades and wealthy families.
But it turns out that it wasn’t as gruelling as I feared. The foundation year had given me what I needed to go into my first chemistry class and not freak out. I knew how to draw those ridiculous chemical equations. I’d formed the learning habits and study skills needed to see me through the bumps of first year and get the high grades required to enter medical school in 2018.
Most importantly, I still had a MAPAS whānau. My Hikitia Te Ora buddies were now medical students too. They were my day-ones, who’d continue to hold my hand through our brain anatomy and respiratory physiology lectures and the rest of the confronting culture of medicine.
They were the ones who giggled with me when we correctly answered a random pop quiz question about gout or diabetes — because all of us have personal experiences with chronic disease. So much of what we already knew about chronic illness came from having experienced it within our own communities.
We went to tangihanga and birthdays together, talked about ways to whakanoa after human anatomy labs with the tūpāpaku, celebrated Moana Jackson’s life when he passed away, said karakia when a patient died, gossiped about Te Matatini and other Māori kaupapa during lunch breaks — and dreamed up big plans for Māori-centred healthcare systems.
If Mum or my career advisor at high-school had known about MAPAS and Te Ora, I may have pursued medicine far earlier.
I’m now in my final year of study, and I’m on track to my career goals. The difference the MAPAS pathway has made to my whānau wellbeing and our whānau trajectory is undeniable.
We’re now better able to navigate the healthcare system. While access to healthcare shouldn’t depend on how much you know about it, as with any job, having a medical student in the whānau sure helps. So much about healthcare, wrongly, relies on knowing what questions to ask and where to go.
As it stands, the more you know, the better access you’ll get. There are hardworking Māori organisations bridging the gaps, advocating and walking alongside our people through the health system.
But it helps having our own champions in our own whānau. MAPAS makes champions of all students by teaching us context, including the barriers such as health literacy, in a blame-free way.
When a MAPAS student finishes work, they often drive home to a whānau where their knowledge of the health system is so badly needed. We’re pursuing equity not just at mahi, but in our whare, at our marae, and in our whānau circles.
In my fourth year of med school, I was with an orthopaedic surgeon, assessing a young man who’d cut his leg on his bike pedal. The surgeon asked my opinion. Did the patient need a washout in the operating theatre, or could we clean the wound, bandage it and send him on his way?
I opted for the latter. I was wrong. That’s because I was providing healthcare that my own whānau would never even seek out in the first place. I’ll never forget how strange it felt. There’s a lot of that in our communities — a sense of “it’ll be right, doesn’t need a doctor, don’t make a fuss, other things to worry about right now.”
Now, I’ve learned that it’s always better to get that sore back, leg, head or ear checked out. It’s always worth taking your baby to the doctor when they’re not quite themselves. Even if we’re sent home just with reassurance, healthcare of that level is our absolute right.
It never ceases to amaze me the number of questions that non-Māori will ask during a ward round. But I’ve noticed that question time with Māori patients is often comparatively brief. That worries me, because I’ve also observed that, when you ask for things in hospital, you get more than if you don’t ask.
I can honestly say that there’s no place where the myth of Māori always seeking handouts is further from the truth than in a hospital.
So, when I go to see a Māori patient my first thought, as I prepare to walk through the curtain, is this: “What is the extra thing I can do for this whānau right now?”
Sometimes, it’s explaining a disease process in simple terms, speaking te reo Māori, or advocating for a whānau hui. Other times, it’s hustling on their behalf to get a doctor’s signature on some obscure WINZ form that appears to be in circulation only to make access to fundamental resources harder.
MAPAS has taught me — by delivering it to me personally — that we need more in order for equity to occur.
I wouldn’t have made it this far without the extra care from MAPAS. Similarly, we can’t do same things for Māori that we do for non-Māori, who are already living years longer than us, and then just expect Māori to live longer.
My approach in my clinical interactions is an extension of the aroha that I’m shown by MAPAS as a Māori medical student.
Walking the corridors with my own moko kauae and with my own stethoscope (as a final year medical student) is bittersweet. I’ll be a doctor soon — the first in our whānau.
But, as with many of us, it’s the powerful desire to serve our people, not the title, that fills our cup. We need more Māori doctors. Every single time a Māori patient smiles at the kauae they see on my ID badge (the real one is being covered with a mask), I know what they’re thinking. Ko au ko koe, ko koe ko au. You are me, I am you. Being Māori is my superpower.
Knowing what I know now, I firmly believe that my dad, who’s the hardest working fencer and man I’ve ever known, could easily have succeeded at orthopaedic surgery.
And I realise that my mum, who was at times single-handedly raising seven children, taught me more about breastfeeding and raising children than I’d ever learn on birthing units and paediatric wards.
My mother’s belief that I could be a doctor “if I wanted to” planted an important sense of determination in me. But my journey wouldn’t have happened without MAPAS and our wider Te Ora collective. Because it turns out that being a doctor is about stories.
It’s about our personal stories, our whānau and ancestral stories, the stories of how we show up in the system, and, of course, the societal stories.
Programmes like MAPAS uncover the stories for students, and tell them in a way that helps us make sense of health in Aotearoa. They prepare us to be able to dismantle the stories that aren’t serving Māori, so we can create new ones, and provide the healthcare our people deserve.
Chloe Fergusson-Tibble (Te Hikutu, Ngāti Kahungunu ki Wairoa) is a medical student living in Rotorua with her husband and two tamariki.
Made possible by the Public Interest Journalism Fund.
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