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Emma Espiner: the real kaupapa Māori

Politicians like to throw around 'kaupapa Māori' as a solution to our problems but how can our existing structures accommodate tikanga when they were designed by strangers?

Emma Espiner sees real kaupapa Māori in action at Ki A Ora Ngātiwai in Kamo, Whangārei.

We drive to Tūparehuia for a clinic. The road is winding. The driver is a local. We’re driving to the speed limit but it doesn’t feel like it. I wonder if this is how I die. I regret not taking the motion sickness bands that were offered to me before we left. An hour later, a settlement appears on a flat piece of land between two beaches. The sign says Bland Bay. A Pākehā lady in a white puffer vest is walking a Labradoodle and a seven-year-old. It is the school holidays. A nurse points to all the empty beach houses and tells me about the homeless. 

It’s a different day and we’re at Oakura. The four-wheel drive handles the beach and I hang on to the oxygen tank in the back seat. My supervisor tells me about the evidence for how a person’s sense of home and place affects their health. My health is affected by all this driving. We stop for lunch and I eat a cheeseburger at a deserted fish and chip shop by the beach while he talks about the chapter in his PhD titled ‘General Practice as a Colonising Force’.

It’s Thursday and we’re at Hikurangi. It looks like someone’s faded version of postcard New Zealand. Ko Hikurangi tōku maunga but this is not my mountain. I turn in a circle at Ruakākā. I see horses pounding a racetrack across a river whose name I don’t know. I can’t figure out which way to go to get back to Auckland. 

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What happens when the social safety net breaks? When I asked to come to Ki A Ora Ngātiwai in Kamo, Whangārei for my fifth year GP placement, I knew in a vague way that it was a ‘kaupapa Māori health service’ but I didn’t know what that would look like. What I found was a common sense solution, a tight canvas spread below the high wire of deprivation and need. 

Kaupapa Māori is the thing these days. I hear it’s the solution to our unjust justice system, to all the problems in health and education and it can probably fix the housing crisis. I’ve heard politicians getting used to saying the words like they know what they mean. However, at medical school, I’ve had limited hands-on exposure to health services which are based on kaupapa Māori principles. 

Part of the difficulty in establishing such a service is retro-fitting 'kaupapa Māori’ onto a system which is anything but. How far can you push the existing structures to accommodate our tikanga and serve our people when they were designed by strangers who thought it was their duty to smooth the pillow over our faces. We were meant to be a dying race.

Ki A Ora Ngātiwai fits snugly into the gap between the people and the system and, to my eyes, does a remarkable job at being everything for everyone who needs them by practicing kaupapa Māori in everything they do. Free visits. Half an hour for each consultation. Flat hierarchy. I mean - flat as. Dr Kyle Eggleton, the GP who assumed the title "kaupapa Māori medical officer” when he came to this role, is mocked daily by a team who respect his clinical knowledge, but don’t hesitate to give him a hard time about literally everything else. The nurses, community health workers, smoking cessation coordinator, social worker, healthy homes coordinator, rheumatic fever prevention team, administrators, cardiac and cancer specialists all share in the collective work of improving the wellbeing of this community. 

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The CEO is Winston Peters' older sister. I watch her on the first day. She talks like him but she definitely thinks for herself. You’d be stupid to suggest otherwise, especially within earshot of her. I know it's a bit touchy for people in New Zealand to talk about racism, but not her. She calls it out for what it is, every day. When I share a story with her about a whānau who had a particularly moving experience of being helped by the team and how grateful they were, Lynette tells me she wants our people to get the point that they're no longer "grateful". That she works for a time when Māori can expect timely, culturally appropriate and effective care as the norm.

With an encyclopaedic knowledge of the health system and the history of health services in the area, she misses nothing. I miss my grandmother, Kura Wehipeihana, when she's around. I like her so much I'm in real danger of viewing Winston more favourably simply by association. 

Every day we have waiata, karakia and a morning hui. Lots of people don’t ‘get’ this as a routine. It’s too fluffy or cringe or weird or maybe you’re an atheist and it gives you the shits to be in a room when there’s prayer happening. I challenge those people to read on and appreciate the role this kind of routine plays in organisational culture. Each day there’s a discussion about local or national politics, or an update on a service or policy. Sometimes there’s a kōrero about a patient who is having a particularly difficult time, and occasionally there are celebrations about wins. Someone is getting an organ transplant, someone else is getting a home. In some health services the former would be considered within the remit of a health practitioner and the latter a ‘social’ issue. Here, they’re the same thing. They are both understood to be intrinsically connected to hauora. It blows my mind because everywhere else in my training it has seemed too bloody hard to join the dots like this. 

Every day the purpose of the organisation is re-stated: for whānau, hapū, iwi and community. I compare this to screensavers I’ve seen in hospitals shouting the organisational values of this, or that DHB. CONNECTED. EVERYONE MATTERS. WITH COMPASSION. LIVING THE TREATY. 

I thought I knew about poverty. I remember when Mum couldn’t pay the bills. Taking the calculator to the supermarket. The time our windscreen wipers broke in the middle of a storm and I sat in the back seat while she cried in the rain by the side of the road. But I didn’t know about kids eating dog food for breakfast. Jellymeat sandwiches came up in discussion one morning and we were all made to look at this information and look closely, because we need to know the reality of what our people experience. 

I thought I knew about resilience. Medical school. Motherhood. Lots of jobs and all sorts of shit happening all the time. I’m tough. But growing up in a mostly Pākehā environment I hadn’t fully grasped the essential Māori privilege of being resilient, not for yourself, but for your community. I’ve met people who stared me down when I thought to talk about their health problems, who told me their only problem was that their diabetes, their heart disease, their cancer, interfered with their ability to serve their whānau, hapū, community. These are the people who are patronised by our deficit thinking in health. People who lack 'health literacy' only in the most narrow definition of the term. 

I’m leaving Whangārei with a fresh catch of kaimoana from Sharon’s whānau, a collection of citrus trees from Netti’s garden that I’ll try very hard to keep alive in Auckland (against the trend of my previous attempts at horticulture) and a clear understanding of kaupapa Māori in action. Ngā mihi aroha ki a koutou, Ki A Ora Ngātiwai. 

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