What does it mean to be a Māori doctor? Historical and contemporary perspectives. By Andrew Sampson Submitted for the degree of Bachelor of Medical Science with Honours at the University of Otago, Dunedin, New Zealand 31st March 2017 ABSTRACT Background: Māori are under-represented in the medical workforce; however, numbers of Māori medical doctors are beginning to grow. This research explores what it means to be a Māori doctor utilising Kaupapa Māori methodology. By collecting and documenting the stories, challenges and opportunities of Māori doctors, this research hopes to inform and inspire Māori who aspire for, or are involved in medicine, and create perspectives for both Māori workforce development and the health workforce. Review of Literature: The first ten Māori doctors were identified from Dr Paratene Ngata’s speech “The Whakapapa of Māori Doctors in Aotearoa NZ” (Ngata, 2002). Relevant literature was found on each doctor through the Otago library, Te Ara, the National library, Papers past and Te Ao Hou magazine databases, and anything thought relevant by the supervisors was also read for referencing. The focus was on the Doctors’ contributions to health and the attributes they possessed; many similarities were found. Methods: Participants were eleven Māori doctors currently working in Aotearoa, New Zealand, aged between twenty-four and seventy-five years, and one pilot was used. A selection matrix of Māori doctors was created, encompassing diversity in gender, stage in career, specialty, and location. Kaupapa Māori methodology was used. Qualitative interviews took place in a place comfortable to both research student and participant and were audio recorded, to be later transcribed and thematically analysed using Nvivo software. Results: In this section the results of the twelve participants, including the pilot, are described in six themes; their journey thus far, their support, roles they have taken, expectations of them, what being a Māori doctor means to them and their aspirations. Key findings included high levels of commitment to being a Māori doctor, diverse journeys and experiences, with some common experiences. There was a high prevalence of expectations on them from others to be experts with a Māori patient, and to be culturally, and clinically, competent. The pressure and responsibility from expectations was commented on. The participants had many professional roles, serving on boards, taking leading roles in health programmes and lecturing. Connections and whakawhanaungatanga (building relationships) was a common theme brought up as a real strength of Māori doctors. Giving back was a key theme brought up, and Māori doctors having a key role to play in Māori health, and being role models and leaders to everyone. Isolation was ii a prominent theme for the participants, whether it was isolation from other Māori doctors, or isolation within Māori doctors, about who is more or less Māori. Conclusion: The stories of Māori doctors, both historical and contemporary, have similar attributes and aspirations, including mātauranga Māori (knowledge of Māori culture), aroha (compassion), niwha (determination), taking up leadership roles and challenges, and responding to the needs of the next generation. The application of the doctors’ attributes and aspirations was seen both in a community setting, and in a wider, political level, questioning the view of one doctor being more Māori than another. Even though both the historical and contemporary doctors have taken different paths, they share a destination. iii PREFACE AND ACKNOWLEDGMENTS The journey for creating this thesis began when I first entered medicine. Support from the Māori Health Workforce Development Unit (MHWDU) was pivotal as academic support, as well as cultural and whānau (family) support. I had a desire to know who I was as a tāne (man) Māori. I visited Te Poho o Rawiri marae (meeting place) with my dad and met my grandfather for the first time. Opening my mind to the realisation that one day soon I would become a Māori doctor. At a Māori Fresher’s Hui in 2014, a Māori doctor spoke about his experiences of being a Māori doctor. I decided I wanted to write a thesis that would highlight the contributions and attributes of past and present Māori doctors, in the hope that I might inspire more Māori to become doctors. Since then my thinking has evolved and there are some whānau I would especially like to thank, both whakapapa (genealogy) and kaupapa (for a reason). Firstly, to my grandmother who has supported my whānau since I was born. She would often pick me up from school when mum had to work, and she still supports me to this day. I find my whānau have always had my best interests at heart, even if I did not know it. Mum, my provider, strength and encouragement, alongside Craig, always there, ready to support me if he saw the need. Dad one of my best mates, with the same sense of humour, alongside Lesley who is incredibly welcoming. I know that my younger siblings will also be people to look out for in the future. To my, friends, as close as whānau, teachers who have empowered me and role models that have helped me set my moral compass. Including my supervisors; Anna, who gave me all the tools and places to look to complete this thesis, and Jo, who was patient with me when I knew what I wanted to write about, but didn’t know how. As well as the team Fran, Kale and Tui and everyone else from the MHWDU who have all had a part to play in this thesis, tēnā koutou katao (thank you all). My biggest thanks is to my partner, Kitty, thank you for everything you do for me. Your encouragement, understanding of my unusual work hours and you being there for me this year when I needed you most. There are not enough words to express my gratitude. iv GLOSSARY Ako Māori – culturally preferred pedagogy Aonui – thirst for knowledge Aroha – love, compassion Atua – gods Hapū – sub-tribe Hui – gathering Iwi – tribe Kai – food Kaiaka – athletic Kanohi ki te kanohi – face to face Kaumatua – elder Kaupapa – policy Kaupapa whānau – peers Kia piki ake I nga raruraru o te kainga – Koha – gift socio-economic mediation Korero – talk Kuia – grandmother Mākutu – curse Mana – prestige, authority, control, power, Manaakitanga – hospitality influence, status, spiritual power, charisma Manuhiri – guest Marae – meeting house Mātauranga Māori – Māori knowledge Mihi – greet and acknowledge Mihi whakatau – official welcome speech Moteatea – songs and chants Niwha – determination Pā – fortified village Pākehā – New Zealander, European descent Pō-mare – night cough Pou – support Pou whirinaki – sense of responsibility, Pōwhiri – formal greeting Pūkōrero – well spoken Rangatira – chief Rongoā – traditional Māori medicine v Tāmoko – tattoo Tāne – man Tangata whenua – people of the land Tangihanga/tangi – funeral Taonga – treasure Taonga tuku iho – cultural aspiration Tapu – sacredness Tautoko – support Te Ao Māori – the Māori world Te Ao Pākehā – the Pākehā world Te reo – Māori language Te Whare Tapa Whā – the four Tēnā koutou katoa – thank you all cornerstones of Māori health Tikanga – custom Tinana – physical aspect of Te Whare Tapa Tino rangatiratanga – self-determination Whā Tohora – whale Tohunga – expert practitioner Tumu herenga waka - dependable leader Turanga waewae – a place to stand Waiata – song/prayer Wairua – spirit, spiritual aspect of Te Whakamōwai – humility Whare Tapa Whā Whakatoatoa – outspoken Whakapapa – genealogy/family Whakatauki – Māori proverb Whakawhanaungatanga – Building Whānau – family relationship Whanaunga – kin Whanaungatanga – relationship Whare – houses Wharenui – meeting house vi TABLE OF CONTENTS Abstract ....................................................................................................................................... ii Preface and Acknowledgments ................................................................................................. iv Glossary ...................................................................................................................................... v Table of Contents ..................................................................................................................... vii 1 Introduction ......................................................................................................................... 1 1.1 Introduction .................................................................................................................. 1 1.2 Overview ...................................................................................................................... 2 2 Literature Review – An Historical Perspective ................................................................... 4 2.1 Introduction .................................................................................................................. 4 2.1.1 Overview .............................................................................................................. 4 2.1.2 Methods ................................................................................................................ 4 2.1.3 Scope and Limitations .......................................................................................... 4 2.2 Young Māori Party ...................................................................................................... 5 2.3 Politics ......................................................................................................................... 5 2.4 Māori councils ............................................................................................................