“Thank you for this. Do you know Māori and Pacific people do not complain? They do not lodge official complaints,”said Chief Medical Officer, Dr. Margaret Wilsher in a meeting for the Auckland District Health Board (ADHB).
She shared this waving a hard copy of my email complaint in her right hand. As stunned as I was by this statement, it didn’t surprise me at all. For over 10 months, I just could not let go of the deep sense of injustices experienced by my Māori husband, Jonathan, within the public health system. I knew I needed an outlet after re-telling my husband’s story with the fantastic staff at Dove House Hospice earlier this year. So, with my ‘angry Sāmoan wife’ persona, I lodged a complaint on his behalf. You see, being a highly educated, skilled, and mature Pacific woman equipped me with the confidence to start this journey for my husband. Ultimately, this process was about uplifting him, giving a voice to his story, and more importantly to heal and restore his mana.
While there is a growing number of research and media articles on inequitable health outcomes for Māori and Pacific peoples, the statistics remain grim. It all reads towards racial discrimation at individual (micro) and institutional (macro) levels. Despite decades of multi-million dollar government spending to address these, the statistics have barely shifted. Hence, the establishment of the Māori Health Authority is a pioneering step in the right direction. Here I agree with Minister of Health, Andrew Little, that the existing system does not work and it’s time to rip it up and rebuild. More to the point, this system was built from colonial roots to cater for the predominantly white population. This antiquated framework was not designed for us.
I want to add some real-life examples of what a lot of us experience. Although reports include correct terms such as ‘lifestyle advice’, this does not sit comfortably with me. For instance, hands up those that have been told without explanation to lose weight, cut down on our food intake and do some exercise? We are told to go away, sort this out, and then our medical complaints will be taken seriously and treated. This is like a standard script memorised and read to Māori and Pacific patients when we seek medical help. I find receiving this ‘lifestyle advice’ patronising and victim blaming. For me, these messages are received with a sense of shame and with some puzzlement. In that they don’t think I already know I’m big. That I cannot see the obvious looking back at me in the mirror every day.
Although reports include correct terms such as ‘lifestyle advice’, this does not sit comfortably with me. For instance, hands up those that have been told without explanation to lose weight, cut down on our food intake and do some exercise?
According to the newly released report, 2021 Bula Sautu A window on quality 2021: Pacific health in the year of COVID-19, high weight is a contributing factor where the Pacific population that from suffer high levels of gout, diabetes and cardiovascular disease. In the same way being labeled as ‘big’, Midwife Fa’afana Temese experienced barriers as a mother herself in maternal health care. Dr. Sirovai Fuata’i hit it on the nail. ‘We should roll out programmes that support people and help them understand that they still can enjoy life, live socially in a way that their communities naturally happen, but support them in a way that we can say, ‘These are the things you can do, that you can manage and control. And we’ll support you if you reach this end point.’ This approach is both practical and realistic.
Shifting the focus to really listen to what patients are sharing would have made my experience different. I spent over two decades trying to deal with women’s health issues. Back and forth I went to the doctors. Back and forth I went to get ultrasound scans done. As you can guess, I was given countless instances of ‘lifestyle advice’ and told to go on the pill. After years of experiencing these indifferent responses, I just sucked it up and got on with life as best as I could.
However, by 2015 I had had enough. My ordeal was becoming stressful and untenable. I was in the middle of a six-month argument with my gynaecologist over my request for a hysterectomy, when an ADHB quality survey arrived in my email inbox. I thought, ‘Wow! I am actually being asked about my recent experience with the health system.’ So I took full advantage and filled out all the questions. Right at the end, there was an option for my complaints (or “unsatisfactory experiences”) to be followed up by a staff member, which I agreed to. In short, the survey provided an opportunity to lay a formal complaint and I was subsequently re-assigned to a senior specialist.
During my first appointment with her, there was no ‘lifestyle advice’ given at all. The senior specialist took the time to explain to me the different scenarios that were playing out with my health. She even drew pictures and walked me through all these. It was a first for me to be shown a tangible link between weight gain and my condition. Can you imagine how incredulous I was to find out exactly what was happening to me? I was never informed that my reproductive health problems were in fact not normal. The term “shock” is an understatement. This news was more bittersweet because my own teenage daughter was beginning to go through the same thing. She was on the verge of needing a blood transfusion. As a mother, I was devastated because I had no idea our predicament was a problem. Since then, I have shared my stories with many others. I know for a fact that this is not unheard-of in our communities. These are all sad but reoccurring themes.
By sharing my ‘angry Sāmoan wife’ rant, I hope to help others to no longer accept substandard care. I want this story to give our whānau, our ‘aiga, our families, our friends, and our communities clear transparent pathways to voice their unsatisfactory interactions within the health system. To empower them with tools to address situations that don’t sit quite right, situations that are uncomfortable or unsafe, and situations that feel were culturally inappropriate. I am hopeful our story and the following links to our local DHB will start the kōrero, talanoa, dialogue for us to voice our angst so that substandard care is no longer acceptable. Preferably, a thing of the past.
LINKS FOR TĀMAKI MAKAURAU
Auckland District Health Board
feedback@adhd.govt.nz or phone 09 375 7048
Waitematā District Health Board
https://www.waitematadhb.govt.nz/patients-visitors/tell-us-what-you-think/
Phone: 09 486 8920 extn 43153
Counties Manukau District Health Board
https://www.countiesmanukau.health.nz/contact-us/feedback-form/
feedbackcentral@middlemore.co.nz or phone 09 277 1660