25 Jul 2020

Emma Espiner: Witnessing a health system that fails Māori

From Saturday Morning, 5:07 pm on 25 July 2020

The power sharing, trusting Māori, and the funding of Māori initiatives will need to occur to achieve better health outcomes for Māori, says trainee doctor Emma Espiner.

In her new podcast Getting Better: A Year in the Life of A Māori Medical Student, the trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) explores the front lines of healthcare in New Zealand.

She witnesses the real life results of the inequity that sees Māori die younger, get chronic illnesses earlier and receive less care than non-Māori, but also the inspiring mahi being done to reform the system.

Emma Espiner

Emma Espiner hopes to work at Middlemore Hospital when she graduates later this year. Photo: supplied

She witnesses the real life results of the inequity that sees Māori die younger, get chronic illnesses earlier and receive less care than non-Māori, but also the inspiring mahi being done to reform the system.

Espiner told Saturday Morning that over the past 18 months she has had a lot of interesting conversations on where she should go with her career and what it means to be a Māori doctor.

She said her podcasts are a chance to move on further from the fact that the same people have been highlighting the same inequities and problems with Māori health for years without much success.

She wanted to meet some of the people who are directly affected by the lack of progress and tell their stories in her podcasts.

She said while conversations were being held now about Māori health outcomes that would not have taken place 10 years ago, only the easy objectives were being achieved.  

"The hard stuff - the power sharing, the trusting Māori, the funding Māori initiatives -  that's the hardest thing to make happen."

Espiner recalled a GP placement with Māori health advocate Kyle Eagleton in Northland. His practice, Ki A Ora Ngātiwai, focuses on kaupapa Māori - it is not window dressing and not hierarchical like traditional Western medicine, she said.

She was impressed with the practice's approach because it was completely joined up.

"There's the clinical side of medicine, but they have the social workers, there's a school programme swabbing throats and looking out for rheumatic fever.

"If someone comes in and they don't have somewhere to live, everyone mobilises to support that whānau because what you realise when you work in health is that the health bit when you present in hospital is just the tip of the iceberg."

When asked about translating the kaupapa Māori approach from sparsely populated regions to cities, she used the example of a Pacific mental health practice at Green Lane. As well as the psychiatrists at the practice, the community workers, social workers and nurses were doing a lot of work with whānau and took a holistic approach to the people they were caring for.

Espiner said while she was unsure if the current health system could be used to bring about better outcomes for Māori she admired her lecturers, the junior doctors ahead of her and fellow students who were incredibly well informed and weren't racist in their attitudes.

Family's poor experience focus of one episode

One episode of the podcast concerns the Wallace family from Porirua. They took Colin Wallace to the ED because he had suffered a stroke.

Their situation went from the family being told that he was terminal to a better outcome.

It was what she heard afterwards that upset Espiner - Tina Wallace sleeping in a hospital corridor and then not finding out about the support available to her when the family returned home.

"And it really exemplifies how that joined-up stuff, how at every point we're let down."

While Pākehā could also experience the same miscommunication, there was an extra bit "if you were brown".  

Wallace went to hospital as a brown tattooed man so staff assumed he was a drinker and a smoker which was untrue. Within the health system, those kinds of assumptions were made about people all the time, which resulted in Māori not getting certain types of treatment and fewer prescriptions. However, it was time to move on from that, she said.  

Her ambition is to gain a job at Middlemore Hospital where she has worked during her placements with "amazing teams, incredible mentors and a patient population that I've come into medicine to work with".

She is due to graduate as a doctor in three months.

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