Reflections
Dr Papalii Semisi Maiai
Papalii Semisi Maiai, a Samoan GP, has spent most of his working life in the Auckland area. In the 1970s he headed a small group of Pacific peoples known as the ‘Pacific committee’, which was set up in response to the need for general medicine services for Pacific peoples. As a result of this, he began his work with Pacific peoples by setting aside one day each month specifically for Pacific peoples.
‘Issues [for Pacific peoples] arose mostly from social activities and changes in socioeconomic factors.
‘Some of the most important health-related behaviours of Pacific Island people at the time were smoking and alcohol. Our people don’t seem to drink that much, but if they do it is “bingedrinking”.’
'In terms of diet, it was not seen as something important until now.'
‘Sex was never openly discussed in our meetings but it was implied because at the time there were lots of issues about HIV and AIDs … there is a notion that Pacific Islanders are not interested in sex. Therefore, in the family there is a tapu about everything concerning sex, especially in the home. This, however, means that young people go and try sex and this creates a disastrous effect.
‘We as Pacific peoples have very poor incomes. We were employed as an unskilled labour force. Many work just to get the money and a large amount of money has been taken out to church and also to support people back at home. This is still happening nowadays. This may be a sign of collaboration and wanting to help your folks, but it might be going too far. People are removing money from their own family and also getting themselves into debt by doing this.
‘We were brought up in an environment of collective responsibility and sharing of experiences. Houses are like symbols for Pacific Islanders. We were brought up in houses with no doors, like a Samoan house, so we behave like we have been raised in a house like that.
‘It is about our inability to adapt to living in another culture. We carry the culture wrongly on our back. People use culture in the wrong place. We should be able to practice our native culture but at the same time adapt and adopt the new culture so that we can mix the two and then we come out as a winner.
‘There are more Pacific doctors and nurses now. There are more Pacific people in places where they have never been before. We are more conscious and more capable of putting the question to the people who are watching us.’
Dr Leopino Foliaki
Leopino Foliaki is a Tongan GP. He set up the Pacific Island Health and Welfare Society with Dr Papalii Semisi Maiai in 1978 and his children have also become well-known health professionals within the Pacific health sector. His daughter, Lita Foliaki, is project manager, Pacific Health, Waitemata District Health Board and his son, Dr Siale Foliaki, is training as a psychiatrist.
‘In the early 70s there were no organised, specific policies developed by the Health Department for Pacific people.
‘Some people migrated here for jobs, education and also to visit family members and when their time was up they never returned. At the time it did not appear to be a problem but when the economy was low overstayers became an issue for New Zealanders. Lots of people were unemployed so the Government wanted to send people back to the islands.
‘Issues became apparent as people started going to the doctor and could not communicate. This communication problem increased because there were no sources available to help these people at the time.
‘Now about over 50 percent of the Pacific population [in New Zealand]
are New Zealand-born so new problems need to be addressed.
Their attitude, expectation and culture are different.
‘In terms of health professionals working with the community in those early days the majority were nurses who were trained in the islands and when they came to New Zealand they weren’t registered, therefore, they started working at rest homes.
‘One of my key tasks was to talk to doctors about their patients and sometimes follow them up and do all the contacts for them such as social welfare, housing and any other agencies. Most of these people are overstayers, they could not work, were not entitled to get any benefits, and other family members suffered as this led into overcrowding.
‘Common illnesses from the islands were brought here … in addition to the changes in lifestyle, including adapting to climate change, dietary habits, such as what we eat and also the preparation of food. There are also some of us who still like to eat what we used to eat while we were back home, like mutton flaps.
‘Our difficulty these days is the change of lifestyle, we do not promote good health. For example, we usually prepare for a feast of 1000 when there are only 100 people. ‘There are two issues to better health care for Pacific people in future. One is health promotion and the other is primary health care.’
Doreen Arapai
Doreen is a New Zealand-born Niuean and a registered nurse. She says, ‘If you want to get things done you have to make sure your voice is heard’.
‘In the early 60s I think any Pacific Island person who was employed in health was asked to interpret … [although] as a New Zealand-born Niuean my Niuean is not that good … but for an 80-year-old Pacific Island person in hospital, to be greeted in their own language is one of the most reassuring things for them.
‘When you are in an alien environment and you are the only brown face
there and especially if you greeted them in their first language…they
look forward to seeing you.
‘Unfortunately, when you have a very heavy clinical role and you have a family, it is very, very difficult to find time to get out of clinical practice to go and share that information that is going on…
‘With the Cartwright enquiry there was a committee that was formed [but] there was no Pacific Island representative at the highest level.
‘In 1988 they had the first meeting in Wellington after the Cartwright Inquiry. P.A.C.I.F.I.C.A. played a very big part at that time because P.A.C.I.F.I.C.A. was a national women’s organisation.
‘Unfortunately mainstream [health providers] have always thought they knew best. They have not seen that we are quite capable of leading our own programmes, because the expertise is there, the knowledge is there, the
willingness is there, and the goodwill. It has been a hard road but things have started to emerge.
‘There are a lot of unsung heroes.’
Tinai Hancock founded the Fiji Women’s Ruve Group in 1995. The purpose of the group was to provide a platform for health professionals to work with Fijian families and communities. The
group offered health promotion and education training for our women in areas such as child safety, Well Child, breast screening and cervical screening, and was a hugely successful model for the Fijian community.
Tinai says ‘The Fijian community has benefited greatly by developing a capacity that worked specifically in our way, for our people. We soon learnt that improving health outcomes for us as a community was more about just doing health things. We began working in the social service area, firstly doing language and culture classes’.
In 1999 Tinai was one of the founding members of the Auckland Fiji Social Services Organisation. |
Laurel Taufauata
Laurel Taufauata is Tongan. She trained as a social worker in 1973. Along with Doreen, Laurel was involved in Pasifika’s move to improve cervical screening services for Pacific women in New Zealand.
‘I chaired Pasifika and we had a big fono [after the Cartwright Inquiry]. At the meeting we all agreed how hard it was to talk about cervical screening and that this was a national problem. But we knew we had to improve the education angle.
‘It was pointed out that it was no use to educate only the women,
but their husbands too. This was because sometimes men prevented
their wives from going to have the screen done; they didn’t want someone
to touch their wives – never mind it was a doctor – and they didn’t see the point.
So we set up some education things for the men.
‘Moira Douthett, Metua Faasisila and Doreen Arapai went to Australia, too, and brought back lots of information. In Sydney they had information for consumers in 56 different languages.
‘It was all part of the weaving together of public health programmes, and we’re still getting a lot of information from overseas, as it is part of a worldwide public health vision.’
Fuimaono Karl Pulotu-Endemann
Samoan Karl Pulotu-Endemann trained as a psychiatric nurse in 1971 – a time he says when there was ‘nothing’ for Pacific peoples in health.
Although some Palagi and Maori recognised the need for Pacific involvement in health initiatives, he believes things were still mainly community-driven. Karl, who is now actively involved in the health sector as a DHB and ALAC director, believes the concept of the family is a vital element in the success of any Pacific health service.
‘Sometimes the initiatives started before there was a policy. This usually happens with the support of some Palagi people and Maori people who were able to see the need for Pacific Island involvement in the health initiatives.
‘Policy is never straightforward for Pacific Islanders. There are always communities, different organisations and individuals and so on.
‘The other significant thing is that now we have Pacific Island health
providers. Mainstream services are more aware that you need to work at ground level.
‘The Pacific Island communities are more aware now, too, and are more involved.
However, there were positives and negatives when there were only a few of us. In the past it was much easier to access people because there were only a few of us and we used to work very closely. The women have been very strong in my career, like women in Pasifika.
‘We shouldn’t come up with Palagi solutions to Pacific issues. And there is way too much focus on Faife’au, as they are only one group of people … we must involve people from all different levels, like young people.’
Lita Foliaki
Helping her family thrive in the New Zealand way of life has formed the foundation for Tongan Lita Foliaki’s work in the Pacific community. Lita works as a project manager in Pacific Health for the Waitemata District Health Board.
‘When you are part of a migrant extended family and you have some specific language skills and some know-how to interface with the Palagi system then it becomes part and parcel of your everyday life. You end up playing the role, which is about helping your extended family to get simple things like sending money to Tonga, opening bank accounts. It gets to the point where you become an interpreter for the family … my community work is just an extension of that.
‘Having gone through university and having done sociology, I acquired the view that government agencies have a responsibility to deliver services to all people, not just to Palagi people.
‘[As a student] I was quite interested and quite energetic to belong to groups and be part of people who set up groups and it was easier for me to work with Pacific women than Pacific men. My experience of Pacific men at the time was that I was more educated than most Pacific men and knew more about the system than they did. But when you get into the community the men want to take on the authority while they didn’t have the knowledge.
‘Maori people have challenged the governance of New Zealand and claimed a right to be at the governance level based on the Treaty of Waitangi, which is something I as a Pacific person do not think we share…but Ma¯ori people have also challenged the culture appropriateness and the cultural rights of Ma¯ori people…and at the level of cultural needs the Ma¯ori issues are similar to the Pacific. That is one of the things that has influenced policy makers – cultural appropriateness.
‘Pacific people who have worked in the system have gained experience
and have become more assertive in circulating what they want a lot
more strongly than in the past.
‘The political influence of Pacific people has increased absolutely from the 70s where now you have a cabinet minister who is Pacific and three other MPs … the participation of Pacific people in decision-making has changed dramatically.’
Colin Tukuitonga
After spending 15 years as a GP in Auckland Niuean Colin Tukuitonga, Director of Public Health for the Ministry of Health, says he realised there were limitations to how much can be achieved for Pacific peoples in a mainstream general practice.
‘We were waiting in clinics for people to come in with problems, and many simply weren’t coming. You have to ask yourself – is there a better way to deal with this?’
‘I moved to public health in the belief that if we keep people well then we would spend less on fixing people when they get sick.
‘In the 70s people had little interest in the subject of changing the way
services were provided to Pacific people, but in the 80s people started
to sit up and take notice.
‘In the 90s people started to move from being spectators to being citizens. Instead of sitting aside, people were starting to get involved in advocating for better health. We had gathered the information in the 80s so now could say ‘here’s the evidence – what are you going to do about it?
‘So I think we have come a really long way. It has been a hard road at times and there will be challenges ahead, but Pacific people are becoming more active in taking responsibility for themselves.’
Debbie Sorensen
Debbie was one of the country’s first Pacific health managers and has been in many roles involving the establishment of new positions.
Debbie is Tongan and a trained psychiatric nurse but has spent most of her working career in health management.
‘The formalisation of the Pacific health sector came in 1993 with the work of the Northern Regional Health Authority. There were individual Pacific health workers, a few Pacific health providers, but as a sector Pacific health didn’t exist. This work provided the basis for the sector development today.
‘In the years prior to this it wasn’t “cool” to be Pacific – no one wanted to know. As a young nurse in training I was encouraged to be like everyone else, and everyone else was Palagi.
‘The ability to collect population-based data at ethnicity level and to begin
to understand the Pacific communities’ health status was a critical factor
in development. As we gathered more information we were able to gain
a better sense of what was needed.
‘The initial planning was based also on Pacific communities telling us clearly that they wished to be seen by our own doctors, nurses and community workers and services with a particular focus for Pacific peoples.
‘These days we understand our prevalence rates for diabetes and know how to intervene to effectively treat it. We understand the importance of cultural competency in service delivery and how that affects outcomes.
‘Historically, in the health sector there has been enormous pressure to conform and for Pacific people to be the same – we are different, we lead different lives, we have different values – we need to understand this to plan, find and deliver effective health services.
‘The development in the sector has been extraordinary. We have good leadership, we have great health care workers, doctors, nurses and community health workers. There is a philosophy of excellence and achievement in the sector. I believe our workers are the very best at what they do – in particular some of our doctors are the best in the world.
‘I feel overwhelmed at the generosity and commitment of Pacific people who work in the sector. I feel intensely proud of our achievements and the organisational and individual goals we have met. I feel privileged to work with these people.
‘This is a “calling to serve” that is more than a job – I love every day of it.’
Tufuga Lagatule
Tufuga, now retired, worked as a teacher for many years before becoming a social worker in the Pacific arena. She is a mother to six children and grandmother to 14.
‘I became a social worker in 1987. I have a teaching background but that does not train you … when I was appointed as a social worker, you walked into a very foreign culture, culture shock for me …
‘It took me three years to achieve a social work certificate. I felt good about that when they presented that certificate to me … I took the challenge, from there on you are not only a social worker, you are a nurse, a doctor, a lawyer, probation officer – you got all these things because when you go to a Pacific Island family to see the child, you end up with five other things that you need to address.
‘I never regret any moment any challenge that I made as a Pacific woman and a mother of six children and 14 grandchildren … to see us [women] now from 30 years ago, a lot has changed. Change because not only the Pacific women but the women of New Zealand have worked twice as hard and twice as much. New Zealand women should be proud because we are the first women of the world to get the first vote … I always believe that women are the house of the world.
‘The change for the next 30 years is that Pacific Islanders need to be participants rather than the problem. Pacific Island women need to be part of the solution rather than being part of the problem which means if cancer is the issue for Pacific Island women at this time, Pacific Island women should be there doing things, learning why, teaching our people.’
Anne Allen-Moetaua
Dame Silvia Cartwright’s inquiry into a cervical cancer study at National Women’s Hospital in Auckland during the 1960s and 1970s highlighted the fact that Pacific women were not receiving the care they needed in the battle to reduce cervical cancer rates.
Anne Allen-Moetaua, who now works for the Ministry of Health’s cervical screening programme and has a long history of involvement in community health issues for Pacific people and women, says a range of issues affecting Pacific women came out of the inquiry.
‘For one thing, Pacific women were disproportionately represented among those who were unknowingly part of the experiment. I think a large part of this is because Pacific people were used to accepting authority without questioning it. They were brought up to believe that doctors are all-powerful.
‘As a result, many Pacific women who were part of the experiment accepted what was happening because that was the way.
‘The inquiry highlighted the need to set up proper cervical screening programmes for all women, including Pacific women.
‘It was this issue that was the catalyst for the Wellington Regional Pacific Health Task Force, which was set up by a number of Pacific health professionals and workers in the Porirua region.
‘Together, we put forward a proposal to the Government suggesting that community health workers go out and educate and promote women’s health issues, and that screening take place in women’s own homes.
‘This model of community-based care is now used extensively throughout the Pacific health sector.
‘The best thing for our people is if we have real choice – if we have our own Pacific for Pacific providing quality providers. When we start having choice is when we start seeing the change.’
Next:
Looking to the future
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