Since the establishment of colonial society in Aotearoa, Māori have remained massively underrepresented within the medical workforce. Despite increases since the 1990s, many Māori are often only able to find employment in entry-level, minimum-wage jobs such as cleaning, caregiving, and manual labour - jobs which require few qualifications. And people need cleaners, caregivers, and manual labourers - but they need doctors, too. Māori have been calling for more Māori health practitioners for ages and, while a great number of Māori have since risen to the challenge, it hasn’t been an easy process.
The University of Otago is one place where these aspiring practitioners end up in hopes of making the cut into health sciences. Among the lot is Antonia Darcey Hoeta (Ngāti Rangi, Te Āti Haunui a Pāpārangi, Ngāti Porou, Te Āti Awa), or just Toni, who is in her first year of medicine at uni and describes her journey as “a convoluted one.”
“Coming from a rural decile 1 school that didn’t offer any of the sciences left me ill-prepared for the demands of health sciences,” said Toni. “In hindsight, I’d go back and enrol in the foundations programme before entering FYHS - make sure I get all the sciences under my belt first and then hit the ground running.” And while Toni recounts her first year as “a challenging ordeal”, she credits much of her successes - including an undergrad in Anatomy, a Master’s in Science, and two years as Senior Science Engagement Coordinator Māori at Otago Museum - to mentor and confidant Dr. Christine Jasoni. Toni described her as “the most passionate and empowering person I’ve met throughout my studies… Christine has been rooting for me since the start. She noticed every time I missed a class and provided me with options when I felt like I had none.”
“I’m not used to asking for help,” said Toni. It’s a common feeling for many Māori from rural backgrounds. “Living in Raetihi, everyone knows each other, so you’re always guaranteed a helping hand if you need it.” Coming to a city like Dunedin, where the culture is different and the company calls for competition, Toni said that she “constantly felt whakamā [shy] about group work in classes” and often doubted her capabilities in the health science programme. But all it took was one watchful eye to turn her in a different direction. “I failed twice, and just when I thought ‘I’m not good enough’, Christine called and suggested that I pursue research instead.” And for Toni, who swears her strengths lie in self-directed learning, this push began the process of applying for the Master’s programme.
On the other side of the coin is Leila Hemi (Ngāti Toa, Ngāti Koata, Ngāi Tahu, Ngāti Kahungunu), who comes from an all-girls high school in Hamilton, where she was able to easily access the sciences and calculus. Now in her second year of medicine, Leila admits to having known “absolutely nothing about uni or how it works” before arriving in Dunedin. “I just knew it was something I had to do.” While the excitement outweighed the uncertainty, Leila shared that she struggled to settle in her first-year hall St Margaret's College. She said she was made to feel different from the rest and was often confused by her peers alongside the only other Māori girl in the hall. “There was a real element of separation… I remember being told that I am ‘unfairly advantaged’ to others and have an ‘easier way to get in’, but they don’t know that I don’t come from a family of academics like them and that everyone has to do the same shit to pass.”
We spoke to a few students who oppose the Māori Entrance scheme at the University. Emma, who studied FYHS and now is working towards an undergrad in physiology, believes that “proven achievement is the only way” to earn one’s way into these competitive degrees. “If you have to rely on handouts to get into these fields, rather than your own merit, then you shouldn’t be here. Come back when you’re actually ready to work for it.” A common opinion within the student majority, Emma shared that, while she understands the need for alternative entry pathways, she believes that they are indicative of a “separatist agenda” to benefit minority students at the sacrifice of the majority. “You’ll hear people discussing that these pathways are in place because of the inequities Māori and Pacific Islanders face. But they’re here, at University, so what inequities are they actually facing?”
For many Māori families, sending their children off to university has been a stagnant dream. For Toni, the first in her whānau to pursue study, medicine was her calling from a young age: “I used to be that weird kid in school with a fanny pack in case anyone needed anything: antimicrobial gel, antiseptic cream, plasters, even a ‘scab container’.” However, it was different for others like Leila, who said that her mum went back to school after becoming a young parent to three kids so that Leila wouldn't “have any excuse not to go.” Leila’s mum now stands as a firm example for her whānau, having put herself through law school and is now working for the Māori Land Court. Now part way into second-year med, Leila described her journey after FYHS as “liberating” and “eye-opening”. Many of her tutorials “share the discussion about what it means to be a ‘good doctor’ and having empathy for patients. But it’s laughable because we as Māori are learning stuff we already know. It’s buzzy to see how new it is to people,” Leila said. “It’s also interesting to see the importance of holistic perspectives in the coursework – what once was considered unprofessional is now a requirement.”
It’s no secret that there’s a stigma that surrounds Māori in competitive pathways like the health sciences, which are often plastered across social media forums like ‘UoO Meaningful Confessions’ and news outlets, where tauira Māori have been subject to ridicule based on their “unfair advantage”. Sweeping headlines are quick to put the blame on Māori students, often disregarding the wider socio-economic imbalance between Māori and Pākehā, but Toni shared that it goes deeper than blatant favouring of one ethnic group over another. “The large majority of my non-Māori peers came to uni from high-decile schools and academic families. They’ve been provided with everything you need in order to succeed and still find something to complain about.”
Leila reckoned the promotion of Professor Joanne Baxter to Dean of the School of Medicine, and the way it was received, showed this best. “There are articles every time a Māori does anything. Jo Baxter mentioned providing equity for all and people extinguished her for it,” said Leila. “It shows you that people are ready to have a tangi when a Māori does something we would otherwise praise in someone else.” And while Professor Joanne Baxter is the first wahine Māori to hold such an esteemed position at the School of Medicine, the wider statistics regarding Māori in the health sector seem a far cry from that. While Māori make up some 16% of the general population, they are still severely underrepresented in the medical workforce and overrepresented in several negative health outcomes. According to Māori Health Authority data, Māori face a death rate twice as high as non-Māori from cardiovascular disease, a 25% higher chance to be diagnosed with cancer, and a 79% chance of dying from it. Considering these heavy statistics, it’s reasonable to expect that people may be reluctant to trust doctors who are less likely to understand and abide by cultural rituals surrounding wellbeing. Leila said that this lack of Māori doctors is the largest driving factor for many young Māori in the health sciences. “A lot of Māori want to help our people and that is why they’re here. We’re doing it because we’ve been let down so many times.”
There are issues with who the current doctors are, but there are also issues with where our current doctors are. Toni said that her home in rural Raetihi is some 70 kilometres from the nearest clinic, “raising further inequities if there weren't enough already… This makes it super difficult for our kaumātua [elderly] who, in life-threatening situations, aren’t able to just ‘hold on’ for a doctor. Making healthcare accessible even in rural areas would make all the difference for our people,” Toni argued. She described places like Raetihi as “tight-knit communities filled with Māori who are scared of going to the doctor or talking about their health with a stranger who won’t ask about their wairua [spiritual health].” For Toni, who is able to visit home a few times a year, the rare trip is bittersweet. “Everyone knows everyone, so they know I’ve always wanted to study medicine, to give back to my community. And you often hear the narrative that we as Māori are taking up space, but people don’t bat an eye when non-Māori who ‘want to help people’ aren’t going into these rural areas to work.”
According to both Toni and Leila, studying medicine is a breeze once you make it past the competitive nature of FYHS. Toni said that during her undergrad years she often felt “whakamā to even mention I am Māori - it was already apparent. I transferred to Arana College in my first year and in a college tutorial someone piped up to ask if I’m Māori and then immediately shrugged me off.” Leila said she shared a similar experience, and that it’s 100% easier to make friends without the competitive nature of first-year looming over her. “In a hall where I barely knew anyone, they sure liked to remind me of my advantage over them.”
When asked about the student culture within health science circles, Toni expressed disappointment at what she thought was an elitist cohort. “Entitlement is a disease down here. Kids that don’t qualify for special consideration will claim to be disadvantaged while they’ve been advantaged their entire lives and now have to compete for something they’d otherwise have received.” But Toni said it’s “the little things” that make all the difference in her studies. “One lecturer took it upon himself to provide a trigger warning before a lecture that focused on the topic of depression and started with a karakia,” she shared. “That showed me that it really isn’t that hard to be culturally sensitive for the sake of others – that a lecture theatre can be a safe place if you make the effort. [If] the Uni knows people don’t understand karakia: how to use it, what it means, when it is appropriate – put it in the curriculum!”
“People will come here with preconceived ideas of ‘how to help people’. The first thing you can do is get on their level. You have to know who you’re working with.” Now, three rejections into Med School, a Master’s in Anatomy, and in her first year of Medicine, Toni said that it is “everything I hoped it would be. I don’t feel the same disconnection I did in undergrad – I know I’m meant to be here, enjoying the process. It’s a great mash of building connections with people and acquiring unlimited knowledge.”
And from the outside looking in, it can be an easy mistake to assume medicine is all book work until placement, which Leila says “couldn’t be further from the truth. In Clinical Skills, we are expected to be building rapport with patients and learning professional empathy.” Toni added to this by sharing an experience in a non-Māori class, having been paired with another wahine Māori as a patient and immediately hitting it off with her “on the basis of being Māori… I think it happened in real-time for my classmates who came up to me afterwards and apologised for previously disregarding the need for Māori doctors – which is great because we need that accountability from our future doctors. You need to own it and say you have grown.”
One thing that Leila and Toni certainly share is the desire to blaze a trail in a new direction. When discussing future aspirations, Leila was quick to express her desire of working in orthopaedics, which she described as a “very male-dominated field within the workforce… No Māori women come to mind when I think of orthopaedics,” she said, going on to credit her support system. “When I tore my ACL in basketball, I had to get to know my orthopaedic pretty well. I’d like to be that person for other people, and I have a good circle of inspiring Māori women in med around me too - they often remind me just how important it is for Māori to look after Māori.” Toni, on the other hand, eagerly shared a desire to make impactful change for her own community: “If I’m going to do this, I’m going to take it as far as I possibly can. I know I’d thrive in paediatrics or as a first of something - we don’t have a wahine Māori neurosurgeon in Aotearoa, and I’d love to work at home with our tamariki and be a constant figure for them; reminding them that they are not ‘outliers’, and they are not the exception to the rule. We make our own rules.”
Part of those rules is to have grace. “Without Christine, I’d have given up, undoubtedly. I owe it to her and my whānau, Raetihi and beyond, to do something great,” said Toni, “to be that beacon of change.” Leila felt the same way: “If you’re gonna do it, do it big, and do it where people can see.” Because you cannot be what you cannot see. And that’s on thriving, successful wāhine Māori.