Teuila Percival: There’s more to being a doctor than medicine

So, as well as her work at Middlemore Hospital in South Auckland, she also lectures part-time at the School of Medicine, University of Auckland, and chairs SouthSeas, a healthcare provider based in Ōtara, which she and other Pacific doctors set up 20 years ago.

Here she is talking to Auckland journalist Teuila Fuata’i about her work, and the need for doctors and other clinicians to play a broader role in health.

Talofa lava, Teuila. And maybe I should start by saying that, as well as sharing the same first name — the beautiful Sāmoan name of Teuila! — I’ve also known about you for many years, because you and my dad, Siro, have been colleagues for a long time, and the two of you were among the Pasifika doctors who founded SouthSeas back in 1999.

So, I know you’re the first Sāmoan paediatrician in the country, that you’ve been working with Māori and Pacific children for nearly 30 years — and that, for most of that time, you’ve been at the coalface, working as a paediatrician in South Auckland.

But why paediatrics, and why South Auckland, which some people might think would be the most challenging place to practise medicine?

Well, firstly, paediatrics is a great specialty. My patients are babies, children, and young people — and their families. It’s a holistic speciality, so I get to think about children’s development and learning, as well as illness.

And, in paediatrics, most of my patients get better. They can come in really, really sick, needing intensive care treatment — oxygen, breathing support, antibiotics, circulatory support. And the next day, they’re sitting up in bed, asking where the sugar is for their cornflakes.

Secondly, South Auckland is a great place to work. It’s diverse and colourful and exciting. The patients and communities can have huge needs and often have little money — but, in my experience, South Auckland people are a joy to work with. They are gracious and respectful.

The young people can have a bit of attitude, too, which is a good thing. It makes life fun. Don’t get me wrong — they’re mostly polite and respectful. But what I like is they have a sense of who they are. They’re proud of being Southsiders, and proud of their own stories. Of being Sāmoan, or Tongan, or Māori, or Korean.

Tell us a bit about your family. Were you born in New Zealand?

Yes, I was born in Auckland, but my parents moved to Sāmoa in the early 1960s, and we lived there for a few years. That was when Sāmoa had just become independent from the colonial New Zealand government.

My dad is Fiola Siatu’u. He’s 86, and he was born in Sāmoa. His family is from Ofu, in Manu’a. My mum, Patricia (nee Higgs), died two years ago. Her family is from Blackpool, Manchester, in England.

They met at radiography school in Auckland. They both trained as radiographers. And, after they married and had my older sister Masele and me, we moved to Sāmoa.

My father worked at the hospital in Apia as a radiographer. My mother was home looking after Masele and me. She used to harvest and sell cocoa beans to supplement my father’s hospital salary, which wasn’t much to live on. It was quite a struggle.

We came back to New Zealand when I was about three. My maternal grandmother was unwell, so my parents wanted to be in New Zealand to be closer to her. And I think my father felt it would be better for their careers.

So they came back, to Thames, in the Coromandel. I went to primary school and high school there. That was in the 1960s and 1970s, when it was a farming town with a few small industries. We were the only Pacific Island people there in those days — and no one could say our names.

I’ve got two sisters and one brother. I’m the second. Both my father and my mother expected us to work hard and excel at everything. We were sporty, and we were always doing stuff, and good at what we did.

I remember when I was seven, my father said to me: “Do you want to be a swimmer, or a runner?” There wasn’t really a choice in not being competitive. I chose swimming and, because I excelled at it, it didn’t matter so much that someone couldn’t announce my name properly when I was standing on the blocks.

That’s not to say it hasn’t bothered me when people mispronounce my name. Even now, at Middlemore, when I go and order coffee, and they say, “What name?”, and I say Teuila, there’s just a pause. And this is in South Auckland. When you go to Sāmoa and people say your name right, it’s beautiful.

I understand you’re the only one of your siblings to go into medicine. What made you want to become a doctor?

My father and mother were both radiographers at Thames Hospital. And I would often go into their department and just hang out there. So I grew up around a little hospital. And I liked the sciences.

But, you know, you go into medicine because you have a science background and you’re interested in people. And then, certainly in my experience, the further you get into medicine, the less important the science becomes. What’s more important is the social activism side.

There’s much more to being a doctor than science.

And when you do paediatrics, you just see so much which is preventable and not right. You see unjust stuff. Things happen to kids that shouldn’t happen, and they happen because of the system and the social structure and poverty.

So, you can carry on just doing your job — or you can get involved in something else to try and change all that. That’s why I say, some doctors can just do medicine and science, and that’s fine. Or you can take another sort of journey.

Is that why you wear all these other hats?

Yeah, that’s right.

What are the biggest issues, in your view?

I think the dominant thing that causes all this unjustness for children is basically poverty. It’s one of the biggest drivers of poor health. And then we have a system that doesn’t enable people and communities to get out of poverty.

The other thing that we see — and it’s probably unintentional — is the racism in the structures and systems we have.

As an example, we have a hospital clinic system which is set up so it’s hard to see a specialist. If you’ve got a health problem that requires a specialist, you’ve got to see your GP and get a referral. Then you get a phone call asking you to prove you’re a citizen entitled to go to the clinic. So, one, you’ve got to have a phone, and then, two, you’ve got to have a birth certificate or passport to show you’re entitled.

So there’s all these things that make it difficult, unless you’re an educated, well-resourced person, to make it through the system. Never mind if you’re poor, or you’ve got a whole lot of other stuff that’s a priority in your life, like feeding your family or putting a roof over your head.

Those are the things that we need to fix. And that means big, country-level policy changes. Like the level of benefit that people are on, for example. I can’t influence that as a paediatrician, but we can have conversations with people who can.

One of the big things that just holds people back, certainly in this community, is housing. Decent housing, and houses with enough room, and houses that aren’t just a garage with a concrete floor. Housing is a huge issue for people, and it impacts on health, education, mental wellbeing.

And I don’t know that we’re making a lot of progress there.

One of the hats you wear, of course, is as the chair of SouthSeas Healthcare in Ōtara, which you helped to set up 20 years ago with other Pacific Island doctors, including Debbie Ryan and my dad (Siro Fuata’i). What was the thinking behind setting up SouthSeas? Was there anything in particular that spurred that initiative?

We had seen West Fono, the first Pacific health provider in the country, set up in West Auckland. As doctors we could see there was an even bigger need in South Auckland. It was about creating a clinic where our people felt comfortable and where we could do things in a ways that suited our people.

I think the big thing that makes us different is that we have staff that reflect the community here. There’s no issue with communication. People understand one another, understand one another’s background, and there’s empathy between the clinicians here and the community they serve.

The other thing we can do is look at cost. We can make sure that cost is not barrier in a clinic like this. There are things we can do that are within our power.

SouthSeas recently celebrated its 20th anniversary as a healthcare provider. What achievements have you been most proud of over that time?

I think I’m most proud of the staff, though. They’re so dedicated. They go above and beyond for their patients and families.

But even with the things that SouthSeas had achieved, we’re still seeing the health outcomes in our communities getting worse. Would you say there’s progress being made?

I think you can make progress in small areas. One of the things you can do with a health team here is you can make sure they work in a way that focuses on those important issues, like housing and people’s income, and education for kids.

Within a small group of people, which is how this team works, you can make a difference. Family by family.

Is that enough, though?

No. It’s not enough. And for us, just to get money to do what we do is a neverending battle. We’d like to do more, but we’re always fighting to get enough money to do what we do.

When you’re bidding for contracts, you’re always in competition with other things. You’re in competition with people who are doing operations for hips, or something else.

So the question is: Are poor brown people important, in terms of trying to get money to do stuff? And the answer to that is: “Sort of.” But a lot of the time, not particularly.

You see a lot of talk and strategies around equity being really important. But when you drill down, the resources and funding don’t match the talk.

Many organisations have said, not just us, that the way we contract and do business in New Zealand doesn’t work. If you have to keep getting a new contract every year, it doesn’t enable you to grow and develop and do innovative stuff. Because you spend half your time getting money, and then writing another report and trying to get another contract.

A lot of it comes down to those who control the money. They want to be measuring and seeing something for their money all the time. That’s why things are so highly controlled. To change that, you need to convince central government and the ministry that the way that they fund things isn’t working.

There’s lots of conversations going on, including in Wellington. It just takes someone brave enough to say: “Let’s do something differently.” I don’t see why it can’t be done.

You mentioned that it comes to back to valuing whether or not these communities of poor brown people are important. What do you think stops these communities being counted the way they should be?

Some of it is that, when you’re a minority, in terms of power and governance, you’re always going to be an afterthought. You’re not going to be as important as the majority. Also, it’s around being heard and having a voice in the right places. The lobby groups that are well-off and well-educated can have a louder voice than us.

I certainly see that Māori and Pasifika are in conversations and they’re in plans and people want to do stuff, but what frustrates me is that they don’t do enough.

As an example, we’ll come up with a health project or programme, and it might get the go-ahead, but in a limited way. First, they don’t develop it with us as the people who came up with the idea, so someone else decides how we do things.

And then it’s not the right fit for us, or for our communities.

For example, rheumatic fever. Which group has the most rheumatic fever? It’s always been Pacific people. We have a lot of programmes with Pacific as a priority group, but it’s only in the last year or so that they’ve actually had some pamphlets explaining about rheumatic fever in our languages.

Why is that? Why has officialdom not thought we should have had this a decade ago?

Another example is Sudden Infant Death Syndrome. There’ll be a promotion talking with mothers about having babies sleep in a safe way. So they’ll have pamphlets, and the midwife and the Plunket nurse will talk with the mother about how baby should sleep to prevent Sudden Infant Death syndrome.

And that’s fine, but for our families, they have to think about how we have multiple caregivers. So mothers aren’t always the ones putting babies to sleep. And then, the big issue for us, is co-sleeping. We need to address safe co-sleeping.

Diabetes is another example. You get your diabetes patient and you talk to them about their diet and give them their sheet of advice, and off they go. But we eat and buy food as families, so it needs to be a family thing, not just aimed at one person. There’s a huge opportunity to do that better if we took a family approach.

What kinds of health problems are you seeing with the kids that come through Middlemore?

It’s the same things that we’ve been seeing for decades. Infectious disease, pneumonia, bronchiolitis, meningitis — those are always there. Injury — a lot of it preventable.

The thing that I see a lot of — and where we’re not getting traction, and this is particularly for Māori and Pacific, and especially Māori — is children who have adverse trauma in their lives. Children who are exposed to family harm, family violence, neglect and abuse, adult illicit drug use, as well as poverty.

Some children survive and they manage to be okay. Others have learning problems and behavioural problems and mental health problems. Little kids who grow up in these households with continuous adverse trauma and violence around them — it affects their development and their growth and their potential.

The one thing those children need is a safe, secure, supportive home, and that’s often the biggest challenge. We have families who are incredibly stressed, who are trying to live with all their difficulties.

It’s a huge issue, and again, individually, family by family, that’s what we have to focus on: our wins.

Because a lot of the time you don’t have wins. A lot of the time, it’s incredibly sad and things aren’t good and they end up with five caregivers — and you see them again five years later and it hasn’t got better.

We need to intervene earlier, before they end up with Oranga Tamariki and Gateway. It comes back to supporting families, and helping parents to be the best parents, and families to be the best they can for kids.

If you’re not poor, it makes a big difference. It makes life so much easier. If you’ve managed to get an education in your life, and you’ve got through high school. If you’ve got a job. If you’re not on drugs. If we had really good alcohol and drug progammes that were holistic. If you could have somewhere decent to live.

I know that police are doing a lot to try and work with families and intervene. But, in the meantime, these little kids are just there, invisible, until they come and see me years later and life’s pretty shit then. No one looks and sees what happens to the children until the kid’s pulled a knife on someone at school.

A lot of clinicians and health people think violence isn’t our problem — we just want to do heart disease and diabetes. But, it is. Because it affects mental health, it affects the development of babies’ brains.

And then, when we think we might do something, we just do a little bit. We might think about referring someone for counselling.

But if we took a systems approach, we could line up our universal systems to be doing more around helping people with positive relationships, intervening and talking about violence.

Every Plunket nurse could be trained so every single household they go into, they have a lens and a focus and skills to talk with families about relationships and to think about violence and what we could do about it.

That’s something we’re looking at with our Well Child nurses. How can we work on things which are really going to affect the trajectory of people? One of those would be positive relationships and violence.

And, again, nurses might think their job is to check babies’ hips and to weigh them and talk about feeding. That stuff is all very well and good, but if you’ve got a baby that’s spending its first five years of life exposed to chronic violence — that’s going to affect its growth and its development. Its educational potential. So, that should be our business.

At the very beginning, I said poverty is an issue. What’s the most effective thing you can do to reduce poverty in a community? It’s to educate that community.

So, how do you ensure good educational outcomes for our kids? You start when they’re babies, ensuring there’s a positive home and positive people and relationships around those kids. So they enter school ready to learn, with good development and good social skills.

In my view, that’s definitely health’s business.

You said earlier that social activism is becoming a more important part of being a doctor. Is this something that’s being reflected in medical schools?

If you look globally at medical-student training, you’ll see that’s where it’s been moving over the last few years — the importance of humanities, professionalism, and social activism as a part of medicine.

It’s quite new in medical curriculums, but it’s increasingly being seen as really important. Some medical schools have arts programmes because they recognise that helps to shape better doctors.

Are you getting more Māori and Pasifika students, and students from different backgrounds, at medical school?

Yes. And we have more supported programmes for Māori and Pacific students. They’ll probably tell you that it’s still tough and they still have that inadvertent racism. I think that’s just a function of people not knowing.

For example, often in teaching, Māori and Pasifika are the “other”. When you’re in a lecture and the lecturer is not me, they’ll talk about Māori and Pacific as “them”, and as “they”. So you get our students sitting in these big lecture theatres and they feel small and marginalised — and that they’re a problem that people have to do stuff for.

But if the curriculum is taught by Māori and Pacific, we won’t talk about ourselves as “them”. It’s “us”. We’re teaching and running the show and designing stuff and being the group that’s going to lead and decide what we want to do for ourselves.

It’s a huge jump — and it changes how they feel.

If you look at what’s going on with Pasifika in New Zealand, if you look at our literature and our drama and our movies — that’s another area that helps how people feel about themselves.

I know it’s a long way from health, but if our kids see themselves portrayed in a positive way, and they see that our arts and our literature is vibrant and innovative, it makes them feel better about themselves. And that we’re not just the problem with the diabetes that other people need to do things about.

And that helps everything.

You have three children yourself?

Yes. Rachel, who’s 30. Kate, who is 23. And Simon, who is 18.

None of them have gone into medicine. They’ve seen the long hours, so they know it’s not that fun.

And I have a husband, John MacIntyre, who is Ngāti Maru, from Hauraki. He’s a longtime Treaty negotiator and CEO of the Hauraki Māori Trust Board.

What’s something not many people know about you?

A lot of people don’t know that I have a grandson with autism. Michael is nine, and he has autism spectrum disorder and an intellectual disability. He’s lovely and adorable and I love him to bits.

As a paediatrician, I’ve spent decades helping families with disabilities. But when you have someone in your family with a disability, it changes your life. It changes you from being an advocate, to really being a fighter for them.

This interview has been edited for length and clarity.

© E-Tangata, 2019