Taking health services to Māori: learning from the past

There are differences and similarities between the current Covid-19 vaccination campaign and the earlier mass x-ray campaign. Science, technology and the pathogen may be new, but the nature of people has not changed so much. The health promotion techniques learned on the ground in the 1940s and 1950s remain applicable today.

‘Shot buses’, Māori and Pacific health providers taking vaccinations out to the people, towns and district health boards competing against each other for the most vaccinations, entertainment and give-aways. These are all part of the country’s 90 percent-plus campaign for vaccination against Covid.

Endeavours like this are not new. There are many parallels with New Zealand’s successful mass x-ray campaign against tuberculosis (TB) in the 1940s and 1950s.

At this time, Taranaki had exceptionally high rates of TB, especially among Māori. In 1941, the Hawera Hospital Board visited the Taranaki Māori Trust Board to discuss urgent and co-operative action. They suggested acquiring a mobile x-ray unit to take technology to the kāinga.

Taranaki kaumātua needed little convincing of the gravity of the situation and promised a substantial grant of £2,200 to buy a unit for the use of everyone in Taranaki. The hospital boards funded the operational costs and agreed it was first and foremost “a Māori unit”.

In the 1940s, TB was still a health threat to New Zealanders. The contagious bacteria was spread by respiratory droplets and aerosols, especially in overcrowded living situations, but the full disease usually took years to develop, and there was no known cure. Overall, TB was slowly declining due to better living conditions and nutrition, but there was still an unacceptably high death rate, especially among young people in their 20s.

The New Zealand Health Department’s regular claim that the country had “one of the lowest rates of tuberculosis in the world” told just part of the story: true for the European population but the rate for Māori was estimated to be more than 10 times higher. The Second World War and the successful mass x-ray screening of recruits for the armed forces showed the potential for mass x-ray to detect TB and break chains of transmission.

War-time supply constraints delayed the arrival of x-ray equipment which was extensively damaged during the voyage. The Ministry of Supply, however, had taken the precaution of ordering two units. So one functioning unit was assembled from the unbroken parts and was dedicated at Te Āti Awa’s Ōwae Marae at Manukorihi Pā, Waitara, on May 4, 1946.

In the first 12 months, the unit x-rayed 2,514 Māori and 3,666 Pākehā, visiting 26 marae and kāinga, as well as hospitals, schools and towns throughout Taranaki. The unit’s staff were eager to foster Māori interest and took on board kaumātua requests that the unit visit marae at weekends when people were not away at work. When Māori themselves organised the Whanganui visits in 1948, the unit staff noted a much higher response.

The Taranaki Mobile X-Ray Unit was the pilot for the nationwide campaign that followed. It was also an uncommon example of bi-cultural co-operation in the 1940s, one based on the perception that it was a project between equal partners. Two further units, one based at Whangarei from 1955 and one at Gisborne from 1957, later travelled to the large Māori populations of Taitokerau and Tairawhiti.

Mobile x-ray units became familiar sights across New Zealand and it’s easy to recognise promotional parallels with today’s Covid campaign. Leading citizens lined up to have a promotional x-ray and record numbers of x-rays were proclaimed. Units attended events such as A&P Shows.

In February 1957, a unit spent four busy days at the Auckland Birthday Carnival, x-raying more than 900 people in one day. In Dunedin, on September 26, 1959, an x-ray unit broke its own record, x-raying over 1000 people as the team worked non-stop for 12 hours.

A mobile x-ray unit visit to a Far North settlement of about 200 Māori in 1960 demonstrated the difficulties of getting the heavy unit over rough roads. It took the unit more than three hours to travel six miles. Sometimes the unit couldn’t get through at all and people were delivered by tractor.

The visits appear to have been memorable events, with overnight stays, speeches in the whare nui and the sharing of food. The Northland unit staff encouraged singing to help break the ice; songs were recorded on tape and played back the next day to attract a good turnout for the x-rays.

During the evening, staff explained the importance of x-rays and showed films about tuberculosis, other health issues or Māori activities. The Department of Health’s promotion of mass x-rays to the public, both Māori and Pākehā, was an attempt to merge complex information into simple public health messages.

It also seems that the visits of te pahi nui o te eki rei (the big bus of the x-ray) into the sparsely-populated and seldom-visited parts of Aotearoa were conducted and received with a spirit of goodwill that delivered mutual benefits.

There are differences and similarities between the current Covid-19 vaccination campaign and the earlier mass x-ray campaign. Science, technology and the pathogen may be new, but the nature of people has not changed so much. The health promotion techniques learned on the ground in the 1940s and 1950s remain applicable today.