Dr Emma Espiner speaks from the heart as a Māori doctor

Faculty of Medical and Health Sciences alum Dr Emma Espiner (Ngāti Tukorehe, Ngāti Porou) has written a memoir that charts her journey as a Māori medical student and doctor. In this moving excerpt, she talks about the lecturers who inspired her and the layers of challenges she encountered while studying. This extract from her memoir previously appeared on E-Tangata and is republished with permission. 

A friend had to go to hospital recently with acute appendicitis. It wasn’t my hospital and I wasn’t sure who would be looking after her. She’d had a horrible experience with racism in the health system when her father died, and she was scared. She texted me and asked if I knew her surgeon: “E kare, I think he might be Māori.” It turned out my friends were looking after her, and she said it made all the difference. She made the team take a photo and sent it to me, her in her hospital gown, everyone smiling behind their masks.

I went to medical school to train to be a Māori doctor. Not a doctor, a Māori doctor. I was going to turn up with my tohu — my medical degree — and my kia ora and nō hea koe, and it would be great. I would, in time, learn that many of my Māori patients are not all like my friend with appendicitis. They often don’t give a shit.

You’re in pain, back at the hospital where nobody can pronounce your name, they didn’t catch your aunty’s sepsis last year so she died, and here’s this cheerful brown face trying to mihi to you but it’s all the same: she’s still part of the system designed to let us die sooner, sicker, unloved. One of my bosses says the Māori patients respond differently when I’m in the room with him, but I think they probably just find my hair distracting.

Every year, the University of Auckland schedules a week-long symposium on Māori health for second-year medical students. In an effort to offset the resentment that this symposium happens during a mid-term break, the university hires a conference centre in a local hotel.

A change of scene is as good as a holiday. I remember scuffing the toes of my shoes through the damp leaf litter on the footpath as I walked from the bus stop on Symonds Street, past the plaza in front of the neo-gothic High Court, and up to the hotel opposite the ivy-wreathed Northern Club.

It was cold, and there was a billy of instant coffee in the foyer. We balanced tiny white cups on tiny white saucers and counted the hours until the Friday half-day off. My skin felt electric with anticipation and I ran through scenarios in my head, responses to racist questions, trying to anticipate the worst.

I thought of my daughter at daycare with sniffles. It was 2016, years away from the Covid-19 pandemic, and everyone sent their kids and spouses to daycare, school and work with raging respiratory infections because that was our work culture. I wanted to be literally anywhere but here.

At events like this, Māori students steel ourselves for a week of torture, feeling vulnerable and visible as our non-Māori peers are confronted with concepts like racism, white privilege and the white supremacist origins of colonisation, usually for the first time.

Nothing has brought home to me more clearly the calculated impact of not teaching our history comprehensively in high schools than the experience of sitting in a room and feeling the fear and confusion of young New Zealanders hearing the truth about our country for the first time.

I imagined I could feel the hostile gaze of those who wanted to reject what they were being told sliding over me like the blade of a knife, the edge running close to my veins. The most entitled ones would ask clever questions like “Aren’t we all immigrants to New Zealand anyway?” and “My ancestors came here on a boat, so does that make me Indigenous?”

Each time they would be answered patiently, respectfully, no hint of frustration from the Māori lecturers who hear a variation of this shit every year as they tried to explain the historical context for our people’s poor health.

Our teachers were people like Papaarangi Reid, Donna Cormack, Rhys Jones and Elana Curtis. They lead the world in Indigenous health research and advocacy, and every year they have the hard conversations in the hope that these students will become doctors who have the ability to address their own biases, to challenge damaging power structures and to make a difference for their patients. That they will advocate for their Māori patients in particular, knowing the full story of how they came to be where they are, and will tell that story the right way.

Papaarangi, inscrutable and intimidating, existed in my imagination long before I met her, a collage of scraps of media interviews that were part of what inspired me to become a doctor. Papaarangi is a lake, fathoms deep and enduring. Rhys, dignified and softly spoken, impassioned about equity and the environment, and endearingly fanatical about cycling. Donna, a staunch aunty with a fierce publication history of titles like “Rationing Māori Life and Well-Being — Who Decides and How?” Elana, whose mental clarity can cut through the most waffly research pitch, or through the most offensive question from a student or a colleague.

The students were generally not impressed by this line-up. They’re just Māori academics, after all.

In my first year of study, the year before the Māori health symposium and its trial by compulsory attendance, we were based at the main University of Auckland campus. This is not a beautiful place. The impressive trees framing the hurtling rush of buses and cars down Symonds Street with fire in autumn, and the proximity to Albert Park and its fountain and carpets of flowers, are an aesthetic reprieve. The quad is dirty and cold, an asphalt depression. The student bar Shadows is worse than any of the fetid caves I frequented at Otago University. The sprawl of chaotically disparate buildings tells the story of the organic and untidy growth of this learning institution.

Our classes were spread throughout buildings on either side of Symonds Street just before the turn-off to the High Court. The biggest classes were held in the business school, a monstrosity of glass and steel named after a man who insisted that his middle initial be used so that people would know it was him and not his father who donated the money for the building. Owen G. Glenn. We called it the OGG like something out of a nineties rap song and gave him little thought.

Scattered around Owen G. Glenn’s monument to himself were small villas housing the arts departments: sociology, history, politics. The science buildings, where we perched on high stools and pipetted chemicals or made playdough embryos, were encased in brick, with willow trees gently brushing their sides. The library is horrible. Stark and utilitarian, the interior is foreboding — and not in a fun, haunted way. The book stacks extend into the gloom, the astringent bathrooms splay off the staircase that winds up the left-hand side of the building, the couches are worn and stained. The tables are mean, small things, ordered in exam rows as if to remind students of their final destination.

We aspired to ascend from the main university campus to the Grafton campus, where the Faculty of Medical and Health Sciences is based. The excessively keen ones liked to study at the Grafton library before they were even offered a place in the programme, as if they were already medical students and were just waiting for their place to be formalised. I was so worried I wouldn’t get in that I didn’t want to go anywhere near Grafton. I didn’t want to get used to the space, to feel like I might belong there, in case I would have something to miss later on.

The squat collection of interlinked buildings that makes up the Faculty of Medical and Health Sciences isn’t beautiful either. It sits in the shadow of Auckland City Hospital. Academics chain their bikes to the aluminium stands outside, and I think of cowboys tying up their horses outside a saloon.

There is a secret tunnel which tracks underneath Park Road from the Faculty buildings and comes out near the medical wards in the hospital. The tunnel is suffocatingly hot, feels like the physical manifestation of a fire risk, and we’re discouraged from using it. My access card once declined my exit from the tunnel and, sweating, I retraced my steps back to Grafton wondering if this was how I was going to die.

The Māori academics were not given offices in the main Faculty buildings, but were housed in a nondescript office building down a steep street ten minutes’ walk from the campus. We observed how racist systems tangibly reflect their values every time we traipsed up that hill and back down again. Our shared area for Māori and Pasifika students was in that same building, and it wasn’t lost on us that we had to go off campus to be in a completely safe and nurturing space.

I didn’t know anyone when I turned up for the pre-med year. It was too much of an ask to make friends somewhere in the spaces between getting Nico to daycare, trying to imprint vast swathes of textbook material directly onto my brain, attending lectures from 8 a.m., then staying for three-hour labs in the afternoon.

I felt like the oldest person on campus, and tried to be as invisible as possible. I didn’t sit at the front with the other mature students. From my vantage point five rows back, off to the side, I observed the way some of the kids who had come straight from high school rolled their eyes every time an older student spoke up. I sat with the other odds and ends: the Māori and Pasifika students who already had undergraduate degrees but who, like me, would be the last people to ask a question.

There are plenty of reasons behind the desire for invisibility in a class of people trying to get into medical school. Medical school is a hotbed of fear — full of people feeling like they’re going to fail. I was also very aware of the views about MAPAS, the Māori and Pacific Admission Scheme, and being proud of being Māori isn’t the same as being impervious to the resentment and hatred of others.

How could we not be aware? Every other year there is a campaign to discredit or undermine social justice interventions like MAPAS and the Otago University equivalent, the Mirror on Society policy. Don Brash would have withered on his stalk a long time ago if he did not have a small but committed segment of New Zealand on his side.

I would stand alone in the foyer of lecture theatres, waiting to go into the various exams that would make or break my attempt to get into medical school, and I would eavesdrop on other students who didn’t know or didn’t care that I was Māori, talking about the “special treatment” of Māori and Pasifika. A floppy-haired teenager with a khaki backpack and jandals tells his friend in an ironic tee-shirt and ripped jeans that the Māori and Pasifika students get the answers to the exams in advance. They both shake their heads ruefully.

I get into medical school the next year, and a Pākehā colleague asks me to share the special resources that the Māori and Pasifika students are given. When I ask what she means, she says, “Exam answers, you guys get them in advance, right?”

Every time a Māori or Pasifika student said or did something stupid during those years, I would feel furious with them. All while knowing that I was holding them to a higher standard than other students, that I was internalising the racism, but also knowing that the world would be holding us to a higher standard too.

We have to be twice as good — impeccable — to offset the assumptions and racism of other students who believe we are so stupid and undeserving that we need to be given the answers to exams in advance.

Every year there was attrition as people failed their exams and had to re-do a year of medical school. Every year we would do the mental arithmetic to figure out the proportion of us, Māori and Pasifika, who made up that group. Every year we would feel a collective failure if one of us was struggling, no matter how reasonable the cause.

The hostility I felt in the first few years at medical school drained away like water from a bath over the course of six years studying with my cohort of peers. The consistency of the teaching we received, and the omnipresence of our Māori academics, had an observable and meaningful impact. The shift in the broader public discourse about Māori health equity can be attributed to this same group of people, who pay a high cost personally for doing this work. You will never meet a Māori academic who has only one job; the kaupapa demands far more from them than that.

The experience with our senior colleagues in the system has been more variable. A disappointingly large amount of calculated ignorance persists among this group of people, who have no real excuse, given their education, resources and access to Google.

Recently my friend sent me a text message from her car, where she was trying to regain her equilibrium before driving home: So sick of being grilled about my Māori heritage . . . today from the reg [registrar] was “what’s your heritage” and I said Māori and they were like “what like 1/200th or enough to get into medical school” like fuck off . . . and “if I was adopted and brought up Māori would I get into medical school?” When will this stop?

During the pandemic, the issue of “special entry” flared again. Despite a global health crisis, knowing the worst of the worst about the racism in our workforce towards Māori and Pasifika doctors, what I’ve seen during these Covid years shocks me — and still, somehow, the problem is us?

We are all tired, worried about our colleagues exhausted by nearly three years of the pandemic, increasingly scared for our patients whose care is being delayed because of this situation completely out of our control. The 2022 medical workforce survey has Māori at 4.4 percent. Our social justice projects — MAPAS and the Mirror on Society — are pushing that proportion up so slowly, and yet it’s too much for some people.

I know exactly how it feels to be one of those MAPAS students feeling targeted and undermined in the midst of medical school. If anything, these students are more resilient, more capable than the others, simply because they’re passing all the same exams in the midst of constant attacks, notwithstanding the odds being stacked against them in an education system that has been proven to discriminate against Māori.

This is the education system that, threatened by the graduation of the first Māori doctor, Māui Pōmare, and others, around the turn of the 20th century, responded by focusing the curriculum for Māori away from “professional” vocations and into labouring and domestic-work training. We were told that we were too stupid and unfit for higher education by the same people who ensured we wouldn’t have the chance to even try.

I want to say to the students now: you are so needed and wanted. Don’t let petty envy and mean-spirited, racist attitudes dissuade you from your aspirations. Our people need you, your colleagues need you, the health system needs you.

The crazy thing is, once you graduate and you’re working as a doctor, the system can’t get enough of our Māori and Pasifika doctors. There’s unpaid work on every bloody committee going, research projects that need your support, leadership positions, policy advocacy — literally so much work that our existing Māori and Pasifika workforce is overwhelmed.

I remember attending the Pacific Region Indigenous Doctors Congress in Auckland as a third-year medical student, and seeing the reverence with which our Māori lecturers were treated by the visiting academics. I felt embarrassed by my childlike assumption that, like parents, our teachers existed only for us.

The few extant photos from that congress show me standing with Camara Jones and Kalama O Ka Aina Niheu, the sheen of sweat on my brow matching my sickly grin after I’d asked for a photo with two heroes. Camara is an American physician and epidemiologist renowned for her anti-racist activism. Kalama O Ka Aina is a Kānaka Maoli, Indigenous Hawaiian doctor.

At the end of the congress, the Indigenous doctors and academics assembled on the solitary handkerchief of grass outside the Owen G. Glenn building, and raised their fists in solidarity with protest action taking place over 7,000 kilometres away.

Mauna Kea is a mountain that is significant to the Indigenous people of Hawaii, just as we are connected with maunga in Aotearoa. It became a global movement when dozens of elderly Kānaka Maoli were arrested for protesting the desecration of sacred land. The Indigenous doctors stood on that handkerchief of grass in Auckland, an iPhone capturing a sea of implacable faces.

Knowing how utterly supported I’ve been by the community of Māori working in health, there aren’t many days in this job when I don’t think of the heartache of the people who went before, and of those who had to suffer, be marginalised, discriminated against — the silent losses to the profession who left before they started or couldn’t even get started. Of the legacy of those who kept going, their determination to make things better, and how this has been no less than life-saving for our patients and for us.

One of the most expansive forms of activism is to speak each other’s names in places where they might not be heard. I learned about Rose Pere, Irihapeti Ramsden, Moana Jackson and Camara Jones from Papaarangi Reid’s lectures at medical school. She would repeat them like a prayer, cementing the importance of these rangatira and their ideas with each repetition. I started to notice when other people did this.

In the red-carpeted, neutral space of the main conference room at the Pullman Hotel during the annual Māori health symposium, our leaders speak each other’s names into the dark ignorance of our future doctors’ life experiences. They karanga to each other, linking up with a strength that isn’t visible to the students levelling entitled gazes in their direction. They reference each other and open up worlds, connecting us with thinkers across time and space.

We can see that naming things is activism. To cite is to be seen, and our Indigenous academics are disestablishing colonial knowledge systems, which shut our knowledge out, by citing whakapapa, science through oral history, stories that form our evidence even as they master the tools of the coloniser and set about creating something better.

Tonight I went home through ED because I wanted to show my friend a picture of an ulcer that one of my patients was struggling with, so she could help me decide if it was life-threateningly dangerous or just bad.

I’ve noticed that demented patients often sit at the nurses’ stations on hospital wards. They bring their walkers and sit companionably with the nurses and healthcare assistants like they’re at somebody’s house for afternoon tea. Usually there is a “care partner” or “healthcare assistant” standing sentinel against the wall in light-blue scrubs, ready to glide in and redirect a confused arm or leg.

When I got to ED there was a kuia in hospital pyjamas with long white hair sitting at the nurses’ station. She looked at me brightly and asked me if I could read “all that stuff”, waving her arms like seaweed in the direction of the whiteboard.

“Can you see my name on the board?” she asked, looking at me, though one eye was clouded and sightless. “They think I’m pōrangi,” she said. “Joke’s on them, bub, because I am!” She beamed.

Her name was one of our names, from Tukorehe, from home. I looked at her closely. “Where did you get that name?”

She had married a great-uncle of mine who was from Tukorehe. He bore one of our names, but also the name of a famous poet who comes from Ngāti Wehiwehi just down the road from us. This nanny told me she used to love hitting the piss at my marae, and I thought my Nanny wouldn’t have liked to hear that, and we just looked at each other for a while and she said it was neat that I was a Wehipeihana but I was so far from home, and she missed her husband — they took him back home to be buried three years ago.

I held her hand for a while and then said goodbye. As I walked away she called out to another patient, “Can you see my name on the board?”