Flying high: Associate Professor Elana Curtis

In the 1990s, Associate Professor Elana Curtis (Ngāti Rongomai, Ngāti Pikiao, Te Arawa) was one of 12 Māori and Pacific students in her year to study medicine at the University of Auckland. She spoke with Teuila Fuatai for E-Tangata on her journey as a MAPAS student and, later, director, and reflected on how both these roles helped her to make changes to the programme. This piece previously appeared on E-Tangata and is republished with permission.

I was 10 when I decided I wanted to become a Māori doctor. I was a little Māori girl in West Auckland and four houses up the road from us in Rehia Road, in Massey, were my two cousins Kiri and Ngaroma Tahana.

We’re all from Rotoiti and were brought up together.

We wrote out a contract, and it said: I, Elana Tai Curtis will go to the University of Auckland and I will become a doctor. And if don’t, I owe them $20 each. If I do, I’ll give them free medical care for the rest of their lives. We laugh now at how one-sided that was. Kiri and Ngaroma went on to do law, and they’re both judges.

Our fathers were in education and we had our Pākehā mothers, who were very supportive of us. We were quite politicised at a young age. We understood that Māori didn’t have a fair deal and so, whatever we did, we had to make a difference for our people. Going to university was one of those things. I also really wanted to piss Pākehās off, so I thought, in my little 10-year-old brain, that I’d do something I’m not 'supposed' to do as a Māori girl.

Thinking about it now, that attitude probably reflected a bit of internalised racism, but it was all part of what drove me.

I was lucky to go to high school on the North Shore at Carmel College. I went because my father, Toby Curtis, was principal of Hato Petera, the Catholic Māori boys’ boarding school over there.

At Carmel, I was one of only two Māori left at the end of seventh form. Te reo Māori was my favourite subject, and one of my top ones. But Carmel didn’t teach it after fifth form. We ended up going to Hato Petera to take classes with the boys in sixth form, and then taking it by correspondence in our last year. It was scary for us, coming from a girls’ school, and being left on our own to learn. That disruption ultimately affected my bursary mark for university.

So, for me, it was the MAPAS pathway which made it possible to get into medicine. I probably went in with some of the lowest marks in my year. But I also saw it as my right to be there. I didn’t want to apply for medicine any other way, because I knew MAPAS was about righting inequities and countering the Pākehā privilege which makes it so hard for my people to do well at school, to go to university, and to become doctors. I was so proud to be part of it.

At med school, I was part of a cohort of 12 Māori and Pacific students. Back then, you went straight from school into medicine. There was no competitive year of health sciences first. I reckon I had a bit of imposter syndrome, because I felt so out of place when I got there.

I remember walking around our freshers camp of 80 students, and looking at the faces of anyone who I thought was like me, and going: “Are you Māori, are you Māori?” I was desperate to connect with others like me, with anyone I could recognise.

At that time, even the interview process to get into MAPAS was alienating. We had to go before a panel which focused on how Māori we were, and whether we deserved a place within MAPAS.

Even though I staunchly felt Māori, and was from a staunch Māori whānau, that whole process made me feel like I wasn’t good enough. I remember feeling like I had to make things up about how Māori I was.

At the time, I grabbed whoever was around to come with me, and my dad’s the youngest of 15, so there were a few. My uncle Robert and my cousin Theresa represented the whānau. The process really influenced the changes I helped to bring in as a MAPAS faculty member later on.

At the beginning of my studies, I remember working so hard and being very studious. I wouldn’t go out, I wouldn’t do anything. There was sport, med school and whānau, and that was it. I lived at home, and my family supported me through everything.

To this day, my besties are Heidi Muller, Fionna Bell and Claire Paterson. Heidi and Fionna are Sāmoan GPs and Claire is a Māori psychiatrist in Auckland.

We all came through MAPAS together. Dale Bramley, who’s part of the leadership team at Te Whatu Ora, also came through with us. We were among those who helped fight for a dedicated MAPAS space on campus — Ngā Kete Mātauranga — our own room where we could gather together, study and strategise about what we needed as students.

Collectively, we were able to argue for MAPAS, and articulate why it was important. That was particularly important as the programme was regularly attacked by the public. By the end of my time, there was enough support for us among the faculty to allow us a little MAPAS completion ceremony.

We did a lot of that largely off our own backs. I also drew on that experience when I went back to the university as a faculty member. If those things are what’s needed, then it shouldn’t be left up to students — the university should step in and help.

When I finished, I went to Middlemore Hospital. Of all the hospitals I’d go on to work in, I felt most at home there. It was very much about digging in and looking after a community that was very brown, very Māori, very Pacific.

At the same time, I struggled to find my place. I looked around and couldn’t see myself in any of the clinical specialties. I also found the racism and sexism in hospitals quite hard. There was a never-ending arsenal of ignorance and discrimination coming from all layers of the hospital. I got it, my colleagues got it, and the patients got it.

Plus there’s the hierarchy of medicine and the way it operates. It wasn’t something that, spiritually, was good for me, and it wasn’t something I looked up to.

Eventually, I chose public health as my specialty.

I spent a few years overseas as a locum in the UK, then came back and did my specialty training at Te Rōpū Rangahau Hauora a Eru Pōmare in Wellington. I got exposure to Papaarangi Reid, Bridget Robson, the late Vera Keefe-Ormsby and the work they were doing. I also met my public health bestie there, Ricci Harris. I realised there was a specialty in public health medicine where you could focus on Māori health, which took me back to my 10-year-old dream and was right in my sweet spot.

Everything I learned, and the connections I made at Eru Pōmare, came full-circle when I started my academic career at the University of Auckland in 2006 in Te Kupenga Hauora Māori. That’s the department which coordinates teaching in Māori health across the Faculty of Medical and Health Sciences.

I came in as the academic director of the Certificate in Health Sciences, which is the one-year bridging foundation programme for Māori and Pacific students. Papaarangi was the new tumuaki, the deputy dean Māori, for the Faculty of Medical and Health Sciences.

Sue Crengle, Rhys Jones as well as Gwen Te Pania Palmer and others were also there. Many of us had come through MAPAS and wanted big changes in Māori health and our next generation of Māori doctors and health professionals.

I was so green, and so fresh, and, looking back, that was probably a blessing in disguise.

I arrived to a course where most of our students were failing. The data from the previous year showed that, of about 85 students, only 15 had passed. I was shocked.

I saw these beautiful Māori and Pacific students coming through, and just thought: “Wait a sec. They can’t all be failing students. This is wrong. These are the top students the communities are giving us. How is it that we’re not making this work for them?”

That was the start of unpicking what we were doing with MAPAS and re-imagining the admissions process.

Instead of looking at the students, we turned the mirror on ourselves. And that change in headspace, that shift in “the problem”, changed everything. Because what we ultimately found challenged the framework around how universities were setting entry criteria to programmes, and how we as MAPAS assessed our applicants.

Essentially, government funding for a university is based on bums on seats. If you go under your predicted student numbers, or over, that’s not good. So a lot of the entry criteria for programmes are set up to meet those caps.

It’s about ensuring the university has enough students — and that doesn’t necessarily correlate to whether a student has the right academic building blocks to pass a course, let alone do well. For Māori and Pacific, who are already underserved in the education system, it’s another barrier to navigate, another layer of inequity.

Constantly, we’d get students telling us: “I got told I didn’t need physics or I didn’t need biology.” Yet they still had the overall marks for entry. In some cases, although they were able to enter the programme, they struggled to survive.

And the data showed that was happening a lot. We were getting students in our bridging course without any science background. These were the same students who went on to struggle academically and fail. Studying science at university is very hard, especially for something like medicine. It’s a huge jump if you haven’t had any exposure at school or in earlier studies.

So, by the end of that year, we had a completely different process for MAPAS. We did a structural analysis of the student data, and brought in a system which selected students based on their academic building blocks, and then determined the best starting point for them.

We removed the testing around cultural knowledge, which I and so many others had contended with. Our position was, if you have the whakapapa, then it’s your right to be part of MAPAS. Judging a 17- or 18-year-old on how much they know about te ao Māori isn’t helpful in the context of colonisation. It’s like whacking the victim for being a victim.

Cultural knowledge should never be used to judge if someone is eligible for an equity admissions process such as MAPAS. However, once we admit students, we can and should support them on their cultural journey.

Once we’d sorted those things out we were able to ask: Should this student be in the bridging course? Should they go straight to the health sciences degree? Or is there another option, somewhere else, that’s even better for them, to start them on the path to medicine?

It was that last question which got the biggest backlash from the institution.

You don’t really hear of a university encouraging eligible students to go to another institution, because it’s not in their financial interest.

But MAPAS protected us from that. We had a social justice agenda to rectify the inequities and unjust acts that mean Māori, and Pacific, are failed by the education system, struggle at university, and are so few in the health workforce.

For Māori, the MAPAS agenda is grounded in our rights as tangata whenua. We have the right to become doctors in our own land, even in western medicine. We should be able to dream of becoming a health professional and have access to that pathway. It’s part of our Indigenous rights to outcomes, to sovereignty, to self-determination.

That was our starting point. It enabled us to put our students first and ask what they needed at that moment and time to succeed on the path they’d chosen.

And, as honourable and simple as that sounds, it’s been a constant challenge. From inside and outside the university.

Year after year, we had students at the interview day who’d been given the wrong advice, or no advice, from guidance counsellors and teachers because of a narrow analysis about how to get into a course.

We have to say to them: “Look, we think you need to start over there.” And that place may be our bridging course, or it may be a course at a polytech or a programme at Unitec, depending on what their academic background is.

Then we say to them: “If you do well there, you’ll be in a better place for our bridging foundation programme. Or, if you do really well, you might be able to come straight into the health sciences degree. You go suss that out, then we can help you back in with us, with what we’ve got mana over in our faculty.”

That’s not always easy for a student and whānau to hear, and it isn’t what the university system is geared towards either.

But the payoff for us is two to three years down the line when the students come back and they’re ready. That’s the power we have to do what’s right for our students. We don’t just want to see Māori and Pacific at the University of Auckland — we want to see them fly.

It’s why our evidence base gets bigger each year, why we’re constantly looking at our data, checking in with students and tweaking our systems. It’s why we now have better pass rates and increasing numbers of our students succeeding. That’s not just good for us, but for the entire medical school faculty — who I’d say have warmed to us over time.

Having said all that, as Indigenous leaders, we needed to be constantly telling our story and articulating the value of what we’re doing because it wasn’t always obvious to people. Across the university, there are constant threats to social justice programmes like MAPAS. A lot of our job required us fighting to be at the right tables at the right time so our funding wouldn’t be taken away, and so that decisions wouldn’t be made that undid the progress we’d achieved.

Today, we know that most Māori and Pacific people still don’t see Māori and Pacific doctors or health providers, and we’re a long way off from having a workforce that represents our population. Māori doctors now make up about 4 percent of the medical profession, and Pacific about 2 percent. Yet, we’re about 17 percent of the population, and Pacific are about 8 percent.

It’s why we need all doctors, nurses, and healthcare professionals to be culturally safe and to provide bias-free healthcare. So, through our teaching about Māori health, we also brought the principles of Indigenous rights, and our understanding of inequity, to non-Māori, non-Pacific students.

It’s about trying to help students who aren’t Māori to understand racism and privilege and the ongoing impact on health outcomes. It’s hard to understand what to do about Māori health if you don’t even know the basics about what it means for someone to be Māori.

We’re also conscious of what that’s like for our Māori and Pacific students. We continue to put them at the centre, rather than pandering to the lowest common denominator, which is the really ignorant non-Māori, non-Pacific student. It’s a big challenge in the medical curriculum, and that’s really the art of teaching Māori health.

Last year, after 16 years, I left my role with the University of Auckland. I wanted to do my own mahi, and have a bit more autonomy and sovereignty, and bliss, in what I was doing, which was becoming increasingly challenging in the university environment.

When I look back, we’ve done so much with MAPAS, and it’s informed numerous research articles, including my own doctorate. But the best way to understand our mahi is by going to a MAPAS completion ceremony. You see the tears on the faces of parents and grandparents, and the joy. And you just can’t beat that.

Now, when you walk through the corridors of the Faculty of Medical and Health Sciences, it’s not unusual to see a Māori or Pacific student. The Certificate in Health Sciences has an incredibly high pass rate and there’s a huge learning community that wraps around our students. I’m incredibly proud of that, and of my colleagues who are continuing to do the mahi at Te Kupenga Hauora Māori.

Of course, there are still problems and challenges to overcome. But I’m glad we stuck to our principles and were brave enough to challenge and change ourselves too, as well as the system.

The changes we made for the students, and for Māori, ripple way beyond what happens in the institution. It changes their whānau trajectory, and that changes what happens in their hapū and their iwi, and then in our wider communities.

And that’s exactly why I became a Māori doctor.