Graduate has vision for Māori eye-care

A new medical graduate grew up largely identifying as Pākehā, but his koro’s death and the University of Auckland’s Māori and Pacific Admission Scheme (MAPAS) fostered his pride in his heritage and vision for improving Māori  healthcare.

Isaac Samuels (Ngaati Hauaa, Ngaati Tuwharetoa) graduated on 14 December with a bachelors in medical and biomedical sciences (honours) and hopes to specialise in opthalmology.

Isaac has already researched and developed a kaupapa Māori framework for eye-care consultations, which he hopes will contribute to improved eye care for Māori patients.

Feedback from a controlled trial showed while Māori patients prefer the framework consultations, Pākehā patients do, too.

It’s exciting, Isaac says, because it shows, if trained properly, Pākehā doctors can provide culturally safe consultations.

“If our clinicians are able to engage in a culturally safer way, then we can be sure Māori will start to achieve better health outcomes.”

Isaac is proud to be Māori and his goals are around advocating for whānau and improving healthcare for Māori. But it wasn’t always like that. Isaac grew up in relative privilege in Tāmaki, attending St Kentigern’s College and regarding being Māori as part of his DNA more than his identity. 

This belief was confirmed by an ‘upsetting incident’ when he visited the family marae in the Waikato as a child.

“I got chased off the marae because I was Pākehā-looking and kids didn’t believe I was Māori.”

His relationship with his own heritage started to change when his koro, his grandfather, who lived with Isaac and his whaanau, became very unwell with conditions relating to diabetes.

“I just couldn't get my head around why he didn't want to go to the doctor and why his doctor didn't look after him very well.”

Seeing his father’s distress over not understanding his father’s illness or the medications, sparked something in Isaac where he saw he could use his education and learn the skills to help his whaanau and to be an advocate.

Isaac gained entry into medical school at Waipapa Taumata Rau, University of Auckland through MAPAS and through its supportive environment,  his understanding of his potential started opening up.

“I didn't know the extent of Māori health inequity until I heard [Tumuaki] Professor Papaarangi Reid speak in Population Health in my first year. It was all around colonisation and the impacts of colonisation on Māori health,  what we can do as Māori health practitioners and how few of us there are around.

“I thought, oh my goodness, I can help my whaanau, but I can actually help all  Māori by pursuing this career if I  play my cards right.”

Later, Isaac encountered ophthalmology while on a two-day placement and felt he had found his calling.

He also found allies who were interested in Māori eye health. One of those was Jennifer Craig, a professor of optometry, who supported him to come up with an original research project.

Along the way, Isaac was awarded a Kupe scholarship, which recognises leadership potential, and was mentored as part of that by Dr Mataroria Lyndon.

He also met doctoral candidate in optometry and vision science Renata Watene, with whom he went on to collaborate.

At the outset of his research project, Isaac spoke to a large group of Māori who were either engaged with eye-care services or who had whānau who were.

Questions included, ‘What does eye health mean for you?’, What is the cohesion between te ao Māori and eye health?’, ‘How does eye healthcare engage with being Māori?, and ‘What are the priorities when you're seeking care?’

The biggest theme to come out of that study was the importance of communication and a genuine connection.

“We talked about this concept of whakawhanaungatanga, building relationship. It's a large reason for Māori knowing their whakapapa, so we can connect things.

“If a doctor comes in and goes, ‘Cool, sit down, what's wrong with you? Okay, sweet. Here's a medication. See you later.’ There's no connection there. So, there's no incentive to return. You don't know the person.” 

Another theme was that patients’ historical experiences significantly informed their healthcare practice and their healthcare beliefs.

“If they have had a poor experience, or a relative has, they are significantly less likely to go and seek care. But, it also works for a positive experience. If a whānau member has a positive experience with care, they're far more likely to return to care.

“So then we can start to develop positive relationships around follow-up and management strategies for Māori.”

Another theme was the importance of Hauora Māori – the concept of holistic Māori health.

“It goes so much further than the biomedical, which is often what we were taught in med school, to the importance of the health of the family, spiritual health, mental health and how that impacts on the physical health.

“It's really important and it's often not acknowledged, especially in specialty care. So, in ophthalmology, they're going to look at your eye. They often don’t have the opportunity nor has traditional practice encouraged us to ask, ‘How are things at home, do you have any stressors going on in your life at the moment or is your spirituality important to you?’

“That’s massive for Māori and massive for building rapport. Clinicians can do this.” 

The other important points were around tikanga and tapu; the tapu of the head and the eyes.

“They are sacred parts of the body for Māori. It's where we connect to our tīpuna and our atua. So touching the head is really full-on. It needs to be established through the consent process for Māori.” (See Clinical and Experimental Optometry, 12 Dec 2022)

Isaac then went on to develop a Kaupapa Māori framework. The idea was to provide guidelines Pākehā could use in consultations with Māori whānau.

“We talk a lot about we need to increase the Māori health workforce and we do need to. But that's years away and we need to fix inequity today.

“What we need to do is equip those who are in the workforce with the necessary tools.”

Isaac is currently writing up results from a controlled trial of the framework where participants visited three stations and then gave feedback.

There was a Pākehā clinician who wasn't trained in the framework, but knew how to do an eye exam.

The second was a Pākehā clinician who was trained using the framework and then Isaac who did a full kaupapa Māori approach to an eye exam.

They filled out a questionnaire, ranking each station based on cultural safety, the adequacy and professionalism of the clinician, and provided some qualitative feedback.

The results showed Māori significantly prefer whakawhanaungatanga at the beginning, and appreciated consent around examining the head and touching the face, acknowledging tapu.

They also preferred being able to allow whānau to be part of the consultation.

“It was interesting because non-Māori participants felt more comfortable with the framework being used too.," says Isaac.

“It differed depending on ethnicity. We found many of the East Asian ethnicities didn't like the personal aspect of whakawhanaungatanga and thought it deterred from professionalism.

“But a lot of the Pākehā participants said that it added a kindness to the to the clinical encounter,” Isaac says. “I's early days and this study was conducted in a very controlled setting, but it's a really good start.”

Isaac hopes to extend the research and start rolling out guidelines. There have been concerns about time, but he believes the value of engaging Māori whānau with healthcare makes it worthwhile.

So as Isaac sets out on many more years of research and training, he has his sights set on making a difference for Māori.