Breath of life for Waikato med school

A Waikato University Medical School is still on the cards despite major health reforms announced by the Government last week.

The shift in the New Zealand health system has also caused a change within the university’s plans to create a third medical school and partner with

Ma¯ ori, Pasifika, and the rural community to build a new curriculum from the ground up.

It had initially pitched a bid to establish the country’s third med school in 2016 focused on high needs communities, but the idea languished after lukewarm support from Labour.

The university currently has a nursing school in partnership with the Waikato District Health Board, and is offering a new Bachelor of Health in population health or biomedical sciences.

The university hopes to train general practitioners who will eventually go on to work in high-needs communities where there is a shortfall.

The re-emergence of the school comes after the Government abolished all 20 district health boards and created a Ma¯ ori Health Authority that would take care of Ma¯ ori health needs.

The Government hasn’t ruled out a third medical school based in Waikato.

At a rural health conference in Taupo¯ on Friday, Health Minister Andrew Little said the school still had a way to go but stopped short of ruling it out.

‘‘But having said that, we do know there is a huge unmet need, and we’re looking at alternatives that get us there,’’ Little told Stuff.

It would be another few weeks before he could make any comment on the proposal or what alternatives might look like.

Ma¯ ori and Pasifika health experts say a medical school that delivered on closing inequities in high-needs communities is needed.

Previously the proposal came under attack when it was first submitted in 2017.

It failed to get support from the Government and current medical schools in Auckland and Otago. The bid became tarnished when one of its lead submitters, former Waikato District Health Board chief executive Nigel Murray became embroiled in a spending scandal that cost his job.

The district health board is no longer a partner in the new proposal.

The new leadership team at the university’s Te Huataki Waiora School of Health, Dean Sarah Strasser and Professor of Rural Health Roger Strasser want the targeted communities to help build a fit-forpurpose school that addresses their health and cultural needs.

And those needs are critical.

In 2019, the Waitangi Tribunal found the severity and persistence of inequity Ma¯ ori experienced indicated the health system was institutionally racist and resulted in bad health outcomes.

On average, Ma¯ ori children saw general practitioners and primary care nurses at the same rate as non-Ma¯ ori, and Ma¯ ori adults at a higher rate than non-Ma¯ ori. Yet Ma¯ ori had on average the highest levels of unmet needs of any population group.

Pasifika communities also suffer similar inequities according to the Ola Manuia: Pacific wellbeing action plan 2020-2025 report. It found despite high enrolment in primary health organisations Pasifika communities continue to suffer from preventable health conditions..

Last year’s Health and Disability System Review found that self-reported experiences of racism, including by health professionals, are higher for Ma¯ ori, Pacific, and Asian communities compared with European and other communities.

Roger and Sarah Strasser began their medical careers as rural doctors in Australia, before the couple moved into academia.

In 2002, they moved to Canada where Roger Strasser was the founding dean and chief executive of Canada’s Northern Ontario School of Medicine.

He said the school’s success in retaining general practitioners in remote indigenous communities was because it actively sought students from those communities, and they were largely trained in local primary health organisations.

This time around, the Strassers hope to recreate a similar vision here in partnership with Ma¯ ori, Pasifika and the rural sector, the three areas that are underserved and underresourced in New Zealand.

The school will offer a graduateentry, four-year training programme, where the learning will be largely based in rural communities. They hope to have an annual intake of 100 students.

The school submitted a letter to Little in early March, asking the Government to explore the potential for a new and different medical school.

Roger Strasser said despite attempts to address the needs in high-risk communities by other medical schools, the data showed it was not working and a new school that was built with those communities is the way to go.

‘‘They are really learning from their community, and it’s the community that motivates them to study hard and to learn,’’ he said.

‘‘And the community members get involved by contributing to the education as teachers themselves as well as the local health care providers.

‘‘We want to go to Ma¯ ori and Pasifika, go to their tables and listen and learn from them. We are quite new to New Zealand, and we are on a steep learning curve, and we need them to guide us.

‘‘We want to partner with Ma¯ ori to honour the Treaty of Waitangi. We want to partner with Pasifika and rural communities to understand and be able to tailor our services for them.’’

One of the original tribunal claimants, Waikato kauma¯ tua Taitimu Maipi said he had had initial discussions with the university and supported the concept.

Maipi said he had visited other first nation health authorities in America and Canada and said a focused school that incorporated Ma¯ ori from the start would not only improve the care Ma¯ ori received, it would also cure racism

‘‘We want to partner with Ma¯ori to honour the Treaty of Waitangi.’’ Roger Strasser

within the sector.

’’If we can reach these students during their learning years, and they are exposed to tikanga. If they know the history of Ma¯ ori health outcomes are why they are the way they are, if they live in those communities and learn the culture, then I think it would change the behaviour and attitude when treating Ma¯ori and other minority cultures as well,’’ he said.

’’There are models in Alaska and Canada that are fit for purpose and the First Nations people there are reaping the benefits. We can do this here if we are partners from the start.’’

And those on the frontline say a school that is focused on Ma¯ori and Pasifika health workforce is needed.

Pasifika Medical Association chief executive Debbie Sorensen said a medical school that increased the Pacific health workforce is sorely needed.

‘‘It is absolutely clear that right across the health workforce we do not have enough Pacific people, and we don’t represent the communities that we serve,’’ she said.

‘‘Having academic institutions considering how they can increase the workforce and encourage young Pacific people to come into an academic career is fantastic. What I would say is that there are lessons to be learnt from both Otago and Auckland University’’.

National Hauora Collective chief executive Simon Royal, the other tribunal claimant said the collective would support any school that is building a clinical workforce with a Ma¯ ori orientation.

‘‘The smart decision is always to work with the communities you serve,’’ said Simon.

‘‘If they were to build a medical school whose philosophy was rooted in Wha¯ nau Ora from the outset, is capable of rethinking the culture to be driven with the idea – that wha¯ nau being at the centre of care and how does that work in a medical context – would be hugely supported by us.’’

Associate Health Minister Peeni Henare said both he and Little agree there was still work to be done to the university’s plans before it would be reconsidered.

He said the Ma¯ ori and Pasifika health workforce faced significant challenges and a medical school that aimed its resources at underserved communities would get his support.

‘‘Certainly from my perspective, because I can’t speak on behalf of Andrew, a Ma¯ ori Health Authority would drive and inform an initiative that leads to Ma¯ ori health work development and if this particular initiative is one that does that then I would expect that the Ma¯ ori Health Authority would be in a position to support that.’’

Henare said once the Ma¯ori Health Authority had its infrastructure and people in place it would be best suited to examine whether the school does meet the equity challenges in respect to Ma¯ori doctors.

National Party Health Spokesperson Dr Shane Reti has been an advocate for the school since 2020.

Reti completed his general practitioner’s training in remote rural areas and says the proposed format works.

He said if National was in power the school’s focus would be to train doctors in rural environments, so they could build their social networks in those communities and stay there.

‘‘Ma¯ori would be a key stakeholder alongside rural communities, alongside women.

‘‘Ma¯ ori are part of the rural communities, so they are a stakeholder by default because that’s who we are serving. If we were to co-design a curriculum best suited to the audience we are trying to serve, then we would need all those voices and all those stakeholders at the table.’’