Kaitaia GP Dr Lance O'Sullivan rarely minces his words, especially when he's talking about how he sees the primary health system failing the poor, and in particular Maori.
He had a very prominent stage from which to deliver that message on Saturday night when he addressed an audience of Northland GPs at Omapere, beginning by placing his concerns within a personal context.
"I keep an image of my son and I to remind me that every father or mother should have the opportunity to hold their son or daughter in their arms, knowing they will be physically and socially equipped to achieve their potential as New Zealand citizens," he said.
"As many of you in this room know, this is not the case for many people in our region and across the country ... I am here to recruit passionate and willing people to become champions in their communities to address the shameful burden of disease that falls on my people in Northland ...
"I am here to challenge you to play a part in the solutions to improving Maori health. I am here to leave you with the belief that you can play a part in improving health outcomes for Maori despite many of your patients living in the most difficult of circumstances."
Maori were resilient, Dr O'Sullivan said - in 1856 physician and politician Dr Isaac Featherston said it was the duty of Europeans to "smooth the pillow of a dying race" - but there seemed to be a significant gap in the communication between Maori patients and non-Maori clinicians, evidenced by doctors' seeming inability to connect with Maori patients.
He cited the example of a patient he referred to Kaitaia Hospital for likely transfer to cardiology.
"I was shocked to read the transfer letter to the cardiologist, asking them to accept said patient 'recently released from jail'.
"Neither the patient nor I could for the life of us think why this was relevant. You can only imagine how this form of communication made the patient feel.
"What relationship is there between poor compliance and poor communication between clinician and patient? ... Changing behaviour for your Maori patients is only second in importance to saving their lives in an acute emergency, and is probably more challenging. However, just like anyone, we are sensitive to messages that come across as judgmental, impersonal, and robotic."
Census 2006 data shows Maori make up almost one in three Northlanders. "This means that the chances of you having a Maori neighbour, workmate, friend, son/daughter-in-law should be fairly high. One Northlander in three is paying for a health care system that seems unable to arrest the tide of disease, morbidity and preventable mortality," Dr O'Sullivan said.
"In your clinic next week one of every two children under 4 and one out of eight patients over 65 will be Maori. This highlights a very concerning trend, indicating that only one out of every 3.5 Maori children you see next week in your clinic will be around in Northland for their 65th birthday."
PREMATURE
"How many of the Maori babies, children and young people that you see next week will be the two-thirds that die prematurely? We know that death before 65 years of age in a Western and developed nation such as New Zealand is premature."
He said income levels were directly related to the ability to have a healthy life. A healthy level of income allowed the ability to have a warm, dry home. In a fee for service health system it allowed access to primary health care services, including prescriptions.
"We have recently heard that there will be an increase in the surcharge for prescriptions," Dr O'Sullivan continued.
"This is very concerning for me, as I am sure it is for many of you who will see our high-needs patients further disadvantaged. We already see patients who make unsafe decisions on what medicines they can afford to pay for on the script we are giving them ...
"It is not just beneficiaries who are struggling. Three weeks ago I had a waged female not being able to collect the iron required for her anaemia that had required transfusion ...
"We know there are significant health needs for Maori citizens in our country and our region, and we need to look at what part we as primary health care specialists may play in both the problem and the solution."
For a long time the doctor has been commenting publicly about how the health system is failing his people and citizens.
"For some time I have seen this happening very close to home.
"I have seen sick children being turned away because their whanau owe money.
"I have been reprimanded for treating patients who owe money," he said.
"I have been told by patients they are too ashamed to make an appointment due to outstanding fees.
"These are high-risk patients."
The night before his speech he had seen a 1-year-old asthmatic child living in a home with multiple broken windows, holes in weatherboards and leaky pipes.
The child was presented at the clinic at 3pm. He was not there, no other option was offered and she was "sent on her way".
She was seen at the hospital ED at 5pm and told the GP clinic would start at 7pm. Dr O'Sullivan saw her and treated her.
Next day she was better, but still living in a cold, damp home.
"We cannot do a lot about the seemingly insurmountable problem of child poverty or dire economic times our region is facing," he said.
"We can do something about how we respond to the dire needs of Maori patients in our region, and we do this on Monday.
"In the end the value of doing this is being a part of making a change to the outcomes for the patients you will see in your clinics next week.
"A change has to occur, because what is being done now is going to mean the same old outcomes, and you will still see two out of three of your young Maori patients denied the chance to grow old in Northland."
