Who is Apisalome Talemaitoga?: Delving into the New Zealand Doctor archives

Alan Perrott asks Apisalome “Api” Talemaitoga about starting over (and over), coming out, and his early years adjusting from Fiji to South Island temperatures

Apisalome Talemaitoga knew he had been set up.

In my darker days, I wonder if they’re trying to kill off general practice so they can replace us with robots

But you can’t say no to a bride, not on her wedding day.

Dr Talemaitoga had flopped down after a spirited Brooklyn hustle with newly wed GP Helen Wood, when she and practice co-owner Kris Yee ambushed him.

Dr Yee started: “So…what are you going to do when you grow up, Api?”

“What is this?” he spluttered.

“Come on Api, come and work with us…”

“Ummm…”

After years of following orders, Dr Talemaitoga was lo­cuming at the pair’s suburban Christchurch practice and relishing life. “I was free, and I was loving it.”

He was also heading to Europe with his partner, but now a life decision would be riding shotgun. And yes, Normans Road Surgery was one of two medical centres he had idly pondered joining, more as a pipe dream, not a serious commitment.

But, again, you can’t say no to a bride. On 1 February 1999, he walked into his surgery as a practice owner, wondering, oh my God, how is this going to work?

Then he rolled up his sleeves and got stuck in, just as his mum and dad had taught him.

Now, with his big 6-O approaching in November, as he’s trying to slow down, he’s still juggling roles in four practices and sundry governance positions across two cit­ies. But then, when you’re a Pasifika physician, the stand­ard medical career is not really an option.

Known to everyone simply as Api, Dr Talemaitoga is a familiar face – and a distinguished fellow of the RNZCGP.

He is always sharply dressed and inevitably smiling, unless talking about the health of Pasifika peoples, in which case his eyes inevitably well up.

The tears are born of empathy, but increasingly are also due to anger. After decades working within the system he worked so hard to be part of, he is now stepping aside – and wondering if it ever really cared.

Born in Savusavu, on Fiji’s Vanua Levu, Api Talemai­toga was the eldest child of parents who had also been eldest in their families.

Each was a leader in their community, church and fami­ly, and they expected the same of their boy: “It’s a role you are born into and then subtly trained for,” says Dr Tale­maitoga. “You’re told this is what is expected of you and what you will do. I had a lot placed on me.”

With four of his father’s brothers and eight of his mother’s 11 siblings all teachers, he followed suit. Edu­cation, he and his siblings were constantly told, was their only door to a better life.

After passing his sixth-form exams, he spent three days at teachers’ college before his parents sat him down. His aunty had seen his marks and they had almost got him into medical school, so why not do sixth form again?

At 18, he did as he was told and, sure enough, bettered his marks. The college wanted him back, and pilot train­ing was also putting out the welcome mat (“I’ve no idea where that idea came from”), but he chose medicine.

Commonwealth scholarships were available to the top three first-year students and, by the end of 1979, he had snared one to the Dunedin School of Medicine. The only catch was, once graduated, he would be bonded to work in Fiji for the following five years.

Dr Talemaitoga disembarked in Dunedin, resplendent in short-sleeved shirt, shorts and sandals, and walked out into a southerly: “Bloody hell, I couldn’t believe it…”

He quickly found refuge with other international stu­dents but, horrendously homesick, he warned his parents he might not last the distance. The choice was almost made for him: “One night they called me up: ‘What is this flatting you do?’…they were very religious.” Even 3000km away, their influence was inescapable.

“One of my flatmates said he thought it was sad, ‘hav­ing all these people hanging on to you, you’re not free’. But it’s funny, I don’t feel like that. It’s a family thing. I didn’t feel any pressure, and I knew how much it meant to them.”

Their oldest boy was growing up and feeling less be­holden to his parents’ wishes, however. “It was during second-year anatomy and physiology, seeing how this stuff could be applied practically. I didn’t so much have a light-bulb moment as come to a slow realisation of what I could do, and then I started to enjoy myself.”

One of his flatmates was Garry Nixon, now a rural hos­pital generalist and director of the University of Otago ru­ral postgraduate programme. Dr Nixon says that once his mate mastered the weather, Dunedin was his oyster: “He was a really sociable sort of guy, he can fit in anywhere. It’s fair to say he’s a champion networker.”

A career was taking shape in Dr Talemaitoga’s mind. Spending time as a student doctor back home, he got to know the Fijian GPs by name, and he liked what he saw of their lifestyle.

“That was the life I wanted to create for myself...Five years in a government post, then private practice.”

He had only one qualm. Chatting at a dinner party to a woman he had just met, he was asked, “Would you look at my plantar wart?” – and she promptly removed her shoe.

“Disgusting,” thought the young doctor. “But I’ve got better at handling those situations now,” he says.

Recalling his 1984 graduation still brings him to tears.

Many members of his extended family – all but one are now dead – travelled from home for the occasion; his mother and aunties made special tapa outfits. A friend even gave up his flat for his parents. It was a “scarfie” slum, but it was warmer than his.

“I felt incredibly happy,” Dr Talemaitoga says, “because I’d realised how important this was to [my parents]. I was also happy for myself, and knew I would have a good lifestyle. That sounds really money minded, but I wanted my parents to enjoy some of those things as well, and I paid for them to visit, otherwise they would never have travelled.”

His whānau responsibilities remain a constant. Early on, he made a commitment to his siblings and cousins. Their children shouldn’t expect presents from him, but he would help pay for their education.

Then, after completing his house-officer years in Christchurch, he returned to Fiji in February 1989 and re­ported for duty at the Colonial War Memorial Hospital.

The medical superintendent offered three choices: medical, surgical or obstetrics and gynaecology registrar.

“But I’ve only done two years as a house officer?”

“Yeah, whatever, choose one. Come on…”

“Okay, medicine.”

It was seat-of-the-pants stuff, with long shifts and ru­dimentary equipment: “You had to rely on your clinical skills, and I learned a lot from the locally trained doctors.”

After two years, he got a VIP patient. “I got a call asking me to travel with major-general (and then prime minister) Sitiveni Rabuka as his private doctor. He had arrhyth­mia. I went home and told my family, and they thought it sounded really glamorous.”

Rabuka began requesting his presence more often, even calling for his private doctor over the hospital public ad­dress system or sending a car to pick him up at night.

“He’d want me to check his blood pressure or some­thing, but he really wanted someone to talk to.”

It was exhausting. Dr Talemaitoga had to find cover for every shift he missed, only to return, hoping for a break, and be told “right, it’s your turn to cover me”.

When Rabuka was invited to be the first Fijian leader to address the United Nations, he wanted his doctor with him. On the way, they would visit Fiji president and par­amount chief, Ratu Sir Penaia Ganilau, who was being treated for Guillain-Barré syndrome at Walter Reed Hos­pital in Washington DC.

“After the traditional greetings he says [to Rabuka]: ‘Hello, Steve’ – Ganilau had a very Oxford accent – ‘so, this is the doctor you travel with? Steve, your doctor will stay with me from now on’. And that was it.”

Dr Talemaitoga spent the next two years running from his hospital work to whichever leader wanted to see him.

“I’d get home from a shift, and there would be a knock on the door: ‘The president is asking to see Api.’ And I’d have to get dressed again and go.”

The workload was manic, but he felt his career was stagnating.

By 1993, he knew he had to leave. He contacted a for­mer mentor, Christchurch Hospital head of medicine Mike Beard, to ask if he’d take him back. “Absolutely,” was the reply.

Somehow, Sir Penaia got wind of the plan, and a sum­mons was issued. After hearing what Dr Talemaitoga had planned, the president said: “Well, I find that totally un­acceptable” – but was dead by the end of that year.

Rabuka wished Dr Talemaitoga good luck for his fu­ture, but the Fijian public service wasn’t letting go so eas­ily. He had completed his bond, but the bureaucrats tried to post him to the Outer Islands.

They then wanted him to apply for leave without pay, but only for one year. So, Dr Talemaitoga resigned. Sorry, came the reply, “we do not accept your resignation”.

Returning to New Zealand was about more than his career. Dr Talemaitoga had also been wanting to come out as a gay man for some time, but had felt unable to do so in Fiji.

“If I’d stayed in New Zealand, I’d have been out in the 1980s, but Fiji in 1989? No way, not in the situation I was in. When I did come out to my New Zealand friends, they just laughed: ‘We already knew.’

“Then I had to go home and tell my family. Fiji is con­servative, and that caused tensions and stresses in the family, but I like that my immediate family accept me as who I am. I’m too old to care now. If you don’t [accept me], oh well, I don’t need you in my life.”

After a few years as a medical registrar in Christchurch, Dr Talemaitoga hit another wall. “I was asking myself why am I doing this?” He told Dr Beard he wanted to try gen­eral practice.

“He just said ‘Oh, you’re leaving us for your first love?’ We’d talked about it a lot, and he was really supportive.”

So, Dr Talemaitoga stepped down to senior house of­ficer, completed the paediatrics and O&G rotations, and applied for general practice. Not yet a resident, he had to fund the training himself. He was feeling motivated, having seen former classmates establish themselves in practices, “and here I was, starting from scratch”.

“It was hard work, but I got great advice from an ac­countant friend: ‘Be your own boss and be a locum’, and that’s what I did, until Helen Wood’s wedding.”

And that decision meant a lot more than just buying a practice.

A few years earlier, he had met Alistair. It had been tricky; he hadn’t been out for long, and still felt like an exotic outsider in suburban Christchurch. But they soon became a couple.

“So, I decided, this is it. I’m going to stay in New Zealand.” The deal was sealed with a house purchase.

Without a registered patient to his name, the new practice owner began gatecrashing every playgroup, preschool and kindergar­ten to talk hygiene and glad-hand parents. He also contacted the local resthomes, and an old friend “gave” him a ward to look after.

“I was told it’d take a year to break even, and I did it in six months, probably because all the time I was thinking, how am I going to pay for all this?”

By 2008, things were working well. He had built a practice and an income, while taking on wider Pasifika responsibilities.

“I’d been going about 10 years,” says Dr Talemaitoga, “and I’m liking it. I’m also on the Pegasus Health board and various subcommittees, including one on Pacific health. These jobs just come to you. You don’t get asked, you’re told. It’s a function of being a Pacific Island doctor.”

He was a founder of the Pacific Medical Association, a group that had an informal arrangement to provide a chief advisor Pa­cific health to the Ministry of Health. When Debbie Ryan stood down, she called her old friend: “Your turn.”

Dr Talemaitoga made it clear he would not give up clinical medicine. “You can have me for four days a week, but on Mondays I’m in Christchurch, so that’s the only day my pa­tients can get sick.”

He asked a medical school friend, Elizabeth Middleton, to fill in as a locum, and promised to be back in two years. He was away for five.

Still, his new role provided a career highlight. On only his second day, he became involved in a human papillo­mavirus awareness campaign that featured a television advertisement showing three young, glam women shop­ping, accompanied by an up-tempo jingle.

The advert upset a reverend, who called the new chief advisor and demanded to know “what the hell” he thought he was doing.

“They’re giving these injections to turn our girls into nymphomaniacs.”

This confirmed his suspicion that the campaign, osten­sibly targeting Māori and Pasifika, had missed the mark.

He lobbied for it to be redone with a focus on Pasifika families, with the message that immunisation would pro­tect the Pacific family for future generations.

“And within three months, Pacific [rates] were the high­est for the first, second and third immunisations. I really liked that work.”

Then, just to complicate his work situation further, in 2012, Dr Talemaitoga and his partner moved to Auck­land. He was now working across three cities.

He began doing locum work at Siro Fuata’i’s Bader Drive Doctors practice in Māngere, south Auckland: “I thought Pacific Islanders in Christchurch had it hard, but this was another level of difficulty,” he says.

“I really admire the doctors here for what they do.”

Dr Fuata’i then began talking about the two of them setting up another practice together. He eventually agreed.

Cavendish Doctors opened in 2014 in Manukau and, after plenty of effort, is now the preferred health provider for 35 local businesses.

“Again, it was a huge financial outlay,” he says.

“I also had a new mortgage, and Alistair had retired – he got that right. It felt like 1999 all over again, and there were plenty of times when I told Siro ‘I just want to throt­tle your neck’.”

For the past four years, he has been commuting be­tween the practices in Auckland and Christchurch. While he has dropped his ministry commitments, he has also begun treating prisoners at Corrections facilities in Mt Eden and Wiri.

But, with his 60th birthday approaching, he is in­tent on reducing and changing his workload: “It’s been a slow process – that’s probably my personal­ity, I can’t just cut it off and stop.”

Dr Talemaitoga has decided to shift from general prac­tice into appearance medicine – Cavendish Doctors is only minutes from Auckland International Airport and he has been doing a roaring trade with cabin crew.

The work has become as much about his mental health as it is about income, given his rising frustration with in­action on Pasifika health issues.

“I try to remain positive, I do,” he says.

“But I’m becoming more and more cynical. Nothing ever happens. I’ve made throwaway remarks on reports being left to gather dust, but it’s true.”

He was angered recently to receive a Pacific action plan, along with a request to provide a review in two days.

“I mean, jeepers…when was this plan even done? They say, ‘oh, we've collected feedback from the community’. Who? When? It’s just so disappointing, and I can’t believe we’re still having these conversations.”

Sadly, Dr Talemaitoga is also losing hope for his Pasifi­ka patients who return time and again to collect prescrip­tions with no sign of improvement.

“I sometimes think we should give up on this genera­tion,” he says. “It’s just too late to change some people.”

He also wants more accountability within secondary care, to stop the “dumping” of patients on GPs.

But he doubts the health system values GPs. It’s that whole “just a GP” thing, he says. “You’re a bloody techni­cian. In my darker days, I wonder if they’re trying to kill off general practice so they can replace us with robots.”

But he is steadfast in his view of general practice as a privilege. More often than not, he can look back on a day of care that was “such a privilege to be part of”.

“Like becoming a distinguished fellow. I was shocked, and I cried. To be acknowledged in front of my peers, and not just Pacific, my wider peers, classmates, colleagues.

“I was asked ‘what do we call you now, Mister Distin­guished?’ And I said: ‘Nothing, you just bow.’

“I have no regrets...I just wish I could have done it all sooner.”