Coalition of the willing offering health to Parihaka

It isn’t long after Kiri Wicksteed’s practice door opens that the laughter starts.

I think Parihaka could be a lightning rod for discussions around equity

“That’s the thing that warms my heart the most,” she says, “that laughter coming from the waiting room. “Everyone can see when the front door opens, and if they see an auntie come in, they drop by to hang out and have a cup of tea. This is a place that’s familiar to everyone, they feel very comfortable here, and that’s what makes it an extra bit special, I think.”

But then this is Parihaka, and as place names with historic resonance go, they don’t come much more special, if special is the right word.

It was founded as a pacifist community during the 1860s by Te Whiti o Rongomai and Tohu Kākahi. Situated on South Taranaki land that had been confiscated after government officials reneged on previous agreements, Parihaka became a beacon for similarly dispossessed Māori and, at its peak, had a population of about 2000.

Calls for military action intensified as the growing community responded to constant intimidation with stubborn yet passive resistance until, on 5 November 1881, soldiers and cavalry, backed by a cannon, advanced on the village and were greeted by a line of singing children offering bread.

The subsequent arrest of the village leaders was followed by weeks of repeated attacks which saw the homes and crops of Parihaka systematically destroyed and community members arrested or forcibly evicted without food or cover.

It’s no surprise then, that trust must be earned in Parihaka, and it is a challenge Dr Wicksteed (Tūhoe, Whakatōhea and Tūwharetoa) welcomes: “I feel really honoured to be part of this community, it’s a significant place, and despite everything that has happened here, all that history, it is such an open and welcoming community.”

All the same, the most common questions she has fielded since opening in November 2020, have been “how long will you be here?” and “when will you be leaving?”

The last practice in Parihaka lasted six years and closed about eight years ago, when funding was withdrawn, so there was understandable suspicion this newcomer wouldn’t fare much better.

But then her predecessor didn’t have the supporting cast Dr Wicksteed enjoys. Her clinic was 18 months in the making, with ongoing community input and root-to-tip support coming from Opunake Medical Centre, Parihaka Papakāinga Trust, Pinnacle PHO, Taranaki DHB and whānau ora provider, Ngaruahine Iwi Health Services.

The result is a co-designed, whānau-centred service with free, open-ended consultations and a booking system that allows for unexpected walk-ins. Patients are not required to be enrolled, so as not to interfere with existing GP relationships, and the practice (including Dr Wicksteed’s salary) is, initially at least, being bulk funded by the PHO, to remove the impact of low capitation income.

It is presently running on a fortnightly basis, with Dr Wicksteed otherwise based at Opunake Medical Centre.

The Parihaka community of about 40 whānau sees the clinic as central to the infrastructure needed to encourage more whānau back to the kāinga. Pinnacle deputy chief executive Justin Butcher says it is a model they hope to replicate in other rural communities.

“I guess I do feel a bit of pressure to make this work,” says Dr Wicksteed, “but I’m really lucky with the support I [have] without the pressure of producing immediate outcomes. Instead, I’m providing a service in the way it needs to be done and, while you can only do what you can do, I think this model will give us the flexibility to change up what we’re doing and respond to feedback.”

But there is no avoiding the legacy surrounding her. Their practice name, Whakaihu Taiora, references the ships that transported those arrested by the constabulary to prison in Dunedin and speaks to demanding journeys and being carried on tides of wellbeing. Her first meeting with the community also took place at one of Parihaka’s monthly assemblies. This is a regular event first established by Te Whiti which also came to commemorate the deaths of the community founders, who are buried at the pa.

Which is a lot of weight to carry for a project that grew from some consulting-room conversations.

Nick Loveridge-Easther is a co-owner and GP at Opunake Medical Centre. He treats several Parihaka elders and says their conversations often raised the difficulties they had in accessing medical services, with his clinic requiring a 20-minute drive with limited transport options.

After approaching his PHO and DHB in early 2019 about the problem, the Parihaka Papakāinga Trust came on board and the decision was taken to ask the community itself what they wanted.

“I think Parihaka could be a lightning rod for discussions around equity,” says Dr Loveridge-Easther, “and that is one of the reasons why we and the PHO are backing this to succeed, so we can say this is a clinic that is successful and flexible with equity and equitable outcomes as its focus. I thought it was an absolutely wonderful idea, but we needed the community on board from the start, there is no point throwing money at something that does not serve the needs of its patients, it has to be sustainable and wanted.”

Mr Butcher says everyone involved in the project has benefited from their involvement.

“It’s really a collection of willing partners,” he says, “and we’ve all built some really good relationships out of it so we’re keen to replicate this type of co-design in other areas and are now taking guidance on that from iwi and Māori providers. For us, it’s about taking health to the marae and allowing the community and providers to work together on how the service should operate.”

Their financial backing comes from the PHO’s flexible funding which pays for the equipment and medical staff, including Dr Wicksteed and practice assistant Alex Neil.

“Our commitment is long term, we intend to fund it as an evergreen arrangement and haven’t put a time frame around the clinic becoming self-sustaining, as long as it is being ulitised and is needed by the community. But this isn’t a project we can hang our hat on, it is something that has grown organically, we’re just one of the willing partners,” Mr Butcher says.

“To be able to work alongside clinical (services) has been amazing,” says Parihaka Papakāinga Trust general manager Mitchell Ritai, “they offered this as an opportunity for us and then joined in the consultation process with whānau.”

The trust sees the practice as vital to their future prospects and is hosting Whakaihu Taiora in its own premise. Mr Ritai (whose whakapapa is connected to the Tokomaru, Kurahaupō and Aotea waka) says clinic attendance began slowly as there were doubts about how long it would remain while many already had long associa­tions with outside GP services. But positive feedback has seen interest grow.

When the clinic is not open, Mr Ritai says follow-up medical services, including access to a health improvement practitioner (HIP), are available from Ngaruahine Iwi Health Services.

Such services are essential to their aspirations for the community, he says. Aside from the clinic, the Provincial Growth Fund has provided $14 million for the construction of a visitor centre, while further funding will enable improvements, including high-speed broadband, for their three marae, Takitūtū, Te Niho o te Atiawa and Toroānui.

Maara Kai, a community garden and food forest, has also been established to help feed the marae and residents, while the village’s profile has been boosted by the Parihaka Peace Festival and the Parihaka Puanga Kai Rau Festival which heralds the Māori New Year.

Mr Ritai hopes such initiatives will provide the employ­ment opportunities needed to attract young families who will, in turn, expect access to local healthcare.

Parihaka Papakāinga trustee Rawinia Leatherby-Toia (Taranaki, Te Atiawa, Ngā Ruahine, Ngāti Ruanui) has ancestors on both sides of the Parihaka attack and is proud of the kaupapa set in place at Whakaihu Taiora.

“Having a Māori doctor is wonderful, and we have all met her twin girls, so she is one of the home people now… for us, last year was about protecting our whakapapa, now we are all about protecting whānau.”

A kaupapa Māori approach is vital for community uptake, says the former health equity adviser at Taranaki DHB, as elders often feel alienated by outside healthcare where they are not greeted, and their names are mispronounced, leaving them feeling disregarded and unimportant. Such experiences make it less likely they will return.

And yes, she says, the story of Parihaka surrounds them. Many streets in Taranaki are named for those involved in raupatu, the widespread confiscation of land, most of the pubs along the coastline were originally hostels for the constabulary, and Taranaki Cathedral, the church of St Mary, was used to store gunpowder.

But, she says, the clinic is a step in their intent to carry the wairua of Parihaka forward. “We just have to make sure it continues, not just for us, and not just for Māori, but for everyone in the region. Everyone is welcome here and we need them to know that.”

A deliberate effort is being made to reach out to the farmers, especially their children, “the next generation of landowners”.

“Yes, we have historical trauma and distrust, but we are not leaving it here, we are taking our history into the future and we don’t want our children to carry that negative attitude with them as they grow. Healthcare is part of the solution, it changes lives, so I don’t want Whakaihu Taiora to fail, I would love to see a beautiful little medical centre that is fit for purpose remain here. In the end, it is not just a health project, it is about all that legacy, everything that has gone before and everything that will follow.”

For her part, Dr Wicksteed is taking things one step at a time and earning the trust of the community.

“I am passionate about Māori health, so this is some­thing I want to be part of, something I am committed to, and I’ve been getting some great support from other rural Māori doctors. I want to be able to help with health literacy and build therapeutic relationships, and we have some ideas around creating opportunistic screening opportunities.

“Continuity of care was my big concern, so we have set it up as a satellite clinic to Opunake Medical, but we still have to prove its value. For me, though, that won’t be reflected by diabetes markers, it’ll be in the relationships we build with the people, and figuring out how to demonstrate that in a meaningful way is top of my job list.”

A decibel meter in the waiting room might be a great place to start.