Dr Lance O’Sullivan: The good doctorby Guyon Espiner
Far North GP Lance O’Sullivan is fighting poverty’s effects but not everyone backs him.
Update: In 2014, Dr Lance O'Sullivan was named New Zealander of the Year.
We lurch into town a little fast, the car handling badly on the winding roads. O’Sullivan leans forward and folds his arms around the steering wheel, more concerned with the direction of the conversation than the car, which finds its way through the back streets of Kaitaia. A passing car toots. “Oh. I just cut his eye open,” O’Sullivan says, recognising the driver, a patient he saw that morning for an abscess.
We walk into Kaitaia Hospital where O’Sullivan has his clinic. He’s barely in the door before a middle-aged man flashes him a rogue finger. “Healing all right, eh,” he says, pulling back the bandage.
Tracy, O’Sullivan’s wife of 20 years, is in the command centre at the reception desk, directing proceedings, organising rosters and taking calls. With her go-ahead we leave the crowded waiting room and go through to the hospital cafe to talk.
I know this is a poor town; the statistics tell you that. But not in the same way O’Sullivan tells it. He talks about kids with nasty skin infections or with strep throat that goes treated until, a few weeks later, they have swollen joints. Still they don’t get taken to the doctor and so they end up with rheumatic fever. There are 35 cases in town. One is a Pakeha boy; the rest are Maori. A bad attack can cause permanent heart damage. “A kid can end up with the heart of an old man,” O’Sullivan says.
The main cause of these high rates of disease is the overcrowded, damp, cold homes. “It’s poverty, basically. I worked out I don’t need to be a doctor to treat these people; I need to be a social worker.”
The parents have no money. They don’t have a landline. They ring the hospital on their mobile phone and get put on hold. They spend precious dollars on the call but hang up before they get assistance. They book a time but don’t come in. They couldn’t afford the petrol for the visit. A relative was going to look after the kids but never shows. So they wait for a crisis because at that point it’s free to get the emergency care. They are rewarded for waiting until it is dangerously late.
O’Sullivan has devised a counter-intuitive solution. Between 8am and midday he doesn’t take bookings. If you show up you will be seen. You might have to wait but you will be seen. That way, if Aunty can look after the kids that day and the car has petrol in it, you go. It makes for some hectic mornings. Like this morning. But it seems to work.
O’Sullivan has star status up here. On Waitangi Day he was named Maori of the Year/Nga Toa Whakaihuwaka and he believes in walking the talk. Well, running it actually: he’s a regular competitor in triathlons and Ironman events and his example inspired more than 200 people from Kaitaia to enter the Ironmaori challenge last year.
He says Maori tend to not be into running as much as Pakeha, partly of their generally heavier builds. “When I first started running, I could hardly run a kilometre,” he has said. Now he runs or cycles the 30km to work.
His celebrity profile helps but can also be uncomfortable. Such as when a woman stopped him in the supermarket asking for the results of a smear test; and the man who thought a local store would be a good place to confide about a worrying discharge.
As we speak, two medical students bring over assessment forms. They also bring cake. It seems to work. There are lots of ticks in the “excellent” column. O’Sullivan talks to me while writing detailed remarks on their forms.
There isn’t enough time for him to be everything he wants to be: doctor, teacher, social worker. Maybe politician, too – but we’ll get to that.
O’Sullivan is also something of a recruitment agent; hence the encouragement of the two young Maori men who will soon be qualified doctors. “If you get 50 medical students up here, how many might decide to stay up here and how exciting would that be?” he asks. There are now four Maori doctors in Kaitaia. Not bad when you consider that nationally only about 3% of GPs are Maori despite Maori making up 15% of the population.
O’Sullivan went through the Maori and Pacific Admissions Scheme established in 1972. He still supports the affirmative action system but reckons there should be a quid pro quo so Maori doctors are bonded to stay for a number of years. In fact, he thinks all Maori doctors have a moral obligation to work for their people rather than moving to Australia to earn the big bucks.
O’Sullivan says his Pakeha patients get just as much from him as his Maori ones. But it is something special for Maori to have a Maori doctor – someone who speaks their language, knows their culture and customs. They open up a little more, they tell him things.
Even a Kiwi doctor up here has been rare at times, let alone a Maori one. O’Sullivan says American doctors have missed signs of rheumatic fever because they’ve never seen it before and didn’t ask the right questions.
The poverty in the Far North is obvious to see and complex in its cause. In his inimitable style, former Maori Affairs Minister Parekura Horomia, who died in April, called this the “matrix of dysfunctionalism”. The wrecked cars, the wrecked lives, the few options and the bad choices. The poor families with poor education, bad diets and a lack of jobs. Where do you start?
O’Sullivan appears to see solutions where others would see hopelessness. He combines big-picture thinking with small-scale solutions. He’s set up an emergency prescription fund and solicits donations for it. If a parent can’t pay for medication, he dips into the fund.
Local pharmacist Garvin Shackleton tells me the programme saves lives. “These people have already spent their money,” he says, gesturing around the waiting room. “I know it’s hard for some people to understand but they don’t have $5. They live day to day.”
And no, he says, they aren’t all angels. Some of them don’t have money for prescriptions because they bought a box of beer. But if you’ve bought a box of beer, does that mean you don’t deserve help?
Of course, not everyone agrees with O’Sullivan’s ways. His critics call him a maverick. He responded by setting up a company called Maverick Health at the end of last year.
But it was more than an ironic riposte. O’Sullivan went independent late last year after walking away from his former employer, Te Hauora o te Hiku o te Ika, a Maori health provider trust. It was a well-publicised stoush at the time. He’s reluctant to talk about it now and open up the wound. But it’s clear what happened. The iwi health provider didn’t like the fact that he’d treat patients regardless of whether they could pay or whether they owed money. O’Sullivan didn’t think the trust, chaired by Dr Bruce Gregory, was providing value for money and putting its community first. So they parted ways and O’Sullivan started an independent clinic at Kaitaia Hospital in late 2012.
It’s been reported by some media that O’Sullivan doesn’t charge his patients. “That isn’t true,” he says, adding that those reports got him into a lot of trouble. Of course he charges his patients, but a lot less than they’d pay elsewhere, and he won’t turn away those who can’t pay.
Is it true there were protests in the street when he resigned from the trust? He flashes the smile that opens doors and nods: “There were about 150 people in the street,” he laughs, letting a little pride show.
O’Sullivan has not long hit 40 and has already achieved a lot. But it was a rocky start. He was raised by a solo Pakeha mum in the Auckland suburb of Howick – not exactly a prime place to explore his Maori heritage.
He was soon in trouble, expelled from Pakuranga College and also from Timaru Boys’ High School before his mother sent him to Maori Catholic boarding school Hato Petera College. His sense of self was engaged and he ended up school dux, head boy, sports champ and a kapa haka star.
It wasn’t until he was in his twenties that he traced his whakapapa: tribal affiliations to Ngapuhi, Tainui, Te Rarawa, Ngati Hau and Ngati Maru. That long journey of self-discovery taught him that a sense of belonging is a key ingredient of success.
O’Sullivan doesn’t lack for confidence now. He knows how to make noise and use the media. He caused a huge stink when he went public with stories about a child foraging through a pig bucket for food and another who drank a bottle of medicine because it was the only thing in the fridge.
He constantly badgers the Government over child poverty and can claim some credit for getting it to shell out an extra $21 million in the 2013 Budget to combat rheumatic fever.
He has also set up a school-based health programme to check on kids who might otherwise be overlooked. We drive down to Kaitaia Primary School to visit one of the clinics in the Moko programme (short for Manawa Ora, Korokoro Ora – healthy heart, healthy throat). It caters for about 2000 children at 14 schools. “We can’t wait for the parents to bring the kids in to us, so we go to them,” he says. These are children who come to school with no shoes or shoes with gaping holes in them.
A nurse and three community workers show me several photos of serious skin infections on little bodies. Another picture documents what chicken pox looks like if left untreated. They also tell me about infections from a new game that is popular in town where a child takes a sharp object and scratches “a, b, c” into the back of another child’s hand until it bleeds.
One of the community health workers says that when she first came to Kaitaia she thought there was a weekly night festival in town. “People were all crowding around the ATM machines,” she says. Turns out it was benefit night. By the time the money cleared, the supermarket was closed so they’d go to the garage to buy food, where the groceries cost a lot more. And so it goes on.
As we talk O’Sullivan is mulling over new projects. Maybe he could go door-to-door? Get a few basic pieces of medical equipment and set up shop in a mobile truck?
Back at the hospital, he takes me to a room at the end of a corridor. Inside is his new toy: a wide-screen TV with a camera. It’s a virtual consulting room. He can get expert advice from Auckland or America.
He wants to roll it out to the towns outside Kaitaia, the small communities where the people won’t – or can’t afford to – travel to town to see a doctor. Of course, he’ll have to set parameters: the things he can treat and the things that might be too risky. He pulls up Google Maps and shows me the town of Te Hapua, 110km north of Kaitaia, as he enthuses about the benefits of virtual consulting. He already has some money from a sponsor to fund part of the project. O’Sullivan often reaches out to the corporate Pakeha world. Often it reaches back.
It’s time to go. We get into the battered Subaru to drive to the airport. On the way back we talk politics, not poverty. He’s quite open that he’ll give it a crack – perhaps in another five years or so. He’s a candidate from central casting, that much is obvious. It’s been obvious to all the political parties that have asked him to stand, which is the lot except National.
Funnily enough, that could be his best shot. He doesn’t rule it out. He finds Labour paternalistic at times, although he doesn’t rule it out either. He knows he’d get flak from his people for throwing his potae in with National but there is a knowing grin that suggests he might quite enjoy the fuss. Nothing has been decided. There’s time for that.
I wait for my plane at the Kaitaia Aero Club, where the fire is going and the bar is open. Inside are a dozen locals, mostly over 60, all Pakeha. I get talking to Jimmy, who wears a blue-and-white checked shirt and a sleeveless puffer jacket, his badly dyed hair slicked over his head. I tell him I’m writing an article on Lance O’Sullivan. “Bloody socialist,” he says. “Keeps trying to give things away for free.”
Deidre is serving drinks behind the bar but comes out to join us. Maori are trying to take over the hospital, she tells me. Deidre used to work for Social Welfare in Kaitaia; she says when the benefits came through, the men would spend the money at the pub and a few days later the women would come in for the special needs grants.
They soften a little after a couple of drinks and acknowledge that O’Sullivan means well. But the resentment remains. They feel Maori are getting special treatment in Kaitaia and are wasting their opportunities.
I walk back down the gravel road to the airport terminal. It’s open now and I wait to board the flight, looking through the notes from my day with O’Sullivan. There’s a large asterisk next to his comments that Maori leaders trying to make gains for their people must take Pakeha with them and keep them on board. “We have to be generous. We have to welcome Pakeha into our world.”
This article was first published in the August 17, 2013 issue of the New Zealand Listener.
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