Standing on the Shoulders of Giants | Te Whatu Ora - Te Tai Tokerau

Standing on the Shoulders of Giants

The importance of strong relationships was echoed in each speech at this year’s Pūkawakawa year five and trainee intern farewell pōwhiri at Kaka Porowini, Terenga Paraoa Marae in Whangarei on Monday.

The Pūkawakawa programme was set up by the University of Auckland’s Faculty of Medicine and Health Sciences and the Northland DHB in 2007. It offers fifth year medical students the opportunity to gain experience in regional and rural health, spending the majority of the year working at Whangārei Hospital and the remainder working in integrated care/GP attachments at Dargaville, Bay of Islands, Kaitaia or Rawene hospitals. 

After acknowledging the passing of Reverend Hare Rihari and the re-election of current Northland DHB Board chair Sally Macauley, chief executive Dr Nick Chamberlain encouraged the students to be adventurous in their career and always go that extra mile. He reminded them what an incredible privilege it is to care for others and highlighted that they must remember that everyone is as important as each other, and we all have the potential to do great things.  

He asked that the students try not to change and always retain their humility, finishing with the words of Christchurch Boys High Head Monitor, Jake Bailey who found out he had cancer just before his end of year speech, “Be gallant, great, be gracious, be grateful”.

University of Auckland Faculty of Medicine Deputy Dean Professor Alan Merry and Tumuaki and Head of Department Māori Health, Professor Papaarangi Reid both thanked Northland DHB for their successful relationship with the University and noted their ongoing pride in the programme since its inception 12 years ago.

Professor Merry said after spending time in the region, the students would have come face to face with the inequities in healthcare that Māori face and recommended the audience read the Waitangi Tribunal’s Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry.

“It’s a matter of considerable sadness that we continue to have substantial health inequities, particularly for tāngata whenua – which is wrong. We should have equity - not be working towards it.” 

Professor Reid discussed how part of the journey of becoming a doctor was to understand their relationships. She said she hoped that the students learnt from the Northland patients and their whānau, and said that we all have to get past stigmas and learn to love our people.

Both she and Sally Macaulay also mentioned the importance of communication between doctor and patient.

Each student spoke about how much of an honour and privilege it had been for them to be part of the programme, particularly the integrated care attachments where they had the opportunity to get a feel for what people are going through.  University of Auckland academic coordinator Dr Win Bennett and site team leader Caroline Strydom were also thanked for the support and care they provided throughout the year to the students.

Northlander Raveena Nand described one of her clinical experiences in the delivery suite, where she had the most incredible experience of her medical career thus far.  Raveena explained that the mother was Māori and had the full support of whānau during the birth of her child that arrived into the world being greeted by a karanga and karakia. 

“I was holding back the tears – it was beautiful. The whole experience of being there, being together and being safe was amazing.

“It’s kind of like us coming into Northland. We were new students coming into Northland, and were enveloped into it with welcoming arms to guide and help us, and be our friends.”

When the father was handed his new baby, he looked straight at Raveena as if to ask her to take the baby, but she told him, ‘You’ve got this,’ and guided and supported him to feel confident in what he was doing. 

“I had one Nan glued on each shoulder, and they trusted us at that moment. It was the first time I felt like a proper health professional.”

Year five student Hannah Pitman-Bell said she found Northlanders to be extremely open and welcoming.  The experience has reinforced to her that practising medicine is about people.

She said they have all learnt that rural medicine goes beyond simply treating patients. It is also about dealing with other issues such as transportation and cost, which will stay with them even if they end up practicing in larger hospitals.

Hannah said she feels more integrated in the smaller hospitals where consultants know who you are, and that makes a big difference to learning. 

“You have more one on one time with the registrars and consultants and feel like you can easily talk to the house officers.   

“I couldn’t speak highly enough about the programme and the work the University do. I recommend that everyone should do at least one year in a rural programme.”

Kaitaia student, Anaru Williams said he felt grateful for the opportunity to work with Ki A Ora Ngātiwai and hoped other students take the opportunity to work with Māori health providers because of the work they do in outreach clinics.

“I saw more patients than I would have in any other placement. There are lots of issues with poverty, drug abuse, and a massive access issue for rural people. Removing the fees removes barriers – it’s really interesting.”

The experience has solidified Anaru’s decision to work in rural medicine and eventually return home to Northland to work in the future.  

The students serenaded the audience with waiata.  Then gifted a bench seat to Northland DHB for patients to use on the Hospital grounds and a Kauri tree symbolising that every kauri seedling has the potential to be a Tāne Mahuta, but they need nourishing and protecting. 

Year five student Don Laing finished saying, “Even if some of us don’t come back, we’ve all been able to grow because we’ve been able to stand on the shoulders of giants. A lot of us will go away, leaving a little bit of us here. And a lot of us will come back.”

Pūkawakawa year five and trainee intern farewelled.

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