The moko behind the white face

27 May 2022

By College writer Steph Julian Ngati Porou ki Harataunga

A lot has changed since Dr Jim Vause (Kai Tahu rāua Kati Mamoe) trained to be a doctor in the 1970s. Back then, he found the lack of support for Māori disturbing. “I saw the injustice in the system. I didn’t function very well in that medical school type environment.”

During his time at medical school, Dr Vause found that his appearance as a “white Ngai Tahu” meant he could sit down the back and not be seen, unlike his fellow Māori classmate who felt the full brunt of the racism that was rife at the time. As Dr Vause developed throughout his career and connected more deeply to his own whakapapa and Te Ao Māori, his appearance allowed him to break down racist stereotypes from the inside. 

“There’s a whakatauki that, in English, says that you must be careful, behind that moko there might be a pale face, I twisted that around, I may not appear Māori but behind the white face is a moko. People did reveal their racist thinking to me a lot more because of that.” 

Dr Vause recalls forming a connection with an English immigrant who had moved to New Zealand to ‘come good,’ leaving a life of gangs and crime in his home country. Unfortunately, he presented with some strong misconceptions about Māori which he openly discussed with his new GP. “He felt comfortable saying things in front of me because I’m not brown, but it gave me the chance to connect with him and teach some aspects of Māori culture and to slowly break down his racism.” 

For someone who has such mana for his role in healthcare in Aotearoa, Dr Vause never dreamed of being a doctor. A chance visit from Dr Peter Moodie to his school in his final year, planted the seed that medicine might be a viable option. “He asked who wanted to go to med school and lots of people put their hand up. I didn’t put my hand up. In those days, I didn’t have the drive to do anything. That drive came over time. But I was brought up both Māori and Pakeha, and neither side had been to university. I wanted to change that.” 

Despite struggling with the Pakeha-driven system of medical training and hospital hierarchy, Dr Vause went on to become one of the country’s most influential GPs; serving as the first Māori GP President of the Royal New Zealand College of General Practitioners and subsequently receiving the honour of a

Distinguished Fellowship in 2006, being a Health and Disability Commission expert advisor and a regional representative on Te Ora, and representing the College on Wha me Wha. Dr Vause has advised on clinical guidelines for weight management and worked on a taskforce to raise prostate cancer awareness. 

Now two years into his retirement, Dr Vause says that he is still cynical about the disconnect between bureaucracy and what happens ‘at the coalface.’ He’s hopeful that the Māori Health Authority can evoke some changes at the frontline, but he is concerned that progress will be slow. A focus on genuine community engagement is crucial, he says. “Corporates are disempowering GPs.” Having helped develop a patient care programme for the Ministry of Health, he was then presented with the programme by his PHO . “We handed the Ministry four pages of recommendations. When it came  onto my desk in my practice, it was 32 pages. Practices no longer trust bureaucrats. That trust has gone to pieces.” 

When specifically discussing a vision for Māori health, Dr Vause expresses a need for genuine equity of outcome, but advises that GPs need to understand what these outcomes are and how they differ depending on cultural elements. As an example, outcomes for Māori, who might put the value of whanau before their value of self, changes what Māori frame as success for themselves and their own personal health. “It comes back to community engagement. It’s critical. It’s the same with Pasifika and Asian patients – I found that I advantaged my Māori patients over my Asian patients, simply because I understood the outcomes for Māori. Building that into your practice is a huge challenge.” 

Community engagement is also at the heart of what Dr Vause sees as the biggest opportunity for GPs. “If the drivers are right and the support is there you can move practice into community engagement in a far more genuine manner.”

Although he may call himself cynical, Dr Vause celebrates the success of his work with the Health Workforce Advisory Committee, founding Te Akoranga a Māui and what he calls ‘making the soil right for the kūmara.’ “Some of the College’s achievements, like supporting an increase in the number of graduates who are Māori and therefore getting the number of Māori GPs up. I think that’s good. That’s probably my most successful thing – but it wasn’t my doing. I was just part of the wider effort.”

Dr Vause took an earlier than planned retirement two years ago when COVID-19 took a toll on the practice he was working in, deciding to step aside rather than lose a younger doctor to reduced hours. He says he’s enjoyed retirement so much he’s stuck with it. After recently undergoing cardiac surgery, Dr Vause is focused on rebuilding his physical strength through lots of exercise. And although he’s enjoying the slower pace of retirement, when asked if he misses his days at the practice he replies, “oh hell yeah.”