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Medical School Admissions - A Maori Medical Student's Perspective

Quis custodiet ipsos custodes?

Juvenal from Satires (Satire VI, lines 347–348)

In the news recently we have been hearing about Otago university’s “discussion” of the Mirror on Society policy. The Dean of the Medical School and the Pro-Vice Chancellor of Health Sciences have put forward a paper regarding the university’s Mirror On Society policy and they will not release the contents of the document, a decision no doubt based on University policy. I am writing this necessarily anonymously as I am a current Māori medical student at the University of Otago.

One of the discussion points of this elusive document is that of putting a cap on the numbers of Māori (56) and Pasifika (20) students that can enter the highly competitive medical professional program through targeted pathways. Programs such as these have been proven to be effective not just here in New Zealand but overseas also. It would seem that the program is a victim of it’s own success, as the number of Māori and Pasifika students have increased dramatically since it’s inception, and further categories to address other areas of concern in our health system have been added, Refugee, Rural and Socioeconomic. In fact, the Pro-Vice Chancellor said as much himself this morning.

Systemic racism is the way that a system that favours one ethnicity over another. Without these pathways, the system favours privileged Pākehā New Zealanders. I understand this statement might cause bristling and outrage but bear with me. Privileged Pākehā New Zealanders are more likely to be accepted into medical school than any of these equity groups, purely based on the way our society is set up. We have all heard the deficit-based statistics on the TV. Māori are more likely to be incarcerated, live in poverty, have inadequate housing, and suffer from worse health outcomes. The invisibility of privilege means that when we see these statistics, we don’t always realise that for disadvantage to exist, someone must be more advantaged. As a population, Pākehā New Zealanders are less likely to be incarcerated, be of higher socioeconomic status, have more adequate housing, and better health outcomes. In the context of becoming a doctor, these students are more likely to have been able to study in a warm dry house, at a well-resourced school, access to extra tutoring, preparation programs for medicine application, and the list goes on.

This is in no way an attack on Pākehā individually. The Pākehā students that I study with are absolutely delightful. They are smart, driven, and on the whole, really nice people. I would say that most are aware of the need for an equity based approach for selection to medical school. A recent government report has shown that we still remain far from having equity in the health workforce or health outcomes for Māori and other disadvantaged groups. Pākehā New Zealanders are no more individually responsible for being wealthier, better resourced, or having better health outcomes than individual Māori are for the reverse. The problem is actions that prop up an inherently racist system, like how the criteria for employment in the decision making jobs are valued.

Racism is an active process and so anti-racism must be also. Therefore, in the interest of shining further light on the invisible, let me draw your attention to a couple of facts. The authors of the aforementioned paper were Professor Paul Brunton and Rathan Subramaniam. Professor Paul Brunton, the Pro-Vice Chancellor of Health Sciences at Otago University emigrated to New Zealand in 2015. Only 5 years ago, when he took up the Dean of the Faculty of Dentistry position and then became Pro-Vice Chancellor of the Health Sciences in 2018. Rathan Subramaniam, the current Dean of the Otago Medical has come from his previous position in the United States to take up the Medical School job in 2019.

Before the cries of “reverse racism” or xenophobia come streaming in, I want to make something clear. There is no personal grudge against these people, in fact, I am sure they are highly capable of their roles in a technical sense. The question is one of systemic bias. Why are we hiring people with little to no knowledge of the New Zealand specific context within which they must operate? Why is this not a key hiring principle? I don’t mean superficial talk about honouring Te Tiriti principles, and encouraging minority participation in the health workforce. The skills and knowledge required of these positions include a thorough understanding of the rights of Māori and history of colonisation. That this has even been put on the table to “discuss” is a symptom of the inability of those put in positions of power to see the invisible privilege they are trying to preserve. This makes them unacceptably ill-equipped to hold these powerful positions.

Imagine the modern-day uproar if the university was to “discuss” the number of women who are allowed entry to the medical school program. These exact debates were had in 1891 in fact, and yet they would be completely unacceptable today, if not laughable. Equity for women is still far from achieved, but we aren’t restricting the numbers of women, even though the majority of medical students are now women. According to the Medical Council of New Zealand in 2018, 45.8% of women were registered as doctors, yet as a percentage of overall population women make up 50.84%. It is unacceptable to put forward a paper suggesting that we cap the number of women allowed entry into medical school, because our society has partially removed the barriers for women to succeed at education prior to applying to medical school. Until we do that for the groups that the equity pathways target, we need the unrestricted equity pathways to help even the playing field.

As a nation, we are becoming more and more aware of the inherent racist structures that we have in place. Other new articles in the last few weeks have included Māori teachers at Waikato University discussing systemic racism that they are experiencing in the selection and retention of staff, and the blindness of the university management to the successes of Māori within their organisation. Those aforementioned lovely fellow students wring their hands and ask, “what can we do to help?”. Perhaps after reading this very brief explanation of an area many of my teachers and mentors have spent their life dedicated to mastering, you too are wanting to know what you can do.

You can help by actively fighting those who are trying to reverse progress for Māori and other minority groups. Racism is an active process, and one that favours the invisible majority. We need to talk about the other, invisible side of privilege. If someone is being disadvantaged, there is someone who has an advantage. We have enough privileged Pākehā doctors. There isn’t a maximum level of equity that once reached is enough. Equity means equal outcomes, and until we reach that point, we need to actively stop any racist “discussion”.

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