Kei nga taringa rahirahi o te motu rarau mai ki te whare korero o Te Hui. Ko Mihingarangi tenei e mihi atu nei, nau mai, tahuti mai ra. Welcome to The Hui, Maori current affairs for all New Zealanders. E taro ake nei. It's a crippling form of arthritis and Maori are three times more likely to suffer from it. It's like being electric shocked. It's easily treated, so why aren't Maori receiving the care they need? Historically, there is been this association with lifestyle, and I think that's so unfortunate and so wrong. We talk to Maori men living with the pain of gout. It affects your family. It affects you up here. Definitely up here. You feel useless. And groundbreaking artist Mr G opens up about his personal work to date, his upcoming exhibition 'Home'. I want people to feel the hearts of these portraits, you know, and just the love and honour I have for my parents. Captions were made with the support of NZ On Air. www.able.co.nz Copyright Able 2019 Karahuihui mai. It's an agonising condition, likened to having shards of glass in the joints. Gout is the second most common form of arthritis in New Zealand, and Maori and Pasifika are much more likely to be affected. For years, misconceptions have prevailed that gout is caused by lifestyle factors such as consuming too much kaimoana or alcohol. In fact, diet has no more than 10% influence on the uric acid that causes gout. But the stigma is preventing Maori from getting the care they need. John Boynton has this report. And a warning ` it includes medical images some may find distressing. As the mist lifts around Turangi, the town slowly wakes on a cold winter morning. Aaron Moeke helps to bring the town to life every morning as the local DJ at iwi radio station Tuwharetoa FM. (SPEAKS MAORI) Turangi is a predominantly Maori town and one where gout amongst Maori men is rising. ...this morning with Azza. Morena. Aaron knows the symptoms of gout all too well ` an arthritis which causes painful swelling in joints like the big toe, wrist and elbow and is triggered by high uric acid levels. Whatever part of your body you get gout in it, it just continuously throbs, and it's like being electric shocked continuously ` the slightest movement or whatever. And it's like glass. It's just` It's like literally walking on glass. However, it took him years to be properly diagnosed by doctors. My local GP at the time basically said, 'Well, look you're overweight, and here's some diclofenac. 'That'll fix it.' So basically I was fed up on that stuff for good maybe four, five years. And then we finally got a GP that said, 'Oh have you ever had the gout?' I was like, 'Well, no, because my last GP said I'm too young to have it.' Since receiving his diagnosis, Aaron is now seen by prescribing pharmacist Leanne Te Karu. Ah, kia ora, Aaron. Kia ora. For the last 20 years, Leanne's sought better treatment of gout in Aotearoa. Nice to see you. Yeah. How's things? And she says the myths around diet being the major contributing factor aren't true. We do know that there is this genetic variance in the way that Maori and Pacific Island people handle this thing called uric acid. We think that mai rano that was an advantage for our tupuna on the sailing journeys, you know, voyaging times, because uric acid lets you store salt and it lets you store kai, so, you know, that was an advantage all those years ago, but in 2019, it is not an advantage any more. Leanne works closely with Maori communities like Turangi across the country. Anywhere that you've got Maori and Pacific Island people, the prevalence of gout increases and increases significantly. And people don't realise that it's not really just about joints. It's about heart disease and kidney disease, and it's also about life expectancy. So it's a significant issue and one especially so for Maori. For Father of two Tairon Rikki, finding the motivation to overcome the pain is a daily struggle. He recalls the first time he experienced a gout attack as an 18-year old. I thought it was my boots. I thought they were too tight on my feet. Yeah, I went to sleep, it was pretty all right, and then I woke up, and it was there, and I thought` tried to put my boot on, but I couldn't. How would you describe the pain? It felt like heaps of glass stabbing into your foot. Any little movement, it's like someone pushing the glass right in. Got these. The 32-year-old lives on a cocktail of powerful pain killers to manage gout attacks across his body. Tramadol. Morphine. At times, living with the pain is unbearable. It affects family. It affects you up here. Definitely up here. You feel useless. You feel like you can't do anything. You know? And what's the point in life if you can't do anything? His gout became so bad, a mass of uric acid crystals built up on his big toe. After meeting with Leanne, he had surgery this year to remove the mass. So, was this before you had your surgery? Yeah. It was before I had my surgery. It was hard on the kids' mother. She had to cater to all my needs. Sometimes I couldn't even make it to the toilet. I had to go piss in a bowl. That was embarrassing. Why do you think doctors didn't take it as seriously ` something that is supposedly preventable like gout? The way I felt is that they didn't really care. It took this long to for me to get help. It took me to come to a little town to get help off a lady I didn't even know. She was only one that paid attention and actually, like, tried different ways instead of, like, just going... feeding me up on pills. Leanne Te Karu says instead of heavy pain killers to treat attacks, she wants to see doctors prescribing allopurinol, a drug that's been available for the last 50 years. We know lots about it. It's cheap as chips. There are some provisos in that it needs to be stated at a really low dose ` a dose that's right for a person's kidneys. Recent data from the Health Quality and Safety Commission shows Maori were less likely to receive allopurinol compared to Pakeha groups, despite being three times more likely to develop gout. Hohepa Solomon always knew there was a high chance he'd develop gout after seeing his dad suffer for years. This is despite him being fit, strong and training up to five times a week at his local ju-jitsu club. My sisters use to tease me from a young fulla, going, 'You're going to get the gout. You're going to get gout,' and, yeah, surely enough, I got the gout. Hohepa says it's difficult for Maori men to come forward because of the stigma attached to gout. A lot of our tane are quite whakama about it, they're shy about it, they don't want to say anything because of the whole sort of myth around it's an old-man thing, and it's because you drink too much beer and eat too much seafood. Hohepa developed a management plan with Leanne and even has his own special gout stretches for his ankle. It wasn't until she sort of gave me the cold hard facts ` I could be a vegan and still get gout. Seeing Maori men like Tairon suffer from a preventable condition is frustrating for Leanne. It is unacceptable at every level. It's shameful. You know, how have we not got to the stage where we're prescribing these medicines as we should be, that we're having conversations with people around exactly what gout is. Dr Rawiri Jansen works alongside Leanne to try and help clinicians to provide better plans for gout patients. However, he says there's still a way to go in Primary Health Care. Primary care has to change its delivery so that Maori and Pacific so get what they're entitled to ` good management of an important health condition. This is something we can manage. This is something that we can prevent. Now Aaron Moeke is on the right treatment plan, he's seeing the benefits for his health and whanau. I've had no major attacks for years now. And that's just based on the fact that I have my medication right and Leanne set me set me straight. And thanks to Leanne, Tairon Rikki now feels he can start to move beyond the pain of gout. She made me, like, have a bit of hope that I can get better. My mind's thinking, 'Yeah, maybe in two years' time, I'll be able to do something.' All I really want to do is work. I wanna go out, and I wanna go and work for my kids. Na John Boynton tera ripoata. Hei muri i nga whakatairanga ka matapakihia te ripoata a te Taraipunara o Waitangi mo te hauora o te Maori. The Waitangi Tribunal has released a damning report on inequity in the health care system, finding that Maori are being failed and recommending the establishment of an independent Maori Health Authority. The findings are no surprise to our panellists. They are claimant Lady Tureiti Moxon, managing director of Te Kohao Health, and health commentator and med student Emma Espiner. Tena korua. Kia ora. Kia ora. Just reflecting on that story earlier about gout, I guess ` Maori three times more likely to suffer from gout. Is that an example of health inequality? Absolutely, and I think` I really want to mihi to Leanne, because she's been talking about this stuff for a long time now. The evidence has been there for a long time, and there's been o significant action taken. So in 2016, she helped to co-author an article in the NZMA which talked about ` so the NZ Medical Journal ` which said 'Are we going to wait three more years for action on gout 'and do nothing?' And they have done nothing. Lady Tureiti, how is accessing primary healthcare, like some of the men in that story there, how is it different when you're Maori? Well, for a lot of Maori, they're not actually given the allopurinol straight up. What they're given is medications that actually help with the pain. So they're actually not dealing with the cause and the reason why this is happening. And the other thing too is that they're not being given the information in terms of education around what gout is, because everybody thinks it's connected to food and to alcohol when in actual fact, it's a hereditary thing; it's genetic. And we need people to understand that that's what it is and to deal with it early and deal with it aggressively, because it should never get to the stage where it's so uncontrolled that people actually live in huge pain, as was described earlier. I guess that's part of the problem, though, when you look at the doctor in that story who actually took some time to do some research. Is that the issue ` that we only have a few doctors who are thinking like that? Is it the medical staff as well ` the doctors, the nurses, the specialists? I think it's a perfect microcosm, really, of what's talked about in the Waitangi Tribunal Claim Report, because what you have is a` you know, one of the patients talked about his GP saying, 'Oh, you're too young to have gout.' And so the baseline there is a health system which is only looking at Pakeha ` so what's normal for Pakeha. And then a patient like this presents ` 'Oh, you can't possibly have gout because you're too young.' And so it goes untreated. And then what it turns into, 'Oh, Maori are getting gout younger. 'It must be their lifestyle choices.' And then that plays into the stigmatism around, 'I'm making bad choices. I'm doing this to myself.' And I'm sure that has flow-on effects to mental health as well. So it's this multifactorial thing, and it stems from a system that wasn't designed by us or for us. Lady Tureiti, what's your reaction to the report, the findings this week and the recommendations? Well, we're very happy with the report, and we're certainly pleased that the tribunal were courageous and brave around that, because it has been a difficult, long road. It's been a good 13 years that it's taken us to get to this point. And so we've been very pleased with the out come, and certainly the fact that it's brought together all the information and the research that's around Maori health. It's brought it all together into one place at one time, with all the experts that have actually said, 'We have not been getting these services when we should be getting these services, 'and it's time for that to change,' and that's been wonderful. And bold recommendations ` a Maori primary health provider. Mm. How would that work, Emma? I don't know, but I think what we've done hasn't worked, so... And to your point ` I mean, this is an incredible piece of work, and the people that have contributed to it are our best and brightest, so a rangatira of Maori health, and I just would love to see their attention diverted away from having to justify our continued right to exist and live healthy lives into building something that would work for us. So I think, you know, (CHUCKLES) we can't possibly do any worse. One of the findings in there was removing that idea of reducing disparities. Why has that not worked for us? Well, it hasn't worked for us, because we actually don't have control over the system that we're in. And as much as people have a, you know` feel that they're actually contributing to the health of our country and our people, they're actually not contributing a huge amount to Maori because I think that there are attitudes around that some people are just undeserving, some people are just not looking after themselves, are not losing weight, are not, you know` so there's a whole lot of negative connotations around Maori health. And yet, you know, all they want is somebody to say, 'This is what needs to happen to you. 'You need to go to see a specialist,' when they need to see a specialist, 'You need to have an X-ray when you need to have an X-ray or an ultrasound,' but they're not even getting that far. And in those hearings, were you hearing from examples of people who were not getting the care that they needed? Yeah, and I think` I mean, I'm working on a podcast at the moment for RNZ looking at Maori Health and equity, and this is a lot of the same sort of stuff that we're hearing. And also from clinicians and practitioners who are, you know, really burdened by trying to find new and different ways to say the same stuff. Because I absolutely agree that that report puts all of that information into one place and links it up as a coherent, historical narrative. So it's really undeniable what's go on. But it's not` none of it's new information. You know, all of us have known all these statistics for a long time, and yet no action has been taken. Just thinking about this idea of a Maori PHO, or provider, Sir Eddie Durie has said that, you know, almost like, 'Don't settle for the co-design,' because the co-design doesn't work because that's just DHBs coming out with an idea, and then going to Maori to comment. Does it have to be independent? Well, from our perspective, we want to design it and be a big part of designing it in our own way, based on our own tikanga, based on our own world view, and not be as it's always been ` you know, you're called in at the last minute to comment. Well, we're over comment. Let's just get on with the job and let us do it ourselves, because that's what this is all about. It's about our on rangatiratanga and our expression of rangitiratanga and Maori mana motuhake. And if we can get this right, do you feel like, you know, all of those other issues will fold into them ` the Oranga Tamariki issues, the housing issues, the homelessness? Well, because it's so political, Maori health is so political and Maori housing's political, everything is so political, so one government has a bright idea ` 'We're going this way.' Then the next government has another bright idea ` 'We're not gonna do any of that.' And so we're actually always` So it needs to be legislated. So it needs to be legislated, and it certainly needs to be... Maori need to be leading it. Maori need to be at the forefront of it so that we can design it and do it in our own way. We can't carry on the way that we've been doing. Any response so far from the government? Not yet. What are you hoping? (CHUCKLES SOFTLY) Well, I think` and to your point about leadership is really important, and I work in public health as well, and so you see this all the time ` being called to comment, putting the brown tick on things. It has moved a little bit, but what you see is that you make small gains, and then that becomes the new baseline, and it regresses back to that. So unless you are really explicit about this goal over here, the system will always come back to this point, because it's not run by us, and so, you know, we can't opt out of looking for equity. This is our whanau and these are our mokopunas. It's about being a good ancestor and things like that, so we have to be leading that to push it forward to where we want to go. Tena korua. Looking forward to seeing what the response is and where the next move is. Kia ora ra. Kia mau tonu mai ra te titiro, he hakari ma nga karu e whai ake nei. Auraki mai ano. Graham Hoete, aka Mr G, has made his mark around the world, from Sydney to Scotland, but his latest project has brought him home to his beloved papakainga. Mr G invited reporter Ruwani Perera to see the inspiration behind his latest exhibition, his proudest work to date. His art is in your face and seen on buildings all over the world,... but for artist Graham Hoete, better known as Mr G, there's no place like home. The thing is over here, the lifestyle is very simple. It's a different kind of wealth here. He's re-discovering his roots for his most personal work to date. Is this a legacy project for you? Yeah, I guess so. It's an opportunity for me to create, I guess, my most meaningful and my best work, really. 40-year-old artist Graham Hoete is bound for Matakana Island. It's a barge ride across a sandbar from Tauranga. I always love coming here. It's a privilege for me to be connected to a place like this. It's one of two islands he whakapapas back to. And through his art, he wants to tell the stories of the people and the places where he comes from. On my Matakana side, I immediately thought of my nan and koro and the memories I have of them and their connection to the moutere as well. The inspiration for his latest assignment began here on Matakana, at this old corrugated iron shed on his grandparents' papakainga. I just wanted to use my art to honour them and being able to paint a portrait of them on one of the old sheds, on their own homestead ` again, that just kind of reeks connection. The shed is being taken down and transported to Tauranga Art gallery for Graham's first solo art exhibition in November, called 'Home'. I've named the theme of my show 'Home', and I'm excited to be sharing it with you all at the end of this year. Can't wait to see you all there. Nga mihi. While he's always celebrated his Ngai Te Rangi and Ngati Awa heritage, recently, Graham's been delving deeper into his Scottish whakapapa. My great-great-great-grandfather, John Alfred Murray Bordell, he came over to Aotearoa in the 1840s, and he married Katarina Te Kuni, and that's pretty much where all the Murray side comes from. Graham travelled to Scotland last year to visit the hometown of his tupuna. Just arrived in Moffat. It's two hours out from Edinburgh. And true to form, he was determined to honour his tupuna there the best way he knows how. I managed to paint a portrait of him there. It was the first mural ever painted in the town of Moffat as well, cos it's all historic buildings, but it was hugely well received over there. Mr G carefully handpicks every art assignment, always keen to experiment with ideas. Yeah, I guess I'm not afraid to give things a crack, you know, and I've always kind of believed nothing ventured, nothing gained, so you'll never know if you don't give something a go. And that's what he did almost eight years ago, relocating across the Tasman to pursue his career. When I was in Sydney, for the first time, I went through depression. I went through a whole series of relationship breakdowns and disappointments and a whole lot of stuff, really. In Sydney, it's very fast-paced and everyone is highly strung, just pursuing things that, you know, I guess... a lot of things that don't really matter in life. So two years ago, he came back home, to the other special island in his life ` Motiti, his turangawaewae. The very first thing I done when I landed back in Aotearoa was come straight to the island, and me and my mum went diving and got a fresh feed of kina and paua, and when I had that first paua down on the beach, just had a bit of a tangi, you know, cos I felt like I'd reconnected back with home. The simplicity of the lifestyle here kind of really helps just balance things out a bit, sets the priorities straight again. His connection here runs deep. I heard a good saying about 'How do you define the word "home"?' And it's 'Where do you want to be buried?' And, yeah, this is definitely the place for me, here on Motiti Island. It's where my sister was buried. Yeah, this is home for me. Around 60 people live on this tiny, rugged slice of paradise, including his parents who moved here 30 years ago. Dad. Hey, Mum. Kia ora, Graham. Aww. Nice to see you. All through his parents' property are some of his earliest artworks that they've proudly preserved. These are all Graham's? Yeah, yeah. These are all his paintings around here. Come around here. That's my great tipuna Himiona Tearonui. Oh, wow. And when did Graham do this? Oh, a few years back now, and he couldn't get it on a plane; he had to come over on the barge. He's always been an artist. As he grew older, especially when he got into college, the teacher saw that he had some talent in him, so he sort of carried on from there, more or less. It's Graham's folks, the most influential people in his life, who will be the main focus of his 'Home' project. Graham says it is his most important work that he's ever done. Oh, I'd say it would be. It would be his most important work. I think a lot of people are looking forward to it ` all Graham's family here, and my family. You know, they're looking forward to seeing his exhibition, and it's good too, because being in Tauranga, we have lots of whanau here in Tauranga, so it'll be a real eye-opener for a lot of them. This is where he creates his magic ` in his garage studio at home in Papamoa. Work's already started on this stunning spray-painted depiction of his father. I want people to feel the heart of these portraits, and the love and the honour I have for my parents. Mr G extending his talents beyond spray paint, turning his hand to whakairo that will frame his father's artwork. The portrait of Dad ` I'm not just painting a photo-realistic portrait of him. I'm also incorporating other aesthetic techniques as well that are gonna portray and tell his story and his connection to his tipuna, and to Motiti and to Tametea ki te Huatahi, which is his whare tipuna. He'll shortly begin work on his mum's image next. You're humble people, Kathy. What is it going to be like seeing your face up there on his artwork? It's gonna blow me away. I haven't seen the one of me yet, but every time I see the one of his Dad ` like he did one at a building at the Mount ` and every time I saw it, it made me want to cry, because it was so real. So I'll probably be the same with these ones. (LAUGHS) Mr G's mahi a powerful reminder that home is where his heart is. I make an exerted effort to make time and create moments with my parents. They're not here forever, so I cherish those moments with them, and I tell Mum and Dad that I love them while I have the opportunity to do that. What do you want the general public to take away from your exhibition? I want people to feel that sense of home and maybe encourage them to revisit their connections to their people and to their homeland as well. Ka pai. Na Ruwani Perera tera korero. Kua hikina te hui mo tenei ra. Pai marire ki a tatou katoa. Captions were made with the support of NZ On Air. www.able.co.nz Copyright Able 2019 ALL: He mea tautoko na Te Mangai Paho. The Hui is made with support from NZ On Air.