David Tipene-Leach: the doctor with a prescription for change
"I never really wanted to help people," laughs David Tipene-Leach.
It's an intriguing admission from a health professional and researcher whose work is behind a significant reduction in sudden unexpected death in infancy (SUDI) among Maori.
"I grew up in the 1960s and 70s, a time when we were all rapidly becoming aware there was something sticky going on in this country, and that Maori were not getting a fair deal," the 61-year-old explains.
"We didn't have a grapple on it but we were beginning to get that feeling and early people were beginning to talk about those things. So rather than wanting to go and help people you wanted to go and make change.
He cannot recall when a profession of doctor occurred to him, "although I think I wrote in my [university] application I wanted to be a doctor because it was a powerful position in the community to make change".
Four decades on, this change agent's "best piece of work" has been to develop and champion the wahakura, a woven flax bassinet that allows Maori mums to share a bed safely with their newborns.
The "safe sleep" programme that has flourished around the wahakura – and a plastic version, the pepi-pod – is credited with decreasing SUDI deaths by 30 per cent in just six years.
Tipene-Leach's "mixed career" has included academic postings and front-line general practice roles at Maori health centres.
Last month he was appointed Professor of Maori and Indigenous Research at Hawke's Bay's Eastern Institute of Technology.
He previously spent 14 years as a senior lecturer in Maori health at Auckland University but joins EIT after 10 years at a Maori health centre in Hastings.
Tipene-Leach was running another health centre in Gisborne in 2006 when the wahakura initiative was launched with 88 of the bassinets and a group of Maori midwives charged with distributing them around the district.
"[The wahakura] created a focus for the midwives to engage with a group of mums," he explains.
"Suddenly you have this flax thing in the middle of the room which evokes these responses like, gosh, this person [the midwife] isn't going to talk about my health, they're going to talk about something that comes from my culture, my history, something that might give me some clues and might make me feel better. And it might make my baby safe," he says.
"It's having an intervention that grabs you and gives you some energy for beginning to make change that wasn't there before."
Gaining acceptance for the wahakura hasn't been easy but Tipene-Leach has been supported in his mission by his partner and long-time academic collaborator, Dr Sally Abel, an Otago University health researcher.
In the early stages the couple's wahakura pitch was essentially "recommending exactly the opposite of what the rest of the world was recommending", he says.
"The rest of the world was recommending don't bed-share and we were saying here is a way that you can bed-share, and do it reasonably safely."
Scepticism about the wahakura and pepi-pod has been chipped away through academic studies and papers that he, Abel and others have produced over the past decade – including the latest study which found the bassinets have reduced infant mortality by 30 per cent in the past six years.
With SUDI deaths previously as high as 80 a year, that means several hundred young lives have been saved over the past decade, Tipene-Leach says.
"This is huge. If this was an immunisation it would be a billion-dollar product. If anything else had dropped infant mortality by 30 per cent across the country you would think somebody's career would have been made, all that sort of stuff.
"In this case – and this is a little bit cynical – it's Maori babies that are no longer dying; they come from [the likes of low-socioeconomic Hastings suburbs] Flaxmere and Camberley and frankly I don't think anyone gives a toss. If they were babies from Glendowie and Remuera who were no longer dying there would be huge philanthropic money that came in and said, God, here's $3 million, let's get this thing started."
As late as last year, government health officials blocked public funding for the bassinets, saying there wasn't enough evidence they saved lives. But they were over-ruled in August by Health Minister Jonathan Coleman, who promised an urgent national rollout.
The son of teachers, Tipene-Leach lived in several places growing up, including in Malaya during the Malayan Emergency.
His secondary schooling was in Taranaki, until his final year, which was spent at Auckland's Wesley College.
But home has always been the small settlement of Porangahau, in southern Hawke's Bay, where he would spend every Christmas holidays at his grandparents' place.
During his final year of medical training at Auckland University, Tipene-Leach spent time working for Australia's aboriginal medical services.
When a groundbreaking national Maori health hui, Hui Whakaoranga, was held in Auckland in 1984, he recalls championing the idea that Maori should run and own their own health services, and being told it was impossible.
Tipene-Leach began his career as a GP serving small, Maori-dominated communities in the Eastern Bay of Plenty.
"The first one was my own [practice]. It didn't work. It went broke because I had these funny ideas about how healthcare should be free but unfortunately I couldn't pay my bills with puha and pork bones. I got a lot of those."
He paints a grim picture of what GPs face on the "frontline" of Maori health. "What you see is multiple co-morbid patients with low levels of health literacy who have come from deprived socio-economic circumstances and who don't have many options. So they are pretty sick, with not many places to go."
And while it's "a terrible thing to say", he believes many doctors working in these environments are overwhelmed by the workload, becoming "so busy they don't have time for their patients".
"These are very high-needs communities and very sick communities, so you've got to be a very good doctor to work in these communities."
Tipene-Leach says there is more work to be done championing the wahakura in his new role at EIT. It will also allow him time to work on other Maori health initiatives, including treating pre-diabetes.
"This is an opportunity to be able to participate in those projects as opposed to seeing patients every day."
Less helping people, more effecting change.