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The New Zealand Medical Association, Holy Trinity Cathedral

Issue date: 
Sunday, 17 May 1987
The Hon and the Rt Rev Sir Paul Reeves, GCMG, GCVO, QSO

It was in this Cathedral that in September 1985 I said farewell to the Diocese of Auckland. I had been a Bishop for 14 years, 8 as Bishop of Waiapu, 6 as Bishop of Auckland. I had also been a priest since my ordination in 1960.

I am still a priest and a Bishop and I try to express these indelible realities, not in an ecclesiastical context, but in a context which is as wide and varied as the country and peoples I seek to serve as Governor-General.

Within this context I recognise goodness and sacrificial action for what they are: costly things which people do for others. I don't ask people for their credentials. "By their fruits you shall know them" is still sound advice. I am not primarily concerned with why people should be as they are or act as they do. Often I see goodness and sacrifice arising out of ambivalent situations as qualities arising out of people who may have broken the rules or fallen below the so-called standards which society has established.

For me the visible church is the small group of people who gather each week when I celebrate the Eucharist, who offer me a support which I also feel when I meet with other groups in other places. Those other groups may not be overtly religious, let alone ecclesiastical. I believe in the Church but I see that the Church in whatever form you find it is struggling to be a picture or sign in the world of how things could be. Baptism, our second birth, reinforces and underscores the significance of our natural birth into this world of space and time.

Judged by its own claims, the visible Church is a failure. It is a scarred body. Yet at its poor best, the Church is struggling to plant peace where others fight, or to love where others hate. Conversely, when the Church sees peace and love, it seeks to join them.

I am becoming conscious of what I call the transparency of doctrine. Jesus said: "He who has seen me has seen the Father." In a similar way we must see through and look beyond our particular viewpoints and affirm not our own interest group or our own traditions but the complex and rich world of which we are all a part. In theological terms, any doctrine of redemption or the redeemed community must reinforce our basic commitment to creation and all that it may have to offer.

It is something which any professional group must do. The world does not exist so that there can be doctors, lawyers, teachers or clergy. But doctors may exist so that there can be a better and more healthy world.

So the important thing on an occasion such as this is to talk about health, care, well-being, security and the people who provide these within our society. Just as the Church has not cornered the market on goodness and sacrificial action, so members of the medical profession are not the only healers or health givers in the community.

Increasingly doctors will have to forge partnerships with people who do things they cannot do: counsellors, dieticians, exercise instructors, community psychologists, family lawyers, crisis services of all sorts. Let me illustrate that. In his book "Eruera, (the Teaching of a Māori Elder)", Eruera Stirling describes the following incident:

"Not long after that same doctor rang me again and asked me to see another sick person, and I said to him "Hah Doctor! You ring me for all your worst cases!" "No, Mr Stirling, I think you're the only one that can deal with this." Well, I went to that chap's place and when I came up the path to his house I could hear him crashing and banging and rattling inside the house, he was moving around from one room to the next. I knocked on the door and nobody answered, but when I called out, the wife heard my voice and she came to open the door. "Quick, Mr Stirling, come in - I'm frightened!" I walked in and the next moment her husband jumped on me, cursing and crying out, "Don't kill me! Don't kill me!" I stood there and listened, and as soon as I heard his voice I knew it was a spirit talking. He said, "Hey, what are you doing here? Are you coming to kill me? Don't kill me! Don't kill me! The man was jumping around and I knew I had to do something, so I asked the wife to bring me a bowl of water and I blessed it, and started to sprinkle it all around the house. The spirit began to cry right then and he said to me, "Give me back my adze, that's all - it doesn't belong to them. Don't kill me! Just give me back my adze!" I began to pray, and as I held my service the spirit settled down, and in the finish the man came back into his right mind. I told his wife, "Now, go and bring me that adze." She went into the bedroom and came back carrying a beautiful greenstone adze that her husband had found somewhere in Whanganui, he's picked it up and brought it home. I rubbed the adze and blessed it and then I said to her, "I want you to get in touch with some people from Whanganui and ask them to come here and take this adze away - it belongs to their ancestors, not to your husband!" A few days later she rang and told me that the Whanganui people had taken the stone adze away, and from that time on her husband started to get better. She thanked me but I told her, "Don't thank me, my dear, it was Almighty God who saved you."

It's worth noting that the Director General of Health in a recent memorandum entitled "Treaty of Waitangi and Māori Health" said:

"Concepts of health are firmly based in Māori Culture (which, according to the Treaty, has a right to official recognition and protection) and Māori people have a right to appropriate services - funded through our health system."

Dr Salmond urged the inclusion of traditionally competent Māori people in professional health teams.

Here is another example of a Māori elder who was mis-diagnosed at a psychiatric hospital because the staff lacked the cultural awareness to understand him. The man had gone to visit his son for the weekend. His son, who was married to a Pakeha had gone off pig-hunting and because this man was a priest, he was praying the whole time for the safe return of his son. He was saying his prayers the whole time and the daughter-in-law got scared. The doctors came and took him away. A Māori nurse came on duty and found the man in a straightjacket. She saw on his chart he was down as psychotic, hallucinating. He had been offered plates of food in his room which had a toilet in it. This was against his spiritual belief and he had thrown the food back at the staff. When he saw the nurse, he talked to her in Māori saying he did not know why he was in hospital. When he was talking and praying they had thought he was hallucinating.

I hope there was a happy ending to that story. What you should be aware of is Māori people want to be seen, not as a minority but as the people of the land, the Tangata Whenua who in 1840 entered into a partnership with the Crown.

Such a recognition will mean all carers and health givers will need to be as sensitive as Māori Culture as they are to their own, and their own training and qualifications may need to be expanded.

Such a recognition will mean all carers and health givers will need to be as sensitive to Māori culture as they are to their own, and their own training and qualifications may need to be expanded.

This raises great questions of equity, social justice or just getting a fair go. Maoris certainly are looking for a more equitable sharing of resources. But, as Alan Williams, Professor of Economics at the University of York explained, to establish priorities within a health system means asking who gets what at whose expense? I am the Patron of the AIDS Foundation and I know the cost of a campaign to respond to the urgent danger of AIDS means the other claimants on the health vote to go back one pace. The number of psychiatric patients and intellectually handicapped people in hospitals may have halved in the past 20 years but organisations such as the Schizophrenia Association or the Richmond Fellowship which are seeking to care for these people in the Community, are inadequately funded and woefully understaffed. An editorial in the "Dominion" concluded that "The money saved by reducing institutional care is not being put back into the community so that these people can be adequately cared for in more appropriate surroundings."

My understanding is that many of these voluntary agencies could disappear in the next year or so. Corporate and private sponsorship is a fiercely competitive field and some of the agencies are going to run out of money.

For a growing number of women, the situation is equally desperate. They have lost faith in the Health Services. Women's Health Groups seek to show women their health is their responsibility and if they have the information, then they can make decisions about it. These groups seek not to treat but to inform, support and direct women to existing health services. But it is the familiar feature of under-funded voluntary organisations which increasingly feel frustrated and powerless in the face of their problems.

I am conscious that I have spoken about the health of the Community in very broad terms and have said very little about the medical profession. However, the starting point for me were some words of Lord Porritt, when he delivered the first memorial oration to the New Zealand Medical Association in 1950. He said "A life without health is less than half a life; a nation without health is at best second best; an empire without health is on the way out. The future of medicine undoubtedly lies not in curing disease but in maintaining health."

My point is there are people in this nation who lack the resources to maintain health. There are also identifiable groups whose health is at risk. A report commissioned by the Medical Research Council has shown New Zealand's performance in reducing infant mortality has declined significantly in the past 10 years. A report by the New Zealand Board of Health says the health needs of adolescents have been largely ignored. Their biggest problems lie in mental health. Cervical cancer cases have increased dramatically, to what some call 'epidemic proportions'.

However, we must beware lest we construct a load too heavy for the individual medical practitioner to carry. I suspect that many doctors feel powerless about issues of inadequate resources and ill health on a national scale. In the face of cosmic issues, most of us define the patch we can manage and work within it.

Commonsense is not a commonplace virtue, but I have come to expect a certain commonsense from doctors which enables them to cope with the imponderables. G. E. Waterworth was a General Practitioner in Napier and towards the end of his career, he wrote a book "One Man in his Time". He was in Napier during the 1931 earthquake and was called to the ruined Cathedral where Mrs Edith Barry was trapped. She could not be freed and with fire approaching, Dr Waterworth injected an overdose of morphine into her scalp. "Was I right?", he asked. Of course he was and every time I see the plaque to Mrs Barry in the new Saint John's Cathedral, Napier, I thank God for the Doctor who helped her in her time of need.

In Maurice Shadbolt's book "Season of the Jew", the events are seen through the eyes of George Fairweather, sometime Imperial Officer, sometime itinerant artist. To one of his officers he says: "If we accept what we are, Herrick, we make no arrangement with what we might be." Those words encouraged me to look at the Hippocratic Oath which states the fundamental principles of behaviour of a medical practitioner. It is a noble statement of intention from which I have lifted the words "With purity and with holiness I will pass my life and practice my Art." I want to develop that theme.

I cannot tell Doctors how to be better Doctors but I can say that if we spent as much time on the search for compassion as we do on the search for perfection, we would be better equipped to face the enormous and complicated issues that beset us.

Compassion is not pity. It is not feeling sorry for someone, nor is it a pre-occupation with pain. Compassion, from the Latin cum patio, means to suffer with. Its spirit is expressed in the German proverb: "A sorrow shared is a sorrow halved; joy shared is a joy doubled."

In the Bible, the word for compassion is used as a verb rather than a noun. Compassion is about doing and relieving the pain of others. Compassion leads to feeding, clothing, sheltering, educating, comforting, and so on. There is nothing sentimental about compassion.

In the Biblical tradition, all experience of God leads to a creative and rich compassion towards one's neighbour. Being alone with your Maker is not a Biblical ideal.

I don't know how you can make the capacity for compassion a pre-requisite for entry into Medical School. It is one of those indefinable things, hard to measure but without which a doctor becomes a technician. And, according to the Hippocratic Oath, the practice of medicine is not a technique but an art. It is also a privilege and the source of great satisfaction to those who espouse it.

Privileges carry their responsibilities and these responsibilities can be onerous. May God help you find the strength to be the very best doctors you can be.

Last updated: 
Sunday, 17 May 1987

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