Plunket takes on its history, and future, to be 'a better Treaty partner'

Friday, 27 August 2021

Last year, Whānau Awhina Plunket set out on a mission to distance itself from its founder, Sir Truby King, widely regarded as a white supremacist. But some say the reimagining won’t work. CATE BROUGHTON investigates.

This story is featured on Stuff’s The Long Read podcast. Check it out by hitting the play button below, or find it on podcast apps like Apple Podcasts, Spotify or Google Podcasts.

In 1906, Hera Ellison* gave birth to her last baby boy, Thomas Rangiwahia Mutu Ellison, known in the whānau as Mutu (last born).

But Hera, who had already given birth to at least seven children, had trouble breastfeeding him. She had lost a baby a year earlier, so this time two women – Mere Harper and Ria Tikini – stepped in.

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Both were known as midwives and healers in the village of Karitāne, on the Otago coast. Harper was a neighbour of Dr Truby King, the medical superintendent of the nearby Seacliff Lunatic Asylum.

The pair took baby Thomas to King and asked him to help. King and his wife, Bella, took the child in. He thrived under their care and, months later, was returned to his whānau.

This work by King with Mutu, and other infants, would form his greatest legacy.

By 1907, he and his wife had taken in 13 emaciated babies and transformed them back to full health, with the use of formula and King’s regimented programme of feeding, sleeping and excreting “by the clock”.

The same year, a new society was established, driven by King and supported by a host of influential women, dedicated to the wellbeing of mothers and their newborns.

It took its name from one of King’s wealthy benefactors – Lady Victoria Plunket.

Over the next century, the Plunket Society became an established part not just of early childhood care, but the wider New Zealand culture as well.

King’s system of “mothercraft” was credited with dramatically reducing infant mortality rates in the first half of the twentieth century.

Plunket became synonymous with motherhood, childhood, and life itself. If you were born in New Zealand in the last hundred years, there is a good chance that you and most of the people you know were “Plunket babies”.

But the success hid a darker truth. Plunket was a product of colonial, white New Zealand and its beneficiaries were overwhelmingly Pākehā mothers and babies.

Many of the celebrated statistics around reduced infant mortality didn’t even count Māori infants.

Successive governments, while supporting Plunket as a quasi-state institution, marginalised Māori mothers, babies and whānau through legislation.

The Infants Act 1908, and the Native Land Act 1909 ended the practice of whāinga-ū (breastfeeding another whānau member’s child) and the new Native Health Nursing Service, woefully under-resourced compared to Plunket, entrenched well child services along racial lines.

And at the heart of it was King, whose theories on motherhood and childcare were based on a profoundly racist ideology. In the years after Plunket was formed, King wrote and spoke extensively about his desire to strengthen and protect “the race”.

In one speech he railed against the “danger of racial degeneracy as civilisation weakened women's instincts and removed men from the hardy virtues of a natural life”.

In a 1917 article in the Otago Witness he warned that, with the loss of so many of its “strongest bravest and most spirited…men” in World War I, the white race was in danger of exterminating itself, and needed to “redouble our attention to Motherhood and Mothercraft”.

“The most fundamental factor of Racial Efficiency,” King wrote, “[is] the ensuring of strong, healthy mothers who will nurse their babies in their own homes.”

King’s motivations were laid bare in a 1981 article in the New Zealand Journal of History – Truby King and the Plunket Society, by the historian Erik Olssen.

For decades, the awful truth was an open, if not widely-known secret.

Thomas Mutu Ellison, who King cared for back in 1906, “worshipped” King for saving his life, according to his son, David.

Before he died in 1986, Mutu asked David to “get the history corrected”, but even then he was more concerned that pioneers like Mere Harper and Ria Tikini were absent from Plunket’s origin story than any wider whitewashing of the society’s history.

But the further Plunket got from its past, the larger it loomed.

King’s racism, and Plunket’s legacy of segregated child care in New Zealand, was inescapable.

More than a century after its birth, the society set about acknowledging its history and realigning its future.

That included resurrecting the story of Harper and Tikini and baby Mutu as a parable of bicultural harmony.

It’s one thing for an organisation to confront the racism of a founding father; another to have that racism guide its evolution over the next century.

At least one critic believes Plunket is hopelessly compromised: “They are trying to recycle a white supremacist organisation… [they should] close it up and put it into something better.”

A new story

Last year, a statement on Plunket’s website about its founder, Sir Truby King, was amended: “[He] played an important role in the founding of Plunket, however, he also held a number of views on eugenics, race, and women’s roles, which Whānau Āwhina Plunket fully rejects.”

“We acknowledge that our own whakapapa includes a legacy which has caused harm to whānau Māori and apologise for their influence on some early Plunket policies and processes, and any harm these caused.”

The acknowledgement was driven by current Plunket chief executive Amanda Malu. King’s view, she said, was “very much a white supremacist view… he believed in that notion of a master race”.

But there is more to Plunket than its founder’s deeply troubling ideology, she says. The story of Thomas Ellison’s care by King, Harper and Tikini is “a classic example of a bicultural community, family, and professional partnership”.

“Biculturalism is in our DNA, it was a bicultural practice, if you look at the players, Mere, Ria and him, they were working in a bicultural way, and he went on to set up the Karitane centre, and they worked there, and I think there was a level of mutual respect there.”

Still, King’s racism had caused harm to Māori over the years. Outcomes for Māori and Pasifika whānau remained significantly lower than for other ethnic groups.

Since 2019, Malu has set about making Māori and Pasifika whānau, pepi and tamariki a top priority for the organisation, but why were things allowed to be so wrong for so long?

Malu says over the decades local Pākehā communities rallied and fundraised to support the much-loved service provided by Plunket nurses. This meant the service wasn’t culturally sensitive to non-Europeans.

A recent damning review of the Well Child Tamariki Ora (WCTO) programme – of which Whānau Awhina Plunket is the largest provider – by the Ministry of Health found it had failed to deliver care to Māori, Pasifika, disabled and state care children and their whānau.

The WCTO programme is a series of scheduled visits by child health nurses to screen and monitor babies and children up to 4 years old, to provide health education, support and referrals where needed.

Whānau Awhina Plunket’s contract is for about 85 per cent of the population. The rest is delivered by about 60 Māori, Pacific and public health non-government organisations.

The proportion of Māori, Pacific and families living in high deprivation areas accessing Plunket’s service was 79, 83 and 82 per cent respectively in 2019-20.

This compared to 91 per cent for European Kiwis.

Only between 59 and 66 per cent of people in those three groups – Māori, Pacific and families in high deprivation areas – received all their visits in the first year of life, compared to 75 per cent of non-Māori.

Malu says Whānau Awhina Plunket needs to take some responsibility for the inequities.

“We had such promising beginnings with a beautiful bicultural story and then between then and now the organisation really did, somehow, lose its way.

“Thousands of women throughout New Zealand have fundraised and marched … but to be really honest they were, mostly, Pākehā women.”

Malu acknowledges government funding has favoured Whānau Awhina Plunket over others providing kaupapa Māori services. The Ministry of Health review confirmed this.

Whānau Awhina Plunket has set itself a goal of achieving equity by 2025. It has redesigned its logo and website and made a 12-hour online course “Being a Better Treaty Partner” a requirement for its 1100 staff. Three Kaiārahi Māori (Māori capability advisors) were recruited last year to increase “cultural responsiveness”.

During the nationwide Covid-19 lockdown last year, when home visits were not possible, the organisation identified whānau with the greatest need and provided remote support.

In partnership with Ngāi Tahu, Whānau Awhina Plunket has set up a $3000 memorial Mere Harper and Ria Tikini nursing scholarship for Ngāi Tahu descendants.

In June, the organisation took 89 clinical leaders to the Puketeraki Marae in Karitāne to confront its past and, Malu says, “so it can authentically commit to an equitable future”.

David Ellison, upoko for the marae, said the event was a “wonderful experience” and the marae had “adopted” the organisation.

“It’s really marvellous what’s happened.”

Ellison dismissed King’s views as outdated and irrelevant.

“Those were the thoughts of the day, that was the way things were in those days, but we’re doing things differently now.”

Plunket ‘not fit for purpose’, should be scrapped

But at least one expert in the Māori health sector is not convinced of Whānau Awhina Plunket’s capacity for change.

National Hauora Coalition clinical director and leader for service design and development Dr Rawiri Jansen has called for the organisation to be defunded and disestablished.

“I think they are trying to recycle a white supremacist organisation and I don’t support it,” he says.

“They are not fit for purpose. They are not fit for our Aotearoa health system going forward. They are not fit to be a part of it because of their origin story. Because of their history of under-serving and, in fact, harming Māori and Pacific populations.”

Jansen met some members of the Plunket board in March last year and made his views clear.

His audience was shocked, he says.

“[I said] they should deliberately, ethically, consciously close it up and put it into something better, and they didn’t want to do that. They want to defend their white supremacist origin story.”

Jansen says the racist history of Plunket is still evident today.

He points to a recent review of an immunisation incentive programme for Māori, delivered by Whānau Awhina Plunket, which found staff involved to be racist.

A review of the programme, commissioned by the Counties Manukau District Health Board, found “implicit and explicit biases, as forms of racism, were present in both whānau and staff interviews”.

The health board said it would work with Whānau Awhina Plunket to address the problems.

Jansen is unmoved. Plunket has had the same problems for decades, he says, and needs to go.

“Plunket [nurses] used to come in and do things that were offensive to Māori. Come in and undress babies on the table… they were culturally offensive for generations and lots of Māori communities didn’t want to have anything to do with them.

“Now Plunket is trying to reimagine itself and do a better job, it’s failing at it. My point is not trying to test them against doing a better job, the point is they shouldn’t be part of our system.”

Whānau Awhina Plunket trust chair Dame Fran Wilde rejects Jansen’s view.

“The criticisms of Plunket, ‘Oh it’s a white supremacist organisation’, that’s just nonsense,” she says.

“It might have been able to [be] called that at one stage, but actually it’s not… the whole health system could be defined in the same way at one stage as well.”

Wilde said Whānau Awhina Plunket was “ahead of the pack” in trying to make positive changes.

“All the whānau and babies that we care for now wouldn’t get any health care if you just closed it down and started a new organisation. I mean, it’s kind of a ridiculous notion.”

At the coalface

Kelly Tikao completed her PhD in Ngāi Tahu birthing practices last year.

She says Māori lost cultural practices and much of their confidence around birth and child-rearing as a result of European settlement and colonisation.

Practices such as the use of massage, different positioning in birth and preparing young men and women for the role of parenthood were successful and contributed to healthy whānau, she says. But they were not considered worthy by European colonists.

“Yes, babies did die, but they worked so hard on that not happening because of the need to keep the whakapapa going.”

Plunket’s move to acknowledge its past and embrace Māori health practices is welcome but overdue, she says.

“[It’s] taken way too long and too many people to feel unworthy and the trauma of not having our own knowledge accepted as being useful not only for ourselves but for others on the whenua.”

Jay Beaumont, 28, is among about 60 Māori midwives in the South Island and spokeswoman for Māori Midwives ki Ngāi Tahu.

At 17, she had the first of three children and a Pākehā Whānau Awhina Plunket nurse came to visit her.

She says her confidence was undermined by the visits.

“The organisation will look at what a family is supposed to be doing and try to make it fit into this box rather than… going with what the family needs are, and I hope that is something they can work on.”

Beaumont says most of her clients choose to go to a kaupapa Māori provider, Te Puawaitanga ki Ōtautahi. Many feel Whānau Awhina Plunket has a reputation of being “authoritative, not engaging and not home-based”.

Midwives were responsible for the first visits under the WCTO programme – from birth up to 6 weeks – before referring the whānau to Plunket or another WCTO provider.

Beaumont says poverty, family violence, and accessing health services were the main issues for the whānau she worked with, and these could attract “a lot of judgement”.

“Māori women are afraid. They are more afraid of the system than their own circumstances, and so we need to break down those barriers and meet people on the same level so that we can elevate change because what is happening at the moment is not creating change.”

In early August, Stuff spoke to Whānau Awhina Plunket nurse Candy Woollett and tagged along on a visit to Sasha Robinson and her baby Sage.

Woollett supports Plunket’s change of direction and says most of her colleagues feel the same way. She is now learning much more about Māori culture and the Treaty of Waitangi.

“In the nursing degree we touch on it, but I can’t remember it being a huge thing, so actually it is a learning curve, I’m not going to lie.”

She plans to learn te reo and is looking forward to completing the online “Being a Better Treaty Partner” course.

Woollett is a priority team nurse. Many of her cases (42 per cent) are Māori. She also sees Pacific whānau and others with complex needs.

“I go in and respect them and ask them what they want from the service,” she says, “Try to engage with them early. Sometimes, and with everybody though, it’s hard to engage, or you can’t get in touch, but that’s this job. Some don’t want you and that’s just the reality.”

Woollett learned about King and his views in a personal development day.

“[I was] shocked, but not too shocked because he was a man of his time. And while he did some good he did a hell of a lot more harm, particularly to Māori wāhine, and now that it’s been acknowledged it’s fantastic. We can help to right those wrongs, I guess.”

On the day Stuff shadowed Woollett, 5-month-old Sage was weighed and measured. Robinson and Woollett discussed Sage’s progress since a recent chest infection. Robinson said she was concerned Sage was not getting enough milk and had been trying to feed more during the day, when she was not so tired.

Robinson says she has had positive experiences with Plunket for all three of her babies. She remembers a Plunket nurse supporting her mother with her younger brother.

“Plunket has always been at the forefront of my mind, and my husband’s as well. They’ve just been a really good support for us with all of our children.”

Robinson had no idea about King or his views. She and her husband are Ngāi Tahu, but had not been brought up with much understanding or connection to their iwi. Now, they are working to reclaim this part of their identity for themselves and their children.

“It’s sad to hear that’s what the history was and, when I reflect back on stories of my whānau and how they were treated … it still hurts. That’s a big hurt. We teach our kids, you do a wrong, you make it right.”

* An earlier version of this story said Thomas Rangiwahia Mutu Ellison was the last born child of Nani Ellison. In fact Thomas Rangiwahia Mutu Ellison was the last born son of Hera Ellison. Thomas Rangiwahia Mutu Ellison’s grand-mother and a younger sister were called Nani. Story updated August 28, at 2.12pm.