After a stormy year and on the eve of opening his own practice, outspoken Kaitaia GP Lance O'Sullivan tells Peter de Graaf what shaped him as a doctor and about his hopes for his new venture.

Northland's most outspoken doctor is out to prove a point.

Kaitaia GP Lance O'Sullivan is about to go it alone in his own practice, hoping to prove he can look after his neediest and most cash-strapped patients - without his business going under.

For the past two years the 40-year-old doctor has been in the news for speaking out on the extremes of poverty he encounters in his work. His account of children caught foraging in a pig bucket for food, and the child who drank a bottle of medicine because it was the only thing in the fridge, made national headlines.


Then there was the public falling out with his employer over what he calls "philosophical differences" and the street protests over his resignation. At the heart of the dispute was the vexed question of how a medical practice should deal with patients who can't pay.

Tomorrow, however, Dr O'Sullivan's own practice at Kaitaia Hospital will be formally blessed and from Monday he'll be open for business - albeit with just one arm, the result of shoulder surgery last week for a rugby injury.

Its name, Te Kohanga Whakaora ("The Nest of Wellness"), was given by master waka builder Hec Busby; the logo was gifted by artist Theresa Reihana.

But the golden boy of Maori health, who counts Associate Health Minister Tariana Turia among his allies, hasn't always had it this good.

He was raised by a solo mum as a part-Maori boy in the mostly Pakeha Auckland suburb of Howick.

"It wasn't a place that was fully supportive of trying to find out who you are as a young Maori man," he says.

The young Lance developed a reputation as a trouble-maker and, after being expelled from two schools, his mum packed him off to a boarding college for Maori boys, Hato Petera on Auckland's North Shore.

It was a turning point for the 15-year-old and his first real exposure to the Maori world.

"As a part-Maori child at school the perception was that you were going to be trouble. After three years at Hato Petera I went from being the kid who got expelled from two schools to being dux, head boy and sports champion."

Dr O'Sullivan put the change down to an environment that encouraged and recognised his skills. The experience had a profound effect on his beliefs as a doctor.

"What that spelled out to me is this: Rob people of their self-belief and you deny them a bright future. I believed I couldn't be anything other than the naughty boy teachers perceived me to be. So I'll never turn a kid away and say he's a lost cause, or a patient when people say he's just trouble, he's aggressive and he's going to try to rip you off."

He was not accepted for medicine at first, instead spending two years in a mind-numbing Customs job before getting into Auckland Medical School under a Maori preferential admission scheme. As long as Maori make up 16 per cent of the population but just 3 per cent of the nation's GPs, such schemes will have his backing - and he hopes he's proof they work.

The first five years of his medical career were spent in the Bay of Plenty, where he was influenced by the passion of doctors he worked with in isolated, deprived places like Murupara and Kaingaroa.

But he was always keen to come "home" - his iwi affiliations include Te Rarawa through his grandmother from Pukepoto, as well as Ngapuhi and Tainui - so he jumped at the chance when a Kaitaia Maori health provider offered him a job.

Ironically, one of Kaitaia's attractions was its reputation as a tough place to work.

"Professionally there's a lot of challenges, and I wanted to work among my people. It's also a great place to raise a family."

That family now numbers ten, including Tracy, his wife of nearly 20 years, seven children aged 3-19, and one whangai child, all packed into a modest home at Lake Ngatu.

Dr O'Sullivan says the true extent of poverty in Kaitaia has only become clear to him in the past two years.

"I was aware it existed but I must have had filters on ... As I got more involved in children's health, especially the absolute tragedy of rheumatic fever, I realised behind that lies poverty. The issues that drive it are not medical, they're social - poor housing, low incomes, low levels of education and poor access to health care.''

Dr O'Sullivan realises his frequent appearances in the media mean some people think he's a show pony.

However, he does it not to attract attention to himself, but to issues which matter. On days when he's reluctant to face another interview, his wife insists he pick up the phone because he has an important message to share.

"If there was another Maori doctor working at the coal face in a deprived area like Northland, with a good understanding of the health conditions affected by poverty, I'd love them to take my place. But at this point in my life, this is my calling."

He also knows he is accused of being "all talk" - and admits he felt that way himself, until he went it alone six months ago.

Now, however, he can point to real gains for health in the Far North. First among those is a new school-based health service for 2000 children in the Kaitaia area (see the story below); another project starting to gain traction is Kainga Ora ("Well Home").

His housing improvement project sprang from the realisation that only changing people's environments would make them better, not endlessly writing out prescriptions.

"I was feeling really frustrated. I've got a big bucket of resources to help people, but even if I wrote out a prescription for 100 medications it wouldn't solve the fact that many people live in cold, damp, over-crowded homes and have no money to see me when they need to - so they end up in the emergency department instead."

He started the project by driving around Kaitaia and calling in at a few of the worst-looking homes to see if things were as grim on the inside. He found three families with children whose health was suffering due to the state of their homes, then set about recruiting people to help. A building company has inspected all three homes and work is underway to fix the first, using donated materials and labour.

Dr O'Sullivan says he can't solve the world's problems, but with Kainga Ora he can make a difference for three families. He is also bringing more young Maori doctors to Kaitaia, with one due to start by February and another within a year.

"In the next three months we'll have a health service serving 2000 kids for the next four years and we'll have one, if not two homes repaired. And in 12 months we'll have three Maori doctors working in Kaitaia. That's not talk, that's action."

Despite his reputation for never turning away a patient with empty pockets, Dr O'Sullivan says he isn't concerned about his new venture failing financially. Nor is he worried about being taken for a ride by patients who simply don't want to pay.

"Where some people see bludgers or people who want to manipulate me, I see people who are desperate and need my help. My challenge is how can I access support for them so they can pay me something, so I'm still there in two years' time."

Dr O'Sullivan says his practice will be different because it will be patient-centred and the community will have a say in how it is run. Patients that have to be seen will be seen the same day, and he will do home visits when genuinely needed. Some clinics will run until 7pm so workers don't have to take time off and - this is the bit that may convince other GPs that Dr O'Sullivan is crazy - he will do his own after-hours care.

By bringing passionate young Maori doctors to Kaitaia, Dr O'Sullivan believes he can make a real difference to health in the Far North.

"I'd like to think that in five or ten years' time, people will say, 'Have you heard about that awesome young Maori doctor up in Kaitaia?' - and they'll be talking about someone else."

MOKO makes kids medical focus

A new health initiative in the Far North will provide medical care for 2000 children at 14 schools in the Kaitaia area.

Called MOKO (short for Manawa Ora, Korokoro Ora or "Healthy Heart, Healthy Throat"), the new service was opened two weeks ago by Associate Health Minister Tariana Turia and is based at Kaitaia Primary School.

It will be run by a company set up by Kaitaia GP Lance O'Sullivan, under contract to the Ministry of Health with extra funding from the charity KidsCan.

Dr O'Sullivan said it was the first full-time, school-based health clinic in Northland.

Once fully operational it would provide medical care for 2000 children at all primary and intermediate schools within 25km of Kaitaia, with nurses and community health workers visiting each school three times a week. Two GP sessions a week would take care of trickier cases.

MOKO's main focus was preventing rheumatic fever by taking a throat swab from every child with a sore throat and testing for the "strep" bacteria responsible for the potentially fatal illness. The new service would also tackle skin and chest infections, nits and injury prevention.

Kaitaia was only the second place in New Zealand, after South Auckland, to get the MOKO programme.

Rheumatic fever is caused by a bacterial infection of the throat which, left untreated, can cause heart damage and premature death. It is associated with poverty and overcrowding, and in Northland is almost entirely confined to Maori. Of the 35 known cases in Kaitaia children, only one is Pakeha.

MOKO is based on Church Rd in a building called Tuwhare, in honour of a local tupuna (ancestor).