Stacey Morrison, Gabrielle Baker, Emma Espiner and Leonie Hayden react to Kiritapu Allan’s cervical cancer diagnosis, and reflect on healthcare for wāhine Māori – and how we can be our own best health advocates.
Yesterday the country woke to the terrible news that popular MP Kiritapu Allan has been diagnosed with stage three cervical cancer.
Not only has she been living with the diagnosis for many weeks, but she revealed via a Facebook post that the growth was discovered the same day she stood before the country and allayed our fears about earthquakes and a possible tsunami, guiding us with a calm authority that on reflection, must have required herculean strength.
In the same Facebook post, Allan answered the question “Is there anything I can do?”
“My answer now is yes. Please, please, please – encourage your sisters, your mothers, your daughters, your friends – please #SmearYourMea – it may save your life – and we need you right here.”
Here, friends and admirers reflect on how we do just that.
Stacey Morrison (Ngāi Tahu – Kāti Irakehu, Te Arawa) is a broadcaster and te reo Māori advocate who lost her friend Talei Morrison, founder of the Smear Your Mea campaign, to cervical cancer in 2018.
Who am I to have tears bristling in my eyes when Kiritapu is being so brave. Why does it feel like I’ve been punched in the stomach at this news, how could I even have a right to feel so impacted? Maybe it’s because it’s her, but it’s also us, wāhine Māori, yet again.
Ahakoa tana kotahi, he manomano kei muri. While she is but one, she represents a multitude.
I saw Kiritapu a few weeks ago. I remember thinking “wow, she has beautiful skin”; she was looking healthy and vital. How do women manage to push on? Actually why do we push on, when our bodies are telling us things aren’t OK? Kiritapu mentioned Talei Morrison and how her last smear had been because of Talei’s #smearyourmea campaign, so that must have been in 2018.
Talei’s diagnosis had rocked everyone too. Talei had an other-worldly beauty and presence that shone from the kapa haka stage; she was an inspirational teacher, so on to it, and yet she avoided having a smear for 10 years because she’d had a bad experience. The churning frustration rises again. He moumou – such a waste, so unfair she died at 42. Who am I to live longer than her, to witness her whānau growing, when she can’t?
Wāhine reached out to each other at Kiritapu’s news, assured each other that we are talking about an exceptionally strong woman (one may have even said “stubborn”) who will get through this and come out healthy again. We wondered what we could do to help, to offer something helpful. Kiritapu wrote in her post the most helpful act women could do right now is to get that overdue smear done. She profiled us, correctly, as busy women and māmā like her, making sure the kids are up to date with their appointments, but putting our own needs on the perpetual to-do list. It’s easy to put off because it’s not exactly fun. I’m scheduling mine and scrolling to the day a female doctor is available. I know they’ve got the latest chair that apparently makes the smear easier and less… awkward. Five other friends on my timeline have heeded Kiritapu’s words and booked their smears. What else can we do? I signed the HPV self-test kit petition, cried a little bit again, and felt silly doing so, again.
Gabrielle Baker (Ngāpuhi, Ngāti Kuri) is a Māori health advocate and health policy consultant.
My first real job was working on cervical screening legislation that was drafted following the Gisborne Cervical Screening Inquiry. That inquiry (which finished in 2001) looked at the under-reporting of cervical smears in Tairāwhiti by Dr Michael Botrill in the 1990s. And it came a little over a decade after the Cartwright Inquiry found (to paraphrase) cervical cancer research carried out on women in the 1960s and 70s in Auckland was unethical. This context is important for my personal understanding of the health and disability system. It taught me the health system’s history of failing women, even (and especially) in areas of “women’s health”. And that Māori women in particular have every reason to be dubious about the (patriarchal) medical profession.
So, even putting awkwardness of the test itself to one side, I totally get why we feel reluctant to participate in screening. But we should do it anyway. My social media has been crammed with people with cervixes booking in to see their GP and sharing this information as a form of public support for Kiritapu. It’s been a week of complex feelings for lots of us and having a task like this is helpful – and maybe also putting it on Facebook is a useful form of public accountability for some people, to make sure they follow through.
And the Ministry of Health and the National Screening Unit – what’s their task? Surges in Māori cervical screening rates are amazing but they shouldn’t be the result of Māori women sharing their stories publicly. I want to see it happening by design, because the programme works for Māori, unlike now, where about 80% of eligible Pākehā have a regular smear but only about 65% of Māori (this is based on 2016 data, Google couldn’t get me more recent data that was easy to interpret quickly). Working for Māori probably also includes the move to the “gold standard” of self testing that Dr Bev Lawton has reminded us was supposed to be rolled out in 2018. And, frankly, was discussed by experts back in the 2000s when I was a new policy analyst.
Emma Espiner (Ngāti Tukorehe, Ngāti Porou) is a doctor and writer who works at Middlemore Hospital.
At the annual hui for Te ORA (the Māori Medical Practitioners Association) last year, Māori doctors reflected on the ongoing impact of Covid-19 on Māori health. Dr Rawiri Jansen warned of the unseen consequences – the missed screening tests, the delayed appointments, the compounding impact of the sledgehammer of the pandemic on our insufficient interventions to correct the existing inequities in Māori health.
Last night, on Twitter, Professor Papaarangi Reid again reminded people that the solutions to issues like inequities in screening, prevention and treatment of cervical cancer are already here – we just haven’t enacted them. There are always “reasons” to not prioritise Māori health, but in the post-Covid world we know that governments can make rapid and extraordinary calls in the name of population health, and so we can call their bluff when they don’t do it for Māori.
It’s impossible to know what to do when a friend has cancer. I got my letter from the National Cervical Screening Programme last week and promptly put it aside, figuring it could wait. After hearing Kiritapu’s news yesterday I came home and stared at the cheerful pink and orange letterhead. Further down the page it states my name and NHI, my birthday next weekend when I’ll turn the same age as my friend who has cancer now, and my ethnicity.
It is of no surprise to anybody who knows her that Kiritapu used the announcement of her personal tragedy to encourage others to protect themselves. We would do anything to stop this happening to her but it already has. The only thing left is to do as she’s asked and look after ourselves and each other. I’ll make my appointment for next week.
Leonie Hayden (Ngāti Whātua ki Kaipara) has a cervix and is scared of going to the doctor.
If you’re between 25 and 70, have ever been sexually active and have a cervix, you need to have a cervical screen (also known as a cervical smear or a pap smear) every three years. Many GPs send out reminders, but if you’ve changed GPs or moved around a lot, you might not have received one. I get emails from my GP, and they become very persistent if I leave it too long to book an appointment. I haven’t been great at keeping up with my tests – I’ve only had two even though I’m 40 (although I’m not overdue for one currently). I’m vowing now to never be overdue again.
You don’t have to go to a GP. You can go to a practice nurse, Family Planning, or community health services such as Māori health services, Pacific health services, women’s health services, or screening support services.
Cervical cancer is caused by certain types of the human papillomavirus (HPV). It is one of the most preventable of all cancers. Regular screening reduces our risk by 90%! That’s a lot of percents.
The last smear I got I was asked to lie like this, like a yoga pose (one of the easy ones, I love those). The lower part of my body was covered with a sheet, and my GP stood down by my feet and only lifted the sheet while she was administering the test.
I just went with the whole yoga thing and closed my eyes and did some overly dramatic deep breathing. I also have an aversion to needles, so I sing when I need a blood test or a jab, to distract myself. I sang a little bit during my smear too – ‘Rivers of Babylon’ by Boney-M. Don’t ask me why, the human mind is a mysterious thing. My GP didn’t say a word but she did smile. I saw her.
Things I thought about while I was getting the test:
What if I’m too tense and it won’t go in.
What if I look or smell weird down there.
What if it hurts.
What if it’s cold and I get a fright and I kick my doctor in the face.
Things my GP did:
Warmed up the speculum (I don’t know how, but it’s the little things!).
Gently opened the vagina with a speculum and took a sample of cells from the surface of my cervix with a small brush.
Said: “All done” after about two minutes.
Things that didn’t happen:
She didn’t comment on my vagina or vulva (although a GP once told me I had a lovely cervix. Put it on the cover of Vogue!).
It didn’t hurt.
I didn’t kick her in the face.
The sample was then sent to a laboratory to be examined. I was told I’d only get a call if they found abnormal cells. I never got a call.
Here’s something that’s worth remembering – your GP, nurse or healthcare provider has seen hundreds, if not thousands, of genitals. To them it’s no different to a throat or an ear canal. They’re not judging you or marvelling at your downstairs business. In fact, they’re probably thinking about what they’re going to have for lunch.
You can, however, expect (nay, demand) as much support as you need from your healthcare provider. If you’re scared, you can tell them, and expect sensitivity. If you’d like them to talk you through each step before and during the procedure, you can. If you’d prefer a woman or a Māori, Pasifika or Muslim person to administer the test, it’s your right to ask for that. You can ask as many questions as you want.
There are situations where people might need a bit of extra help. Let’s be honest – lots of people have had negative experiences in healthcare. Some of them are linked to cultural competency, some to insensitivity, transphobia or misogyny.
Unfortunately, in the year of our lord 2021, the healthcare needs of transgender people, gender-diverse people and people with diverse sex characteristics are not always met by healthcare providers. If you don’t already have a trusted healthcare provider, Rainbow Youth can help put you in contact with clinics who understand your needs. If you’re in Auckland, you can also contact ASHS (Auckland Sexual Health Service) based at Greenlane hospital, which specialises in the healthcare of trans and gender-diverse people.
If you are a sexual violence survivor, then the idea of a smear will naturally be incredibly stressful. This is often overlooked in the conversation. Approximately one in five New Zealand women experience a serious sexual assault. That’s a lot of people who are traumatised by the idea of a stranger, however professional, touching them. And it’s your right not to be retraumatised. But if you’re willing to give it a go, there may be some tools that can help you: if you’re already receiving help from a counsellor or therapist, they can help you work towards it. You can book a double appointment so you don’t feel rushed, and take a support person with you. Disclose as much or as little as you want to the person administering the test, but letting them know what words, positions or actions might trigger you can help them to help you.
Family Planning, non-cis men GPs and NPs and women’s health services are likely to be a more comfortable option. Do your research and find a healthcare professional that you trust.
Barriers to sexual healthcare exist for disabled people too. If you already have a trusted healthcare provider, discuss with them what you need. If you want to use a service you’ve not accessed before, call ahead and talk through your needs and they can prepare for you.
There’s not a lot of definitive information on how much it costs. If you have a Community Services Card, all appointments at Family Planning are $5. A standard cervical screening appointment at Family Planning is $40. Your GP’s standards rates will apply (which vary). But if you meet certain criteria, some programmes offer free smear tests at pop-up clinics. There are some listed here for Auckland on the Well Women & Family Trust website. Māori and Pacific healthcare services often offer free cervical screening because our screening rates are so low.
You are your own best health advocate. If something doesn’t feel right or if you don’t like how you’re being treated or talked to, you can can ask to see someone else. Remember you can also take a support person to any appointment.
Be brave, like Kiri.