With sophisticated medical imaging devices, Tairāwhiti Gisborne’s Mātai Institute has been set up with the explicit purpose of improving health outcomes of Māori and regional residents.
It’s not often an advanced medical research centre sets up outside of New Zealand’s main centres – far removed from large study populations. It’s even less common that one sets up with the exclusive intent of improving health outcomes for kaupapa Māori.
Yet that’s exactly what Dr Samantha Holdsworth did. In 2019, when she returned to her hometown of Tairāwhiti Gisborne in 2019, the former Stanford scientist founded the Mātai Institute, a not-for-profit research centre that specialises in medical imaging using new and advanced software, post-processing and artificial intelligence. Since late 2020, the institute is home to a state-of-the-art MRI machine – a General Electric Healthcare 3-Tesla – which is able to create high-resolution scans of the brain, heart and body.
But it is helping Tairāwhiti’s residents, and including more Māori in the healthcare conversation, that is truly the purpose of Mātai’s advanced technology. Mātai Institute COO Leigh Potter (Ngāti Porou, Ngāti Kahungunu, Rongomaiwahine, Rongowhakaata) believes that making the best use of this MRI machine will require gaining the participation of Tairāwhiti’s locals. Potter spent 15 years setting up and supporting the radiology clinical practice at Hauora Tairāwhiti (Gisborne Hospital) and so has first-hand experience of the needs of this community.
An important part of Mātai’s engagement effort will be to connect with Mātai’s Māori community, says Potter, who has been passionate about improving outcomes for Māori throughout her career.
“First and foremost we set up a Māori advisory board that we’ve called Ngā Māngai Māori, which translates to the ‘Voices of Māori’,” she says.
“We have representation from local iwi health providers, primary care, a local kaumatua who works at Hauora Tairāwhiti and other experts from the area.”
Potter says the combination of different expertise at the table will ensure the research at Mātai responds to the needs of the local community with the aim of improving health outcomes.
“We’re always thinking about how we might do better for Māori or engage more effectively with our Māori community.”
Potter points to Mātai’s planned research into dementia as being a body of work that was directly inspired by input from Māori whānau who were concerned by the increasing rates of the condition among their loved ones. In other cases, Mātai’s work has been motivated by differences in disease outcomes between rural and urban patients – a prime example being its ongoing research into prostate cancer.
The institute recently made a significant breakthrough by developing a “game-changing” prostate cancer diagnostic pathway. The project, titled Accuracy and Equity in Prostate Cancer Diagnosis, will be led by the clinical lead at Mātai, Dr Daniel Cornfeld, and is aimed at vastly improving New Zealand’s current diagnostic pathway in prostate cancer, particularly for those who live in under-served and remote communities.
Potter says addressing the disadvantage of regional communities is what Mātai is all about. The best way to create equitable health outcomes, she says, has been to look for ways to flip current clinical models on their head.
“In some rural locations, it’s very difficult to get access to specialists. For example, in Tairāwhiti you might only have a specialist that visits once or twice a month. So, alongside my colleague Dr Daniel Cornfeld, we looked at a model whereby patients who have an elevated PSA (prostate-specific antigen) are first brought into Mātai to have a scan of their prostate.
“MRI is very good at examining the prostate, and we then have the equipment to do a targeted biopsy. We’re able to target the area of concern and validate that there’s an issue,” she says.
Essentially it means the specialists can make sure people who are waiting to see a urologist are triaged properly. Those without an issue are taken out of the queue, therefore speeding up the process for those who are in urgent need of treatment.
One feature that makes MRI a useful research tool is the fact scans are noninvasive and use a magnetic field and radio waves instead of radiation. This broad applicability has led to Mātai’s plans for the Tairāwhiti Child Wellbeing Study, which will use MRI to follow the health of 500 local children from a young age.
Robby Green is one of the researchers working on the project and he believes Mātai is uniquely located to undertake this study:
“Tairāwhiti has the youngest population in the country… Tairāwhiti is also a stable community, making it a great opportunity to design research in partnership with our local people and with increasing retention of those participating in the research.”
Alongside local iwi health organisations, Mātai plans to build on growing relationships with staff from the Auckland Bioengineering Institute and Faculty of Medical & Health Sciences to find a range of MRI approaches that will support the Tairāwhiti Child Wellbeing Study. With ground-breaking MRI methods, the team will work towards an hour-long MRI scan with a break in between, which has previously been unachievable with young people, to capture high-quality images of various organs.
No other study the Mātai team is aware of has involved children and used this level of advanced imaging of the brain and other organs. It will allow the researchers to detect the early signs of diseases such as cardiomyopathies, diabetes and lung disease that usually don’t present clinically until patients are 40-50 years old, even if they begin developing much earlier. Once the pilot study is complete, the staff at Mātai will embark on extensive consultation, Green says.
“Mātai is a small organisation and Gisborne is a relatively small community so it’s realistic to visit every school, community centre and marae that will be involved to build the relationships that you need to make this kind of study work.
“We want to build a study that is in tune with the priorities of our community – asking questions that align with what people here want to understand and address; designing it with them in such a way that they don’t just feel ownership but do have ownership of it.”