BRILLIANT NIUEAN ACHIEVER: DR. COLIN TUKUITONGA

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By John Andrews As published in the New Zealand GP Magazine July 2000

One of Niue’s brightest sons places New Zealand’s primary health care needs ahead of personal political ambitions in the South Pacific Island of his birth.

Dr. Colin Tukuitonga believes general practitioners are spread too unevenly around the country -- and he wants that changed. And that mission means that, for the time being, he will ignore urging by fellow Niueans to return to take up politics in his homeland. Instead, as one of two New Zealanders awarded a fellowship to Harvard University this year, he will head to the United States next month as the Harkness Fellow in health policy. There, the 42-year-old senior lecturer at Auckland Medical School will learn how authorities persuade GPs to take up posts in less attractive areas.

"In New Zealand we have too many doctors in the same place and not enough elsewhere," says Dr. Tukuitonga, who is also director of the Pacific Health Research Centre. "As a nation we spend far less at the front end and far too much at the hospital end. The sufferers are Maori, Pacific Islanders and rural New Zealanders. "Older New Zealanders too need more care but their ability to get GP care is limited."

Dr. Tukuitonga says New Zealanders tend to put off seeing their doctors until too late and end up in hospital. He contends New Zealand GPs, who regard themselves as small business entities, set up their practices according to market place principles. The result is "a classic situation where the market fails to deliver."

"I am not likely to go and set up shop in South Auckland when I know the ability of these folk to pay for my services is limited. That, basically, is the problem." Dr. Tukuitonga believes many New Zealand policymakers agree with his analysis but some in the medical fraternity are opposed to state intervention and incentives for GPs to set up in less attractive areas.

"People want freedom to charge what they want and open and close when they want," he says. "People are averse to the big stick. "The GP in New Zealand is regarded as a private business. The fact they get 80 percent of their income from the State -- they do not want to talk about it.

"If you look at the United Kingdom and Australia, they have no significant barriers to accessing GPs. They are the first point of contact. "The excuse here from policy makers is that there is nothing we can do about it." Dr. Tukuitonga hopes to find evidence to the contrary in the United States.

"Some organizations in the United States have demonstrated that you can redistribute primary care practitioners more equitably. "Several universities have got leading researchers who are examining the reasons and interventions that are needed to encourage family practitioners to work in less desirable communities or areas."

As well as doing research at the Harvard School of Public Health, Dr. Tukuitonga will visit other American institutions such as UCLA. Will his findings influence New Zealand health policy makers? "It depends if people think health care should be a benefit to those who need it most," he says.

While New Zealand’s primary care needs are his immediate priority, his homeland is never far from his mind. Dr. Tukuitonga believes he’s inherited many characteristics of his grandfather who raised him on the tiny tropical island.

"He had no education and thought outside the circle," says Dr. Tukuitonga. "He did not rely on anyone else. He taught himself to read by reading the Bible. "The Niue thing is to value lawyers and doctors. I’m sure that introduced me to the notion of being a doctor."

New Zealand-born doctors used to run Niue’s health services and it was one of them, Dr. Winton Barnes from Gisborne, who recognized the teenaged Tukuitonga’s potential. He gave the young Niuean work in non-medical areas of the island’s health system. Initially hell-bent on training in New Zealand, Dr. Tukuitonga was finally persuaded to take up a scholarship at Fiji’s School of Medicine.

After qualifying, he spent a year at Suva’s Colonial War Memorial Hospital before becoming Niue’s medical officer. Since 1987, his career in public health has taken him to Sydney and Auckland.

Niue’s economic woes attract Dr. Tukuitonga’s attention. "The whole thing (on Niue) has turned to custard," he said. But he is stalling on his political aspirations. He says he may seek election after he turns 50, maybe sooner.

"I am pretty determined to get a professorial position (in medicine) and I have a number of important milestones to achieve first," he says.

For additional reports from the Niue Economic Review, go to PACIFIC ISLANDS REPORT News/Information Links: Magazines/Journals/Niue Economic Review.

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