RACP — Kia ora, Renee, thanks for being available to chat. You're currently on the New Zealand Policy and Advocacy Committee (NZPAC) – how is that going?
Renee Liang — Yes, I am really enjoying it! I’m a big picture thinker and I like getting insights into how people come together to discuss complicated topics. It’s been an amazing learning opportunity and also a chance to meet with colleagues that I wouldn't necessarily see in the workplace (paediatricians are so siloed!). My colleagues on the NZPAC are all really motivated and passionate about improving health at a policy level.
What's your background and your pathway of getting into medicine?
Well, unfortunately I do fit all the statistics! I come from a medical family where my dad was a paediatrician, now retired, and my sister is a surgeon, and to top it off I also went to a private school.
Do you think there was an expectation early on that you would follow the medical path?
Not at all. My parents expected us to get a degree, but my dad told me that he wasn’t sure he would recommend medicine. It was too late by the time he said that. My primary school friends remember me stating specifically that I wanted to be a paediatrician. I was about 7! My dad often came home with chocolates and talked about how great his day was and what fun he had so I thought ok, I want to have fun and get chocolates too.
Later on, when I became a medical student, there were some really inspirational paediatricians, like the late Tanya Gunn, who took me under her wing and was the first person to tell me I could have multiple careers. There was also Cameron Grant at Starship Hospital and Steve Bradley at Rotorua Hospital. I have since ended up working with them in various roles, so coming full circle is very satisfying. I just loved their energy and youthful outlook. I thought, if I do paediatrics I don’t have to grow up!
I like that in paediatrics you can actually cure people and they never have to come back to see you, which is not always the case in other specialties. Also, a daily job perk is meeting amazing kids and families. A cute baby first thing in the morning is better than a coffee.
Paediatricians are well known for their vibrancy and this is often evident at the ASM’s.
Case in point (pointing to sparkly shoes), so yes, I'm wearing kids' shoes right now. I also get to dress in kids’ clothes because of my size. Even our clinical tools are often toys.
Can you tell us a little bit about your involvement in Asian health?
When you look like I do and when you grow up in a community like mine, it's not really a choice that you have to represent and advocate. To be clear, I am doing it because I want to. But as anybody that comes from an ethnic or minority community will know, at a certain stage you feel like you have to stand up and remind people there are different experiences to take into account. This is especially the case if you’re on a governance or research group where you might be the only one from your community.
I've been lucky to be invited onto research groups like Growing Up In NZ. I’m there because I'm a paediatrician with a developmental and clinical perspective, but also because my links with the communities that I've grown up in, and my access to voices and opinions, are those that researchers need to hear.
So this highlights the importance of a strong consultative approach which includes cultural safety?
Of course. It’s not always the norm in academia, but I’ve had the good fortune to join several amazing research groups with leaders already skilled in considering equity. I often find that I'm aligned with the Māori and Pasifika research leads in the room, as we all know how hard it is to get our voices heard above the other considerations.
We get that a Western framework pervades both the academic and medical environment, but because we’re also fluent in that framework, we can help translate both ways between researchers, clinicians, policy makers and our own communities.
It’s useful to recognise that I’m already biased in my thinking from the Western medical viewpoint. I’m trained in that and it was my only training. I have since sought training in Māori, Pasifika and Asian cultures because it became obvious there was a gap that impacted my effectiveness with patients. I’m sure it will be a lifelong journey, but it’s one that I find interesting. Learning language or culture often gives me tools that I can use immediately in my clinic room. My journey in using my ancestral language of Cantonese (even with patients when I can) goes even deeper, as it impacts on my identity and what I want to pass on to my kids.
Do you think medical training is changing?
Yes. When I talk about cultural safety and data sovereignty to medical students or junior doctors, the conversations I have tell me that they're so much more advanced compared to where I was! That shows me that our teaching and curriculum has evolved, thankfully, though we’re not there yet.
I also see that younger colleagues feel much more empowered to speak up when they see there's a problem. I think that's amazing. We're not going to change unless people recognise the issues and keep pushing for change.
I do know that in trying to bring attention to Asian health inequities, we're just starting. If you look at the traditional research, Asian communities in New Zealand seem to be statistically ‘fine’ (at least, doing as well as Pākeha). But the reporting is flawed. We’re usually analysed as one homogenous group, but we’re by far the most diverse broad ethnic group in Aotearoa. So many factors such as specific ethnicity, how recently you’ve migrated and what socio-economic group you were from before, influence how well you’re doing. If you analyse us as if ‘all Asians are the same’, you’re going to miss the people who are quietly falling through the cracks.
It’s a far more complex picture than most people think about at face value.
Yes, absolutely. Personally, my family are well off. We migrated 50 years ago when New Zealand was a different place and we are well established in terms of language, cultural understanding and economic resources. We’re going to have a really different story compared to a new migrant family who sets up a takeaway shop in a rural town and whose access to and knowledge of health services is completely different.
The problem with the research is that often with the limited numbers, we have resources to recruit. We're not able to analyse the different Asian subgroups with sufficient power. When we collate the groups together instead, it looks like we're doing well, but it’s a mirage. It’s not right that the way we report research doesn’t allow the most vulnerable to be seen.
“When we collate the groups together instead, it looks like we're doing well, but it’s a mirage.”
There’s been recognition of this through organisations like the Centre for Asian Health Research at the University of Auckland, and they have been working hard as part of a coalition of community and clinical groups to draw attention to the issue.
For example, Asian health and mental health in Asian populations is worsening at a worrying rate, affecting all ages. It's to do with inequitable access to health, but also other resources such as housing and social cohesion. It’s been shown to relate to racism as well. The solutions include developing better services which serve those populations specifically, including languages and cultural framing.
Achieving cut-through in what is a very under-resourced health funding environment is the hard part. It’s hard enough to get the funding to do this research in the first place. Getting the attention of the policy makers and our clinical colleagues is difficult too.
Have you found that working in regional areas has added a different kind of dynamic or interest to your work?
Yes, I really love working in different centres, sharing the ideas or tools I’ve learnt in one place with colleagues in another place who might find it useful. There are many differences, but I think there are more similarities. People are the same and the root causes of their issues are largely the same too. It’s also such fun, not to mention a privilege, getting to experience different parts of New Zealand by living there temporarily and meeting families.
One of the challenges we have is trying to socialise or encourage people to work in rural and regional areas. Do you see benefits to working in these areas?
Well, I choose to base myself in the biggest city in New Zealand! I’m an Aucklander, born and bred. My extended family live here and we see each other all the time. There is never an issue getting babysitters or other support.
I think you're either wired to love what the rural lifestyle gives you, or not. Some of my colleagues enjoy the pace of life and the fact that their kids have easy access to leisure and sport. Many colleagues are happy to experience a place they’re not from when the kids are young. My kids used to travel with me to locums when they were babies and toddlers but school, especially secondary schooling, is a different consideration.
I’m also a big city girl because of the other stuff I do. I have a major other career in Arts and there's only one place in New Zealand where there are enough Asian artists to collaborate with.
You are well known for your contribution to the Arts in Aotearoa NZ and have received an MNZM for this. How did that all start and what are you up to at the moment?
I'm very lucky that I found a parallel career that is outside of medicine. I actually took up my arts career during a break from medicine, which I did at the end of gaining my fellowship. At that stage, I was burnt out and disenchanted with the hospital system due to workplace bullying and being chronically overworked. The process of gaining an FRACP is gruelling and stressful, but we won’t go into the discussion here of how much of that is necessary! I do think the College could do more to recognise the stress of what it puts trainees through and how much of their lives are put on hold, sometimes to the detriment of health.
My solution for burnout/bullying was to grant myself a ‘sabbatical’ and enroll in a Master of Creative Writing once I gained my fellowship. I felt that I owed it to myself to take a break, reset my brain and find out who I was after all of that. It turned out to be a combination of growth and good timing which has meant I found a meaningful second career (which I run alongside the first). More recently I also picked up a third career in research, which is maybe a more usual additional career alongside clinical work.
Through this, I have essentially ended up becoming a career locum, and I think that's been a good option for me. It wasn't a decision, but rather something that just happened. But then alongside that, I've been able to grow satisfying careers that have happened organically and incidentally improve my clinical skills.
I get to say things with my arts work that I probably wouldn't get to say as a practitioner. Conversely, my arts work has given me experience and confidence to advocate for health, as a science communicator and columnist.
Do you achieve some balance in your career where you work in medicine, but you also work in the arts?
No, it's not balanced…! It is passion focused though and that helps give me energy enough to keep it sustainable.
I love medicine because I get to do just enough of it, but I don't depend on it for my identity. I just saw some families today and they left feeling happier than when they entered, and that is a huge reward. I got home in time to see my family which is awesome as well, and that is not always a given for SMOs.
Earlier today I had conversations with friends about some projects that we're working on, including a musical. When the kids have gone to bed, I'm going to be working online on my research journal role as an associate editor for BMJ Medical Humanities and chatting to colleagues who are mostly in UK and Europe.
My parallel careers aren’t luck, well mostly not. They happened because I allowed myself to follow the trail of my passions and interests. I don’t think we're very good at doing that as doctors, as the system doesn't really allow us to do that easily. It should though, because a happy, balanced doctor is also a better and a safer doctor.
“It should though, because a happy, balanced doctor is also a better and a safer doctor.”
The last time we talked, you were coming down to Wellington to do a puppet piece at a puppet festival. How did that go?
Yeah, so the 10 minutes of puppetry got really great feedback from a room full of very experienced puppet makers. The mere fact that they loved it and were asking me lots of questions meant I went back to Auckland going, okay, I'm going to make the whole thing now. Now I'm going to pitch a full show for families at the upcoming New Zealand Market for Performing Arts, which happens in Auckland every year. This will be the first time that I've pitched a show in which I'm the solo performer, as I'm normally the writer. I will also be pitching a full-length musical which has gone through three rounds of funding and is now ready to premiere, but we need lots of backing.
Is this your first foray into puppetry or have you done some of that before?
I've had lots of puppetry in my shows, but I've never been the person making or performing the puppets. Last year I did three courses and residencies to upskill and from there, I took all the opportunities that I was offered. That’s how I ended up premiering a ten-minute beginner’s puppet show!
Similarly, is writing a musical a new foray for you, or is that something you've had experience with before?
It’s actually my third one, if you include the opera! I've had a career as a professional artist in New Zealand for as long as my career as a Fellow - about 22 years now. I’m now regarded as an established New Zealand artist. I've got a member of the New Zealand Order of Merit from 2018, that I was awarded for Services to the Arts. A lot of my work is about mentoring and helping other artists to succeed, but I teach a lot and I'm involved in governance and leadership in arts spaces.
When you received the MNZM, did you have any inkling about that or how did you feel about that?
Oh, I had no idea, and I still don't know who nominated me. I thought it was quite early in my career to be offered an honour. But it was a chance to dress up and go to Government House. I took my very young children with me, breaking the ‘no kids under 15’ rule. They weren’t going to stop me! And I invited my dad who got an ONZM some years earlier (for paediatrics, especially his role volunteering for the Asthma Society for decades) so we both got to pose with our medals. I met a lot of really cool people during the ceremony and for a couple of years afterwards I got invitations to government events. I got invited to a reception by (the then) Prince Charles and Camilla and talked to Charles about his recollection of the handover of Hong Kong! I’ve stayed in touch with lots of Kiwi leaders that I talked to at those events and we help each other out.
Do you think your work in the arts contributes to your work in medicine?
Yes, I believe the arts makes me better at medicine and vice versa. In fact, I think I’m boosting the same set of skills - storytelling. If you think about a consultation, somebody comes in and the first thing you say is, please tell me your story. But we call it ‘history’.
“I believe the arts makes me better at medicine and vice versa. In fact, I think I’m boosting the same set of skills - storytelling.”
When you're a doctor, you're trying to listen to somebody's story to understand it on all its levels. You’re trying to notice the inter-connections between the things that are being said as well as the things that are not being said. Then the next part is to help the person whose story it is make sense of it. And finally, you workshop with them how to change their story. I believe that’s what many clinical encounters are. The better I am at understanding how stories interact with people, the better I am as a clinician and the better I am as a storyteller.
As a writer, it’s a similar process, although obviously there are some differences. I get to create a character and place it in a difficult situation, but many of the techniques for understanding story and tensions are similar.
In the arts I learnt about story sovereignty, and the idea that I’m just a guardian or mentor of the story, I don't own it. That’s similar to how we’re trying to evolve medicine, by letting the patient lead and move away from paternalistic care.
Thank you so much for your time today, Renee.