Telehealth has been touted as one solution to New Zealand’s ongoing health-care crisis, which is particularly stark in rural regions. But moving health services online can have a number of unintended consequences that can impact the wellbeing of patients and doctors.

In my poem Heart risk 1 v Sore puku 0, that was published on Corpus, I wanted to capture the tension between the demands of health funders, who concentrate on specific health targets, and the needs of patients who present to the iwi health clinic that I work at. I have a real concern that taking a target based approach can lead to unintended consequences. The poem potrays this unintended consequence as a disconnection between patient and doctor and the loss of trust.

Recently I had a patient who was discharged from hospital after a hip joint replacement. The trouble was that she had no home to live in and had to make do with a leaky bus. Living in a bus is not great for rehabilitation purposes!

During the week I had a conversation with someone about his land that he owns. It is Māori land owned by a number of shareholders. His family have had ownership to a large portion of the block. The issue is that other shareholders have begun to encroach on his family’s block of land and erect buildings where, by custom, they should not have been erected. This has resulted in a great deal of tension and conflict between shareholders, who are all whānau. Some of the conflict has become violent and has created rifts between whānau. He remarked that this conflict distracted Māori from the real fight – that of fighting for the return of other land that was lost through the colonisation process. What this man was referring to is termed horizontal violence. Horizontal (or lateral violence) is displaced violence where conflict occurs between peers rather than towards a true adversary. It occurs as a result of oppression and colonisation.

There are a number of theories that attempt to explain power. One such theory is Gaventa’s Power and Powerlessness.¹ This theory describes three dimensions (or faces) of power. In the one-dimensional approach to power the oppressor has power over the repressed to the extent that they can get the repressed to do something that they would not otherwise do. There are a number of assumptions made with this approach - that people would act upon injustice, that there are no impediments to them acting on injustice and that they would act either themselves or through leaders. If inactivity occurs then it is assumed that this inactivity is not a political problem. Inactivity is framed as a deficit of the powerless through discourse that blames the victim.

Colonisation has a negative impact on indigenous cultures and ways of life. Disease, death and despair are its handmaidens. Colonisation is not a word that is bound in the past tense, chained to the actions of previous settlers, but is a word that continues to creep and choke in the present tense, perpetrated by our own actions or inactions.

Research has the potential to affect change for the betterment of society, but it also has the power to cause harm. One of the ways in which harm occurs is through the appropriation of knowledge for the benefit of researchers and not the benefit of the researched. For indigenous people research is often experienced as a colonising tool. In part, related to the colonising aspect of Western-led research, indigenous methodologies have developed in which research is participatory, reciprocal, accountable, culturally appropriate and led by indigenous people for the benefit of indigenous people.