Transcript THE AOTEAROA HISTORY SHOW: Epidemics MĀNI: Over the last year and a bit you might have noticed people saying “we’re living in unprecedented times” WILLIAM: And every time they do that. A historian dies a little bit inside. Covid-19 might be new to the world but there is nothing new about epidemics and pandemics. Disease has shaped human history for thousands of years, including here in New Zealand! MĀNI: It used to be that most people would die from an infectious disease - actually, they’d have a very good chance of catching a lethal bug before their first birthday. And Aotearoa has a particularly weird history when it comes to epidemics. INTRO STING MĀNI: Ok, what’s so weird about New Zealand’s history of epidemics? First weird thing. For the first 500 hundred years of our history, from about 1270 to 1770AD there were no epidemics. Māori occasionally got stomach bugs or pneumonia, and sometimes those infections killed people. But there was no mass death from disease. WILLIAM: Meanwhile, in Medieval Italy, people were writing stuff like this “The condition of the people was pitiable to behold. They sickened by the thousands daily, and died unattended and without help. Many died in the open street, others dying in their houses, made it known by the stench of their rotting bodies.” MĀNI: So why were things so different in Aotearoa than in Europe or Asia? Partly because Māori didn’t have any farm animals. Usually the worst epidemics evolve in other species, then jump across to humans. WILLIAM: Covid-19 is a good example. As we’re recording this, in December 2021, scientists think Covid first evolved in bats, then moved on to another kind of animal, before finally jumping into a human. MĀNI: For thousands of years in Europe and Asia, people were constantly rubbing shoulders with livestock like cows, pigs and chickens ...and also with pests like rats. WILLIAM: Also, Europe and Asia had heaps of crowded cities where an epidemic could quickly spread to hundreds, sometimes even thousands, of people. There was also a lot of long distance trade, which carried disease between communities. Most infamously the Black Death, which reached pretty much every part of Europe MĀNI: Meanwhile Kāinga Māori, villages, were relatively small and isolated - from each other and the wider world. So diseases didn’t arrive from overseas, and when they started locally they probably didn’t spread far. WILLIAM: But in 1769, when Europeans landed in Aotearoa for the first time, they brought their diseases with them. MĀNI: One of the worst early epidemics was known as “rewharewha”. Historians think this was an outbreak of influenza which happened around 1808. Historian Dr Don Stafford wrote this about the impact on Te Arawa in the Rotorua region “Kawaha [Point] suffered severely, tradition claiming its residents died in such numbers that they were buried where they lay or just left in heaps. Two houses, Raparapa and Mokai-a-te-koko, were full of people, 6 to 10 in each. They all died and were left where they lay, the houses being abandoned.” WILLIAM: Rewharewha may have been the worst epidemic New Zealand has ever seen, some stories talk about half the community dying. MĀNI: The Ngāti Ruanui poet Turaukawa composed a waiata, a song, describing the impact of introduced diseases like a spear from heaven. “Tokotoko tao, kotahi te turanga, Tokotoko rangi, ka ngaro te kai, ka ngaro te tangata.” “The spear of wood slays one person at a stroke, The spear from heaven sweeps away food and obliterates people.” WILLIAM: And Rewharewha wasn’t the last epidemic. Missionaries like John Hobbs regularly wrote about the impact of introduced disease on Māori in the 1820s and 30s. “We have of late had a very uncommon degree of sickness amongst the people and vast numbers of them have died. I have taken the principal charge of giving them medicine and great has been my distress at witnessing their miseries … Some of the people are taken and dead in a few hours.” MĀNI: But at the time, nobody could explain why Europeans in New Zealand were relatively healthy, while enormous numbers of Māori were getting sick and dying. The understanding of bacteria and viruses was in its infancy. WILLIAM: There were lots of different theories though! Some missionaries suggested God was punishing Māori for failing to convert to Christianity. Some Māori agreed with the missionaries, others thought they had angered traditional atua, gods or deities, by adopting the new faith. MĀNI: Even in the early 20th century there was widespread misunderstanding about why the Māori population had fallen so quickly. Some blamed alcohol and tobacco, others blamed warfare. WILLIAM: And you know what? We still don’t know exactly. But we do have some better ideas. Many scientists and historians think that the waves of disease which ripped through Asia and Europe over thousands of years boosted immunity in the wider population. Whereas Māori and other indigenous communities never had a chance to build up those defences. MĀNI: The other big factors in the high Māori death toll were land and food. At the same time the Māori population was reaching its lowest number in the late 19th century, Pākehā colonists were thriving. Between about 1870 and 1940, Non-Māori New Zealanders probably had the longest life expectancy anywhere in the world! WILLIAM: Partly that’s because of what historians call the Healthy Migrant Effect. You’re probably not going to sail halfway around the world unless you're relatively young, fit and well. And those who weren’t often died on the way. So colonists were healthier than your average European to start with. MĀNI: Then, once they arrived, they had access to a better diet than your average European. With the boom in sheep and cattle farming they got a lot more meat and milk … and good nutrition helped fuel their immune systems to fight off infection. WILLIAM: But this food was grown on land which had been owned by Māori. Loss of land through colonisation led to a loss of traditional foods, and also an inability to grow new foods. So, less weka and eels, and little mutton and milk in its place. MĀNI: It also meant Māori were forced into environments which damaged health in other ways … epidemiologists Dr Alistair Woodward and Professor Tony Blakely put it like this. "There are many reports of crowded and poorly ventilated housing. … water was taken from shallow wells, or from streams, that were often contaminated by sewage or other wastes. … Some typhoid outbreaks were caused by discharge of raw sewage from European settlements into open waterways which then polluted traditional gathering sites for shellfish and other kai moana." WILLIAM: What’s worse, in the late 1800s thousands of Māori had to attend the Native Land Court to try and hold on to what little customary land remained. MĀNI: If you don’t know what the Land Court is, don’t worry, we’re going to do another episode all about it. For now, just know that while they were waiting for Court hearings, Māori had to spend weeks or months hanging around colonial towns and cities. WILLIAM: And what was so bad about that? Well here’s a poem about Auckland from 1882. “Foul putrescence lieth on each site of the street, And in each festering backyard, slops swelter in the heat. The cess-pits belch forth gases on fever-laden air, And fever damp uprolleth from sewer-gullies there. Death grins, ‘twixt each fence paling, upon each passer-by, And the earthless privy boxes cry out, "prepare to die." MĀNI: In many 19th century towns and cities it was totally normal to throw human waste into the street... or into a pit in your backyard. Dangerous bugs from human waste easily contaminated wells, rivers and lakes. Contaminated water was a major cause of death in Aotearoa, especially for young children, and especially for Māori. WILLIAM: One of New Zealand’s more deadly cities was Christchurch. In 1870 the city’s death rate was twice the national average. MĀNI: If you want to stop epidemics, you need to keep poo out of your drinking water! And in the late 19th century the government stepped up its game. WILLIAM: In 1882, Christchurch became the first city in New Zealand with a proper underground sewage system. Over the next few decades the government invested huge amounts of cash building sewers and high-pressure water systems. But this was a long process. Even in the 1950s most communities didn't have access to safe drinking water. Some places in New Zealand still have problems with dodgy drinking water today. MĀNI: The epidemics of tokotoko rangi, the spear of heaven, lasted more than a hundred years. Measles, Typhoid, Whooping Cough, Influenza, Tuberculosis. How many died from all these diseases? Well we don’t know exactly. For most New Zealand history there isn’t good, nationwide data on the Māori population. Instead, historians make estimates based on local surveys, written reports and oral history. WILLIAM: Our best estimate is that between the time James Cook arrived in 1769 and the year 1900 the Māori population fell by 50 to 60 percent - From roughly a hundred thousand, to less than 50 thousand. MĀNI: The Musket Wars and the New Zealand Wars account for some of those deaths, but it’s likely far more Māori died from disease than were ever killed in combat. But… Here's the second weird fact about New Zealand’s history of epidemics. Māori death tolls from disease were relatively low compared to other colonised indigenous people. WILLIAM: In Aotearoa impacts of colonisation like disease and war cut the Māori population in half. But over in the USA, the impact of disease was even more devastating; it's thought the Native American population fell by around 90 percent. In Australia, historians estimate the Aboriginal and Torres Strait Islander populations fell between 80 to 95 percent. You see similar numbers for indigenous communities all over the Pacific, and the Americas. So… why didn’t that happen in Aotearoa? MĀNI: Well.. maybe it did happen. A few historians think we’ve underestimated how many Māori were living in Aotearoa before Europeans arrived. If they are right, then the toll from disease might have been similar to other indigenous communities. WILLIAM: But if we are sticking with the most widely accepted numbers, there are a few explanations for the lower death toll. First, timing. When colonisation happened in other parts of the world, like America, there were some absolutely massive epidemics rolling around Europe. So a lot of people who got on ships to colonise those countries carried the infections with them. But by the time New Zealand was colonised those epidemics were mostly over. So there weren’t as many sick people on the ships coming here. MĀNI: Second, Aotearoa was a long way from Europe. If any colonists were sick when they set sail, they usually either died or recovered before they got here. So some of the deadliest diseases, like smallpox and cholera, either never made it to New Zealand, or caused relatively small outbreaks. WILLIAM: And at least to start with, there was some collaboration between Pākehā and Māori to improve Māori health. In 1825, a Māori chief, Te Pehi Kupe, visited England and received a smallpox vaccine; he was the first ever Māori to be vaccinated. MĀNI: By 1854 a national campaign was underway to vaccinate more Māori against smallpox, and Māori were keen to take up the vaccines. WILLIAM: Pākehā Doctors were appointed as Native Medical Attendants to Māori communities MĀNI: Pamphlets with advice on health and sanitation written in Te Reo Māori were distributed far and wide. WILLIAM: Governor George Grey also built several small hospitals in colonial settlements which he encouraged Māori to use free of charge - Europeans had to pay for treatment. MĀNI ...And some of them were pretty annoyed by that. Like the Otago Settlers' Association which said. “If the hospital be for the Natives, it ought to be on one of their reserves ... and not in Dunedin, where there are no Natives, and which is so distant from and inaccessible to their locations”. WILLIAM: But the Otago Settlers Association was missing the point. The idea of government-funded healthcare wasn’t just to treat sickness, it was to pull Māori into contact with Europeans. Some colonial leaders, like Governor Grey, hoped British-style healthcare would encourage Māori to assimilate into British society. MĀNI: But Māori were often very wary of hospitals - and that was a fair call! 19th century hospitals were dangerous, unhygienic places. Until the 1870s, surgeons didn't even wash their hands! And in the middle of all this, in the 1860s, the New Zealand Wars happened and a lot of those early healthcare efforts were interrupted. WILLIAM: By the 1890s there was a new generation of leaders taking on the challenge of Māori health. Especially a group called the Young Māori Party. The Young Māori Party were a bunch of high-ranking, highly-educated Māori men who’d graduated from the Anglican mission school, Te Aute College, in Hawkes Bay. Many went on to become lawyers, historians, politicians… and doctors. They wanted to bridge the gap between Māori and Pākehā. Encouraging both the adoption of new knowledge and the preservation of aspects of Māori culture MĀNI: For example, the Ngāti Mutunga leaders Māui Pōmare and Te Rangi Hīroa, also known as Peter Buck. They travelled around Māori communities in the early 1900s encouraging people to improve sanitation, dig new drains, improve ventilation and set up latrines - basically an old fashioned outside toilet, or long drop. And when a kaumātua complained to Te Rangi Hīroa that latrines were a Pākehā invention with no role in the Māori world, he didn’t dismiss those concerns. Instead he quoted old purakau and whakataukī, stories and sayings, which referred to latrines way back in the past. There’s one famous one, “Ngaua te pae hamuti”, which loosely translated means something like, “bite the toilet seat”. It’s sort of like the Māori version of “bite the bullet” or “grin and bear it” The community was convinced and got to work. WILLIAM: Māori nurses like Ākenehi Hei of Te Whakatōhea also learned to blend European medicine with Mātauranga Māori, traditional Māori knowledge. In 1909, Ākenehi travelled to a gum digging camp at Te Kao in Northland to treat a typhoid epidemic among local Māori. She took a hardline approach, scolding patients who refused to accept new styles of medical treatment. The community turned on her and refused to listen. MĀNI: But Ākenehi Hei learned a lesson from this. She wrote in her journal that... “Great discretion must be used not to offend the patient's beliefs, and at the same time uphold one's own mission” Later, when Ākenehi was treating another outbreak in Hiruhārama, Jerusalem, on the banks of the Whanganui River, she used a more collaborative approach. Whānau worked with her to dig drains, move homes to higher ground, and isolate sick people. WILLIAM: And around 1890 thanks to a combination of increasing immunity, improved sanitation and better access to food, the national Māori population started recovering. MĀNI: But while average Māori life expectancy was rising, outbreaks of infectious disease still killed a lot of people. Ākenehi Hei was one. She died from a typhoid infection while treating an outbreak of the disease among her family in Gisborne in 1910. She was just 32 years old. WILLIAM: Pākehā authorities often praised people like Ākenehi Hei and Te Rangi Hīroa, but they didn’t treat Māori healthcare as a priority. Efforts to create independent Māori health councils collapsed. There was limited funding to improve infrastructure in Māori communities, or to train Māori nurses and doctors. MĀNI: The first systematic tuberculosis survey among Māori was in 1933 in Waiapu on the East Coast. One in every 20 Māori had the disease, and the death rate was 10 times higher than for non-Māori. WILLIAM: And Māori weren’t the only ones to suffer unequal burdens from disease. Chinese, Indian and other non-British migrants were often unfairly stigmatised as carriers of infectious disease. Sometimes with tragic results. In 1903 Kim Lee, a Chinese fruit seller in Wellington, was suspected of having leprosy. He was quarantined alone in a cave on Mokopuna Island in the middle of Whanganui-a-tara, Wellington Harbour. Food was delivered by a rowboat, or a flying fox from nearby Matiu/Somes Island. MĀNI: It’s now thought Kim Lee didn’t have leprosy at all, it was probably a more common disease like tuberculosis. He spent six months alone on Mokopuna Island before he died there of heart, liver and kidney failure. WILLIAM: New Zealand’s most deadly pandemic was the 1918 influenza pandemic, commonly called the Spanish Flu. It probably started on a pig farm in the United States, then made its way into the trenches of Europe in the final year of the First World War. It spread around the rest of the world as soldiers returned home, and is estimated to have killed at least 50 million people: That’s double the death toll of the First World War itself. People sometimes compare the 1918 pandemic to Covid-19, but there were big differences. The 1918 pandemic mostly killed young, healthy people and its deadliest wave spread across the world in a matter of months before mysteriously vanishing. MĀNI: In Aotearoa, some efforts were made at local lockdowns. But those lockdowns weren’t strict enough to prevent the virus spreading, and they weren’t centrally organised. Each region came up with their own rules. What’s worse, many communities organised public celebrations for Armistice Day, marking the end of the First World War. Those celebrations turned into superspreader events. WILLIAM: There was no paid sick leave, so many people either risked catching the disease at work or went hungry - like 19 year-old Janet Fenton, who lived in Mount Eden. Janet got some shifts at the Ammunition Works, but she also had to steal from the greengrocer to feed herself and the family she was living with. “One by one, all of us came down with the flu. I was the last. I was sitting on the front porch, waiting for the doctor to come. Next thing I knew he was carrying me to bed. “It’s your turn now,” he said. “Well,” I said, “who’s going to steal for us now?” … We were skin and bone when it was over.” MĀNI: In many places communities banded together. Food was delivered to the houses of sick people by volunteers, including children in the boy scouts and church groups. Doctors and nurses caught the disease themselves, and ordinary people had to fill their place. Berta Scott started off washing dishes at Masterton Hospital. Three days later, she was second in command of nursing. “We did our best goodness knows but we knew so little. … I think the worst ordeal was when some husband or wife would ask me to find out about his or her spouse, and I’d lie when I knew he or she had died.” WILLIAM: Outside the Pākehā dominated towns and cities, Kāinga Māori were hit even harder. The 1918 flu killed 49 out of every thousand Māori, compared to just 6.5 out of every thousand Pākehā. MĀNI: Pākehā volunteers often organised relief missions to their Māori neighbours. But the more remote kāinga had no outside support. In some small communities, everyone got sick, no one was healthy enough to feed and care for the most vulnerable. The famous Te Rārawa activist Dame Whina Cooper lived in Panguru on the Hokianga Harbour. She was pregnant when the flu hit. “I was the only one that came through out of all the ones that were pregnant … they all died and also the babies, they died ... Everyone was sick, no one to help, they were dying one after the other. My father was very, very sick then … he was the first to die … I couldn’t do anything for him. There was a feeling that aroha, love, is nothing. Your feeling for your relation wasn’t there. Like my own father, when I knew he was dead, I don’t think I even cried.” WILLIAM: Whina Cooper, just like many others, was in shock. Nationwide at least 9 thousand people died in just two months. MĀNI: But New Zealand’s worst legacy from the 1918 pandemic was in Samoa. New Zealand soldiers captured Western Samoa from Germany early in the First World War. But military administrators failed to maintain a quarantine, then doubled down on that failure by refusing food and medical support to sick Samoans. WILLIAM: It's estimated 8 thousand 5 hundred people died… More than 20 percent of the entire Samoan population at the time. Many of them are buried in a mass grave right in the centre of Apia. MĀNI: Despite all the tragedy, one good thing came out of the 1918 flu - a major review of New Zealand’s healthcare system. There was heavy criticism for the government’s lack of preparedness. One doctor, David Lloyd Clay, who had experience treating flu outbreaks overseas described the Health Department as “helpless” and “wholly unprepared”. WILLIAM: Clay and other critics focused on the failure of quarantines, which could have stopped the disease reaching Aotearoa in the first place, or prevented it from spreading so quickly. MĀNI: In response the health system was completely overhauled. In fact, many of the laws being used to combat Covid-19 today were first written in the wake of the 1918 flu. WILLIAM: For example, the Health Minister was given the power to close down public events and private businesses, and to requisition food and medicine for patients. Voluntary organisations like the Red Cross and St John Ambulance were bolstered with government funding. MĀNI: But historians such as Geoffrey Rice say the most significant change was the establishment of the Division of Māori Hygiene, under the leadership of Te Rangi Hīroa, one of those Te Aute graduates we mentioned earlier. WILLIAM: The Division was chronically underfunded but it made significant improvements to the health of Māori communities: effectively scaling up the Young Māori Party’s healthcare policies It sent Māori nurses and doctors into kāinga, and gave advice on reducing the risk of infection. MĀNI: In 1924 Te Rangi Hīroa presented a report which said. “The tokotoko rangi that the ancient poet Turaukawa lamented over, no longer makes thrusts that go unparried. Sanitation has made great advances… Water-supplies are protected, and modern systems installed.” WILLIAM: Over the next few decades, the death toll from infectious diseases plummeted for all New Zealanders, and especially for Māori. Some of the biggest killers like tuberculosis and typhoid are now easily treated with antibiotics. MĀNI: There have still been other outbreaks, like the polio epidemics of the 20th century. WILLIAM: Yeah, the polio virus caused paralysis, and these are callipers, used to help people walk. The country suffered a string of polio epidemics – in the 1910s, 20s, 30s, 40s and 50s – it killed hundreds, especially children. Schools were closed, and families had to quarantine. But, increasingly medical technology has come to our rescue. Vaccines all but eliminated the threat of polio, and dramatically reduced the impact of measles, mumps, rubella, meningitis and influenza. WILLIAM: But there are still inequalities in New Zealand healthcare. Māori and Pasifika children are far more likely to suffer infections due to damp, overcrowded housing. Sometimes those infections turn into rheumatic fever and cause lifelong disability. MĀNI: And as we’re recording this now, in December 2021, the vaccination rates for Māori have lagged other ethnic groups and the government is facing stiff criticism that it’s Covid-19 response is failing Māori. MĀNI: So we have learned lessons from history when it comes to epidemics but there are still clear inequities. That’s all for this episode.