George Laking: Cancer specialist develops a rare form of cancer and considers it a learning experience

Dr George Laking is an associate professor of medical oncology and clinical director Māori in the Centre for Cancer Research, Te Aka Mātauranga Matepukupuku.  Cancer specialist Dr George Laking’s interest in medicine took root in his teenage years, sparked by his mother’s nursing career which ranged from theatre nursing to hospice care. Little did he know that his Māori heritage, initially hidden in the folds of family history, would also later emerge as a powerful guiding force. That was because George’s iwi affiliation, Te Whakatōhea, was revealed in adulthood, through genealogical research conducted by his mother’s cousins.

 

“When that information reached us in adult life, we had to process it, but it all started to make sense.”George attended Karori Normal and Wellington Boys, but it was in the first three years of his medical degree at Otago, that he’d first felt he was missing something.

“It was such technical training. There wasn’t the mind-extending content I thought I’d find at university. I needed some philosophy.” He approached the dean and asked if he could step out of the medical programme to enrol in a few arts papers and return to medicine later.

“He told me not to leave, but to do a medical science degree and include a philosophy paper. I did philosophy of mind with ethicist Grant Gillett, including a project on criminal responsibility and how that’s legally understood. We also covered sanity in medicine, psychosis and the likes.”

After that, George thought he would end up in neurology or psychiatry. He finished his medical degree at Wellington School of Medicine and his first house officer job was in oncology. “I knew a bit about the challenges in that field as Mum had been working in the hospice. That’s what I ended up specialising in. I don’t regret it.”

By the time George had received the revelation about his whakapapa, his career in healthcare was well under way, setting the stage for the integration of his personal and professional identities. George now incorporates tikanga Māori in all of his work. He follows Māori health protocols considering the wairua (spiritual), hinengaro (psychological), tinana (physical) and whānau (extended family) dimensions. He acknowledges the scholarship that’s gone before in this area. Sir Mason Durie has been a leading light since the 1980s with his paper about the ‘Te Whare Tapa Whā’, the four corners of well-being and the Māori model of health. He said the World Health Organisation’s biopsychosocial model of health wasn’t working for Māori because it didn’t have a spiritual dimension to it. That taha wairua aspect has been a real journey of understanding for me. Spiritual elements of health are also strongly developed in the Western tradition through the work, for example, of Dame Cicely Saunders, founder of the modern hospice movement.

“In tikanga Māori, wairua explains so much about what it means to live here, so that is one of the motivating reasons why the health culture we develop has to have recognisable continuity with tikanga Māori.”

 

“Ultimately, there could be better outcomes for patients’ recovery if they could get the rest they need in a more holistic environment.” – Associate Professor of Oncology, Dr George Laking

George undertook his postgraduate work overseas, between 2000 and 2007, completing an MD on tumour perfusion and PhD on the economics of diagnosis. “One of my focuses now is the pursuit of equity. I’m very glad to see increasing talk about it because it wasn’t really part of the health economic training I had in the UK 20 years ago.” When George returned to Aotearoa, he applied for a job at Pharmac, on its Pharmacology and Therapeutics Advisory Committee. “Central government was becoming a lot more interested in ethnicity, so when I applied they said, ‘Do you whakapapa Māori?’ It was the first time I’ve been confronted with a box to tick like that and I thought, ‘What do I do? I suppose, yes’. So I ticked it and they said, ‘We’ve got a job for you in Māori health.’ I didn’t look back.”

Now as well as his hospital role, George is an associate professor of medical oncology at Waipapa Taumata Rau and clinical director Māori in the Centre for Cancer Research, Te Aka Mātauranga Matepukupuku. He is also the co-medical director of the Cancer Society of New Zealand, the first Māori in the position. His specialty is sarcoma, tumours that grow in the connective tissue. But also Māori health, lung cancer, smoking cessation and health economics.

It was his involvement with Te Ohu Rata o Aotearoa (Te Ora), the Māori Medical Practitioners’ Association, that led to him finding a bridge to connect the world of medicine with Māori culture. The annual Reo Wānanga organised by Te Ora offered further opportunities to explore his heritage.

“I already spoke some te reo Māori before we went overseas, but I had to learn pretty rapidly at Te Ora.

“I try to fit language exercises into the 15-minute ferry ride coming across the harbour to work from Devonport.”

He’d like to be as fluent in te reo as he is in German, which he learnt in his 20s encouraged by his German wife.

“I feel very relaxed with conversational German, and I just wish I would get to the same point with te reo,” he says.

“My fluency is nowhere near where I want to be. I feel okay about mihimihi but conversationally, I’m a long way short of what I want.”

In his dealings with cancer patients, George has come to believe that physical spaces in the New Zealand health system are not conducive to healing, a point that became all too apparent recently when he himself was a cancer patient. In 2023, George was diagnosed with a metastatic basal cell skin carcinoma on his neck for which he underwent surgery, skin grafts and radiotherapy. He has now been given a clean bill of health.

“It’s a rare kind of cancer and I guess as an associate professor of oncology, it became all part of the research, for me to get a rare one.”

It’s a cancer caused by exposure to UV rays, and since George had another cancer on the top of his head some years ago, he has been very careful – despite his love of outdoor activities including cycling, hiking, trail running and kayaking. These had to be put on hold during his cancer treatment but he’s now had the clearance to return to his bike and kayak.

 

The health culture we develop has to have recognisable continuity with tikanga Māori.- Associate Professor of Oncology, Dr George Laking

George’s experience in hospital brought home concerns he has had about the hospital environment for some time.

“The staff were great and nice people, but the environment, ironically, is not a healing one. There are fluorescent lights, the constant beep of monitors, alarms, processed air and the smell of disinfectant. It’s actually stressful and hard to sleep at a time when you need it most,” he says.

George points to architectural research being conducted overseas to design better hospitals.

“I went to a big exhibition of architecture when I was in Munich, Germany, that presented the best ways in which a hospital can be designed to be a healing environment.

“Every time we rebuild, we have an opportunity to include these architectural ideas. Ultimately, there could be better outcomes for patients’ recovery if they can get the rest they need in a more holistic environment.”

George also has a practical way to improve communication between hospital patients and medical professionals.

“All staff should have a proper name badge the patients can see. Lanyards often face the wrong way or are hidden from view. Patients then have to describe information that’s been conveyed to them by ‘the tall guy with frizzy hair and glasses’. It’s such a simple thing.”

His Health Research Council-funded research through Māori health advocacy group Hāpai Te Hauora and Hei Āhuru Mōwai, cancer specialists’ network, aims to reimagine healthcare and create healthcare services that extend beyond hospital walls, connecting with communities and fostering trust. In his clinical work, George has seen the devastating effects of delayed cancer diagnoses. He believes community connections are vital to reforming New Zealand’s health system. The usual pattern is that patients attend appointments at clinics and hospitals that can be some distance from their home environs.

“Although operations and some scans still have to happen in the hospital, these days a lot of the knowledge work can be discussed anywhere. So it’s possible that you can have a meeting with a specialist closer to your own place and there’ll be advantages to that. Being on your own turf, you’ll feel stronger.”

“Also, with cancer, many people suffer, the whānau as well as the person with cancer,” says George.

“But if we’re there as experts helping them in the community that’s so much better. There’s also Whānau Ora which pre-exists in the community. So these services need to talk to each other… that’s what Hāpai Te Hauora is looking at.”

By embracing cultural traditions like tikanga Māori, he envisions a healthcare system that not only heals bodies but also strengthens the fabric of society.

“It can be simple things like improving communications to ensure people arrive at the right place and the right time for their treatments. There’s strong evidence about this hypothesis that shows it will lead to better outcomes.

“Māori have all sorts of reasons to mistrust health services, but more generally, we’ve seen erosion of trust in social institutions. So if you can make one social institution work well – health – that’s nation building.”