When you think of drugs, your mind probably goes straight to the obvious – weed, party culture, the spectacle of harm. But the substances most deeply embedded in Aotearoa’s everyday life rarely attract the same scrutiny. Sugar, alcohol, and caffeine have been normalised to the point of invisibility. Their impact is not immediate, but cumulative, shaped as much by environment and access as by what we are told is “individual choice.”
That idea of choice, however, is far less straightforward than it is often made out to be. Health behaviours are frequently framed as personal decisions, yet they are deeply influenced by what people have access to, what they are exposed to, and what they are able to understand. When health information is unclear or inaccessible, the ability to make informed decisions becomes limited. In that sense, gaps in health literacy do not just shape outcomes; they shape what feels possible in the first place. It is within that landscape that Māia Lockyer’s story sits.
Raised Between Worlds
24-year old Māia (Ngāti Kahungunu ki Heretaunga, Ngāti Porou, Rongomaiwahine) is a fifth-year medical student at the University of Otago, but her pathway into medicine – and into Aotearoa itself – has not followed a conventional route. Born in Tāmaki Makaurau and raised largely in the Middle East, she spent most of her childhood between Dubai and Saudi Arabia before moving to Ōtepoti at eighteen. “That was my first time really living in New Zealand,” she shared. Her sense of home, like her pathway into medicine, has never been confined to a singular place.
Māia’s upbringing gave her an unusually broad vantage point early on. She did not grow up assuming that one system, one culture, or one way of living was the norm. Being immersed in different religious, cultural, and social environments meant she learned early that the way a country structures care, community, and daily life is always shaped by values. Nothing simply appears that way by accident. That perspective would become especially significant once she began comparing the healthcare she experienced overseas with what she saw members of her own whānau navigating here.
As a teenager in Saudi Arabia, Māia required orthopaedic surgery and was able to access specialist care almost immediately. “I was seen by a surgeon the same day, and within a week, I had my surgery done,” she shared. Back home, her whānau were dealing with a reality that looked very different: delays, scarcity, pressure, and the quiet indignity of trying to secure care in a system that always seems stretched too thin. What that contrast revealed to her was not just the difference between two countries, but between what systems make possible for some, and what they deny others. That gap would stay with her. So would the knowledge that in Aotearoa, many of the things hurting people most are neither hidden nor rare – they are sold, promoted, and normalised every day.
Taking the Scenic Route
Māia’s path into medicine did not arrive wrapped in prestige, but the decision to pursue it emerged gradually. As the eldest daughter and granddaughter in her whānau, care had always been expected of her. Over time, that expectation became something she chose to carry. But care is not only something we give; it is also something we owe ourselves. For Māia, that meant leaving high school before completing her final year, stepping away from an environment so relentlessly competitive that it had begun to erode her mental health.
While that decision disrupted the conventional route into university, it did not end the journey. She finished her entrance requirements through alternative measures, arriving in Aotearoa bursting with ambition and an awareness of how much she would have to figure out as she went. It seems that responsibility, once something expected of Māia, had begun to shift – no longer just something to carry, but something that carried her forward as well. Though initially enrolled to attend the University of Auckland, it was a trip south to support an uncle at his Māori graduation ceremony that shifted things. “The energy was so beautiful. [It felt really] unique to Otago, and that's what made me want to come here.” Settling into Ōtepoti, however, brought its own kind of adjustment. Moving to the other side of the world and stepping straight into flatting independently meant that much of the transition happened all at once – new city, new rhythms, and, of course, new expectations. But her first year unfolded during the outbreak of COVID-19 and the rise of public debate that made the space feel less like somewhere you belong, and more like somewhere you had to justify your place.
Earning Your Place Twice
Medicine doesn’t leave much room for anything outside of itself, it seems. The workload is constant, the expectations are high, and the pace rarely lets up. For many students, that’s already enough. But for tauira Māori, Māia says “there tends to be this underlying expectation that I’ve got to prove why I have a place here.” It shows up in how people talk about pathways, in the assumptions that sit just beneath conversations, and in the way you become aware of how you are being read in the room. You keep up with the content, sit the exams, do the mahi – you meet the standard, and then are expected to keep proving that you belong.
By her third year, that pressure had shifted into something larger. In 2023, while serving as Tumuaki of Te Oranga ki Ōtākou, much of her time sat alongside student advocacy – responding to concerns around structural racism, unsafe learning environments, and the conditions students were being asked to move through. It was, in Māia’s words, “hard for so many students to be able to navigate medical school on top of being away from home and all of those normal experiences that you have as a young university student,” a year that stretched well beyond coursework alone.
But not everything holds. Amongst the chaos of being Tumuaki while navigating her third year, Māia describes it as one of the hardest periods she’s experienced. It’s something she speaks about directly and with intention, however. “I would love to be able to help normalise failure – because in the end failure will never truly be failure unless it stops you from picking yourself up and trying again.” It leaves the direction unchanged, even as the route readjusts, drawing her toward emergency medicine.
At the Point of Entry
Emergency departments are often where unmet needs surface most urgently, and where impressions of care are formed early. That is what first drew her in: the pace, the intensity, the expectation that you act. “That moment in the emergency department can either make or break your experience with secondary health care,” Māia said. For Māori and Pacific patients, who are overrepresented in acute presentations yet severely underrepresented within the workforce, those encounters carry weight the system has yet to learn how to hold.
These encounters don’t sit in isolation. They track directly into the broader conditions that continue to shape health outcomes in Aotearoa, where responsibility is often watered down to individual behaviour – what people eat, drink, or consume – while the environments those choices are made within are left largely unexamined. In clinical settings, she says there is a pattern: “The instruction is there, but the explanation as to why our health behaviours matter is not.” Without that context, patients are expected to change without being given the means to understand what change requires, or why it matters. Health literacy, then, is not just the transfer of information. Instead, it is about whether people are equipped to interpret, question, and act within systems that have not always made that possible.
Substances such as sugar, alcohol, and caffeine sit at the centre of this conflict. In Dunedin, that normalisation is easy to recognise. Caffeine runs through the veins of student life, fuelled by deadlines, late nights, and a culture that rewards constant productivity. It is rarely questioned, even as dependence becomes routine. These substances are not inherently harmful, yet their constant availability and saturation within everyday environments make them difficult to avoid and easy to normalise. In many communities – particularly those shaped by economic constraint – these are not just options, but some of the most accessible forms of consumption. Their use, then, cannot be reduced to individual choice. “Targeted marketing has a lot to answer for here,” Māia said, pointing to how access is not only uneven, but actively shaped. She notes the concentration of liquor and tobacco outlets in Māori and Pacific communities, and more broadly in areas experiencing deprivation. What is available, what is affordable, and what is repeatedly placed in front of people cannot be separated from what is consumed. Alcohol follows the same pattern. Its normalisation obscures its harm, while its distribution reflects the same logic – profit prioritised over people, and consumption sustained by design.
What Brings People Here
What Māia speaks to is not just what shows up in emergency departments, but what leads people there in the first place. The substances, environments, and patterns of harm she describes do not sit outside care – they arrive with it. When access is shaped, exposure is uneven, and explanation is absent, outcomes follow. What is often framed as individual choice is, in reality, determined well before a patient walks through the door. Māia moves toward that space not just to meet what arrives, but to change what is carried there – carrying that weight, and still insisting on the possibility of something better.
