In a job where he's faced with unimaginable horror on a daily basis, a Starship Hospital doctor is remarkably positive - particularly when speaking about the resilience of children.
"I've seen so many children and young people over the years. When you consider what they have lived through, I'm just astonished how despite all of that they are able to move forward and make progress," Patrick Kelly (ONZM) from Starship Hospital's Te Puaruruhau Child Protection centre told Newshub.
Optimism aside, he's calling family violence one of the biggest health issues New Zealand faces and is urging the new government to prioritise a response to it.
Dr. Kelly was head of Starship's Child Protection centre for 25 years. He recently stepped down but still works as part of the team.
The team - including doctors, nurses, psychologists and social workers - see children under 18 who have been abused, neglected and sexually assaulted. They offer a 24-hour urgent medical service for acute abuse cases.
Dr. Kelly is speaking to Newshub in his capacity as an expert paediatrician in the area of child abuse and neglect and not on behalf of Te Whatu Ora.
While he doesn't go into specific detail about aspects of his work, it's clear he has seen it all and then some.
"Sadly just about anything you can conceive of an adult doing to a child's head - we have seen," he said.
Most children who die from abuse, die from injury to the head, according to Dr. Kelly.
"On average there's a child in Starship Hospital once a month with a serious head injury from child abuse that almost invariably has caused brain damage," he said.
Lower Hutt toddler Ruthless-Empire Ahipene-Wall died just days before his 2nd birthday in October.
Post-mortem results confirmed the little boy's cause of death was from blunt force trauma.
Police believe the injuries were not accidental.
No charges have yet been laid and police previously indicated they were not getting the full information they needed from persons of interest in the case.
Dr. Kelly, who received a Queen's Birthday Honour in 2016 for services to children's health, says he's tired of the issues that keep recurring again and again.
"I do get tired of the lack of sustained attention that is paid to this issue," he told Newshub.
"There is a cycle of interest driven by the latest tragic case but no sustained committed policy that is adhered to and built on government after government.
"Take for example smoking - most governments have recognised it's bad for you. Whatever government comes in continues that. There isn't the same kind of sustained and continued focus on child abuse."
Dr. Kelly said New Zealand's rate of child abuse is much higher than many comparable countries.
Jane Searle, Chief Executive Officer of Child Matters - a group working to prevent child abuse - said while she's always saddened at child abuse cases, she's never shocked or surprised.
The charity Child Matters was started almost 30 years ago after the death of 2-year-old Delcelia Witika in south Auckland in 1991.
The toddler was found lying dead in a pool of blood, urine and faeces. She was emaciated and had also suffered serious burns.
At the time, the judge in the case called it one of the most disturbing cases of child abuse to ever come before the High Court. While a newspaper headline stated: "Jurors wept over photos of child's injuries".
Delcelia's mother and her mother's partner were jailed over her death.
If she was still alive, Delcelia would have soon turned 35 years old.
Searle believes since Delcelia's death back in 1991, no politician or political party has ever made any significant change on the issue.
"No politician stands up every year and commits to bringing child abuse statistics down. It's not a vote-getter. No political parties have moved the dial at all," Searle said.
Official Information Act data recently provided to Child Matters shows between January 1, 2015 and October 31, 2023, 71 Kiwi children aged under 14 died as a result of murder or manslaughter.
Searle told Newshub the new government needs to prioritise bringing child abuse statistics down.
"A coalition made up of three parties is a real opportunity to implement change and show leadership on the issue," Searle said.
"We have been waiting too long to implement solutions. Everyday children in New Zealand are suffering from abuse and neglect so it has to be something of urgency."
Searle has previously worked in the police helping investigate child abuse cases.
"It's incredibly demanding and complex work and it's always tragic. It is a confronting issue as it exhibits the worst of human nature," she said.
She moved to Child Matters as she wanted to be part of the solution.
"Doing nothing is not an option for me. That means we've given up on the issue and that's not even an option."
In terms of solutions, Searle believes New Zealand needs to implement mandatory training for professionals who work with children (e.g. teachers, health workers, coaches) to identify risks and the signs of abuse and neglect and know how to respond.
"There's a lot of people who slip through the gaps and don't receive the training they need. This is a tool we should be using and we're not using it," she said.
Searle also stresses the importance of the monitoring of children.
"What we need is a system - that once risk is identified, the system is able to have on-going monitoring of the wellbeing of that child because at the moment that doesn't always happen," Searle told Newshub.
"Sometimes that can be years of support and involvement. The system may need to commit years of support to the family to ensure the wellbeing of the child. The government needs to put a framework in the system so that community organisations can be part of the response. We are missing opportunities to protect these children."
There are countries overseas where Searle said it's mandatory for professionals working with children to report concerns of abuse or neglect.
She believes that could be a useful tool if it was introduced in New Zealand as part of other reforms.
Another thing New Zealand is not doing according to Searle is ensuring child abuse statistics are publicised every year.
She recently wrote an opinion piece stating that her charity is forced to collect figures on the number of children who have lost their lives to abuse and neglect from media reports.
"One would think these critical figures would be collated, published and debated …. " Searle wrote. She compared the fact that Waka Kotahi and Water Safety New Zealand openly report death numbers.
Oranga Tamariki's own website says "there is no single data source that gives a holistic and exact understanding of harm to children in New Zealand. Current data sources include Oranga Tamariki, Police, the Integrated Data Infrastructure (IDI), the Ministry of Health, and the University of Otago's Injury Prevention Unit.
It goes on to say "the current level of unreported harm to children in New Zealand is suspected to be significant. Therefore, relying on official records is likely to understate the problem."
Searle also states there needs to be an independent investigation of all cases where a child has lost their life to abuse or neglect.
"That's so we can understand where the system should have responded better. That will bring accountability and enable us to strengthen the system," she told Newshub.
Dr. Kelly believes while Oranga Tamariki can often get blamed when things go wrong, we all need to take responsibility.
He said family members, early childhood centres and the wider health system all need to be on the look-out for signs of violence and neglect.
"It's everybody's business. It requires the whole community to pull together on this."
He's also adamant that better support for frontline health staff is part of the solution.
"Outside of the Child Protection team at Starship, we don't have a similar structure of support for frontline health staff to seek a second opinion if they're concerned about something," he said.
"It's up to them to report it or not. They only have one option and that is to ring Oranga Tamariki and make a report of concern. Starship has a multidisciplinary child protection team. It's not a system replicated elsewhere around the country.
"We need to grow a culture which makes it easier for people when they have those concerns to get appropriate advice. At the moment it's just phoning Oranga Tamariki and that can be a difficult step for people to take," Dr. Kelly said.
"People think oh what if I'm wrong? It's okay to not be sure. Professionals are paid to figure that out," Searle said.
"People don't realise they can make an anonymous referral".
Searle wants the new government to stand up and acknowledge New Zealand has a significant issue with child abuse.
"We will never eliminate child abuse or neglect but we need to bring the statistics down. When we reduce statistics we are saving the lives of children and that's what makes it worth it," Searle said.
While Dr. Kelly has thought of quitting his job in the past, what keeps him going and makes it worth it is seeing a child's potential.
"The other thing is the heroism of family members. Often when a tragedy happens we focus on the person who caused the injuries," Dr. Kelly told Newshub.
"Those children have come from families where extended family members have come to the party to support that child. I see heroic efforts from grandparents, aunties, uncles and other extended family members."
While he would like to be out of a job and not needed, he says it's "pie in the sky" to think that child abuse will never happen but he says surely New Zealand can do a lot better.
If you have a story to share please contact journalist Dianna Vezich at dianna.vezich@wbd.com
