Everything about Rachel Smalley radiates that she is someone who appreciates she is exactly where she’s meant to be. Geographically, the broadcaster, journalist and healthcare advocate has found solace in the space around her home on the North Shore. Professionally she’s found an ideal fit with an early morning slot on Today FM. And she is aligned with a purpose much greater than herself, or any of us; elevating the voices of those who can no longer speak.

Rachel moved to the Shore from Piha in 2021. Having lived on Auckland’s West Coast for 10 years, she chose to swap the darker, wilder energies of the surf town for the serenity of three flat hectares on the Shore with her partner of four years, Dave Pretorius. She had previously lived in Devonport, Takapuna and Murrays Bay during her 20s, and took the decision to return to the Shore in March 2020, moving the following year, given lockdown restrictions and the tumultuous time that was.
“I feel at peace here,” she shares. “Growing up on a farm in Canterbury, and after living on a ridge in Piha for 10 years, I began to crave some flat, accessible land. I have a 13 year-old son who loves to kick a ball around and I really wanted a big garden.” The garden is Rachel’s happy place. Choosing mostly trees over floral planting, she is planning to install a large glasshouse for vegetables. For Christmas 2020, Dave bought her a Massey Ferguson tractor. And, in the two years they have lived on their lifestyle block, Rachel has already planted several very special trees. Each is rooted in memory of a person who has passed away while she advocated for treatment funding for the disease they had.
The latest of these, Rachel planted for Dr Heidi McRae. Long-serving North Shore GP and MedPlus Hauraki Corner co-owner Heidi died of triple negative breast cancer in November. The Stanley Bay mother-of-three developed a strong rapport with Rachel and helped open doors to medical professionals who, like her, were courageous enough to speak out about healthcare inequities.
“Heidi popped up in my inbox about a month after her cancer diagnosis,” says Rachel. “She very eloquently shared her frustration – not only at the significant failures in the way we treat cancer in New Zealand – but at herself, as a practicing doctor. She was frustrated because she didn’t realise how poor our access to life-saving medicines was. She worked in primary care, so she wasn’t at the coal face of cancer treatment at a hospital level.”
Heidi self-funded an immunotherapy called Keytruda, at a cost of $70,000. She spoke out, including in October’s Channel magazine, about the unfairness of this, given many more Kiwis were unable to do the same. Some of the latest treatment options available within healthcare systems overseas, remain unavailable or hugely costly to patients in New Zealand. It deeply saddened Heidi knowing that people were being forced to re-mortgage or sell their homes to potentially save their lives, if they even owned their own home to begin with. “Treatment becomes inaccessible for most people,” she said. “And that is absolutely wrong.”
Rachel became a vocal ally of Heidi’s and is still coming to terms with her loss. “Heidi once said to me that she knew change wouldn’t come in time to help or save her, but she said ‘hopefully it will help those who come after me’.
“She kept referring to herself as privileged, in spite of it all. I don’t know any mother-of-three who has triple negative breast cancer – the most aggressive form of breast cancer – would describes themselves as ‘privileged’?  She felt she was privileged because she could access the funds to pay for some of her treatment, but she knew there were many others who couldn’t.”
When Rachel woke to a text message early one November morning, she raced to Heidi’s bedside at North Shore Hospice. Letting tears flow, Rachel shares, “She wanted to see me and it was so moving and humbling to sit with her. She wanted to thank me, not only for supporting her, but to urge me to keeping fighting for others.
“When I left, the world felt very broken and out of shape. Heidi was a remarkable woman who deserved to still be here. Her last words to me were, ‘Keep going’.”
And she will. Rachel says, “Heidi was a courageous voice, speaking up for better, fairer access to cancer treatment for all New Zealanders and I want her voice to continue to be heard. That’s what Heidi wanted too.”
Since launching The Medicine Gap campaign in late 2020, Rachel has advocated for the funding of many crucial treatments, five of which are now available in New Zealand. On her website – themedicinegap.co.nz – are the stories of Kiwis currently living with life-threatening diseases for which the latest Medsafe-approved treatments still remain unfunded by Pharmac.
“It is no exaggeration to say that New Zealanders are dying waiting for modern medicines,” Rachel writes. Alongside the human stories are some startling facts and figures, such as the average wait time for the government agency to fund an already Medsafe approved treatment is 4.7 years.
The latest ‘win’ is bittersweet. The mid-January announcement that Pharmac will look to fund a second drug, Risdiplam, to treat Spinal Muscular Atrophy (SMA) in children came just days after The Medicine Gap supporter and advocate Fiona Tolich packed up and left NZ for Australia. New Zealand now funds Spinraza and Risdiplam to treat Kiwis aged under 18 but doesn’t fund treatment for the 35 adults who also have this debilitating disease, like Fiona. Yet they can be treated for SMA in Australia for free.
As well as years spent fighting Pharmac, Fiona took her case to the Human Rights Commission and also addressed the United Nations. Rachel says, “Her remarkable work over the years has undoubtedly saved the lives of Kiwi kids, however she’s been forced to move to Australia to save herself.”
Stories upon stories of different Kiwis with different diseases and different prognoses are harrowing.
The Medicine Gap estimates the Government needs to allocate another $400m this year alone to Pharmac so doctors here can access more than 70 prioritised modern medicines on the waitlist. In this election year, Rachel wants to bring both the ruling and opposition parties together to take ownership of the problem.
“I would like to get an acknowledgement from the Government that they, and successive governments, have really dropped the ball. They particularly need to face up the fact that they are failing patients with cancer.”
That New Zealand sits at the bottom of the OECD for per capita spend on modern medicines, Rachel says, demonstrates this.
“We need to modernise our approach to funding the vital medical treatments that are out there. We need the Government to strategize, in a measurable way, how we are going to ensure these lifesaving drugs available elsewhere in the world are accessible to all Kiwis who need them.”
Even through the tears, Rachel is radiant. It seems she shines not only her own spirit, but that of all those she has supported during their darkest hours and for whom she now speaks and strives for change.