ONE of my favourite sayings is: “The older I get, the less I know”.
As a young graduate over 30 years ago, I thought that “knowledge”, particularly as a doctor, was possible. However, working with vulnerable populations — those who grapple with their psychological health; refugees who have suffered enormous turmoil; Aboriginal people who live in remote areas; and people from a range of other cultural beliefs — I have walked beyond knowledge.
One of my greatest challenges is learning to “not know” — to never be really sure about what is going on for the patient. Those of us who work in the area of mental health are more used to this, but when this is converted to a place like remote Australia or Vanuatu where there are no translatable words for the concepts we are trying to convey, it is extremely difficult.
Often the importance of spiritual and cultural beliefs cannot be interpreted in a way that I can understand as I lack the words or concepts. Similarly, health promotion takes on a new meaning when opening a discussion about chronic illness with someone who has only ever been treated for acute illness with short-term medication as they have always lived in a resource-poor environment.
Most of the evidence we rely on in our day-to-day medical practices has been collected from ethnicities and social backgrounds of the majority population of Western countries. It mostly has not been done in developing countries, in refugees, in Aboriginal people who live a remote lifestyle, in different ethnicities or in those who do not have access to adequate or stable social determinants of health.
Considerations such as cultural interpretations of mental health problems, unpronounceable words and overwhelmingly complex physical and social health issues are but the tip of the iceberg. Advocacy, good management, research, flexibility, a team of like-minded people and a sense of humour are essential features when working outside your comfort zone.
Some of my strength in doing this work lies in my courage and tenacity (some would say stubbornness). But more than this, I bring not just my experience as a GP, but also a belief in the ultimate goodness and oneness of people and the social responsibility that comes with that.
I try to heed the advice of an Aboriginal woman from Queensland who said: “If you’ve come to help me, you’re wasting your time, but if this is about your own struggle for survival as well as mine, together we can make a difference”.
My award last month as a Member of the Order of Australia for my work in the areas of mental health, refugee health and Aboriginal health is recognition of my small contribution to this struggle. I share it with my patients, family, friends and colleagues as hopefully together we make a difference.
Dr Jill Benson AM is a GP in South Australia. She was awarded an AM in the 2012 Australia Day honours for service to medicine through contributions in the field of mental health, particularly for refugees and people seeking asylum, and to the Indigenous community in SA.
Posted 13 February 2012