This is the 10th article in a monthly series from members of the GPs Down Under (GPDU) Facebook group, a not-for-profit GP community-led group with over 6000 members, which is based on GP-led learning, peer support and GP advocacy.
Dr Annalyse Crane (AC) and Dr Tim Senior (TS): We recently returned from the Australian Indigenous Doctors Association (AIDA) conference. Annalyse wanted to write about how important the AIDA conference is for Aboriginal and Torres Strait Islander doctors. It is a safe space with a rigorous academic program and a place where Aboriginal and Torres Strait Islander doctors, associate and community members come together for education and, importantly, cultural and spiritual empowerment and reflection.
As it happened, one of the main speakers, a non-Indigenous medical leader, gave a talk that included mention of safe spaces. His safe spaces were sporting arenas, he explained, as he was shortly to leave to attend a football grand final. AIDA was clearly a place of safety for Aboriginal and Torres Strait Islander people doing medicine. The friendly and supportive atmosphere among the, mainly Indigenous, audience confirmed that.
The implication of defining our own safe spaces, of course, is that not everywhere is safe.
AC: My grandfather Thomas Ellis grew up somewhere between Tingha and Moree in New South Wales. He and his father hunted rabbits to sell. They didn’t live with anyone else and we don’t know why. He was of Chinese and Aboriginal blood. Pop wasn’t much of a gossip and never really talked about much. When I was a kid, he would carve out boomerangs and cricket bats for us to play with in the yard. He only died last year and was aged 95. He served in New Guinea and worked on the railways. Pop never attended school and was the wisest man I know. Nan and Pop cared for me and my sister while my mum worked as a midwife. A year on from his death, I am still only realising the great impact he had on my life and journey into medicine. It was Pop who said, “you might as well give it a go”.
I left school in the 1990s and was encouraged to try to get into a TAFE course. I was reminded that “university was hard work and required good Higher School Certificate (HSC) results”. I got my HSC results and surprised myself. Mum cried when I rang her because she was never expecting me to even pass. I was the first person in my family to attend university and I wanted to be a physical education teacher like the role models I had at school. A year into teaching, I was living with medical student flatmates in Newcastle. I wanted to sit the Undergraduate Medicine Admission Test but it cost $100 that I didn’t have. Fortunately, if you had a health care card the fee was waived. I didn’t do well in the spatial awareness section and didn’t get into medicine at that point. Ironically, that part is no longer included in the test.
I had never heard of an Indigenous entry pathway despite doing my photocopying in the Aboriginal study centre at the university. It is funny now how 20 years later some of the legendary Aboriginal doctors were studying in Newcastle at the same time as me, but our paths never crossed at the bar on the hill.
TS: I had never heard of a special entry pathway. I am English, white, middle-aged (though I’ll never admit it) and straight. Almost everywhere is my safe place. I don’t mean I am comfortable everywhere I could go. I mean that the institutions I am involved in – university, the health system, even politics – are set up by people like me, for people like me. I didn’t need to hear of a special pathway to go to medical school, because medical school is full of people like me. The people in charge are like me, who mostly understand my background and my thought processes. It’s not that I’ve always had it easy – I haven’t – but when I need help there are people like me in positions of power. I’ve never been questioned as to whether I am taking up somebody’s place, or whether I should be in medicine at all. My world is my safe place.
AC: Fast forward more than 10 years. I was teaching physical education at an international school. My dentist was a Māori woman who explained the entry pathways in New Zealand. I had a bit of a life-changing moment when I came home for Christmas and over a beer a mate said, “if you ever want to do something you have to do it, don’t regret never having a go”. I applied for graduate medicine, borrowed books from the school library and read novels to prepare for the written section of the Graduate Medical School Admissions Test. I studied 5 hours a day around full-time work. I allocated a week of intense study during my annual leave until my best friend from school rang the morning my study leave started to explain her youngest brother had died from suicide – the second of her brothers lost to suicide and the third brother to die, in addition to their father. All the men in that family were gone. My study plans went out the window.
I was studying in Darwin and had booked to go out to Kakadu. The first stop was an Aboriginal cultural experience at Casuarina beach led by the Lee brothers. Upon walking on the beach one of the brothers said, “come here, you need to be smoked, there is a spirit hanging around you and he needs to know he can go”. I will never forget that feeling. They understood what I was feeling and helped carry the spirit on. I was actually inspired to really try and make a difference in health care due to seeing what suicide does to a family.
Months later, I was granted a position in the first intake at the University of Notre Dame Sydney. They didn’t have an Indigenous entry pathway and this meant I never had to listen to “oh, you only got into medicine because you are Aboriginal”. I got in on my own merit and just so happened to tick the box. I have never been so shocked in my life. Imagine me, a doctor!
TS: Imagine me, a doctor! I’ve thought that too. But I’m not unusual. I wasn’t even the only doctor in my household. Nobody else suggests that it’s remarkable that I’ve achieved that, or that I may have had special dispensation, or that I’m a credit to my race. Nobody asks what or who inspired me. The health system is not a safe place for many of our colleagues, or for many of our patients. It’s set up to be convenient and comfortable for people like me, in its locations, its buildings and its policies. Throughout my journey in medicine, I’ve never had to endure people making jokes or snide comments about people like me. I’ve never had to hide my racial identity to avoid racism.
AC: On my 30th birthday, I sat in the red dirt and a woman not much older than I explained that she could not have bloods drawn as scheduled as she was going to her homelands for sorry business. Her finger-prick blood sugar level was high, likely more than 26. She asked for more insulin cartridges as she knew she would be busy with family commitments and didn’t know when she would be back in Alice Springs.
In my first semester break as a medical student, I took myself to a placement at Congress in Alice Springs with the Aboriginal health workers and Alukra GP Dr Michelle. I learnt more about myself and health inequity than I ever would in the next 4 years at university.
TS: Working in an Aboriginal Community Controlled Health Service, I have learnt more about myself and health inequity than I was ever taught at university. The health system doesn’t become safer for people by sitting them down in a dark lecture theatre and giving them facts. It becomes safer by sitting in the sunlight and red dirt and hearing the patient voice “even when that voice is a whisper”. It’s rare that the health of my patients is poor because they don’t know things. It’s much more often because they can’t afford to get through the door, or they are told off when they do. So many of my community come to the service – their service – when they should be going to hospital. “I just want to be looked after by my people, and those who look after my people,” one patient told me.
AC: In my third year of university, I elected to attend the Werribee/Melbourne campus. I was in a relationship with an Aboriginal man. He couldn’t get a job, he expected me to support him on my Centrelink payment and I really struggled. I had no textbooks, a bomb of a car and felt very isolated. The relationship disintegrated due to escalating domestic violence and I escaped to a research project in Halls Creek, Western Australia, and never went back to Victoria. Mrs Lyn Long probably doesn’t realise how much her listening ears helped me as we rode in the white 4WD around the streets of Halls Creek. I remember sitting on the bank of the river near the Bungle Bungles and the Traditional Owner telling me it was time to let go. I literally lost everything I owned. I walked away with the suitcase I took to the Kimberley.
My university assisted me to complete my terms in NSW after I outright refused to ever enter Victoria again. It was really challenging having no peer study networks and if it wasn’t for the mentorship of Professor Ray Garrick at St Vincent’s, an excellent GP and psychologist, I would have walked away from medicine.
I survived medical school. I met my now husband, who knows nothing about medicine, and we had three children during my hospital and GP training. Those three children rewarded me with a cumulative 39 days in hospital for pregnancy care, regular sexually transmitted infections screening tests without my consent and lots of insulin. I am really lucky I had such an excellent Aboriginal midwife to complain to about the hospital food.
I constantly feel I have to prove myself to my family, my friends and my medical colleagues. I actually enjoy study and have managed to succeed in being the first one in my family to finish high school and get a few degrees along the way.
TS: People like me – most of those in the health system – need to become those mentors, like Professor Garrick, routinely. It’s not routine, because people like me don’t need it. We need to understand that the systems we’ve constructed that make them comfortable for people like me, make it much harder for those of different cultural backgrounds and those without money and privilege. Cultural awareness needs to start with awareness of ourselves, not “the other”.
Being Aboriginal and Torres Strait Islander is not pathology, and we must not talk like it is. Being Aboriginal or Torres Strait Islander is a marker of the likelihood of being exposed to too many unsafe experiences, unsafe people and unsafe places, all of which cause illness. Being connected to culture is a shield that protects.
AC and TS: We can make our health system a safe place for all of our colleagues, and all of our patients. We all need to make an effort to make it happen in every interaction we have with patients and colleagues. For some of us, that will be just our consultations, for others it will be the practice, the department, the hospital, the Primary Health Network. It is in all our interests that we do this work, for that is how health services become safe spaces.
Dr Annalyse Crane is a GP at Alfords Point Medical Practice. She has consent from the Mulcahy Family to discuss their family.
Dr Tim Senior is a GP at Tharawal Aboriginal Corporation, and the Medical Advisor for RACGP Aboriginal and Torres Strait Islander Health. These are his personal views, and do not represent the views of either of his employers.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.