MJA • Volume 194 Number 10 • 16 May 2011 493 WORKFORCE DREAMING — EDITORIALS n 1983, this country saw a major milestone — for the first time, an Aboriginal Australian graduated from an Australian medical school. This, however, was about 100 years after the graduation of the first Maori, Native American and Aboriginal Canadian medical students. 1 In the following decade, only seven other Indigenous Australians would graduate. We have had enormous ground to cover and obstacles and system barriers to overcome in the 28 years since Professor Helen Milroy’s graduation. It is with great pride that I can now say that there are over 150 Aboriginal and Torres Strait Islander medical graduates and almost 170 Aboriginal and Torres Strait Islander medical students. 2 There is still much work to be done. With the increasing overall numbers of students entering medical training, we need to ensure that the gap between Aboriginal and Torres Strait Islander students as a proportion of all students and non- Indigenous people undergoing medical education and training narrows, not widens. It is timely that, while the Australian Government’s focus is on the imperative to close the gap in life expectancy between Aboriginal and Torres Strait Islander people and other Australians within a generation, we are beginning to hold in our sights the second generation of Aboriginal and Torres Strait Islander doctors. The Aboriginal and Torres Strait Islander doctor profile is not dissimilar to the Indigenous population profile. There are few medical elders; a limited number of Fellows of Australian medical colleges; most of our doctors are in junior years and training programs; and growing numbers in medical schools. A continuing challenge is to improve school retention rates so that more young Aboriginal and Torres Strait Islander people complete Year 12 and have the prerequisite skills to enter medicine. Work on pathways for our people into medical specialties is also important. Building on the Australian Indigenous Doctors’ Associ- ation’s (AIDA’s) successful collaboration with Medical Deans Aus- tralia and New Zealand, we now have a set of priority areas for action in cooperation with the Confederation of Postgraduate Medical Education Councils, 3 and have also committed to collabo- rate with the Committee of Presidents of Medical Colleges. 3 This level of collaboration along the entire medical and education and training continuum is unprecedented. Further, I am bolstered by the level of concrete action by individual medical colleges. No fewer than nine colleges contributed to the annual AIDA Symposium held in Launceston, Tasmania last year, through provision of sponsorship, information and personnel. This is important both for AIDA members and for the colleges as they seek to improve Aboriginal and Torres Strait Islander health and engage with the Indigenous health workforce. A workshop run by the Royal Australasian College of Surgeons, which included a mobile surgical simulation van that travelled from Sydney, is an exemplar of ways in which colleges might work with AIDA in the future. A large proportion of the current cohort of Indigenous medical students have commenced their studies directly from school, in contrast to many earlier Indigenous doctors who started medical studies after other careers when they already carried responsibili- ties as parents, community members and leaders. Despite this shift, demands related to family, the Indigenous community and the wider community continue to be disproportionately high for Aboriginal and Torres Strait Islander doctors, and I anticipate that this will be the case for many years to come. There is often an expectation that, when still relatively junior in their clinical and professional lives, these doctors will take up policy, advocacy, representational and community leadership roles. This frequently occurs within the context of their own communities and families living under stress and with extremely poor health, and a con- gested and changing policy landscape, and while they also need to be servicing their own clinical and professional development requirements. With the expiry of the current National Strategic Framework for Aboriginal and Torres Strait Islander Health in 2013, 4 there will be a new Aboriginal and Torres Strait Islander health plan. Aboriginal and Torres Strait Islander doctors will continue to advocate for the plan to be developed and conducted through genuine partnerships between governments and Indigenous organisations, not only because such an approach is consistent with what is contained in the United Nations Declaration on the Rights of Indigenous Peoples, 5 but because it makes good sense. It will only be through genuine partnership, including mutual respect, proper negotiation with Aboriginal and Torres Strait Islander people and shared decision making, that collective ownership by all parties will be secured. Health workforce will be an important feature of any new plan. AIDA recognises that having an inadequate workforce to deliver high-quality, sustainable health services for Indigenous people is a real problem, and continues to push for more Aboriginal and Torres Strait Islander health professionals across the board. As Australian political leaders point to a need to support employ- ment, 6 it makes economic sense to attract more Indigenous health professionals into the growth area of health care, with multiple flow-on benefits. In some way, every Indigenous doctor is working to improve the health of Indigenous people, whether by leading national policy debates or working at the family or community level. Every contribution is important. The statement “I am an Aboriginal or Torres Strait Islander doctor, not a doctor who is Aboriginal or Torres Strait Islander” holds true for us all; it speaks to the central issue of identity and the primacy of our Indigenous identities being a strength to our practice of medicine. To quote Professor Helen Milroy, now Director and Winthrop Professor at the Centre for Aboriginal Medical and Dental Health, University of Western Australia: Part of the reason why Indigenous doctors are so important is because they can walk in both worlds, bridging an Indigenous knowledge base with a Western one. There is increasing focus on needing more than just an “evidence” base for best practice. Including other knowledge systems and experiences to develop a system of “wise” practice is required in order to close the gap. We are translators, and without translation, we have confusion (personal communication, April 2011). Our doctors making a difference Peter O’Mara I Aboriginal and Torres Strait Islander doctors walking in both worlds for the benefit of all Australians
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WORKFORCE DREAMING — EDITORIALS
Our doctors making a differencePeter O’Mara
The Medical Journal of Australia ISSN: 0025-729X 16 May 2011 194 10 493-494©The Medical Journal of Australia 2011www.mja.com.auWorkforce Dreaming — Editorials
system barriers to overcome in the 28 years since PrMilroy’s graduation. It is with great pride that I canthere are over 150 Aboriginal and Torres Strait Islagraduates and almost 170 Aboriginal and Torres Smedical students.2 There is still much work to be dincreasing overall numbers of students entering mewe need to ensure that the gap between Aborigin
Aboriginal and Torres Strait Islander doctors walking in both worlds for the benefit of all Australians
n anschI
1983, this country saw a major milestone — for the first time,Aboriginal Australian graduated from an Australian medicalool. This, however, was about 100 years after the graduation
of the first Maori, Native American and Aboriginal Canadianmedical students.1 In the following decade, only seven otherIndigenous Australians would graduate.
We have had enormous ground to cover and obstacles andofessor Helen now say thatnder medicaltrait Islander
one. With thedical training,al and Torres
Strait Islander students as a proportion of all students and non-Indigenous people undergoing medical education and trainingnarrows, not widens.
It is timely that, while the Australian Government’s focus is onthe imperative to close the gap in life expectancy betweenAboriginal and Torres Strait Islander people and other Australianswithin a generation, we are beginning to hold in our sights thesecond generation of Aboriginal and Torres Strait Islander doctors.
The Aboriginal and Torres Strait Islander doctor profile is notdissimilar to the Indigenous population profile. There are fewmedical elders; a limited number of Fellows of Australian medicalcolleges; most of our doctors are in junior years and trainingprograms; and growing numbers in medical schools. A continuingchallenge is to improve school retention rates so that more youngAboriginal and Torres Strait Islander people complete Year 12 andhave the prerequisite skills to enter medicine.
Work on pathways for our people into medical specialties is alsoimportant. Building on the Australian Indigenous Doctors’ Associ-ation’s (AIDA’s) successful collaboration with Medical Deans Aus-tralia and New Zealand, we now have a set of priority areas foraction in cooperation with the Confederation of PostgraduateMedical Education Councils,3 and have also committed to collabo-rate with the Committee of Presidents of Medical Colleges.3 Thislevel of collaboration along the entire medical and education andtraining continuum is unprecedented.
Further, I am bolstered by the level of concrete action byindividual medical colleges. No fewer than nine colleges contributedto the annual AIDA Symposium held in Launceston, Tasmania lastyear, through provision of sponsorship, information and personnel.This is important both for AIDA members and for the colleges asthey seek to improve Aboriginal and Torres Strait Islander health andengage with the Indigenous health workforce. A workshop run bythe Royal Australasian College of Surgeons, which included a mobilesurgical simulation van that travelled from Sydney, is an exemplar ofways in which colleges might work with AIDA in the future.
A large proportion of the current cohort of Indigenous medicalstudents have commenced their studies directly from school, incontrast to many earlier Indigenous doctors who started medicalstudies after other careers when they already carried responsibili-
ties as parents, community members and leaders. Despite thisshift, demands related to family, the Indigenous community andthe wider community continue to be disproportionately high forAboriginal and Torres Strait Islander doctors, and I anticipate thatthis will be the case for many years to come. There is often anexpectation that, when still relatively junior in their clinical andprofessional lives, these doctors will take up policy, advocacy,representational and community leadership roles. This frequentlyoccurs within the context of their own communities and familiesliving under stress and with extremely poor health, and a con-gested and changing policy landscape, and while they also need tobe servicing their own clinical and professional developmentrequirements.
With the expiry of the current National Strategic Framework forAboriginal and Torres Strait Islander Health in 2013,4 there will be anew Aboriginal and Torres Strait Islander health plan. Aboriginaland Torres Strait Islander doctors will continue to advocate for theplan to be developed and conducted through genuine partnershipsbetween governments and Indigenous organisations, not onlybecause such an approach is consistent with what is contained in theUnited Nations Declaration on the Rights of Indigenous Peoples,5
but because it makes good sense. It will only be through genuinepartnership, including mutual respect, proper negotiation withAboriginal and Torres Strait Islander people and shared decisionmaking, that collective ownership by all parties will be secured.
Health workforce will be an important feature of any new plan.AIDA recognises that having an inadequate workforce to deliverhigh-quality, sustainable health services for Indigenous people is areal problem, and continues to push for more Aboriginal andTorres Strait Islander health professionals across the board. AsAustralian political leaders point to a need to support employ-ment,6 it makes economic sense to attract more Indigenous healthprofessionals into the growth area of health care, with multipleflow-on benefits.
In some way, every Indigenous doctor is working to improve thehealth of Indigenous people, whether by leading national policydebates or working at the family or community level. Everycontribution is important. The statement “I am an Aboriginal orTorres Strait Islander doctor, not a doctor who is Aboriginal orTorres Strait Islander” holds true for us all; it speaks to the centralissue of identity and the primacy of our Indigenous identities beinga strength to our practice of medicine.
To quote Professor Helen Milroy, now Director and WinthropProfessor at the Centre for Aboriginal Medical and Dental Health,University of Western Australia:
Part of the reason why Indigenous doctors are so important isbecause they can walk in both worlds, bridging an Indigenousknowledge base with a Western one. There is increasing focuson needing more than just an “evidence” base for best practice.Including other knowledge systems and experiences to developa system of “wise” practice is required in order to close the gap.We are translators, and without translation, we have confusion(personal communication, April 2011).
MJA • Volume 194 Number 10 • 16 May 2011 493
WORKFORCE DREAMING — EDITORIALS
But of course, we need a workforce of Aboriginal and TorresStrait Islander people working in health — not only Aboriginaland Torres Strait Islander health but the whole of the health system— as well as a workforce of all people working specifically totackle the disparity in outcomes between Indigenous and non-Indigenous Australians.
This is where our profession, the community of medicine, canlead the way. The health of Aboriginal and Torres Strait Islanderpeople must be a priority for all doctors — not simply because“close the gap” is a part of the contemporary health lexicon, and aCouncil of Australian Governments priority, but because of muchmore. This is about our fundamental roles and responsibilities asdoctors — we must advocate to end the glaring inequity anddifferential health outcomes between our first peoples and otherAustralians.
Having Aboriginal and Torres Strait Islander people practisingmedicine will benefit all Australians, as a comprehensive approachto patient care is a must for achieving better health outcomes forAboriginal and Torres Strait Islander people. Such an approach isclient- or patient-centred while being strongly guided by thefamily and community context; it prioritises partnership and jointownership; and it takes into account cultural, spiritual and clinicalaspects of health. We need look no further than the achievement ofAboriginal general practitioner and 2011 Australian of the Yearfinalist Associate Professor Noel Hayman in establishing the InalaIndigenous Health Service in Brisbane, Queensland, to see theresults of such an approach. Over a 15-year period, the servicegrew from having 12 Indigenous patients to providing comprehen-sive primary health care and public health programs to over 3000.7
Many of the 150 Aboriginal and Torres Strait Islander community-controlled health services across the country have had similarsuccess.
The theme of the AIDA Symposium in Broome in October thisyear is “Our doctors making a difference”. I hope interestedcolleagues will be able to join us to hear about the work beingundertaken by the current generation of Aboriginal and TorresStrait Islander medical students and doctors. I also hope that ournon-Indigenous colleagues will join with us in making a realdifference for our people.
Author detailsPeter O’Mara, BMed, FRACGP, FARGP, PresidentAustralian Indigenous Doctors’ Association, Canberra, ACT.Correspondence: [email protected]
References1 Anderson IPS. The knowledge economy and Aboriginal health develop-
ment [Dean’s lecture]. 13 May 2008. Melbourne: Faculty of Medicine,Dentistry and Health Sciences, Onemda VicHealth Koori Health Unit,University of Melbourne, 2008: 3.
2 Australian Indigenous Doctors’ Association. Aboriginal and Torres StraitIslander doctors and students. http://www.aida.org.au/pdf/Numbersof-doctors.pdf (accessed 7 April 2011).
3 Australian Indigenous Doctors’ Association. The Australian IndigenousDoctors’ Association Ltd 2009 Annual Report. Canberra: AIDA, 2010: 13,17. http://www.aida.org.au/pdf/AnnualReports/AIDA_Annual_Report_2009.pdf (accessed Apr 2011).
4 Australian Government Department of Health and Ageing. NationalStrategic Framework for Aboriginal and Torres Strait Islander Health2003–2013. Australian Government Implementation Plan 2007–2013.Canberra: DoHA, 2007. http://www.health.gov.au/internet/main/publish-ing.nsf/Content/59E57ED5E8E63C04CA2574040004878A/$File/nsfatsihimp2.pdf (accessed Apr 2011).
5 United Nations General Assembly. United Nations Declaration on theRights of Indigenous Peoples. http://www.un.org/esa/socdev/unpfii/en/drip.html (accessed Apr 2011).
6 Wooden M. Abbott’s plan should be put to a work test. AustralianFinancial Review 2011; 2 Apr: 63.
7 Hayman NE, White NE, Spurling GK. Improving Indigenous patients’access to mainstream health services: the Inala experience. Med J Aust2009; 190: 604-606.
Provenance: Commissioned; not externally peer reviewed. ❏
Lydia Balbal
Regina Wilson
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