Dr Marlene Pearce applied for a job in an ACCHO this year — an Aboriginal Community Controlled Health Organisation. In her final year of GP training,she had been mulling over this decision for some time.
Here is her story from the Medical Observer
Initially, I thought about it like wholemeal bread — I should eat it because it’s good for me. I should do an Indigenous health term, because it’s part of being a good doctor. That’s what I told people when asked why I chose such a ‘difficult’ term.
On reflection, my motivations were broader. Two friends signed up for ACCHOs at the same time. I was intrigued as to whether our motivations were similar.
They surprisingly were, and it occurred to me we need to be asking these questions if we want more doctors to commit to Close the Gap.
I believe a good doctor in Australia should be competent in Indigenous health. A single Cultural Awareness Day at university doesn’t cut it. A rotation to a remote community is a better starting place.
One of my friends chose an elective on Thursday Island in Far North Queensland as a student. It so moved him that he made a commitment to return to Indigenous health in his career.
For me, the impetus didn’t come until I learned the startling Close the Gap facts and figures at a GP registrar conference.
Frankly, I was embarrassed and ashamed about the outrageous inequality in my First World country. I wanted to do something about it. I had been brought up with a sense of altruism and a social conscience, and I figured it was probably time I put my money where my mouth was.
I was initially reluctant. I was wary of putting my foot in it culturally. I dreaded imposing myself as the white doctor on a group of understandably angry patients, who would never engage with me in a therapeutic relationship, given I was part of the dreaded white healthcare institution. Then I heard about ACCHOs, and had a chat to the practice manager.
I realised that at an ACCHO — a community-controlled service — I was being invited in by the local Aboriginal community to provide my professional services. The clinic would help make sure I was doing it in a culturally safe way.
It was a far more palatable foray into Aboriginal health for me. I hoped that it would help remove the perceived power differential between the white doctor and the Aboriginal patient, because I was meeting the community on their terms, in their space, at their request.
I looked forward to being able to offer more time to my patients, without the pressures of fee-for-service. It’s incredibly hard to offer good care to complex patients in a standard consult. The added benefit of the supportive health workers and allied health on-site at my ACCHO meant I was not going to be thrown into the deep end.
Of course, I had preconceived ideas about working in Aboriginal health. Were they realised? Well, my eyes have certainly been opened to social disadvantage. I marvel at how stoic and strong people can be despite unimaginable hardship. Battlers have always interested me — Indigenous or not. These people rarely have a voice, and are often judged and given up on, even by doctors. I feel like I’m doing the most good when I’m working with people in hard social situations.
If the federal government is serious about trying to Close the Gap, it needs to attract the young medical workforce into Indigenous health, even just for a term. GP registrars should be supported by Regional Training Providers to take up Indigenous health in later training years, with standardised peer-matched pay rates and quality cultural awareness training.
It’s easy to be blissfully unaware of the Aboriginal health issues in this country from inside an air-conditioned tertiary hospital in a capital city. Or to have false reassurance that you’re aware, when you’re not. Get some wholemeal bread into you. You might enjoy it more than you expected.
Thanks to my mentor in writing this article, Aunty May, Elder and worker at Wathaurong Aboriginal Health Service.
Dr Marlene Pearce
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