Australia has fewer than 300 aboriginal doctors, but things are gradually changing with some aboriginal doctors determined to make a difference.
Sydney: Vinka Barunga was born in the Worrara tribe of the Mowanjum aboriginal community in the remote town of Derby in Western Australia. As a child, she witnessed disease and suicide amongst her people, which made her resolve to one day become a doctor and help break this cycle of suffering. She is one of six, the largest cohort of Aboriginal and Torres Strait Islander (ATSI) students, to graduate in Medicine/Surgery from the University of Western Australia this year.
Australia has fewer than 300 Aboriginal doctors, but things are gradually changing. Vinka is determined to be the first full time doctor in the town of her birth, situated around 2,400 kilometres north of the state capital Perth in the Kimberley region. It is the gateway to the state’s resource rich north, surrounded by mudflats on three sides, with two distinct seasons.
Tropical and non-communicable diseases, kidney ailments, skin and ear infections are common here. “There is also a long history of introduced diseases. Derby had a leprosarium so there were a lot Aboriginal people that had leprosy living here,” says Vinka, who observes that alcohol and high sugar diets have significantly impacted on her people’s health.
The Derby Aboriginal Health Service (DABS) provides walk-in access to General Practitioners and conducts outreach programmes in remote communities along the 670km-long Gibb River road. There are nurses that tend to small community clinics and doctors visit as often as they can.
“Aboriginal people of this region are largely nomadic and the remoteness of communities makes providing 24/7 health service difficult. Even when services are available, people often don’t use them because they might be going to the same clinic, but they are seeing the fifth doctor. It is hard to build trust and that can be quite devastating for people’s health,” says Vinka, who lost her non-indigenous mother to glioblastoma (brain tumour) at the age of 18 and her father to a long struggle with illness exacerbated by alcohol abuse when she was in her fifth year of medicine.
During her 10-month placement at Derby’s Rural Clinical School, she noticed young children looking up to her for inspiration and the elders brimming with pride for what she had achieved. Many aboriginal patients address her and her other indigenous colleagues as aunty or uncle or niece or nephew, even though they are not related.
“I think, everyone unconsciously becomes a part of your large extended family. One really can’t put a price on what aboriginal doctors will bring to an indigenous patient’s experience of hospital, of their illness and of healing. A bit of social and emotional support can work wonders. Having more aboriginal doctors is definitely going to have a positive impact on aboriginal and Australian health”, says Vinka, who at 27 is hopeful that despite the challenges, the health gap between Indigenous and non-Indigenous people will reduce during her lifetime.
“We have to see the positives, where we can and I definitely want to contribute and be part of those positive changes. The big positive for me has been to see how the women in the Fitzroy Crossing in the Kimberley got alcohol restrictions imposed and that has made huge progress in the diagnosis, management and therapy programmes for children and families with Foetal Alcohol Spectrum disorders”, Vinka told IDN.
Aboriginal people make up just 3% of the country’s 24 million population, but they suffer from significantly poorer health, suicides, higher rates of drug and alcohol consumption, imprisonment, homelessness and poverty.
The Prime Minister’s 2016 ‘Closing the Gap’ report states that the target to halve the gap in child mortality by 2018 is on track and immunisation rates for Indigenous children are high. But even though total indigenous mortality rates have declined by 16% since 1998, the target to close the gap in life expectancy by 2031 is not on track. Indigenous people live on an average 10 years less than non-indigenous Australians.
Romlie Mokak, chief executive officer of the Melbourne-based Lowitja Institute, Australia’s national institute for ATSI health research, attributes the simple reason for Indigenous people trailing behind in health outcomes to the circumstances that have been a continuing legacy of colonisation.
He says, “The policies that came out of colonisation had a basis in racism essentially, the superiority of the colonisers and the dehumanisation of the first peoples – taking culture, language, removing people from their traditional lands, forcibly removing children from their families was hugely problematic. We still talk about inter-generational trauma to this day”.
When the British landed in Australia in the 1700s, they did so by declaring it terra nullius, ignoring the original inhabitants who had lived on the continent for nearly 70,000 years. Between 1900 and 1970 under the Government Assimilation Policies to “breed out” aborigine blood and supposedly give them a better life, the government forcibly removed tens and thousands of ATSI children from their families. Many were sent to institutions where they were abused and neglected.
“This continuing disruption and destruction of family and culture is ever present. We also have to deal with the ubiquity of racism in its overt as well as well as systemic or institutionalised form, which many studies have shown to have a detrimental effect on health and wellbeing”, says Mokak, a Djugun man and member of the Yawuru people from Western Australia.
Secondly, he adds, it is the question of equity in services or nation’s resources and policy making, intrinsic in that is how power is exacted. “We continue to be invisible in the corridors of power. The portrayal of our people is largely negative and most people’s understanding of indigenous people is through a fairly narrow lens as they don’t have any real or intimate contact with aboriginal people”, says Mokak
Indigenous policy needs to be an inverted pyramid, whereby the grassroots indigenous communities are at the top of policy making, he adds. There has been some improvement in more indigenous children completing year 12 and university, especially in the medical field.
Katarina Keller is the first person in her family to get a Bachelor of Nursing Degree. Growing up in Ceduna, gateway to the treeless Nullarbor Plains in far west South Australia, she enjoyed the fresh seafood and marvelled at traditional bush medicines used in her Kokatha indigenous community. But she was also distressed to see people in her community die at a young age due to comorbidity.
She is determined to work in making her people live longer and healthier lives. “Coming from similar cultural background, it is easy for me to connect with indigenous patients. They are comfortable sharing their problems and I can better respond to their needs. If the health gap between the indigenous and non-indigenous people has to be closed, we would need many more health workers, who are aware of indigenous history and culture”, Katarina told IDN.