Part 2: #BlackLivesMatter – A starter pack for Australian junior doctors

#BlackLivesMatter – Practical steps for busy but concerned Australian junior doctors to take now

When I think about the injustices experienced by Aboriginal and Torres Strait Islander peoples, I sometimes feel overwhelmed. A widening gap in life expectancy, soaring rates of incarceration, our children taken away from their families at 10 times the rate of non-Indigenous children, our women dying at epidemic levels from domestic and family violence. Where do we even start?”

Ms June Oscar AO, Aboriginal and Torres Strait Islander Social Justice Commissioner, Close the Gap 2020 (1).

Facts are fundamental to instigating change, and in Part 2 we will look at some key statistics for you to take away and consider, and end with a series of practical steps that you can take.

Health & welfare of Australia’s Aboriginal and Torres Strait Island people

For a brief look at the overall current state of affairs, the latest available data is stark viewing – from the health and welfare of Australia’s Aboriginal and Torres Strait Island Peoples 2015 report (9) which should be read in full. I have pulled out a few graphs that I know will be of relevance to doctors in training. Each one of them shows the same tragic story – Indigenous people having higher rates of illness at much younger ages when compared to non-Indigenous people of the same age.

A word of caution – most Australian doctors are highly familiar with the below statistics and would not be surprised by any of the above – it is very important to realise that this deficit discourse is a particular narrative that tends to reduce Indigenous populations to deficiency – absence, lack of, or failure. The implication is that it situates responsibility with affected individuals or communities while allowing the larger socioeconomic structures within which these inequalities are occurring are allowed to escape close scrutiny. The current recommendation is to move away from deficit-based discourses to strength-based discourses – the below data is presented for junior doctors specifically, it is important to have some bearing of the magnitude of disparity between Indigenous and non-Indigenous populations, not to focus on the particular deficits. You can read more about this (10).

1. Diabetes

#BlackLivesMatter - Age-specific prevalence rates of diabetes and those at high risk among people aged 18 and over, by Indigenous status.

2. Cardiovascular disease

#BlackLivesMatter - Age-specific prevalence rates of cardiovascular disease among people aged 2 and over, by Indigenous status.

3. Mental health

#BlackLivesMatter - Age-specific hospitalisation rates for mental health-related conditions, by Indigenous status.

4. Chronic kidney disease

Age-specific incidence rates of treated end-stage kidney disease, by Indigenous status.

5. Cancer

Incidence rates of selected cancers, by Indigenous status.

These graphs are all shocking – what can you do?

Pick the statement that applies to you and read through to see what steps you could take right now after reading this article.

 

 “Look I think this is really important but I am just too busy with clinical work, research work and staying alive” – if you have 15 minutes to donate to this cause   
    1. Educate yourself – read the Close The Gap Report 2020 as an initial step. 
    2. Be aware of other resources collating information about Indigenous health including
    3. Consider becoming a non-Indigenous member of the Australian Indigenous Doctors Association
    4. When giving work presentations or speeches, please consider an Acknowledgement of Country – for instructions on how to do this, read this. You will not be seen as “woke” or “progressive” or stepping out of line – it is a mark of respect to acknowledge. Every voice matters, including yours, however small. You may initially get some questions, and may even get remarks – but you have every right to hold your ground.  
 “This is a fairly important issue and I want to give it some more time and thought” – if you have two hours to donate to this cause.
    1. Meet your Aboriginal liaison officer in your hospital and find out about any opportunities within your local health districts for cultural training. Most major hospitals will have one, and learn about what their skills or, what their advice is and what you could do to get involved. 
    2. Enquire with your training college whether they have Indigenous special interest groups, Indigenous health integrated in the curriculum and how you might contribute or engage with this.
    3. Ask questions about your health services provisions for Indigenous populations and the steps taken to ensure equity of access (this is especially important in your discharge planning!) 
    4. Talk to your consultants during your hospital training rotations and enquire as to whether they do outreach clinics in Indigenous populations – for example, some doctors at Royal Prince Alfred Hospital do outreach clinics at the Redfern Aboriginal Medical Service.
 “This is a hugely significant issue and I want to spend more of my professional life working on it” – if you want to become professionally involved
    1. Do a rotation in an Indigenous community and seek a clinical placement – there is scope in almost every specialty to do part of your training in an Indigenous community. For example, in Alice Springs there was scope to do surgical training, medical training, psychiatry, paediatrics and others. Speak to your training director and there may be an opportunity to do a term, even if it is not part of your network’s usual rotations.
      • During this time, take some time to engage in some cultural training in how to engage with Indigenous patients in a culturally safe way, by considering holistic care approaches, for example with  Clinical Yarning (e.g. https://pubmed.ncbi.nlm.nih.gov/28442021/)
    2. Consider pursuing research (Masters or PhD level) to improve health outcomes for Indigenous populations and improving equity for Indigenous populations – remember the NHMRC has dedicated funding streams for this research.

If you have any other practical suggestions, please send them through and we will add them to the table above.

  1.  Australian Human Rights Commission. Close the Gap (2020) [Internet]. Australia: Australian Human Rights Commission; 2020 [cited 2020 Jun 30]. Available from: https://humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-justice/publications/close-gap-2020)
  2. The Guardian, May 2020 [Internet]. Black people four times more likely to die from Covid-19, ONS finds. Australia: Guardian Media Group; 2020. [cited 2020 Jun 30]. Available from: https://www.theguardian.com/world/2020/may/07/black-people-four-times-more-likely-to-die-from-covid-19-ons-finds)
  3. #BlackLivesMatter. Black Lives Matter. [Internet]. USA: #BlackLivesMatter; 2013 [cited 2020 Jun 30]. Available from: https://blacklivesmatter.com/about/)
  4. Tweedy D. Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine. [Internet]. UK: Picador; 2015 [cited 2020 Jun 30]. Available from: https://www.amazon.co.uk/Black-Man-White-Coat-Reflections/dp/1250105048
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461149/
  6. The Guardian, June 2020. [Internet]. Australia protests: thousands take part in Black Lives Matter and pro-refugee events amid Covid-19 warnings. Australia: Guardian Media Group; 2020. [cited 2020 Jun 30]. Available from: https://www.theguardian.com/world/2020/jun/13/australia-protests-thousands-take-part-in-black-lives-matter-and-pro-refugee-events-amid-health-warnings
  7. Walker et al. Experiences, perspectives and values of Indigenous peoples regarding kidney transplantation: systematic review and thematic synthesis of qualitative studies. International Journal for Equity in Health. 2019, Dec 30. Abstract available from: https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1115-y
  8. Berwick DM. The Moral Determinants of Health.  JAMA. 2020, Jun 12. Abstract available from: https://jamanetwork.com/journals/jama/fullarticle/2767353
  9. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015. [Internet]. Australian Government; 2015 [cited 2020, Jun 30]. Available from: https://www.aihw.gov.au/reports/indigenous-australians/indigenous-health-welfare-2015/report-editions
  10. Department of Industry, Innovation and Science. Deficit Discourse
    and Strengths-based
    Approaches. [Internet]. Australian Government; 2018 [cited 2020, Jun 30]. Available from: https://ncis.anu.edu.au/_lib/doc/ddih/Deficit_Discourse_and_Strengths-based_Approaches_FINAL_WEB.pdf

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Abhijit Pal

Abhi is a medical oncologist currently completing the second year of his fellowship in drug development and early phase anti cancer trials at the Royal Marsden Hospital, Sutton in the United Kingdom. In his non existent spare time he is completing a part time PhD through Sydney University in informed consent and clinical ethics during communication with patients with advanced cancer. He has a strong interest in drug development, clinical trials, communication and also in hospital culture, burnout and doctor welfare.

Tags: #Aboriginal,#Aboriginal and Torres Strait Island Health,#Aboriginal and Torres Strait Islander health assessments,#Aboriginal liaison officer,#Australian Indigenous Doctors Association,#BlackLivesMatter,#close the gap,#Close the Gap 2020,#discrimination,#indigenous health,#indigenous medicine,#racial discrimination,#Torres Strait

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