Bridges Over Chasms - A student writes...

I was thrilled to hear from my friend, colleague and naked doctor (yes, he tells me he really is naked under all those clothes) Justin Coleman this week. He has been using the #Supertwision conversations with his registrar and medical students. One of his students, Susanna Rossotti, wrote this for us as a result of her attachment at Inala in Brisbane.

I admire her passion. There's a sense in GP registrars and medical students coming through that the current situation is unjust and must be changed. There is never any doubt that it will be, or any doubt that they will be involved in changing it. Like them, I am also very optimistic. It's one of the few issues currently on which we have bipartisan support, a real achievement in the current political climate. Tomorrow there will be a record number of events - close to 1000 - held for National Close the Gap day. The gap in health outcomes is one that will be closed. And that can't come soon enough.

Bridges over Chasms

By Susanna Rossotti, 4th yr med student, Griffith University

One of my primary motivations for beginning this journey in medicine was to provide health care to people in disadvantaged communities. I had heroic visions of working for Medecins sans Frontiers in countries ravaged by war or natural disasters. Little did I know that there was a natural disaster still unfolding within the apparent safe confines of the beautiful sunburnt country that is Australia. This natural disaster is not of the variety that garners short-lived sensationalism by media, or any sort of significant mainstream media attention at all. But it is cataclysmic nonetheless. It is the state of affairs for the first custodians of Australia. These custodians successfully lived in some of the harshest conditions and their inherent respect for the land and their natural environment ensured its pristine preservation until the arrival of the white fella. While I still have much to learn about what happened to the indigenous custodians of Australia, I have learnt enough to feel that their very functional traditional way of life has been destroyed. Their social fabric, their culture, their sense of self respect and worth has been severely battered. No human being, regardless of race, could survive such a battering without crippling emotional wounds and scars with inevitable sequelae for physical and mental health.

I am a white fella and I have struggled for some time to define what it is that draws me to indigenous health. Today I may finally have arrived at a definitive answer: I perceive an enormous miscarriage of social justice which threatens the very survival of one the world’s most ancient people. On a global level, I want to help them work towards preservation of their existence in the gene pool. On a local level, I want to help build bridges over chasms that have opened between indigenous and non-indigenous Australians. I want to show indigenous people that I respect and value their heritage. I want to learn more about who these amazing first custodians are. And I want to take what I learn back to my non-indigenous friends and colleagues, in the hope that this will further help to close the gap between indigenous and non-indigenous Australians.

Why do I work in Aboriginal health?

That's the question I was asked on Twitter the other day. I was (almost) unable to answer in 140 characters, but it did get me thinking. So here's why.

The first place I got off an aeroplane in Australia was in Alice Springs. I was a naive, young junior doctor. ("You sound like an adventurous sort" said the recruiter. "How about the Northern Territory?" How was I to know any different?). Anyway, I had an absolutely wonderful year in Alice, Tennant Creek and Darwin, and met the woman who is now my wife. After going back to the UK and doing GP training, I came back to Oz and worked in Alice for another year. I spent a long time thinking Alice Springs was just normal Australia, and that work as a doctor in Australia just meant you saw Aboriginal patients. So at one point asking why I work in Aboriginal health would have been like asking me why I see patients. Or like asking a firefighter why they go to put out fires. Isn't that just what you do?

A few years later, I found myself in South West Sydney, and I started to realise that my Alice experience wasn't typical, and that actually Aboriginal health was seen as something seperate from normal practice. There were a few of us (and you can find out exactly how many here) drawn to Aboriginal health, but we were a bit... missionary!

So the first part of why is that I hadn't realised there was an alternative!

But the second part of why I work in Aboriginal health is why I stay in Aboriginal health.

Somewhere along the line in my career (and I can't for the life of me remember when) I learnt about the Inverse Care Law. In a classic paper - in 1971 - that's 1971 - Julian Tudor Hart described a law that is as relevant now as it was then: Those who need medical care the most get the least. It works on a global scale - think of the majority world compared to developed countries. It works on a National scale - think of urban centres compared to rural areas in Australia. And it works across a city - think of the Northern beaches of Sydney, compared to the south-west suburbs.

The areas I worked in the UK all experienced this acutely, and the people who trained me all had a strong view that part of doing General Practice well was working to reduce inequalities (respect to Sheffield VTS!). There is a strong culture in General Practice of working to reduce health inequalities. And this sits with other General Practice values such as Patient Centred care - not the buzzword, but actually trying to do it, and being the speciality with expertise based on research evidence of how to do it well.

So it was natural that I would be drawn to working in Aboriginal health, and that, though the context is different, the skills and the role are those of General Practice anywhere in Australia, anywhere in the UK.

This is where my 1 word Twitter answer is sufficient - values. I am in the hugely priveleged position of being paid to do something I love, which is (I hope) useful, and allows some of the most disadvantaged people to "live lives they would choose to live" - through trying to limit the effects of ill health on them, and through empowering them to be able to make decisions about them, their family and their community.

I'm not alone in this. Some interesting research from Canberra shows interviewed doctors working in challenging areas for more than 5 years shows

"All doctors [in this field] were motivated by the belief that helping a disadvantaged population is the `right thing' to do. They were sustained by a deep appreciation and respect for the population they served, an intellectual engagement with the work itself, and the ability to control their own working hours (often by working part-time in the field of interest). In their clinical work, they recognised and celebrated small gains and were not overwhelmed by the larger context of social disadvantage."

 I wasn't interviewed for this study, but I read it and thought "That's me!"

I finish with a reframing of the original question: Why wouldn't you want to work in Aboriginal health?