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Australia's Leading Ophthalmic Magazine Since 1975

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Closing the gap from both sides

The dire state of Indigenous eye health is one of the most well documented, yet enduring features of Australian eyecare.

There are countless reasons for this and improvements can be made in a whole host of areas. However, an area that is rarely discussed is the relative lack of Indigenous eyecare professionals comparative to the rest of the population, especially ophthalmologists.

Out of more than 1,000 ophthalmologists in Australia there is just one Indigenous ophthalmologist – me. Three months ago there were none, ever. It is 2018.

The Aboriginal and Torres Strait Islander population constitutes 3% of the Australian population and in order to reach population parity of ophthalmologists in Australia we need another 29 of me. The trouble is, the country’s only training body – RANZCO – has failed to recruit a single Aboriginal or Torres Strait Islander trainee to the vocational training program since I began in 2009, which means in reality it will be at least another half a decade before there’s even a chance of adding to the tally. Why?

There is lack of knowledge within the medical system of what it is to be Aboriginal, institutionalised racism is endemic and the system remains culturally unsafe.

"My own dealings with blatant racism, degradation, training delays, bullying, harassment and racial vilification are unfortunately considered an unremarkable experience amongst my indigenous medical brethren"

My own dealings with blatant racism, degradation, training delays, bullying, harassment and racial vilification are unfortunately considered an unremarkable experience amongst my Indigenous medical brethren. To many of us, racially motivated workplace violence is the norm. Institutionalised racism, unconscious bias and cultural insensitivity might sound like buzzwords people kick around, but they are real and their impact is real.

There were countless instances where I experienced direct and unashamed racism during my training. Some of those approaches were so bold as to be committed in writing. Without naming individuals, those responsible were my superiors, who in most cases had the ability to directly influence my progression or failure through the training program – they held absolute power over my career. These were individuals of high status and wealth, held in high regard by society and whose behaviour was expected to be beyond reproach.

The reality is that the college training system is structured such that a trainee is too often disempowered and cannot exercise their right of reply or defend themselves against malicious behaviour. To run against a senior colleague or question the college would mean running the risk of punitive action. As an Aboriginal or Torres Strait Islander doctor you are even more powerless than your peers, coming from a background of genocide, poverty and dispossession.

That’s not okay and it shouldn’t be this way.

Ignorance is the bedfellow of racism and to combat it we need to invest in continued education focused on Indigenous cultural sensitivity. It can’t just be restricted to university either, as Aboriginal 101. What is required is cultural competency and a commitment to life-long learning just as ldoctors do with their clinical training.

Designs for Vision

We undertake continuing medical education (CME) to maintain and improve our clinical skills, but we should also ensure our social abilities are not only at the requisite level, but improved over time just as our scientific knowledge is. The ability to listen, express compassion and empathise are qualities all doctors should have. In an increasingly multicultural society, the skills that we learn through Indigenous cross-cultural competencies are universally transferable and desirable.

At the moment ignorance of cultural competency is a self-fulfilling prophecy; many people aren’t exposed adequately to Indigenous Peoples and culture and therefore are unaware of their ignorance regarding cultural sensitivity. Openly racist individuals are not challenged.

Key to the solution is training adequate numbers of Aboriginal and Torres Strait Islander health professionals across all areas in an environment of genuine respect and partnership, addressing entrenched institutionalised racism, improving cultural competencies amongst health practitioners, and reforming the college system to be more transparent and responsive to change. All Australians gain from a better system.

Name: Kristopher Rallah-Baker
Qualifications: B. Med, AMA(M), MAICD, FRANZCO
Workplace: Southeast QLD/ remote Aus
Position: Ophthalmologist
Location: Brisbane, QLD
Years in the profession: 16


RANZCO responds

Following the publication of Dr Kristopher Rallah-Baker’s Soapbox article, RANZCO CEO David Andrews submitted the following letter to the editor in response.

Dear Editor,

RANZCO Fellows have a proud tradition of caring for Indigenous Australians, starting with early pioneers such as Professor Ida Mann and luminaries like Fred Hollows and Hugh Taylor.

While there is certainly still a lot do with respect to Indigenous eyecare in Australia, it is in fact very well served by RANZCO Fellows and outcomes are consistently improving. Closing the Gap in Eye Health has been one of RANZCO’s top priorities.

We have developed a multifaceted policy to improve the quality and sustainability of care of Indigenous communities, recognising that excellent eye health service needs more than an improvement in cultural safety.

*The full text can be read here

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