Issue 2 • 2021

Time to talk about transformation

Building a solution space for Indigenous health at the RACP
Organisational transformation is often preceded by frank and open discussion. When the College invited Associate Professor Luke Burchill FRACP and Professor Megan Davis to speak at RACP Congress 2021 on the topic of ‘Building a solution space for Indigenous health at the RACP: transformations, challenges & opportunities’, their passion and personal experience in this arena was always going to make for a powerful conversation.
Associate Professor Luke Burchill FRACP took to the stage in Melbourne and commenced the session with details about his own personal journey. It was an honest account where he spoke of being the son of an English migrant and the benefits of this. He spoke of how he perceived the benefits of inheriting his father’s white skin, and the access to educational, medical and legal systems that might have otherwise been denied to him, as well as an awareness of how this system was built by, and for, those of privilege.
At the same time, he spoke of how he is also the son of an Aboriginal Yorta Yorta/ Dja Dja Warrung woman and how, in this, he received the benefit of being born and raised on country, and being surrounded by this community and culture.
He then went on to speak of his time at the College and the sobering realisation when he noted that, when he became Chair of the RACP Aboriginal and Torres Strait Islander Health Committee, there were three numbers that stood out. Thirteen was the number of physicians who identified as Aboriginal and Torres Strait Islander within the College, 19, the number who identified as Māori and 18,350, the total number of Fellows.
This, he reflected, led to the obvious question, “Why are there so few? In the last five years there have been 210 medical graduates, yet most will not enter specialty training.” Where do we begin to create the solution that will change this?
Associate Professor Burchill spoke of an environment that he described as a problem space. “The problem space is where one encounters stigma and deficit narratives, with regards to Indigenous people and health outcomes every day. Questioning deficit narratives leads to you being labelled as challenging and difficult.”
The challenges include being asked to be all things Indigenous. Being asked to speak at NAIDOC week, deliver the Acknowledgement of Country, serve on ever expanding committees, asked to bring the Indigenous community and Indigenous funding to the table. To work in an environment that favours western science and practices. Ultimately, this space becomes a lonely space where you are being constantly asked to tick boxes for others at the expense of ticking boxes for yourself.
So how do we transform the problem space into a solution place? How do we lead a transformation shift that is needed to shift the status quo and attract more Aboriginal and Torres Strait Islanders into specialist careers? The starting point, Associate Professor Burchill said, is that it is important to recognise that the problem space has been built for them. It has been created by those who come from a position of privilege. This recognition may be uncomfortable, but it is necessary. From there the College needs to build a new narrative that seeks to Indigenise and decolonise, and to work with the community as partners.
“The College motto to serve the health of our people, should remind us to look inward and embrace First Nations health as the work of this College and its membership.”
Professor Megan Davis followed on from Associate Professor Burchill, delving into the substantial work that went into designing and leading the 13 Regional Dialogues across Australia with First Nations communities and which culminated in the Uluru Statement from the Heart being presented to the Australian people in May 2017. A Cobble Cobble Aboriginal woman from the Barrungam nation in South-West Queensland, Professor Davis is the Pro Vice-Chancellor Indigenous, Professor of Law and Balnaves Chair in Constitutional Law at UNSW and a Fellow of the Australian Academy of Law. Her scholarly research work is focused on law reform in the areas of constitutional law and Aboriginal women.
She addressed the proclivity of the Australian state to prefer symbolism over substantive change that empowers people to have a voice and make decisions. Australia is in the second decade of pursuing constitutional recognition. Since that time, we have had multiple panels and parliamentary reviews.
So why is constitutional recognition important? As she put it simply, “Constitutional recognition is important because it allows for some redistribution of power in the constitution to empower Aboriginal and Torres Strait Islander people to be at the table when laws and policies which impact their lives are made”.
It is important to address the legal fiction that Australia was unoccupied. To recognise that colonisation is a continuing process, that Indigenous land was taken, and the population was intended to be replaced with people, institutions and society from the motherland. The end result of this is a powerlessness that comes from not having sovereignty and a space that is heavy with tokenism and symbolism, but with minimal action and accountability.
As Professor Davis pointed out, Australia is an outlier in the world, being one of the few countries that did not sign a treaty with the Indigenous population. “The failure to enter into treaty manifests in many ways, structurally, in legal and political systems for Indigenous populations and one of those is the issue of legitimacy.”
Failure to recognise and to provide First Nations people with a voice impacts upon people’s health. It is more clearly defined in the concept of ethical loneliness, the experience of being abandoned by humanity, compounded by the cruelty of wrongs not being acknowledged.
She then went on to explain the process used to create the Uluru Statement from the Heart. The Statement was preceded by 13 deliberative Regional Dialogues held in First Nations communities across Australia in 2016 and 2017. These Dialogues provided an opportunity for First Nations participants to discuss what meaningful constitutional recognition would look like to them. The Dialogues were run in partnership with a local host organisation to ensure that the community was properly represented. Discussion was led by local leaders and the process ensured that every attendee had an opportunity to consider several possible constitutional amendments to ‘recognise’ First Nations people. Delegates had the opportunity to express their views and to be able to participate in discussion to reach a consensus. Common participation was the model, with the discussion to be led by local leaders rather than facilitators.
The Dialogues culminated in a national constitutional convention at Uluru in May 2017 at which the Uluru Statement from the Heart was presented to the Australian people. The statement delivered at Uluru in May 2017 was based on what the community prioritised at the Dialogues. At Uluru, the Delegates confirmed that they agreed with the records of meeting, and what would be included in the final statement. Achieving consensus at every single dialogue ensured that everyone was comfortable that their views were captured correctly and that there was agreement on the content in the Uluru Statement from the Heart.
The reforms called for in the Uluru Statement are known as Voice, Treaty, Truth and have been asked for and considered since the 1830s. A Voice for First Nations enshrined in the Constitution is the vital first step to the reforms, as it would ensure and compel the state to have an Indigenous voice at the table when laws and policies affecting First Nations people are being considered. To date, governments, she noted, have only been prepared to have First Nations people at the table if they are compelled, even though their input would always result in better laws and policy. When the community is not the driver of the policy and focus, or even consulted, throwing money at problems will not be effective. Symbolism is, after all, cheaper and easier, whereas meaningful Constitutional recognition is harder to achieve and causes discomfort.
The session then allowed time for the audience to ask questions of the speakers, the most obvious question being, what can we do as physicians and clinicians to help?
Both speakers had a common response. They need allies. They need people who can stand alongside and support them. As Associate Professor Burchill pointed out, sometimes experience in how to navigate systems of privilege can be vital in achieving success.
He then went on to encourage people to ask of their communities, “What is our policy for building the next generation of Aboriginal and Torres Strait Islanders scholars, medical students and doctors? How is it being supported? How is it being funded? How are we going with building the numbers and what metrics are being used to actually determine that we are making progress?”
Professor Megan Davis then finished with some simple, yet succinct advice. “We need allies who will listen.”
You can read the Uluru Statement from the Heart on the Uluru Statement from the Heart website.
© 2021 The Royal Australasian College of Physicians