Family, Unity and Success – Australian Indigenous Doctors’ Association (AIDA) 2017

Conference Report

The Australian Indigenous Doctors’ Association (AIDA) celebrated 20 years strong by holding their annual conference for 2017 in the Hunter Valley, traditionally owned by the Wonnarua people. This four-day long intensive collaboration of keynote speakers, engaging workshops as well as invaluable cultural and networking events created a leading platform to connect and be inspired. The AIDA 2017 conference focussed on “family, unity and success” with the overarching theme of supporting and connecting Aboriginal and Torres Strait Islander medical students and doctors to ultimately improve the health of Indigenous people in Australia.[1] This conference has grown to not only bring Indigenous students and doctors together but also to provide networking opportunities for associate members, medical college representatives, other health professionals and key invited guests, making it an important medical and political event.

Hunter Valley

Family

This was the second AIDA conference I have attended as a medical student. I believe many people would underestimate the value of bringing together fellow Indigenous medical students and doctors from across Australia. However, this sense of belonging and knowing you are not alone in medicine, whether it be through sharing stories in the yarning circle or networking in the lunch break, is why I believe the AIDA conference and AIDA itself is so successful. Recently, AMSA Blue Week highlighted conversations regarding the need to do more about the mental health crisis amongst medical students and doctors.[2] Research also shows that mental health disorders are more prevalent amongst Indigenous Australians than their non-Indigenous counterparts [3] and it is well documented that good social support is protective for mental illness.[4] This highlights the importance for Aboriginal and Torres Strait Islander medical students and doctors, in particular, to have a strong support network throughout their medical journey. AIDA provides a support network as a family-like organisation, its members backing each other as they embark on their medical careers and embrace the enormous task of improving Indigenous health.

Unity

So what do we know about Indigenous health? There is still a lot to do, but as an attendee of the AIDA conference, I was surrounded by people who are already are, or are soon to be, making a real impact on many people’s lives. However, the media continues to portray a narrative that there are only a few well-educated Aboriginal or Torres Strait Islander people. Australia’s history of Aboriginal and Torres Strait Islander people is still poorly taught in schools. Not only this but key Aboriginal and Torres Strait Islander people in the past who have formed a better path for our people are either unheard of or undervalued in our society.[5] This is reflected in the medical curriculum, where education about Aboriginal and Torres Strait Islander culture and cultural safety is often poor, undervalued or realistically done too late to change some attitudes and beliefs.[6]

The question then arises: is the problem really about the lack of teaching about Aboriginal and Torres Strait Islander culture, when racism (both institutional and interpersonal) is known to be associated with poorer health and poorer health outcomes?[7] Should the curriculum entail teachings on racism, both identifying it and stopping it? This conference asked whether it is the job of Indigenous people to educate non-Indigenous people on racism itself. The term “hidden curriculum” – the values and attitudes that medical students see around them – highlights the importance of lecturers, tutors, administrators and academics in showing strong leadership and changing the culture of our universities to stop racism and strongly value Aboriginal and Torres Strait Islander culture and health.[8]

It is not just universities that need to step up. The United Nations (UN) recently described Australia’s progress in Closing the Gap as “woefully inadequate”.[9] Hearing this in a room full of people who are driving positive change and having real impacts on lives can be very disheartening, especially when Aboriginal and Torres Strait Islander people make up only 2.8% of Australia’s population.[10] However, this highlights the importance for all Australians to unite to make Indigenous health an absolute priority amongst many key stakeholders. There needs to be a cultural change in broader society, particularly in how we value Aboriginal and Torres Strait Islander lives, challenge racism and become more culturally aware.  At this year’s AIDA conference, it was encouraging to see many of the medical college representatives understand the need for more Indigenous doctors, and the need for cultural change to challenge racism and improve cultural awareness within their own colleges.

Medicare exclusions for prisoners is a key issue that highlights systemic racism and contributes to health disparities. Currently, prisoners in Australia are excluded from Medicare and the Pharmaceutical Benefits Scheme subsidies. This limited access to good healthcare is shortening life expectancy and decreasing the quality of life of many people who are incarcerated.[11] Aboriginal and Torres Strait Islander people are over-represented in prisons and are 13 times more likely to be incarcerated.[12] This is not closing the gap but in fact, widening the existing chasm in health disparities.[13]

The beautiful but complex aspect to Aboriginal and Torres Strait Islander people and culture is that there are many communities, languages and cultural protocols; in improving Indigenous health there is no “one size fits all” approach. The best outcomes at a grass-roots level are when a community is meaningfully involved, a lengthy but essential strategy to drive improvements to Indigenous health.[14] Targeting the social determinants of health are also key, however tackling systemic racism, the lack in cultural awareness and creating a cultural change in society to value Aboriginal and Torres Strait Islander lives should be our focus for enduring change.

All medical students and medical schools in Australia should start talking about the idea that you are not clinically competent until you are culturally competent. This is imperative to reduce existing health disparities and eradicate diseases still present in remote Indigenous communities. AIDA and their supporters are ready to save and improve Aboriginal and Torres Strait Islander peoples lives, but everyone should also feel a sense of responsibility to unite to change the narrative from “woeful” to making real and lasting change.

Painted Stethoscope

Success

One of the most anticipated events of the conference every year is the stethoscope ceremony. This ceremony is where newly graduated Indigenous medical students and newly qualified Indigenous fellows are recognised for their hard work, sleepless nights, sacrifice and often added weight of responsibility by being presented with a hand-painted stethoscope. This creates mentorship at AIDA and inspiration that success is possible and very achievable as an Indigenous medical student and graduate.

The other most anticipated event (for me anyway) is the cultural excursion on the last day. I had very high expectations after last year, living dangerously and tasting a particular species of ant that tasted like citrus. However, I survived that last year, and can tell you that I thoroughly enjoyed the trip this year when people of the Wonnarua nation took us to Biame cave, the site of a significant piece of rock art in the Hunter Valley. These opportunities to have culture and knowledge shared are invaluable. What I also learnt was about how the traditional owners had worked with the non-Indigenous property owners on which this significant site sits in order to protect it, and make it accessible for those who wish to visit and appreciate its significance – thousands of years of culture and knowledge. The Wonnarua people also believe there are many other significant sites around that area. They hope that by setting this as precedent, not only can they work with other property owners in the region, but this can be applied to other significant sites across Australia. So, if you, your family or your friends own a property with an Indigenous site on it, or if you are unsure, please be in contact with your local Indigenous community because there may be thousands of important sites nationwide that need to be protected for generations to come.

When talking about medicine today, we often think of just the mind and body, but for many Indigenous people, there is an element of the spirit. It is also important to recognise that before colonisation, traditional healers or Ngangkari looked after our people, probably with the same care and dedication we hope to have as good doctors one day. These Ngangkari included the spirit in healing; some are still around today treating Indigenous people. So from an Indigenous medical student’s perspective, in a society faced with racism and disparity, perhaps we should put the humanity back into medical school and not just hope, but work hard to create a better world and health outcomes for this nation’s first peoples.

Narawi Foley Boscott

Narawi completed a Bachelor of Science (Biomed) at the University of Queensland and is currently completing a Doctor of Medicine as well as a Graduate Certificate in Business Leadership. Narawi is pssionate about Badtjala culture and aspiring to improve Indigenous and mental health. 

Conflict of Interest
None declared

Correspondance

narawi.kefb@gmail.com

References

  1. Australian Indigenous Doctors’ Association. AIDA Conference 2017 [Internet].[cited 2017 Oct 1] Available from: https://www.aida.org.au/conference/
  2. AMSA mental health. About the Campaign. [Internet]. [cited 2017 Oct 1].
    Available from: http://mentalhealth.amsa.org.au/about-the-campaign/
  3. Jorm A, Bourchier S, Cvetkovski S, Stewart G. Mental health of Indigenous Australians: a review of findings from community surveys. Med J Aust. 2012 196 (2):118-121.
  4. Ozbay F, Johnson D, Dimoulas E, Morgan C, Charney D, Southwick S. Social Support and Resilience to Stress. Psychiatry (Edgmont). 2007 May 4(5):35-40.
  5. Do our teachers care enough about Indigenous Australia to bring it into the classroom? [Internet]. 2017 May 9 [updated 2017 May 9; cited 2017 Oct 1].
    Available from: http://www.sbs.com.au/nitv/article/2017/05/09/do-our-teachers-care-enough-about-indigenous-australia-bring-it-classroom
  6. Durey A. Reducing racism in Aboriginal health care in Australia: where does cultural education fit? Australian and New Zealand Journal of Public Health. 2010 July 34(1):87-92.
  7. Larson A, Gillies M, Howard P, Coffin J. It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians. Australian and New Zealand Journal of Public Health. 2007 August 31(4):322-229.
  8. Mahood S. Medical education-Beware the hidden curriculum. Can Fam Physician. 2011 September 57(9):983-985.
  9. Brennan, B. Australia’s progress on Closing the Gap ‘woefully inadequate’, UN says. [Internet]. ABC News. 2017 September 11 [cited 2017 Oct 2].
    Available from: http://www.abc.net.au/news/2017-09-11/closing-the-gap-progress-woeful-un-says/8892980
  10. Australian Bureau of Statistics. Census: Aboriginal and Torres Strait Islander population. [Internet]. 2017 June 27 [updated 2017 June 26; cited 2017 Oct 2] Available from: http://www.abs.gov.au/ausstats/abs@.nsf/MediaRealesesByCatalogue/02D50FAA9987D6B7CA25814800087E03?OpenDocument
  11. Plueckhahn T, Kinner S, Sutherland G, Butler T. Are some more equal than others? Challenging the basis for prisoners’ exclusion from Medicare. Med J Aust. 2015 203(9):359-361.
  12. Australian Bureau of Statistics. 4517.0 Prisoners in Australia, 2016. [Internet]. 2016 Dec 8. [updated 2016 Dec 7; cited 2017 Oct 2] Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4517.0~2016~Main%20Features~Imprisonment%20rates~12
  13. Durey A, Thompson S. Reducing the health disparities of Indigenous Australians: time to change focus. BMC Health Serv Res. 2012 June 12:151.
  14. Rowley K, Daniel M, Skinner K, Skinner M, Whyte G, O’Dea K. Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community. Australian and New Zealand Journal of Public Health. 2000 April 24(2):136-144.

Four perspectives on the World Congress on public health

Conference Report

15th World Congress on Public Health

April 3-6, 2017

Melbourne, Australia

“Leadership is the capacity to translate vision into reality” – Warren Bennis

The World Congress on Public Health (WCPH) is held every 2-4 years and organised by the World Federation of Public Health Associations (WFPHA).  Attracting between 2000-4000 delegates from over 80 countries, the main objective of this international forum was to engage diverse voices, ideas, vision and actions of committed professionals and citizens to strengthen and transform the global public health effort and influence decision makers.[1] With a comprehensive academic program, field trips, World Leadership Dialogues, satellite events and meetings, and a glitzy social program, this is truly the ultimate conference for public health inclined peers.

We evaluate the experiences of attending the WCPH, the benefits of meeting like-minded individuals, the sense of optimism in the face of challenge and the problems on financial supports in four different perspectives: a volunteer, a presenter, a medical student and a young researcher.

A Volunteer’s Perspective – Helena Qian

Helena is a third year medical student at the University of Newcastle with a keen interest in improving global health and aiding underserved communities.  She hopes to work with WHO and MSF in the future as a collaborative researcher, advocate, field doctor and volunteer.

“When ‘I’ is replaced with ‘We’, even ‘Illness’ becomes ‘Wellness’.” – Malcolm X

As someone passionate about improving public health, I noticed a curriculum gap in which public health was only briefly touched upon. WCPH was the perfect meeting of likeminded individuals, leaders and global health enthusiasts from which I could gain a holistic understanding of public health from a grassroots standpoint to a global perspective. With a registration fee of $770 for students (excluding accommodation and flights) and being on a uni student budget, I opted to attend the conference for free as a volunteer.

To apply, there was a simple online questionnaire and requirement to volunteer at least 20 hours throughout the conference. As this meant volunteering for four hours per day, I wasn’t able to attend all the academic workshops/sessions. I mainly worked with the media department whereby I sent interesting quotes from plenary sessions to the team for Twitter content. I also had the opportunity to directly converse with speakers in a relaxed setting, after their interview with the media team.

Despite the vast array of expertise and interests, discussion points centred around the confluence of global environmental degradation, differing political agendas, civil unrest and widening inequities in health outcomes. Interestingly, despite proven health detriments from excess alcohol, tobacco and sugar consumption, Prof. Mike Daube stated, ‘Where engagement has occurred, it has invariably been counterproductive.’ Hence, a significant barrier preventing implementation of effective public health policies are the industry groups who place private profits over the health of their consumers. As Dr Bronwyn King eloquently encapsulated, “60% of the tobacco industry involves child labour – is there no baseline standard below which we will sink to raise money?” Where negotiations with industry have failed, focus has shifted to the consumer. Exposing the fund managers who invest in these corporations and highlighting that indirect health and environmental costs rest with taxpayers, whereas revenue stays with manufacturers, have resulted in approximately $5 billion AUD being withdrawn from investment in the tobacco industry alone.[2]

Ultimately, the conference epitomised the power of public health to draw connections to unseen patterns of disease, highlighted hidden societal inequalities and served as a platform for marginalised or underserved populations to have a say. Backed by epidemiology and evidence based medicine, public health brings ugly truths to the forefront of discussion and ‘has a duty to speak truth to power’.

I’m immensely grateful to have attended as a volunteer and to have met such an inspiring network of public health leaders and fellow peers. As a student, I highly recommend attending as a volunteer, especially as you gain unprecedented access to event organisers and plenary speakers. Hope to see you at the 16th WCPH in Rome 2020!

A Delegate’s Perspective – Michael Wu

Michael is a second year medical student and current Chair of GlobalHOME at the University of Sydney with a burning passion for health that disregards borders. Like Helena, he dreams of working all over the world with MSF. His heroes include inspirational figures such as Dr Catherine Hamlin. He also enjoys sunsets and hummus.

The most palpable feeling one senses at a gathering of minds tackling the most complex social health issues in the world is that of positivity. Despite the clear adversity, there is a strong belief that we have the tools and allies needed to succeed in our agendas.

As anyone that is interested in optimising health outcomes and promoting medical equity, the words “World Congress of Public Health” instantly caught my attention when I first heard them. The WCPH was a melting pot of inspiration, edgy research and health reform superstars from all over the world. This gathering does not come cheap but it also comes only once every 2-4 years and can be anywhere in the world. It was an opportunity I couldn’t miss.

To pay for my privilege to be a fly on the wall I sought the assistance of the University. Unfortunately, the Sydney Medical Program only sets aside funds for conferences if you are a presenter, however, the Sydney University Postgraduate Association was more than happy to hear me out. All I had to do was attend a general meeting, provide background information on the event and my interest and how this can benefit their interests then prepare an “ask”. They saw fit to offer me a grant for $480 to subsidise my registration in exchange for sharing what I learnt with their Women’s Officer and Environmental Officer.

This year, the University of Sydney’s Global Health Society – GlobalHOME – committed to numerous key areas of interest, including climate change and the impact on Healthcare. The plenaries for the WCPH not only had this, but also talks about Female Genital Mutilation, First Nations people, Non-Communicable Disease and Tobacco Control. These were talks dedicated to some of the most difficult healthcare issues today, and WCPH would see some of the greatest minds gather to discuss them. With Plain Packaging 2.0, we may start seeing cigarettes marked along their length with the cost to your life expectancy. There was research on the resiliency of health care systems in warzones. One researcher working on his PhD had just returned from Eritrea to add to his pool of data from nine other countries into which he had ventured during active fighting.

As a student, it is a little daunting to attend a professional conference out of your direct field but all you need is an interest and passion. I made many connections and took home plenty of key messages. I would encourage anyone looking to attend a professional conference to do so and to not be fazed by a lack of scholarship availability. It would be worthwhile approaching your student council or representative organisation and present to them to secure a bursary of your own making.

A Presenter’s Perspective – Michael Au

Michael is a fourth year medical student at James Cook University. He is committed towards the promotion of human rights, social justice, and health equity. His interests lie in refugee and maternal health, health systems and the social determinants of health. He is currently completing research investigating refugee health systems in Far North Queensland.

Although there is much to celebrate in public health, Dr Margaret Chan at the conference described “new challenges of unprecedented complexities” facing the world in the areas of antibiotic resistance, obesity and chronic diseases. These issues are intertwined with social, political and cultural issues which make them increasingly difficult to address.

The status quo is not enough and there is still so much to be achieved in public health. However, many students, including myself, fall into the trap of complacency towards the state of affairs in global health. As Australian students, we view the rest of the world through the lens of a developed country, distorted by daily privileges which we take for granted. The solution? A continual pursuit for truth and information with a high degree of scientific scepticism. This was just one of the few gems I gathered from this conference.

With the support of the Royal Australasian College of Physicians (RACP), I was fortunate to be given full registration and travel assistance to attend the WCPH as a John Snow Scholar. The scholarship gave me the opportunity to present research which I had completed as a medical student, entitled “HIV/HCV Prevention in Australian Incarcerated Populations: A Review into Preventative Practices and Outcomes”. My review highlighted the growing disparity in health outcomes between prison populations and the community due to a lack of preventative programs in Australian prisons against infectious blood-borne diseases. I encourage all medical students to consider applying for the John Snow Scholarship.[3]

Attending this conference gave me the opportunity to meet with leading academics in my area of research. In addition to bringing together academics from across the globe, both government and private sectors were closely involved. It was my great pleasure to meet with the Australian Capital Territory (ACT) Chief Health Officer who was leading the reform in needle-syringe programs as well as other academics prominent within the field of my research topic. I found this most peculiar and warming, that an event like this is able to bring people together from different parts of the world, addressing a certain issue and to share, foster and inspire other like-minded individuals.

Many medical students would have had experience in attending AMSA Global Health and AMSA National Convention events. The WCPH differs to AMSA events in that it is a professional research intensive conference. These events demarcate the knowledge frontier in public health in a setting that aims to create professional networks and expanding partnerships.

A Young Researcher’s Perspective – Ka Man Li

Ka Man is a final year Biomedical Science student at the University of Melbourne with a strong devotion to furnish approaches for current health concerns: healthy ageing and preventive cardiology. She aims to serve as a part of WHO and WFPHA to optimise global health in the nearest future.

Pioneering spirit should continue, not to conquer the planet or space…but rather to improve the quality of life.” – Bertrand Piccard

As a young researcher, I always dreamt about either standing behind the podium presenting my novel research findings in front of experts in the field, or seeing my name on publications. On the 4th of April this year, my dream finally came true.

It all began an hour before a regular Monday meeting with my supervisor. With little progression in my thesis, I did not want to be a disappointment thus I googled an upcoming conference related to my research field. I submitted an abstract in the spur of the moment to this conference. Months later, I got accepted as an orator for my study entitled, “The Effect of Physical Activity, Body Mass Index on Cardiovascular Risk in Australian Older Women”. I was overwhelmed by a cocktail of excitement and anxiety.

Weeks before the conference commenced, I spent countless days and nights working on my results for the presentation, enduring many failures along the way. Numerous times, I had to go back and forth changing the inclusion and exclusion criteria for my literature review, refining the rationale and interpreting my statistical regressions. However, with the support and encouragements from my supervisor and colleagues, I finally finished my results for the presentation.

As soon as I arrived at the venue of WCPH, my first international conference, all my doubts, insecurities and anxieties suddenly vanished. I was impressed by the scale, the conference production value and the number of people participating! It was a pleasure to meet with a diverse group of delegates from different professional fields across the globe. We were able to share personal experiences, discuss typical research mistakes and exchange knowledge about improving global health. One of the most memorable highlights was meeting with leading academics, including Dr Michael Moore, President of the World Federation of Public Health Associations (WFPHA) and the CEO of Public Health Association of Australia. Not only did he inspire me with his persistence and belief in research but he also expanded my vision for certain health issues with different perspectives.

Ultimately, WCPH was a life-changing conference. I was delighted to achieve my dream at such an early stage of my research career, presenting formally at one of the biggest international conferences. WCPH has certainly reignited my unwavering passion for public health research despite all the challenges. It has given me an opportunity to engage, learn and foster ideas with many like-minded individuals.

Although funding is not always available for research students, conferences like WCPH are worth the cost! As Mr Greg Hunt, MP, stated at the opening ceremony, we need more frontier researchers to contribute to and enhance quality of life. We, as tomorrow’s researchers, ought to raise our voices to develop a comprehensive vision to take action and improve global health nationally and globally.

Photo Credit

Helena Qian, Michael Wu, Michael Au, Ka Man Li

Conflicts of interest

None declared

Acknowledgements

Sydney University Postgraduate Representative Association (Michael Wu) Royal Australasian College of Physicians (RACP) (Ka Man Li)

References

1. WCPH About [Internet] Retrieved on 28th August 2017; Last Updated 2017. Available from: http://www.wcph2017.com/about.php

2. WCPH Program Handbook. Proceedings of the World Congress of Public Health; 2017 Apr 3-7; Melbourne, AU. 2017.

3. John Snow Scholarship Information website [Internet] Retrieved on 10th September 2017; Last Updated 2017. Available from: https://www.racp.edu.au/about/racp-foundation-awards/division-faculty-chapter-regional-awards/australasian-faculty-of-public-health-medicine/john-snow-scholarship