RANZCO urged to apologise to first Indigenous ophthalmologist – and more news from #MovingBeyondTheFrontline

(This article was updated on 14 November – see additions at end).

Introduction by Croakey: Leaders in Indigenous health from Australia and New Zealand have called on the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) to make “an unreserved apology” to Australia’s first Indigenous ophthalmologist, Dr Kris Rallah-Baker, “for its callous disregard of his experiences of racism and bullying”.

The call is published in this open letter to the College. It follows the College’s response to an article by Rallah-Baker, president of the Australian Indigenous Doctors’ Association (AIDA), describing his experiences of “direct and unashamed racism” during his training.

Professor Gregory Phillips, Dr Chelsea Bond, AIDA, members of the Leaders in Indigenous Medical Education (LIME) Network and other signatories to the open letter call on the College to engage in an independently facilitated discussion with Rallah-Baker to review and meaningfully address the concerns he has raised.

They also want the College to outline specific strategies in place to safely support its members in reporting discrimination, harassment and bullying; and to advise what it will do to ensure staff, board and members have a sufficient practical and theoretical understanding of what constitutes a culturally safe ophthalmology as experienced by the providers of care as well as its recipients.

The College’s response to Rallah-Baker  was published on the eve of the National Conference on Indigenous Health Workforce Leadership convened in Brisbane last week. It generated much discussion about how illustrative it was of the experiences of Aboriginal and Torres Strait Islander health professionals, according to the article below by Dr David Singh from the University of Queensland’s Poche Centre.

“In light of Rallah-Baker’s experience, we should also, as non-Indigenous colleagues, take responsibility for our own anti-racism,” writes Singh.

Croakey is seeking a response from the RANZCO. Professor David Tipene-Leach, Chair of Te ORA (Māori Medical Practitioner Association) has also issued a statement in support of Rallah-Baker.

And see beneath this article for a Twitter wrap from #MovingBeyondTheFrontline.

David Singh writes:

The National Conference on Indigenous Health Workforce Leadership, held in Brisbane on 2 November, brought together Indigenous health leaders from across the Australian health system in order to reflect on the transformative presence of a rapidly growing Indigenous health workforce.

Drawn from clinical practice, research, administration and advocacy, conference delegates were particularly concerned to identify the success factors that enable strong Indigenous leadership across the health system.

By fostering dialogues that privileged Indigenous knowledge, insights and experience, the conference undoubtedly succeeded in advancing understandings of Indigenous health workforce leadership and excellence beyond the usual [white] assumption that aspiration and capacity must first be built before routine acceptance of the idea of Indigenous health leadership.

The conference began with a recorded message from the Honourable Ken Wyatt AM, MP, Minister for Indigenous Health, Minister for Senior Australians and Aged Care. The Minister reiterated the Commonwealth Government’s concern for Indigenous health and highlighted the priority of growing the First Nations health workforce through the National Aboriginal and Torres Strait Islander Health Workforce Plan.

Strikingly, the minister saw fit to highlight the need for a broader health system understanding of the importance of an Indigenous health workforce, suggesting that hearts and minds had yet to be completely won over.

Pioneering leaders

Many of the programs and projects described at the conference were often conceived against a backdrop of indifference at best, and hostility at worst. Coupled with the vicissitudes of government policy and funding, it is remarkable that these projects gained traction, much less embed themselves over the long term.

That they were being described at this conference is testament to the pioneering leaders who worked to develop and refine a process that recognised and then thwarted inhibiting circumstances. Indeed, the process could be said to begin with contestation, followed by innovation and negotiation, and marked throughout by strong leadership and a political commitment on the part of all involved. As such, these programs and projects were marked by daily protestations of sovereignty, which serve to remind those minded to listen of where they are.

As befits a conference concerned with leadership, we heard described incredibly sophisticated leadership styles, which anywhere else would be the stuff of good practice in business textbooks.

Strikingly not many referred to the professional development they had been offered. It was not clear how many of the delegates were valued and nurtured by their organisations, such that they could be taken off ‘the front line’ and given, say executive coaching sensitive to Indigenous leadership styles.

Instead, we could hear, though it was not necessarily given verbal expression, how race stalks Indigenous leadership. Indigenous leadership is clearly precarious. No sooner is one garlanded than the white anting begins. Deficit framings of Indigenous ability break cover and , and Indigenous leaders must find ways to remain effective whilst constantly being drawn by racism. I was here reminded of Toni Morrison’s famous quote describing racism as a distraction:

The function of racism, the very serious function of racism is distraction. It keeps you from doing your work. It keeps you explaining, over and over again, your reason for being.

Somebody says you have no language and you spend twenty years proving that you do. Somebody says your head isn’t shaped properly so you have scientists working on the fact that it is.

Somebody says you have no art, so you dredge that up. Somebody says you have no kingdoms, so you dredge that up. None of this is necessary. There will always be one more thing.”

A case in point

As to what happens when you call out racism, the conference furnished a clear example of the kinds of retribution that follows. The second keynote was given by Dr Kristopher Rallah-Baker, Australia’s first Indigenous ophthalmologist and President of the Australian Indigenous Doctor’s Association.

Rallah-Baker, whilst exhorting more Indigenous people to study medicine, tempered his message with reference to his own experiences. It is not necessary to repeat all that Dr Rallah-Baker has had to contend with as an Indigenous medical professional, save one example that he described: the rebarbative response he received from his professional association after writing an article pointing out the poor representation of Indigenous people in ophthalmology.

This was not a polemical piece, but one that stated fact, and yet the response was swift and damning. Here racism is more than a distraction – it is one that one that leaves you feeling threatened and menaced. It leaves you feeling unsafe. Here professional status counts for very little. The racism may be more genteel, but the message is the same – ‘know your place.’

Rallah-Baker’s example is a reminder, if one were needed, that anti-racist policy declarations, such as the key objective of the Commonwealth government’s National and Torres Strait Islander Health Plan 2013-2023 – that of ‘a health system free of racism and inequality’ – must always be tempered by the raw experience of Indigenous colleagues.

In a panel session concerned with the Aboriginal Health Worker (AHW) workforce, we heard how the AHW remains central to the health system’s ability to provide comprehensive, culturally safe and clinically competent care, yet remain one of the least recognised occupational groups.

Black excellence is everywhere on display in the health system, not least within Black communities, but recognition is at best uneven. Conference delegates made clear their respect for the work of AHWs, but much needs to be done to ensure professional parity with other workers in the health system.

Further panels considered the success factors for building an Indigenous health workforce, including supporting the training of Indigenous professionals, and enablers for Indigenous leadership within the health system.

Take responsibility

The importance of cultural competency was stressed with regard to the prospect of a radically transformed health service, with the onus falling on the 97 percent of the non-Indigenous population to take responsibility for their own learning. In light of Rallah-Baker’s experience, we should also, as non-Indigenous colleagues, take responsibility for our own anti-racism.

All too often we are content to express sympathy and whilst shortly after return to sailing the tail winds left by our Indigenous colleagues as they struggle daily with the racist indignities heaped on them, often by the very institutions and organisations that employ them. What is our role in forging ‘a health system free of racism and inequality’?

The final word should be left to Dr Chelsea Bond, a key organiser of the conference and in my view, an exemplar of Black excellence.

In a searing piece written for IndigenousX entitled ‘Moving Beyond the Frontline: The power and promise of an Indigenous Health Workforce’, Dr Bond is inspired by John Newfong, a Ngugi Man and journalist, who provided the foreword to the nation’s first National Aboriginal Health Strategy. She writes:

I wonder how, in the advances we have made, we might reflect upon and return to a more radical reframing of the capabilities of an Indigenous health workforce; one which talks of collective resistance and struggle rather than individual aspirations and incapacities?

How might we subvert the everyday mythologising of our presence as a cheap and substandard labour force that requires propping up by white overseers? How might we use the positions we hold, whether we are located in clinical, administrative, research, or policy contexts, to reconfigure power relationships rather than reproduce them?

Perhaps we could return to the call of Newfong and speak of sovereignty rather than capacity more explicitly within the discourses of Indigenous health advancement. Perhaps we could think of resistance as an everyday workplace practice.

But most importantly, perhaps we could see Black excellence and leadership as a destination that we are already at, rather than an aspiration to be built.”

• Note to Croakey readers: This article was edited on 8 November after publication, and on 14 November the update was added, including a response from the RANZCO, as reported by Insight magazine.

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