Indigenous health panel urges GPs to call out ‘elephant in the room’

‘This is just one Aboriginal man’s journey, sharing with an enormous group of people. Feeling rather vulnerable is an understatement, but having absolute trust because we’re all here on the same journey.’
 
Those are the words of Associate Professor Brad Murphy, a GP and immensely proud Kamilaroi man.
 
But he is also a man wounded, mourning the result of a referendum that ‘put human rights to a popular vote’.
 
‘We’re going to be healing for a very long time to come,’ he said.
 
‘It would be such a shame to leave a gathering like this and not have the opportunity for us to at least call out the elephant in the room and talk about a great travesty – an opportunity that has gone begging.
 
‘However, it’s only gone begging in one respect, because good people with good hearts continue to do good things, and that’s what we all need to do.’
 
Met with a standing ovation and a room full of teary eyes, Associate Professor Murphy shared his own honest and emotional story as part of WONCA 2023’s Keynote Panel on Indigenous Health.
 
The panel, moderated by RACGP Aboriginal and Torres Strait Islander Health Medical Advisor Dr Tim Senior, also featured WONCA President-Elect Professor Viviana Martinez-Bianchi and Māori and Indigenous Research Professor David Tipene-Leach, world leaders in indigenous health and best practice recognition of culture.
 
It was a raw and reflective presentation, reacting to the fragile and complex battle for acknowledgment dividing Australia in real time.
 
‘The history of this nation caused people to do things to be able to survive in a land that was intensely racist and that’s incredibly shameful,’ Associate Professor Murphy said.
 
‘I know that a lot of people who voted yes in our referendum weren’t voting for the referendum, they were voting for progress and equity, seeing that there was an opportunity here to advance the system that needed help.
 
‘It’s not about guilt. People say, “I can’t be held accountable for what happened in the past” and, no they can’t, but we’re all responsible for what we do today and how we respond to this and how we move forward.’
 
Around 1000 GPs and other delegates witnessed the presentation in Sydney’s Darling Harbour Theatre, with around half hailing from outside Australia – each with their own Indigenous cultures, languages, and values.
 
But at a time in Australia when closing the gap seems further away than ever, Associate Professor Murphy said GPs need to act, to empower and lead their communities to a healthier future.
 
‘As a GP, I’m not even sure why we’re having this conversation because is what we do each and every day not about equity?’ he said.
 
‘The first patient that walks through my door in the morning is someone in need, because if they weren’t in need, they wouldn’t be there.
 
‘[We need] to do the right thing, to be good GPs, to be equitable and conscious in the way that we see all our patients and our communities as we move forward.’
 
As well as being WONCA President-Elect, Professor Martinez-Bianchi is also the Director of Health Equity at North Carolina’s Duke University and, hailing from Argentina, she knows all too well what it is like to live and work in a country that is not your own.
 
She said GPs need to always be thinking of ‘culturally humble care’, as health disparities worsen.
 
‘How often we talk about how not literate our community is, without us being literate about their strength, and their power, and how they take care of each other,’ Professor Martinez-Bianchi said.
 
‘Knowing who is marginalised and part of an under-served community, who is working in overcrowded infrastructure or insufficient infrastructure, who has high dependence on informal economy, daily wages, who leaves armed conflict and violence, and for whom our systems are weak.’
 
Professor Martinez-Bianchi said it family doctors have a responsibility to give these communities a voice, but not speak for them.
 
‘We are there to listen, to take the time to listen, to decide that we want to listen, and to listen with our hearts and seeking to engage,’ she said.
 
‘We need to open doors we have never opened before and ask questions we have never asked before. We need to train ourselves and our learners to understand factors of vulnerability.
 
‘We need to be role models asking the difficult questions at a systems level, checking in about equity, and setting up accountability systems so it is not based on one individual remembering to do something.’
 
Meanwhile, Professor Tipene-Leach, who for decades has advocated for change in his own community to establish a healthcare system that truly cares for all, said GPs need to constantly push for equitable outcomes, both in their own practices and in the wider system.
 
‘A politician and a bureaucrat are not going to solve this,’ he said.
 
‘[It] can only be addressed by you and I grabbing hold of something, and I’m putting up the thesis that cultural safety is the thing that we should grab hold of.
 
‘We should be forever reflecting on our practice, we should be forever auditing outcomes by ethnicity, applying that knowledge, applying it in a horizontal fashion to our colleagues, [and] in a vertical fashion to our seniors and juniors.
 
‘I urge you all to adopt cultural safety as a way to promote equity for indigenous peoples.’
 
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