Walking the walk

Dr Aleeta Fejo survived a long and arduous journey to qualify as a general practitioner. She has curated a book telling stories of Indigenous medical registrars and their common experiences of racism, bullying and an endless series of hurdles

DR Aleeta Fejo is a Larrakia woman. She grew up in Darwin and, like the other members of her tribe, attended the funerals of family and friends every couple of months.1

“I thought it was normal to go to funerals that often”, she tells the MJA.

At the age of 25, Dr Fejo was working at Centrelink when the opportunity came up to work as a research assistant on a Menzies School of Health Research study on low birth weight Indigenous babies.

“That’s when I realised; I understood why so many of my family and friends were getting sick and dying from chronic diseases like renal failure, diabetes and cardiac conditions”, she says.

“That was the first time I realised that what was normal for my family was not normal at all for the rest of the population.”

Her time at the Menzies School of Health Research also presented another opportunity — encounters with medical students.

“I thought, well, if they can study medicine, so can I.”

That’s how Aleeta Fejo became the first Aboriginal medical student from the Northern Territory.

It was an arduous path from that point until graduation, however.

First there was relocation to Melbourne to complete a science bridging course before enrolling in the medical course at the University of Melbourne. But that coincided with the birth of her third baby, and the going was difficult, she says.

“I transferred into a science degree and then went home and finished my science degree at Charles Darwin University.”

That wasn’t the end of her travels, however. Determined to finish her medical degree, she moved again, this time to Adelaide, where she enrolled as a mature age student at Flinders University.

She spent the next 2 years in the South Australian capital before heading home again to finish her medical degree at the clinical school in Darwin, graduating in 2004.

It was, she says, a journey that is not unusual for Indigenous medical students who inevitably must endure relocation and separation from their family, friends and culture in order to achieve their professional dreams.

In 2008 she founded the Indigenous General Practice Registrars Network, which aims to offer peer support and advice to Aboriginal and Torres Strait Islander GP registrars.2

“There are about 30 Aboriginal Fellow GPs in Australia and about 30 GP registrars, with about a hundred doctors in the hospital system and about 200 medical students behind them,” Dr Fejo says.

“But there have been a lot of issues that are not letting the registrars progress smoothly from general practice registrar training into Fellowship, where they are consultants and can work independently.”

Resources are limited for Indigenous registrars, she says, despite the existence of some government funding, and the costs of sitting specialist exams can be prohibitive.

The result is a bottleneck, Dr Fejo says. More Indigenous students are coming through the system, but are falling by the wayside or becoming caught in an expensive loop of trying to get through registrar training.

Now she has written a book — Shattering stereotypes: experiences of Australian and Canadian First Nation general practitioners and family doctors — personal accounts by Indigenous Australian GPs and First Nation Canadian GPs aimed at encouraging prospective family and community doctors through hearing the authentic voices of those who have completed the journey.

Speaking at the launch of the book at Flinders University last month, Dr Fejo said racism, bullying and constant stereotyping, such as laziness, lack of motivation and lack of intellectual ability, were constants for Indigenous medical students.

“Here are stories that blow stereotypes out of the water, because these people have again and again faced the odds, hurdle after hurdle, and have been successful”, she said.3

The book also summarises recurrent themes and issues for Indigenous students and registrars, and reveals that they are likely to encounter very negative responses within the health system.

“A supervisor of mine once said to me that all these [Indigenous] people should be shot and the place bombed, and burned to the ground”, Dr Fejo tells the MJA.

“I started this book in October of last year”, she says. “It’s been a really therapeutic process for me. Many of our doctors have traumatic memories [of the training process]. I asked myself if I really wanted to put myself out there, but it’s helped me to come to terms. And I’m so, so proud of the Aboriginal doctors [who contributed to the book] and their families. It’s important for Aboriginal voices to be heard, by their parents and their families.”

Dr Fejo sought the involvement of Canadian Indigenous doctors when she started to wonder “is it just us?”

“I contacted some Canadian colleagues and asked them to give me their stories — the good, the bad, the happy and the sad — warts and all.

“It turns out their issues are very similar to ours — repeating through the generations.”

Dr Fejo believes the presence of Indigenous doctors is vital, not just to the health of Aboriginal people, but also to eliminate racism and stereotypes from our society.

“I want the children to see an Aboriginal GP”, she says. “Until a lot of people see an Aboriginal GP, they don’t see that it’s possible. It’s about raising potential.”

She would like Shattering stereotypes to be required reading for all medical students, their supervisors, medical educators, and those working within the health care system.

There’s also a down-to-earth reason for wanting the book to sell well — all profits will be poured back into resources for Indigenous registrars.

“Some of the Aboriginal registrars are really struggling”, she says. “We need to change the system so that we have more success, and we don’t lose our doctors at the end of this hard, hard journey.

“With a significant increase in the number of Aboriginal GP Fellows we could transform Aboriginal health almost overnight.”

In 2013, Dr Fejo was made a Fellow of the Royal Australian College of General Practitioners, at her fourth attempt.

“I failed the RACGP exams three times”, she says.

“[Being assessed by exam] was not working for me. I tried the practice-based assessment pathway and I got through.

“It’s vital that the RACGP continue to allow practice-based assessment as an option.

“You need a clear mind to take exams and to study for them. When you’re being bullied almost daily, it affects you spiritually, physically and mentally. So there needs to be an alternative to sitting exams.

“There cannot be just one way over the mountain.”

Words are one thing, actions another, Dr Fejo says.

“Nobody likes to talk about racism”, she says. “It makes us all uncomfortable, but it’s a conversation that has to happen. We must call out racism for what it is, that’s how to get rid of it. But it’s not good enough to just talk about zero tolerance. We must back it up with action.”

Shattering stereotypes is available from Magpie Goose Publishing at http://www.magpiegoose.com.au/