The quiet achievers helping to close the gap

One university college is giving Indigenous students a fighting chance of completing a medical degree

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A small Jewish residential academic college in Sydney’s east is the quiet achiever in Australia’s bid to build up an indigenous health workforce, graduating 18 indigenous doctors in the past 12 years.

Shalom College at the University of NSW launched its scholarship program in 2005 to give Aboriginal and Torres Strait Islander students a fighting chance of completing long-haul degrees such as law and medicine: 30 have graduated so far.

“Drop-out rates for indigenous students, as everyone knows, are exponentially high,” Dr Hilton Immerman, CEO of the college, told The Medical Republic. “Everything mitigates against their success.”

Typically, on top of socioeconomic disadvantage, indigenous students live far from campus, are the first members of their family to study, lack friends who understand the rigours of a long course, such as medicine, and spend a lot of time commuting and working part-time jobs to complement Abstudy payments.

“The whole notion of this program is that people come and live in a safe, secure, culturally sensitive environment, with zero tolerance of any form of prejudice, stereotyping, racism and discrimination.”

Of the 130 students now living at Shalom, 30 are indigenous, as are three of the six tutors in residence. Twenty of the indigenous students are on Shalom Gamarada residential scholarships, each costing $24,000 per year. In the 2017 intake, two are studying medicine and two are reading law. There are a total of 48 indigenous medical students at UNSW.

The program’s expansion has fed its success.

“Coming into a new environment a long way from home is tough going,” Dr Immerman said. “When you come to the college, there is a community to welcome you, and other indigenous students are there to support you. We do a lot of tutoring, mentoring and counselling. Because of all these things, we’ve had phenomenal success.”

The Shalom Gamarada scholarship students, who are selected primarily on the basis of need, have achieved pass rates well over 90% in the past five years, surpassing the scores of non-indigenous students at UNSW.

“We do a lot of tutoring, mentoring and counselling. Because of all these things, we’ve had phenomenal success.”

Like a lot of ideas that seem blindingly clever in hindsight, the program evolved from a combination of need and audacity. In 2005, Professor Lisa Jackson Pulver, an epidemiologist who was running the Muru Marri indigenous health centre at UNSW Medicine, approached several colleges pleading for help to house the university’s only Aboriginal medical student.

“She was going broke fast, failing every exam and living in diabolical circumstances. She was in a shocking place, she needed a place where she didn’t have to travel four hours to the university,” Professor Jackson Pulver told TMR. “I went to the colleges. No one would help.”

A few weeks later, however, Professor Jackson Pulver was invited to speak to the NSW Jewish Board of Deputies about her own extraordinary career path from troubled Aboriginal teenager to acclaimed health professional.

After a tough start as a “14-year-old runaway chick”, she had gone to train as a nurse because it gave her a place to live, was admitted to Sydney University’s medical school but failed, and ultimately found her calling in epidemiology, with support from Sydney’s Koori Centre and a mentor in Charles Kerr, a professor of social medicine.

“Professor Kerr said to me: “If you fail and leave university, you will never come back. So I want you to think very carefully.”

He advised her to defer medical school for a year and do a master’s degree in public health.

“So I did. And I thought I had died and gone to heaven.”

Professor Jackson Pulver also told the board of deputies about the medical student’s plight. As a result, a Shalom College board member whipped out his chequebook to cover the student’s expenses for a year, on the condition that Professor Jackson Pulver joined the college board. The task then was raising funds to cover the rest of the student’s degree.

Thus came the scholarship program, which is funded largely by donations and bequests.

Dr Khyarne Biles, an emergency department registrar in her home town of Dubbo, in western NSW, arrived at Shalom as an overawed country kid of 17. Her dream of studying medicine was inspired by seeing doctors help a severely disabled cousin and, later, a grandfather in intensive care at the end of his life.

“What I got from that experience was seeing these doctors, what they do on a daily basis, and how they interact with people and the things they can achieve. I thought, that’s what I want to do. I want to be able to help people.”

But she can’t imagine how she could have stuck out a six-year medical degree without the financial and collegiate support, which allowed her to travel home for weekends with her family.

Dr Biles, a 2013 graduate, agrees that having more indigenous health professionals is one of the best ways to tackle the health disparities between mainstream and indigenous Australia.

“We need indigenous people to be there, because they are invested, they want to help, they want to see change. Unfortunately, though, we don’t have the numbers we need,” she said.

“I see people every day, indigenous and non-indigenous, from all backgrounds. There are people who can’t afford to present to a GP because they can’t afford to pay. And patients who present with end-stage conditions from what should have been a treatable disease. And cancer patients who come here from further west, only to be told they have to travel further to get care.

“You can read the statistics, but you don’t fully appreciate it until you are standing there with a man you have just told has cancer and he needs to have treatment, but he says I can’t, I’ve got my wife at home and I can’t leave her for six months.

“We really need to achieve something better, using the resources we have right now to start making change.”

Dr Josef McDonald, a 2011 graduate of Shalom, went into medicine because it married his interest in science with a sense of social justice. His family encouraged him, but there was no clear plan about how to pay for it.

After 18 months, he had exhausted an inheritance from his grandfather. Through a phone call from Professor Jackson Pulver, he heard about the possibility of a Shalom Gamarada scholarship.

“It allowed me to study. It’s a binary outcome. You either have the money or you don’t,” Dr McDonald said.

“As well, I think what a lot of indigenous students, including myself, experience when they move to Sydney is loneliness and isolation. Living at the college you are with likeminded people you can get along with, and there is no tolerance of racism.”

The psychiatry registrar, now working in the Newcastle area, north of Sydney, where he grew up, said university opened his eyes to a world of privilege he never knew existed – things such as summer schools and interview preparation – which heightened his sense of being an outsider.

“I’m not sure if I coped with it, or just survived it. When you are young, you are told that successful people like doctors and lawyers are somehow different. You are from a different country, different people. You often feel, do I really belong here?

“But what the college offered was peer support. My attitude my whole life, if people told me I couldn’t do something, that would make me want to do it even more. “

Dr McDonald hopes eventually to work in indigenous mental health, particularly developmental disorders where there are barriers to care. For now, he is mentoring a younger Shalom Gamarada student preparing for psychiatry studies.

“There’s a situation now where we not only have (indigenous) students but a critical mass of professionals who can continue helping each other. We are now turning out graduates across the country and we keep in touch with each other and share.”

Medical professionals who identify as indigenous in Australia currently number just 261, but a larger number – more than 300 – are in the training pipeline.

Dr Kali Hayward, an Adelaide GP and president of the Australian Indigenous Doctors Association, says the importance of role models can’t be underestimated in the drive to encourage more indigenous health practitioners.

After leaving school during year 11 and having children, she had thought medicine was beyond reach.

It was not until she took a foundation science course at Adelaide University and met Aboriginal medical students that she dared to rekindle her ambition.

“They told me about their journey into medicine and the issues they had overcome. They gave me the strength to verbalise what I wanted to do. I wanted to go into medicine, but I had never seen an Aboriginal doctor.”

The association had recently been approached by medical colleges and universities to work on improving indigenous health and increase the ranks of health workers from Aboriginal and Torres Strait Island communities, she said.

“These residential scholarships and foundation courses are vital. We also need strong indigenous health units within universities to support our guys going through.”

Professor Jackson Pulver, now pro vice chancellor at Western Sydney University, with responsibility for engagement and Aboriginal and Torres Strait Islander leadership, points to the multiplier effects.

“The greatest gains in health are always in education,” she told TMR.

“If you develop a health workforce, you are educating large numbers of people in things like health literacy.

“If you focus on an area of need – growing doctors, nurses, optometrists, podiatrists, physiotherapists, etc – they pretty much walk into a job straight out of university.

“Secondly, they talk to their relations, siblings and communities, and provide good health advice. When we look at things like cardiovascular disease obesity, diabetes, just name the condition, Aboriginal people win the poor-health stakes every time. If you train more practitioners who have the inside run on the health story, it makes a difference on a community level.”

Dr McDonald recalls the “imposter syndrome” he felt at medical school and says Shalom kept him grounded. The experience made him acutely aware of the huge amount of untapped potential in disadvantaged communities.

“I don’t describe myself as particularly special. I didn’t have a special family or a special education. The mind boggles at the missed opportunities that must be out there. We could have missed the next (indigenous surgeon) Kelvin Kong or the next Lisa Jackson Pulver. You just wouldn’t know.”