Tracing ACEM’s steps towards Reconciliation
I would like to acknowledge Aboriginal and Torres Strait Islander Peoples as the First Peoples of the lands now known as Australia, and pays respect to Elders past and present. I am deeply thankful for the continuous, uninterrupted care and connection to Country held by Aboriginal and Torres Strait Islander Peoples, and acknowledge that their sovereignty has never been ceded.
There was a time where I was considered “the expert” in Indigenous health at ACEM. As a non-Indigenous person, that label made me extremely uncomfortable.
So, in 2023, I am thankful that ACEM listens to Indigenous voices for direction and guidance. My role now is through allyship – amplifying these voices, as well as clearing space so Indigenous Fellows, trainees, staff, community members and friends of ACEM can lead.
“Tom sought me out after the session, and with a sense of urgency he enquired “Liz, what do we do first?”
My answer was then – and continues to be now – “First, we must listen.””
As Australians prepare themselves to vote on Constitutional Recognition and an Indigenous Voice to Parliament – a process arising from one of the recommendations in the 1987 Royal Commission into Aboriginal Deaths in Custody – I wish to reflect on ACEM’s own journey to where we are now – with Indigenous health embedded in the core of College business.
Just as many are not aware of the links between the 1987 Royal Commission and the upcoming Referendum, I wonder whether members and trainees of ACEM are aware that it was the work of two of the founders of emergency medicine in Australasia that initially propelled us along this path.
Looking back, I can see the College-wide movement took its first breath on Larrakia Country, in a lunchtime gathering at the 2009 ACEM Winter Symposium in Darwin.
Dr Elizabeth Mowatt after delivering the Tom Hamilton Oration in 2017.
Dr Tom Hamilton, the inaugural President of the College, was there with other members and trainees who shared an interest in Indigenous health. That day Tom put his signature at the top of the list in support of ACEM forming a Special Interest Group in Indigenous health.
Tom was also in the room in 2011, when ACEM hosted the first panel of Indigenous health leaders from Aotearoa and Australia at an Annual Scientific Meeting, in Sydney on Gadigal Country.
Tom sought me out after the session, and with a sense of urgency, he enquired, “Liz, what do we do first?”
Even though I embrace emergency medicine as a specialty of action, my answer then was – and continues to be now – “First, we must listen.”
“ It has been an incredible feeling to be welcomed into the room as a friend and ally, and I know my life and medical practice have been enriched by my growing understanding of Indigenous cultures, knowledges and protocols.”
Around this time, ACEM became invested in the cross-college efforts through the Council of Presidents of Medical Colleges (CPMC) to address disparities in Indigenous workforce, curriculum content and health outcomes. Being at that table and starting to formalise relationships with organisations such the Australian Indigenous Doctors Association (AIDA) helped the College to see there were changes that needed to be made.
Still, it was the personal commitment and unwavering advocacy of Associate Professor Joseph Epstein, co-founder of the College, that underpinned the first real steps toward strong Indigenous representation within ACEM membership.
Joe turned his attention to actively growing the Indigenous emergency medicine workforce when he established the Joseph Epstein Scholarship for Aboriginal, Torres Strait Islander and Māori Advanced Trainees. Since its launch in 2013, eight trainees have been awarded the scholarship. Joe’s contributions also saw Indigenous Health embedded as one of the three pillars of the ACEM Foundation.
I was fortunate to have many conversations with Joe about the need for more Indigenous medical specialists in Australia and how this would impact positively on health inequities. He often expressed his regret to me for not having acted on this issue when he was ACEM President.
FACEM Dr Glenn Harrison presenting at the 2016 AIDA conference.
In 2013, ACEM sponsored a booth at the AIDA Symposium on Ngunnawal Country in Canberra, further strengthening the relationship between our two organisations. Joe and I were also invited to participate in the first ever “Growing our Fellows” Workshop, a session to promote the various medical college training schemes to the students and graduates in the room.
Since then, ACEM has participated in every AIDA conference, and personally, I have only missed one of those events. It has been an incredible feeling to be welcomed into the room as a friend and ally, and I know my life and medical practice have been enriched by my growing understanding of Indigenous cultures, knowledges and protocols.
I have learnt so much listening to Indigenous Elders and strong, resilient health leaders talk to the successes of self-determined healthcare delivery. I have heard directly from AIDA members about the issues and barriers Indigenous medical students and graduates experience in mainstream health and education services. These stories have helped me understand what needs to change within the organisations where I work and hold influence.
Inaugural ACEM Indigenous Health Subcommittee (IHSC).
I can see that ACEM has also listened and acted to make changes over the past decade. In 2013, with the support of the Public Health Committee of ACEM, the Indigenous Health Special Interest Group became a Working Group and then a formal Sub-Committee.
In 2019, the College elevated the Indigenous Health Committee (IHC) to report directly to the ACEM Board, and established identified Co-Chair roles, ensuring the IHC would be led by Indigenous Fellows.
ACEM has stepped into public advocacy, by pledging support to the Uluru Statement of the Heart in 2019, and becoming contributing members to the Australian Human Rights Commission’s Close the Gap Strategy Campaign.
“The meetings have become a safe place for frank and fearless conversations, so that we can hear the truths of Indigenous peoples, from Indigenous people. ”
ACEM has also embraced the work of Reconciliation. The first ACEM Reconciliation Action Plan (RAP) was launched in 2017, and we are currently delivering the actions of our third Reconciliation Action Plan. I have had the joy and privilege of being a Co-Chair of the RAP Steering Group, alongside Ms Jacqui Gibson-Roos, Community Member to the ACEM Board and proud Wongatha woman.
A diverse group of Indigenous and non-Indigenous Fellows and trainees, community members, ACEM leaders and staff have contributed to the Steering Group over the years. The meetings have become a safe place for frank and fearless conversations, so that we can hear the truths of Indigenous peoples, from Indigenous people.
This group has been an important mechanism for the College to understand the links between self-determination and health outcomes, to see the historical and ongoing impact of colonisation, and to ensure that the changes we need to embed across emergency medicine are driven by Indigenous voices.
ACEM’s RAP has always wanted to be more than a document that speaks to the organisation situated within the walls of ACEM headquarters on the Wurundjeri Lands of the Kulin Nation. We want our RAP to reach into every emergency department in Australia and create a better future.
We want our services to uphold Indigenous peoples’ right to healthcare that is self-determined. For our departments to be places that are free from bias and racism — where Aboriginal and Torres Strait Islander patients can participate in, and have control over the care they receive.
Health care will never be clinically safe until it is culturally safe. We desperately need emergency departments in Australia to be places where Indigenous patients, families and staff feel welcomed and respected.
Emergency departments are the front door to the hospital system, and if they are not seen as culturally safe, Indigenous people stay away. Patients will not present for the care we provide until they have no other choice.
ACEM Indigenous Health Project Lead Gabrielle Ebsworth (left), FACEM Dr Glenn Harrison, Uncle Ringo, ACEM Board Member Dr Jacqui Gibson-Roos, and RAP Community Member Sam Beattie at the smoking ceremony for the 2022 RAP Launch.
So much work and research within emergency medicine emphasises the importance of time to definitive care. This is because we understand that delays in commencing treatment are harmful.
Yet still, we remain focused on examining “time to care” as a metric that starts with triage, rather than considering why patients who need emergency care are not seeking treatment.
To be able to address the barriers and issues that delay presentation, we have to understand what it is that makes us inaccessible.
This is why I am so passionate about transforming emergency departments towards cultural safety, which by definition, can only be determined by the person receiving care.
“Nothing is more important than how we have grown the representation of Aboriginal and Torres Strait Islander peoples and Māori within College structures and processes. We have elevated their voices, and we will become a better organisation for having achieved this. ”
As a first step, we need to ask Indigenous patients, their families and communities about their experience in the ED. This was the foundation of ACEM’s research project, Traumatology Talks. After we listen to this feedback, we need to invest in ways to respond to what we have been told and make the necessary changes.
Just as cultural safety is now included in the Medical Board of Australia Code of Conduct as an expectation for individual practitioners, the Australian Medical Council (AMC) includes criteria around Indigenous health and cultural safety in medical college accreditation. ACEM received Accreditation Commendations in both 2018 and 2021 for our continued work in Indigenous health.
Tom Hamilton and Joe Epstein started ACEM on this path through their support and advocacy, and in 2020, as a membership organisation, we overwhelmingly voted to enshrine a commitment to equity in Indigenous health in the ACEM constitution.
ACEM has travelled a long way since that group of non-Indigenous people came together in 2009 on Larrakia Country. There have been many milestones and achievements for us to celebrate.
From where I sit, nothing is more important than how we have grown the representation of Aboriginal and Torres Strait Islander peoples and Māori within College structures and processes. We have elevated their voices, and we will become a better organisation for having achieved this.
I will be voting Yes in the upcoming Referendum because I support the Uluru Statement from the Heart in full. I believe this is how we show we are listening and that we want to hear more.
