Opinion

Australian hospital wards may not be segregated but we need to decolonise healthcare

When seven-year-old Aishwarya Aswath Chavittupara died, the medical community was devastated and pointed to substantial systemic issues at the hospital where she died. “The system isn’t safe, any child could have died,” was a popular conclusion.

But then Amrita Varshini Lanka, eight, and Hiyaan Kapil, five, died in similar circumstances, their parents’ concerns unheard in a system under strain. We have to ask ourselves: was it really any child that could have died? Or did these minority-background children have the odds stacked against them? Is the healthcare system racist?

I could tell you about the time my boss muttered about “these bloody primitives”, the paediatric nurse who yelled at the large family visiting their very sick child and the midwife who believed Cambodian women didn’t need pain relief in labour. I could tell you about the ECG technician who wrinkled his nose at the “smelly Indian”. None of these people would say they are racist, and each of them defended their attitudes and were outraged at any suggestion that these comments were inappropriate.

But I hesitate to focus on these examples, as they are the easy pickings of racism.

The more dangerous, more pervasive racism is insidious and difficult to call out. Very few now openly proclaim that those of a different culture are lesser people. Most of us believe in equality, but we still hold biases and perpetuate stereotypes on the basis of gender, ability, class and other demographic features.

And racism, just like sexism, is baked into our systems.

Our wards are no longer segregated, yet Aboriginal and Torres Strait Islander women are more than twice as likely to die from pregnancy complications as non-Indigenous women. There is still much work to be done in understanding the experiences of people of colour in Australia’s healthcare system. Little data is collected and analysed to help us understand it. We can guess at some of the answers, but we also need to listen.

In recent years, Brown doctors have started to publish on dermatological conditions in Brown skin. When a medical illustrator drew the Brown foetus last year, the internet went wild. Had we even noticed that our textbook anatomy models were white? In the age of Covid the makers of pulse oximeters are still scrambling to make a device that accurately detects hypoxia in people of colour.

We are a multicultural country, still reliant on migration, and this has served our economy and society well. But how do we ensure that systems also serve our First Nations communities and communities of colour? How do we create a health system that is inclusive, supportive and takes people seriously?

As a GP I know that health workers often do not contact an interpreter to communicate with patients who do not speak English. Earlier this year, I called a patient in a Covid ward who said nobody had spoken to her with an interpreter in the week she was admitted. She was tired, confused and powerless.

Our systems are strained, and they are not set up for culturally sensitive care. Understanding an unwell person, from a different cultural background, takes time and knowledge. Our systems do not fund or support this and deem it “low value care”. We all carry implicit bias, inherited prejudices and ignorance, for we can only know what we ourselves have learned and seen.

Too often, when things go wrong, we see the blame laid on the patient: “non-compliant”, “discharged against medical advice”, “aggressive parent”, “late presentation”, “poor historian”, “quiet”. In a recent interview, Amrita’s father said: “Some Aussies have told us, ‘you should have shouted at them, you should have banged the table … (but) people like us are very humble people, we are very soft.”

In the same way that women have been labelled “hysterical”, so too are labels applied to people of colour. These stereotypes might seem to help us understand our patients in a system too rushed to sit down and learn who they are as individuals. But labels stick to a person, distance ourselves, explain away bad outcomes, lead to stereotyping and poor care.

On the flip side, witch-hunts for racist clinicians aren’t helpful. This is no longer about the bad apples: we need to rebuild our systems. What might be helpful is to fund research and collect data about the experiences of immigrants and people of colour, and ask them what needs to change. We could recruit students, clinicians and administrators from diverse backgrounds and train students to listen to patients’ stories – not just their medical histories.

We need to make sure that interpreters are available at every clinical encounter for patients who want them, and understand that not everyone asks for help in the way we think they should, or expresses pain or distress in the ways we understand.

We must commit to decolonising healthcare to unlearn patriarchal, settler understandings of care, and to look to Aboriginal and Brown ways of listening, yarning and journeying with our patients.

It is deeply uncomfortable to speak about racism in Australia, but we need visionary and courageous leadership to create safer care for all people, regardless of race, religion or colour. Our wards may no longer be segregated, but our journey in anti-racism is still young.

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