For most of Karlie James's life, studying medicine was a "pipedream".
Then she grew up, started working full time and had kids of her own, and she felt that dream slipping away.
"Part of the reason why I wanted to become a doctor when I was little was that my passion was science and learning and wanting to help people," she said.
Then, around the time the Gunaikurnai, Yorta Yorta and Kuku Djungan woman turned 30 and had her third son, she reached a turning point.
Growing up between Darwin and Katherine in the Northern Territory, she realised becoming a doctor was something she had to do.
"It became more apparent as I got older in the workforce, how much of an impact it would [have] to create more Indigenous doctors, especially in the community," she said.
"And that was one of my driving motivators to pursue medicine."
Having graduated from the Flinders University NT medicine program late last year, Dr James is now among the 0.5 per cent of doctors in Australia who identify as Aboriginal or Torres Strait Islander.
But that figure, which is recorded each year by the Australian Health Practitioners Agency (AHPRA), is slowly shifting and is up from 0.3 per cent in 2016.
Also shifting is the understanding that in order to close the gap in health outcomes between Indigenous and non-Indigenous Australians, Australia needs more First Nations doctors.
According to an NT government study published last year, the average life expectancy for Indigenous men in 2018 was 65.6 years, compared to 81 for non-Indigenous men.
For Indigenous women, it's 69.7 years compared to 85.1 years for non-Indigenous women.
"Developing the Indigenous health workforce contributes to creating a more culturally safe and appropriate health service for our mob," Dr James said.
"And that can contribute to having better health outcomes."
Breaking down barriers for patients
Dr James said the first time she realised how important it was to have Indigenous doctors treating Indigenous patients was when she was on placement in a remote Aboriginal community.
"I was treating a patient with a non-Indigenous doctor and when they left the room [the patient] turned to me and said 'Doc, I just want to let you know I also have this, this, this,’" she said.
"Without me even having to open my mouth and say anything, I was able to obtain practically a thorough medical history from her, just because she knew that I was an Indigenous person.
"It's just an automatic, I guess, awareness of what needs to be done and what we need to take into account providing holistic care to our mob."
Simone Raye is the President of the Australian Indigenous Doctors' Association (AIDA) and a GP who lives and works in Darwin.
She said a major barrier Indigenous people face to getting adequate health care is a distrust of health professionals because of experiences of discrimination or cultural inappropriateness.
The Bardi Jabbir Jabbir woman said having more First Nations doctors helps break down this barrier.
"One of the biggest things is that having First Nations doctors provides a culturally safe space for other First Nations people to seek help … and makes them more comfortable within the health sector," she said.
She said it was also important to have doctors who understood the specific health needs of Indigenous people.
For example, rheumatic heart disease, which is rare in most developed countries but impacts Aboriginal and Torres Strait Islander people at one of the highest rates in the world.
Dr Raye said she once had a cardiologist tell her a patient couldn't have had rheumatic heart disease because it didn't exist in Australia.
"I said 'I'm sorry, I come from the Northern Territory. My family who have rheumatic heart disease, are you saying that’s a figment of my imagination?'" she recalled.
"With my journey, there were a number of instances where things would be said or done that the person that was saying it didn't realise that it could potentially be a microaggression or racism or pure ignorance."
Challenges along the way
The most recent Medical Training Survey results revealed that 55 per cent of First Nations trainee doctors experienced and/or witnessed bullying, discrimination and harassment, including racism, during the last year of their training.
This is compared to 34 per cent of all trainees.
"It's not only from fellow students, sometimes it can be from supervisors, it can be from patients, it can be from other staff members within the hospital," Dr Raye said.
Dr James has had her own set of unique challenges.
One was her commitments as a mother of four, and a guardian and leader for her broader family and community, which she said many other First Nations people have too.
"I've got a sister in Darwin … she has 10 kids, or nine plus our other nephew. So in our culture … they are like my own children," Dr James said.
"We all are very close and committed to raising our children like that together."
She was also working full-time, doing most of her undergraduate degree at night or during playgroup.
But in her final year, her son Jacob was diagnosed with leukaemia, prompting the whole family to move from Darwin to Adelaide for his treatment.
For her, it was a major hurdle but also what pushed her to commit to medicine.
"I had my mum there initially … I was talking to her and then she encouraged me to talk to the uni [to see] if I could keep continuing my degree," she said.
"And they were very supportive, and so I just kept going.
"I did almost all of my final year … in the parent hospital bed next to Jacob.
"In a way, as crazy as it sounds, it helped to deal [with] and process everything that was going on."
The 'domino effect'
Dr James said for a lot of potential First Nations doctors, a major challenge is a belief that, like she initially had, studying medicine simply wasn't a possibility.
"I think one of the barriers is just the belief that they [First Nations people] can't achieve," she said.
"Education already can be so poor in communities. Not even just communities, but in general."
She said having more First Nations doctors to act as role models would help to turn this around.
"We all [her and her Indigenous doctor colleagues] hope to have some sort of a domino effect,” she said.
“So people can aspire to go on and do tertiary studies, and not just become doctors, but just further education in general."
"They can come to us and know that they can do it."
Dr Raye said for many potential First Nations doctors, getting into and staying at university could be a major challenge.
"The first thing is the challenge of getting into the universities in the first place, with a lot of First Nations people … being the first one to finish high school and first in their families to get into university," she said.
"In some universities, there may only be one or two First Nations people within that year and so they don't have a safe space," she said.
"They don't have that collegiate support around them."
She said cultural training programs needed to be implemented in institutions like universities and hospitals, which she said had begun to happen in recent years.
"It's baby steps, but it is changing."
“The thing is, providing a culturally safe space — it's not only better for First Nations people, but it's better for all people," she said.
