Working towards transformative change

Indigenous Health Committee Chair Dr Maxine Ronald talks about the committee’s work to improve surgical health equity for Indigenous communities, and surgical training for Indigenous doctors.

In 2018, Dr Maxine Ronald became the first Māori Councillor on the Royal Australasian College of Surgeons (RACS) Council. In doing so, she also became the first female Māori Councillor to sit on the Council in its 93-year history. Dr Ronald is now also Chair of RACS Indigenous Health Committee (IHC) and, along with eight other Australian and New Zealand surgeons, is seeking to address the inequities of healthcare in Indigenous communities across the two countries. The committee also works to improve access to training and provide appropriate support for Indigenous Trainees and surgeons. After graduating with an MB ChB from Auckland University in 2005, Dr Ronald completed a Colorectal/Acute Surgical Unit Fellowship in 2013, and an Oncoplastic Breast Fellowship in 2014 – both at Perth hospitals. As a general surgeon she became more involved in Indigenous health issues and noted there was a “significant acceleration of the Indigenous profile at RACS”. There were “a lot more sponsors and engagement promoting surgery as a career for Indigenous doctors”, she said. Indigenous doctors have probably not seen surgery as a safe place to work, Dr Ronald added, pointing out that “most of us who have trained recently will have experienced racism as Trainees”. RACS recently approved the inclusion of cultural competency and cultural safety in the core training competencies for all Trainees across all specialties. “It’s a significant and massive thing because we’ll be teaching surgeons to interact, not only with Indigenous surgeons, but with Indigenous patients and their families in ways that are culturally safe,” Dr Ronald said. The way that healthcare is delivered to Indigenous people may look different to non-Indigenous people, but it will achieve the same outcomes, she said, emphasising that Indigenous models of health are broader than just disease. “Hopefully, it will provide a signal to Indigenous doctors, who might be considering surgery as a career, that it’s a real and substantial commitment from RACS to support Indigenous surgeons.” It’s essential that Indigenous people are involved in decision-making from the beginning, Dr Ronald explained. “Too often we’re asked for an opinion at the end when a lot of decisions have already been made. Then it’s frustrating because it seems like a tick-box exercise, as though we’re just being asked for an opinion,” she said. “Indigenous people need to be at the table from the beginning making decisions on their own behalf.”

One of the most important relationships in Māori culture is Tuakana–Teina, Dr Ronald said. “It’s important to have these mentoring connections to the people you work with and those relationships are key.” Five years ago, there were so few Indigenous people in surgery that “we didn’t have the critical mass to be able to do it – or perhaps just in small ways, but it’s difficult when you have to spread yourself so thin”, she said. These days there are more Indigenous Trainees and surgeons across Australia and New Zealand, as well as “nonIndigenous people who are supportive of equity so we’re hoping we can build on creating those connections”, she added. One of the aims of the IHC is to increase the Indigenous workforce. For this to happen, specialty training programs and surgical professions need to be more attractive to Indigenous doctors, so they see surgery as a safe haven in which to train. There also “needs to be strong mentorship and strong support for Indigenous Trainees”, she added. Evidence has shown that, over time, affirmative admission programs that provide strong support through training to undergraduate medical students have the most success, Dr Ronald explained. “It is important that RACS aims for transformative change with real and tangible outcomes and improvements in both surgical health equity for Indigenous communities and surgical training for Indigenous doctors,” Dr Ronald said. As Chair of the IHC, there is a lot of ongoing work to be done, and “an opportunity to create real change”, she added. The “size of the task can seem daunting,” but the support within RACS is both exciting and encouraging. 