Building on Progress: Becoming Australia’s First Indigenous Ophthalmologist

In 2018, Associate Professor Kris Rallah-Baker became Australia’s first Indigenous ophthalmologist.

Today, Kris looks to the near future, where four more Indigenous doctors are soon to join him as ophthalmology Fellows — a momentum we need to see continue.

As Kris sat down and explained to your ASO, this achievement has been the result of a collegial effort from key stakeholders that is informed by Indigenous perspectives. 

Action which is positioning ophthalmology admirably as a progressive leader in this space.

Although the journey has brought its challenges, Kris shares his insights on how Australian ophthalmologists as a community can contribute towards a better healthcare environment for not only Indigenous patients, but a culturally safe one for future Indigenous doctors.

Becoming Australia’s first Indigenous ophthalmologist

In the year that Tasmania became the last state in Australia to decriminalise homosexuality and Pauline Hanson made her entrance into the political arena — 1997 — Kris began his medical studies. 

“It sounds cliché, and it is the absolute truth, from my first year of medicine, I wanted to be an ophthalmologist,” Kris reveals.

“Ophthalmology provides a mix of internal medicine that keeps it interesting, as well as surgery, so I very quickly decided that was going to be it.”

Despite his ambitions, Kris explains he did not think he would be selected to pursue ophthalmology training. 

“We had less than 10 Indigenous doctors across the country in 1997,” he said.

 “It was 30 years post the 1967 referendum, so we [Indigenous Australians] had been citizens for less than 30 years. 

“Bodies such as the Australian Indigenous Doctors’ Association (AIDA) and Indigenous Allied Health Australia did not yet exist.

“Nationally, we really only had the National Aboriginal Community Controlled Health Organisation (NACCHO) — which then-Prime Minister, John Howard, had come in and attempted to gut — and we were about to lose the Aboriginal and Torres Strait Islander Commission (ATSIC) under his leadership.

“In that environment to even dream of being a doctor seemed impossible, let alone to have the gall to contemplate entry into one of, if not the most competitive specialty — but that’s where I was at 18. I had no idea of the challenges ahead but was up for whatever may come.”

Finding little cultural safety in the workplace at this time, Kris reflects that his early years in medicine were among the hardest and resulted in him taking a pause.

“My internship year was spent on the Gold Coast, where I was the only Indigenous doctor in the entire hospital,” he recalls.

“I was a bit of a novelty amongst the staff because many had never even imagined an Indigenous doctor was possible.

“The following year, I moved back to Brisbane and ventured on to work at the Princess Alexandra Hospital (PAH). 

“It was there that I was joined by another Aboriginal doctor and good friend who I went to medical school with, which made things a little easier. 

“It seems strange now, but even at a major institution like the PAH, people found it difficult to believe there could be Aboriginal doctors — that was 2004.

“It was an awful year,” he continues.

“I was in an environment that was almost universally hostile and culturally unsafe, where bullying and abuse were the accepted standards of behaviour.  

“It was Samuel Shem’s House of God — it was so bad that out of respect for myself, I decided I wouldn’t continue working within a large abusive institution and withdrew from clinical medicine at the end of that year.  

“My colleagues told me that my decision would end my career, but I placed my wellbeing before anything else and followed my heart.”

Kris would go on to find understanding and community working in the Community Health Unit within what was then the Logan-Beaudesert Health Service District in South East Queensland. 

“I was still with Queensland Health, in an environment of patient care, and maintained my medical registration,” he said.

“In retrospect, by moving into community health, I had inadvertently transferred into a culturally safe space that allowed me to heal from the horrors of the wards; I was able to re-grow in myself and I met amazing people.”

One of these people was ENT surgeon, Dr Chris Perry, who had significant experience working with Indigenous patients, and who began to mentor Kris. 

“While I was working on a hearing health project called Deadly Ears with Chris — ‘deadly’ in Aboriginal English means ‘excellent’ or ‘good’ — he encouraged me to go back into full-time clinical medicine.

“He wore me down like water on a rock over about nine months and I agreed to return to the wards.

“Chris was a big part of me finding my pathway into ophthalmology. 

“He was a key mentor and respected senior surgeon and introduced me to the people I needed to meet to make my journey into ophthalmology.”

Kris reflects that while his journey was anything but the norm, by taking an indefinite departure from clinical medicine, he met important mentors who guided him back to where he ultimately wanted to be.

A Founding Member of AIDA

As a first-year medical student at the University of Newcastle in 1997, Kris was invited to attend a meeting of Aboriginal and Torres Strait Islander medical students and doctors at Salamander Bay in Port Stephens.  

That meeting attracted international speakers and highlighted a growing community of local Indigenous medical students and doctors, where it seemed possible that advancement of the Indigenous medical workforce in Australia was finally possible.

“We [University of Newcastle] had about eight out of around only 10 of our Indigenous doctors in existence, and I was one of only about 20 total Indigenous medical students — it was almost all of our historical Western-trained Indigenous medical workforce in one room at once,” he shares.

“At the international level, we had Maori, native Hawaiian, and Indigenous Canadian representatives who respectively had Indigenous doctors in their home countries for over a century — we were in awe and starkly aware of how far behind we were.  

“They were still shooting us only 69 years earlier at the Coniston Massacre of 1928, and probably later,” Kris said.

That meeting resulted in the formation of the Australian Indigenous Doctors’ Association (AIDA) — a national peak body Kris would later lead as President.  

The formation of AIDA was years in the making and came on the back of groundwork from some of our first Indigenous doctors at the time — A/Prof Noel Hayman, Dr Louis Peachy, Dr Ngaire Brown, and Dr Mark Watego — who with others had the foresight to establish an organisation that would support the ongoing growth of an Indigenous medical workforce.  

“I was in the right place at the right time in choosing to attend medical school at the University of Newcastle,” Kris reflects.

“Not only was it the oldest and first problem-based medical school in the country, but it was the second oldest problem-based medical degree in the world and led the path to Australia’s current medical school pedagogy — we were at the forefront.” 

A component of that forefront was an investment in part by the medical school into rural health, rural workforce, population medicine, and growing the Indigenous medical workforce — which today are key tenants of the work of all medical schools across the country.

 Kris explains that in working to increase the number of Indigenous medical graduates, the University of Newcastle established an Indigenous Support Unit within the medical school building. 

“That unit was a key to the success of the Indigenous medical students at Newcastle, which at that time, had graduated almost all of the Indigenous doctors in Australia,” he said.  

“Applying to study Medicine at Newcastle was a wise choice for me at the age of 17. 

“Thinking back now, we were brave. AIDA was brave. We were up against a conservative profession with a limited understanding of Indigenous Peoples,” he reflects.

“1997 was a time when only thirty years prior, our forebears were not even citizens and Indigenous land rights had only been recognised with the Mabo Decision five years earlier.  

“Yet, here we were, as a handful of medical students and doctors setting up an organisation designed to lead and advise on national Indigenous medical workforce issues.

“We didn’t care about people who thought we shouldn’t be there in the medical schools and colleges — we had our citizenship and were making inroads.

“We were supported by our communities and people. We were there to stand on the shoulders of those who worked before us to improve the lives of those who came after us. We weren’t going away.  

“Fortunately, we had many non-Indigenous allies and made many more friends who supported us in achieving what we have today.”

AIDA now has hundreds of members with more than 865 doctors in Australia identifying as Indigenous on their AHPRA registration. 

Advocating for Indigenous doctors in Australia

Behind the scenes, significant work has been underway to address a lack of Indigenous doctors in specialist medicine, particularly in ophthalmology.

Six years ago, the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) responded to a call for action from the Australian Medical Council (AMC) to bring its selection process up to modern standards.

Kris explains that the selection process used to be a very localised network-based process, but RANZCO created a bi-national selection system as the first step in addressing the AMC’s concerns regarding registrar appointment, which is a merit-based points system.

“I was on the RANZCO Selection Board that designed the bi-national selection process,” he said.  

“As a part of that reform, the College made a step in the right direction by having Indigenous perspectives from both Australia and New Zealand involved,” he said.

“The consequence of this work is that we currently have four Aboriginal and Torres Strait Islander trainees in Australia — a male Aboriginal registrar in third year training, a female Torres Strait Islander registrar in third year, a female Aboriginal trainee in second year, and a male Aboriginal trainee in first year.  

However, the work does not stop here.

Through delivery of its Reconciliation Action Plan (RAP) — and reinforced with advocacy from Kris — the College joined with AIDA and the Fred Hollows Foundation to sign a memorandum of understanding (MOU) to provide funding support to Indigenous ophthalmology trainees.

This materialised in funding a dedicated support person to assist Indigenous ophthalmology trainees as they progress through their training.

“While AIDA is there to recruit and support Indigenous students into the field of medicine, we still need to get them through medical school and their training, so this working relationship is bearing fruit,” he said.

Kris further explains the Australian and New Zealand Eye Foundation (ANZEF) — the charitable arm of RANZCO — completes another part of the puzzle. 

“In addition to providing the funding for RANZCO-branded scholarships to attend the AIDA Conference each year, the Foundation has agreed to financially support trainees’ through their registrar years,” he said.

“The reality as a registrar is that there is not a lot of money, especially so in ophthalmology because you do not have to cover the hospital all the time, so your overtime does not pad things out.  

“Compounding the issue of poor registrar remuneration and high training costs is the fact that most Aboriginal and Torres Strait Islander people have no intergenerational wealth to assist their career goals.”

The outputs and results being achieved within the College space — namely through RANZCO, AIDA and Fred Hollows Foundation collaborations — are being looked upon enviably by other medical colleges.

“They are looking at how to do something similar because fundamentally it is about collaboration that is informed by Indigenous perspectives, so it respects the principle of self-determination,” Kris said.

“This work has met in the middle within the last five years or so, and we are starting to get runs on the board in terms of the recruitment and successful advancement of trainees through the system, but there is obviously still space to go.”

The ‘Eyecare Now, Eyecare Always’ Campaign

In 2022, the Indigenous Eye Health Unit (IEHU) at Melbourne University began to engage with community to develop the ‘Eyecare Now, Eyecare Always’ campaign. 

This approach was community-led and centred around the principles of self-determination, voice, and connections. 

The result is a suite of eye health promotion resources aimed at promoting regular eye checks in Aboriginal and Torres Strait Islander peoples across Australia, which are informed by Indigenous perspectives. 

The resources are primarily used by primary health care providers — including Aboriginal health workers and practitioners — to promote regular eye checks. 

Kris was invited to participate in the campaign as an ‘eye health hero’ to showcase the ways he uses his eyesight to highlight the importance of keeping up with regular eye checks. 

“I have been involved with the IEHU for a number of years now, and as of last year, sit on its Advisory Board,” he said.

“Logically, from the Unit’s point of view, if you have only one Indigenous ophthalmologist and are putting out an eye health campaign, it made sense for me to become involved.”

With the resources being valuable tools to culturally connect with Indigenous patients, Kris notes he is always surprised that they are not more widely distributed. 

“I know the campaign is getting airtime throughout Aboriginal medical services in Australia, but outside this Indigenous space, there has not been a great deal,” he said.

“It is a real shame because the campaign is a valuable resource to connect and interact with Indigenous patients, so I encourage my colleagues and their practice managers to utilise it where appropriate.”

The role you can play

Leaning into Kris’ experiences, we can each take direction on the factors and barriers that can influence Indigenous doctors’ pursuit of medicine and patients’ willingness to access services and seek assistance, with much heed due to a breakdown of cultural safety. 

As individuals, we can each play a role by participating in ongoing cultural safety training, as Kris shares.

“What the College has done — driven through its RAP and the reform of the training program — is make cultural safety training mandatory for all trainees,” he said.

“This is an important start as we go forwards towards increased diversity and inclusivity.

“Cultural safety is a process of lifelong learning; there is no such thing as an expert in cultural safety training because you can never actually know everything about it.

“Think of it as a spiral of learning, built on year after year.  

“In many respects it’s similar to building and growing our western scientific knowledge through the CPD process; it’s the same with cultural safety training.”

In addition to the College introducing mandatory cultural safety training for trainees entering the program, in the near future, cultural safety training will likely become mandatory as part of our AHPRA registration requirements.

Kris recommends all doctors begin this process now.

“As a starting point, you will gain background and have a framework to hang your thoughts on around these issues,” he explains.

“This will go a long way to eroding many of the unconscious biases that drive culturally unsafe practice.

“Generally, once people engage with this process, they actually find it interesting and want to learn more as it is a process of learning about oneself as well as others.”

Kris gained deeper insight into this at the Pacific Region Indigenous Doctors Conference held in Hawaii back in 2018, where Australian psychologists presented on what underpins effective cultural safety training — and it tells us more about ourselves than anything else.

“If you take a group of people, about 10 per cent will understand cultural safety issues immediately from past learning, so they are done and are the easy ones,” he said.

“You will then have about 90 per cent who do not understand cultural safety issues, and these will be at varying stages of understanding.

“This 90 per cent is then taken through a cultural safety program — over time, it’s not a one-off course — and by the end of that initial process, little by little, the majority of that cohort will express an understanding of themselves and the world around them that they did not have previously.  

“There will be a recalcitrant 10 per cent of the original group who will refuse to change or believe what they are being taught.

“Often people go through a process similar to the Kübler-Ross stages of death and dying, with initial anger and/or grief as their understanding of the world around them is challenged.

“The final phase is resolution and inclusion of what they have learnt into their lived reality.  

 “There are a lot of factual gaps in the understanding of Australia’s history within non-Indigenous Australia.  

“It changes perceptions of identity, which is very difficult for people, and they must go through a process of internally ratifying this. 

“At the end of that resolution, people can come to a better understanding of who they are and in the context of where they are.

“This is why cultural safety training is important — it is not just learning about Indigenous people; it is learning about yourself and questioning your beliefs and challenging those beliefs with facts.”

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To understand how the community-led resources that comprise the IEHU’s Eyecare Now, Eyecare Always campaign were developed, your ASO spoke to David Williams, Executive Director of the Indigenous creative agency, Gilimbaa, that brought the campaign from concept to vision.

How did Gilimbaa become involved with the Eyecare Now, Eyecare Always campaign and what role did the agency play?

Gilimbaa had worked with the University of Melbourne in 2015 on a previous iteration of the Indigenous eye health campaign, so there was an existing relationship there that we were delighted to re-visit for the 'Eyecare Now, Eyecare Always' campaign. 

Through extensive workshop consultation, the information and key messages gathered were integral to our development of the ‘Eyecare Now, Eyecare Always’ campaign. 

The Gilimbaa team developed the campaign’s videos, cultural artwork, and campaign resources, which were designed to encourage the primary audience to start caring for their eyes today, so their eyes are always as healthy as possible.

It’s reported between 90–95% of cases of blindness among Australia’s Indigenous peoples are preventable. 

Were you aware of this statistic coming into the campaign and does it motivate you personally being an Aboriginal man to break down barriers in communication and messaging?

Having travelled to Bourke, the resting place of Fred Hollows, I learned of the work that he did, knowing he’d worked in remote communities throughout his lifetime. 

It was understanding his work that I learned of the high statistic around blindness that is preventable amongst Aboriginal and Torres Strait Islander people. 

For Indigenous patients receiving eye care treatment, can you describe the ways the campaign resources may impact and make a difference to these patients? 

It was important that the campaign materials are things that the target audience can engage with and relate to. 

That is why it was important that an Indigenous agency, such as Gilimbaa, was engaged to work on this creative. 

The resources needed to be engaging and relatable to First Nations people all over Australia to ensure the campaign’s success.

What stakeholders were engaged to develop the campaign messaging and materials? 

We engaged eye health heroes Nornie Bero, Karlie Noon, A/Prof Kris Rallah-Baker, and Scott West and Mantua Nangala with the Kiwirrkurra Rangers. 

It was important to engage a diverse pool of ‘real-life’ eye health heroes, so the target audience could see themselves in the campaign talent and better connect with the campaign messages — the importance of getting an eye check.

In your own words, why should Australian ophthalmologists refer to and use these resources in the delivery of their work? 

It’s all about meeting people where they’re at. 

A better understanding of the patients that the ophthalmologists are treating leads to a better outcome. 

These resources aim to assist in that process.  


 

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