Tackling diabetes in Indigenous communities with Indigenous doctors
As diabetes prevalence—and in turn diabetic eye disease—increases across Australia, Dr Justin Keevers is keen to tackle the scourge in Indigenous communities. The 29-year-old electrician-turned-doctor says while he grew up aware of the importance of physical activity, nutrition and regular check-ups, other Indigenous individuals aren’t so lucky.
“I’ve always had a big interest in health, and I played a lot of sport growing up. But for others, there’s a huge hangover from the time of the White Australia policy and the stolen generation. Mental health issues that have emerged from the impact of those policies are also a cause of high drug use, and high drinking and smoking rates. Then there was also the fact that Indigenous children were only allowed a primary school education. So information wasn’t passed down about healthy habits from parents, and children didn’t receive that education at school. There’s a huge lag in health education, but 200 years of oppression is not going to be fixed overnight.”
It’s something he is hoping to address throughout his medical career, having graduated from the University of NSW medicine faculty earlier this year. He calls himself ‘lucky’ having been able to enrol in the degree through the University’s Nura Gili Pre-Medicine Program. “I grew up not knowing what I wanted to do but I knew from about the age of 16 there’s not much career to be had in Byron Bay. After high school my parents pushed me into doing a trade rather than taking a year off. I became an electrician and I did that for just over four years.” After becoming disillusioned with the work in 2007, Keevers decided to stretch his academic wings. “Luckily due to UNSW having a Indigenous pre-medicine program, it gave me an alternate entry into medicine. It was one month of intensive examination to see if we could handle medicine. It was a baptism of fire. However, since doing medicine, I feel both academically and mentally fulfilled. It’s very hard work, but very rewarding work.”
Now Keevers is completing his internship at the Prince of Wales Hospital, before he can train further in his speciality—bariatric surgery. “There’s a complicated relationship between obesity and Type 2 diabetes. There will definitely be things in the future that will be better at controlling this relationship, but at this stage, bariatric surgery is the best way of tackling the epidemic that is increasing diabetes rates.”
Yet for Indigenous communities, dealing with diabetes is further complicated by relationships with health professionals and health systems. “I’ve heard stories of people in the Northern Territory not wanting to send their elderly to hospitals because they believe when they do send someone who’s sick enough to go into hospital, they’ll never come back,” notes Keevers. “There is a lot of mistrust. A lot of Indigenous people mistrust people who work for the government, due to things that have happened. But I also feel that a lot of doctors have an inability to talk to the individuals, to express what they have in their head to something the community can understand. They need to be able to distil it to if you have diabetes and you get a cut on your foot that it may not heal because it’s harder to fight an infection. There are risks of amputations, a higher risk of heart attacks, strokes, and of course even eye problems.”
To solve the issue Keevers is adamant. “One thing I know for certain is that Indigenous people trust other Indigenous people in health. We need more Indigenous doctors. That’s why we have things like alternate pathways. We have 290 Indigenous doctors in Australia now, and we need to be closer to 3,000 for population parity.”
It’s not easy, and he admits that very few individuals would be up for the challenge. “Not a lot of people from the west want to come to live in the city for six years, do a medical degree and everything that comes with that and then move back to the country again. That’s a hard thing in itself. But long-term we need more Indigenous doctors, just to stop a lot of the perception that Indigenous people don’t have the will to look after their own health and to bridge the gap themselves. Seeing what I’ve seen, they do, they just don’t trust a lot of the doctors that have these perceptions.”