On asking the clinically-relevant questions

There's a question out there in medical land that apparently asks whether you are racist or not. The question is: "Do you identify as of Aboriginal and/or Torres Strait Islander background?" Now, the response to this question  – which in Australia IS of clinical relevance – is not what matters, but the fact that some people are unwilling to ask this question in this first place for fear of "offending" a person who isn't of this background.

Fear of offending a racist person is the reason some people give as to why they feel uncomfortable asking the question. They imagine they may encounter a racist person who'll take offense at not clearly being identified as non-indigenous. More specifically, though, they fear that they'll meet a non-indigenous person who they will offend by implying the negative stereotypes associated with people of Aboriginal and/or Torres Strait Islander backgrounds. But who's given this question that connotation? The racist person who holds those prejudices – and that is the person fearing to ask the question! You don't know the strangers mind that you'll be asking, only that you imagine it may believe what you (either consciously or subconsciously) believe yourself.

And briefly before I leave this topic, let me explain why I say that it is clinically relevant to know whether a person is of Aboriginal and/or Torres Strait Islander background. In Australia, there is difference in the life expectancy, the mortality rate, and the burden from disease between indigenous and non-indigenous Australians. This difference is commonly referred to as “the gap” between indigenous and non-indigenous Australians. Clinically, a person may be more likely to suffer from one or another illness (e.g. diabetes mellitus) if he comes from an indigenous background than if he doesn’t, and his/her symptoms may be more likely to be caused by a disease that is more prevalent in those of indigenous background than those that aren’t. This is turn is relevant to both the adequate diagnosis and treatment of this person’s illness. Further to that, the government may have incentive programs aimed at “closing the gap” in the health of indigenous and non-indigenous Australians, some of which can be quite helpful in allowing indigenous persons to overcome some other indirect/social difficulties in accessing adequate health care. So, asking whether a person is of Aboriginal and/or Torres Strait Islander background needs to remain a relevant clinical history-taking question, and one devoid of prejudice from the person who has been tasked with the job of looking after the health of a community consisting of people of all types of backgrounds. And perhaps we should stop fearing to encounter a racist person if it will only make us become the racist one ourselves.

On "the boat people"

Someone asked me the other day what I think about refugees, specifically the illegal immigrants that enter Australia on boats and are intercepted by Australian authorities. These last specifiers are important because they make this situation particularly unique. It’s no secret, and I consider this absolutely nothing to be ashamed about, that I entered Australia as a refugee from a war-torn country. I, however, find it difficult to form an opinion about the so-called “boat people” given that my family and I all entered the country legally on a comfortable passenger plane, were granted permanent resident status immediately on arrival, were escorted from the airport to a furnished and fully-stocked home in inner-city Brisbane, and received so much governmental support with negotiating a new country and a new language. The illegal immigrants I was asked about, although both refugees, are in a such completely different scenario that I find it personally hard to put myself in their shoes… And yet, so many people who are so much less qualified than even myself find it too easy to comment on “the boat people”.

A colleague once asked ‘why don’t illegal refugees from south-east Asia and other countries do what people from wealthier countries do?’ You know, just buy a plane ticket and come to Australia on tourist visas which they can then overstay and support themselves and escape the authorities however best they can. She suggested this would solve the issue of the Australian government having to process these illegal immigrants’ after-arrival applications to remain in Australia as refugees. Then Australian taxpayer’s money also wouldn’t be “wasted” on arresting and then housing refugees in detention centres, etc. Well, if you’re a citizen of certain countries, it’s actually quite difficult to get a tourist visa to Australia to overstay, and thus getting on a boat for illegal migration is much cheaper and easier despite all its inherent dangers. Well, this colleague suggested, why don’t the boats filled with illegal immigrants just get turned away or their passengers put on planes back to their own countries of origin before their stories/reasons for migration are heard. The reason for that is that would give the Australian government a bad human rights record… Oh yeah, it might actually be a violation of human rights.

So what do I know about refugees? I know that it must be a difficult decision to make to migrate to a country where the only certainty is that it’s not your own country (ideally for the better). When my family lived in El Salvador, people were migrating illegally into the surrounding countries, mostly northbound to the U.S.A. Around the time we left for Australia, the majority of people migrating illegally into the U.S.A. were leaving for the same reasons we were: seeking refuge from the hardships of war, the threats of death, and the intense poverty. Only a very very small minority were leaving “just for the hell of it”, and I believe perhaps no-one migrated illegally with the intention of hurting North-American citizens on their arrival. I also believe these broad categories/reasons remain true of all people who choose to migrate into another country. Why did my family migrate legally when others chose to do it illegally? Because we could. Why did others do it illegally when they could have done what my family did? Fear, lack of knowledge, I don’t know. I just don’t know. And I think that that’s the thing, that it is extremely hard to even imagine what it takes a human being to go through to make the choice where they consider it a lesser danger to hand over non-refundable money to an illegal human trafficker in order to board a shabby boat for a rough sea journey to a place you’ve never been to that speaks a language you don’t understand. How horrible must the other options have been?!

How do I feel about the “boat people”? A great curiosity to know their stories. And a wish that no person in this world had to suffer the hardships that lead most people to seek refuge in another country.

On racism in Australia

Dr. Charlie Teo, an Australian-born neurosurgeon of Asian descent, recently gave a speech on being Australian. He addressed the common denial of certain politicians, and in fact of a large segment of Australia’s population, that there is in fact a lot of racism in Australia. He pointed out that you cannot believably state that there is no racism in Australian unless you are of Indian or Arab appearance. I would add to that list Asian or African or Indigenous appearance at the very least too. That is because people of these backgrounds, with phenotypically prominent features in their face, skin colour, clothing, etc. are the ones that are often the recipients of the racism that occurs in Australia. But Australians in general aren’t racist, are they? Australians in general think they can make “non-racist” racist remarks by prefacing a racist statement by the words “I’m not being racist, but…” then following that up with an overgeneralisation or stereotype about a cultural group of people. It is such a common phrase in Australian parlance, really, but the preface doesn’t exonerate the content of the message.

The population of El Salvador is said to be over 99% ‘mestizo’, that is to say there are less than 1% “indigenous” Salvadorians or Mayan and/or pipils. Who in El Salvador does this matter to? No one! Because almost completely the people of El Salvador consider themselves Salvadorians rather than part Mayan with part Spanish ancestry – yet all of us, in varying proportions, are exactly that. You see it in the skin colour and physical features of the people. In terms of identity and culture, however, they call themselves Salvadorians only. Isn’t that a better method?... And yet maybe it isn’t about one method being better or another being worse, but perhaps it’s a cultural thing to think this way.

I remember when I was in Peru for the first time with some Australian-born girls and they were surprised by the way people describe each other in Latin American countries: skin colour, stature, hair colour, eye colours, nose length, personality, and other physical features – mostly in that exact same order! We were often trying to find people within a local hospital we were undertaking a medical school elective in. The oncologist was the white, tall guy, a bit chubby, with black hair, brown eyes, big nose, and was such a lovely man. The gynaecologist was the dark, short guy, who was overweight, had black hair and eyes, and was an arrogant prick. Found these guys in no time with those descriptions! Maybe our culture hasn’t been too marred by “political-correctness” and that’s why we can communicate so freely, but what else is the point of communicating if not to get a clear message across? I don’t know.

A few months ago I attended an indigenous culture awareness course, of which I’ve written about before. Before us non-Australian-indigenous folk was a man of Australian Aboriginal descent teaching us things about the differences between certain aspects of indigenous and non-indigenous culture. One of the rules of the course was that there were no “stupid” or “offensive” questions; all discussion and questions were allowed. As tends to happen in these kind of conversations, people soon start talking about “them” and “us”. The speaker at the front kept speaking about “us”, so a student of the course asked him a question: does he consider himself Australian at all? The question was based on the fact that we all, the speaker included, were living in Australia and sharing the experience of what living in Australia is. The speaker answered, “I consider myself an Aboriginal man”. Well, yes, but did he identify as both Australian and as an Australian-Aboriginal? The speaker laughed mockingly and said, “There is no Australian culture! What is Australian culture? Eating sausages and drinking beer?” There was an all-round “Ooh!” heard from around the room… I guess no-one likes to be stereotyped.

Is racism rife in Australia? Probably. Is this surprising? No; why should it be? Because suddenly it’s no longer acceptable to acknowledge flaws of the past (or present). What this reminds me of is of certain oppressive governments that seek to rewrite the history books that retell of their defeats or of their gross inhumane mistreatment of masses of people. If those histories or those actions are so reprehensible, then the wisest thing may not be to deny its existence, but to admit it and accept it as a challenge, to set it as the target away from which we must aim our future. If we are lucky enough not be part of a minority group, then what we can do is to personally not discriminate minority groups. But if we are part of a minority group, we must recognise also that this does not entitle us to be racist in return to “the oppressor”. We may not be able to change Australia, a whole country, but if we each make a commitment to change…