Elizabeth Castiglia

Indigenous Health Scholarship 2018

University of Notre Dame, NSW
Doctor of Medicine
Scholarship Awarded 2018
Sponsored by:

MECC/Boronia Medical Centre

How will I contribute to improving Indigenous health as a qualified medical practitioner or health worker?

I am passionate about working in, and making a difference to health outcomes for Aboriginal and Torres Strait Islander peoples. I am aware that the health disparities faced by Indigenous peoples are broad and complex. Health literacy and opportunities to access resources supportive of living a healthy lifestyle can build a positive health culture among Indigenous people and communities.   But many ‘top-down’ policies and programs have had limited success in closing the gap in terms of morbidity and mortality as these approaches have failed to account for the heterogeneity of Indigenous communities, the critical role of employing cooperative and empowering approaches, and the uniquely Aboriginal conceptualisations of health, in which the individual is inextricably tied with the health of the whole Community.

Aboriginal Community Controlled Health Organisations have been an important development in this area, and I have had the privilege of working in these during my clinical placements – the Gathering Place, in Werribee, Victoria, and (later this year), at the Biripi Aboriginal Corporation Medical Centre in Taree – the land of my ancestors. These experiences have confirmed for me the importance of cultural identity and self-determination in forming our own (Aboriginal) solutions to health problems. But it still brings home strongly the incredible disadvantages and struggles that Aboriginal people face across many dimensions of health, and which they face with so much unquestioning strength. Therefore, we also need to pay attention to addressing the reasons for, and seeking to rectify the disproportionate distribution of poor social determinants of health in Aboriginal communities, importantly by making greater efforts as a social and global community to take Reconciliation seriously and to offer our sincere efforts at understanding the tragic cultural loss that instigated an inter-generational pattern of disadvantage and suffering.

Given the complexity of the problem that I am passionate about addressing, I understand that there is only a little that I can do as a medical practitioner. However, even this little is important to me. I want to work in a variety of Aboriginal communities – from metropolitan to rural and remote – learning from the people and providing whatever medical care I can. I wish to listen to and assess the needs and barriers to Aboriginal health and integrate these into the ongoing research that I am undertaking (with ethical approval and supervision) so that I can advocate for effective program design and delivery through my research and through representation to political leaders and stakeholders. I wish also to address the continued ignorance, apathy, and even racism, that is often entrenched in the attitudes of the general public by evaluating systems of delivering effective education into culturally appropriate practice for non-Indigenous health workers, and respect for the cultural expertise of their Indigenous colleagues (themes of my current MD research project based in the Hunter New England Health District). I would also greatly value the opportunity to draw on my educational experience to build the capacity of young Indigenous students to learn about healthy living and to consider training in medicine, whilst drawing on the rich tradition of Aboriginal medicine.

Current Progressive Report

The first semester of my fourth (and final) year of medical studies was both eventful and enjoyable. It was characterised by the establishment of an orientation towards internship, which will continue over the year, and by practical preparations toward the same goal.

My clinical placement-based learning continued this year and began with rotations in cardiology, palliative care and advanced surgery. This was followed by another palliative care placement at two different sites and an orthopaedic surgery rotation to complete the semester. The experiences afforded by these rotations were varied and, at times, challenging. Palliative care frequently evoked feelings of inadequacy in the face of immense patient suffering and sometimes tragedy – and I learnt that where medicine has its intrinsic limits to treatment, the human element of care is what is most valuable. I was privileged to be able to sit with patients and listen to their stories at this moment in their lives – sometimes at the end of life. It was a meaningful and rewarding experience.

My surgical rotations were most enjoyable and served to confirm my interest in the field as a potential focus of future training. I had the chance to assist at many operations from specialities including orthopaedics, urology, upper gastrointestinal surgery and general surgery, oral maxillofacial surgery and plastic surgery.

Beyond these learning experiences, during rotations, I have particularly focused on refining my skills and knowledge of the principles of patient care applicable to internship. At our academic days at university, we study topics each week focused on the preparation for internship. This concept has been exciting as I have developed greater awareness of the impending reality and role I will perform next year as a doctor. To close the semester, I prepared the required documentation and applications for intern positions at a range of Victorian hospitals. This was quite an extensive process, but in the end, I was rewarded by the offer of interviews at three fantastic hospitals. I undertook interview preparation and found that I really enjoyed the interview experience.

Related preparations have been ongoing in my personal life. Attempting to tie together a range of family needs such as schooling choices, housing and extended family supports, I finally settled on a selection of hospital preferences. I was astounded to discover, when the allocations were released, that I received an offer for my most desired position – internship at the Royal Melbourne Hospital. I am extremely excited and know that I am privileged to be working there next year.

It is challenging at times to manage family and studies, especially when extra supports need to be arranged for the children to assist them where they are struggling (such as speech therapy etc.). I often need to manage my own feelings of regret that I cannot be there for them more. But I have a wonderfully supportive husband who has dedicated the last four years to caring for our family to support me in my studies and the end is now almost in sight. This endeavour is a whole-family goal and with each other, it has been a wonderful journey. I look forward to writing about my final semester when the year ends!

2018-09-07T16:45:37+00:00