AIDA Representative to AMA (NSW) Council Dr Dana Slape

WHEN DANA Slape was in ninth grade she ventured to tell her school career adviser she wanted to become a doctor.

She was told to set her sights lower. “I remember being told that that wasn’t for people like me. And I remember believing them. I think that it was based on good intent, in that they didn’t want to set me up for failure. But I do remember thinking no one else was being discouraged from their goals and dreams.”

Born and raised in Sydney, Dana is a descendent of the Larrakia Nation from Darwin. Despite graduating Dux from her high school, she was pushed down the path toward teaching “because that was something that I think the teachers felt was a better fit for me given my background, and the social, financial limitations of my family,” she says.

So she put her dreams on a shelf to die and spent the next eight years successfully building up a career in the cosmetics retail industry. She was good at her job, and her selfconfidence grew. And eventually she decided she was ready for the challenge of tertiary education.

Dana returned to her buried desire to become a doctor, which was something she had long considered to be a significant means of addressing the inequalities Aboriginal people face.

“For me, I was acutely aware at a very young age of suffering – particularly with regards to mental health and addiction, and the social determinants that are so deeply intertwined with health outcomes for Indigenous people. That was my lived experience growing up. And I think there was an ingrained awareness within me that that suffering needed to be addressed and ameliorated, and a way that I could do that was to use my academic capabilities, dedication and connection with people.”

She started medical school thinking she would pursue a career in mental health, but quickly realised that wasn’t the right fit. Instead, she soon set her sights on dermatology.

Dana graduated with Honours from a Bachelor of Medicine/Bachelor of Surgery degree from the University of Western Sydney in 2013. She is the first person in her family to go to University, and she credits her husband, friends and mentors with giving her the inspiration to complete medical school.

It was at UWS that Dana started work with the immunology team, looking after children with severe eczema. After completing university, Dana did her internship and residency at Westmead Hospital, and is currently in the second year of her dermatology training program.

Throughout her training, Dana says she was fortunate to have many kind and supportive dermatologists who nurtured her – people with a dedication to rural, remote, urban minority and Indigenous dermatology, who have a commitment to addressing the workforce shortage and health outcomes for these communities in need.

Friends jokingly say Dana went from mascara to medicine and she admits when she runs into former colleagues and mentions she’s currently working as a doctor, “there’s a little bit of surprise and confusion.”

And yet, despite all her success, she says she’s not immune to the imposter syndrome – a concept describing individuals who feel underserving of their success.

“You want to do the best for your community, for your colleagues and peers, for your mentors, and for your family, and sometimes the weight of the world rests on your shoulders because this is an untrodden path. There’s a responsibility to make this work, to pave the way for more equitable Indigenous representation in niche medical specialty careers, to make that an accessible and realistic journey for people. People from minority backgrounds do struggle to not feel like just a diversity quota, but what we have to give to the medical community and our patients is something that can’t be trained and that’s a shared lived experience.”

She adds, “There are people who have done that before me and there are many, many people who will do it after me. But at the moment, within dermatology, it’s a new space. It’s one that is going to hopefully grow, but that’s not without its challenges.”

And for Dana, there are her own expectations as well.

“First and foremost, I’m doing my best to learn how to be a good registrar who knows her stuff. Most doctors have high expectations of themselves, but added to that is the ‘first in family, first in community’ trailblazing pressure.

Throughout her training Dana has enjoyed the support of many mentors. She credits the Immunology Department at Campbelltown Hospital, as well as the Dean of the University for helping her push through medical school and beyond. Her colleagues and peers from the Australian Indigenous Doctors’ Association (AIDA) have also been very supportive.

“Having walked the same journey as you, they understand the fact that you feel like you’re standing at the bottom of the mountain and that sometimes it’s insurmountable. But you can look up and see that other people are ahead of you and you just want to keep going.”

She currently serves on the Board of the Australian Indigenous Doctors’ Association, and recently joined AMA (NSW) Council as the AIDA representative in July 2017.

“If you can have a voice on something that matters deeply to you then I think it’s critically important to speak up and stand up. It’s deeply rewarding when that passion impacts policy and patient care.”

During her training, Dana had the opportunity to work in several different communities across Australia, including the top end and central desert parts of the Northern Territory, the Kimberleys, and urban communities with high Aboriginal populations. In North East Arnhem land Dana was involved with addressing scabies and other infectious skin disease.

“The aim of programs such as these is not only to eradicate scabies, but also the downstream sequelae, such as invasive group A streptococcal infections, rheumatic heart disease, and poststreptococcal nephropathy leading to chronic renal failure.

“Ultimately, there are pressingly urgent issues to be addressed with Indigenous skin health and these include both infectious diseases and connective tissue disease, such as systemic and cutaneous lupus erythematous, which has a high prevalence, earlier onset, and poorer prognosis in Indigenous people, particularly in the North of Australia.

“I think there’s definitely great health needs and the social determinants of health cannot be extricated from the health outcomes. They are intimately tied together. The primordial factors of housing and sanitation and access to clean running water – all of those things shouldn’t be a challenge in a country as wealthy as Australia, but they are and they do intrinsically tie into why skin conditions and health in general are so problematic in those areas.

But it’s not all doom and gloom, she says. “There’s definitely strength in those communities. It’s the world’s oldest living culture and something Australia should be proud of. As a country, I think embracing more understanding and more awareness of the strengths of these communities is going to go a long way in creating positive relationships.”

While Dana has succeeded in achieving her dream of becoming a doctor, she has a new dream – and that’s to see population parity for the Indigenous medical workforce.

“There are about 300 Indigenous doctors across the country and I’m one of them. So that means out all the doctors in Australia, less than one third of one percent are of Indigenous heritage, whereas Indigenous people represent three percent of the population. So we are well behind in population parity.

“We are headed to a new and exciting place where Indigenous medical students are considering careers and training pathways in Colleges that have never had any Indigenous trainees or fellows.

“Ultimately, the downstream effect of this will be improved access to care across a diversity of fields and a change in the way the medical community views Indigenous Peoples: not just as sick patients, but as colleagues. As a result, we will hopefully see Indigenous health become something that all medical graduates will be aware of and involved in and that can only be a good thing.”

She adds, “If we collectively work towards addressing the catastrophic statistics in Indigenous health, then the effect will be a better healthcare system for everyone.”