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Growing up in a remote part of central west NSW, Rachel Farrelly would spend two hours travelling by bus to get to school each morning.
The daily routine was so gruelling that, by the time she was eight, her parents made a life-changing decision: they would ditch traditional school and teach their children from home, about 40 kilometres southwest of Orange.
“I loved it. There was way more freedom, but it was still really tough,” she says, crediting the discipline needed for home-schooling as the ideal training ground for what came next: more than a decade in medical school, including seven years specialising in orthopedic surgery.
After sitting her fellowship exam later this year, Dr Farrelly, a Gunu woman who was raised on Wiradjuri country, is set to become Australia’s first Indigenous female surgeon.
“I’m a practical and pragmatic person, which is part of growing up in the country,” Dr Farrelly, 33, said. “It’s probably what drew me to surgery.”
“Being raised in an Aboriginal community, I really wanted to contribute positively to the health inequality that you see in rural and regional NSW every day. But it was hard, I did have thoughts about quitting at times… going from this small rural community to a city university.”
There are just four operating surgeons in Australia who identify as Indigenous, according to figures from the Royal Australasian College of Surgeons, and another eight surgical trainees in the pipeline. All are men.
The College estimates that there are 3500 patients for every non-Indigenous surgeon compared to roughly 200,000 patients for every Aboriginal and Torres Strait Islander surgeon. Another 230 Indigenous surgeons are needed to reach parity.
“I find surgeons are pragmatic in the way they think about diagnoses, the way they treat patients,” Dr Farrelly said. “I did orthopedics for my first clinical term of medical school and… I never looked back.”
“I was the first in my family to go to university,” Dr Farrelly said.
“And when I started in medical school, there was only one Indigenous surgeon working in Australia. There were no role models, not much to look up to,” she said. Her father works in horticulture and her mother is a full-time carer for her brother, who is disabled.
“For so many students at med school they have been thinking about medicine since high school, or their parents are doctors. They have spent years preparing for it. That was just so foreign to me.”
In the past ten years conversations about diversity in medicine have definitely improved, Dr Farrelly said, with medical colleges now encouraging more women through their programs and Australian Indigenous surgical pathway groups have been set up.
Despite these improvements, the gender gap in surgery is most pronounced in orthopedics: of 1300 operating orthopedic surgeons across Australia, just 77 are women.
After graduating from the University of Western Sydney, Dr Farrelly spent her intern and registrar years at Royal Prince Alfred and Dubbo hospitals, then as a doctor at Bankstown, Hornsby, Wollongong, Norwest Private, Wollongong and Sydney Children’s hospitals. She will finish her training at Prince of Wales public hospital in Randwick and plans to specialise in hand and upper limb surgery.
“Junior doctor training is probably the darkest period of your career. I often ended end up working 60 to 80 hours a week and there were so many sacrifices … I’ve probably spent half of my marriage living apart from my husband.”
Peter Malouf, the chief executive of operations at the Aboriginal Health and Medical Research Council, said medical colleges have improved their commitments in recent years to cultural safety and “making sure Aboriginal and Torres Strait Islander registrars coming through the system are properly supported.”
“But there is a long way to go.”
A recent Australian Indigenous Doctors’ Association report found of Australia’s approximately 71,700 medical specialists only 0.15 per cent identify as Aboriginal or Torres Strait Islander.
Royal Australasian College of Surgeons NSW chair Dr Payal Mukherjee said the College is “on a mission” to address both the gender gap and workforce inequities faced by Aboriginal and Torres Strait Islander people.
“We know good health outcomes are attained when people providing healthcare are representative of the community,” Dr Mukherjee said.
Midway through 2021, the College launched the Australian Indigenous Surgical Pathways program, with a pilot program being run by Royal Darwin Hospital.