We See You ‘Niya Nulla Noogalla’: First Nations Doctors Reshaping Eye Health

Not so long ago, the picture could only be described as bleak. In a 2023 conversation about Indigenous eye health, ophthalmologist Associate Professor Kris Rallah-Baker put the gap plainly: he was one ophthalmologist, and the country needed something closer to 40.

That was the beginning of change. There are now several Aboriginal and Torres Strait Islander trainees and prospective trainees in the ophthalmology pipeline, with the field’s second First Nations fellow on the way and a widening pre-vocational cohort behind them. Those in it describe the growth less as a recruitment drive than as something organic – a community pulling itself up, person by person.

“It’s a very community, family vibe,” said Dr Thomas Mylne, an Aboriginal ophthalmology registrar who grew up in Gladstone in Central Queensland and has become a connective figure in the group. “Everyone in this room knows each other really well. When people fly interstate for interviews, it’s ‘come stay at my place’. We make them feel welcome and safe, so they’re in the best headspace going into a system that wasn’t really designed for us mob. We make it work because we support each other through it.”

For each of the Indigenous doctors and students in this emerging group – as well as their colleagues – that support has been key to getting ahead.

A Path That Started Long Before University

Jennifer Gulson, a Gunggari woman whose Country is around Mitchell in south inland Queensland, is a fifth-year medical student and one of hundreds of cousins. She is already publishing research on the barriers and enablers to First Nations medical school success and helping write national policy on medical curricula. But the barriers she is now researching began early in her own life.

Her father’s schooling was limited, and English has remained a struggle for him ever since. Ms Gulson was among the first of her cousins to finish high school, let alone go to university.

“Not having anyone medical in the family, getting into medical school was hard, and I didn’t really see myself in that space,” she said. “Then doing well in medical school was hard. I didn’t see myself doing well. And I never really saw myself in a specialty. But having all these people in front of me now, it does seem like I can achieve it.”

She has felt the pull towards eye care throughout her life, thanks to a personal connection. Her grandmother was a member of the Stolen Generations, taken, the family was told, “to have her eyes cleaned” – an account the family has always suspected pointed to trachoma. The experience left a lasting fear.

“My father told me that for the rest of her life, Nana wouldn’t see any doctors, she wouldn’t get glasses, she wouldn’t see anyone about her eyes,” said Ms Gulson. “She didn’t like seeing medical staff. That story was always my driver.”

Dr Sorren Thomas, a Torres Strait Islander woman with ties to the Maluligal people of Moa Island, was raised in Rockhampton in Central Queensland by her mother, alongside five older brothers. She is the first in her family to graduate high school.

“That’s not a unique background for any Indigenous doctor,” she said. “A lot of our parents, aunties, and uncles were denied an education. My mum was pulled out of school in grade nine to support her family. She wanted so much more for us. When she saw I took to school well, she put me into a private high school.

“‘Private’ is a real stretch to say, coming from Rockhampton,” she said. “But she instilled a belief that I could do whatever I wanted. I’ve never really seen anything as a barrier, and I owe that to my mother.”

Now a postgraduate year three hospital medical officer at the Royal Victorian Eye and Ear Hospital in Melbourne, Dr Thomas is interviewing for the ophthalmology training program with the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) this year. Her goals include completing a PhD alongside her vocational training. “And truly, all of that’s been fuelled by the people (Ms Gulson, Dr T’Kido Titasey, and Dr Mylne) in this room,” she added.

For Dr Titasey, known as TK, a Naghir man with blood ties to the Kulkalgal and Maluligal nations of the Torres Strait, the barriers to medicine ran through questions of identity. His grandmother grew up in the era of the Stolen Generations and, having overcome significant adversity, raised her family to prioritise education and integration – often at the expense of language and culture.

“Growing up in the Torres Strait, you’re Indigenous, your father’s Indigenous, you come from a very well-known family, but you can’t speak the language, you can’t do the dances,” Dr TK said. “So you sit on this fence between two communities, not really accepted in either, and it’s really hard to find your true identity.”

Some of that rejection was physical. “Some of the kids I grew up with were resentful that I had a white mother and an education and the chance to go down south, and they’d bully me for it. Sometimes it got quite physical. That was hard.”

As an adult, he made a deliberate effort to reconnect: travelling back to the Torres Strait at least once a year, going out to the outer islands, relearning Torres Strait Creole, and taking his wife up to show his community he was serious. And now, with a newborn baby, his desire to relearn the language and dances has taken on new urgency, so he can pass them on to his child.

While living and practising full-time within his community isn’t likely to be feasible, his regular trips already let him provide care that makes a difference. “When you show your community you’re serious about wanting to better them, it’s this warm feeling,” he said. “Patients remember you from when you were young. They respect you, and they’re comfortable telling you everything they won’t tell their regular doctor.”

The Mentors Who Cleared the Path

Ask any of them who their shining light in Indigenous eye care is, and the same name recurs. Assoc Prof Rallah-Baker is spoken of with something close to reverence. “Kris has been so monumental in getting this Indigenous ophthalmology mob going, I have the utmost respect and admiration for his resilience and leadership.” Dr Thomas said. “Likewise, I owe so much to Tom [Dr Mylne] as well. Without his help and gentle guidance, I wouldn’t be where I am in my career. All of us coming through ophthalmology are blessed to have them both.”

But as well as Assoc Prof Rallah-Baker, they want the Elders acknowledged: the first five Aboriginal leaders who went out with ophthalmology legend Professor Fred Hollows in the early days, taking eye health into communities, and through their own self-determination, setting the trachoma work in motion:

Gordon Briscoe, a Mardudjara-Pitjantjatjara man who served as the deputy director of the Trachoma Program alongside Fred Hollows,

Jilpia Nappaljari Jones, a Walmadjari woman, one of the first registered nurses at the Redfern Aboriginal Medical Service, and a vital field worker,

Trevor Buzzacott, an Adnyamathanha man who acted as a key field worker and cultural liaison on the road,

Reg Murray, a Wongatha man who helped design and navigate the delivery of services in remote communities, and Rose Murray, a Wongatha woman who served as a field worker.

RANZCO’s reconciliation action plans and the college’s Aboriginal and Torres Strait Islander committee, together with the support of the college’s eye foundation (ANZEF), also draw praise.

“If we did not have absolute giants of Elders who came before us to make that path easier, I would not be here,” said Dr Thomas. “Many of us would not be doctors. My aunties’ and uncles’ wages were stolen. That’s one generation before me. And now there’s this huge jump where I’m now a doctor, effectively a leader in society. That jump needs a lot of support, and it would be remiss of me not to mention the assistance from our friends and allies in that process also. I can’t thank or praise them enough for all their support and encouragement.”

As small as it currently is, the group said the support is real within the Indigenous healthcare community. “It really is a family thing,” Ms Gulson said. “TK and his wife took me out for dinner in Mount Isa. Tom’s offered me somewhere to stay in Melbourne. Riley, who’s trying to get into the program, has given me resources. There’s no lateral violence in the eye space. Ophthalmology sits at the top and nurtures everyone: our orthoptists, our optometrists, our Aboriginal health workers.”

For Dr Mylne, the hope is that as more Indigenous people follow Dr TK, Dr Thomas, and Ms Gulson into medicine and progress towards ophthalmology, the ripple effect will grow. “We’re creating an emerging community of leaders within First Nations eye health. Ophthalmology has not been a Black space. To see it grow like this is something else.”

Connections That Can’t Be Faked

Pressed on why an Indigenous ophthalmologist can make a difference, the group is unanimous in its response: it’s a connection that cannot be faked.

“For us First Nations doctors, you have a different connection with your patients,” Dr Mylne said. “You get people coming back saying, ‘I only want to see Hannah’, or ‘I only want to see Tom’, because we see them holistically. We practise the concept of Dadirri: deep listening. We listen for more than the clinical triggers. Yes, here’s a diagnosis – but what does that actually mean to you as an individual?”

Asked whether that way of relating to patients is something learned or something innate, Dr TK leant towards innate – pointing to his current boss, visiting ophthalmologist Dr James Walker in Mount Isa, who has remarked that the ease of rapport, body language, and ability to strip out jargon that Dr TK brings is something a lot of non-Indigenous colleagues work hard to acquire.

Dr Thomas agreed but was quick to highlight the importance of lived experience as well. “We grew up watching our mums, uncles, and aunties struggle to communicate, resist seeing the doctor, face barriers beyond mistrust: finances, complicated family dynamics,” she said. “We understand deeply what influences whether someone engages with healthcare. We don’t need to fill it with fluff. Our patients know we’ve lived it too. There’s no stigma, no hierarchy. It just translates.”

Ms Gulson reflected on a phrase from language classes taken with her family – ‘Niya Nulla Noogalla’ – an expression her auntie uses that translates, roughly, to “I see you” – but means something deeper. “It doesn’t just mean I see you,” she said. “It means I see everyone who’s come before you, I see your struggles, I see you: heart, soul, body. You’re not seeing a condition, you’re seeing the person.”

It shows in small ways. When Dr TK collects his patients from the waiting room, he walks over, helps them up, and carries their things. Clinic administrative staff told him he was the only doctor in a decade to do it that way. “Patients see you as someone human, someone who cares, not someone standing 10 m away yelling your name and turning their back as you walk over,” he said. He traces the habit to his own upbringing: “If I didn’t help someone off their chair, or clear the table, or if we were driving and someone was struggling with their shopping, my dad or my grandmother would pull the car over and say, ‘Boy, go over there and help.’ That’s how we were brought up.”

The group insists this way of relating is not reserved for their own mob – it translates across cultures and borders. Dr Mylne described a defensive patient, wary after a string of missed appointments, whose partner wore a moko kauae, a Māori chin tattoo; a few words of genuine recognition eased the wariness in the room. He also recalled staying back, having sought executive approval for overtime, to support fellow Torres Strait Islander doctor Hannah Wood through a gruelling night in the Royal Victorian Eye and Ear Hospital emergency department when the rostered doctor had called in sick at the last minute. Patients in the department picked up on the two First Nations doctors working as family.

“There’s power in leadership that is gentle,” Dr Mylne said. “We’re leaders, but not with sharpness or bluntness. There’s a gentleness and a care in the way we lead. One of the best pieces of feedback I ever got was, ‘You might be a little too casual for some of the city folk’.

I said, ‘Great’, because I’ll never be that sterile, clinical doctor who doesn’t try to connect.”

Never a Smooth Ride

While it currently “seems to be in vogue to be Indigenous”, Dr Thomas said resentment remains real, and it comes from more than one direction.

“It’s heartbreaking, because many of us who grew up in culture were bullied and teased, and our achievements were stamped down to ‘oh, it’s just because you’re Black’,” she said. “I’ve had immigrant med students and doctors ask me whether, if they’re dating an Aboriginal person, they can claim Indigenous status to get onto the program.”

Scholarships and pathways, she said, may be controversial, but they are necessary. “If those pathways hadn’t existed historically, our journey to medicine would have been much longer and the challenges much greater. We didn’t start at the same point as many of our non-Indigenous peers. We were way, way back. You won’t make everyone happy. But the right people will understand, and that’s all we can really hope for.”

Ms Gulson echoed the sentiment, describing the pathways and scholarships as “not a charity”.

“Us being here benefits everyone: Indigenous, non-Indigenous, international, culturally and linguistically diverse patients,” she said. “It shows in patient satisfaction; it shows in people turning up for their appointments. I used to think, just be quiet and be happy you’ve got a chair. But no – we own a seat here. It’s not a mistake that we’re here.”

She is direct, too, about the language the system uses. “We need to stop being lazy and saying being Indigenous is a risk factor. Being Indigenous isn’t a risk factor. The risk factor is that we’ve built a society that’s put our people into poverty, into overcrowded housing. It’s the environment and the social determinants we’ve forced our people to live in.”

To change that perception, she said, the medical curriculum itself needs to change.

“A lot of Australia’s history isn’t that old. It was only 50 years ago. My dad was nine before he was counted as a citizen of this country. When our colleagues understand that, and understand why there’s mistrust, why patients are scared to be in these spaces, a lot more empathy comes out. Cultural safety starts with us, but it doesn’t end with us. We’re 200 years behind, and we can’t do this without our allies.”

Building Bridges

For all the talk of barriers, the prevailing mood in the room was excitement for Indigenous eye care in the years ahead.

Dr TK’s ambition is to be “the bridge”, providing eye health to the people of the Torres Strait and flying to the outer islands so families don’t have to make the long, costly trip to Cairns, Townsville, or Brisbane for care that could be delivered closer to home. Dr Thomas is preparing to undertake her PhD alongside her ophthalmology training. Ms Gulson, still a student, is already publishing research on the barriers and enablers to First Nations medical school success and helping write national policy on medical curricula. And Dr Mylne looks forward to creating more opportunities for colleagues to take up the spotlight as emerging leaders, while continuing his own strong advocacy.

“When you see these guys speak the way they do, it’s self-explanatory,” he said. “We’re creating the colleagues and the family we want. I’m excited for the future of eye health, because it looks bright when you’ve got people like this in the room.”