First published in The Australian

LATISHA Petterson counts herself lucky that when she enrolled as a first-year medical student at the University of Newcastle in 1995, there were a "handful" of other indigenous students in the 100-strong intake. Likewise, when she went to do her intern year at Cairns Base Hospital, she feels lucky that out of the group of 12 postgraduate colleagues, there was one other indigenous doctor whose presence ensured she did not stick out like a sore thumb.

"I entered at a time when there was more active recruitment (of Aboriginal students), and there was a strong emphasis on recruitment through formal processes that allowed us to be retained," says Petterson, now a final-year GP registrar based in Palmerston, a suburb of Darwin, who plans to sit her GP fellowship exam next year.

"There weren't the numbers that are currently there in the medical schools today."

Petterson works in the Danila Dilba Aboriginal Medical Service, where she works in an outreach program serving the outlying communities outside the Darwin region, as well as local town camps. She also works at a "sobering up shelter" run in conjunction with Mission Australia, where indigenous people found wandering the streets in an intoxicated state can sleep it off, and have a shower and nutritious meal in the morning.

She accesses patients' medical records wirelessly on her laptop, and also has access to a specially equipped ambulance, which is more like a mobile medical unit.

Petterson will continue working in indigenous health after she becomes a fully qualified GP, although she says she may in due course move interstate to further her experience, which already includes time practising in the Torres Strait and Cape York.

But while Petterson is an undoubted success story, there's no doubt that the overall picture of indigenous health, and indigenous health recruitment, is less rosy.

Last year just 12 indigenous doctors graduated from all Australian universities combined. There are currently 129 indigenous medical students studying.

By the time they have all graduated, they will double the number of indigenous doctors Australia-wide, currently at about 125. But it's slow progress, as the Australian Indigenous Doctors Association (AIDA) concedes.

AIDA celebrates its 10th birthday this weekend, at a symposium being held in Darwin. The association's CEO, Romlie Mokak, says there were only about 30 indigenous doctors nationwide when AIDA began. While this means numbers have quadrupled since then, Mokak says the 125 now practising is still far below what is required.

Certainly the national Aboriginal health statistics continue to show a yawning gap between the health of Aboriginal people and the mainstream population. The latest national figures, released by the Australian Institute of Health and Welfare earlier this year, show that in 2004-05 indigenous adults were twice as likely as non-indigenous adults to report their health as fair or poor (29 per cent compared to 15 per cent), and twice as likely to report high or very high levels of psychological distress.

Indigenous people are also hospitalised for preventable conditions at five times the rate of non-indigenous Australians. The hospitalisation rate is a staggering 14 times higher for care involving dialysis, and three times the rate for hormone-related, nutritional and metabolic diseases including diabetes.

Part of the problem is that indigenous people have difficulty accessing health services. Cost is a barrier for indigenous people living in cities and other non-remote areas, while for Aboriginal people living in the bush, distance from services, and the lack of services in the first place, are the main problems, the AIHW report found.

It also found indigenous people are under-represented in almost all health-related occupations, making up just 1 per cent of the health workforce, despite making up 2.5 per cent of the overall population and being at enormous disadvantage in health status.

Mokak says indigenous doctors are so badly needed because to turn around the abysmal health disadvantage, indigenous communities need health workers who are "not only clinically competent but culturally competent". Above all, they need doctors who are "able to understand and work with indigenous people in ways that are effective for healthcare delivery".

"We have been doing a lot of work in training all medical students in this country around having some cultural competency in Aboriginal health," Mokak says. "We have made sure we have indigenous health in the curricula - that's about giving every medical graduate, at some point in their studies, indigenous health education and experience."

AIDA is aiming to attract more indigenous people to apply for medical school, and to that end will this weekend sign a new agreement with the heads of Australia's medical schools that aims to translate that into reality.

The agreement, which extends an existing partnership between AIDA and Medical Deans Australia New Zealand, will increase the awareness among medical students of how their own cultural values and assumptions might affect their ability to help patients.

Recruitment of medical students, and support and retention programs for existing students, will also be increased under the deal.

"We are trying to push for greater numbers (of students) recruited and supported," Mokak says. "But there are a number of barriers and we need to overcome those. There's a discourse in many places around the benign acceptance of Aboriginal people not staying at school. Aboriginal educationalists are pushing not only for retention, in other words staying for year 12, but for that to be a quality experience - they have to be achieving."

There's also been a failure to challenge an expectation for, or acquiescence in, Aboriginal children choosing softer subjects instead of the hard sciences that traditionally prepare the ground for a career in health.

"Part of what we are on about is the way that Aboriginal people are seen in this country," Mokak says. "It's more than health: it's well-being, what makes for our people to be strong, not only physically but emotionally and strong in their identity.

"As a national professional body we will advocate for this other perspective. But often we have these discussions and find out people often don't know what makes people strong, and even contest it."

However, there's no concealing the fact that it will take a lot more indigenous doctors such as Latisha Petterson coming through the system to fulfil Mokak's aim that in 10 years' time there will be no more discussion about Aboriginal people being unable to access health care.

"The work doesn't happen overnight, but the benefits are going to be enormous in the future," he says.