Professor Julie Satur on setting a new course

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professor Julie Satur Joining the Dots
Professor Julie Satur describes herself as “a long-term ally” of Indigenous Australians. Photo: Eamon Gallagher

A new education curriculum in dental schools is putting a focus on the needs of Indigenous Australians, and according to the program’s creator Professor Julie Satur, it’s long overdue. By John Burfitt

Each year as part of the Bachelor of Oral Health studies at the University of Melbourne, Professor Julie Satur would take a group of students to the Victorian Aboriginal Health Service to meet the medical team and learn about the clinic’s range of activities.

After one visit, a fellow academic pulled Professor Satur aside and questioned the appropriateness of the visit. “This person said to me, ‘Those students, as the only non-Aboriginal people there, were so uncomfortable sitting in that waiting room’,” Professor Satur recalls.

“And I responded, ‘I’m pleased then, because that’s exactly how Aboriginal people usually feel sitting in a dental clinic waiting room.’ I believe there’s strength in doing such things; to live in that space for a while when you are not the majority and understand what it feels like.”

It is such learning strategies Professor Satur, the university dental school’s director of Engagement and Indigenous Programs, has been employing over the past 25 years. Having graduated as a dental therapist in Melbourne in 1977, Professor Satur spent 18 years working for the Victorian School Dental Service as a clinical dental therapist and in the dental health education unit, followed by post graduate studies in public health. Since 1996, she has been involved in tertiary education at the Melbourne Dental School, with a special interest in Indigenous Australians. 

“I have always worked in the space of inequalities and how we can improve oral health care for the 45 per cent of our population that doesn’t have good access, and that includes new migrant and low-income communities, people with disabilities and those living in rural areas.”

Professor Satur is not Aboriginal but describes herself as “a long-term ally”, and has worked with communities in Arnhem Land and along the Murray River. At the Melbourne Dental School, she has worked to embed Aboriginal health issues in the Bachelor of Oral Health and Dentistry programs, including clinical placement of students in Northern Territory communities. 

Over the past year, Professor Satur has taken that commitment to a new level by creating the recently released resource, ‘Joining the dots: A dental Aboriginal and Torres Strait Islander cultural safety curriculum’

Unveiled in September, this new curriculum offers a comprehensive outline for the development of graduate dental practitioners with the appropriate knowledge, skills and practice to provide culturally safe oral health care. It’s also hoped, in the long term, to support the development of an Indigenous dental workforce.

Commissioned by the Australasian Council of Dental Schools, the new curriculum is based on key areas of culturally safe practice underpinned by the expertise of Aboriginal and Torres Strait Islander people. Joining the Dots has been designed with the flexibility to meet the different dental programs across Australia. 

Professor Satur created the new curriculum with her University of Melbourne colleague Joanne Bolton, the University of Sydney’s Dr Cathryn Forsyth, and in consultation with Aboriginal and Torres Strait Islander practitioners and dental academics.

“It is time we changed our approaches to managing oral health with Indigenous peoples, and we believe the new curriculum is a step towards achieving better outcomes,” she says. “The expertise in the dental schools needs support and this was designed as an enabler, to help academics.

“The Joining the Dots curriculum offers 36 learning objectives, ideas for lecture topics, suggestions for classroom activities and assessments, and the existing resources that makes all of this easy to integrate into an existing curriculum.”

Professor Satur claims the ongoing impacts of colonisation and racism positions First Nations people in a system of disadvantage and produces inequitable barriers to achieving good oral health, and there remains limited participation in the dental workforce by Aboriginal peoples. 

When we see a strong, healthy Aboriginal and Torres Strait Islander presence in our dental workforce, then that will be the signal that we have started to make some ground. Until then, there’s a huge amount of work for all of us to do.

Professor Julie Satur, Melbourne Dental School

The 2020 report ‘Factors influencing the perceived importance of oral health within a rural Aboriginal and Torres Strait Islander community in Australia’ concluded that Indigenous Australians suffer from higher rates of oral disease and have more untreated dental problems and tooth extractions than the general population. Indigenous Australians also have lower rates of accessing oral health services.

Joining the Dots has been built on the Australian Health Practitioner Regulation Agency (AHPRA) guidelines for four key areas required to ensure culturally safe practice.

“One of my favourite work philosophies is, ‘Without cultural safety, there’s no clinical safety’,” Professor Satur says. “What I mean is a practitioner can do the most perfect fillings, but if you can’t work with the person whose mouth that filling belongs to, then you’re not a successful practitioner.

“In dentistry, we are in a people business. Oral health is not just created inside the mouth of a patient; it’s created in the context of their lives. If we are going to be successful at improving Australia’s standard of oral health, then we’ve got to be able to understand and accommodate people’s cultures.”

The program will be implemented over the coming five years in response to new accreditation standards established by AHPRA and the Dental Board of Australia. Professor Satur says the dental schools at both the universities of Melbourne and Sydney will be implementing aspects of the new curriculum from 2023, and she’s in discussions with other dental schools about doing the same. She adds the ADA is looking into including such issues in CPD topics.

While such moves suggest a step in the right direction and she’s hopeful the new program will have an impact on future dental graduates, Professor Satur stresses taking such an approach in dentistry is long overdue. 

“Aboriginal and Torres Strait Islander people are the oldest continuing culture in the world and have generations of wisdom and practice knowledges regarding health and healing with much to offer contemporary healthcare systems,” she says. “Yet I’m always shocked when dealing with students coming out of secondary schools, at just how many don’t know Australia’s black history. They often respond with comments like, ‘I didn’t know any of this’,” she says. 

“But that’s a good admission as it then generates discussion around the impact of colonisation and racism and the social and structural impacts for Aboriginal and Torres Strait Islander health inequalities, and what we can do in our profession to address that.”

That lack of knowledge and exposure can sometimes result, Dr Satur adds, in students becoming anxious about engaging with Indigenous communities, for fear of accidentally saying the wrong thing or unintentionally causing offence. 

“If you go in with some cultural humility, and recognise that people have expertise in their own lives, then over time, the better you’ll be with it,” she says. “I don’t mind a bit of discomfort because it makes us think a little more carefully about what we’re doing. 

“Which is why we need the dental schools to get behind this learning in a comprehensive way, to make it easier to generate this discussion and grow our capacity. We need a community of practice among dental academics, and a recognition that every graduate has a responsibility to be concerned about appropriately addressing the dental needs of these communities.”

Despite all the hard work that has gone into the new resource, Professor Satur hopes it will evolve and be updated within the coming years. 

“Aboriginal people are the experts in their own lives, and this should be led by Aboriginal people, but unfortunately in our current dentistry workforce, there are not a lot of Aboriginal practitioners or academics,” she says. 

“But I hope that changes and when this comes up for review, the Indigenous Dentists’ Association Australia leads the way. When we see a strong, healthy Aboriginal and Torres Strait Islander presence in our dental workforce, then that will be the signal that we have started to make some ground. Until then, there’s a huge amount of work for all of us to do.” 

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