Passing physician exams in Australia shouldn’t require passing as a white man.
“We told him to change into a pine-tree, and he did it so well that we were all applauding him” – scholars of the Patriarch in Monkey King: Journey to the West by Wu Cheng’en
As the last moon of the lunar calendar wanes for 2024 and the Year of the Wood Snake emerges slightly out of sync with the Western New Year, Asian families everywhere are starting to frantically cleanse the previous year away to make room for new possibilities.
What you do on the first day (some say month) of the Lunar New Year reflects your labours and loves of the year to come. We’ll dutifully pack all the inauspicious things into the days and weeks before the Xin Nian starts, and not bring last year’s unhappiness into this shiny new future.
Great example of cultural awareness from the paediatric college, to apologise for systemic racism in clinical examination practices in the leadup to the new year instead of during.
There will be no racial profiling in clinical examinations for the year of the wood snake. Lunar New Year, new us!
Growing up in a Malaysian Chinese community is not altogether dissimilar to studying medicine. The entry program requires APGARs of 9 and 9 transitioning to straight As and a letter of good standing from your community.
You must understand the concept of complex social hierarchies, and there is a minimum of two languages in your little brain. English and Latin for medicine; English, Bahasa Melayu, and your mother tongue of Mandarin Chinese/Hokkien Chinese/Hainanese Chinese/Cantonese Chinese/Hakka Chinese depending on your family’s lineage.
There are complex rules and systems to understand from as early as your first breaths in life. The Asian culture of “confinement” after having a baby ties in well with mandatory septic workup including lumbar puncture for febrile neonates.
Some of these rites and rules meld seamlessly into Australia’s medical culture, like “A minus is A minus my love for you”, which is a more potent stimulant for exam preparations than the Very Secret Very Rare phenomenon of black-market stimulant use among students of our craft.
As a child in the old country, there is no first-name basis between parent (consultant) and yourself (registrar), and you’d be labelled “Never die before” if you tried that on the grandparents (Prime Minister).
There is much less emphasis on what you did over your weekend, given the overwhelming saturation of the waiting room and the need to review 80 patients in a single shift. There is also very limited scope for a young person’s opinion to be heard, because children, while loved in the form of being forcefed dumplings and cakes, are generally regarded to be in the cute but nonsense category.
Now are all these things right? Obviously not, but they are very much a reality.
How then does a migrant medical student or doctor seamlessly enter the Australian workforce without changing everything about themselves? How does one go from a blossoming angsana tree rooted deeply into tropical earth to a homogenous pine (note I did not say eucalypt) in the time required to be IELTS- then AHPRA-registered?
Consider even my simple journey into medicine, a journey not anywhere close to disadvantaged.
Poor dad + rich mum = poor parents due to patrilineal inheritance of wealth. Two kids, one in the arts, the second in the path of least resistance: medicine. Two tweens enlightened in the Malaysian understanding of institutionalised racism and the rising star of Britney Spears. One who chose rebellion, the other assimilation.
Both taught the colonists’ ways by an ultimately colonised nation in order to grow beyond the confines of their home country. Both applauded for academic excellence but still called “banana” – yellow on the outside, white on the inside for not being Chinese enough and escaping to the understanding and wise institutions of the promised land: Australia.
Because surely Australia, historically a land of forced migration and refugees, would love to have migrants of all origins? The lessons from her own history of ill-fated assimilation policies surely must still be bitter on her now multilingual tongue?
Nah. One could almost taste the desperation for cultural homogeneity, represented in the lack of practised multiculturalism, the insistence on holding on to “traditional” national holidays, and monarchist tendencies.
Despite all her obvious challenges, Malaysia as a nation built by migrants is flush with cultural festivals, temples and respect for each other’s “adat-ibadat”. You’d go from Lunar New Year to Hari Raya (Eid Mubarak) to Deepavali to Christmas. I mean, you could barely get any work done for public holidays and feasting. The politics might be firecrackers in a bin fire but there’s nothing an invite to a festival couldn’t improve.
The desperation to assimilate into a new country’s beige background doesn’t cease upon encountering its troubled policies, as it should; instead it deepens. It becomes more profound the more feedback the new culture rewards you with. Negative feedback for the ethnic cuisine, which gets wrinkled noses and commentary of “ew what’s that?” (it was 2012 and soy-braised tofu in Melbourne: come on); positive feedback for vomiting your 20s away in binge-drinking sessions paid for on credit cards. Positive for taking part in mandatory Aussie slang integration sessions provided to Asian international students and learning how to say the term “fair dinkum”; negative for your “attitude” while feeding back that the session was irrelevant and racist. Negative from doctors for “I don’t know what you do and never hear you speak on ward rounds”, paired with positive feedback from nurses for quietly cleaning up all the jobs, concerns, speaking to families and procedural skills while someone else gets a leg up for banter.
Given enough institutional feedback, an overwhelming need to kowtow to the masses begins to set in, and the “other” begins to make excuses for their own erasure. If I dress differently, speak differently, lose my accent, forget to use spices etc. maybe my own team will respect me, see me, consider my opinion, let me be one of them. And the more censorship of angsana and the more pine-fresh, the louder the scholastic applause, so why not?
I certainly coach all my exam-sitters to speak like and project the confidence of a white Australian man in order to survive their clinical exams. But to live so far from one’s own authentic self generates an internal dialectic tension that will not stay contained, and a sizeable gap emerges in unexpected ways.
The gap between 40% and 93%, to quote a purely random number off the top of my head, for example.
Quite an unexpected pre-Lunar New Year explosion of truth from the college, but the truth does come out eventually.
Life still needs to be lived, decisions need to be made to ensure that you’re in the 40% of non-Caucasians who survive exam season.
Those familiar with the Monkey King myth will have no trouble recognising that no matter how far you jump you may still end up on the other end of Buddha’s palm.
So, what about an alternative to jumping when told to? Instead of “how high?”, perhaps our pledge for the year of the wood snake will be to hiss a “why?” back. Why, to qualify as an advanced training in a reportedly reputable professional college, must I change my culture completely? Why, if my home country’s doctors can lead the world in malaria research, do you think I cannot fare well in this country’s workforce?
And conversely, it is important as educators, whatever cultural background they might have, to look at a trainee and ask themselves the same “why”.
Why is this person, who others claim to be so highly skilled, unknown to me? Why are they so quiet – could it be a cultural barrier rather than a language one? Why is speaking like a white man more important than clinical acumen, procedural skills, knowledge or whatever the allegedly objective examination of the day is? Why don’t I see a health leadership as diverse as the community we serve?
The path forward for all of us – colleges, systems and nation – is long and sinuous, and made of many unknown variables. But I do know a sassy, bespectacled little boy who used to collect the bright red angsana tree seeds outside his school, who used to live in privileged assumption that he was the same as everyone else, who will walk it with you.
He’s a bit beat up and jaded now, and if you catch him wandering about irritably quoting the NZ Herald, be sure to think of the “whys”, and do wish him: Happy Lunar New Year, may the year of the snake bring you an abundance of health, joy and hope.
Dr York Xiong Leong is a general paediatrician in Eastern Health, Melbourne, working in public inpatient and community paediatric services, and a medical educator with Monash and Deakin universities. One of the best compliments he has ever received is “Babe you barely live on this planet”.