Now more than 75 per cent of the indigenous community in Inala attends the clinic, and there's been a dramatic increase in the numbers of teenagers and men, groups Hayman says have traditionally been reluctant to access mainstream health services.

Before, indigenous people said they felt uncomfortable, misunderstood and unwelcome at the clinic. Staff had seemed rude; their body language was offensive.

"White people use too many big words, they have lived different lives, talk down to us," is how one patient from a focus group described the previous situation at the clinic.

To combat the problem, the centre employed more indigenous staff as receptionists and health professionals, provided cultural awareness programs for all its staff and purchased culturally appropriate decor for the waiting room.

Patient satisfaction questionnaires found the strategy worked.

"Because the staff here is indigenous, people felt we could relate to them better and had more understanding of their needs," Hayman says. "People come here because I'm Aboriginal and a doctor. They say 'I can talk to you easily,' and 'You explain things well'."

At its annual conference last weekend the Australian Indigenous Doctors Association (AIDA) launched Healthy Futures, a report defining best practice for the recruitment and retention of indigenous medical students. There are just 76 indigenous doctors in Australia, while the number of indigenous students has remained at 102 since 2003.

The association's chief executive, Romlie Mokak, says the current situation is far from ideal.

"While the number of doctors -- and health professionals themselves -- are increasing each year, they remain only a fraction of what they need to be. There's a huge disparity," he says.

AIDA has set a target of 350 more indigenous medical students by 2010 and is calling for medical schools to provide specific pathways for indigenous medical students. The Healthy Futures report found that while 86 per cent of the 14 medical schools surveyed offered links with generalised indigenous support units, only 50 per cent had specialised health or medical support. Not surprisingly, they were the schools with the most indigenous students enrolled.

Despite some improvements, the grim statistics around indigenous health remain: life expectancy is still 20 years less than for the average Australian, chronic illnesses such as heart disease and diabetes are much higher among the indigenous population, child mortality rates are four times higher for indigenous babies than other babies. The highest published incidence of acute rheumatic fever in the world is among Aboriginal people living in the 'Top End' of the Northern Territory. And the list goes on.

"They're dying in droves from conditions that are diagnosable and treatable, such as diabetes and heart disease, and renal disease," says Ian Ring of the Centre for Health Services at the University of Wollongong.

Experts in indigenous health agree that many of these premature deaths are preventable. But Aboriginal people and Torres Strait Islanders are far less likely to go to GPs than other Australians, so illness and medical conditions that could be cleared up rather up rather easily go missed until it's too late.

"You go to a doctor you know and understand and are comfortable with, and in turn you want a doctor who is comfortable with you, and many indigenous people aren't finding that," Professor Ring says.

Though much of the evidence in Australia is anecdotal, most doctors working to improve health outcomes in indigenous communities say access rates improve as indigenous staff in clinics increases. The majority of Aboriginal people access primary health care through one of the 130 National Aboriginal Community Controlled Health Centres around Australia, where 70 per cent of staff are indigenous, though just 40 per cent of the centres can afford to employ a doctor. According to the latest available statistics, 1.4 million consultations took place at community-controlled centres in 2000-2001.

"People are more responsive when there are indigenous faces greeting them when they walk through the door," says Mark Wenitong, a senior lecturer at James Cook University and a GP at the Wu Chopperen Aboriginal Medical Service in Cairns.

He says the difference is more than cosmetic. Aboriginal and Torres Strait Islander doctors are more likely to understand different communication styles, facial expressions, language and general lingo that indigenous patients use, and understand the background they're from. "If someone's auntie dies and they're depressed, they might not share that with a doctor -- but if the doctor is indigenous they will understand the social context. Often when they come to an Aboriginal doctor they open up. You know what they're saying."

Indigenous doctors may also be more familiar with the clinical context of the different diseases affecting the indigenous population. For example, indigenous people are more likely to have multiple, interrelated problems, or to suffer from chronic illness at much younger ages. Some diseases, such as rheumatic heart disease and fever, are rare in the general population but common among indigenous communities.

But Mokak cautions that responsibility for improving Aboriginal health should be shouldered by white and black doctors and health workers alike, and not seen as something for indigenous people to fix by themselves. To that end AIDA signed an agreement last Sunday with the deans of Australia's medical schools to give Aboriginal health issues more prominence in medical school curricula. While he agrees indigenous doctors bring "unique perspectives", that "doesn't mean that non-indigenous people shouldn't be learning about indigenous health".

"There shouldn't be a presumption that just because you are indigenous, you have to practise solely in Aboriginal health. Aboriginal students and doctors need to have the full range of possibilities open to them ... it's also about the non-indigenous world taking the collective and personal responsibility to improve indigenous health in this country."

Some non-indigenous doctors are already doing their bit: in a letter in this month's edition of Australian Family Physician (2005;34:807), the journal of the Royal Australian College of General Practitioners, Glynis Johns writes of her satisfaction working as a GP in a remote Arnhem Land community. Formerly a doctor in inner-city Sydney, Johns's letter urges other "world-weary GPs whose kids have finished school" to "forget your dreams of restoring a house in Tuscany or Provence. Here there are people who need you."

Meanwhile, in recent years the government has sponsored a number of initiatives to increase the number of indigenous doctors. In 2002 it launched the Puggy Hunter Memorial Scholarship Scheme, offering Aboriginal and Torres Strait Islander people scholarships worth $15,000 per annum to study medicine, nursing, allied health, Aboriginal and Torres Strait Islander health work and health service management. Eighty-seven scholarships have been funded, and 60 more are expected next year. Other scholarships are available to rural students studying medicine.

Around the country there are eight government-funded programs to train Aboriginal health workers who help bridge the communication gap by liaising between patients and doctors.

But despite the initiatives, the struggle for numbers remains.

Six universities offer 33 dedicated places for indigenous students studying medicine, but the positions are not all being filled.

Louis Peachey, medical educator at the Mount Isa Centre for Rural and Remote Health, says there are often not enough applications to fill the five places available for indigenous students there.

He and Wenitong say the problem starts in early education and continues right through to university. Wenitong says the problem won't be rectified until more indigenous people first get into university.

"There's not enough happening -- there's not enough kids finishing high school, and the ones that do are taking soft subjects so if they do want to get into medicine they're going to have to take bridging courses to get up to speed in maths and science," he says. "They're smart kids but they're not doing well enough in school." Only 12.5 per cent of the indigenous population aged 15 years and over has attained post-secondary qualifications, compared with 33.5 per cent of the non-indigenous population.

PEACHEY says a culture that limits the dreams of young indigenous people means that few can imagine going on to become doctors. He recalls being informed by his high school guidance councillor that he'd "never make it to university".

"They're not getting the hope they need in primary school. What's being taken from them is the capacity to dream," he says.

But even for those who do go on to finish high school the barriers continue.

"There's a change of culture and a financial burden," Wenitong says. Students often have to travel a long way from their communities to study, leaving their support networks behind. Their approaches to learning, their values, such as their relationship to the land and the sea, are different from their peers, Wenitong says, and the rigid culture and lack of flexibility at medical school often difficult to cope with.

"There's an inability to have the same priorities you had before," he says. For example, when funerals arise, especially more than one in a short space of time, it can be an enormous source of stress: "You can't just take time off from medical school."

Equally, the financial burden is a major struggle for indigenous medical students, even with the government initiatives in place, Mokak says.

"There's a lot of mythology that pathways into medicine are smooth paved with gold for indigenous doctors, but getting a scholarship and getting through the system is actually very difficult," he says.

Brad Murphy is in his final year studying medicine at James Cook University. He left school at Year 10, joined the Navy and then worked as an ambulance paramedic before making his way into medicine. For two years he paid his own way through uni, and even started a business providing first-aid instruction to "keep my head above water". But it nearly grew too difficult.

"If I didn't get this scholarship I would have had to pull out, there's no two ways about it. I just did not have enough money, even with my savings as a paramedic."