124: Critical gaps in Indigenous menopause care with Prof Odette Best

When Professor Odette Best, Pro Vice-Chancellor (First Nations Strategy) at UniSQ discovered she was experiencing perimenopausal symptoms, she turned to her healthcare provider for answers, only to find a glaring absence of research, resources, and support specifically designed for Aboriginal and Torres Strait Islander women.

"The last lot of research that we did or was done in Australia was about 12 years ago, and it was done by a group of non-Indigenous women and there were 10 women that they interviewed. That's it. That's the only body of research that has been done in the country around the menopausal or perimenopausal experiences of Indigenous women," she reveals in this eye-opening conversation.

Professor Best, who has worked in women's health for 35 years, doesn't just identify the problem - she's actively working toward solutions. After appearing at the "So Hot Right Now" event at the Sydney Opera House, she assembled a team of 32 mostly Indigenous women researchers from 13 universities to study the unique experiences of Aboriginal women traversing menopause.

The challenges are significant: funding bodies that create competition rather than collaboration, healthcare providers with minimal training on menopause and diagnostic tools that fail to incorporate cultural considerations..

During our conversation we examine how proper healthcare requires cultural understanding, appropriate funding, and research led by Indigenous women for Indigenous women. 

Are we ready to acknowledge these gaps and take meaningful action to address them?

Links:

Prof Odette Best

Thank you for listening to my show!

Join the conversation on Instagram

Chapters

• 0:01 Welcome to Dear Menopause
• 1:25 Professor Odette Best's Heritage
• 3:05 Journey into Indigenous Women's Health
• 8:01 Indigenous Health Progress and Gaps
• 10:11 Menopause in Aboriginal Communities
• 17:24 Research Funding Challenges
• 24:10 Navigating Menopause as an Indigenous Woman
• 27:19 Need for Cultural Competence in Healthcare

Transcript

Sonya: 0:01

Welcome to the Dear Menopause podcast. I'm Sonia Lovell, your host Now. I've been bringing you conversations with amazing menopause experts for over two years now. If you have missed any of those conversations, now's the time to go back and listen, and you can always share them with anyone you think needs to hear them. This way, more people can find these amazing conversations. Welcome to this week's episode of Dare Menopause. Today, I am super excited to be joined by a guest that I've wanted to chat to for quite a while. It impacted me more after seeing you on stage at the Sydney Opera House at the so Hot Right Now event earlier this year. I'm speaking to Professor Odette Best.

Prof Best: 0:43

Welcome, odette, thank you, sonia, lovely to be here.

Sonya: 0:47

It's awesome to have you here. To make it a little bit easier, why don't you introduce yourself and tell everybody a little bit about who you are? Okay, thank you.

Prof Best: 0:56

Well, my name is Odette Best. First and foremost, I'd like to acknowledge the land where I am today being recorded on, which is the land of the Yugara and the Yugarram people and in a little town or city called Ipswich. Myself I'm an Indigenous woman. I have two bloodlines through a set of grandparents which is Goren Goren and Bontemora, and that's through my grandmother, who is still alive she's a very old woman now we think about 106, and that's through my grandmother, who is still alive she's a very old woman now we think about 106, and that's my Goren Goren bloodline. And my Bontemora bloodline is through my grandfather, which was her husband for a very long time. So that's a channel country way out west in Queensland, a quite stark and very beautiful country.

Prof Best: 1:41

And by adoption I am also a Kumbumburra Yugambeh woman. So I didn't grow up with my blood family and I was adopted by a mixed marriage couple back in the late 60s that they called them, and my adopted dad, who is my dad, he's my dad, I love my dad. He's Kumbumburra Yugambeh, so that's around Southport Gold Coast and across the Stradbroke Island, and it's his last name that I absolutely proudly carry still to this day. I am a registered nurse and I've been a registered nurse for a really really long time probably about 34, 35 years now and I commenced my training at the Princess Alexandra Hospital in Brisbane back in the late 80s. So I've worked for a very, very long time as a nurse, in different capacities and settings, and I currently sit in a role at the University of Southern Queensland as their Pro-Guys Chancellor for First Nations Strategies.

Sonya: 2:33

Amazing and thank you so much for that background into your Indigenous family history. I find that so fascinating. Thank you for sharing all of that. What I'm keen to hear from you about first off, is what inspired your focus into Indigenous women's health and midwifery. Obviously you've got that family connection, but from a career perspective, what inspired you to move into that space?

Prof Best: 2:56

Yeah, good question. When I got through my hospital training at PA, I was very, very clear that I wasn't going to work in a hospital. I didn't like hospitals. I was very, very clear that I wasn't going to work in a hospital. I didn't like hospitals. They smelt bad and it was just.

Prof Best: 3:07

It was full of contested spaces for me which were really hard to navigate, and we didn't deal with intersectionality very well back then at all. It wasn't even a term that had been, you know, a phrase that had been coined by Kimberly Crenshaw at that stage, and so I always knew that I was destined to work in Aboriginal health and I just had to make that happen. And so for me I did go and work clinically at the Brisbane Aboriginal and Islander Community Health Service, as it was called back then, and I worked there for approximately a decade and for me I was particularly interested in youth health, but young women's health, more to the point, and so I would eventually take on the role working at Brisbane Aboriginal Medical Service as a clinical coordinator of young, at-risk Indigenous women and their sexual health. So for me that was kind of like where it was just like oh, this is really exciting, this is really excellent. I feel like I can have an impact. I feel like I can lean into this space.

Prof Best: 4:07

I did attempt to do my midwifery because I had quite a bit of pressure on me from different people around. Well, you need to be a midwife, you need to be a midwife. We need more black midwives, we need more Aboriginal midwives, and I must admit it wasn't something that I particularly and naturally leant towards. However, I did attempt to do my midwifery down at the Martyr Hospital in Brisbane and I lasted seven weeks. Yeah, when I'm going, yeah, this is so, not for me. And so I rang back Uncle Mick Adams, who was the chair of the board at that time at the Brisbane Aboriginal Medical Service, and was like crying and sobbing going Uncle Mick, have you given my job away yet? And he was like no, when do you want to start back? It was like I want to start on my own. I attempted my midwifery. I never went back, so I never worked in the space of midwifery. It was more sexual health for young, at-risk, indigenous women.

Sonya: 5:01

Okay, and so I'm assuming this must have been 80s, 80s, 90s. No that was 90s early 90s.

Prof Best: 5:08

Early 90s yep.

Sonya: 5:10

And what change have you seen in that time when it comes to the health of Indigenous communities, and particularly those young women that you were so invested in helping from a sexual health perspective as well?

Prof Best: 5:23

There has been change, and in different respects over different things. So whilst I was also working at Brisbane Aboriginal Medical Service, I would go and do some clinics and then I would end up working there part-time and usually on weekends, at Bogger Road Women's Prison, and I was the sexual health nurse in there as well. And one of the really big, fundamental changes that I did see around helping Indigenous women full stop was sitting on the founding board of an organisation called Sisters Inside, and that was very much about supporting Indigenous women inside and as they journey outside of their prisons. The other thing, I think and that organisation still goes today and it's based in Brisbane and it has expanded out but the level of support that it gave women was something we had never seen in this country before. So I'm really proud of that. Having been attached to Sisters Inside, we now have more Indigenous nurses we don't have enough, clearly. So that's also been a change.

Prof Best: 6:27

And I think what has changed as well is we see, have seen some amazing indigenous researchers coming through and doing really amazing work in the space of indigenous women, and when I talk about that, I talk about, uh, people like lisa wop at um australian national university. Now she's a Taurus woman epidemiologist researcher and she looks at cervical cancer in Indigenous women. We have some better funding within our Aboriginal medical services around sexual health and that's things like pap smear clinics and specifically focusing on women's sexual health. So we certainly have got more of that. But of course there's really big gaps that are still there to this day and hopefully we can start to redress them, especially around the area of the journey or traversing perimenopause and menopause for Indigenous women. There's just a dearth of information out there for us. Clinical services out there for us, resources out there for us, they services out there for us, resources out there for us they are nearly non-existent.

Sonya: 7:27

Wow, that's really sad. As a very privileged white woman, I live in a city, I have all the privilege literally it breaks my heart when I hear that there is such a gap that exists. And I don't think it's just the care, it's in the acknowledgement of the fact that the experience for Indigenous communities through midlife, that transition period, is just so different to what is talked about, is researched. And what do we whether it's we as a country, we as a nation, we as a global community, have to do better to support our Indigenous communities. Look.

Prof Best: 8:03

Sonia, that's such a loaded question. How long do we have, seriously? Oh look, I think at the moment it's a very long road back for the Indigenous community, clearly after the result of the referendum in 23. So that was a lost opportunity for this nation to have a voice to Parliament and to be able to talk at levels about things like perimenopause and menopause, just saying so yeah, we've got a long road back from that and the acknowledgement of Indigenous history and Indigenous occupation of this continent is a very long way off.

Prof Best: 8:41

The latest federal election that we had and I wasn't in the country, I was actually in New Mexico, so I was being ping, ping, pinged for hours and hours from friends and I brought up Anthony Green as you do, you know your iPad to watch it. Go down and watching a really ugly campaign and a very divisive campaign against Indigenous people was just terrible. So we've got an incredibly long way to go in acknowledging the history of this country, acknowledging our rightful place in this country and, unfortunately, now having to start to kind of like visualise and conceptualise how we actually are going to be able to raise really important health issues and other issues for Indigenous people to government, where we are seen and we are heard, because that opportunity was, you know, really lost for the no vote. So, yeah, we've got a long way to go, sonia.

Sonya: 9:38

I don't know how we get there and it's a real shame to say that. You know it's 2025 and that's the situation that we're in and you know I hope that we do see some progression towards change, but yeah, it's, uh, it's hard. So let's go back to off politics for a little bit, back into some health topics which might be a little less loaded to talk about. The health is political though, but anyway well. So is menopause something that's talked about openly in Aboriginal and Torres Strait Islander communities?

Prof Best: 10:11

Yes, and no. So, of course, as a menopausal woman, of course I rely on my girlfriends and my community and the women within my world and realm to talk about, and my own perimenopause and menopause journey has not been pleasant, has not been good, has not been fun, and so, of course, you know, there are always those times and those moments and those elements where it's just like, oh my God, what are you doing for the lack of sleep? And, jesus, what's your GP telling you? Or I found this really good resource. I think maybe this will help us. So, of course, on an individual level, yes, I talk to my community around. You know, not only support, but about perimenopause and menopause and what they even mean, and I will be really incredibly honest when I say I only started talking about this, as I think a lot of women do when it actually starts happening to us I think it's a fairly common experience for a lot of us women is, we have these niggly symptoms, but we don't have the language to actually go oh that's perimenopause or oh that's menopause.

Prof Best: 11:17

And that certainly happened for me for a number of years before I finally was in a privileged enough position to be able to afford to go to a private diner and go, can you talk to me about what's happening with my body? Because I don't know and I don't have language. But it was actually one of my dearest friends who's now passed. He's not with us any longer and he grew up in a household of five sisters and he was the baby, spoiled baby. I was down in Melbourne for the weekend and I was with him and his partner, rodney, and I started doing the profuse sweating that we all do at some stage. And one of them looked at me and was just like what's going on with the sweating?

Prof Best: 11:59

And Jeffy, my best friend, my bestie, said to me it's clear what's going on, this is menopause stuff. And I just looked at him like what, like what, like what. I've got my best mate, who's a boy, who's telling me that I'm going through. It was like what, um? And we were using the word menopause.

Prof Best: 12:16

We didn't even have that language of perimenopause back then, so even my language probably wasn't right, but it was a word that I could anchor it to, to go, oh right, oh yeah, that's when it started for me and I went to a gyne and said, like what's going on for me? And then the whole perimenopause language came into being and this is what's happening with your body. So that triggered me to go on my own journey of self-discovery and I'm still discovering a lot of stuff around it. So, yeah, it's not as widely talked about in the community as it could and should be, and that's what we've got to change. But yeah, of course we talk about it, you know, amongst our friends in our community, going, oh my God, this is so full on.

Sonya: 13:02

Well, it's interesting and I'm pleased that that's the case, because I have read different narratives where, when it's brought up that we ignore this huge sector of our community, when we do talk about menopause here in Australia and that is in our digits I've read narratives where it's like, well, it's different, because culturally it's not something that they talk about, and I'm like really, how do they know that?

Prof Best: 13:24

I'm not saying it's not the case, but the reality is, when you make motherhood statements like that and that's what I call a motherhood statement, there's no research that's been done. Sonia, the last lot of research that we did or was done in Australia was, I want to say, about 12 years ago, 13 years ago, and it came out of Western Australia and it was done by a group of non-Indigenous women and there I think, I want to say, 10 women that they interviewed. So that's it. That's the only body of research that has been done in the country around the menopausal or perimenopausal experiences of Indigenous women. So when we have these motherhood statements of, oh, they don't want to talk about it. My question back to that is well, how do you know that? Good question, how do you know that? Yeah, totally, because we don't get asked, we don't get spoken to. So, yeah, there's some other good statements that go on around Indigenous health that just have to stop around menopause and perimenopause.

Sonya: 14:19

So then, what does need to change from a research perspective? That's different for the Indigenous communities, the Aboriginal, the Torres Strait communities, what research that we know needs to happen. It's different for the Indigenous communities, the Aboriginal, the Torres Strait communities, what you know, research that we know needs to happen at a general level.

Prof Best: 14:38

But what research do we need? More specific? We need more specific research around Indigenous women, because not all women are the same right and there are cultural contexts to all women and that's, you know, around our ethnicities and around our identities. So we do need to have research done with Indigenous women, for Indigenous women, but really importantly by Indigenous women, because the assumption in that a lot of Indigenous research that occurs is that if we look at some of the stuff that Indigenous people say, there's probably a myth out there that it's absolutely inherently correct.

Prof Best: 15:09

For all you know, prior to invasion and colonisation we had 250 countries, nations, indigenous nations in Australia. So the assumption is that what's good for one group of Indigenous people will be the right thing for all Indigenous people and that's just actually not the case. So there's a lot of diversity amongst Indigenous voices that has to be represented within research that it's not just one group of Indigenous women and Aboriginal trans men that we need to be talking to. It's lots and lots of Indigenous women from right across the country, from urban to metro to regional to remote, to very remote to the Torres Strait Islands. So there has to be the diversity amongst the Indigenous representation that the research is being done about or with and for and by. The other thing that really needs to occur is the research needs to be led by Indigenous women, because we do have language that we are all familiar with, if you grew up in community, right? So we do have a lot of unfortunate Indigenous people here in Australia that have been really disconnected from their country and from their communities.

Prof Best: 16:12

Um so, we but we do have similar and same language when we talk about things.

Sonya: 16:16

I think it's about showing the diversity and understanding that there is differences and I think, from my very, very uneducated view of or understanding of the indigenous cultures within Australia, the Aboriginal cultures in particular, is just the amount of languages that there are. That's just an example of how different language needs to be and the experiences and the perceptions.

Prof Best: 16:40

We don't seem to like. No other continent on the planet seems to do this. We don't see that all Europeans are the same right. You know what I mean. We don't say all Africans are the same right. You know what I mean.

Prof Best: 16:48

We don't say all africans are the same, or all native americans it's one of those really big things that we have to break down here in australia the diversity here, and you know a lot of us indigenous people will always argue and say, oh, we were multicultural way before non-indigenous people even came to the continent.

Sonya: 17:04

Yeah, and that's a very fair and valid point. Yeah, it's interesting, isn't it? Because that's something that Australia likes to hang its hat on, isn't it? How multicultural our society is.

Prof Best: 17:14

Yeah, but we've always been multicultural.

Sonya: 17:15

How close are we getting to having those Indigenous researchers that can actually get funding for these projects and actually get all this work underway?

Prof Best: 17:25

Absolutely. Therein lies the issue, right, sonia? I put in for a grant with a dear colleague of mine, professor Tracey Bunda she's over at University of Queensland and we put some funding like in 2022, I think it was, and it was an Indigenous health funding round and it was government. We wrote what we thought was a fabulous application and it was. But we got knocked back and what they said to us was like a really well-written application, you've really identified a gap within the gap, but it sits outside of these funding parameters, so it didn't get funded. No surprise there.

Prof Best: 18:05

And then back in I want to say 2024, when the Senate inquiry was happening, I sat down at quarter past three in the morning, as you do in your manic state when you can't sleep and you can't drink any more cups of chamomile tea, otherwise you'll just burst. That's when I wrote my own personal account into the inquiry going. I'm only purely writing as myself. I don't represent Indigenous Australia, but this is a single worldview of an Indigenous woman and I just you know, let it rip had at it just bang, bang, bang. And I actually said in my written submission about that the funding knockback that I'd gotten in 2022. And so I did get contacted and they said oh look, we think you are the only Aboriginal woman in Australia who did a written submission into it. I was like well, we think you are the only Aboriginal woman in Australia who did a written submission into it. I was like well, how do you?

Prof Best: 18:53

know that Will you come in and talk to the senators. And I was like Jesus really. So I rang up Tracey, as I do, and go, trace, we're off to see the senators. And she's like what are we doing? She's like we're off to see the senators and so we went in to speak to the five senators and in that session we were the only ones there, so it was probably about 40 minutes, I want to say, and I was just talking to Jason and I.

Prof Best: 19:13

So we talked about the funding and the knockback. We talked about the need for better funding services around our Aboriginal community-controlled health organisations and sector. We talked about the need for resource development. But also we talked about the round that had literally just happened and opened up about three weeks prior to that around the MRFF round on menopause and perimenopause. Now the bottom line is we haven't heard anything, whether we've gotten that or not, and we submitted that six months ago. So you know, the kind of like feeling is we probably haven't got it, but it it kind of like fueled us, I suppose, to actually got it, but it kind of like fuelled us, I suppose, to actually get a really good funding MRFF in. And so we did. So we've collected 32 mostly Indigenous women from 13 universities across Australia to actually undertake a mixed methods research into the experiences for Indigenous women traversing menopause and perimenopause, and also Aboriginal trans men as well, if they've still got their ovaries. So for us it's been difficult. We have had a knockback.

Prof Best: 20:17

What I did say to the Senators at that time was because they did say oh look, how do you think we can best support you? And it's like, well, the MRFF, for that particular strand or stream that we put in for they're only going to award one. So it's really tricky when you have one bucket of funding and you've got women competing against women for the same essence of research that is needing to be done, and I don't understand that. You know what I mean. So I said to the senators what we need you to do is to actually really talk to MRFF and funding bodies and government around better representation in their funding models to have better representation of women being researched. So that's what we said and that's where we are at.

Sonya: 21:07

Still to this day Haven't heard the findings that were handed down from the senate inquiry, how did you, how did you feel they reflected, or did they reflect any of the feedback that you were given the opportunity to provide?

Prof Best: 21:20

yeah, they actually did so. They've quoted myself and tracy bunder in the indigenous section in there and where we specifically talk about funding for our Aboriginal medical services sector and things like Closing the Gap for those of us who choose to engage with hormone replacement therapies or MHTs it gets all called as well and resource development. So all of that got reported actually in the findings document. I was pleasantly surprised. For us it was kind of like yay, the very first inquiry at least had Indigenous women's voices in there going. This is what we as Indigenous women need to be able to successfully traverse this really, really at times hectic period of a woman's life, and it is.

Sonya: 22:10

It's a small step forward, isn't it? But, as you've already explained, lots and lots of progress and work to be done to really really make a difference. Odette, before we wrap up, what message would you share with any Indigenous women that's listening today and is either about to start navigating or is having trouble navigating the health system today?

Prof Best: 22:34

Yeah, that's a really good question. First thing I'd probably do is go oh you poor bugger, and do you need a cup of tea? Yep, tonya, the knowing. Look the knowing, nod, yeah, the kind of like you, poor bugger, what's going on for you? Because that's what usually our menopause conversations start with. Right, for us women who've got those bits in our body that you know, make us traverse this, it's like, because not all of us women have the same symptoms. Right, it's talking, it's showing compassion and it's yarning and just being open to learning at all stages and from anywhere you can.

Prof Best: 23:10

So, for example, when I was down at the it's so hot right now with the lovely Kerry Sessional and M Harvey oh my God, what dynamic, amazing women doctors we have and an Aboriginal doctor that we also have up here in Queensland, Dr Anne-Marie Nielsen, mine. So we're really lucky, we've got this amazing woman. But you know, you sit in the green room and you're anxious and you're nervous and it's like, oh my God. And I'll be honest with you, that was the first time I'd ever actually been to the Opera House and, of course, I had my support troop with me. So I had Tracey Bundle, the amazing Tracy Bundle, with me and Annie Nielsen, the GP I just told you about, and they had them sit in the front row so I could always clock them and see that they were there.

Prof Best: 23:54

But when I was in the green room and talking and I was talking to one of the women, michelle, and she told me about the hip pain that she had and I was just like you need to talk to me about that, because I've had really full-on hip pain for about the last 18 months and I'm thinking to myself what the hell is going on with me. And she said, oh, it's really common amongst some women to have this really bad hip pain as they're going through this journey. So it's kind of like always being open to receive new information about what it is. And I've been talking and playing in the space now for kind of like you know, not quite a decade my own journey doing some publications, and I have got some publications that will be coming out very soon that talk about what is happening for Indigenous women.

Prof Best: 24:45

But just get help wherever you can and know you're not going mad. And if a doctor wants to put you on antidepressants or other medications that you don't feel comfortable with, seek information to find out more, because it's one of the common things that they and we talked about this at the so Hot Right Now gig that a really common thing is for women to be diagnosed and given antidepressant medication instead of doing a deeper dig to actually find out. Hang on, what is more broadly going on for you and your body yeah, I think it's easier to prescribe.

Prof Best: 25:19

I think that seems to be it's lazy prescribing yeah yeah, it's lazy medicine and because we do such in medical programs and I only found this out by talking with so many gps they just get these very small, minimal amount of information in their training about our perimenopause and menopausal women's lives. So it's like we don't teach our gps, our doctors nor our nurses about this in any of any of our medical professional training. So it's another area that really needs to be looked after.

Sonya: 25:51

And it really extends into the whole allied health services as well. When you talk about your hip pain, often for many, many women the first people that they will go and see about something like that is a physiotherapist or a chiropractor. You know they're also not educated on these things. I have a whole bunch of friends that are physiotherapists and I'm always saying to them if they're presenting, if they're this age and they're presenting with plantar fasciitis, frozen shoulder, you know inflammation, strange, weird hip pain, you know you can't prescribe for them but you can have a conversation about. Well, have you considered that you're at this stage in your life that maybe it's time to go and have a conversation with your GP?

Prof Best: 26:30

Absolutely, absolutely. And one of those things that has to occur with the GP is we need better diagnostic tools, because they're a tool that often gets used Nothing on there about culture or Indigenous people or like, there's just nothing. So we need better development of tools for assessing Indigenous women, who, of course, can go to our GPs and they'll say oh yeah, that sounds like perimenopause to me or menopause to me. So, yeah, we need to help support our medical professionals better to be able to support us better.

Sonya: 27:06

And we need to put a call out for some funding to be sent your way. Thank you, oh, sonia, that would be great.

Prof Best: 27:12

Thanks, if you can get onto that, we'd love it. I will Look. I'll put that onto my schedule for later today.

Sonya: 27:25

It's just so infuriating that there's a dirge of research that exists in, you know, across the whole spectrum of helping women through this midlife stage. Absolutely absolutely. And at the end of the day, so often, it's just coming down to the fact that nobody is funding the research, absolutely.

Prof Best: 27:44

That's absolutely right, and also to understand that you know there is difference for women and the journey. You know what I mean and it's about respecting that and understanding that, and that's why Indigenous women need to lead this research.

Sonya: 28:00

Yeah, to me it makes perfect sense, and if I had a few million dollars in my bank account, you'd be top of my list for spending it. That's heaps, sonia, amazing. Thank you so much for everything that you are doing, for having these conversations, for putting in the applications for the MRFFs, the fingers, toes and knees crossed. That you know no news is good news. I know that in my circle of friends we're all waiting on the outcome of that. Thank you, thank you, sonia.

Prof Best: 28:36

Yeah, because we're in that beautiful mrf space too. You know it gets to work with. You know, non-indigenous women who are on our page and are really good supporters and advocates and allies for us, like the m harvey's of the world and you know kerry sessionals and erin um down in south australia. Those non-indigenous women it's not to say we're excluding.

Sonya: 28:52

You know what I mean, because we know who our allies and supporters are Sonia, yep, yep, there are plenty of us, and we will do everything we can to shine a light on where these gaps exist and provide the solutions, and then we just need them to come to the party. Please, that would be great. Thank you so much for your time. It was great to chat my pleasure.

Prof Best: 29:11

Thanks heaps.