Kiawal Toran (our presence our time): The urgency of eliminating racism from the Torres and Cape Hospital and Health Service

“For a population of 15,000 having three to four [preventable] deaths per week was very alarming [and] traumatising…Having in the back of our minds, ‘why are people, our families, dying such deaths that could have been prevented?’” 

Mayor Phillemon Mosby, Torres Strait Island Regional Council

For the past two years, the Queensland Government claimed to be seeking answers to these questions posted by Mayor Mosby and a coalition of Zenadth Kes leaders. After a drawn out ‘independent’ investigation into the failings of the Torres and Cape Hospital Health Service (TCHHS), Queensland Health would arrive at the astounding conclusion that “there was no evidence of TCHHS systems and processes being culturally unsafe for staff or community members”.  

The investigation was prompted by calls from a coalition of Zenadth Kes leaders concerned about the preventable death of a two year old infant from Umagico, who had presented multiple times to Bamaga Hospital. The leaders had drawn attention to the systemic failings of the health system which they argued, explained the declining and dire health status of the community more broadly. 

Central to their concerns was the TCHHS’s focus on tertiary care at the expense of frontline preventative care and an over-reliance on a largely non-Indigenous managerial infrastructure incapable of providing culturally safe and responsive health services across the region. The leaders urged the Queensland government to restore the Torres Model of Care. 

The Torres Model of Care

Developed in the mid-1990s by co-author Uncle Phillip Mills, the Torres Model of Care oversaw improved health outcomes through a radical reorientation of the health system via a culturally grounded community leadership structure. It emphasised a health systems approach that meaningfully attended to the social determinants of health, long before any World Health Organisation or United Nations Declarations on this issue. 

This model was both ahead of its time and of its time. 

Indigenous community control over health care was not limited to ancillary Indigenous services alongside the mainstream system but involved Indigenous leadership and governance across the entire system. In the wake of the 1992 Mabo decision, it is not surprising that in this place and at this time, a model of health care grounded in Indigenous sovereignty emerged. 

Indigenous control over the provision of mainstream services was not widely embraced by non-Indigenous clinicians and administrators. A twice-sacked non-Indigenous former CEO of TCHHS discredited the model years later at a rural health conference where she described Torres Strait Islander health staff as incompetent, uneducated, manipulative, “politically motivated”, and resistant to “innovation and evolution”. 

She alleged “high levels of nepotism and cronyism”, “bullying and harassment”, assaults, “death threats”, “evidence of fraud, crime and misconduct” and “evidence of black magic interventions against themselves”. “Non Torres Strait Islander staff” she would claim, “frequently suffered racial (sic) motivated abuse”.  

There was scant scholarly evidence to support her claims, yet her sole testimony represented itself as the authoritative account of the model. 

 A community led and governed research project funded by The Lowitja Institute, The Ume Project has examined the Torres Model of Care through engaging with the accounts of over 30 Indigenous health professionals. 

In their speaking back through the project, Torres Strait Islander leaders and health professionals illuminate a richer understanding of the confluence of health, care, and culture – one that is not incommensurable with, but integral to living a longer life.  

As part of their investigation, Queensland Health agreed to give consideration to “any strengths of the previous Model of Care” and examine the “cultural safety of TCHHS as experienced by Aboriginal and Torres Strait Islander staff and community members”. 

The system investigates and celebrates itself

The coalition of leaders were sceptical of the supposed ‘independence’ of the investigative team, the lead of which is a long term board member of a Queensland Hospital and Health Service. After significant delays, expressed in countless communiques promising “further updates”, Part A of the final report emphasised “recent improvements” of TCHSS despite evidence of persisting excessive rates of avoidable deaths in the region.  

The investigation did not take seriously the strengths of the Torres Model of Care describing it as an “historical model” that is “poorly understood” and “inconsistent with modern practice”. The report claimed that community aspirations to reinstate the model “undermines the work of dedicated staff in the system and causes confusion for new staff, which negatively impacts on community perceptions of the health system and its outcomes”. 

Community leaders publicly contested these findings refusing to meet with the Health Minister following its release.  

Just weeks later, the Queensland government announced its investment of $288M for two emergency “modern” helicopters for the region, boasting ‘Sky-high healthcare for the Torres and Cape’.  These new helicopters, they claimed, “[would] support our hardworking health heroes” to “safely undertake high-stakes rescue operations”.  

Little mention was made of the community members who would be transported in the course of such ‘operations’. . 

The helipads situated in TCHHS feature prominently in Queensland Health reports, and media reports. Local people are absent from this imagery and in their place, the stark helipad markings set the parameters for how we are to understand health in places like this. It is “high-stakes rescues,” of emergencies and evacuations; the medical care one might imagine in a war zone. And the heroes in this war are medical doctors, pilots and crew. 

Darumbal and South Sea Islander scholar Dr Amy McQuire observes:
“If you want to know the difference between the Black and White Witness, all you have to do is mention the war…In this telling, the White Witness becomes a war correspondent, He or she is the credible observer who has ventured from the borders of respectability to the borderlands of ‘out there’, most commonly remote Australia, where blackness is seen as savage and violent, and the victims are given no voice, no agency, no humanity”.

The declarations of hundred million dollar investments in helicopters should have worked as a distraction from the failings of the system which deem them necessary. But it could not, at least for the Indigenous community members who continue to pay the immeasurable price of countless  avoidable deaths.  Elder of the Wakaid clan of Badu Island Uncle Bongo, keeps track of the names and numbers of people who have died from conditions that could have been treated with earlier detection. At last count, he had 53 names in his notebook for this year alone. 

Amid the state’s self-congratulatory stance, the Ume Project heard accounts from local Torres Strait Islander health professionals who were less assured by the helicopters’ presence. 

“..in our minds, every time a chopper left or landed, it was like another community member being flown off the island and I suppose from the time of the model, you’d hear the choppers, but it wasn’t as regular. But then as the models been whittled away, you hear those choppers more regularly and because we are a nation of people, whenever the chopper leaves, it’s like, yeah, it’s an aunt, it’s an uncle…And in the back of your mind is like, ‘will they come back? Will, they come back for us to bury?”.
– Torres Strait Islander health professional

No evidence of failings

Queensland Health’s Director General released the final report of the two-year investigation in September 2025 with little fanfare, despite the astonishing finding that there was “no evidence” of any failings of TCHHS systems and processes. The Torres Strait Islander Regional Council contested these findings, identifying a lack of transparency and protections for those participating in the investigation. 

A closer look at the investigators’ methodology clearly reveals more than it obscures.  In order to arrive at their findings of “no evidence”, the investigators invented their own definitions of both ‘cultural safety’ and ‘institutional racism’, neither of which is supported by the scholarly literature. They removed the foundational principle as first conceived by Dr Irihapeti Ramsden, in which cultural safety is defined by the recipients of care. Ramsden makes this clear stating, “Safety is a subjective word deliberately chosen to give the power to the consumer”. Yet the investigators note that their “primary source of information was TCHHS.” 

Within the report, the investigators made repeated reference to the “unique cultural characteristics” of the region as “circumstances”, “differences” and “challenges”. These ‘differences’ were code for deviance, expressed via “low SES”, “racial difference” and “geographic remoteness” with its majority Indigenous population framed as a problem in and of itself. 

One would assume these factors would be central to shaping the model of care in the region. Yet throughout the report ‘Indigenous cultural otherness’ appeared to work as a useful alibi for any hint of system failings, which were recast as “opportunities” under the guise of taking a “strength-based approach”. 

The investigators failed to see the strengths of the Indigenous health professionals employed by TCHHS. Even when tasked to examine the problems they experienced, the investigators emphasised the Indigenous health workforce as the problem. 

For instance, the report focused on high rates of personal leave, allegations of fraudulent leave and workcover claims and poor uptake of professional development opportunities by Indigenous health staff exclusively. Senior Indigenous health workers, the investigators asserted, should be retired “urgently”, while the high dependency on “agency nurses” from outside of the community, they observed “should not be taken as a criticism”.  

One need not be a race scholar to realise that the juxtaposition of Torres Strait Islander health staff as incompetent and uncaring against the innocence of non-Torres Strait Islander health ‘heroes’ is a racist framing. The reliance on racial tropes to downplay and dismiss concerns about the conditions which produce very real racialised health disparities is a most clear example of the operations of institutional racism.

Eliminating institutional racism through definition alone

The investigators downplayed the reality of institutional racism by inventing their own definition; one which is at odds with Queensland Health’s own legislative definition as expressed in the landmark ‘health equity legislation’. Both this definition and legislation emerged from the Qld Human Rights Commission independent audit of institutional racism into Queensland’s Health and Hospital Service Report (known as the Marrie Report) which found high levels of institutional racism across every Queensland Hospital and Health Service.  

The investigators dismissed the Marrie Report as an “historical document…[which] should not continue to be used as a basis to draw conclusions about institutional racism across TCHHS” and proposed a new institutional racism matrix “which celebrates the good work being done in the region”. The requirement to speak of the good work of systems that produce bad outcomes for Black people would be laughable if this were not a matter of life and death, and not just for communities across the Torres and the Cape. 

Upon releasing this report the Director General “separately requested that all HHSs and Hospital and Health Boards carefully consider the report to ensure that the learnings … are consistently applied across all Queensland HHSs”.  

The real learnings for Queensland Health was the formulation of a political strategy for shirking their legislated mandate to ‘eliminate institutional racism’ across the state. It is a strategy, not of eliminating racism, but eliminating the Indigenous health workforce, specifically those who embody both the cultural and clinical authority and expertise to provide care to Indigenous people.

These are the real health heroes in the war against the racial violence that settler colonialism perpetuates. It is this workforce that is situated on the frontlines, both of being the first responder in almost every medical situation and too, as the first line of defence against the dehumanisation that is central to the denial of Indigenous self-determination, sovereignty and survival. 

Kwame Ture and Charles Hamilton who first coined the term ‘institutional racism’ in the critical text ‘Black Power: The Politics of Liberation’ explain: 

“The point is obvious: black people must lead and run their own organizations. Only black people can convey the revolutionary idea—and it is a revolutionary idea—that black people are able to do things themselves”. 

Contrasted against the methodology of Queensland Health’s ‘independent investigation’ is the Ume Project, which was explicitly anti-racist. It adopted the “revolutionary idea” that Black people are capable of authoring their own account of the Torres Model of Care. These stories tell of the power of the Torres Model of Care and the power of the people. 

The findings of the Ume Project contest the state’s claims that the Torres Model of Care was a “historical model…inconsistent with modern practice”. It is an ongoing movement that is resistant to colonial control and insistent upon Indigenous survival.  At the heart of the Torres Model of Care is the consciousness of a people who have long refused to accept settler colony fantasies of Indigenous inferiority and erasure. 

Earlier this year, a class action was lodged in the federal court by the community alleging clear breaches of the Racial Discrimination Act by the Torres and Cape Hospital and Health Service (TCHHS).  Queensland Health may well have presumed their ‘independent investigation’ would pre-emptively absolve them of any wrongdoing. Unfortunately for them, the investigation’s methodological approach and the discourses deployed to demonise the peoples of the TCHHS is in fact incriminating.  

It is in the state’s refusal to accept the “revolutionary idea that “Black people are able to do things” that we find the clearest evidence of the racism that they claim does not exist.