Sunday, October 14, 2007
Proud To Be An OTD
When I was a 3rd year med student my intern used to refer to patients to be discharged as OTD- or "out the door".
Here, it means Overseas Trained doctor. In Australia OTDs are an issue because they make up 30% of the workforce. In the 80's the government decided the way to control medical costs was to train fewer doctors. They cut training posts in half, which led to the current severe shortages of doctors and nurses. In addition, the chronic underresourcing of hospitals by state governments has led to events such as the recent uproar in New South Wales where a woman miscarried alone in an ER toilet after waiting 2 hours just to be triaged. Of course, this kind of thing probably happens all the time in the U.S., but because of the abundance of lawyers, hospitals are held accountable and work to prevent such horrors. Or at least pay for their mistakes. Here, it becomes an election issue, which is ironic, because health care is a State responsibility. But the Prime Minister and his Opponents are threatening to take over health care because of public discontent.
OTDs have become an issue in politics as a side issue to service inadequacies. Several years Australia had a doctor who killed a large number of people through bad practice. Jayant Patel, Queensland's "Dr. Death" was an OTD who was not credentialed properly by the Queensland Medical Board, but this case has tainted the reputation of all OTD's in the public mind. So there is much discussion in the press about foreign trained doctors and perceived problems in language, culture, and knowledge base.
Add to this the case of Mohamed Haneef, an Indian-trained doctor who was detained incommunicado by the authorities for 5 days under anti terrorism charges after the bombings in the U.K. this year. One of the bombers was a distant cousin. But after an exhaustive investigation the police were forced to drop charges. Never ones to admit error, the government nevertheless cancelled his visa and deported him back to India. He was greeted there as a hero wrongly persecuted by Australia. By all accounts he was a good doctor in Queensland and is missed by his colleagues. Inquiries from Indian doctors for Australian jobs have subsequently dropped by 80 % .
Last week the Rural Health Network sponsored a social dinner for Derby doctors and their families at The Point restaurant. As I looked around the tables, I was struck that we were the U. N. of medicine. The Hospital's Senior Medical Officer is one of two Australian trained doctors in the room (the other is a temporary Pediatrician). The SMO is the youngest doctor in the room. Besides working full time as a GP/Anesthetist, she is expected to supervise and direct medical care at the local hospital. Yet as far as I can tell she is not supported by the WA Country Hospitals with the time nor staff to do this.
Who are the doctors we SMOs support? Starting at the hospital, Chris is a tall, dignified Nigerian doctor, trained in GP/Obstetrics in Ireland. His wife, our pregnant Paediatric registrar, worked in the hospital caring for sick children until she herself delivered last week. Duncan is from Papua New Guinea, a single parent of 3 kids, he did over 200 anesthetics last year in addition to clinics and inpatient work. Eric, from Singapore, climbs mountains and makes delicious chili mudcrab. He has extensive experience in emergency medicine and Aboriginal health from working in the NT. Gowri is a Tamil from Sri Lanka, happy to have escaped the violence there. The students love him for his supportive teaching. Finally my friend Arvind, from India, is a lovely, gentle pediatrician who has worked all over the world, including experiences in the war zones of Ethiopia.
At DAHS, where I am SMO, Cyril is a devout Buddhist doctor who spent 6 months as a teenager in Burmese prisons. His crime was being a leader in the medical student association during the time of the 1988 demonstrations. He got out, came to this country, learned English, and finished med school. He just passed his RACGP exams and will leave soon to study palliative care. Lilley and Charles are a Malaysian couple in their 60's. They have a son living in Melbourne. They worked in Aboriginal Health in Kununnura for 2 years before coming to Derby. Finally, Marina, our DAHS GP Registrar emigrated from Irkusk in Siberia and is retraining here. She came to Australia for a better life for her daughter, who now lives in Perth.
All these doctors, like me, are granted visas restricting their practice to "areas of need". In other words, only places so poor, remote, and/or underresourced that Australian doctors don't want to be there. Many of them have spouses and children who must deal with the isolation, lack of family and cultural support, and poor schools in rural towns. Additionally, in Derby there is the added stress of the cultural collision between European and Aboriginal peoples.
And all OTDs must deal with the inevitable homesickness the results from being an expatriate. About 10 years ago I read My Own Country: A Doctor's Story, Abraham Verghese's powerful description of his life and adaptation to being an OTD caring for AIDS patients in America. But I don't think I ever really had a chance to understand how it feels to be away from your native country for a prolonged period of time until this experience. And Australia, while having many similarities to the U.S., also simultaneously feels like a very alien planet. I strongly suspect that all the OTDs here suffer similar episodes of missing their own places.
Yet despite these challenges, the Derby OTDs do the best they can for their patients. Daily they try to bridge the cultural gaps. They apply their knowledge and hands humanely. The wide array of training they bring might not make it easy for them to pass the written RAGCP exam. But they have immeasurable and invaluable skills and memories that help them adapt to practice here. And in some cases, as in undernourished infant needing IV access or a woman having a vaginal breech birth, OTDs have the experience that young, city-trained doctors could never have.
I have learned a lot from my association with these fine doctors and their families. It is a shame that they suffer discrimination and exploitation on the basis of their OTD status. Australia's gain is under-appreciated, although it comes at great cost to these doctors' home countries.
So it is with humility that I join their ranks, firmly in the back row, and say, "I am proud to be an OTD!"
Here, it means Overseas Trained doctor. In Australia OTDs are an issue because they make up 30% of the workforce. In the 80's the government decided the way to control medical costs was to train fewer doctors. They cut training posts in half, which led to the current severe shortages of doctors and nurses. In addition, the chronic underresourcing of hospitals by state governments has led to events such as the recent uproar in New South Wales where a woman miscarried alone in an ER toilet after waiting 2 hours just to be triaged. Of course, this kind of thing probably happens all the time in the U.S., but because of the abundance of lawyers, hospitals are held accountable and work to prevent such horrors. Or at least pay for their mistakes. Here, it becomes an election issue, which is ironic, because health care is a State responsibility. But the Prime Minister and his Opponents are threatening to take over health care because of public discontent.
OTDs have become an issue in politics as a side issue to service inadequacies. Several years Australia had a doctor who killed a large number of people through bad practice. Jayant Patel, Queensland's "Dr. Death" was an OTD who was not credentialed properly by the Queensland Medical Board, but this case has tainted the reputation of all OTD's in the public mind. So there is much discussion in the press about foreign trained doctors and perceived problems in language, culture, and knowledge base.
Add to this the case of Mohamed Haneef, an Indian-trained doctor who was detained incommunicado by the authorities for 5 days under anti terrorism charges after the bombings in the U.K. this year. One of the bombers was a distant cousin. But after an exhaustive investigation the police were forced to drop charges. Never ones to admit error, the government nevertheless cancelled his visa and deported him back to India. He was greeted there as a hero wrongly persecuted by Australia. By all accounts he was a good doctor in Queensland and is missed by his colleagues. Inquiries from Indian doctors for Australian jobs have subsequently dropped by 80 % .
Last week the Rural Health Network sponsored a social dinner for Derby doctors and their families at The Point restaurant. As I looked around the tables, I was struck that we were the U. N. of medicine. The Hospital's Senior Medical Officer is one of two Australian trained doctors in the room (the other is a temporary Pediatrician). The SMO is the youngest doctor in the room. Besides working full time as a GP/Anesthetist, she is expected to supervise and direct medical care at the local hospital. Yet as far as I can tell she is not supported by the WA Country Hospitals with the time nor staff to do this.
Who are the doctors we SMOs support? Starting at the hospital, Chris is a tall, dignified Nigerian doctor, trained in GP/Obstetrics in Ireland. His wife, our pregnant Paediatric registrar, worked in the hospital caring for sick children until she herself delivered last week. Duncan is from Papua New Guinea, a single parent of 3 kids, he did over 200 anesthetics last year in addition to clinics and inpatient work. Eric, from Singapore, climbs mountains and makes delicious chili mudcrab. He has extensive experience in emergency medicine and Aboriginal health from working in the NT. Gowri is a Tamil from Sri Lanka, happy to have escaped the violence there. The students love him for his supportive teaching. Finally my friend Arvind, from India, is a lovely, gentle pediatrician who has worked all over the world, including experiences in the war zones of Ethiopia.At DAHS, where I am SMO, Cyril is a devout Buddhist doctor who spent 6 months as a teenager in Burmese prisons. His crime was being a leader in the medical student association during the time of the 1988 demonstrations. He got out, came to this country, learned English, and finished med school. He just passed his RACGP exams and will leave soon to study palliative care. Lilley and Charles are a Malaysian couple in their 60's. They have a son living in Melbourne. They worked in Aboriginal Health in Kununnura for 2 years before coming to Derby. Finally, Marina, our DAHS GP Registrar emigrated from Irkusk in Siberia and is retraining here. She came to Australia for a better life for her daughter, who now lives in Perth.
All these doctors, like me, are granted visas restricting their practice to "areas of need". In other words, only places so poor, remote, and/or underresourced that Australian doctors don't want to be there. Many of them have spouses and children who must deal with the isolation, lack of family and cultural support, and poor schools in rural towns. Additionally, in Derby there is the added stress of the cultural collision between European and Aboriginal peoples.
And all OTDs must deal with the inevitable homesickness the results from being an expatriate. About 10 years ago I read My Own Country: A Doctor's Story, Abraham Verghese's powerful description of his life and adaptation to being an OTD caring for AIDS patients in America. But I don't think I ever really had a chance to understand how it feels to be away from your native country for a prolonged period of time until this experience. And Australia, while having many similarities to the U.S., also simultaneously feels like a very alien planet. I strongly suspect that all the OTDs here suffer similar episodes of missing their own places.
Yet despite these challenges, the Derby OTDs do the best they can for their patients. Daily they try to bridge the cultural gaps. They apply their knowledge and hands humanely. The wide array of training they bring might not make it easy for them to pass the written RAGCP exam. But they have immeasurable and invaluable skills and memories that help them adapt to practice here. And in some cases, as in undernourished infant needing IV access or a woman having a vaginal breech birth, OTDs have the experience that young, city-trained doctors could never have. I have learned a lot from my association with these fine doctors and their families. It is a shame that they suffer discrimination and exploitation on the basis of their OTD status. Australia's gain is under-appreciated, although it comes at great cost to these doctors' home countries.
So it is with humility that I join their ranks, firmly in the back row, and say, "I am proud to be an OTD!"
