G’day doc, I’m right off me tucker and crook azadog. Yesterday arvo me neighbour said it’s just the collywobbles but, crikey, he’s mad as a cut snake so I thought I’d better find out what the doc has to say.
I know youse are flat out but waddaya reckon, she’ll be right? I feel weak as a wet whistle. Not droppin’ off the perch yet am I? Probably just old age.
Howyagoin’ anyway, settlinin’ all right? Gotta love the top end, mate, heaps better than the big smoke.
When I arrived in Australia – in Cooktown of all places – one of my biggest challenges was understanding the accent and the slang.
I also struggled with basic expressions. I remember being invited ‘for tea’ one night. So after dinner I went over expecting only a cup of tea or coffee but, to my surprise, my host had prepared a delicious roast. On another occasion I was asked ‘to bring a plate’, so I took a few plates and, just to be sure, some cups and cutlery, too.
I thought the communication was problematic because I come from a non-English speaking country (the Netherlands). But it turned out that most immigrants – regardless of homeland – struggle with language, communication and the often slightly different meaning of common expressions, not to mention the bureaucratic jargon.
As Dr Jennifer May wrote in the Medical Journal of Australia, a term such as ‘reciprocal recognition of qualifications’ has a different meaning in different jurisdictions.
The first six months were a crash course in ‘Strine’ (as in, Australian). The patients were wonderful and seemed to strangely feel sorry for the new overseas doctor in town. They taught me all the basics; some gave me Australian slang dictionaries and Indigenous Australians told me stories about their culture. Still, it took a few years before I could fully understand most conversations.
For most immigrants, the challenges begin long before entry to Australia. The paperwork and background checks required by the Australian Government and healthcare organisations – which can take 1–2 years to complete – are only a small part.
Even though the decision to emigrate is mostly a voluntary one and it’s a privilege to be welcomed to Australia, it doesn’t mean that there are no downsides. Emigrating doctors and their families have to give up their lives in the home country and say goodbye to loved ones, familiar neighbourhoods, cultures, customs and careers.
It’s not uncommon for overseas doctors and their family members to experience some adjustment problems. Many tears have been shed when settling in a remote Australian outback town or new suburb. It can be stressful when a spouse struggles or children have problems at the local school.
Often well-established and respected at home, immigrant doctors start all over again. They’re initially temporary residents with limited rights and no access to Medicare. Their medical registration is conditional, they have to work in places where many Australian-trained health professionals don’t want to work, and their future is uncertain and dependent on passing health checks, police checks, language tests, assessments and exams.
It can be difficult to negotiate employment conditions or discuss real or perceived injustices – a conflict may lead to cancellation of sponsorship or visa. Financial challenges are common, as starting over in a new country doesn’t come cheap. There are all sorts of legal and tax problems, such as dual taxation. I had to give up my Dutch citizenship when I became an Australian citizen.
For the immigrant, there is always ‘the other world’ of their home country. They often use the holidays to fly ‘home’ and visit family and friends for a few weeks, which is joyful but can be intense and emotional.
Migrants may never feel 100% part of the Australian society and, at the same time, they often no longer fit in in the home country, which can affect their sense of belonging and create feelings of loneliness.
For me, another culture shock was rural medicine. The contrast with Amsterdam, where I trained as a doctor, could not have been greater. I quickly had to learn about tropical diseases, snake bites and Irukandji – just to name a few.
Shortly after I arrived in Cooktown, a 4.2 m saltwater crocodile dragged a fisherman from his tent on the riverbank when a woman jumped on its back to stop the giant reptile. The story appeared in all the newspapers.
Although many of the medical textbooks back home were written in English, learning to speak the medical jargon in another language was yet another challenge. Names and doses of commonly used drugs differ between countries, not to mention the different guidelines.
I was able to do a few up-skilling courses, including trauma and emergency medicine, and with assistance from helpful and skilled colleagues – sometimes over the phone – and a great nursing team, we were able to manage many problems locally.
I’m grateful for all those who have welcomed and taught me over the years – patients, staff, nurses, fellow doctors and others.
Not so unique
For a long time I thought my ‘adventures’ were unique, but over the years I learned about similar stories, not only from overseas doctors but also from Australian graduates, all struggling during their first placements in rural and regional hospitals and practices.
These stories are often tales of incredible resilience and courage, and I’m always amazed to hear how valued health professionals are in their communities, even though we may often feel ill-prepared or have doubts about our skills and knowledge.
The demands on doctors in small towns can be high, often 24 hours per day. Working towards another degree or Fellowship is taxing for anyone, but for international medical graduates (IMGs) coming from a different background there are many extra challenges. The working hours and fatigue don’t go well with training and exam preparation.
The workload and the tyranny of distance can make supervision sub-optimal. There is often limited support and the amount of bureaucracy can be perceived as overwhelming.
On the bright side, there are many people who warmly welcome and support the newcomers. Professional bodies and colleges offer introductory, support and exam-preparation programs, but often the local and individual initiatives make the difference.
An example is Dr Farooq Ahmad who, after passing his Australian Fellowship exam, decided to support others and has since helped hundreds of doctors pass their exams.
Although many areas of Australia rely heavily on IMGs, not everyone is happy with the influx of doctors from overseas. Critics of the Australian skilled immigration policy have often mentioned the ‘brain-drain effect’ on developing countries: the recruitment of healthcare professionals compromises the, often already struggling, healthcare systems in the developing world.
Concerns have publicly been expressed about doctors from non-Western training backgrounds and the uncertainty around standards and relevance of knowledge and skills to the Australian situation.
The regulation changed in the aftermath of the Dr Jayant Patel case. Dr Patel, nicknamed ‘Dr Death’, was permanently barred from practising medicine in Australia in 2015.
Legislation introduced in 2009 now protects patients by ensuring that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner can be registered.
Although there’s anecdotal evidence that patients sometimes avoid seeking treatment from IMGs, research indicates there’s no difference in patient satisfaction with, and acceptance of, care by Australian graduates and IMGs.
The ‘doctors from overseas’ bring diversity, expertise, experiences, cultures, innovation and stories to Australia. Cross-cultural experience appears to be valuable in many ways; some have argued that immigrants are more entrepreneurial, resilient and creative. Whether this is true or not, one thing is for sure, starting a new life in a different country takes courage and perseverance.
My wife Nancy and I have never looked back. Although we miss our family and friends in the Netherlands, we’re grateful for the opportunities Australia has given us. I can only hope I am able to give back what I have received.
Dr Edwin Kruys
The column was first published on Doctor’s Bag and is reproduced with its permission.