*The Canberra Hospital, ACT, Australia
I am very honoured to have this opportunity to share my thoughts and experiences with the readers of MSJA.
I have spent a total of twenty-two years working in developing countries. Eleven of these years were spent on long-term placements with the remaining years spent on short-term assignments. The places that I have worked in are Africa, Asia and the Pacific Ocean.
How does one get into this line of work? I did not really go looking for a career in international health but as a young doctor, I was keen to do something different before settling into a long term commitment in Australia.
With short term assignments you have a specific task with a defined start and end point. Your expertise (and you do have more than you realise) gets utilised intensively over a brief period of time, and generally you are able to leave feeling satisfied to have achieved your goals.
With longer-term assignments, you start feeling like a ‘local’, considering a more enduring commitment and even staying permanently. You are able to transfer knowledge and expertise to many more people. Any changes you make are more sustainable as you are there to pick up the pieces if things don’t quite work out. The problem is that you are not a local and at some stage you have to return home.
This brings up two issues. Firstly you may have created a new service or expectation that may not be replaceable after you leave. I have seen this happen many times. This is why it is important to look at the long term sustainability of any new service that is introduced. The other issue is what happens on your return home. Having got out of the mainstream track, it may be difficult to get back into the career path that your peers are now enjoying. These are important considerations for both you and your family.
Working in developing countries creates lasting memories. In addition, there is the satisfaction of having made some difference for the better. One of my favourite memories occurred in Timor in the nineties. At that time, all of Timor was under Indonesian rule and only two young graduate doctors worked at the highland hospitals. The maternal mortality rate was high, especially because there was no caesarean section service available. On one visit I took one of these young doctors through the procedures of performing a caesarean section on an on an emergency case of footling breech. On my next visit, I found he had been faced with a similar emergency two days later, and had successfully performed a caesarean section. I like to think that he then went on and not only continued to provide this service but also taught others how to do it.
Nowadays international aid is a huge industry, which has resulted in the commercialisation of some international relief and assistance efforts. Although this may appear to be at odds with the altruistic ideology of aid work, it does mean that services are better structured with more opportunities for doctors to become involved. For example, you can get involved through student electives, WHO, AusAID, army reserve as well as other not for profit organisations.
To conclude, I thoroughly recommend taking some time to get exposure to medicine in developing countries, as an experience that will enrich your future career.