The couple should have applied as OTDs under 5 years contract(possibly shorter for remote areas) and then sit for FRACGP, which allows them to avoid sitting AMC exams. Another Bangladesh couple did the same way in SA, after given return tickets to visit the place before taking up the jobs. In SA, OTDs' children are allowed free education even the couple are not yet Australian PR, the only state in Australia
doing so.
Embracing the culture --- Dr Pratap Phillip
‘The general feeling of happiness and quality of life, and the honesty in relationships and the friendliness, I have not experienced in any other country.’
Dr Pratap Philip loves medical practice in Griffith, New South Wales. He and his family have truly embraced the Australian culture and rural lifestyle and couldn’t be happier. Pratap and his wife are particularly impressed by the standard of Australian education, in which their daughter Divya has flourished.
Born in India, Pratap has travelled or worked in nearly 40 countries. In Australia
, he began working at the Flinders Medical Centre in Adelaide, where he received an award from the South Australian Premier for ‘outstanding humanitarian service’. He was also awarded ‘best teacher in medical services’ at Flinders University in 2005.
Having worked in rural and remote areas in India, Pratap found the transition from Adelaide to rural practice in Alice Springs and, later, Griffith to be easy.
His wife Leela, an opthalmologist, was initially unable to gain Australian medical registration, which made their future in Australia
uncertain. She has since pursued training in Psychiatry
and is now working as a Career Medical Officer.
However, Pratap offers this advice to OTDs considering work in Australia
. Medicine in Australia
is practised at a very high level. Unlike many countries where medical registration is retained for life, here, it must be maintained. You must remain up-to-date and competent by continuously studying and reading, or you will not survive in the Australian system.
Strangers in a strange land 14-Jun-2007 (australian doctor)
With the current focus on international medical graduates ’ skills and training, it ’ s easy to lose sight of the personal upheaval doctors and their families face when they move to isolated rural Australia
. By Heather Wiseman
SEA spray has dried into a crusty white fog across the windscreen. It’s late in the afternoon and we’re driving into the sun, down an isolated country road. Dr Saiful Islam Choudhury’s hands are set conscientiously at ten-to-two on the steering wheel. He’s a short man. His seat is pushed forward, as far as it will go.
In Bangladesh, Dr Choudhury had a chauffeur and rarely drove. When he did, it was in city traffic. But the international medical graduate has been living in the tiny seaside town of Robe, SA, for nine months now and driving an hour to a neighbouring town no longer appalls him.
As the glare turns to pink, Dr Choudhury pulls over so I can take one last photo. It is shivery cold as I trudge off, over short grass. Dr Choudhury, 36, stays beside the parked car looking worried.
“Are you not scared of snakes?”he says.
Moving to Australia
has tossed Dr Choudhury and his family into a quiet, picturesque world where life is focused on conquering the unfamiliar. At the most basic level, he and his wife Dr Afroza Begum, 31, also a GP, have had to learn how to use a vacuum cleaner and a washing machine. It’s a novelty for them to iron their own clothes, shop for groceries and spend time with their two young children, Mahiat, four, and Sadia, one.
Dr Choudhury shakes his head and smiles, trying to explain the magnitude of the adjustment.
“It’s being reborn,” he says. “But I enjoy it. I am more empowered — I know so many things now that I didn’t know before, like doing housework and driving and taking care of kids. In our country, doctors are well off enough to afford a helping hand and servants.
“You are more independent here. But you are lonely here. One of my patients says everybody is lonely in Australia
. If you come from a different country, then you feel it more.”
Dr Begum felt the isolation seep into her bones like a chill in September last year, as she watched the landscape unfold during the 90-minute drive from MountGambierto her new home.
“It was just open spaces all around us, and just this road,” says Dr Choudhury, who’d made a two-week orientation visit to the town, as well as one previous visit, in April, before accepting his job (see box, page 20).
He and his wife had never travelled internationally before, but felt a move to Australia
would provide greater opportunities for their children.
Dr Choudhury also says the pictures he had seen of Australia
were very beautiful and he and his family were keen to live somewhere pristine and clean. Before the move, they had only ever lived in Bangladesh’s capital Dhaka— a city of 11 million people and one of the most densely populated in the world. Robe’s resident population of 1000 swells to 14,000 during peak tourist season.
Dr Choudhury laughs to ease the tension, but looks forlorn as he remembers his wife’s response to the rural setting.
“It was very shocking that we were going to the middle of nowhere,” he says. “She was not actually very happy.”
Dr Begum’s shock at having moved to such an isolated small town was magnified by having to adjust to a new role in life. Her previous career spanned general practice, ultrasound, radiology and imaging, but she can’t practise in Australia
until she passes an English proficiency test. She knew that moving to Australia
meant sacrificing her medical career — for at least a few years — and becoming a full-time mother and housewife. But that domestic role became more deeply entrenched when she discovered, just three months after arriving here, that she was pregnant with the couple’s third child.
“The age of our last child is only 13 months, so she is grappling, coming to terms with this situation,” Dr Choudhury says. “But everything will be sorted out with the course of time.”
Time has helped the couple adjust to Robe’s most disturbing feature — the silence. Dr Begum says it was like moving to a ghost town and while Dr Choudhury now enjoys the peace, initially it made him feel disturbingly alone.
“[In Bangladesh] in the evening, you can go to some places, move around, and you can hear that someone is moving. Now I go really early to bed,” he says. “At first, I got the feeling of being lonely.”
It took many weeks to ease initial concerns that moving to Australia
was a big mistake.
“In the first place, we didn’t think we would last three months,” he says. “But now I think we can look forward to staying here a long time. I’m a very optimistic person.”
Dr Choudhury grins. It’s convincing.
“It is very difficult to get myself in a negative mood.”
Dr Choudhury’s mood changes markedly several times during our drive. At his most serious, he is reflecting on the workshop we’ve just attended in the neighbouring town of Penola. Dr Choudhury and nine other IMGs spent the day sitting around a long antique table at the local town hall, black-and-white photos of the town’s past mayors staring down at them. Unlike many IMGs across the country who face the daunting prospect of sitting the RACGP exam with little support, they are being coached by a college examiner and a GP from Scotland who recently sat the exam and passed.
Tension is palpable during one role-play, based on the mock consultations in the exam, in which an IMG has to tell a patient she has a malignant melanoma. Dr Choudhury relates to the difficulties his colleague had, trying to break the news accurately but sensitively. Although he studied English at school and his medical texts were in English, it’s still natural for him to think in Bangla and then translate.
“Sometimes it is difficult to apply the right word,”he says. “You need to show some empathy to that patient, but you are not getting the right word to do that. It seems it is hovering around you, but you are not catching it.”
It’s only the second time he’s attended the workshops, but already he thinks they are making his knowledge gaps clearer. For one thing, it has made him keen to improve the information he has readily to hand.
“You need to give some facts and figures to relieve the patient,” he says. “The treatment options, the outcomes. This information I need to get on top of.”
Passing the FRACGP is important to Dr Choudhury, who is working on a temporary visa. He’s here under a scheme that requires him to work in an isolated area for five years. Once he’s done his five years and achieved fellowship, he’ll be eligible for permanent residency and an unrestricted provider number — meaning he will be able to work anywhere.
Dr Choudhury says it is “definitely” fair that he has to pass the FRACGP.
“This gives some opportunity to improve yourself and get to know the standard of general practice in Australia
, because in every country it is different,” he says.
But he is concerned that he will not have adequate time to prepare.
“The study is a big issue,”he says. “This is the most frustrating thing. I’m not getting enough time to study. I get home from work and have to help Afroza with the kids. And then I feel tired to go through books.”
Dr Choudhury is indignant that, as temporary residents, he and his family are not able to access Medicare. Given that he is paying tax and ensuring an isolated rural community has access to medical care, it seems a gross injustice to have to pay for care himself. He shakes his head, unable to make sense of it.
He and his wife are already feeling the costs of the standard tests required during her pregnancy.
“I didn’t realise actually, how much it would cost,”he says.
While Dr Choudhury has no desire at this stage to leave Robe, he’d like the freedom to be able to move in the future, in order to educate his children. He’s fortunate that in SA, unlike some other Australian states, IMGs have access to free public schooling for their children.
But that’s all a long way down the track. And at this stage, he’s happy working for the people of Robe.
“It is a very small community and they are very community minded,” he says. “Wherever you go they exchange smiles. At supermarket, at petrol station, they are there. One of the advantages of being in a country town is that there is social bonding. Overall they are friendly.”
FROM Dr Choudhury’s consulting room there is a view across green lawns, down to boats at the marina. As he closes the door and sees his first patient of the day, a local cray fisherman in long white rubber boots scrubs the deck of his boat with a soft broom foaming with detergent. Cray pots filled with rope and red foam balls are stacked on a nearby trailer. There’s silence but for the occasional cry from a seagull and a quiet humming from the local fish co-op’s generator.
A silver 4WD towing a caravan pulls around the corner, carrying a silver-haired couple in discussion over a map. Robe is a beacon for grey nomads, with its rugged coastline, pristine beaches and quaint historic limestone buildings. These travellers and resident retirees largely define the town and Dr Choudhury’s professional life. Having come from a country where the average life expectancy is 60, he’s intrigued by them.
“I see many of the patients in their 80s and they’re walking around with a triple bypass, prostate taken out and pacemaker, and they’re driving around, having a happy life,” he says. “Many of them have a colostomy. But it is hard to imagine they have these disadvantages —they are doing great.”
Dr Choudhury works three days a week in Robe and another two in the nearby town of Kingstonand is enjoying practising medicine in a developed country. In Bangladesh, where he and Dr Begum were partners in a four-doctor practice, he generally had to make treatment decisions without first ordering diagnostic tests and his prescribing was limited by what the patient could afford.
“Here we have much liberty in terms of diagnostic options. I feel more comfortable with the facilities here. In our country they [patients] don’t get any subsidy for medications from the government so you need to think about cost. Here, I have that liberty to prescribe medications and order tests.”
Now his professional challenges focus around tourists forgetting their medication, having complex co-morbidities and not staying in town long enough to be followed up. He’s had to learn the practice software from scratch — there was not the same emphasis on keeping records in Bangladesh and patient notes were all paper based.
“I am gradually getting over the big cultural differences. In our country the system was doctor-centred. We used to pay less attention to what patients want from us.”
Like any GP, Dr Choudhury enjoys a sense of being valued. He is clearly chuffed to have received a note of thanks from the parents of a child who he stitched up at 2am.
“Is very frightening for the parents, so I came down and stitched up. They send me a letter down the track, a month later perhaps — a nice letter to say you treated us all, the child is alright.”
And while he’s intrigued to have learned a technique for removing fishhooks, he is also clearly chuffed with the relief he brings to patients with swimmer’s ear.
“Instantly they can hear everything and they express their gratitude from the bottom of their heart,” he says.
WITH Sadia smiling in his arms, Dr Choudhury opens the front door of his home and offers a formal welcome. Dr Begum, immaculately groomed and dressed modestly in traditional clothing, offers a shy but warm smile and we sit together in the living room. Young Mahiat says hello, happily informs me that her 13-month-old sister speaks Bangla, not English, and then moves closer to the television to get a better view of a Tom and Jerry cartoon. Sadia bounces up and down on the brown velveteen lounge. There’s a brown and orange seascape on the wall and a large bookshelf around the corner sits empty.
Dr Choudhury is grateful to his practice for organising the house; a modest brick home with slate floors, a few blocks back from the beach. The house has an echo about it and none of the clutter you might expect of a home with two children. Bringing furniture and other belongings from Bangladeshwas an expensive option, so Dr Choudhury and Dr Begum have started again, buying all of their basics from scratch.
Dr Begum offers a cup of tea and heads off to the kitchen, returning with a heavily laden tray and I get a small taste of the misunderstandings that can occur across cultures. There’s a plate of strawberries, another of sliced apple, squares of a home-baked sweet custard slice and a small bowl with three meatballs. I compliment Dr Begum on the slice, enjoy one meatball and enthuse about its cumin. I feel a little awkward, eating alone, and have an uneasy feeling that something isn’t quite right. Later in the day, I’m mortified when Dr Choudhury explains that they rarely have guests and it was odd that I ate so little of the meal Dr Begum prepared for me.
Dr Choudhury is happy that he hasn’t had to make major adjustments to his eating habits. He can buy Halal meat from the local butcher, but because it tends to be expensive they buy it in bulk when they can get to Adelaide, about a four-hour drive from Robe. In the city, they also stock up on spices and imported fish on their rare visits.
“Local fish tastes awful to us, because the seafood we get from here, the fishes are very salty. We are used to freshwater fish. One shop brings fish from our country — hilsha fish. They are the tastiest fishes.
“My wife cooks well. This is the luxury I am having: traditional food. If I lived alone, I could not prepare so many dishes,” Dr Choudhury says.
Dr Begum is not as confident with her English as her husband. She is eligible for a $3000 grant that could be spent on private tutoring (see ‘A helping hand’ below), but Dr Choudhury says at this stage there is no one available to teach her. He would like to speak English more at home, to help her learn, but it feels unnatural. Given the language and cultural barriers, he says the Internet has been “indispensable” in helping Dr Begum cope with being so far away from family.
“Through broadband we can set up web-cam and they [family] can do the same back at home, so we can see and talk to one another,” he says. “It makes a big difference. If we can’t talk to them because of some technical difficulty, my wife gets quite upset. I try to make sure she doesn’t miss home very much.”
The Internet also enables Dr Begum to watch Bollywood movies and her daytime drama serials, and they both rely on religious programs to help them feel less spiritually isolated. They are the only Muslim people in Robe and Dr Choudhury misses going with other men to the mosque on Fridays.
“In terms of religion I am isolated definitely,” he says. “There is no mosque here, no other Muslim.”
The most empty he and Dr Begum have felt since arriving was during Eid —an annual two-week festival that they have always celebrated with family, friends and neighbours.
“As a human being, since my childhood, we always celebrated together; family members, neighbours, going to mosque, saying prayers, having special food and socialising. In Australia
it feels like you’re missing something — a big part of you,” he says.
But with his trademark buoyancy, his mood suddenly lifts.
“You can’t do anything about it,” he says.
“Perhaps we will get used to it in the near future.”
A HELPING HAND
The support available to IMGs varies considerably across Australia
, but the assistance below made the move to Australia
easier for Dr Choudhury and his family.
Initial orientation
The Rural Doctors Workforce Agency (RDWA) paid for Dr Choudhury to visit Australia
for two weeks in April last year, when he was given a tour of MountGambier and Robe and a choice of working in either town. Funding for this site visit is available for doctors' spouses too, but Dr Begum was caring for her newborn baby and so was not able to travel.
When Dr Choudhury arrived in September, he was given a one-week introduction to the Australian health system in MountGambier and a week's introduction to the practice in Robe.
Financial support
IMGs on temporary visas usually have trouble accessing bank loans, so the RDWA offers interest-free loans of up to $31,500 for a car and $15,000 for personal use.
Dr Choudhury is eligible for a Federal Government-funded grant of up to $10,000, designed to reimburse airfares and relocation costs.
Dr Begum is eligible for a $3000 grant each financial year for training to assist with employment.
Support from the practice
Dr Choudhury's new practice organised his housing in Robe and provided him with a vehicle. He says the practice staff are "very caring"; they organised his driving lessons and a preschool for his daughter, and have taught him to use the practice software.
Training
Dr Choudhury and 18 other IMGs are attending monthly meetings that focus on communication skills, colloquialisms, resources and exam techniques. The initiative was instigated by RACGP examiner Dr Cheryl Wilson — a GP from MountGambier, who provides tuition with Dr Ann Dunbar, an IMG from Scotland, who recently passed the FRACGP. The project receives Federal Government funding.
RDWA also funds Greater Green Triangle GP Education and Training to provide an individual learning plan for each IMG to help them gain fellowship.
Why Drs with kids & family have immigrated to OZ & are trying hard to pass AMC under employer sponsored visa thou they have SA citizenship ??
Bcoz it not safe to raise their children up in SA
Malaysia has easy & relaxing jobs for Dr
Culture is well adaptable
Weather & food are excellent !!
but no opportunities for the kids to go further if not PR
did u say malaysia
well do u know the procedures for there i mean malaysia
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