I’ve spent most of my free time this past week in bed trying to shake off my own infection. Nothing exotic I’m afraid, just the same sore throat/fevers/cough/body aches that the rest of the world gets from time to time. It would make for a better story if I had malaria, or melioidosis, or Orientia tsutsugamushi. Alas, no such luck. My list of “interesting diseases I have had” remains stuck at one – my Malawian cholera episode some years back. Not very impressive for a future ID physician, I really feel like I should hatch a botfly out of my head, or have a light touch of leprosy. I don’t need Ebola or SARS, just something to get some street cred.

I did manage to have dinner this week with Tim (hopefully without infecting him, his wife and lovely children), an ID physician from Malaysia who has the same job here (medical registrar) that I do. All of his training had been in Malaysia until this point, and just as I did, he wanted to get some experience in another country and medical system. Despite the fact that he has been a physician for a decade, including serving as the sole infectious disease specialist for an entire state in Malaysia for the past few years, his credentials are recognized as the same as mine in Australia. This is understandable, I suppose, in that the training in the US is probably held to a more consistent standard; it’s likely difficult to assess the qualifications of a Malaysian physician. But having worked alongside Tim for the past few months, there’s not much he hasn’t seen and that he’s not comfortable with. And the stories he has to tell – managing an entire state hospital, traveling throughout Malaysia as the only HIV doctor in his region, responding on the front line for the SARS outbreak – it makes an impressive résumé.

Tim’s story has been a recurring theme here in Darwin (a leitmotif, you could say – putting my Infinite Jest vocabulary to work). Darwin is a popular place for temporary employment for doctors from all over the world, offering tropical medicine in an English-speaking town in first-world conditions. And most physicians from outside the US or UK have to accept working below their level of training, just as Tim has. Thus Martha the Zambian doc with five years experience in Africa starts as an intern along with the newly-minted Australian graduates. And the “intern” who worked with me for the past three weeks is Harish, who had been a general practitioner in India, then in England, and now is again working as an intern in Australia. Which for me was a blessing – he was in no way overwhelmed by our service when it ballooned to fifty patients, and when we were getting slammed with admissions, we could separate and work in tandem, with my oversight consisting mostly of agreeing with what he was doing. This week he has moved onto another service and has been replaced by an Australian intern – a fantastic guy, and quite bright – but who is orders of magnitude less efficient. If I ask him to do an admission, he’ll do a great job, but I will have admitted eight other patients by the time he finishes with one, and he’s not comfortable with any autonomy in medical decision-making, so all management issues great and small run through me.

So where does Harish go from here? I perhaps shouldn’t have been surprised to learn that he is applying for residency positions in the US, where once again none of his training will be recognized, and he will start again as an intern. And that’s only if he can get a position; he has applied to over a hundred programs in hopes of getting a few interviews.

On my general medicine service we are currently preparing for a potential influx of Indonesian refugees if the earthquakes continue to cause problems. Thankfully no tsunamis, but we are discharging anyone who can go to free up beds. Royal Darwin Hospital is the primary medical evacuation point for East Timor, but could potentially accept patients from anywhere in Indonesia if need be – the quakes have been off the coast of Sumatra, which is near Jakarta, and north of Sulawesi, which is on the far side of Indonesia from Darwin.

And at any rate my time is drawing to a close here. Saturday after my morning round I’m off for a long weekend in Sydney, just to get a taste of another part of Australia. Although I don’t know if I’m quite urbane enough to take in a performance by myself at the famous Opera House, I’m pretty sure I’m sufficiently couth to climb the harbor bridge, and visit Bondi Beach, take a train up into the Blue Mountains for some hiking, and swill a beer or two in the Sydney pubs. Then a few days back in Darwin to wrap up at the hospital before my bride arrives at the end of next week. I’m thinking our reunion will be one of those deals where we run to each other from opposite ends of a long terminal, and cameras will be flashing and there will be lots of general applause. We’ll do a bit of light touring, biking, hiking, canoeing, swimming, and general national park gazing. Then time to head home to unite with my progeny; I’m definitely approaching the limit of how long I can bear to be apart from the little men.

Thanks for reading my blog.