With a comfortable retirement on the horizon, paediatrics Professor David Brewster turned his back on a new house and the rich cultural life of Canberra to take up one more teaching position in a developing country
Professor Brewster, who had been clinical director of paediatrics at Canberra Hospital for a year, started in his new role this month based in Dili where he will set up and run the first specialist postgraduate diploma training course in paediatrics.
AusAID and the Royal College of Surgeons are funding the project, along with training in surgery and anaesthetics.
Until now, teaching in Dili’s medical school was given in Spanish, complementing the Portuguese spoken in Timor. Training local doctors was largely funded by the Cuban government with its strong emphasis on community medicine, and in particular, reducing infant mortality.
“AusAID has agreed to support this project because Australia also has a responsibility to its near neighbour. Part of this initiative is for English to be used in postgraduate medical training. And language is a crucial issue in Timor”, he says.
Professor Brewster expects his Algerian-born wife, Catherine, who had been teaching English as a Second Language at the Australian National University, will also become involved in this latest posting. The couple has lived and worked together in many developed and less developed countries throughout Professor Brewster’s career. Through this work, two children have been adopted into the family.
First was Sophie, who had been left in a rural hospital in St Lucia in the West Indies, where Professor Brewster was working as a young medical officer soon after completing his studies at McMaster University in Ontario. Catherine, who was then pregnant with their son, offered to look after the baby, whose condition was declining despite the hospital setting. When they left St Lucia two years later, they formally adopted Sophie.
Setha was adopted from India, while Phillipe, Sarah and Julian complete the Brewster’s five children. There are now four grandchildren too.
The family spent time in New Zealand, where Professor Brewster did his paediatrics training, and then worked in Samoa, Sydney, Zimbabwe, the Solomon Islands, Gambia, Newcastle, Darwin, Vanuatu, Cairns, Fiji and Botswana. He ran medical schools in Darwin, Gaborone in Botswana and Suva in Fiji.
“The opportunity to teach again is also a chance to practise the kind of medicine I know and love. I made a commitment to teach before going into medicine. It was an active choice”, he says.
“Many colleagues say they would love to do this sort of work but for the constraints of child schooling or a reluctant partner, but our children went to good schools in developing countries.”
His family also flourished in the diverse cultures where they have lived, with three of his children now following careers in less developed countries, including one who is a doctor in Vanuatu.
Professor Brewster is not new to Timor and had made many visits as part of outreach work while based in Darwin. His son also worked in Dili previously, where he helped set up an English school. There had been plans for Professor Brewster to be involved in research with the NHMRC and the Wellcome Trust in a province north of Dili, investigating Helicobacter, but political instability and rioting in 2004 scuppered the plans.
Professor Brewster’s work in Dili will allow the first locally trained paediatricians to qualify at the end of his four-year term, after completing a one-year diploma and three years’ additional training. The goal is to have two or three properly trained paediatricians. They will be selected for the program initially on the basis of having expressed interest.
“In Timor there is a lot of infectious disease, including TB and dengue fever. It’s the medicine of poverty that you find anywhere with overcrowding, poor living conditions, and malnutrition”, he said.
He believes the political elite in East Timor have also been sensible so far, including the allocation of limited resources on health spending.
“When you go to these countries you do so with a commitment not to get involved in politics“, he says. “There is a syndrome of people arriving from rich countries who can’t adapt. You need a pragmatic approach; money and goodwill are only part of the picture. It’s not unlike working in indigenous heath where you may not always be in control, but you can contribute if you adjust to the frustration, and focus on where you can make a difference.”
Professor Brewster recommends young doctors consider a path in development medicine, but suggests a commitment of two years is necessary to make a difference. On a clinical level, it means recognising that context is all important, he says.
“So much of diagnosis is knowing the local situation and how things present. You also have to enjoy living there, lead by example, not get into an expat rut, nor lecture the locals on what to do. And most importantly, immerse yourself.”
Which is exactly what Professor Brewster intends to do in Timor, long after many of his contemporaries have wound back their careers.
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