Wellness ideas from around the globe

From Nigeria to Central QLD

Around the World….

Foreword by Dr Una Harrington

Over the past year, there has been an increasing conversation about the value of diversity in our Critical Care workplaces.

Emergency Medicine attracts a wonderfully diverse multicultural group of trainees and FACEMs. In fact, according to ACEM, just over 40 % of both ED Trainees and FACEMs identify as International Medical Graduates (IMGs).

Many years ago, as a recently qualified Intern, I came to Australia, for what I thought would be a six-month job in Fremantle ED. Thirteen years later, I’m still in Oz, now on the East Coast and happy in my more permanent ED home!!

With all this talk of diversity, at WRaP EM we got to thinking – what would you find if you asked some Ex Pat ED doctors a few questions……..

What do the Ex Pats  bring to the ED melting pot?

How do diverse cultural backgrounds and medical training enrich our workplaces and our teams?

What are some of the challenges of being an Ex Pat in the ED?

What advice could be given to others who are thinking of embarking on the Ex Pat journey to our EDs down under?

First to share his story is our FACEM colleague, Dr Titiosi Adegbija. His journey has brought him from Nigeria all the way to Central Queensland. Over to you Titiosi…….


Dr Titiosi Adegbija – FACEM


From Nigeria to Central QLD

By Dr Titiosi Adegbija

There have been a number of studies recently that have shown that a diverse work force provides better team-based performance and care. What do you think you bring to your team where you work, based on your experience as an Ex Pat?

I tend to agree with that statement. I work in a regional referral centre in Central Queensland where the staff, albeit mostly junior, are an eclectic mix of international medical graduates. It can be quite interesting to see the flavours and experience they bring to the medical team. On a personal note, I did my medical training in Nigeria and worked there for about five and a half years which included an internship year, one year of compulsory national service as a local community doctor and three and a half years in a tertiary trauma centre. As such, I believe my prior practice in Africa affords me a breadth of experience not just clinically, but also in the capacity to interact with the patient more practically and at their level, especially where cultural influences are significant in the physician-patient experience.

Ex Pat doctors bring a diverse range of experience, both culturally and clinically to the ED. How do you think the culture and/or the clinical nature of your work earlier in your training abroad has influenced how you work in the ED now? 

My work in Nigeria took me from a tertiary centre as a medical student and intern to a very rural facility where I was the solo doctor, and then back to a huge trauma service that served a lot of the south west of Nigeria. There was wide-ranging variation in healthcare resourcing required to provide optimal care in each setting. In comparison, good healthcare is more consistently available in a place like Australia. I thus feel equipped to cope and adapt in whatever situation I find myself – whether I’m in a quaternary centre such as The Prince Charles Hospital in Brisbane where I did most of my training or in the remotest regions of Australia such as Broken Hill where I once worked as a locum!

Nigeria has 450-plus ethnicities – this means I have learnt to not just deal with a wide range of problems, both medical and otherwise, but also to try to listen to each patient’s unique story, and to deal with them as much as possible within that context.

Moving countries and changing health care systems and employers can be a big challenge for Ex Pats . What have been the biggest challenges working as an Ex Pat doctor in the Emergency Department – either personally, professionally or perhaps both? 

On a personal note, the biggest challenge probably was leaving family and friends behind. At the time, you think a lot about whether such a move is worth the effort at all. I’ll quickly add that I think it has been absolutely worth it in more ways than I may be able to itemize here. There was no doubt some culture shock as well. It took a while getting to understand the Australian way of life which is very different. There were other elements such as the dry humour, the abundant Australian colloquialism that I found strange at the outset, as well as the staunch independence that was most vividly evinced in the elderly patients that presented to the ED that I had to rapidly adapt to.

Professionally, probably the biggest factor was adjusting to the Australian healthcare system and how it worked. I had to write qualifying exams (AMC) and started work in Australia as a senior house officer even though I had progressed way beyond this level back in Nigeria. The spectrum of diseases was slightly different, with conditions deemed ‘diseases of affluence’ such as dyslipidaemia being way more common in Australia. There were new drug trade names to be learned and nobody paid for health out of pocket – which was just brilliant!

What is one piece of advice would you give to other doctors wishing to embark on an Ex Pat experience? 

Have a clear vision of what you want to achieve, professionally and personally. It definitely can be challenging getting used to a different system of operation but when there is clarity and things are taken one step at a time, it is almost invariable that you will begin to make a difference at some point.

About Titiosi Adegbija



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