Bouncing on a trampoline at an Aboriginal camp in Australia's red centre, two-year-old Danae Moore faces a future filled with first and third world health problems, which an army of foreign doctors has been recruited to treat.
In the remote Northern Territory, patients are as likely now to be attended to by an Indian, an African or a European as an Australian doctor.
AdvertisementThe foreigners are brought in to do jobs that Australian doctors generally shun, opting instead for the more relaxed lifestyle of the coastal cities and state capitals.
Without the thousands of expatriate doctors, Australia would be unable to provide medical services for many like Danae, health officials say.
The practice has proved controversial as critics say it is stealing doctors from countries with a greater need for their skills, while some of the screening procedures have come under fire, in 2005 one Indian surgeon was linked to a series of deaths.
At every election, the shortage of doctors in "the bush," as the remote heart of the country is called, is a major political football, with constant calls for more money to attract new recruits.
The run-up to the November 24 election is no exception.
At a clinic in Alice Springs run by the Central Australian Aboriginal Congress, Belgian doctor Kristien Brouwers treats Aboriginal patients from the town and remote communities in the surrounding area.
After years working in South Africa with her husband Koen DeDecker, they were kicking their heels back in Belgium, a country over-supplied with doctors, when they found a congress advertisement on the Internet and decided to apply.
At 41, the graduate of Belgium's University of Leuven has now been in Alice Springs for six years.
She and her husband entered the country under a special scheme for doctors with advanced training and were able to by-pass the qualifying exams.
Now they have a good lifestyle, a high standard of living and Australian residency, and say they feel they are doing something worthwhile.
They have two sons, William, 11, and six-year-old Lenhard who was born in Australia.
"It's good to live here," Brouwers said between consultations. "It's a beautiful place. It's a unique environment, quite relaxed, still the advanced world, not the developing world, so it is quite all right to bring up kids."
The congress serves the local Aboriginal population and takes doctors out to remote bush communities, where the medical challenges are daunting.
Patients often have trouble expressing themselves in English or may simply be reluctant to discuss details of their illness, especially with a doctor of the opposite sex. But medical services are sorely needed.
The population suffers not only high rates of diabetes, renal failure, heart disease and other health problems of developed countries, but also syphilis, scabies and others more typical of the third world, plus social afflictions like petrol sniffing and child sexual abuse.
Many of the patients still live a semi-nomadic lifestyle, speaking English as a third or fourth language. Not every rural area in Australia is like this, but foreign doctors now make up a large proportion of the medical workforce in most remote parts.
To deal with the shortages, hundreds of new medical school places have been granted on condition the students agree to spend a certain number of years working in the bush after graduation.
Financial incentives have also been tried to lure Australian doctors, with some success. A general practitioner in a rural area can easily earn 300,000 dollars (270,000 US) a year, in return for a gruelling schedule with plenty of after-hours work.
But even with financial incentives, most regions have also been forced to look for foreign doctors, with special schemes offering them permanent residency and citizenship after a number of years.
John Boffa, a public health specialist with the congress, says that by and large it has had great success with the doctors it has recruited.
People who have made their way to Australia's outback have traditionally been regarded as "misfits, mercenaries or missionaries" and, Boffa said, the congress has mostly attracted the "missionary" type -- people with a zeal for social justice.
But there have been some weak points elsewhere, he says, particularly in Queensland state, on the northeastern corner of the country, where a scandal erupted in 2005 over Indian surgeon Jayant Patel.
Nicknamed "Dr Death" by the Australian media, Patel was accused of gross incompetence while working at a hospital in the town of Bundaberg.
He was recruited despite earlier concerns about his performance while working in the US, igniting a political scandal which is still reverberating.
This year another Indian doctor working in the same state, Mohamed Haneef, was controversially forced to leave Australia after he was linked to terrorists and his visa was cancelled. The charges were later dropped.
Of around 55,000 doctors in Australia, some 40 percent are thought to have had foreign training.
At the same time politicians are crying out for more doctors for the outback, thousands of foreign doctors who migrated to Australia based on their medical qualifications are out of work, caught in a tangled bureaucratic web because they are unable to pass difficult Australian Medical Council (AMC) qualifying exams necessary before they are allowed to practise.
"The financial stress these people are under is incredible," said Ronald Pepper, chief executive of the Australian Doctors Trained Overseas Association.
"The only people who can pass the AMC exam are younger doctors just out of medical school. It is an exam about passing exams. It has nothing to do with medicine."
Most practising Australian doctors, he added, would not pass.
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