School of Historical and Philosophical Studies - Theses
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ItemA History of Australia's Immigrant Doctors, 1838-2021: Colonial Beginnings, Contemporary Challenges( 2022)Since colonisation in 1788, Australia has been populated by immigrants. Among them, for all this period, there have been practitioners of Western medicine who qualified overseas. This thesis is about them, now termed International Medical Graduates (IMGs). Starting in 1838, when the first colonial medical Acts were promulgated, it explores who those graduates were, from where they came, why they migrated at specific times in response to geopolitical and other events, how were they received and what were their experiences. Their history is integral to the history of medical practice and medical politics in Australia. It has not previously been examined across the longue durée researched here; the purpose has been to better understand the evolving and continuous process of medical immigration, rather than the fragments that constitute the current historiography. The methodology is quantitative and qualitative. First, a prosopography was constructed comprising all IMGs registered in each colony, state, and territory from 1838 to 1984, supplemented by data from a random sample of contemporary IMGs to bridge to the present. From this, the time course, profile of donor countries, and characteristics of successive waves of IMGs has been documented, then linked to causal historical events, including the changing and frequently obstructive medical legislation. Throughout the colonial period and the first half of the twentieth century, nearly all immigrant doctors had trained in Great Britain and Ireland, often motivated by difficulties establishing practice at home and attracted by opportunities in a new land, but with source countries restricted by the Medical Acts. Then, as Australia opened to migrants from the rest of the world in the second half of the twentieth century, so the spectrum of IMGs expanded immensely—approximately, but not completely matching that of the immigrant populations overall. Currently, about 30 percent of the Australian medical workforce was born and trained overseas. A second aim was to understand and learn from the experiences of living IMGs. For this, 87 oral histories were recorded—using criterion-referenced, random, and snowball sampling. Many were negotiating the pathways to medical registration, under the now national regulator, the Australian Health Practitioner Regulation Agency (AHPRA). The thesis gives them a voice, and illustrates their difficulties and crises—sometimes at the hands of what seems to have been a Kafkaesque bureaucracy. The other pathway for some has been to persuade a specialist college that their overseas qualification is comparable to that of the Australian college. Interviews with college and AHPRA representatives confirm the author’s impression that much has been done recently to improve the fairness of those processes; but the thesis also provides evidence in the oral histories of what appear to be historical and recent injustices. Australia owes much to its IMGs. The thesis allows us to learn from their history during almost two centuries. It concludes with recommendations for how we can still assure the paramount need to protect Australian patients, yet also improve the effectiveness and fairness of our current processes for registering and supporting those who received their medical training overseas.
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ItemThey came to heal: Australia’s medical immigrants, 1960 to the present( 2018)This thesis examines the patterns of migration of international medical graduates (IMG) since 1960 and the processes used to decide who would be licensed to practice. It draws on several historiographical genres. Quantitative methods were used extensively to ascertain trends for which explanations based on political and social history could be sought. Complementing this larger picture, a collection of oral histories explores the social causes and consequences of migration, and the actualities of Australia’s licensing processes as experienced by individual immigrants The thesis fills a gap in historical research on the subject by compiling and analysing information previously reported only incompletely and in cross-sectional fashion during this period, juxtaposing it with examples that reveal the human impact of fluctuating official policies during this time. It will argue that Australia has unresolved problems when it comes to balancing the desire of immigrant doctors to practise in their new country with the expectations of the population for equitably distributed and high-quality health care.
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ItemSettling the mind: psychiatry and the colonial project in Australia( 2012)Set in Australia during the late nineteenth and early twentieth centuries, Settling the Mind tells the story of three Sydney psychiatrists who sought to understand the relationship between race, nativity and madness: Frederic Norton Manning, Chisholm Ross and John Bostock. Their influential (albeit limited) contributions to comparative psychiatry centred on insanity in Aboriginal people, immigrants and native-born settlers. Drawing on asylum case records, official government reports, scientific studies and medical literature from the period, this thesis argues that the doctors’ interpretations of mental disease in ‘others’ were, in the main, reflections of their own concerns and self-image. Manning, Ross and Bostock’s preoccupations with notions of progress and degeneration, belonging and maladjustment, and superiority and inferiority so shaped their findings and distorted their conclusions that the patients upon whom their studies were based all but disappeared from view. Through a deep analysis of the doctors’ writings, this thesis tentatively recovers traces of these patients. Settling the Mind also, however, takes a much wider view, charting the spread of medical knowledge about madness in ‘other’ peoples across borders and between nations from the late eighteenth to the early twentieth centuries. In so doing, it not only illuminates Manning, Ross and Bostock’s scholarly inheritance, but also sheds light on two persistent and seemingly contradictory facets of the Western medical and scientific imagination: first, the theory that civilisation was a potent cause of insanity; and secondly, the association between madness and savagery. This thesis explores why madness was associated with savagery when it was supposedly caused by civilisation, and how mental disease was interpreted in peoples already defined as savage, and thus mad, by nature. It argues that from the late nineteenth century, comparative psychiatry destabilised the opposition between madness and reason, just as it reflected and informed emerging neurological and psychological theories about the nature of insanity itself.