Life & Death Decisions

Life & Death Decisions

Dr Lachlan McIver’s memoir Life & Death Decisions is an account of his experiences providing care in some of the most remote and neglected parts of the world.

DR LACHLAN MCIVER decided to become a doctor after his father died of a heart attack. He now specialises in rural & remote medicine, tropical medicine and public health, and did his PhD on the health impacts of climate change. Originally from Millaa Millaa in Far North Queensland, his travels have spanned almost 100 countries. He has co-authored many articles in medical journals and textbooks on topics ranging from environmental health and infectious diseases to anaesthetics and emergency medicine.

He is an adjunct Associate Professor at James Cook University in Australia and the co-founder of the international non-profit organisation Rocketship Pacific Ltd, which focuses on improving health in Pacific Island countries. He currently lives in Switzerland, where he works as the Tropical Diseases & Planetary Health Advisor at the Geneva headquarters of Médecins Sans Frontières (Doctors Without Borders). Dr McIver’s memoir, Life and Death Decisions, provides perspectives on matters ranging from international health systems to personal grief.  

What prompted you to put pen to paper? 

I’ve devoted most of my career to trying to tackle complex problems like Indigenous health inequities, the health impacts of climate change and the rise of drug-resistant infections. Along the way I’ve also led a pretty wild life, so I’m using stories of the latter to deliver serious messages about the former. 

Does the writing process reflect advice given to you by other doctors? Would you recommend it?

I’ve definitely benefited from the guidance of other doctor-writer colleagues, and writing can be a very cathartic process, as I discovered when scribbling poetry by the light of my headtorch sitting on the floor of my mud hut in a civil war zone in a swamp in South Sudan!  

It’s pretty obvious in reading your book that your career hasn’t followed a plan. Is this a ‘path’ you’d recommend to today’s junior doctors?

Strangely enough, the steps I’ve taken over the years do appear to make some sense in retrospect, but that’s more by accident than by design! I would encourage junior colleagues to keep an open mind and try to soak up the broadest possible range of experiences before making decisions about how to spend the rest of their lives and careers. 

When you took a ‘break’ after fourth year of medical school, did you really think you’d go back?

It was touch and go for a while there, but I think I made the right decision. I eventually found my calling within medicine and I daresay I make a better doctor than I would have been a scuba divemaster or a hostel manager in Dubrovnik. 

What did you like about rural and tropical medicine that made you keep going back to remote areas
of Australia?

Variety, community and adventure!  

You talk of the ‘psychological shift’ necessary to accept that your patients die ‘on a near-daily basis’. Is this conscious? Is it a shift that occurs once, or repeatedly or continuously over your career?

I imagine it’s a little different for all of us, and probably evolves over time. I find myself much more conscious of death these days, particularly given I’ve officially hit middle age. 

You’ve worked with many different population groups. Which issues do you think lead to the most stigma and discrimination and impacts on health and wellbeing? Is the situation improving? 

Poverty is pernicious and racism is sadly very widespread. The former is slowly improving at a global scale, but I’m not so sure about the latter. 

Your career has taken you from PNG rainforests to the Swiss Alps. What are the biggest similarities and differences between approaches to health care you’ve encountered and had to overcome?

Humanity is a shared experience the world over, but one of the issues I struggle with most is inequality, particularly when it comes to the gap between rich and poor, and those who can access quality healthcare and those who can’t. 

What do you consider the biggest ramifications of climate change on health – and vice versa?

It’s essential that we recognise climate change as one of the defining challenges to health in the 21st century. Both the current and previous WHO Directors General have defined it in precisely these terms, but paradoxically the level of awareness of the scale and scope of the threat is troublingly low on the part of health professionals, politicians and the public. So I’ve written a book about it! 

Australia is experiencing a critical shortage of GPs. Do you have any answers? 

I’m a passionate advocate for rural generalism as a specialty discipline and rural medicine as a core component of any medical school’s curriculum. The more we can expose and support our junior colleagues to and in the practice of rural generalism, the more likely they are to see the appeal and commit to the specialty. This is not just my opinion; it’s a fact supported by a wide range of evidence. 

What are the most immediate impacts of climate change and the ones we could address the fastest?

The health impacts of climate change are all occurring simultaneously I’m afraid, so we can’t afford to be choosy. Immediate, effective and sustained action is required to slow, halt and reverse carbon emissions and global heating if we are to reduce the expected burden of millions of avoidable deaths every year due to climate change. 

You’re now in a non-clinical role. How long do you think it will be before your love of clinical work draws you back to that side of medicine?

I remain happily and actively engaged in clinical work as a rural generalist in Australia, both through the Virtual Rural Generalist Service in NSW and rural hospital locums wherever there’s a need for a rural generalist with anaesthetics skills when I’m back in the country. South Australia is one of the few states where I haven’t worked yet, so I’ll definitely be making that a priority! 

This article was originally published in medicSA and has been reprinted with permission.