Pediatric Gastroenterology “Down Under”

Paediatric GI, as an organized subspecialty, has a fairly short history in Australia. The Australian Society of Paediatric Gastroenterology, Hepatology & Nutrition (ASPGHAN) was established as recently as 1986. However, its historical origins are quite venerable, with the pioneering work of Charlotte Anderson and others on coeliac disease, cystic fibrosis, and the different types of carbohydrate malabsorption dating back to the 1950s. The training of Australia's practicing pediatric gastroenterologists originally followed two distinct paths to either North America or Great Britain. It was, however, unusual to see these paths cross for most individuals. There was a time when every major center in Australia could trace a direct path to the Hospital for Sick Children in Toronto and the tutelage of Dr. Richard Hamilton, while a few others went to other parts of North America or Britain. More recently, with the advent of what could be considered the third generation of Australian pediatric gastroenterologists, these patterns have become much more eclectic and blurred. With the worldwide explosion in training positions and opportunities, Australian pediatricians are being trained all over the world as well as at home. One of us (M.G.) trained in Melbourne and England with Professor Charlotte Anderson and Dr. Valerie Burke in the 1960s when pediatric gastroenterology was in its infancy. Several months working in Papua New Guinea in the mid-60s as a pediatric trainee showed him the devastating effects of gastroenteritis, dehydration, malnutrition, and multiple other infections on children in a developing country. He has since worked extensively in countries like Indonesia, India, Thailand, and with Tibetan refugee children in the Himalayas. He has also worked for 30 years with Australian Aboriginal infants and children among whom intestinal infections and infestations are endemic. His long involvement with the International Paediatric Association has shown him how important these basic GI problems are for infants and young children in developing countries and in disadvantaged populations in our own country. Pediatric gastroenterologists from industrialized countries should also be exposed to this problem either by working in these areas themselves and/or teaching local health professionals, including pediatricians, about appropriate advances in the diagnosis and management of these acute and chronic paediatric gastrointestinal diseases. Traineeships in paediatric gastroenterology in accredited hospitals or training posts will help to upgrade the skills of visiting trainees for practice in the settings where they are so badly needed. There has been another trend in recent times as Australian centers are now being seen as desirable training centres for young pediatricians from around the world. Appropriately, many of these trainees come from countries in the Asian Pacific region as they recognize Australia as a leader in education in this region. In addition however, pediatricians from the UK, Europe, and North America have also journeyed down under. It is very gratifying to witness this first generation of Australian-trained fellows as they return to their own countries as full-fledged pediatric gastroenterologists to continue successful professional careers. The training programs in Australia have required modification to adequately address the needs and health care of the countries from which our trainees come. This in turn has been very beneficial to us and our own local fellows in broadening their experience with other cultures, their challenges, and their opportunities. We have found that we must expend particular emphasis upon nutritional issues, usually malnutrition, but increasingly also on over-nutrition and obesity. Exotic (in the developed world, but common in developing nations) infectious diseases are also of paramount importance in these training programs. These modifications have helped to enhance everyone's training, irrespective of their level of seniority. Australia also has some unique educational and research opportunities because of the close juxtaposition of its first class medical facilities and its local areas of third-world health and nutritional problems. Some of us have committed our professional lives to studying and working with the nutritional and gastrointestinal problems and their attendant issues in our indigenous population. Knowledge of and the ability to perform an ERCP or virtual colonoscopy is not as important as being able to recognize the re-feeding syndrome, understand the causes and implications of iron deficiency anaemia in infants, or the knowledge of how to treat intestinal parasitic infections. However, we feel that those who have chosen to focus on the gastrointestinal and nutritional problems of the developing world are just as important to the ranks of pediatric gastroenterology in Australia as those whose careers have followed a more traditional NASPGHAN or ESPGHAN path.

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