The visit is the latest in a string of official trips to Australia’s Pacific neighbours since the election of the Albanese government last year amid concerns relations had drifted under the previous administration and spooked by China’s growing posture in the region.

But beyond building reciprocal trade arrangements, collaboratively addressing climate change and boosting security, what else can these revived relationships offer?

Plenty, and not just for Australia, according to Queensland-born and raised doctor Lachlan McIver, who honed his skills between PNG and Queensland through the islands of the Torres Strait and the wider Pacific region before taking his expertise globally with the international Médecins Sans Frontières (Doctors Without Borders).

The opportunities, for people of different backgrounds and professions, are boundless if we take a stronger interest in our own back yard, he says.

InQueensland caught up with McIver late last year on the eve of launching his first book, Life & Death Decisions, described as “part rollicking medical memoir, part analysis of global health crises, that highlights the pressures on those who administer primary health care in some of the toughest places on the planet.

“The focus of the book isn’t on me, it’s on our communities and our profession. These are stories that I think all Australians should be aware of,” McIver says.

“The title of the book is not just about the decisions doctors and other health professionals make every day, but what our patients face when they live remotely.”

McIver knows what that adversity looks and feels like, because he’s been there – delivering care to patients on almost all continents from the middle of Australia to the Torres Strait, Pacific Islands, South East Asia and war-torn South Sudan and the volatile Democratic Republic of Congo.

As the climate crisis worsens, energy prices increase and food supply becomes more vulnerable, in turn weakening global security, those pressures to keep people well are only intensifying.

But there is hope, McIver says, and it comes in the form of the rural generalist doctor, a type of medical subspeciality that was forged in Queensland from the late 1980s to service the state’s large, decentralised population.

The training is now offered nationally through the Australian College of Rural and Remote Medicine (ACRRM) headquartered in Brisbane and now supported with federal funding to get more doctors into rural and remote locations.

McIver describes those doctors attracted to the career and lifestyle as adventurous types who are resilient, adaptable, can-do and aren’t afraid to “muck in and get blood on their boots”.

That was the type of action a young McIver was seeking when he graduated from Monash University in Melbourne in 2005.

It was already a world away from home at Millaa Millaa in far north Queensland and lightyears from where he would eventually find his calling.

“Monash University in the early 2000s was not a place where you were exposed to rural generalist type roles,” he says.

“I don’t ever recall that term being used and I certainly don’t remember that particular branch of clinical work being portrayed as a viable career choice.”

Stints working in WA’s Kimberley region on a John Flynn Scholarship and as a doctor in training followed.

“I took any opportunity I could to get out of the city and work in the bush,” McIver says.

“At that time, I had no particular interest in general practice, but I liked the idea of spending time in the Kimberley, roaring around in a LandCruiser for six months working in Indigenous communities providing primary care, public health and emergency medicine.”

A further six months in the emergency department at Alice Springs cemented the path he would follow.

“That’s when the penny dropped; I liked the mix of work and being in the bush and I’d met enough characters along the way who gave me some insight into what a career pathway that encompasses all of that might look like.”

In 2008, McIver started his ACRRM training back in north Queensland, including a year in anaesthetics in Cairns, followed by a job as a senior medical officer in the Torres Strait, which he describes as “the formative period of my career”.

“Dealing with the problems faced by Papua New Guinean patients, in particular, while working in the Torres Strait was like a punch to the face,” says McIver.

“I’m sure most Australians wouldn’t be aware that through the Torres Strait we share a busy, porous border with PNG where people move quite freely between the two states.

“You get this mix of genuine tropical health problems from this low resourced, developing country being serviced with the resources of one of the wealthiest countries in the world.

“In terms of key indicators like per capita GDP, life expectancy and child mortality, the differences between PNG and Australia are further apart than any two countries that share a border anywhere in the world.”

McIver left the Torres Strait in 2011 to take up a job with the World Health Organization in the South Pacific.

While the focus of his work and PhD was on the devastating health impacts of natural disasters and climate change in Pacific Island countries, it quickly became clear that these island communities had another health crisis on their hands: too few doctors overall, and almost none in rural and outer-island communities.

“It seemed that no matter where I travelled, the conversations with various Pacific governments followed the same pattern,” he says.

“The health needs were greatest in the rural communities and outer islands, but the very small number of doctors in each country were concentrated in the urban areas.

“Even more concerning was the fact that opportunities for Pacific Island doctors to train as rural generalists were almost non-existent. We realised there were opportunities to adapt the Australian rural generalist training model to Pacific Island countries, and that’s how Rocketship was born.”

Rocketship Pacific Ltd is an international health non-profit organisation focused on improving health in Pacific Island countries through stronger primary care.

It stands for ‘Remote Opportunities for Clinical Knowledge, Education, Training and Support for Health in the Pacific’.

After several years working in Fiji, Vanuatu and across the Pacific region, McIver moved to Switzerland to take up a consultancy contract at the headquarters of the World Health Organization.

He then switched to MSF and has been working at their Geneva headquarters for the last four years.

But relentless travel while working in hostile environments, surviving war zones and near kidnappings, eventually took its toll, leaving McIver emotionally exhausted and financially bereft despite the joy of starting a new relationship and working his dream job.

“I’m very upfront about this in the book – working for Doctors Without Borders doesn’t pay very well,” he says.

“I had financial commitments and mortgages that I couldn’t maintain.

“I was broke and became suicidally depressed and stayed pretty close to a very dark precipice from about 2017-2019.

“It was a nasty combination of social isolation and professional frustration. It was extremely difficult to find a balance between my core clinical role as a rural generalist and my work with MSF, which was more focused on public health and infectious diseases.”

By 2020, the “ship started to right”, McIver explains.

“After some long and tough periods of hardcore clinical work, spending many months apart from my partner, I was finally able to drag myself out of debt.

“Then when the Virtual Rural Generalist Service was established in western New South Wales in early 2020, I jumped at the chance to join the team.

“The timing was almost miraculous – definitely for me, but also for the community, as within weeks the Covid pandemic hit and telemedicine services became more important than ever before.”

As the world’s health system felt the strain from the pandemic, McIver began to piece the threads of his life and the chapters of his book together.

He remains based at MSF’s Operational Centre in Geneva where he is the Tropical Diseases and Planetary Health Advisor while dually committed to his role in western NSW through the Virtual Rural Generalist Service.

“I’m using my experience as a rural generalist to shine a light on the work we do as doctors and the challenges we face as a society, particularly in regard to health, from climate change impacts, inequities in Indigenous health, pandemics and antibiotic resistance,” he says.

“Rural people and rural doctors are the beating heart of this book; I’m attempting to demonstrate the challenges that rural doctors face, but highlight the amazing things they do because of who they are – their resilience, adaptability and strength of character – which they all share in common, whether they are working in the Torres Strait, the central desert of Australia, Vanuatu or a swamp in a war zone in South Sudan.”

For more information on Rocketship Pacific visit www.rocket-ship.org

For crisis support in Australia: Lifeline 13 11 14