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I had been in the USA for almost 10 years and was enjoying a blossoming career. I was an Associate Professor of Neurosurgery and Chief of Paediatric Neurosurgery at the Arkansas Children’s Hospital. The previous Governor of Arkansas, Bill Clinton, had invested wisely in health infrastructure and the neurosurgical facilities at my hospital in Little Rock were world‐class and represented one of the largest units of its kind in the world. I had been head‐hunted around the continent and was in an enviable position of being able to navigate my academic future.
Genevieve was pregnant with our fourth child and life was looking pretty good. Although Genevieve had been hinting at returning to Australia, she knew the academic track that I was on and with my ambition in full throttle, Genevieve and I were confident that a department chair was just around the corner. It was time we had an in‐depth conversation about our future. It went like this: Genevieve to Charlie...”I’m going back to Australia. Are you coming?”
It was a done deal. We decided to return to Australia for lifestyle reasons and for our children’s heritage. We both wished for our children to be Australian and to grow up in Australia. Our reasoning was as simple as that. The decision was made not because we didn’t like Americans, or that we didn’t like living in America. On the contrary, I found Americans to be gracious, diligent, positive and charitable people for whom a meritocratic workplace had paid generous dividends. My personality was not dissimilar to my American colleagues and I found my inquisitive nature and my challenging of neurosurgical dogma was encouraged and nurtured. I did express to Genevieve one note of caution. Did she understand that the academic road back in Australia would have its challenges and might be rocky?
So on a very simplistic level, what is it about Australia that makes it the greatest place on earth to live? Those of you who have lived overseas for any length of time will recall that it is very easy to reflect on your homeland with rose‐coloured glasses. When in the US, I would recall Australia’s magnificent beaches and national parks and sunny summer days with flawless blue skies. I would reminisce on the irreverent humour of Doug Mulray, the natural beauty of Australian girls, the fresh and bountiful seafood, my friends from childhood and university days with whom I could be at total ease and the relaxed quintessential Australian way of life. I conveniently forgot about the Sydney traffic, the tall‐poppy‐syndrome, the flies in summer, the geographical isolation and the hidden and sometimes overt racism.
My parents arrived in Australia in the early 1950s, my father to pursue a medical career and my mother a nursing one. They were given a warm welcome by many Aussies who adopted them into their families, giving them financial and emotional support. I was born in 1957 in a rented apartment in Mosman and soon moved to Picnic Point into the house in which I would live on and off for the next 20 years. Although both parents were Buddhists, my parents felt strongly that immigrants should assimilate with the local culture, adopt the local traditions, and be cognisant that we were “guests” and as such we should always be on our best behaviour. If a Chinese person were to fall on the wrong side of the law, it would be to the detriment of the entire Chinese community. It always made sense to me that if a country was attractive enough to uproot your family, leave your loved ones and friends, learn a new language, travel for weeks on a boat across an ocean, then why would you wish to change anything about the local culture.
You would embrace everything about that new country because every aspect surely might contribute to the very timbre of what you found so attractive in the first place.
Consequently, Easter and Christmas were fun events. Every year at Easter, without fail, we would spend the day and night at my Italian God‐mother’s family farm in Leppington. The air was filled with the sound of a piano accordion, countless elderly men would chat to me in heavy Italian accents, and all the elderly women would squeeze my cheeks so hard they would be bruised by night’s end. The food was fantastic and the feeling of “family” was overwhelming. At Christmas, joss sticks would sit alongside the Christmas tree, my dad would throw an extravagant party, and our Chinese family accountant would dress up as Santa....not a little confusing.... and hand out the best gifts ever to all the kids.
Racism was rife in those days. I can’t remember a day that I wouldn’t be jeered or mocked by some group of kids anytime I ventured into a public space. It made a child tough. In my case, not as tough as I should have been, given my sister, diminutive but ferocious, would take on the toughest lads and I would be left enthusiastically backing her up. My father was a rigid disciplinarian. I was beaten to a pulp by a school bully and returned home that afternoon in the hope I would get some sympathy from my parents. Instead my dad castigated me for not fighting back. I was instructed to return the next day to reciprocate. Australia has become multicultural and racism has certainly diminished over the last 50 years but it still disturbs me when I hear some of our politicians reassuring overseas governments that it doesn’t exist at all.
I have not experienced overt racism since returning 11 years ago from the USA, but one of my visiting Indian neurosurgeons was spat on by an adult male who drove past him as he waited at a traffic light. It is incorrect and naive to say that there is no anti‐Arab or no anti‐ Indian sentiment, just ask someone of Middle Eastern or Indian appearance. Unfortunately, racism still exists in Australian culture today. But if you think it’s bad, you would’ve cringed if you had heard some of the things my mum said about you “white devils”. In my case, the lessons I learnt as a child, to never give‐in without a fight, the strength that I gained in order to overcome the insecurity of being in a minority, and the overwhelming sense of fairness I acquired by experiencing such unfairness, would influence how I would react to similar challenges in my professional life years later.
After an acrimonious divorce in 1969, my mum sacrificed any semblance of luxury in her own life to give me every opportunity to make mine better. I was schooled at the Scots College, travelled to Edinburgh to perform in the military tattoo, played rugby and cricket (...very poorly), debated and made lifelong friends. My mother made me work every school break and I have since found out, would ask the employer to reduce my pay to make me appreciate the value of money. I was paid $2.20 a day as a bowser boy and my lunch of a hamburger and soft drink would cost $1.65...it may explain why I was so conscientious with my studies! My father provided no financial assistance, but I applied for and received assistance from the government to attend medical school at the University of New South Wales.
I supplemented the government assistance by working as a barman and then, after offering assistance to the hotel manager during an altercation with a drunken patron, as a bouncer, which gave me a substantial boost in my salary. I am proud of the many jobs I had before neurosurgery, milk‐run boy, bowser boy, gardener, apprentice mechanic, barman, bouncer, electrician’s assistant. It was in fact during these times that I was exposed to and fell in love with the quintessential Aussie. In those days, my view of an Aussie was someone who was hard working, unaffected, genuine, affable, relaxed, egalitarian, irreverent and charitable. I still believe most Aussies share these appealing qualities, although I am saddened by the increasing incidents of rage in our society. Once there was only road rage but now it seems to have spread into the workplace, the malls and even the last bastion of the laid‐back, free spirited Aussie, the surf! I don’t wish to trivialise the adversities of everyday life, but when a mother has just lost her son to brain cancer, or a husband his wife, or a daughter her father, and I see this 7 days a week, 365 days of the year, it makes the driver who overtakes on the left or the surfer who cuts in on your wave, seem so inconsequential.
I am sure, if you are one of those angry people, if you could spend a day in my shoes, you would rapidly attain a more realistic perspective that the most important determinant of happiness is our health and the health of our loved ones. Brain cancer kills more children than any other cancer, more women under the age of 35 than any other cancer and more men under the age of 44 than any other cancer. It is totally indiscriminate and accounts for more person years lost than any other cancer. I am forced to deal with these statistics on a very human level every day. But quite separate to giving me a balanced perspective on life, I am in awe of the dignity and courage that my patients consistently demonstrate in their struggle with cancer. Not that my overseas patients are that much different, but the Aussie spirit is as impressive in the living as it is in the dying. To raise money for my Foundation, the Cure for Life Foundation, I have had the honour of talking to people from many walks of life, from miners in Muswellbrook, to fisherman in Hervey Bay. I am constantly overwhelmed by the generosity of my fellow Australians who dig deep when made aware of the worth and importance of this cause.
My university years were full of fond memories. I was lucky enough to be financially secure with my job as a bouncer at Centrepoint Tavern and later the New Chevron Hotel. Dealing with the intoxicated Aussie wasn’t quite the positive experience I had doing the milk run but once again, the trials of working in the service industry was a priceless lesson in life. I acquired a newfound respect for police officers. They have had and will always have my unconditional support. Indeed, the real heroes of our society are those who work diligently behind the scenes. I have also had the pleasure and honour of working closely with the tireless and self‐sacrificing individuals in the medical world. They are the nurses, without whom I would be unable to offer my patients such quality care, the paramedics who are at the emotionally taxing coal‐face, the hospital volunteers who are truly selfless and my fellow doctors, most of whom dedicate their lives to the betterment of their fellow man.
The nobility of our profession is unparalleled. I never cease to be amazed by the trust that my patients place in me, a total stranger, at a time when they are most vulnerable. The privilege of operating on the very organ that defines the essence of that person, their mobility, comprehension, communication, vision, motivation, sensations and even their vital functions is unique and humbling.
Spending 9 years in the USA was an enlightening experience. Before I went to America I had an unresolved internal conflict on the issue of immigration. My parents were immigrants, my Godparents were immigrants and many of their friends were immigrants. As a child growing up amongst immigrants and die‐hard, true‐blue Aussies in blue‐collar Picnic Point, I feel I am somewhat qualified to offer comment on the issue of refugees. I was proud that Chinese never featured in the tabloids or the evening news. I wanted it to stay that way and I thought that limiting the number of Chinese entering the country would ensure the bad ones would be excluded. I felt Australia was such a great place to live, in no small part as a result of its isolation, not despite it. We appeared to be immune from World Wars, border conflicts and dwindling natural resources. Why would you ruin this blissful isolation by allowing “queue jumpers”, potential criminals, into our Utopia? My time in the USA made me reflect on how a country that was not that much older or bigger than ours had achieved such a standing on the world stage. In general, Americans were not more intelligent, diligent or talented than Australians. They have natural resources, so do we. Their pioneers did it tough, so did ours. They had a national pride, so do we. Speak to most Americans and they will be the first to concede the dependence of their economy on the hard‐working and fiercely loyal Mexicans.
Speak to almost any taxi driver anywhere in the 50 states and you will be inspired by a story of tragedy and conflict followed by hope and opportunity and concluded by a statement of national pride...in America NOT their country of birth. I don’t know for sure, and I don’t think anyone knows for sure, but, having lived in the USA for 10 years, I would be hopeful that our country would benefit from immigration of peoples from countries of conflict, or those subjected to political persecution, who are simply seeking refuge from violence and a better life for their children. I believe Australia has a moral and social obligation to demonstrate a higher level of kindness to and acceptance of refugees. I don’t know how this may be achieved but I certainly know that both sides of the political fence are floundering. I would humbly suggest that a bi‐partisan approach would be one step closer to a solution and we need it now!
The USA does one other thing very well....it encourages scientific curiosity and innovation. After I completed my fellowship in paediatric neurosurgery and before I ended up in Arkansas, I wanted to return to my homeland. I wrote to every senior neurosurgeon in Australia whilst I was working in the USA in the hope that by sharing my dreams and relaying the magnificent experience I was getting in the USA, they would offer me a job back in Australia. Alas, the story was the same, only the names changed.....”.....I am so pleased you are enjoying your time in Dallas. Unfortunately there are no opportunities now or in the foreseeable future. It would be better for you to make your future over there. Kindest regards”. I was reassured that if I published at least 3 peer‐reviewed articles every year, I would be so well qualified academically, they would be obliged to give me a job. So I worked tirelessly for the next 9 years. I published 79 papers, wrote 27 book chapters, made over 200 presentations and pioneered minimally invasive neurosurgical approaches. I was courted by industry as well as many of the finest universities in the USA. I became a consultant for a German company that produces over 70% of the world’s surgical instruments who encouraged and rewarded my adaptation of precision technology to keyhole approaches. For my hard work I was promoted to Associate Professor and interviewed for “Chairman” positions at 2 acclaimed institutions. A senior Australian neurosurgeon, Dr Bernie Kwok, a man of rare vision and integrity, visited me in Little Rock and was impressed with what he saw. He suggested I return to Australia with his blessing and support. However, it became rapidly obvious that others would not share his vision for Australian neurosurgery.
Maybe it was the tall poppy syndrome, maybe it was the conservatism of the profession. When I was the only applicant for positions at two of the Children’s hospitals in both Melbourne and Sydney, the positions were withdrawn. Since returning I have had obstacles placed in my way, but that hasn’t lessened my resolve to offer the Australian public the latest and most innovative cancer treatment in the world. Don’t get me wrong. The vast majority of doctors are caring and skilled, giving their patients the best treatments available. They are and should be held in high esteem. Unfortunately, a small number of doctors have forgotten the nobility of our profession, more concerned with their own empire building than patient care, confronted and insulted when patients request an explanation or a second opinion, unwilling to adapt to change and new treatment regimens and failing to continue self‐education. This should never be allowed to happen. A selection system that identifies a caring nature and good communication and inter personal skills in medical school applicants would be one step in the right direction. This would be difficult but we shouldn’t give up finding a better way of selecting doctors and then nurturing their compassionate side.
I am at an enviable stage of my professional life. With my international reputation I am fortunate enough to be invited to lecture, operate, direct courses and spend time in foreign neurosurgical programs as visiting professor. I see it as an opportunity to keep abreast of current trends in clinical medicine and basic science research and in so doing, ensure that Australian patients with neurosurgical conditions are getting the very best the world has to offer. An unexpected consequence is that it exposes me firsthand to the enormous disparity in scientific funding between Australia and the USA, Japan, Germany, Sweden and many of the other OECD countries.
My good friend and colleague, Prof. Mitch Berger was recently awarded a SPORE grant of $50 million a year for 5 years to be spent on brain cancer research only. He was so impressed with the volume and quality of work I was doing in Sydney, he sent his chief resident to spend 6 months learning my minimally invasive techniques. When he asked how much funding I received from my government, I was ashamed to say only $150,000 over three years. He was totally shocked. The USA and California specifically has shown tremendous foresight in their approach to scientific research. A recent meeting I attended in California on stem cell research was the perfect illustration of this disparate approach to scientific excellence. I was impressed that the Australian scientists at the meeting could hold their own when it came to innovative ideas and universal knowledge of stem cell therapeutics. I was equally disappointed to hear that our funding of stem cell research, although not as dismal as brain cancer research, was poor.
One of the greatest gifts given to humanity by a few socially responsible corporations and Governor Arnold Schwarzenegger, maybe not on the same level as “I’ll be back”, was a $3 billion grant for stem cell research. Australia has a perfect opportunity to ensure our children and their children will see a bright future. The wealth generated by the current mining boom should be seen as an opportunity to build the foundations of the next boom, the mind boom. We have the scientists. We have some of the most inquisitive minds in the world. We clearly have the resources. All we need is the insight and foresight to put our resources to good use. Of course this has long term benefits in sustaining and growing our economy. As they say, you don’t need to be a brain surgeon to know these things.
Since returning to Australia I have had the privilege of collaborating with some of the best scientific minds in the world. Dr Kerrie McDonald, who heads the brain cancer wing of the Lowy Cancer Institute, Professor Phil Hogg at the University of New South Wales, and many others, lead the world in their innovation and curiosity. They do so at times at the expense of their personal lives, with few accolades or acknowledgments and poor funding and remuneration. Many have left for greener pastures; many have been culled through lack of funding. These are the unsung heroes.
These are the minds that will take Australia from being the greatest place to live, to being, simultaneously, the greatest place to work. We have a history of being able to identify talent, nurture it and reward it. We have done it so well in the sporting arena, there is no reason we can’t do it in the scientific arena. Steve Waugh is an iconic Australian. At an early stage his skills were identified and nurtured. He was rewarded by the Australian public as Australian of the Year and as an officer of the Order of Australia. He has inspired generations of Australian children and has given back to the world, through his charities, in innumerable ways. He is, on top of all of that, an incredibly humble man. He would be the first to acknowledge that he is no better an Australian than Kerrie McDonald or Phil Hogg. If we take this winning template that we use for talented sportsmen, and translate it to our talented scientists, Australians will benefit immeasurably now and in the future. One day we might have two AIS, one for sport and one for science.
Indeed, with diminishing resources and a technological revolution, it may not simply be good for our country, it may be necessary for our country. And medicine is only one field in which Australians may lead the world. Recently I have had the good fortune of being involved with Voiceless, an organisation that is campaigning to have animals treated with respect and compassion. Inspired by the passion of the Sherman family, Voiceless is working to ensure that animal protection is the next great social justice movement.
A few years ago, Barry Kelly, another Australian icon, one of the first RAAF fighter pilots ever to be invited to train at the Top Gun academy, was diagnosed with an inoperable brain tumour. Facing deadly forays was part of his daily routine but, with 3 beautiful young children and an unknown enemy, he was about to face his deadliest encounter. Supported by his wife Jill, he rejected the grim prognosis given to him by his doctors and asked if I could remove the tumour. Courageously, he chose the path less trod, had the tumour removed and is alive and tumour free today.
In true Aussie spirit, not one to take and not give back, he has made the largest personal donation to the Cure for Life Foundation and continues to support brain cancer research passionately. But I am most indebted to Barry for asking me to join him in walking the Kokoda track. Initially I saw it as an exercise in male‐bonding and a physical challenge. But having walked the track with Charlie Lynn who explains the military history and significance of the track, I honestly believe it is a necessary part of being Australian. Kokoda serves as a cogent reminder of our responsibility to fellow Australians and fellow human beings. Our forefathers sacrificed their lives for our current way of life. Young boys lied about their age to fight for this country. The track is full of stories that illustrate the sacrifice, courage, endurance and mateship that contributed to the success of the campaign and the freedoms that we enjoy today.
Australia is a great country. Although my professional career might have been smoother in the USA, my roots are here, the people with whom I relate best are here and my future is here. Generations of Aussies before gave us the foundations onto which we may construct an even greater nation. One that is both culturally and socially sensitive and tolerant, one that acknowledges a responsibility to our own people as well as our near and distant neighbours who are less fortunate than us and one that identifies, nurtures and rewards scientific, economic, technological and environmental curiosity and innovation.
We have the potential to reverse the preconception that one needs to go elsewhere for the best medical care. I have had the privilege of teaching neurosurgeons from all over the world, including the Karolinska Institute in Sweden and Johns Hopkins University, Stanford University and UCSF in America. Patients fly in from every continent to get the most minimally invasive neurosurgical procedures and I am able to disseminate that knowledge to surgeons from developing countries. I hope that I may serve as an example of what Australians may achieve with the support of fellow Australians. I reassure you that if we give our scientists the same support, emotionally and financially, Australia and the world will reap the benefits. I would like to see this Australia Day as a turning point. I want my fellow Australians, those who were born here and those who have immigrated here, to pause and think of the lives that have been sacrificed for what we take for granted today. I want everyone who finds themselves angry and intolerant to think first about the misfortunes of those who are less fortunate...such as those with cancer. I want anyone who has come from another country to embrace the Australian way of life, it has served us well.
I want all Australians to see how immigrants have contributed to our nation and to appreciate that a rich and prosperous country such as ours has a moral and global responsibility to share our resources. Finally, I want to thank Australians for giving me professional and personal fulfilment, for believing in me when some of my colleagues didn’t, for seeing a Chinaman as an Aussie, not as a foreigner and for this wonderful opportunity to address the greatest nation in the world.
Dr Teo is an internationally acclaimed neurosurgeon and a pioneer in keyhole minimally invasive techniques. He has been invited to many distinguished universities in over 50 countries as Visiting Professor, including Johns Hopkins, Vanderbilt and Stanford Universities in the USA, Marburg University in Germany and the Karolinska Institute in Sweden.