2023-11-26 16:01:13
Marcos Rust Moreira, doctor specializing in Internal Medicine and Infectious Diseases
In 1984 I heard the word “gay cancer” for the first time. At that time, the origin of a new lethal disease that affected the homosexual community, later recognized as an infection, and which was called Acquired Immune Deficiency Syndrome or AIDS, was not known. This syndrome had always intrigued me and I was extremely curious to understand everything that happened to the body of an infected person. Ten years passed, I entered the School of Medicine at the Federal University of the State of Rio de Janeiro-Brazil, a university whose university hospital was a reference center for the treatment of people living with HIV at that time, as well as other infections, such as Hepatitis and HTLV. I did it with the intention of learning Medicine in a reference center for Infectious Diseases.
Throughout the medical course we had the privilege of learning from patients living with HIV. Because treatment at that time was not efficient, patients suffered from the most diverse conditions, and were distributed throughout the hospital, in all specialties. I learned not only Medicine, but also infectious disease, a specialty that fascinated me from my first contact with it. I still have the intense memory of my first patient as a student, a 79-year-old patient, who lived with HIV and was treated for cryptococcal meningitis. At that very moment I decided to become an infectious disease specialist.
Currently, Spain is the only country in Western Europe without official recognition of Infectious Diseases as a specialty.
After finishing my training in the specialty in Brazil, I decided to change and exchange with other specialists; a way, I thought, to enrich my knowledge. Being trained in Infectious Diseases in Brazil is a privilege. Given the continental size of the country, combined with the most diverse climates, you can have countless diseases caused by various agents. The hospital infrastructure in the large urban centers where I had the pleasure of working makes this specialty in Brazil comparable to the best-known centers worldwide. With the intention of sharing all this knowledge with countries that did not have this variety of agents and, therefore, diseases, I decided to leave. The chosen destination was Germany, the land of my ancestors and where I thought that due to my citizenship everything would be easier.
The first shock arose during the homologation of my documentation, when they explicitly told me that they might not recognize my specialty, because in Germany Infectious Diseases was not a specialty, but a branch of Internal Medicine. My reaction was to be stunned. I didn’t understand it as the most interesting, and one of the most diverse specialties might only be seen as a sub-specialty. Even so, I decided to continue and share all my knowledge in the various areas of infectious disease with the Germans. At first I was not very well accepted because in Germany, everything that comes from abroad (fremd) is viewed with skepticism, and it is necessary to work a lot to demonstrate your ability as an infectious disease specialist, a specialty that they did not understand very well, even though the country has given so many world-known names in the area such as Robert Koch, Paul Ehrlich, Rudolph Virchow, Alexander Yersin and many others.
“Infectious diseases is one of the most brilliant specialties in all of Medicine”
In order for my specialty to be recognized as a sub-specialty, I had to take an exam so that they might give me the title of Internal Medicine and thus, if I passed, they might recognize my title as an infectious disease specialist. So I did. I passed and since 2014 I have also been an infectious disease specialist in my sub-specialty. After almost 10 years of struggle in Germany, the specialty was finally declared official in October 2022. All people who were specialists in Internal Medicine with more than 3 years of experience in Infectious Diseases might register for another exam which, if they passed, They might finally obtain the title of Infectious Disease Specialist.
After all this time and following many bureaucratic struggles, I obtained a position in which I finally felt recognized. I was delighted to be responsible for the Infectious Diseases fellowship program of a network of 7 Hospitals in Berlin. The fellows who were already specialists in Internal Medicine had to be trained for another 3 years so that they might take the exam that would evaluate their abilities to become infectious disease specialists. After several years, private matters encouraged me to move once more. Living in a long-distance relationship made me have to look for a new job in a new country, Spain. Country that I admire, that I know better than mine, where I can speak the language fluently, I know literature, cinema, music, art.
After almost 10 years of struggle in Germany, the specialty of infectious diseases was finally declared official in October 2022
Unfortunately, it is currently the only country in Western Europe without official recognition of Infectious Diseases as a specialty. I think: “Could it be karma?” Will I have to fight throughout my career as a doctor? Still, I decided to try it. I sent my resume to several heads of the Infectious Diseases sectors in several Spanish cities. All of them, in relation to my experience in various sectors of Infectious Diseases, were extremely kind in praising me, although they were all very sorry not to be able to hire me given that the specialty of Infectious Diseases does not yet exist in Spain.
Every day I read articles published by Infectious Diseases services throughout Spain, both in my area of specialization and in others. I always wonder why I can’t also be there contributing with my 25 years of experience in this field, having worked in 3 different countries, and speaking 4 languages fluently. I still have hope. I continue to try and believe that Spain, one of the countries with the largest number of scientific articles published in the area of Infectious Diseases, will also one day, and let it be brief, recognize this, which is one of the most brilliant specialties in all of Medicine.
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