Simon is right. So is EBR.
Its not complicated to train doctors. Its manpower intensive and takes 7-10 years depending on your system, but its neither complicated nor does it require high technology. Common ailments can be handled by a doctor or surgeon with training; you dont get the same standard of care as in a First World nation, but you work with what you have.
Sure, if you get something that requires expensive screening, or expensive treatments, the patient is fucked.
If you have organ failure and dont have the connections for foreign treatment like 99% of Vics, you're gonna die. If you have a stroke, odds are that by the time you get medical attention the damage is done. If your kid is born with congenital issues, they live or die based on a flip of the coin.
Cancers, neurological damage, serious traumatic injury, most emergencies, survivable illnesses that require temporary life support like mechanical ventilation or dialysis? All death sentences.
But most people dont have those. And that majority can be treated.
But like EBR said, in the absence of doctors, other personnel fill in, officially or not.
Ethiopia has been running a successful program to train selected nurses as Emergency Surgical Officers to help backstop their doctors in rural areas; a year of classwork and I think twelve to eighteen months of field work, and they are trained to handle some of the commonest surgical issues from cesarean section to appendicitis.
I honestly don't think the Victorian medical establishment is necessarily that bad... or rather, I'm pretty sure it's got levels.
...
Level one is actual foreign-trained doctors.
Russia will insist on flying these in to treat actual Russians. But you'll also see them anywhere else in Victoria where foreigners travel (e.g. those 'resorts').
The problem with foreign doctors, well, there are two problems from a Vick perspective.
One is that unless you can get foreigners to pay the entire cost of employing them, they drain Victoria's foreign exchange reserves. And Victoria has a thousand things it needs foreign exchange for (thanks, retroindustry and the deliberate literal gutting of the higher education system!). And their main source of 'free' foreign exchange is Alexander, who, say what you will about him, is probably not a very open-handed paymaster- he expects objective results commensurate with the money he spends. So avoiding having to spend foreign currency on doctors is always good.
Two is that foreign-educated doctors come with ideas. Subversive ideas. Ideas like "slavery is bad" and "beating women up to keep them quiet is wrong" and "John Rumford didn't actually spend five years fighting a heroic Christian crusade at the head of the greatest of his Christian Marines leading the charge of Christendom against the MOSLEM HORDES and valiantly knocking them back before dying heroically, in fact that crusade never happened and John Rumford just disappeared one day." While it is certainly possible to find doctors who can be coerced into... discretion... it's generally risky to coerce a doctor who works on important patients. Likewise, you can get discretion by paying more money, but that loops right back to problem one.
This leads to the next level down:
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Victorian doctors trained by foreigners.
Either you bring the medical students to foreign universities, or you bring foreign medical instructors to the students in Victoria. The former presents obvious problems of ensuring the medical students don't defect, so it can probably only be done on a limited scale where arranging such insurance is feasible. The latter is probably easier to arrange. Of course it has costs of its own (see part one of the problems above), but at least at the end of it you've got a man who's learned to fish instead of having to pay a fisherman every day for the rest of your life.
Alexander may help here, among other things because he has satellite nations he can coerce into providing med school professors for Victoria, which serves the further purpose of weakening that vassal state's own medical establishment a bit.
Then, from there:
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Victorian doctors trained by Victorians.
With the actual universities destroyed more or less, this mostly involves doctors who were in master-apprenticeship relationships with the doctors who weren't purged back in the 2030s and '40s. There were almost certainly some of those who survived and did not flee the country, and they probably took on trainees and apprentices who may well be at least adequate by Third World standards.
At least, most of them adequate. Some of them probably very much not adequate.
The actual problem with foreign-trained doctors is that they are trained for a level of resources and support that are unlikely to exist in Victoria.
Someone trained in a system with a boatload of labtechs and nurses in support, where he can refer a dude with loss of appetite to a gastreoenterologist for a gastroenteroscopy and biopsy, then order a full workup of bloodwork, CT scans and the like is not really set up to function in a medical system where all you have to work with is a patient history, physical exam and experience.
Your ability to recognize abnormal test values depends on the tests being actually available.
Let alone if they have to source their own basic supplies like surgical thread, normal saline and ringer's lactate, and spin their own patient's blood in a centrifuge to find out what their hematocrit is.
But you're right that Victoria makes a good faith effort to train doctors.
They have universities to train their elite; Blackwell went to one. They certainly have medical colleges for training doctors before apprenticing them out.
They probably dont have many specialists around, and I would not be surprised if such specialists are trained abroad, but general practitioners? Do your six years or so of formal training, work under supervision for a year or two, and then you can practice independently. Thats the standard in at least some Third World countries today.
