Since the late 1990s Australian employers have recruited an increasing number of overseas-trained doctors (OTDs) to hospital and "area of need" general practice positions.

In the September issue of the Journal Robinson et a1 [ 19851 reported on a family with the Brachmann-de Lange syndrome (BDLS) apparently inherited in an autosomal dominant fashion. The fact that females with BDLS survive long enough, and can reproduce, was further supported by the report of a pregnancy in a woman with BDLS in the same issue of the journal by Mosher et a1 [ 19851. Another family with dominantly inherited BDLS with variable penetrance was reported recently (Kumar et al, 1985), and the clinical spectrum and causes were reviewed. Most cases have been sporadic; in a number of families autosomal recessive inheritance was suggested and attention was drawn to the fact that the phenotype of dup 3q (3q21+ -qter) is quite similar to that of BDLS.We wish to report another family with dominantly inherited BDLS in which the mother and her two children were affected.The proposita (Fig. 1A,B) was born at 32 weeks gestation weighing 1900 g. At 23 months her developmental age was 10 months. She had microbrachycephaly (head circumference 44.2 cm) and was small, with length (83.3 cm) and weight (9.6 g) at the 10th and 3rd centile, respectively. She also had hyperplastic eyebrows with a medial flare, long curly eyelashes, bilateral ptosis, small nose with anteverted nostrils, long upper lip, downturned mouth with thin vermilion border, and large, apparently low-set ears. The thumbs were proximally set with bilateral 5th finger clinodactyly and left talipes equinovarus.Her younger brother, age 8 months, was also delayed in development. He was born at term weighing 3370 g. He was able to fix and follow visually and was just starting to roll from prone to supine. He had microbrachycephaly (head circumference 42 cm); length (66.7 cm) and weight (6.7 kg) were on the 3rd centile. He had hyperplastic eyebrows, long eyelashes, nystagmus, short nose, downturned mouth with thin vermilion border, and micrognathia ( Fig.2A,B). The ears were large but normally set. The thumbs were proximally set with radiological evidence of short 1st metacarpals.

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Like Canada and the United States, Australia has encountered increasing difficulties in regulating international migration movements. Australia's physical isolation and rigorous entry procedures have limited the arrival of undocumented migrants to a trickle. But the number coming as students, visitors, and under other short-term visas who subsequently overstay these visas and apply to change their status to permanent residence while in Australia has increased sharply since the early 1980s. The management of these claims has proved difficult because of judicial leniency and the advocacy of humanitarian and ethnic lobby groups. However, since the late 1980s, the Australian government has introduced a series of tough legislative and administrative measures that appear to have significantly diminished the problem. These measures have been much tougher than those enforced in North America. It is argued that this Australian response can be traced to the heritage of control that has shaped Australia's immigration policies and Australians' conceptions of themselves as a nation.