UNDER OBSERVATION

As details of Sabeel and Kafeel’s alleged al-Qaeda links and their botched bombing campaign in London and Glasgow trickle out, the Indian medical community is in a state of ‘‘shock and disbelief’’, as Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin (BAPIO), puts it. ‘‘We feel terrible and worried about a possible backlash.’’ Luckily, so far there have been none, he admits.
The BAPIO, says Dr Mehta, will support the sterner background checks on foreign doctors as proposed by Prime Minister Gordon Brown, who worked hard to rubbish racist allusions in the tabloid press. Others of his professional community are with Dr Mehta on the need for more stringent checks.
‘‘These events will result in closer scrutiny of doctors from the Asian subcontinent. But such a thing is necessary to avoid similar calamities in the future,’’ says Dr G. Raghuraman, organising secretary for the British Association of Indian Anaesthetists, Heart of England NHS Foundation Trust, Birmingham.
But even with the recent racist slurs, it is widely acknowledged that Indian doctors are intelligent, honest and hard-working. In some of London’s largest hospitals, the Indian presence is simply overwhelming. A look at the duty roster in the oncology department of the West Middlesex hospital I went to revealed a vast majority of Indian names.

Run on a whopping annual budget of £93 billion, the NHS is the third largest employer in the world after the Chinese Army and the Indian Railways. Set up 1948, it was a product of post-war socialist utopia—a unique health care system available to all ‘‘free at the point of delivery’’. According to Niall Dickson, the chief executive of the charitable foundation King’s Fund, the NHS is ‘‘the greatest social achievements of the 20th century with its promise to care for the British people from cradle to grave.’’

Free healthcare soon became a national obsession. An ambitious programme of hospital construction was launched. But Britain didn’t produce enough doctors, so it looked at their former colonies.
Interestingly, it was the Conservative Health Minister, the anti-immigrants Enoch Powell, who in 1963 opened up the NHS to Indian doctors. By the mid-’60s, 18,000 foreign doctors had arrived in Britain. The kind of influx shocked even Powell and five years later in 1968, in his infamous ‘Rivers of Blood’ speech, he warned of the dangers of unrestrained immigration.

So what got so many Indian doctors to join the NHS? According to Dr C.G. Nanda Kumar of the Huddersfield Royal Infirmary, ‘‘This was the best medical system in the world. The salaries were high, specialist training was rigorous and we spoke good English and fit in better compared to Chinese and European doctors’’.
Getting into the NHS was easy but the inductees were in for difficult times. Most of the Indian doctors arrived in Britain hoping to work in premier hospitals. But they were shepherded to crime-ridden inner cities or to the small rural communities like Rhondda Valley of South Wales, where English doctors didn’t want to go.

A few years ago, Julia Foot’s documentary on BBC traced the history of these ‘‘unsung and forgotten heroes” who later became of the backbone of the NHS. These doctors with unEnglish names—Krishnamurthis, Bhattacharyas and Bodiwalas—aroused curiosity in the mining areas of Wales. Residents here had never seen black faces, except of those coming out of coal pits. And the numbers grew astonishingly quickly. At present, an incredible 73 per cent general practitioners in Rhondda Valley are south Asian and in neighbouring Cynon Valley, the figure stands at 71 per cent.

The doctors were up against a wall of multiple prejudices. Films and stand-up comedians made fun of their thick accent. There were special trainings on how to speak about unmentionable body parts, such as buttocks. There were constant complaints about ‘‘garlic-smelling’’ Asian colleagues in the ward and they were ridiculed for etiquettes, like nodding to seniors with the slavish ‘Yes Sir’.

According to Dr Bashir Qureshi, who came from Pakistan in the early 1960s, ‘‘If a job came up, the English person would get it first, followed by the Scot, the Welshman, the Irish, the Pakistani, the Indian, the Sri Lankan, the West Indian and then the African. This was regardless of qualification—but it meant I knew I would get the fifth job to come up.’’

In June 2004, Dr James Johnson, chairman of the British Medical Association, made a candid confession that the NHS had ‘‘a shameful record of exploitation’’ of overseas doctors. He praised doctors from India, Pakistan and Bangladesh who had been the mainstay of the NHS for the last 40 years but received ‘‘scant acknowledgement’’ and suffered ‘‘outright discrimination’’. ‘‘Never again,’’ said James Johnson, ‘‘must we create a career cul de sac for doctors and then compound the error by trapping our overseas trained colleagues in it’’.

Indeed, professional life was hard and career progression slow. Junior doctors not only languished in small, rural hospitals, they were expected to work for up to 80 or 100 hours a week. Since then, things have improved. ‘‘The system is much fairer now,’’ says Dr Nanda Kumar. Doctors today don’t face the problems their predecessors faced. ‘‘The new crop of Indian doctors is more confident and better trained as training standards in India have improved considerably,’’ says Dr Hilal of the West Middlesex hospital, London.

With UK’s ageing and health-obsessive population, the NHS is a politically sensitive issue. Conservatives lost power because they cut down investments in the NHS. The Tony Blair and Gordon Brown governments have pumped in a lot of cash. Since the arrival of the Labour party in 1997, more than 15,000 doctors and 50,000 nurses have been recruited. More than 70 new hospitals have been opened. The average waiting time for surgery has been reduced from 10 months to three. In the last 20 years, life expectancy has gone up by five years and the death rate has declined by 8 per cent.

Yet, the NHS is proving a bottomless pit. Experts believed it would not be able to meet its ‘‘cradle to grave’’ commitment due to rising costs. When the crunch came, foreign doctors were to be the first to be affected. In April 2006, the government introduced a system of mandatory work permits for all non-EU doctors, which made it tougher for Indian doctors to work there. Today fewer Indian doctors take the plane to London. An estimated 5,500 doctors went to England in 2005, but the number dropped to about 2,000 in 2006, and to a few hundred so far this year. The Indian Government has taken up this matter with the UK Government.

A legal challenge by BAPIO failed in the high court. Despite a pending appeal, many believe that this is the end of the historical link that the NHS has had with India. But a medical degree is still the favoured profession of British NRIs. According to an estimate, at least 30 per cent of UK’s new medical graduates are of Indian origin. So the new breed of Indian doctors may not all be from medical colleges in Patna and Lucknow. But hospital rosters will still have Krishnamurthis, Bhattacharyas and Bodiwalas. Only of course, they will be under greater scrutiny than before.

With inputs from Jayanth Jacob in New Delhi