Russia-Ukraine War Shows Foreign Medical Students’ Struggles & Stigma in India
It would be in our national interest to create a streamlined system for foreign medical graduates in India.
In the fast unravelling situation in eastern Europe, a lot of collateral attention – as well as damage – has been received by foreign medical graduates, leaving many scratching their heads and leading to question such high numbers of aspirants going abroad to Eastern Europe and Southeast Asia.
But for any young student who went abroad to pursue MBBS and is now caught in a bunker with rockets shooting overhead, the experience has turned into a deadly Molotov, to understand the ingredients of which we must rewind a little.
The time is 1991-92. With the advent and repeated accentuation of Mandal politics in India, the already very limited seats for the much sought after MBBS, especially for general category students, suddenly get reduced by half, and the numbers look well set to plummet even further, leaving many genuine aspirants in the lurch.
At the same time, approximately 3,000 miles away, India’s strategic partner for decades, the Soviet Union, collapsed, leaving many middle-class physicians, medical faculties and future medical aspirants in economic distress, unsure of their future.
An Upcoming Market Meets Demand
What followed over the course of the next decade was thus a perfect marriage of convenience between an upcoming market and skyrocketing demand. In other words, Russia & some former Soviet states became for aspiring doctors what Canada is to Punjabis and the Middle East to Kerala. However, before going further to explain why the erstwhile Soviet Union became a popular destination among medical students, it is also important to go back a little.
Along with its growing reputation and credibility in modern-day science such as physics, space technology, etc, the USSR had also made big strides in medical research, gained respect and recognition in medical circles worldwide, and had established the widely renowned Academy of Medical Sciences. Among a long and formidable list of physicians, such as Dr Pirogov, Dr Sergie Botkin, Dr Korotkoff, Dr Metchnikoff and many others, the USSR also had to its credit Nobel laureates in medical sciences, like the widely respected Dr IP Pavlov in 1904, whose research in physiology and conditioned reflexes is taught across the world today.
In 1952, the research of Dr Selman Waksman, a Soviet American microbiologist, led to the discovery of antibiotics such as Streptomycin. Dr Ilizarov’s great work in orthopaedics has and continues to attract many students from across the globe, too.
Therefore, in the backdrop of all this and with close ties, before 1991, too, there were medical student exchange programmes. A small number of Indian students underwent MBBS in the USSR and even vice-versa, some of them on state support and some on their own. Given this, parents, aspirants and, in fact, the then-Medical Council of India were comfortable with Indian students pursuing MBBS in the erstwhile Soviet Union and returning to practise here.
New Business Opportunities
However, after the political tremors in 1991-92 and their after-effects, and especially due to economic distress as well as a much smaller population, Russian medical colleges – which were all government-owned – saw a drop in the number of domestic applicants. They also found it difficult to continue to pay salaries to their doctors and staff in these colleges and affiliated hospitals.
At this juncture, many erstwhile students, including Indians, smelled new business opportunities, which such crises invariably bring along with them. They proposed to universities in Russia to set aside some seats for international students at legally sanctioned, slightly higher fees, which would not only bring in the much-required finances to institutions but also to the markets and cities. Such a proposition would make even Dr Pavlov’s dogs intellectually salivate.
Obviously, these enterprising individuals also simultaneously inked contracts and became agents who scouted students in India to send them to Russia, after charging them a high fee. Given the language difference, the agents would also help the students apply for visas and get settled in their new surroundings. However, in the next decade, the Russian government faced its own turmoil, combined with the emergence of many new and largely unregulated agents.
In a bid to increase their numbers and commissions, the agents started sending some students to Russia from arts or commerce backgrounds as well. Some of them would also identify and reach out to pliable college administrators with financial inducements in return for “helping” some students clear exams.
When such students returned to India after completing their education, it created a collective stigma against all foreign medical graduates, as a few of them were unfit to practise medicine.
Expensive Private Medical Colleges
At the same time, the 2000s also saw a boom in the number of private medical colleges; governments found it difficult to afford setting up new ones and also did not prioritise the healthcare sector as it brought little revenue. However, due to strict rules around setting up medical colleges and hospitals, such as the availability of at least 25 acres of land, urban and populated areas turned unviable for private players. This led to the opening up of colleges and hospitals in far-flung locations. Thus, of course, the major source of revenue for these private institutions was students, which led to a huge capitation fee nexus.
Consequently, the demand for foreign shores increased manifolds, as being state-run in most cases, foreign universities were often cheaper than even a government seat in many private colleges in India.
Given the significant numbers involved, it was only a matter of time before numerous other countries such as China, and even a few universities with questionable antecedents, jumped on the bandwagon to lure in gullible medical students from India.
In 2002, the government of India and the erstwhile Medical Council of India came up with the stringent screening exam, conducted by the National Board of Examinations twice a year, which all foreign medical graduates barring those from the US, the UK, Canada, Australia and New Zealand must clear to gain recognition in India.
The exam is tough and the average passing percentage has since hovered around 20%. This has given further wind to unnecessary generalisation, and, unfortunately, stigma against foreign medical graduates.
Why the Bias Persists
Though there are approximately half a million students who haven’t managed to clear the screening exam, it should be noted that nearly a lakh have indeed cleared it. Many of them have gone on to pursue post-graduation and fellowships, and have established successful careers as doctors not only in India but also abroad, including in highly reputed institutions ranging from the Armed Forces and the AIIMS in India to the NHS in the UK, and even Johns Hopkins in the US.
Many of them have published peer-reviewed research articles, addressed international conferences, become postgraduate teachers and also received numerous awards, including for yeoman services during the COVID-19 pandemic. Sadly, despite all this, the bias against foreign medical graduates in India persists.
Thus, the situation of foreign medical graduates and the reasons behind their high numbers are very nuanced. It would perhaps be in our national interest to create a streamlined system for them. It would also be far more prudent to ensure that a common licensing examination is held for all doctors as in the West, and at the same time, unnecessary and illogical barriers, such as a double internship requirement that was introduced recently by the National Medical Commission, are done away with.
(Dr Saurabh Sachchar is a Consultant Radiologist. He tweets at @dr_sachar. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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