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Going Home

August 23, 2002 at 12:00 AM EDT
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FRED DE SAM LAZARO: Foreign-educated physicians are a staple in inner-city hospitals and in rural areas. They’re needed because their U.S.-educated counterparts don’t want to serve in those locations and American medical schools don’t graduate enough doctors to fill all the open slots. The use of foreign doctors may serve a critical need in the U.S., but what does it do for their home countries? Washington, D.C. physician and author Fitzhugh Mullan says the result is a brain drain from some of the world’s poorest nations.

DR. FITZHUGH MULLAN: By not educating enough of our own people to fill our own needs, we borrow, to put it kindly, from India and elsewhere, from their educational systems, from their families, from their national, intellectual wealth.

FRED DE SAM LAZARO: But to the foreign medical graduates, it is the culmination of a lifelong dream, says Dr. Abraham Verghese, physician and well-known author, who runs a medical humanities program at the University of Texas in San Antonio.

DR. ABRAHAM VERGHESE: I think every medical student in India is aware of the possibility of coming to America. It looms as an almost mythical quest that many people embark on, and there are some schools where fully 20 percent to 30 percent of the class will expect to wind up in America and perhaps more than 20 percent.

FRED DE SAM LAZARO: St. John’s Medical College in Bangalore is one of India’s top institutions. It was opened in the 1960s by India’s Catholic leaders with German and American aid. St. John’s was set up to serve the poor, especially in rural India. However, with the exception of nuns and priests for whom some slots are set aside, many, and in the earlier years almost all, of St John’s graduates quickly left for the West. St. John’s has worked to change the students’ attitudes. This group of freshmen spent their first day of orientation in a village, serving the held needs and learning about an impoverished lifestyle that they rarely see.

SPOKESMAN: You should ask the mothers — would you like her to be educated…

FRED DE SAM LAZARO: They return several times during med school and rural service after graduation is mandatory, a condition of their admission, says Dr. Dara Amar, one of the few members of this St. John’s class of ’73 who didn’t leave for the West.

DR. DARA AMAR: After graduation for two years again, we ask them to go and work in any of our mission hospitals throughout this country. So we have these interventions at various points in their career at the village itself, hoping that this will give them a very practical insight into what the whole thing is about.

FRED DE SAM LAZARO: But if recent history is a gauge, at least half of these students will renege on their rural service commitment. They’ll have to forfeit a bond of about $5,000: Big money in India, but not much for a doctor in the west. We gathered this group of seniors to a pizza parlor near campus and asked how many planned or hoped to go abroad.

STUDENT: I guess it’s a lot to do with newer areas like genetics, immunology, these fields where doctors are now getting into are not that well developed here.

STUDENT: It could be financial, because each dollar is equivalent to 40-odd rupees, so you get rich in India but you get filthy rich if you go to the United States.

STUDENT: I would be lying to you and lying to myself and lying to my god if I said I’m gonna serve the poor, I want to be in the village. No, I’m not gonna do that. I like to help out but that’s it. I’m not gonna get involved with it 100 percent.

FRED DE SAM LAZARO: One solution at St. John’s has been to save 25 percent of its coveted slots for priests and nuns, people who took a vow to serve the poor long before they’ll take their Hippocratic oath. But even among the rest of the students, they say increasingly there’s a desire to eventually return home in a few years, with top expertise and a solid nest egg. I asked this group how many planned to come back after going abroad.

STUDENT: We owe a lot to India. All of us are unanimous in that.

FRED DE SAM LAZARO: But Dr. Thomas Chandy, one St. John’s alum who did return in the early 1990s after years as an orthopedic surgeon in Oklahoma, says those good intentions can give way to new realities.

DR. THOMAS CHANDY: I think many people, when they go to the U.S., they have the intention of getting a good education and coming back, but what happens in the meantime is that when they have a family and they settle down, they do get used to the life, and they do get used to the excellent professional environment, and it is difficult to leave that and come back.

FRED DE SAM LAZARO: Chandy says getting started in India involved difficult bureaucratic dealings, as well as mundane concerns, like erratic utility service. Still, he managed to establish a sophisticated sports medicine center in Bangalore, and he set up several orthopedics and arthritis foundations.

DR. THOMAS CHANDY: In India, I don’t think you will make much money. Just trying to break even is a struggle, but we are able to provide the newest technology, that I was able to bring with my education there, and I did acquire a lot of equipment, which I brought down and is being well-used here. That gives me a lot of satisfaction.

FRED DE SAM LAZARO: But there’s another problem for doctors who would want to return. Many basic amenities, like roads and water, to say nothing of any social life, are simply not available in rural areas, where care is critically needed. So those who do return often find themselves serving sections India’s population that are better off than some they served in America.

DR. ABRAHAM VERGHESE: The naive assumption is that if you go back, you can immediately cater to the needs of the most deserving over there, and the fact is it’s really not set up that way. The Indian government has certain limited resources and if you wanted to survive there, you would either have to do private practice, catering to the rich Indians and the Saudis who don’t have quite enough money to get to London but can come to Bombay, Delhi or Madras, or you’d have to be moved by a missionary zeal that 99 percent of us don’t quite possess.

FRED DE SAM LAZARO: Verghese says just having doctors return home won’t work to solve India’s health care problems.

DR. ABRAHAM VERGHESE: What might work is a collective effort to treat poverty as a disease, and I’m impressed with the efforts of many foreign physicians to not just go back and perform 16 kidney transplants and 200 cataract removals, and then come back, but to try and set up something more lasting in a village, in an overcrowded urban ghetto, and efforts like that are taking shape.

FRED DE SAM LAZARO: One example is the L.V. Prasad Eye Institute in Hyderabad. Ophthalmologist Gullapalli Rao founded it in 1986, coaxed back home from Rochester, New York, by a famous film director and philanthropist, after whom the institute is named.

DR. GULLAPALLI RAO, L.V. Prasad Institute: India has a sixth of the world’s population, but it has 25 percent of the world’s blind. So a lot of work can be done in the country, and that was the compelling reason for me to come back.

FRED DE SAM LAZARO: The Prasad Institute does multidisciplinary training and research and the gamut of patient services, from cataract removal to some of the world’s leading stem cell transplants. Well-heeled patients come from across south Asia, and these revenues pay for indigent care. So does strong support from abroad. Dr. Rao defied predictions of his Indian friends in America who said he wouldn’t last here.

DR. GULLAPALLI RAO: Most Indians living in America gave me five years max, that I would be back in Rochester five years time. So fortunately I didn’t ever go back, and I have no regrets. It’s been a fantastic feeling. Enormous gratification.

FRED DE SAM LAZARO: Despite its success, the Prasad facility meets barely a fraction of India’s enormous need, not just for eye care but for institutions that can match the prestige if not the salary of a medical career in America.