FROM THE PHILIPPINES TO TOLEDO, OHIO
I grew up in Makati City, the Philippines and graduated from the University of the Philippines, College of Medicine. That was a period of substantial tumult, after the Marcos dictatorship in the Philippines. The economic and political climate was not conducive for a fresh medical school graduate.

I originally came over and did my internship at Mercy Hospital in Toledo, Ohio. At that time, it was the height of HIV and I did have some reservations about coming over. But having training in the United States, be it in Toledo, Ohio or Manhattan, it was of a higher caliber than in the Philippines.

In my understanding, (American) students weren't enrolling in medical school and the country wasn't fulfilling its work supply needs, so the United States did rely on a larger influx of foreign medical graduates (FMGs) to cover that service gap in health care.

DECISION TO STAY
I did my emergency medicine residency training at the University of Connecticut, in an inner-city hospital in Hartford. After my residency, things did not change politically, socially and economically in the Philippines as much as I had expected.

So I started scrambling, looking for what we call "J-1 waiver jobs", which are in medically underserved communities. Despite mailing out letters to 500 plus institutions, I had a dismal response. I whittled down my options to two places, Hillsdale, Michigan and Fulton, New York, in upstate New York, and Fulton worked out.

FULTON, NEW YORK
Fulton is approximately 15 to 18 miles north of Syracuse, and one of the most economically depressed counties in the state of New York. The teen pregnancy rate and the unemployment rate were among the highest in the state. It's a small town of maybe 18,000 people. Until recently, it hosted the first Nestle chocolate factory in the United States, this has since shut down. A few years before I came in, the biggest employer was the Miller Brewery. When they left, that kind of broke the town.

It is, I would say, about 95% white. Of the patients that I see in the emergency department, about 30% have Medicaid and about 20% have no insurance, it is a more elderly population. I think the young leave for college and do not come back to rejuvenate the town, so only parents and grandparents are left.

The remaining residents are foreign-born, most are Asian and Middle-Eastern. Because it's a rural area, it does have an agricultural component. So you do have migrant workers, typically Hispanic migrant workers.

The patients themselves, overall, were accommodating, once in a while, you know, you would hear a comment about "your English is good." I don't know whether to take it as a compliment or as something less than a compliment.

I did have some bad experiences. One that really comes to my mind is an individual who said he wanted to see a "real doctor." That is just one example of a hurtful experience that I remember. But otherwise, I would say that is a rarity.

I feel comfortable working in my small town of Fulton, New York. I feel there is still that respect for the physician. Coming from the Philippines, this is one dimension that I still long for.

LAND OF IMMIGRANTS
In this small neck of our woods, the community is being served by FMGs because there are no native American physicians practicing in these communities. We serve a vital role particularly in the rural communities that mainstream America tends to forget when they do their economic analysis.

This country which I firmly believe has the combined heritages of immigrants. FMGs continue this tradition of adding to the tapestry of rich cultures.

Despite the events of 9-11, I believe the United States should not go against its tradition of immigrants. It will deprive its country, its people, of its strength. I strongly believe that misunderstandings and racial crimes can be surmounted by understanding.

BIO
Dr. Cupid Gascon is a Filipino emergency physician practising in Fulton, upstate New York. Dr. Gascon came to the U.S. after graduating from medical school in the Philippines at the height of the HIV epidemic when the country opened its doors to many Foreign Medical Graduates or FMGs. Today, he and his wife, also a doctor, live in a suburb of Syracuse and work at the A. L. Lee Hospital in Fulton.