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UK: Against All Odds - A Personal Story
From A Kurdish Refugee Doctor
19.9.2008
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September 19, 2008
UK, — A refugee doctor has spoken of his
six-year struggle to begin life again as a doctor in
the sanctuary of the UK.
In this week's issue of BMA News, Sarkell Radha
tells how he has battled with the courts to gain
asylum status, passed difficult but vital English
language tests and ploughed through countless
clinical modules and exams to prove his capability
to work as a doctor in this country.
Now, six years on, the refugee from Kurdistan region
in "northern Iraq", whose experience of racial abuse
in Stockton-on-Tees led him to establish the first
Kurdish community organisation in the area,www.ekurd.net
has begun a specialty
training post.
Dr Radha says: "I was subjected to racial attack
almost every day. This pushed me to establish the
first Kurdish community organisation tackling racism
and working to build confidence among asylum-seekers
and refugees in the area."
In addition to the years of legal struggle, study
and hard work, Dr Radha has not seen his sick father
in Iraq since 2002.
He adds: "I have not seen my dad since 2002. Every
single day he's in my mind."
Dr Radha is among more than 1,200 doctors on the BMA
refugee doctor database,www.ekurd.net
and one of only 14 per
cent of them who are currently working in the NHS.
The BMA's refugee doctor initiative support doctors
working towards GMC registration, provides a
24-counselling service, help in contacting relevant
education organisations, access to the BMA library
and free subscriptions to the BMJ and BMA News.
Full text of story follows:
Against All Odds
The personal stories of doctors seeking asylum in
the UK from countries such as Iraq or Afghanistan
tend to have many common themes. These include the
hardships and frustrations they face and the great
tenacity they display in working towards their
goals, as Flavia Munn reports
SARKELL Radha is the epitome of determination. The
Newcastle ST1 (specialty trainee 1) in orthopaedics
came to the UK from northern Iraq as an asylum
seeker six years ago. Arrest, detention and a court
battle for asylum status didn't deter Dr Radha, who
went on not only to see his immigration application
succeed, but also to pass the difficult but
essential IELTS (International English Language
Testing System) exam, the first step towards
registration and employment in the UK, and PLAB
(Professional and Linguistics Assessment Board) 1
and 2, the clinical exams that most overseas doctors
need to successfully complete to gain GMC
registration. And all this within one year.
Last month, he started his first specialty training
post, having managed to prove he had acquired all
the competencies of FY1 (foundation year 1) and FY2,
again within a 12-month period.
'In one year, I had to make sure I covered FY1 and
FY2 competencies. I did about 60 or 70 online exams
and modules. That year was the most difficult
because I was constantly studying or doing
something,' he tells BMA News.
He adds: 'I wanted to do orthopaedics and I worked
very hard for it.'
This comment is testament to the tenacious attitude
that Dr Radha, who was imprisoned in Iraq, takes
towards his work and studies.
He is one of more than 1,200 doctors on the BMA's
refugee database, yet he is among a minority - just
15 per cent - who are currently working in the NHS,
according to the most recent database figures
published last month.
BMA refugee liaison group chair Edwin Borman says:
'It's a wonderful achievement when a refugee doctor
has been able to re-establish their medical career
in the UK. This gives them the opportunity to
contribute to the country that has given them
sanctuary and to regain their identity as a doctor.
This long and very difficult process can only be
achieved by many organisations working together and
considerable hard work by the doctors.'
Familiar experience
Dr Radha's experience on arrival in the UK is not
dissimilar to that of many other asylum seekers. He
was arrested on arrival in July 2002 and detained
for seven days for terror screening. Then, after his
application for asylum failed, he was sent to
Stockton-on-Tees in the north east of England. Dr
Radha was given shared accommodation in one of the
most deprived areas of the market town, where he
survived on L37 a week.
'I was subjected to racial attack almost every day.
This pushed me to establish the first Kurdish
community organisation tackling racism and working
to build confidence among asylum seekers and
refugees in the area,' says Dr Radha, who also did
voluntary work while he pursued his asylum
application through the courts. In November 2002,
his application was approved.
The Home Office appealed against the court's
decision but Dr Radha, who represented himself at
the immigration appeal tribunal, succeeded after
providing evidence of the injuries he sustained
during his imprisonment.
Dr Radha also worked as an interpreter for a year
and a half, and then enrolled with the North East
Refugee Health Workers Programme,www.ekurd.net
which provides guidance
and support for those working towards their IELTS
exam while looking for clinical attachments. He
joined an English class and within a year had passed
his IELTS and PLAB exams. While waiting for his
status to be confirmed, Dr Radha went to every
hospital within the North East seeking clinical
attachments. He finally gained a clinical attachment
in orthopaedics at Queen Elizabeth Hospital,
Gateshead. While working there Dr Radha visited
other wards to gain further experience and, as a
result of this, gained a four-month clinical
fellowship post in respiratory medicine.
He spent a year from August 2006 as an SHO in
orthopaedics at the Queen Elizabeth Hospital.
In Iraq, he had completed the equivalent of FY2 but,
because there was no way he could get confirmation
of this from his university, he was unable to apply
for specialty trainee 1 posts in the UK and had to
complete another year of FY2.
Although he was over-qualified for FY1 jobs, he had
to prove he had the required competencies normally
gained during the year. While Dr Radha is delighted
to be on track for his dream job as a consultant
orthopaedic surgeon, his route has not been without
personal sacrifice. His father is ill in Iraq.
'I have not seen my dad since 2002. Every single day
he's in my mind and every week I have to speak to
[my family],' he says.
Job-ready doctors
Dr Radha is among the 176 refugees on the BMA's
database in work, but a further 232 - 19 per cent of
the 1,200 on the database - are 'job ready' but not
yet working. These are doctors who have either
passed both parts of the PLAB or are exempt from
PLAB but are not in employment.
Another 85 - almost 7 per cent - have passed PLAB 1
and are waiting to sit PLAB 2, and 162 doctors (13
per cent) have received the required IELTS score of
seven or above, but have not yet passed PLAB 1.
An Iranian doctor based in south London who prefers
to be known as AJ, is a 'job-ready' doctor. He came
to the UK in June 2000 and applied for asylum status
in December of the same year. In September 2001, he
was granted permission to work but a year later his
asylum application was refused. A fresh claim for
asylum was also turned down in 2007.
While waiting for his claim to be assessed, he
studied in the mornings and worked in a shop in the
afternoons.
He passed the IELTS exam in 2003, PLAB 1 in 2004 and
PLAB 2 in 2005, and the same year was shortlisted
for a GPVTS (general practice vocational training
scheme) place but was unable to take it because of
his status.
AJ then worked for around 13 months as a trust grade
doctor on a clinical attachment, a post which the
BMA refugee liaison group (see 'The BMA: a vital
source of support for refugee doctors', below)
helped him find.
The BMA Charities fund also paid L200 towards his
GMC registration fee.
No status
Last year, AJ was offered a place on the foundation
programme but again was unable to take up the post
because of his status. He currently does not have
permission to work. 'I cannot go back to my country
but I don't have any status in the UK,' he says.
UK immigration rules mean that asylum seekers are
allowed to apply for permission to work if they have
not had an initial decision on their asylum claim
from the Home Office after 12 months.
Refused asylum seekers who have exhausted the
appeals process lose any right to work. Doctors who
have been granted refugee status are eligible to
apply for and take up specialty training posts.
AJ, who spent 15 years in jail in his home country
on political charges, was entitled to state aid
until his initial application was refused; now the
only money he receives is from his family in Iran.
His solicitor is still pursuing the case.
AJ's experience has also been compounded by the fact
his wife has depression - brought on, he believes,
by their situation - and his son, aged three, has
suffered some developmental delays. His solicitor
has not had any contact with the Home Office since
February.
AJ says: 'I have contacted the Home Office myself
two or three times to see if there's any possibility
of granting me at least permission to work because I
want to work and I want to contribute to society,
but I have heard nothing.'
More than half of the refugee doctors on the BMA
database are, like AJ, based in London, with the
second most popular area being the North West.
Northern Ireland currently has no refugee doctors on
the database.
The majority of those on the database (77 per cent )
are either asylum seekers, have indefinite leave to
remain or have refugee status and the greatest
numbers come from Iraq, Afghanistan and Iran.
As a result of the difficulties that refugee doctors
experience in the UK, Barnet College in north London
has made changes to the ESOL (English for Speakers
of Other Languages) course it offers to health
professionals seeking work in the UK (see 'Testing
times in English' below).
The English for Healthcare Professionals course has
not only been extended to health professionals other
than doctors, but its students are encouraged to
consider other careers. Students have gone on to
take courses in podiatry and global and public
health.
Course co-leader Debra Farbey says passing the IELTS
exam in itself is a tremendous achievement because
it is difficult even for a native English speaker,
and she adds that the jobs market is also very tough
at the moment.
'I have been here for five years and I think the
students that we have seen over the past four or
five years who are now working as doctors are a very
small percentage but we do have exceptions.
'Last year we had a doctor from Algeria who took
PLAB 1 and 2 within nine months and last month she
started a FY1 job,' she says. Dr Radha is a firm
believer in exceptional cases, telling his refugee
doctor colleagues that to succeed they have to be
twice as talented as any UK graduate. But, even if
they are, they still face a struggle.
Testing times in English
PASSING the vital linguistic tests to practise
medicine in the UK is very difficult, admits a
leader of a course helping doctors to do just that.
Co-leader of the English for Health Professionals
course at Barnet College, London, Debra Farbey is
realistic about the incredible skill and hard work
required to pass IELTS and PLAB examinations.
'Refugee doctors need to pass the IELTS exam, which
is an academic English exam and really very
difficult. They need to get a score of seven. The
highest you can get is nine and that's almost
unheard of, even for a trained native speaker, so
seven is a very advanced level of academic English,'
she says.
That is why course candidates who do not have an
intermediate level of English are strongly advised
to take a general English course and reapply the
next year. This prevents students from potentially
wasting the L1,140 course fee, which in itself has
discouraged some applicants.
The course, which is government-funded, had to start
charging students a fee last year. Students on
benefits pay only L50, which just covers
registration.
'The problem is that many of them are not on
benefits because they are too proud,' Ms Farbey
says.
Those doctors who are able to work are often on
minimum wages doing translation work, yet still have
to pay the course fee, even though they can ill
afford it. The number of students on the course has
fallen from around 60 in 2006/07 to 40 in 2007/08.
Ms Farbey, who was enrolling students at the time of
speaking to BMA News, says she expects this year's
course to be full but that numbers will not exceed
last year's intake. Extending the course to all
healthcare professionals, rather than just doctors,
has kept numbers up.
The course provides advice on alternative careers,
CV presentation and interview techniques.
The BMA: a vital source of support for refugee
doctors
Managed by the BMA international department, the
BMA's refugee doctor initiative provides support and
information to individuals working towards GMC
registration. Although the BMA cannot by law provide
legal advice on asylum cases, it can give advice to
asylum-seeking medical graduates about what they
need to do to be eligible to work in the UK.
Between July 2007 and July 2008 the international
department assisted 159 refugee doctors with queries
about issues such as foundation programme training,
regional support services, International English
Language Testing System courses and funding for exam
costs.
The BMA's refugee liaison group brings together a
range of organisations to ensure a coordinated
approach to refugee work. The association
disseminates information from support organisations,
and updates them and refugee doctors on key news
stories. The BMA newsletter Refugee Doctor News is
sent to all refugee doctors three times a year. The
refugee doctor initiative also provides a
confidential 24-hour counselling service, help in
contacting relevant education organisations, access
to the BMA library and free subscriptions to the BMJ
and BMA News.
In 2001, the BMA set up its refugee doctor database,
which now has 1,208 names on it. International
department research and information officer Jo
Attwooll says: 'The database is a vital resource
because it helps to track the progress of asylum
seeker and refugee doctors, and helps to inform the
BMA's lobbying.
'A number of other organisations assisting refugee
doctors have used it to find out about the numbers
of refugee doctors in their regions and to target
service provision more effectively.'
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