You have spent six years training in medicine, then get a reasonable job. You work hard for a number of years, then suddenly your world is turned upside down. There is a revolution and you are forced to work for the rebels, treating the injured. You escape, but fear for your life and flee the country as a refugee.
You arrive in England, hoping to be able to continue your medical career. But you find that your degree is not recognised by the General Medical Council. You cannot work as a doctor any more. You exist on benefits, then eventually get a part-time job in a supermarket.
To progress in medicine, you will need to take at least two examinations, at a cost of several hundred pounds - which you cannot afford. Even worse, to understand the exam system and the kind of questions you are likely to be asked, you need to attend training courses that might cost several hundreds of pounds more. You try an exam but fail, as you have not had time to study, nor do you know what to study.
This was the situation for several doctors in Redbridge & Waltham Forest health authority. We became aware of the problem through the work of our refugee linkworker, Rada Daniel, who knew of seven doctors in the district unable to use their training. Three were Turkish, three Somali and one came from former Yugoslavia.
We prepared a bid for 16,000 of European regeneration funding to help two refugee doctors over the hurdles barring the way to obtaining registration. The scheme was mentioned in the local press and within a few weeks, 20 more doctors were on our books. They came from Afghanistan, Pakistan, Bangladesh, Egypt, Russia, Nigeria, Sierra Leone and Turkey.
We invited these doctors to a meeting, along with Cathy Lee, senior registration manager for the General Medical Council, and her team, who explained the routes to registration. Philip Carter, assistant dean for postgraduate medicine at the North Thames department of postgraduate medical and dental education, also attended and explained the help his department could give with advice on career plans, applications to the GMC and arranging clinical placements.
The HA has a trust fund, bequeathed by the regional HA when it became a regional office. The fund's trustees agreed that its remit - 'to improve health and healthcare in Redbridge & Waltham Forest' - could be met by sponsoring the refugee doctors. It was also seen by the HA as a way of alleviating the shortfall of 15 GPs in the area. The HA has so far spent 7,425 from the fund on training for these doctors.
Some refugee doctors are eligible for limited registration with the GMC, and they have been encouraged to apply. This covers mainly those who have five years' experience in a specialty. Most will need to pass an English exam (the International English Language Testing System) and a clinical exam (the Professional Linguistic Assessment Board) before they become eligible for registration.
We made an arrangement with Colchester English Language Centre, which agreed to run month-long residential courses for the doctors and arrange for them to take the IELTS exam. Five of the first six doctors passed first time.
Five doctors are attending the course in August, and another four or so will attend in the autumn.
We have arranged for the doctors to attend a PLAB course. This will provide them with an assessment of their educational needs and tuition in examination technique, as well as examples of the questions likely to be asked. The PLAB exam has recently been split into two sections, and the doctors will be mentored through both.
There is a journal club in Whitechapel, which many of the doctors attend. They are encouraged to prepare presentations on particular subjects after carrying out literature searches. There are also presentations on particular clinical subjects.
The doctors are also meeting regularly as a group and this is helping to raise morale. The group discusses developments in the NHS. Members of the group have become much more positive over the eight months or so since we started meeting. Many feel they now have a real chance of qualifying.
Local GPs and trusts are also helping, encouraging the refugee doctors to attend education meetings and offering use of libraries.
The local trusts will co-operate in finding suitable clinical attachments as needed. Initially, this will be about four months' attachment, with close supervision, mainly observing clinical practice. There may be opportunities for the doctors to take histories, and occasionally carry out a second, supervised examination. In these 'supernumerary' posts, the doctors will not lose their benefit rights.
At the end of all this, the refugee doctors will be in a position to apply for vocational training courses or other suitable jobs, to move towards full registration. We will then need to involve the Joint Committee on Postgraduate Training for General Practice to see what of the doctors' previous experience will count towards their time as GP registrars. We hope that those who have made links locally will be able to get on to local schemes. Most hope to become GPs locally.
For around 3,500 for the courses and exams, we could have a qualified GP to work with the local population, possibly with members of their own ethnic group. This compares well with the cost of training a new doctor. Two of the doctors are already working as advocates, helping refugees and others to register with a GP. None is yet doing clinical work.