Nurturing the Nation The Asian Contribution to the NHS since 1948
Dr Debbie Weekes-Bernard with interviews by Klara Schmitz, Saher Ali & Valentina Migliarini
Nurturing the Nation
First published in 2013 by The Runnymede Trust, Unit J209, The Biscuit Factory, 100 Clements Road, London, SE16 4DG. www.runnymedetrust.org © The Runnymede Trust 2013. Some rights reserved. ISBN: 978-1-909546-03-5 A CIP catalogue record for this book is available from the British Library. Open access. Some rights reserved. Runnymede wants to encourage the circulation of its work as widely as possible while retaining the copyright. Runnymede has an open access policy which enables anyone to access its content online without charge. Anyone can download, save, perform or distribute this work in any format, including translation, without written permission. This is subject to the terms of the Creative Commons Licence Deed: Attribution-Non-Commercial No Derivative Works 2.0 UK: England & Wales. Its main conditions are: • You are free to copy, distribute, display and perform the work; • You must give the original author credit; • You may not use this work for commercial purposes; • You may not alter, transform, or build upon this work. You are welcome to ask Runnymede for permission to use this work for purposes other than those covered by the licence. Runnymede is grateful to Creative Commons for its work and its approach to copyright. For more information please go to www.creativecommons.org
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Nurturing the Nation The Asian Contribution to the NHS since 1948
Dr Debbie Weekes-Bernard with interviews by Klara Schmitz, Saher Ali & Valentina Migliarini
Contents Preface 7 Foreword 9 Introduction 10 The birth of the NHS
Areas of work for Asian doctors
Reasons for leaving
Asians from Kenya and Uganda
Chapter 1 Biographies 26 Chapter 2 Making the Decision to Leave
The plan to return
Chapter 3 Adapting to Life in the UK
Making the journey
Being a child from overseas in an English school
Finding work and achieving qualifications
Chapter 4 Progressing within the NHS
Facing and overcoming barriers
Combining work and family
Support and mentoring
Going the extra mile
Chapter 5 Job Satisfaction and Achievement
Achievements within the job
The benefits of working in the NHS The overall contribution of those of Asian descent
Chapter 6 The Modern Day NHS
Minority ethnic groups in the NHS today
Evidence of progress
New developments Breaking Through The Equality and Diversity Council
NHS Confederation BME Leadership Forum
The General Medical Council and the British Medical Association
Marking Asian contributions to the National Health Service
The modern NHS
List of interviewees
List of abbreviations
References and Sources
Books and articles
NURTURING THE NATION
Kenyan Asians at Heathrow © Getty images
Preface This year, the NHS marked its 65th birthday. This was an opportunity to reflect on the astonishing achievements that have been made by all those who have played a part in its growth and evolution. So I am delighted to be able to continue that theme by contributing to this project. Since it began, the NHS has been a shining example of diversity. Countless people from different ethnic backgrounds, including the Asian community, have played a part in some of the NHS’s biggest successes. But what this collection of stories show is that the millions of people who have been part of the NHS, regardless of their background, are united by the core values of care, compassion and professionalism. Looking ahead to the next 65 years and beyond, it is clear this will be invaluable as the NHS rises to the challenge of caring for an ageing population with multiple long-term conditions. So just as thousands of people from the Asian community have played an important part of making the NHS what it is today, they will be an important part of what this great institution will be in the future. Health Minister Dr Daniel Poulter
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Arrival 1968 © Getty images
Foreword I am delighted to have been asked to contribute to this excellent piece of work. It is a great effort by all those who have worked so hard to make this happen and to bring it to fruition. Working in such a busy and constantly changing environment like the NHS, it’s often difficult to step back and reflect on things. This is why books like this are so important. These issues may not get the press coverage of reports like Francis or Keogh but they are just as important to understand for the sustainability of our NHS. The phrase ‘the architects of the NHS’ is often correctly associated with the former Health minister Aneurin Bevan and the social reformer William Beveridge who contributed to the development of the NHS. What is often not sufficiently recognised or celebrated is the contribution of migrant workers who have helped deliver the vision of the NHS. The NHS has relied on a constant and steady stream of medical professionals from the Asian sub continent since its beginnings in 1948. This reliance has had social, economic and cultural benefits for the NHS and the wider economy. Currently around seven per cent of the NHS workforce – over 90,000 staff – describe themselves as Asian or Asian British. Many health professionals from Asian backgrounds therefore became the mainstay of the NHS, concentrated often in the lower paid and sometimes least glamorous specialities and working in remote parts of the country. Dipak Ray was such an example. A GP who worked for decades in the Welsh Valley, Ray was a prominent anti-
racism campaigner, trade unionist and medical politician and was also among the pioneers of patient involvement in the running of surgeries. As the largest employer in the UK, our responsibility is to learn from the experience of those who have served the NHS to ensure that this cherished national institution tries to preserve and uphold the principles of equality and fairness on which it was built. The world has changed since 1948. As the healthcare sector becomes increasingly global and innovation takes us in new directions, I believe that the injection of fresh ideas will become more critical. As the world continues to get smaller, I foresee a time in the future when UK born doctors are going to Asia and other countries and regions to find out about innovative technologies and techniques – approaches that will return to benefit UK patients. That – for me – would be a sign of true equality and genuine diversity. And that is where books like this help. They allow us to not just reflect on the past, but also to record and highlight the immense contribution that Asian staff from diverse professions have contributed to healthcare provision in the UK. No doubt things will be radically different in 65 years time. But one thing is for sure. Thanks to the huge contribution of the people highlighted by this project, the NHS has been built on solid foundations, principles of truly global inclusion and commonly shared values. Dean Royles Chief Executive, NHS Employers
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Introduction My hope is that when the continuing history of the development of general practice in this country is written the contribution of the whole cohort of doctors, a large proportion of whom were Asian doctors, who worked in the deprived areas of our cities administering health care to the most deprived sections of our society, to the vulnerable, and to the elderly, will be duly acknowledged. Professor Aneez Esmail, University of Manchester
The birth of the NHS
Aneurin Bevan, who launched the NHS in 1948
The NHS was launched on 5 July 1948 with the opening of Park Hospital in Manchester by Aneurin Bevan. Bevan’s plan for a national health service was certainly ambitious and far-reaching. The health service was to be financed entirely from taxation, which meant that people paid into it according to their means. It established free healthcare for all at the point of delivery, regardless of means and ability to pay. This free system of health care formed part of a package of reforms introduced after the Second World War and picked up on the post-war spirit of community and consensus. The NHS was to bring together primary care, hospitals and public health. GPs, dentists and opticians became part of the service, joining as independent contractors, whilst consultants received financial rewards for giving up some of their private work in order to provide hospital care. Such an unrivalled health care system drew admiration from around the world and it was no wonder that this, together with the old established historical links between Britain and the Commonwealth, drew in prospective doctors and nurses from across Asia. Though there were clearly educational and career-driven reasons for joining the NHS, many of the large numbers of Asian overseas trained doctors and student nurses came to fill the increasing vacancies in the health service. Upon its inception, the NHS gained control of 2688 hospitals which included approximately 480,000 beds. British people clearly welcomed the change, with the number of inpatients rising from 2.9 million in 1949 to 3.5 million by 1953. Demand for dentures and spectacles rose and people sought out and signed up with local GPs in their millions. As a result, however, the general costs of the NHS quickly
INTRODUCTION outgrew expectations, and although the NHS workforce itself began to dramatically increase to meet demand, there were parts of the NHS which failed to recruit sufficient numbers. The NHS had already begun to recruit directly from specific islands within the Caribbean, targeting specific job vacancies from across nursing to auxiliary services. The start of the NHS had also coincided with the first arrivals from the Caribbean of migrants on the ships The Empire Windrush and SS Orbita but also with Partition in India in 1947.
The Empire Windrush
Following Partition, and the separation of India and Pakistan after Independence, up to 55,000 Indians and Pakistanis had begun to arrive in the UK, many of whom had lost their homes and jobs. The new health service also found itself dependent on junior doctors, and though consultants were being paid for their work within the NHS, they continued with their private practices. Attempts to create new posts for young doctors returning from the war resulted in a spread of expertise instead among middle and senior levels. The Willink Committee recommended in 1957 that the number of medical students be cut. High numbers of ex-servicemen were training in medicine, and medical schools subsequently decreased their numbers. However, this recommendation failed to take into account the rising population numbers in the UK and the need to improve the health service itself. This underestimation
played a great part in the first waves of migration to the UK of Asian doctors and medical recruitment then began in earnest in Sri Lanka, India, Pakistan and Bangladesh.
Asian doctors Asian doctors were already working in Britain. The colonial links between India and Britain meant that a stream of British doctors worked in India, and some Indian doctors had, in return, been to the UK for training. Prestigious medical colleges had been established in India as far back as 1835 when the Calcutta Medical College opened. British surgeons had been employed to work for the East India company prior to this, but Indian practitioners were often preferred to Western ones. Following the establishment of Medical Colleges in India by the Indian Medical Service, however, Western courses were taught often entirely in English and the college in Calcutta was quickly joined by the Madras Medical College, the Bombay Grant Medical College in 1845, the Lahore Medical College in 1860, the King George’s College in Lucknow in 1906 and a variety of others across India, taking the total to 10 by around 1926. Courses taught in these colleges met the requirements of the British General Medical Council and students would travel to the UK to continue their studies in order to return to their countries highly skilled. During the 1950s, this, together with increased recruitment, created an Asian doctor population of approximately 3000 in Britain. In these early days, the contribution of this willing, able and skilled group, was welcomed. The Health Minister, Enoch Powell made direct appeals to recruit overseas doctors, welcoming their contribution in assisting with the labour shortage in British hospitals. At the same time as South Asian doctors began to fill posts, UK-born doctors were leaving to work in Canada and America, due to poor pay and conditions in the British health service. Increasingly, the numbers of British 11
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Early pioneers Dr Fredrick Akbar Mohamed (1849−1884), was the first to recognize hypertension as a primary condition and he set up the Collective Investigation Record. Dr Sukhsagar Datta (1890−1967), GP in Bristol, was active in the anti-colonial movement and Labour Party, seconding a Party Conference motion for the withdrawal of Britain from India. Dr Harbans Gulati (1896−1967), GP in Battersea, was the pioneer of ‘meals on wheels’. He resigned from the Conservative Party over its opposition to the creation of the NHS. Dr Jainti Saggar (1898−1954), GP, was the only Indian GP in Dundee at the time. Saggar Street and a library were named after him. Dr Chuni Lal Katial (1898−1978), Britain’s first Asian mayor, set up the now renowned Finsbury Health Centre, creating a centralized local health service, anticipating the NHS ten years before its inception. Dr Dharam Sheel Chowdhary (1902−1959), GP. The Chowdhary County Primary School was named after him. Dr Baldev Kaushal (1906−1992), GP in Bethnal Green, was awarded an MBE in 1945 for bravery during the Blitz.
Calcutta Medical College
doctors leaving grew and it is estimated that almost 3500 doctors permanently emigrated to Australia, New Zealand and South Africa as well as to the US and Canada.
Asian nurses As early as 1949 the NHS began determined recruitment drives in the Caribbean for nurses to fill vacancies. This was to add to the attempts by the British Government to recruit nurses and domestic workers from parts of Europe such as France, Germany, Spain and Italy and the Baltic States (Lithuania, Latvia and Estonia). However, it was difficult to retain these nurses due to language difficulties and many of the countries in Europe were experiencing their own nursing shortages. Going therefore to its colonies in the Caribbean was the next step for Britain and there were clearly prospective nurses of Asian descent included in this group, like Rangena Tilkaran from Trinidad (featured within this book), who were born and lived on the islands. Nurses of Asian descent also arrived in the UK from Mauritius and Malaysia at around the same time. Nurses working in the UK were welcomed wholeheartedly by the Government for filling vacancies. However a variety of immigration laws restricted entry for Asian nurses as well as doctors during the 1970s and staff shortages in nursing became an issue in the decade to follow. By 1998 nursing vacancies soared to approximately 8000 places per year. The British Government turned to overseas recruitment again between 1998 and 2005, although there were increasing concerns about removing prospective nurses from specific countries. It was felt that
INTRODUCTION this could create labour shortages in the countries these nurses left behind. These concerns led to a directive, issued in 1999, creating a list of banned countries from which NHS employers should not recruit.
such popular areas to work. Newly-qualified Asian doctors therefore found themselves quite isolated initially in parts of the UK and in areas of clinical practice which were considered less attractive by everyone else.
Areas of work for Asian doctors
However it is within these specialist areas, and within the general practice surgeries located in parts of the North and West of England, and deprived parts of cities and towns, that Asian doctors established their careers and provided a much-needed service for their patients. Many of these doctors ran single-handed practices, taking over surgeries left by retiring British-born GPs. Single-handed work was hard, requiring a great deal of commitment but provided benefits in allowing Asian doctors to become established in local communities, getting to know and work with local people and many Asian GPs successfully set up and expanded initial singlehanded practices with large patient lists.
Large numbers of overseas born and trained Asian doctors worked within the areas of geriatric and genitourinary medicine, as well as within the fields of general psychiatry, old age psychiatry and learning disabilities. Research conducted in 1987 illustrated that two thirds of Asian doctors who came to the UK to complete postgraduate training, or find work, found themselves working in careers which were not their first choice. Indeed the expansion of the NHS in the 1960s and the call for Asian doctors to work within the emerging health service did not necessarily mean that the aspirations of all those coming to Britain were met. Vacancies existed in geriatrics and mental health as British-born doctors often did not consider work in these areas to be particularly desirable. The growth in the area of geriatrics − the care of older patients − therefore coincided with the increasing numbers of overseas born medical graduates, particularly from India, Pakistan, Bangladesh and Sri Lanka. These areas of work provided many with career opportunities. Those Asian doctors who went into the geriatrics specialty, for example, opened day hospitals, developed acute care facilities and engaged in research specific to the age group of their patients. However, geriatric medicine was known as the ‘Cinderella’ specialty as British-born medical graduates did not want to work within it and they often shunned certain locations, such as Wales and the North West of England. Asian medical graduates therefore found there were many opportunities to work in this emerging field, as well as within general practice, but even here vacancies for GPs were usually located in inner city and small rural areas, which were not
Research in 1999 reported that the majority of Asian doctors who arrived in the 1960s and 1970s in response to shortages in the profession worked as GPs in Britain. These individuals are now due to retire with many having already given up their practices. This has prompted some concern about how to fill their posts. It is estimated that two thirds of overseas born Asian GPs have now already retired. Researchers Aneez Esmail and Donald Taylor concluded that as the majority of these GPs had taken on practices in inner city and deprived areas, given the reluctance of British born doctors to work in these places, it might prove difficult to fill the spaces left by them. Overall deprivation can create a larger number of health problems among patients living there and work can often be less well paid in more suburban practices. However since the mid-1990s the Department of Health has engaged in a variety of initiatives to try to address filling the vacancies that could arise out of large numbers of prospective retirees, offering incentives to recruit new GPs and general practice remains a profession that continues 13
NURTURING THE NATION to draw in applicants wanting to play a central role in local communities. GP recruitment however remains an ongoing issue for the Department and the BMA.
Initial barriers In 1963, Britain publicized a call for overseas trained doctors to work within the expanding UK health service. Eighteen thousand such doctors were recruited from Pakistan and India and by 1971 just over 30 per cent of doctors working within the English NHS had been recruited from abroad. Their presence was greatly welcomed initially, as evidenced in a House of Lords debate in 1961, where Lord Cohen of Birkenhead commented that ‘the Health Service would have collapsed if it had not been for the enormous influx from junior doctors from such countries as India and Pakistan’.
The House of Lords chamber
However responses to the numbers of Asian doctors joining the health service were mixed − letters published in the British Medical Journal between 1961 and 1975 included complaints by some doctors about language 14
barriers between Indian-born doctors and their patients, worries about their competencies as doctors and the standards of training they had received before coming to the UK. In 1972 the General Medical Council decided that no medical qualifications granted in India after 22 May 1975 would be recognized for the purpose of full registration in England. In 1948 the Nationality Act had granted British citizenship to those from British colonies, which assisted those arriving in the UK to fill posts in the NHS. Outside of the health service, however, Caribbean and Asian migrants were finding it difficult during the 1960s and 1970s to find suitable housing or work. A raft of legislation was introduced, on the one hand attempting to improve relations between host communities and new arrivals from the Commonwealth, such as the Race Relations Acts of 1965 and 1968, whilst on the other, seeking to address uncontrolled rates of immigration. Aspiring Asian NHS workers were coming to the UK and applying for training and employment against this backdrop. Overseas doctors were able to undertake postgraduate medical training for four years permit free. This permit free training period was then extended to six years in 1997 at which point 44 per cent of newly registered doctors had begun their training overseas. In 2006, however, in view of concerns about the lack of work opportunities for those born and trained within the UK, the Department of Health introduced a policy that affected, but did not stop, doctors who had trained initially overseas outside of the European Union (EU) or the European Economic Area (EEA), from applying for NHS training posts. These were individuals who had gained both training and work experience in their countries of birth, but who now could only be considered for training posts by NHS employers after those employers had tried to recruit a junior doctor born in Britain or within the EU. The policy affected both the doctors who hadn’t yet arrived in the UK but
INTRODUCTION also those already here. After legal opposition to these developments by an association staffed voluntarily by Asian doctors called the British Association of Physicians of Indian Origin (BAPIO), this policy was overturned. However in the two years it took for the policy to be withdrawn, thousands of overseas doctors unfortunately fell foul of the policy change finding themselves out of pocket. Organisations such as BAPIO, and others set up much earlier, such as the Overseas Doctors Association, were established and run by Asian doctors wishing to provide support networks for aspiring doctors, new to the country. One of the founding members of BAPIO, Ramesh Mehta (featured within this book) cites the setting up and continued success of this entirely voluntarily run organisation, as one of his great achievements.
Overcoming barriers New arrivals to the UK from the various parts of Asia had to overcome a variety of obstacles. These included their attempts to cope with initial racism in their host communities, or the difficulty in getting work or progressing on their courses in view of assumptions made about their abilities. The Asian nurses who came to the UK to qualify faced similar career barriers to their Caribbean colleagues − some, like Krish Goodary, found their progress to move from pupil nurse to registered nurse barred. Others found the responses of patients on the ward extremely negative and quite hurtful, but would simply continue with the jobs they had been paid to do, sometimes surprising these initially negative patients in the process. Those training to become doctors often found their progress up the career ladder barred by their surnames − being shortlisted for jobs became incredibly difficult once it was clear to a recruiter that the applicant was likely to be Asian. Those who were successfully employed faced additional obstacles. The issue of language barriers
was routinely used to explain why so few Asian doctors were able to progress, or why they seemed to fail their exams more than their colleagues. The Merrison Report, published in 1975, noted an overall decline in medical standards that could occur in view of the poor language skills and abilities of overseas doctors. However, research conducted for the book Overseas Doctors in the National Health Service, published in 1980, found that whilst a number of Asian doctors who came to the UK during the 1970s felt it was initially difficult for them to communicate with patients and colleagues, most did not. Even more importantly, these problems had been resolved after these doctors had lived and worked within the UK for some time. Following the Merrison Report, the TRAB (Temporary Registration Board) test was introduced (later renamed as PLAB − The Professional and Linguistic Assessment Board). Those from overseas wanting to work as doctors within the UK had to pass this test which assessed both their medical knowledge and skill in English. If passed, it granted temporary registration in the UK.
Key pieces of legislation 1948 Nationality Act 1962 Commonwealth Immigrants Act 1968 Commonwealth Immigrants Act 1971 Immigration Act 1965, 1968 & 1976 Race Relations Acts enacted 2000 Race Relations Amendment Act 2010 Equality Act
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Reasons for leaving The individuals interviewed for this book came to the UK from a range of locations within Asia. Prospective consultants, GPs, dentists, nurses, midwives, auxiliaries, spiritual co-ordinators, bilingual speech therapists and social workers arrived in the UK from India, Pakistan, Bangladesh, Singapore, Kenya, Uganda, Malaysia, Mauritius, Zimbabwe and Tanzania. The reasons for leaving the countries they were born and/ or raised in are as varied as the places they left behind. The majority came to the UK to complete postgraduate training as doctors, and for these individuals, their initial education in the medical colleges in India, Pakistan and parts of East Africa initiated their wish to study or work in Britain. These medical colleges largely followed a British curriculum taught by lecturers who had themselves completed training in the UK. More broadly, however, the schools attended by all of the individuals born abroad included a British influence. For those born in India before Partition, the influence was particularly huge, but even for those born in other parts of Asia, all learnt to speak English as children and were familiar with a range of English books that many had read when very young.
Those individuals who came to the UK as adults, who were not intending to train as doctors, often did so to pursue a career in nursing. Voon Cheng from Malaysia, Krish Goodary from Mauritius and Rangena Tilkaran from Trinidad in the Caribbean responded to recruitment drives from the NHS for prospective nurses to study in the UK. The British Council often provided a great deal of support for those coming to study as nurses, especially those from the Caribbean, giving them accommodation and also nominating British-born families, who could give them additional support. As prospective doctors, Meher Pocher from India, and Bernard de Sousa from Karachi (in what is now Pakistan), also benefited from British Council programmes, where doctors were given a one month probationary period working and studying within a hospital and were provided with initial accommodation, after which they were required to find work and places to live themselves. Others, such as Rehanah Sadiq from Pakistan, Amar Bains and Malkit Uppal from India, Kuldip Bharj and Vinod Devalia from Kenya and Tony Narula from Burma (also known as Myanmar), were brought to the UK as children following parents who came to the UK to find work, or to continue their own studies as postgraduate medical students.
Asians from Kenya and Uganda
Rangena Tilkaran as a young nurse
For those children born in Kenya, the journey made by their parents to the UK occurred as a result of changes in Kenyan Government policies which resulted in the fleeing of thousands of Kenyan Asians to India and the US, but largely to the UK. During the late-1960s Asians living in Kenya were given the opportunity to take up Kenyan nationality, as non-Kenyan citizens began to find their position increasingly difficult. The Kenyan Government increasingly began to freeze non-Kenyan citizens out of jobs, positions of power and the ability to run their
In 1972 approximately 30,000 Asians from Uganda emigrated to the UK following their expulsion by the then president, Idi Amin. In August of that year, all Asians were given 90 days to leave the country. Many Asians were seen as holding all of the prominent positions in banking and business, though the process of ‘deIndianisation’ had begun before Amin came to power via a military coup. The majority of the Ugandan Asians who arrived in the UK at this time were offered shelter in RAF barracks. Rashmikant Shah, a dentist, who came to the UK in 1975 when aged 25, was born in Kenya, but his family moved to Uganda when he was just 7 years old. His movement to the UK was prompted more by his desire to study dentistry. He went to India to attend dental college but when his parents found themselves removed from Uganda, as with other Asians in the country, Rashmikant came to the UK to join them.
This book documents the lives and working experiences of a number of those of Asian descent who have worked within the NHS over the years since its inception. It notes the journeys taken, the decisions made and the plans to return which were not fulfilled for the majority of those whose views are represented here. The oral testimonies come from a group of individuals whose ages range from being in their late-20s to their mid-80s. They include honest and open first impressions of the UK upon arrival, memories of first jobs, first homes, barriers and pitfalls and moments of achievement. Most importantly they provide a picture of a set of experiences of individuals who have contributed, and continue to contribute, greatly to the NHS.
© Getty Images
businesses. In 1968, Kenyan Asians began to arrive in the UK at the rate of 1000 a month as many decided instead to take up the offer of British passports and citizenship, with more than 100,000 choosing to do so. The Commonwealth Immigrants Act was hastily rushed through in 1968 to Nairobi in Kenya curb the numbers arriving from Kenya, and this only added to the negative initial experiences that some of these Asian families had of the UK. Kuldip Bharj, now a senior lecturer in midwifery and qualified midwife, believes that it took a very long time for those who fled Kenya in the late-1960s and early-1970s to feel at home in the UK. Despite this, Asian families and businesses have remained in Kenya and over 39,000 Asians currently live there.
Ugandan Asians at RAF barracks
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Shapurji Saklatvala becomes the third Asian MP, winning the 1922 election for the Communist Party, representing Battersea North.
After the end of World War Two, the newly-elected Labour Government’s social reforms created the welfare state in Britain, including the NHS.
Earlier Asian MPs were also fellow Parsis. Dadbhai Naoroji was elected as the first Asian MP in 1892, standing on behalf of the Liberal Party. Sir Mancherjee Bhownagree was elected in 1895, representing Bethnal Green on behalf of the British Conservative Party.
There are around 1000 Asian doctors working in the UK, including 200 in London. They are often found working in deprived areas, and faced barriers, but contributed through local politics.
Dr Baldev Kaushal is awarded an MBE for bravery shown during the blitz and his assistance to the injured during the Bethnal Green tube shelter disaster two years earlier.
First Bengali food shop − Taj Stores − is opened in the East End of London.
Outbreak of World War II. South Asian troops are mobilized and 24 Asian pilots arrive in the UK to fly with the RAF in 1940.
1938 First Indian Workers Association founded in Coventry which enables members to highlight the cause of Indian independence.
London was badly bombed by Germany in World War II
The Indian filmmaker Chetan Anand’s Neech Nagar wins Grand Prize at the first Cannes Film Festival. The 1940s to 1960s are hailed as the Golden Age of Hindi cinema.
On 5 July the National Health Service is launched by Aneurin Bevan. The new service will provide free health care to everyone at the point of delivery, regardless of means to pay. The service is to be funded by taxation. Burma becomes independent and is later named Myanmar, though the issue of its renaming has remained contentious. Ceylon becomes independent (it is renamed Sri Lanka in 1972). The 1948 Nationality Act grants British citizenship to all of those born in British colonies.
1940s continued 1947 Independence of India Act comes into force on 4 July. The two nations of India and Pakistan are officially formed on 15 August. After Partition many new arrivals enter Britain − these include qualified teachers as well as doctors and ex-Army officers.
Baganmyo in Burma
1949 Noor Inayat Khan is posthumously awarded the George Cross for bravery. Noor, a British secret agent during the war, was shot at Dachau concentration camp in 1944.
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The Indian filmmaker Mehboob Khan’s Mother India is nominated for the Academy Award (Oscar) for Best Foreign Film.
NHS suffers a serious shortage of doctors, as British-born doctors leave the NHS for Canada, the US, Australia and New Zealand in search of better paid jobs.
Malaysia is formed out of a Federation of Malaya, British North Borneo (Sabah), Sarawak and Singapore.
Eighteen thousand doctors from India and Pakistan are recruited to join the NHS.
The Willink Committee recommends that medical schools cut new student numbers by 10% in view of a predicted surplus in the numbers of doctors as a result of the Goodenough Committee recommendations to expand medical education in 1944.
The NHS begins to recruit Asian doctors, principally from India and Pakistan. Between 30 and 40 per cent of all junior doctors working in the UK were born in India, Bangladesh, Pakistan or Sri Lanka. Over 100,000 Indian and Pakistani nationals have by now become resident in the UK.
Kuala Lumpur in Malaysia
After winning its first medal in the Commonwealth Games in 1934, India wins its first gold medal in the 1958 games.
The Movement for Colonial Freedom holds a demonstration in Trafalgar Square against the UK Colour Bar Immigration Bill which aims to restrict the rights of Commonwealth Citizens to stay in Britain. The demonstration is attended by Mr Qureshi, Secretary of the Pakistani Welfare Association, Ratt Singh, President of the Indian Workers’ Association, Claudia Jones, Editor of the West Indian Gazette as well as John Stonehouse MP and Lawrence Parvitt MP.
The Indian Workers’ Association is set up in Birmingham and all previous branches of it, which existed in areas such as Southall and Wolverhampton, are brought together under one group on the advice of the Indian President, Nehru.
The immigration of Indians, Pakistanis and Bangladeshis increased significantly up until the enactment of the Commonwealth Immigrants Act in this year. Prior to 1960 the arrival in the UK of individuals from these minority ethnic groups equalled less than a third of Caribbean migration. The Act stops all open access to the UK for people born within the Commonwealth.
1969 On 9 April, Sikh conductors and drivers win the right to wear turbans and long beards following an initial ban by Wolverhampton’s Transport Committee. A Sikh leader had threatened to set himself alight in protest, arguing that the ban was a direct attack on the Sikh religion.
The Race Relations Act comes into force, the first such piece of legislation to address racial discrimination. It prohibits discrimination in public places on the ‘grounds of colour, race, or ethnic or national origins’. The Race Relations Board is established a year later to oversee the legislation.
© Bjorn Torrissen
1965 Singapore breaks away from the Federation of Malaya, British North Borneo and Sarawak, becoming an independent state.
Merlion Statue in Singapore
1960s continued 1967
The National Institute of Economic and Social Research publishes a report challenging some of the persistent public perceptions about Asian migrants. It notes that rather than acting as a drain on public resources, as feared by many within the UK, Asian migrants received fewer welfare benefits than the indigenous population. It reports that the majority of Asian individuals contribute to the economy rather than receive support from it.
Mauritius becomes independent. The Royal Commission on Medical Education (Todd Report) recommends an increase in the numbers of students recruited to medical schools in the UK after identifying the likelihood of a shortage of medical doctors. The 1968 Commonwealth Immigration Act, which amended the 1962 Act, curbs the numbers of Kenyan Asians arriving in the UK. By the late 1960s Asian migrants to the UK had bought up to 2000 cinema houses that were being closed down. These were then renovated and used to show the high numbers of Hindi films that became increasingly popular among Asian communities over the following decades. On 20 April, 1968, Enoch Powell MP for Wolverhampton, makes a controversial speech arguing for an immediate reduction in immigration and envisioning the ‘River Tiber foaming with blood’.
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1971 The independent state of Bangladesh is created following a civil war in Pakistan. After Partition the land at the top of the Bay of Bengal became East Pakistan divided from West Pakistan which was about 1000 miles away. Most of the political power centred in West Pakistan which prompted East Pakistan, now Bangladesh, to break away. The 1971 Immigration Act stops migration from the Commonwealth save for those granted a work permit to work in the UK for a limited period of time and in pre-agreed posts. Bayt al Mukkaram, national mosque in Bangladesh
1974 Migration from the Caribbean, India, Pakistan and Bangladesh to Britain continues but at a reduced rate.
1975 The popular song Bohemian Rhapsody written by Freddie Mercury and performed by Queen is the Christmas number one in the UK music charts, staying at that position for nine weeks. Freddie Mercury was born in Zanzibar, now part of Tanzania in East Africa. He changed his name from Farrokh Bulsara when he became part of Queen. He was voted one of the most influential Asian stars of the last 60 years by Time Asia in 2006. The Equal Pay Act makes it illegal for pay and working conditions to differ between men and women.
1970s 1972 The General Medical Council decides that no medical qualifications granted in India after 22 May 1975 will be recognized for the purpose of full registration in England. Qualification of Pakistani doctors is also no longer recognized in the UK for full registration following the country’s departure from the Commonwealth. This also has an impact on doctors from Sri Lanka. All groups of non-EU overseas doctors are allowed limited registration to work in the UK but under supervision. Idi Amin expels Asians from Uganda. Thirty thousand come to Britain.
Queen in Argentina in 1981
1976 Direct and indirect discrimination is banned in the Race Relations Act which also establishes the Commission for Racial Equality (CRE). Overseas Doctors Association (ODA) established. A two-year strike begins at Grunwick Film Processing Laboratories over low pay, compulsory overtime and poor working conditions. As 80 per cent of Grunwick staff at the time were of Asian descent and female, the majority of the strikers were Asian women (mostly of East African heritage), and this was one of the first strikes involving minority ethnic groups to garner wide support across the trade union movement.
Southall Black Sisters established campaigning on issues specific to Asian women, including supporting them against domestic violence.
CRE reports show that overseas-born NHS staff are concentrated in low status posts and unpopular fields such as geriatrics and psychiatry.
Southern Rhodesia succeeds in gaining international acceptance of its independence and the Republic of Zimbabwe is formed on 18 April.
Doctors coming from abroad are no longer given restricted right of entry into Britain. Work permits are instead given to doctors in career positions. For those seeking postgraduate training, four years without need of a permit was granted.
Street in Gwanda, Zimbabwe where Ramesh Naik grew up
The House of Lords rule that Sikhs are entitled to protection under the Race Relations Act as they constitute an ethnic group.
Keith Vaz elected MP for Leicester East. He was the first Asian MP to be elected since the 1920s and remains the longest-standing Asian MP.
Sir Ben Kingsley, born Krishna Pandit Bhanji, wins an Academy Award for his portrayal of Mohandas Gandhi in the film Gandhi. Kingsley, born in Yorkshire, was the son of a Kenyan-born doctor of Gujarati Indian descent and an English mother. Ravi Shankar, Indian composer and musician, is nominated for an Academy Award for the score he composed for the film Gandhi.
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Shri Swaminarayan Mandir and Haveli opens in Neasden, becoming the largest Hindu temple outside of India.
Brimful of Asha recorded by the group Cornershop, reaches number one in the UK music singles chart. The song is a tribute to the famous ‘playback’ singer Asha Bhosle whose voice was often lip-synched over by actresses starring in I ndian films.
East is East a film directed by Damian O’Donnell and based on a play by Ayub Khan-Din is shown in cinemas across the UK. Made for £1.9 million, it grosses £10 million in the UK and wins the Alexander Korda Award for Best British Film at the British Academy Film awards (BAFTAs).
Fifty-five, mainly Asian, female cleaners and members of the union UNISON go on strike over the decision by the company which had taken over the cleaning contract at Hillingdon Hospital to reduce their pay. The strike lasted five years.
Nasser Hussain is made captain of the England Cricket Team. Usha Kumari Prashar, Baroness Prashar, CBE (who was born in Kenya, and came to Yorkshire with her family in the 1960s) is made a Life Peer.
The British Association of Physicians of Indian Origin (BAPIO) founded.
Filipino nurses are recruited to the NHS in increasing numbers. One in four nurses are recruited from abroad to meet the nursing shortage in the UK. British-born nurses begin to leave the profession in increasing numbers, some to work abroad but others largely to work in other jobs outside of the NHS, citing poor pay. The Royal College of Nursing announces that there are 8000 nursing vacancies across the UK.
BBC Radio 4 airs the comedy sketch show Goodness Gracious Me which runs until 1998. The television format goes onto British screens in 1996 running until 2001 and both the radio and television shows feature the comedic talents of Kulvinder Chir, Meera Syal, Nina Wadia and Sanjeev Bhaskar. Sanjeev goes on to star as Prem Sharma in The Indian Doctor on BBC One in 2010 which tells the story of a doctor and his wife who take over a single- handed general practice in Wales.
Baroness Pola Uddin of Bethnal Green becomes the first Bangladeshi-born Briton to join the House of Lords. Baroness Pola Uddin of Bethnal Green
© VJ Photography
The ward of Spitalfields in East London is renamed Spitalfields and Banglatown reflecting the high Bangladeshi presence in the area.
One hundred and twenty Filipino nurses are freed from terrible working conditions in private nursing homes across Britain, after being forced to sign illegal contracts, work 60 hour weeks and complete menial tasks despite their nursing qualifications. According to the trade union UNISON, similar stories of abuse are frequently reported by overseas trained nurses working in private care homes; recruitment agencies based in the Phillipines are accused of exploiting nurses.
Brick Lane in East London
2005 About 200 employees – 95 per cent of whom are Asian and 75 per cent women – working for the catering firm Gate Gourmet which provides food for flights out of Heathrow Airport, stop work when they discover agency staff working on the production line. They are eventually sacked and, following this, ground staff working for British Airways go on strike in support.
Gurinder Chadha’s film Bend it like Beckham opens across the UK to critical acclaim and is nominated for a British Academy Award for Best Film in 2003.
The Equality Act comes in force, merging the following pieces of legislation into one Act: the Equal Pay Act 1970; the Sex Discrimination Act 1975; the Race Relations Act 1976; the Disability Discrimination Act 1995; the Employment Equality (Religion or Belief) Regulations 2003; the Employment Equality (Sexual Orientation) Regulations 2003; the Employment Equality (Age) Regulations 2006; the Equality Act 2006, Part 2 and the Equality Act (Sexual Orientation) Regulations 2007.
Rushanara Ali becomes the first Bengali to enter the House of Commons.
NURTURING THE NATION
© Satinder Lal
The testimonies of 40 individuals of Asian descent were gathered for this book. These NHS staff have worked as GPs, dentists, consultants, midwives, social workers and speech therapists and while many are approaching retirement, others, who came in the very early years, have been enjoying their retirement for some time. All of these retirees remain active in their local communities, some in NHS Trusts and others with families and friends. Their stories, however, began far from the UK – in India, Pakistan, Kenya, Malaysia, Mauritius, Bangladesh, Burma (Myanmar), Singapore, Uganda, Tanzania and Zimbabwe. Here we introduce their testimonies and their journeys and experiences which have helped to shape the NHS as we know it today. Hava Mahal of Palace of the Winds in Jaipur, India
Tomb of the founder of Pakistan, Muhammed Ali Jinnah
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Bangladesh Burma/Myanmar India Kenya
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Malaysia Mauritius Pakistan Singapore
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Tanzania Trinidad UK Zimbabwe
Javed Ahmed Javed was born in Sahiwal, Pakistan on 12 December 1959. He conducted his medical training at the King Edward Medical College in Lahore, one of the oldest of such colleges in South Asia, coming first in his year. He arrived in the UK in October 1983 and undertook some locum work in a hospital in Wales. He then gained a longer appointment, for six months in Bournemouth, and also worked in Kilmarnock and Sheffield. He knew that finding work in interventionist cardiology would be difficult, but was not attracted to work in geriatrics, the area that some of his Asian colleagues went into. In 1994 he gained a Specialist Registrar post in Sheffield, and in 1998 won a fellowship to work at the worldrenowned Washington Hospital Centre in Washington DC, USA. He stayed in the USA for over two years, eventually returning to the UK as he preferred working within the NHS. He gained a consultant post in Interventional Cardiology for the Newcastle Upon Tyne Hospitals NHS Trust, where he continues to work today.
MohammAd Ashraf Mohammad was born in Alipur, Pakistan on 31 March 1952 and works as a Locum Consultant Urological Surgeon. He first came to Dublin, in Ireland, in 1980, and achieved his FRCS in General Surgery. He came to the UK in 1986 to a post in Law Hospital, Carluke in Scotland. He achieved a Diploma in Urology from University College London in 1988. He started working in Urology in 1985 and did 18 months in
Renal Transplantation. Mohammad wanted to return to Pakistan, but found it difficult to find work there. In 1993 he decided that he would remain in the UK. He found work in Nottinghamshire, and has been there ever since. Mohammad achieved specialist register status in Urology in February 2011, and achieved FECSM from MJCSM Europe.
Amarpal Bains Amar was born in Punjab, Northern India in November 1956 and came to England with her family at the age of 12. Amar’s family initially settled in Birmingham, where she attended school and then later moved to Warwick. Amar’s father worked as an electronics engineer at the old Central Hospital in that area and worked there for 31 years. Her mother, who joined the family later, worked as a catering assistant in the same hospital until she retired. Amar and her family lived in the grounds of the hospital and she formed her interest in nursing whilst living there. She undertook her nursing training and worked as a staff nurse in the alcohol and substance abuse unit at Central Hospital for eight years. In 1993, she then found work in psychiatric nursing in Coventry, a role which also involved development work for Asian elders not accessing mental health services for language and cultural reasons. She was eventually promoted to Team Leader, the role she currently holds.
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Rai Mohan Baishnab Rai was born on 28 May 1940 in Bangladesh. He studied at the Dakar Medical College in East Pakistan, coming to the UK in 1969 after qualifying. He came to the UK to undertake postgraduate training, wanting ultimately to get a post as a consultant. He decided, however, to go into general practice, finding work in Salford at a single-handed practice where he remained until he retired in 2008. He found work here difficult initially as the practice was situated in an area with high levels of crime and much deprivation; health problems were numerous and he had a heavy workload. Through his work he developed a reputation as a respected member of the local community, joining the Parliamentary Ombudsman panel and becoming an independent assessor of the Complaints Committee. He was also a member of the Overseas Doctors’ Association.
Arup Banerjee Arup was born in 1935 in Calcutta, now Kolkata, where he attended school. He went on to the Presidency College and the Calcutta Medical College, a highly respected institution set up by the British, where he met his wife. He found work initially as a Houseman in the medical college in which he had trained, and then subsequently in the South India Medical School. Arup and his wife came to the UK in 1960, initially to gain their MRCP qualifications. Arup held a variety of jobs in London, Northampton and Southampton. He spent three years in Malaysia with his family lecturing in Kuala Lumpur where his third child 28
was born, and then returned to England where he took up a post as a Senior Registrar in Portsmouth. He was then offered a post as Consultant in elderly medicine at Bolton General Hospital, where he was also given the opportunity to conduct research on nutrition at Whittington Hospital. Whilst at Bolton General Hospital, he was appointed Medical Director of Bolton Hospital Trust. Arup retired aged 62. Following retirement he was invited to take up the position of Director of Elderly Services at the University of South Manchester and Clinical Director of Elderly Services Wigan and Leigh NHS Trust. He has held a number of honorary posts including President of the British Geriatrics Society, and involvement within the BMA, the Health Advisory Service, NHS Management and Royal College of Physicians Geriatrics Committee among others. In 1996 he received an OBE.
karna dev BARDHAN Karna Dev (better known as Chandu) was born in Jhansi (Central India) on 16 August 1940. He underwent medical training at the Christian Medical College, Vellore, and shortly after graduation won a Rhodes Scholarship to the University of Oxford, and carried out research in the Nuffield Department of Medicine, his first taste of serious investigation. This led to a DPhil and some early publications. Karna then resumed his clinical training, becoming a registrar in Sheffield, and at the then-early age of 32 became a consultant physician and gastroenterologist at Rotherham. Here, research and clinical trials became a major feature of his clinical work. He set up the charity, The Bardhan Research and Education Trust, which continues to support research both locally and
BIOGRAPHIES nationally. Prof. Bardhan, now 70, retired from clinical practice in March 2011 and now works fulltime at Rotherham in research and teaching.
Ila Basu Ila was born in India in West Bengal in 1948 and qualified from Calcutta National Medical College, India, in 1974. While in her final years of study she applied for postgraduate training in the UK, though she hadn’t yet qualified. She worked as a Junior and Senior House Officer in Obstetric and Gynaecology in Calcutta and then became a Medical Officer for the West Bengal Medical Service. Eventually she received a letter from Bath Hospital and came to the UK on 6 November 1977 to take up a clinical attachment at St Martin’s Hospital. She then found work as a Senior House Officer, first at George Elliot Hospital in Nuneaton, then at Derby City Hospital. Changing her specialist subject to anaesthesia, she worked at Margate and South Cleveland and North Tees General Hospital. In 1982 she joined the General Practice Training Scheme in London and then finally went into General Practice. She met her husband (who was her classmate) here then joined as a salaried partner in a practice in East London in 1983, but was asked to leave when she became pregnant with her daughter in 1985. Rather than take the practice partner to an industrial tribunal, she left with her 150 patients to start her own practice, building up to 1800 patients. Then, together with her husband, she built the practice list up to 2500. Following a protracted fight with Newham Health Authority, she eventually received planning permission to move to bigger premises. Her practice list now stands at 5200. The practice now has a full time partner, employs three GPs and offers teaching to medical students.
KULDIP KAUR BHARJ Kuldip was born on 12 June 1953 in Kenya where her father was a teacher. Upon retirement, Kuldip’s father decided to bring his family to England, mostly in view of the educational opportunities that would be available to his children, so they migrated in 1966 when Kuldip was 13 years old. Kuldip and her brother attended secondary school in Bradford, taking some of their GCSEs a year earlier than their classmates. She had always wanted to go into medicine, and when she didn’t quite get the grades for medical school, was about to start a course in IT when her father spotted an advertisement for nursing and gave it to her. After qualifying as a Registered Nurse and Registered Midwife at the Bradford Royal Infirmary, she secured employment as a staff midwife in Bradford taking a lead in providing ante natal classes for South Asian women, and then got promoted to a Sister in 1978. She expressed an interest in teaching obstetric nurses and after obtaining her teaching qualifications she entered midwifery education in 1981 and is currently a Senior Lecturer in midwifery at the University of Leeds.
Kusum Bhatt Kusum was born in India in 1936 and wanted to work in a profession, either law or medicine. Her father had been ill for some time, and died in 1946. Kusum visited him in hospital many times during his illness. Kusum’s family was quite progressive with regard to girls’ and boys’ education and Kusum’s sister (who was over a decade older) was already studying for 29
NURTURING THE NATION a teaching degree, so Kusum had early exposure to both higher education and medicine. She had an arranged marriage at 18 but her husband’s family were quite conservative, not seeing the importance of Kusum’s continued education. Kusum’s husband went to the UK in 1958 as a qualified glass technologist and she followed him in 1960 with their son. The family settled in Sunderland where her husband worked in the Pyrex glass factory. While her husband was in England, Kusum finished her psychology degree in India. She then needed to get an Honours Degree in England as she couldn’t find work with her Indian degree. However she could not get the funding needed to continue, so answered a Home Office advert for a childcare social worker for a 10 month course at Newcastle University. She took two years out to have her second child, but also because her son’s disability was diagnosed at around the same time. She then returned to complete her course and continue working as a social worker in Newcastle General Hospital. Kusum worked there for 26 years, then took early retirement – she was diagnosed with ME and needed rest. She then worked as a primary care counsellor until 2003 when she retired from all work.
Manju Bhavnani Manju was born in India in 1947 where she was educated at a Catholic boarding school. She came to the UK in 1958 when she was 11 years old, and attended a grammar school in London. She attended medical school in Bristol and was one of 12 females, and the only Indian woman, on her course. After medical school, Manju did an elective in America and returned to work as a House Officer in Taunton and in Bristol. She 30
decided that she wanted to specialize in haematology. She then returned to India for three years, and with the help of her supervisor in Bristol, who recommended the pieces of equipment she should take, set up a small lab, looked at samples and saw patients in the evenings. When she returned to the UK she found work at a hospital in London, passed her MRCPath, and successfully applied to take part in an NHS-run part-time women’s training scheme giving her good grounding for the consultant post she eventually secured in Wigan. Manju remained in Wigan until she retired and ran a clinical haematology service, advising GPs and hospital doctors about interpreting blood samples, set up clinics for her patients, and ran the haematology laboratory. She introduced, early on, Nurse Practitioners into the Service, and developed Chemotherapy Services locally, so that patients would not have to travel for treatment. In addition to working in a District General Hospital, she wrote many research papers, and presented them at national and international haematology meetings. She was Clinical Director of Pathology, was Lead Clinician for Cancer in the Trust, and National Clinical Lead for Haematological Cancer. She was awarded an OBE for Services to Medicine in 2006.
Kailash Chand Kailash was born in Shimla, in Northern India, in 1948. His father worked on the Indian railways and Kailash was educated in Punjab. He graduated in medicine from the Punjabi University Patialia and was employed as a medical officer in Kurukshetra University. Kailash was already married with two sons before coming to the UK to take up a clinical attachment at the Alder Hey Hospital in Liverpool and
BIOGRAPHIES also to study Tropical Medicine at Liverpool University. He intended to return to his family once he had improved his qualifications. However, he decided to remain after his wife and children joined him in the UK and saw for themselves the high degree of care and attention his older son, who was born with Down’s Syndrome, received. Kailash worked for 25 years as a GP in Ashton-underLyne, receiving various accolades such as ‘Dedicated Doctor of the Year’ by Doctor magazine and ‘GP of the Year’ from the Royal College of General Practitioners. He is also a Senior Fellow of the British Medical Association and received an OBE for his services to the NHS. He is now retired both as a GP and Chair of Tameside and Glossop Primary Care Trust. Kailash now is deputy chair of the BMA and has become the first Asian to be elected as the deputy chair of the British Medical Association Council (BMA) representing 150,000 thousand doctors of UK.
Bernard de Sousa Bernard was born in 1943 in Karachi, before Partition, in what is now Pakistan. He came to the UK via an exchange programme with the British Council and worked in a hospital in Chichester. He then worked at the Royal National Orthopaedic Hospital in London and studied for his FRCS. He then worked in hospitals in Oxford and Swindon. Bernard worked as a transplant fellow in Liverpool and then acquired the post of Senior Registrar in Surgery there, before becoming a consultant in Bury. Altogether Bernard has worked for the NHS for 41 years.
Vinod Devalia Vinod was born on 7 April 1957 and was one of three children. He came to the UK from Kenya in 1972, aged 15, when his family along with many other Kenyan Asians, were made to leave the country. His father was a photographer and owned a photographic shop in Kenya. Vinod’s family settled in Leicester and he and his sister were registered to attend Soar Valley School. Vinod sat ‘O’ and ‘A’ levels, largely self-teaching himself the curriculum for science in the school library. He went on to study medicine at Glasgow University, and during his vacation periods, worked as a research student at the MRC National Institute for Medical Research and he also worked in the Laboratory of Medical Biology with Fred Sanger, the double Nobel prize winner. Once he had graduated, Vinod worked in Glasgow as a Houseman, and completed his Senior House Officer training. He worked as a Registrar on rotation in Peterborough and Leicester and then moved to London and worked as Registrar at the Middlesex Medical School and University College London. By now he had got married and felt that he would need a larger property for a family and found a post as Senior Registrar in Haematology in Nottingham. He then took up a post as a Consultant Haemotologist in Wales where he continues to work.
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Anil Kumar Dutta Anil was born in India in 1925 and conducted his initial medical training at Patna Medical College. He came to the UK in 1951 and spent a year completing postgraduate courses in neurology, chest diseases and other areas of medicine. His first post was as a Senior House Physician at the West Hill Hospital in Dartford, Kent where he worked on the Geriatric and Mental Observation wards. Following a period of hard work there, he found a post as Senior House Physician at Joyce Green Hospital and before starting work passed the final part of his MRCP in Edinburgh. He worked there for six months and then gained a position as Junior Registrar at Upton Hospital in Slough. He left the UK in 1955 and returned to India where his son Dipankar was born. Anil went on to work as a Consultant Physician in Jamshedpur, a steel town (now with a population of 2 million), best known for Tata Steel in Eastern India in Bihar state (now in Jharkhand state). He used to be the Chief of Medical Services in an industrial (Tata) hospital. Working for the NHS left a great impression on him and he greatly valued his time in it and the opportunities afforded to him. In his view, the NHS in the early days, though still finding its feet, worked well and patients could be treated simply and inexpensively. Whilst working in the UK, he particularly cherished the knowledge that he was helping people who themselves did not have to worry about the cost of their treatment, particularly during emergencies, and witnessed many charitable acts by senior members of clinical staff to help and support others.
Dipankar Dutta Dipankar was born on 20 September 1960 in Jamshedpur, the son of Anil Kumar Dutta, also featured in this book. Dipankar completed his initial medical training in Calcutta, now Kolkata, but then wanted to complete a higher degree, so put in an application to take an MD course in India, whilst also applying to undertake the PLAB test in England. He came to the UK in 1989, passed the test and returned to India to complete his higher degree, coming back to England again in 1991 with his wife. It took some time for both Dipankar and his wife to find jobs in the UK, but eventually he found short term posts for six months at a time, in Rotherham and then in Dewsbury, both in West Yorkshire. He worked in Grimsby and also in Bristol, and, having passed the MRCP exam, he found a Registrar post in Slough. Unlike many others who planned to return to their countries of birth and never did, Dipankar and his wife did go back. This was, in part, because of his father’s health problems. Luckily, his father’s condition stabilised, and Dipankar stayed for 18 months, working in private medicine, but he missed working within the NHS. Both he and his wife found that the only opportunities to be found were in private medicine and they both missed the structure and organisation of working within established NHS hospitals. Though more structured now, at the time hospitals in India were more disorganised than in the UK so Dipankar eventually returned to the UK. He took a staff grade post in Dundee, Scotland, then a Specialist Registrar training rotation. He then moved around the country, working in Birmingham, Worcester, Kidderminster and Hereford.
Krish Goodary Krish was born on 18 May 1954 in Mauritius. He was a teenager at the time when Mauritius gained independence from the UK, and following a good set of school examination results, found it difficult to find work, and then began to consider, along with many of his peers, taking up the offer to study and complete nursing training in England. He came to the UK in 1975 to complete a two year pupil nurse (state enrolled nurse) course, intending to return immediately afterwards, but then stayed on to study for a registered nurse qualification. He found it difficult to progress through to this next stage of qualification, however, and had to take a course in learning disabilities, rather than general nursing. Following some training on a ward with individuals presenting with behavioural difficulties, he applied for a Charge Nurse post in Widnes. He then worked as a Care Co-ordinator in Liverpool where he remained until his retirement in March 2011.
Navinder Jhutti Navinder was born in the UK in Crayford where she went to school and college. Her parents migrated to the UK from the Punjab in India. She has always wanted to work with the elderly or within the community and worked as a Healthcare Assistant for a time at Queen Elizabeth Hospital in Greenwich. However in view of family commitments she eventually became a housekeeper working for Oxleas NHS Trust where she has worked for the past two and a half years. She worked initially within the Disability Unit in Mental Health and has enjoyed
her work a great deal. In 2009 she was awarded the runners-up prize in the Oxleas NHS Trust Recognition Awards under the Safety category. This achievement was acknowledged on the Trust’s website and she has felt very much respected since winning her award. She continued to work as a housekeeper while her children are young, but she would now like to do other work within a hospital, perhaps as a Care Assistant.
Kalyani Katz Kalyani was born on 25 June 1951 in Karnataka, India. She did her medical training in Pune. She gained entry to the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bangalore to specialise in psychiatry. However she left NIMHANS to come to the UK in March 1975 when an opportunity arose. She received some support from an uncle who was working as a GP in England. Kalyani did her basic psychiatric training in Charing Cross and St Bernards’ hospitals, passing her membership examination at the first attempt at a very young age. She did her higher psychiatric training in Oxford by joining the ‘Married Women’s Training Scheme’ which enabled her to work part time. She has continued to work part time with a job share partner as a Consultant since 1989. When not working as a Consultant she is involved in work with the Ministry of Justice and the General Medical Council which she plans to continue even after retirement in addition to her work in rural India with a charity, BasicNeeds.
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Muhammad Yunus Khan Muhammad was born on 11 September 1944 in Tanga in Tanzania, East Africa where he went to primary school. His family moved to Nairobi in Kenya where he went to secondary school. After Kenya, the family went to India, then Pakistan before finally settling in the UK where Mohammed wished to apply for university. After spending some time improving his initial grades, he won a prize whilst at college which improved his chances of gaining access to a medical degree in Manchester. He worked as a locum in accident and emergency services in Kent and then undertook training in Birmingham, working for six months in gynaecology. He then did the first part of his fellowship exam, working at the Royal London Hospital in Whitechapel, East London. When a post became available in Birmingham he did not want to move his family again, so decided to remain in London, but his post there then ended. He found it difficult to find additional work, so then decided to leave the UK for the Middle East, remaining there for 10 years. Whilst he was there he achieved the rank of Advanced Life Support Adviser to the Royal Clinic at Riyadh Military Hospital, Saudi Arabia. He eventually returned to the UK to a post as Consultant Anaesthetist for the Barking, Havering and Redbridge NHS Trust at the King George Hospital. He retired in 2009 and as a practising member of the Ahmadiyya Muslim community holds regular seminars about faith at mosques across the country.
Qaisra Khan Qaisra was born in Pakistan on 9 August 1963 and came to the UK with her parents when she was just two years old, settling in Manchester. She studied History and Archaeology at university in Wales. She moved to London for work and took up a place at the School of African and Oriental Studies in London studying for an MA in Islamic Societies and Cultures. Her career path has led her to work across different organisations and sectors including the voluntary sector and as a Homecare Organiser for a number of London boroughs. Through all of the roles she has had, she has always been fascinated by religion and spirituality and so was offered and accepted the post of Spiritual and Cultural Care Coordinator for Oxleas NHS Trust. Her role crossed all faith backgrounds − she managed the chaplaincy service within Oxleas, co-ordinating all of the chaplains representing different faiths. She advised staff about any spiritual needs that patients had and ensured that whatever religious support a patient requested could be found, from asking for Holy Communion to wanting someone to pray with. Often people who are ill or distressed simply want another person to talk to and Qaisra was available for this. She has written many publications including contributions to: Spirituality and Mental Health: A handbook, by Pavilion and Understanding Wellbeing by Lantern Publishing. She also jointly edited the mental health newsletter of the College of Healthcare Chaplains. She was made redundant in August 2011 but has since returned to provide spiritual care on a freelance basis, doing so at St Andrew’s Healthcare Essex. She also works as a Senior Wellbeing Officer at Mind in Enfield.
Kumar Kotegaonkar Kumar was born on 4 April 1944 in India, where he completed his medical training at the Medical College, Aurangabad, Maharashtra. He worked as a Medical Officer in Primary Care in rural India, covering 30 villages, but seeing how difficult it was to provide care to the young in very remote parts of India, led him to further his interest in paediatrics as a Medical Officer. He was then offered a clinical attachment in paediatrics in County Durham, so migrated to the UK in February 1973. Kumar was initially employed as a Senior House Officer at Pilgrim Hospital, Lancashire and then later, at Bury General Hospital in 1974. He became a Registrar in Paediatrics in 1976 and then qualified in General Practice, in Bury, in 1979. In 1980 he started a general practice in Radcliffe and in 1984 his was the first in the area to be computerised, and also a first teaching practice. He expanded his practice to include other staff including his wife and son, making it very family-based. He became a GP tutor in 1988, and founded the National Association of Primary Care Educators in 1993 for which he was the Chair for ten years. He was Chair of the Health Promotion Committee for Bury and Rochdale Health Authority, and was Founder Director of out-of-hours care for doctors on call in the area. In 1989 he established a single occupancy Nursing Home, the first locally and also set up the Bury Postgraduate Education Charity, providing free education to primary care staff. Kumar gained his FRCGP in 1996, became a Fellow (FRCGP) in May 2008 and was also awarded an MBE. In 2011, he was made a Fellow of the BMA for his services to the profession and that year also retired from active General Practice. He is now developing care services for dementia.
Satinder Lal Satinder was born on 15 May 1926 in India. He studied medicine at Glancy Medical College in Amritsar, gaining his final professional MBBS in 1950 from Punjab University. He was awarded first prize in physiology. After spending a year as a Medical Officer in Uganda, he arrived in the UK in 1952 for further training. Postgraduate training included junior posts in various hospitals. He obtained membership of both Royal Colleges of Medicine, in Edinburgh as well as London. He worked as Registrar at Hammersmith Hospital for two years. Then in June 1963, he accepted the post of Senior Registrar in medicine with the Professorial Medical Unit at Leeds University. He was appointed Consultant Physician with special interest in respiratory medicine in 1964 in Bury. His was probably one of the earliest appointments of a South Asian immigrant to a consultant post in general medicine. He has published a wide range of papers during his time working for the NHS, presenting them nationally as well as internationally. He was well respected in his field. He also participated in a Tomorrow’s World programme in the late 1970s and finally retired in 1992 after working for the NHS for 40 years.
Kay Lutchmayah Kay was born in Mauritius in October 1943 and came to the UK with her husband, Mark in 1962. Mark came to the UK to work in Flag of Mauritius engineering, whilst Kay wanted to take up nursing training. She completed her training and worked as a staff nurse in Brighton but wanted to train as 35
NURTURING THE NATION a ward sister. Her husband meanwhile was working in a variety of jobs, in electronics, for the telephone exchange and as a factory worker. She began to experience some difficulty in gaining recognition for her work and found herself undertaking the responsibilities of a sister without being paid for doing so. She appealed about her staff grading, and was successful, being awarded an E grade. She began to undertake a conversion but was demoted to D grade, for reasons she could not understand, and then eventually lost this grading also. She then found additional work as a private nurse as her family needed her income when her husband, who had worked for three years as a porter within the NHS, became ill. Kay is now retired and though often ill herself spends time looking after her husband.
Anisha Malhotra Anisha Malhotra was born on 14th December 1949 in Khatauli, India and was brought up in Sirinagar Kashmir. Her father worked in the Central Government Service and was one of the pioneers of All India Radio Kashmir. It was while recovering in hospital from an appendicectomy, that an 11 year old Anisha decided that she would like to study medicine, in order to be able to help other people. Anisha conducted her medical studies at Delhi University and then joined the Institute of Medical Sciences at Banaras Hindu University, graduating in 1973. Later that year, she met her husband, Dr. Kailash Chand (also featured in this book) while visiting Delhi and then began work at the Lady Hardinge College Hospital For Ladies in 1974. She did her training in Medicine and Anaesthetics, then she and Kailash got married later that year. In 1975, they moved to Kurukshetra where she worked as a Medical Officer, in the District General Hospital. Both 36
of her sons were born in New Delhi, Amit in October 1975 and Aseem in October 1977. Then in 1978, she joined her husband in the UK and worked in Psychiatry and Anaesthetics at Trafford General Hospital. After completing her GP training in 1985, she joined a group practice as a salary partner in Manchester. Then on 28th October 1988, her son Amit, passed away, due to heart failure, at the age of thirteen. This was a difficult time but her religious faith kept her going. Then in 1998, she joined her husband as a partner in General Practice in Ashton-under-Lyne. In December 2003, Anisha suffered a subarachnoid haemorrhage. She recovered and her husband and her son, now a doctor, were extremely supportive. Her religious faith has been enormously helpful to her throughout her life and Anisha now keeps herself busy, reading scriptures and contributing to religious websites.
Ramesh Mehta Ramesh was born on 19 September 1947 in a small village in central India; he decided at the age of seven that he wanted to be a doctor. He undertook his undergraduate and postgraduate training in paediatrics at the same medical school in India before coming to the UK in 1981 in order to gain additional training and experience. Following training at various levels and a stint abroad, he accepted the position of Consultant Paediatrician at Bedford Hospital in 1993. He took over as the clinical director of the department in 1996 and was responsible for modernising and expanding the clinical services. He initiated Paediatric Rheumatology services; one of the first to be set up in a district general hospital in the country. Ramesh later joined as Honorary Consultant at Great Ormond Street Hospital, London. Ramesh has tutored widely and has
BIOGRAPHIES been a PLAB examiner for the GMC. He has worked as a Principal Royal College of Paediatrics and Child Health (RCPCH) examiner across a variety of regions. He was instrumental in developing a collaboration between the Indian Academy of Paediatrics and the RCPCH which enabled Indian paediatricians to take the Membership of the Royal College of Paediatric and Child Health examination in India without having to travel to the UK. Dr. Mehta is founder president of the British Association of Physicians of Indian Origin (BAPIO). Set up in 1996, it is the biggest and most influential organization of international medical graduates in the UK. He is a fellow of the Higher Education Academy, UK (FHEA) and is Secretary General for the Global Association of Physicians of Indian origin (GAPIO).
Rajgopalan Menon Raj was born on 1 June 1948 in Singapore, one of five children. His father worked in the Local Authority Water Board and Raj attended a government primary school and government aided catholic secondary school. He then won a school scholarship to continue his secondary education and was taught by French Canadian Catholic Clerics. He was then sent to a Jesuit College in Madras to study for his ‘A’ levels on the advice of his school and he won a Government of India Scholarship to study medicine in Andhra Medical College in Vishakhapatnam, India. He came to the UK in 1974 once his medical education was completed and worked initially as a locum Senior House Officer in chest diseases at Gateforth Hospital, North Yorkshire. He intended to return to Singapore after completing his postgraduate study but the Singaporean Government refused to recognize the Indian degrees of those who had qualified in the UK. Since his degree was no longer recognized
back home, Raj decided to stay in the United Kingdom, separated from his friends and family in Singapore. He then re-qualified in order to remain in the United Kingdom. He found the work schedule fairly relentless which made studying difficult, but he eventually went into general practice in South Leeds, taking over a small single-handed practice in 1981 and building it into a four doctor practice with a list of 6000 patients by 2010. The practice also facilitates undergraduate training. Raj is now retired but continues to work as a sessional doctor and is also keenly interested in continuing medical education. His clinical interests are in cardiology, paediatrics and dermatology and he was also an Honorary Lecturer in general practice at Leeds University. Raj has been involved with Leeds Local Medical Committee from 1995 and has held the posts of Assistant Secretary, Vice Chairman and later Chairman, a position he continues to hold.
Ramesh Naik Ramesh was born in Zimbabwe on 19 November 1944. Ramesh’s father and mother went to what was then Rhodesia, from India, in 1920 and 1940 respectively. Ramesh attended the medical school, set up by and affiliated to the University of Birmingham, and worked for a consultant kidney specialist from England. He came to the UK in July 1972 to study for his MRCP membership in Warwick, worked in Birmingham as Registrar, as a Senior Registrar in Portsmouth and then as a Consultant in Reading at the Royal Berkshire Hospital where he is still currently based. Ramesh worked as Clinical Director of Medicine followed by Divisional Director of Medicine for the Royal Berkshire & Battle NHS Trust and has engaged in a great deal of fundraising both for the hospital, establishing its first kidney dialysis unit, as well as raising sufficient funds to bring 37
NURTURING THE NATION the daughter of a colleague’s brother to the UK from Bangladesh, in order to treat her leukaemia successfully. Medical Students from Oxford have nominated him as Teacher of the Month on several occasions and he has been a regular Examiner for the Royal College of Physicians.
Antony Ajay Pall Narula Tony was born on 14 November 1955 in Burma and came to the UK as a small child with his parents. His father came to the UK to train as a surgeon in 1958, then, following a military coup in 1959, the couple were advised not to return and in effect became the equivalent of asylum seekers in 1960. Antony’s father was categorized as a ‘resident alien’ and was required to report to a police station every three months, whilst working in the NHS as a trainee surgeon. The family planned to return to India, which is where Tony’s parents were both originally from, and Tony was due to attend a school in Darjeeling. A decision was made not to return, however, and Tony was educated and raised in Surrey where his father worked as a GP until retirement in the early-1990s. Tony conducted his medical training at Cambridge, holding junior posts in London and Middlesex and a middle grade post in Ear, Nose and Throat surgery in Nottingham. He conducted further training in Leicester and was appointed Consultant in 1989 at the age of 33, working at a teaching hospital in Leicester for twelve years before taking up a post at St Mary’s (now Imperial) in London in 2001 and he has worked there ever since.
SHIV PaNDE Shiv was born on 25 October 1938 in central India. His father’s business was in Bombay (now Mumbai) so he stayed with him to complete his education. He could not access the Bombay medical colleges as he had not been born there and the medical college in Central Indian state could not accept him as his qualifying exam was taken in Bombay, so, aged 17, he had to make representation to the Health Minister. He then attended medical college in Indore. He completed a Masters in Surgery, and in view of his interest in cardiothoracic surgery, after working in Mumbai, decided to go to the UK in 1971 to get additional training. He initially worked in Accident and Emergency at the Royal Albert Infirmary, Wigan. He found another six month post at the London Chest Hospital, employed as a Registrar and then went to work in Liverpool. He did not extend his study leave from the medical college in India, foregoing his job in India and continued his training in the UK. Potential employers told him to study for the Fellowship exam in order to get other work, but Shiv did not want to do this. He decided to go into general practice, doing a lot of locum work initially, and then joining as partner with another Asian GP. Shiv eventually took over his practice, then in 1981 took over another and was the first-single handed doctor in Liverpool to employ a practice nurse. Shiv became involved in television programmes for Asian people, took up a role as a local magistrate, as well as the Chair of the British International Doctors’ Association. He then became the first Asian doctor to be elected as treasurer of the GMC. He is part retired, continuing to attend GMC Fitness to Practice panel meetings.
Kiran Patel Kiran was born in West Bromwich in the UK on 28 November 1969. His father was born in Kenya; his mother was born in India and migrated to Kenya. Kiran’s parents arrived in the UK with six daughters, Kiran being one of 2 children to have been born in England. Both parents worked as steel factory workers in West Bromwich. Kiran went to Cambridge University where he undertook his undergraduate medical training, completing house jobs in Cambridge and Bristol, before working in Birmingham. He now works as a Consultant Cardiologist and Associate Medical Director at Heart of England NHS Trust. He previously worked as a cardiologist at Sandwell and West Birmingham Hospitals for 8 years where he also held secondments to the senior management positions of Clinical Director for NHS West Midlands Strategic Health Authority and Medical Director for West Mercia PCT Cluster. He is also the Chairman of the South Asian Health Foundation.
Albert Persaud Albert was born on 5 October 1954 in Trinidad in the Caribbean. Both of his parents are of Indian descent and came to the UK when Albert was very young. He completed his school education in the UK and first joined the NHS in 1974 as a porter, working after this as a care assistant. He then studied for his professional psychiatric qualifications and went on to work in public health medicine, joining the Mental Health policy branch of the Department of Health, developing a number of mental health policy
reforms during the late 1990s and through the 2000s. This work included developing and consulting upon the Mental Health Act 2007 and the Mental Capacity Act 2005. He was one of the founders of the National Institute for Mental Health in England (NIMHE) which was established to support the implementation of evidence-based practice. Albert is a lifelong campaigner in equalities and health and a proponent of cultural psychiatry, co-founding the charity CAREIF (Centre for Applied Research and Evaluation International Foundation), a charity based at the Centre for Psychiatry, St Barts and the London School of Medicine and Dentistry. CAREIF works to ensure that working practices and services in the area of mental health are suited to different cultures and societies across the world. Albert also co-authored/edited The Mental Health Legislation Resource, an introductory compendium of commonly used legislation in mental health and has written many papers in the areas of culture and mental health, post natal depression, and the law and clinical practice. Albert is a member of The Mental Health Act Commission, a trustee of the Long Term Medical Condition Alliance, is acting Vice-Chair of the Depression Alliance UK and Chair of the Global Alliance for Mental Health Advocacy Networks Europe Scientific Committee. He also serves on the Advisory Board of the South Asian Health Foundation, as well a number of other scientific committees. He is a founding member of Primary Care Mental Health and Education (PRImhE). Albert is retired but continues be active in the field of mental health research and policy.
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Meher Pocha Meher was born in October 1946 in Bombay, now Mumbai, where she attended medical school and obtained a Diploma in Child Health and an MD in Paediatrics. She came to the UK in December 1974, on a Commonwealth medical fellowship to carry out research at the Institute of Child Health and Great Ormond Street Hospital, London. She then worked as a Registrar at the Alder Hey Hospital in Liverpool and married in 1978. She went into community paediatrics, working as a Medical Officer, as Senior Medical Officer for St Thomas’ Community Paediatric Service and then for St Mary’s Hospital community service in Paddington, London. In between she worked part time in North Hertfordshire, until her children were at school full-time. In 1992 she took up a post as Consultant Paediatrician at Bedford Hospital and the Child Development Centre in Kempston. She was Clinical Director for the Hospital and Community Paediatric Departments in Bedford and Designated Doctor for Safeguarding Children in Bedfordshire before her retirement in 2007. She continues to work two days per week as a consultant paediatrician in Luton.
Rehanah Sadiq Rehanah was born in Pakistan on 14th April 1959 and came to the UK with her family when she was two years old, settling in Sheffield. Her family initially shared their house with another family, an Egyptian student, his wife and two children. After finishing school, her father wanted her to continue her studies and Rehanah initially trained as a laboratory technician. 40
Discovering she was really a ‘people person’ she began searching other avenues. She worked for Mothercare and then taught in a private Muslim Girls’ High school during which time she researched Islamic studies. She began to attend various student conferences where Muslim scholars were invited to speak about Islam, and then she herself began to conduct speeches on Islamic topics in the community, at colleges, institutions and on cultural awareness for service providers. In addition, she worked part time for social services as a Religious Instructor supporting Muslim girls in a Girls’ Home. Rehanah got married in 1984 and moved with her husband to Birmingham. Here she continued to teach including in after school madrasahs, and also worked for a worldwide charity, Islamic Relief, in which she worked closely with women in the community. Her speaking role in Islamic topics increased and before long she found herself working with Muslim families and specialising in Islamic counselling. In 2000, Rehanah was alerted to a job vacancy for a Female Muslim Chaplain at the Birmingham Women’s Hospital, applied and was successful. A month later she also began work at the University Hospitals Birmingham. She has worked there ever since, offering pastoral, spiritual and religious care to patients, relatives and staff. Whilst addressing the needs of Muslims in hospital she also offers her ministry of care to those of other faiths and none. While working at University Hospitals Birmingham she worked hard to represent the views of Muslim female clinicians who came to her for advice about the ‘Bare Below the Elbow’ policy. This policy was introduced to ensure hygiene was maintained so as to reduce the risk of infection to patients and it recommended that staff should wear short sleeved uniforms. Suggesting this policy disadvantaged Muslim female clinicians who wanted to cover their arms for religious reasons, Rehanah helped trial disposable sleeves
BIOGRAPHIES at the hospital. This pilot project was successful, and disposable sleeves are now worn by Muslim female staff wishing to do so.
Nagendra Sarmah Nagendra was born in Assam in Northern India on 4 April 1936. He completed his medical training at Assam Medical College and came to the UK in 1965. After qualification in India he had conducted some training in gynaecology and came to the UK to continue with study in this specialism, settling initially in Cheshire and working as a Senior House Officer at Nantwich Hospital. Though a small hospital, Nagendra found himself working up to 120 hours a week. He then found work in a teaching hospital in Manchester completing a six month post as a house surgeon and then went on to the Wittingshire Maternity Hospital nearby. Nagendra worked at the junior doctor level for two years, whilst trying to get Registrar posts, but without getting an interview. He decided to change specialism to anaesthesia as he now had a young family to support and worked in Bolton in Lancashire. He didn’t enjoy this area of medicine, so continued to apply for jobs in obstetrics and gynaecology and eventually found a Registrar’s position in Liverpool. Nagendra realized that if he took this post, he would only see his wife and two children every other weekend as they were living in Stafford. He therefore decided to abandon his plans to become a consultant and entered general practice, but even here he found it difficult to find enough patients to survive financially.
practice list to 3200 by 1977, taking on a further 1200 and employing another GP at the request of the health authority. He was elected to the local medical committee and also to the Manchester University medical school selection board, winning an award in 1984 from the Manchester Community Health Council for good service to his patients. He suffered from glaucoma and had a heart bypass in the late-1990s so after working part-time for a few years he retired in 2001.
Rashmikant Shah Rashmikant was born in September 1950 in Kenya, East Africa, moving with his parents when aged about 7 years-old to Uganda where he was educated up to secondary level. From Uganda he went to Mumbai, India to study for his dental degree and then came to the UK in 1975. His parents had come before him following the mass expulsion of Ugandan Asians from the country. When Rashmikant came to the UK he undertook some more training and study as he found the degree grade he had obtained overseas was not recognized in England. He decided to go into dentistry while his brother became a pharmacist – they saw it as important to be financially independent, in order to help their parents, so seeking well paid work was essential. He first worked as an associate then purchased his own practice. He found the targets set for dentists over the last few years quite demanding and has now retired though is doing regular NHS work to continue to help the local patient population.
Eventually Nagendra succeeded in taking over a singlehanded practice in Chorlton-cum-Hardy in surburban Manchester, working extremely hard and building up a 41
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Anita Sharma Anita was born in New Delhi, India on 25 September 1952 and acquired her medical training and postgraduate qualification in obstetrics and gynaecology at the Maulana Azad Medical College in New Delhi, India. She came to the UK in April 1978 to join her husband who had come a few months earlier to take his MRCP examination. She intended to return to India once she had completed her MRCOG (Membership of the Royal College of Obstetricians and Gynaecologists). She was pregnant when she arrived in England. Anita joined her husband who was working as a senior house officer in Leighton Hospital in Crewe. Her first child, a daughter was born in May of that year. She got her first job in obstetrics and gynaecology at Leighton Hospital in Crewe, starting in November 1978. As her husband began to rise fairly quickly through his medical career, getting a consultant post within five years, the family decided to stay in the UK. The choice was then between being a stay at home mum or making a full time commitment to her medical career and she decided to go into General Practice, qualifying in 1983 and taking over a practice in 1985 in Oldham where she has worked ever since. She believes that it takes a strong will and hard work to achieve aspirations and as a mother of two children has always worked full time. Anita strongly believes that women doctors cannot have it all and has spent a lot of money on childcare and help in her home. Although she has a medical degree she knows that if her husband had not also supported her that she would not have achieved what she has. Anita is an undergraduate trainer attached to the University of Manchester, a Family Planning trainer and GP appraiser of NHS Oldham. She has written three 42
books and a fourth one is due to be published soon. She also writes for GP, Pulse and, BMA Magazine. She is the GP editor of British Journal of Medical Practitioners. She has served as a Local Medical Committee locality member for the last 7 years and is also the editor of the local LMC newsletter. She organises various fund raising activities and is also involved in a lot of charity work, raising money for Cancer Research. The royalty raised by her recently written book on COPD in Primary care goes to the Breathe Easy group of Oldham. She is also the secretary of the Indian Medical Association, Manchester division and president of BMA Rochdale division. With her recent role as a clinical director in vascular and medicine management with Oldham CCG, Anita believes the new NHS with the new commissioning agenda is in the right place at the right time. Improving women’s health is high on her agenda and she is going to donate the royalty of her recent written book to ovarian charity. Both of her children are doctors and that makes her a proud mum.
Rahat Sohail Rahat was born in Sahiwal, Pakistan on 20 July 1949. She conducted both her secondary and university education in Pakistan, gaining an MA in Journalism from the University of Punjab at Lahore. Whilst there she was awarded the Gold Medal for coming 1st in her academic year by the Pakistan Information Minister who promptly offered her a job as Information Officer for the Government, a role she stayed in for six months. She came to the UK in June 1977 to be with her husband who was studying Computer Science at Manchester University. They lived in both London and Coventry and she spent her time, while her husband was studying and working, in the library working on
BIOGRAPHIES the development of her MA thesis into a book called Evolution of Urdu Editorial: 1802–1974. In 1979, she and her husband and son then went to live in Saudi Arabia where her husband was employed by Aramco and they stayed there until 1985 when they returned to the UK withoftheir Flag Indianow three children. In 1991, Rahat applied for and was recruited as one of four bilingual speech therapy co-workers in Newham, East London. At the time, therapists were finding it difficult to ascertain whether children with speech delay or difficulties were speaking in their first language or simply finding it difficult to communicate. Rahat continues to work in this role, but has also continued to write, publishing three books, of Urdu poetry and nursery rhymes specifically for parents to use when helping their children to overcome speech difficulties.
Rangena Tilkaran Rangena was born in Carolina, Trinidad in 1950 and went to San Juan Secondary school and Furlong College in Trinidad. Both her parents and grandparents were also born and lived in Trinidad but her maternal great grandparents came from India. She arrived in the UK on 31 August 1970, travelling by plane and chose to do so, rather than conduct her nursing training in Trinidad because she had read so much about the UK. She completed her nursing training at Harefield and Mount Vernon School of Nursing and her midwifery training in Luton and Dunstable. She returned briefly to Trinidad in 1974 following some work as a staff nurse in England, but did not enjoy working in a private hospital, so returned to train as a midwife. Her first post was as Staff Nurse in Harefield Hospital. Whilst there the first heart transplant in the country was conducted on one of her patients. She worked for both
the old Queen Charlotte’s and Chelsea Hospital and the Hammersmith Hospital, helping to transfer patients and services from the former to the latter. Together with the consultants she was one of the key people responsible for the development of the West London Gynaecology Cancer Centre at the Hammersmith Hospitals NHS Trust, now Imperial College NHS Trust. Ultimately she was employed to work as Lead Nurse and Manager for Gynaecology for Imperial College NHS Trust, retiring in April 2008. She continues to be very active in her local church, working in her retirement training Primary Health Care Workers in both Sri Lanka and Brazil, running courses in Money Management and providing individuals with career development support. Rangena was also awarded an MBA and clearly remains extremely active in her retirement.
Malkit Uppal Malkit was born in India in 1951 and came to the UK in 1962 with her parents when she was 11. Her father came to the UK in 1953 and Flag of India worked as a labourer, then returned to India and brought his family back to England with him where they settled in Southampton. Malkit initially worked in a factory making sleeves for coats and then, after getting married in 1972, moved with her husband to Warwick. She found work in a factory soon after this but in 1973, with the help of her sister, was recruited to work in the kitchens at Central Hospital. She worked as a deputy supervisor and when the Central Hospital closed and patients were dispersed into smaller units within the community, she continued to work as a server assistant. She has worked for the NHS for about 37 years, taking time out only to have her children and care for them after she was widowed; she continues to work and enjoy her role. 43
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2 Making the Decision to Leave
Intendance Street, Port Louis, Mauritius ©Simisa
In India, I had passionately believed and supported the NHS and saw that it was a unique service provided to everybody irrespective of ability to pay. It is needs based and I think there’s no good model anywhere else. I’ve travelled to various parts of the world and even though we always moan and groan, I still think that the NHS in my view is something to be proud of and that view I formed when I was in India. I wanted to see for myself what the system was and how the system delivers and I also believe that those dreams and ambition can be useful and relevant to the Indian democracy – to health, education. All those things were, and are important to me. Kailash Chand, retired GP, born in India, who has worked as a GP for 25 years The majority of the people featured in this book were born overseas and came to this country to pursue medical training. Some, drawn by UK medical institutions, completed courses started in their own country. Others responded to 1960s and 70s UK recruitment drives, for example for nurse training, across a number of Commonwealth countries. This chapter will explore some of the reasons these groups of determined travellers gave for leaving their places of birth and education to make such long journeys. Coming to the UK from other parts of the world for people who were still themselves quite young was quite a daunting prospect, but the pull of the National Health Service was strong particularly in view of the benefits it provided for all regardless of their financial abilities. Making the decision to leave was not always easy − there were often huge financial sacrifices made by the families of those aspiring NHS workers wishing to leave while other parents simply wanted their children to stay and work in family businesses rather than make such long journeys. However going to the UK and becoming successful carried with it increased status both for the individual leaving, as well as for the family left behind. Britain, as
MAKING THE DECISION TO LEAVE opposed to America or other parts of Asia was a highly desirable destination and for those interested in medicine and caring for the ill, the unrivalled UK health service was something they all wished to experience. Voon Cheng, a Malaysian midwife now working in Essex, was 17 when she decided to travel to England in response to an advert in a magazine. “I was probably 17, 18 and I just applied. I wrote off because my sister had got Women’s Weekly magazine, and in it was a little advert about interest in nursing. So I filled it in and sent it off and just waited. I know the whole process took a year because I was anxious to go. I wanted to go abroad and the door was open because some of my friends had already come here and it seemed to be easy coming in. At that time, it seemed to be part of your life, it takes that long. You cannot just go with the flow – you wait for a reply from England. You can’t just apply and get your ticket to go.”
A young Voon Chan with fellow midwives
Voon had only recently completed her examinations and had not worked in Malaysia before applying for work in England. Many of her friends and other young Malaysians had made the journey either to England or Australia, and the primary reason had been to travel and study. That such a journey at such an age, should seem daunting, did not however occur to her: “I just wanted to go abroad, it’s just instinct, I just wanted to go and travel. I just applied and set off because I remember my mother saying your dad was amazed at
you, you had no fear in you, you just knew this is what you want to do, you yourself just applied, you didn’t ask anybody.” For Krish Goodary, born and educated in Mauritius, the process of making the decision to come to the UK was similar. He too joined a procession of other young Mauritians, having recently completed examinations at school and eager to find work abroad. However, his reasons were slightly broader than a desire to travel and broaden horizons: “In 1968, Mauritius got independence from the UK. It was a very exciting time. I was a teenager and the way the propaganda was, the media portrayed sort of a future which was going to be bright, with prosperity, away from the long arms of Britain – ‘We will be independent, we’ll do our own things’. Unfortunately, things started going downhill very quickly after that. There was poverty, unemployment was rising, although still very young, I was about 14, 15 years old but I could see how poor people were getting poorer and the middle class and rich people were getting richer which made me very sad. I couldn’t understand the depth of the problems at that age, yet I was very sensitive to things and I could see no future for me in Mauritius.” For other arrivals to the UK, the decision to leave was not based on the need to find work, but on a wish to continue medical training in Britain specifically. The existence of medical schools in India, set up by the British, and conforming to GMC requirements and regulations, meant that generally these individuals were responding to a set of personal ambitions, rather than as part of open recruitment. Indian degrees had been recognized by the General Medical Council from as early 1892 and until 1975, and medical colleges taught a curriculum similar to those employed in England and Scotland. In a sense therefore, even before the decision to train in Britain had 45
NURTURING THE NATION been made, the process of medical training, was often highly selective. Arup Banerjee a retired geriatrician who came to the UK in 1960, went through such a rigorous process prior to his decision to leave India: “I applied for a seat in Calcutta Medical College which is again one of the prime institutions in India, one of those three or four which first was established in India more than 200 years ago. These are very old institutions with a very long track record run mainly by British surgeons, physicians, professors in Arup Banerjee the colonial days. When I went there, there were no English there, they were all gone but it still had a very good reputation, high standards and getting in was very difficult. “They usually published the selected candidates at the end of the day’s interview, these are the ones selected and I think there were something like, oh, 80 students interviewed, boys and girls, and I think they took 15 in the first round and I was one of them. So, my name came out, I saw that and was very pleased. So I came home and everybody at home was very anxious at what was happening wondering ‘Why is he so late and what is going on?’ So I entered the house and everybody came, all the lights came on, my uncle came out, brothers, sisters, wife, parents came out, they were all doing other things, and my mum came running to me out of the kitchen and said what happened, I said I got in. They were all very, very pleased.” Arup’s family were not the only ones proud of his selection into medical school – the status of the family among the local community also rose. The costs of medical school were met by his father, and though they were not poor, neither, in Arup’s words, were they rich. 46
I decided to come to England because I wanted to have the full professional satisfaction of being a good clinician.
For most of the doctors and medical students included within this book, the decision to come to the UK was based on the education and training they had already gained, and a desire to continue it in the countries they had learned so much about. A time spent in the UK was also held in high regard by families and communities. Ramesh Mehta, a consultant born in India, wanted to go to England to continue his studies, though he had to work in Oman in the Middle East for three years in order to gain the financial resources to make the full journey to the UK: “I wanted to come to England because I thought to have the full professional satisfaction of being a good clinician, I need the best training and my impression at that time was that the best training is available in England. The best thing about this medical education which has continued since my arrival and before that is the quality which has been maintained.” Having gained access to one of the more prestigious medical colleges in India, Arup wanted to come to the UK with his wife, in order to continue with a form of education that he had already begun to experience: “We were planning to come to Britain at that time, and why Britain? Because in our medical school, our medical environment as it was then, very soon after independence, it was very much British influenced. Most of our teachers had qualifications from this country, not America - they all used to come to England. They all had an English higher degree − MRCP, FRCS. Therefore, accordingly, we had in our mind that we must go for those qualifications.”
MAKING THE DECISION TO LEAVE
I come from a generation where it wasn’t so much that I decided to become a doctor, as that my parents told me I was going to do medicine! Tony Narula
Parental responses Not everyone made the initial decision to come to the UK entirely alone. For some, the decision to go into medicine had been one made initially by parents. For Arup Banerjee, for example, there had been a number of illnesses within the family, and also since his brother had followed his father into the engineering profession, the decision that he should go into medicine seemed almost natural. Dipankar Dutta’s father is a retired doctor and now 85. He trained as a doctor and worked for the NHS for five years, before returning to India in 1954. This not only influenced Dipankar’s decision to go into medicine, but also to go to England so that he could continue his training. Tony Narula came to the UK from Burma with his parents, when he was three years old. Both his father and grandfather had been doctors and it was expected that Tony would do the same: “Well I come from a generation where it wasn’t so much that I decided to become a doctor, as that my parents told me I was going to do medicine! My father and my grandfather were doctors so it was assumed that I would be a doctor and that was it. I was even sent to a boarding school that specialised in educating doctors’ children called Epsom College. It’s well known for having medical links and lots of doctors’ kids go there.” For Kailash Chand, a highly respected and now retired GP, however, the decision made by his family to train and work in the UK, was based on a desire to provide another direction for him:
“It was destined for me to come here. I was very much involved in social activities in India as a student and was involved in the student union and was a student leader. I was the spokesperson and general secretary of the Nonteaching Employees Association at university. At the time if you remember in India there was a very dark period in democracy and that was known as the ‘emergency period’. At that time Mrs Indira Gandhi, who was Prime Minister, declared an emergency in India for political reasons and I was very vocal to the extent that briefly I was even imprisoned. “My friends and family thought, ‘Here is a hot blooded person who is always going to be in the Government’s eyes, so we should perhaps make something of him and ask him to spend some time in England’. “England used to be and I think still is the most favoured destination of people coming out of India, though America and others are as well. But still I think at that stage it was decided by my friends and family, rather than me, that it was high time, that I get out of India.
Indira Gandhi, Prime Minister of India from 1966 to 1977 and for a fourth term from 1980 until her assassination in 1984
”During 1975 a State of Internal Emergency was called by the then Prime Minister, Indira Gandhi, lasting over 19 months. During this highly controversial period elections were suspended, as were any civil liberties demonstrations and activities. Kailash’s political affiliations would have placed him at risk of further imprisonment at that time. It is therefore highly likely that both his parents and other
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© Daniel Berthoud
They didn’t want me to leave. My dad was well off and he wanted me to work in the family business. I was working with him and I knew it was not for me. That’s why I decided to go much to the disapproval of my parents.
family members were concerned for him. He did however also have other considerations which prompted the family decision: “I was newly married and had one child. Unfortunately that child had Down’s Syndrome, and I was seen in my family’s eyes as a person who was taking these critical risks and getting myself into trouble.” The responses of parents to their children’s decision to leave and train or work in the UK varied. Krish and Voon, who both left their countries at fairly young ages to begin their training in the UK, were eventually able to persuade their parents that their decisions to leave had been right. However, initially their respective parents were unhappy that they should want to go, as Krish notes: “They didn’t want me to leave. My dad was well off, he wanted me to work in the family business. He was a land owner and also had a business. He was exporting sugar to England. While I was unemployed, I was working with my dad and I knew it was not for me. I was looking for other jobs which I couldn’t find in Mauritius. That’s why I decided to leave, much to the disapproval of my parents.” Voon’s parents eventually warmed to her decision to go given how determined she was: “My mum told me my dad was shocked. He’d said ‘I couldn’t believe you’re just so focussed and you’ve just sorted out all the arrangements. You never got stuck with anything, you just went’. And he supported me, when 48
Kek Lok Si – Chinese Temple, Penang Island, Malaysia
he realized I was focussed. Then he accepted that and he started to buy things for me − he bought a suitcase for me, he bought a coat for me. “I think maybe because we are girls, girls are not meant to be so career minded, travelling and things like that. It’s always the boys, the male that is supposed to do all these sorts of things but he didn’t tell me that because he was brought up different. He didn’t talk that much. It’s always my mum who told me about him. He used to tell his friends about me, how ‘She’s so focussed, she just did it’. What he meant was I got on with it, I got on with the application, and instead of not doing anything, I just did everything bit by bit and then went.“ Voon and her father never had a proper opportunity to discuss her leaving Malaysia – most of her conversations about going took place with her mother. She did, however, have one opportunity to talk briefly about her decision to leave before he died:
MAKING THE DECISION TO LEAVE “I remember one year I went back and I spoke to him. I said ‘I’m a bit like you. You left home from China and you went to Hong Kong to work for a little while and then you bought a ship passage ticket and you came to Malaysia’. I said ‘You did that. You knew where you wanted to go and you just went. So I’m like you. I just went’.” Voon’s sentiments here reflect an interesting theme about making the decision to leave a country in which a person is born and often raised, to come to another part of the world. Her father had made the journey from China to Malaysia, returning only to make a request for the local matchmaker to arrange a marriage for him with Voon’s mother. She worries that the historical life that he and her mother had lived in China, together possibly with her own early life in Malaysia, will be lost: “I don’t know why but he didn’t tell us stories about his life in China so we don’t know. He seemed to start his life with us in Malaysia which is not good. Now we’re trying to look but we have no documents, we have no names. It’s like people leaving England and going to Australia or America to start a new life, so that part of your life is completely gone. You start anew elsewhere and that part of your history is cut off. And then when you’re growing up without any knowledge of your parents you don’t think to ask until when they are not here. You wish you’d asked.
I think my parents felt medicine would be very expensive, that you’d have to compete in the environment where all the doctors in Rhodesia then were White and the road would be barred. It was a very White profession but I wanted to be a doctor, I wanted to serve people. Ramesh Naik
chose to go into medicine the amount that it would cost for them to do so must have been at the forefront of their parents’ minds. Ramesh Naik, who was born in Zimbabwe, is a Consultant Nephrologist in Berkshire. He noted that the response of his parents to his decision to go into medicine, highlighted not only the impending cost of studying, but also his position and status as an Asian student competing against White doctors, in a very divided Rhodesia before independence:
“My mum couldn’t help us because she’s not educated so she cannot write and she’s limited in telling us the history of things, which is sad, very sad. That’s why I’m interested in history, to know how it shaped you, how it influences you.”
“So my family were sitting at home one day and trying to plan – because my brother was doing so well − to plan his education; where he was going to go, high school, then university, where in England, where would we be able to afford? So my parents were planning his education and I was sitting in the background minding my own business and they just turned around to me and said ‘Well what are you going to do?’ I said ‘I’m going to be a doctor’ and they all fell off their chairs! Because there was no medicine in our family, nobody had even contemplated being a doctor and it would be something that for an Asian family just wasn’t on.
For some of the aspiring Asian NHS workers, the initial responses of their parents to their decision to go to the UK reflected the financial anxiety which accompanied the choice. Training to become a doctor was, and continues to be, an expensive career route, and though most of the doctors included within this book actively
“I think my parents felt it would be very expensive, that you’d have to compete in the environment where all the doctors in Rhodesia then were White and that you would never be able to compete and become a doctor as the road would be barred. It was a very White profession. So they were very surprised but I just felt I wanted to be a doctor, 49
NURTURING THE NATION I wanted to serve people and I admired the doctors that worked there in my community. They were all very well respected, they served the community, worked hard and I thought that’s what I want to be. And then after that, I didn’t want to do anything else.” Rangena Tilkaran, a retired Lead Nurse from Trinidad, made the decision to come to the UK to train as a nurse instead of taking up a training position in Trinidad to work as a teacher. Her parents were proud of her choice though inevitably worried about her coming to the UK to study and live on her own at the age of just 20 without her family. A deeply Christian family, they were ultimately happy that the British Council paired Rangena with a Christian couple to watch over her period of settling into the UK: “When I received the letters to train either as a teacher or a nurse my parents gave me the choice. When I chose nursing my father sold a cow to pay for my air fare! He has a small farm and they were happy that I chose a career but obviously concerned that I would be on my own and didn’t know anyone. They were pleased when I told them that I had met Dr and Mrs Brian Rogers who were Christians. They used to be missionaries in East Africa and without them it would have been very difficult, my first time here in this country. They were significant in that sense as they were Christians and they took me to church. “Before deciding which hospital I should apply to my father looked at the map of England and worked out that Northwood was not in London but not too far away to visit. He did not want me to live in the city. I think his decision was right.” Kalyani Katz’s decision to come to the UK was ultimately one shared by her father. She had decided as a child that she would go into medicine and wanted to come to the UK in order to continue with her training in psychiatry. At the time, the specialism was not considered important in 50
India and she felt that she might find better opportunities to excel in the subject should she go to the UK: “Even before I went to do medicine I knew that I wanted to be a psychiatrist because of my experiences in my childhood. I had a couple of experiences as a child in my neighbourhood which made me interested in psychiatry. There was an uncle of a friend of mine who – now looking back – suffered from schizophrenia. He would collect wooden twigs and would be seen talking to them. He was the ‘village mad-man’. In India, mothers used to frighten their misbehaving children with a threat of calling the ‘mad man to take them away’. My mother did the same. However, I was never frightened of him because he was a very gentle man. I used to think the opposite to what everyone else thought of him. I thought that he had special powers to see things/people that others could not see. So I often tried to sit close to him to see if my eyes could see what he saw. Of course I never could see who he was talking to. I remember very clearly when I decided to study the area where I would find out what special powers he had that allowed him to see what no one else could. And that’s how my interest in psychiatry grew.
My father was a very ambitious man for his daughters – he was ahead of his time and he believed in the education of women. He believed that society functions better when women are educated and he said ‘all my daughters will become doctors’. Kalyani Katz
“In Indian medical schools – even now but worse then – there was little psychiatric teaching in the curriculum. We had just two weeks psychiatric attachment and most students took time off during these two weeks. There was no end of term examination in psychiatry. As I was interested in psychiatry I joined the psychiatric firm. On the first day the professor said ‘What are you doing here?
MAKING THE DECISION TO LEAVE Do you not need a break?’ He was truly surprised by my response, ‘I’m interested in psychiatry’. “My father was a very ambitious man for his daughters. He was ahead of his time and he believed in education of women. He believed that society functions better when women are educated. Since we were born, he’d said ‘All my daughters will become doctors’. He wanted us to have British degrees because he had a high regard for Britain and its educational system. I had an advantage of having an uncle in this country who could provide initial support. So my father felt secure in sending me to England to pursue my studies. In those days in 1975 it was very unusual for an unmarried Indian girl to be sent abroad. I had spent my early years in a traditional non- English speaking Indian household – so my English was not fluent when I arrived in England. It was quite an adventurous thing to have come to England on my own.” For some of the interviewees, the decision to come to the UK was not one of their making as they were either following their parents to the UK, following a spouse who had made a decision to come to the UK to work, or, in the case of those who had come from Kenya or Uganda in East Africa, coming because of policy changes that saw their parents lose businesses and jobs. Rashmikant Shah, a dental surgeon, came to the UK in 1975 after his studies in India, but noted that his decision to come was not exclusively motivated by his wish to conduct his dental education. Born in Kenya, but brought up in Uganda from the age of seven he recalls coming to join his family aged 25, and trying to assist them with settling in, particularly as his father was disabled: “My parents were literally thrown out of Uganda, so I came here to join them. My father was trying to get things done but he had a disability and mobility was a problem for him. Trying to find things that worked for him was a big problem and basically we didn’t want to live on the
Working in dentistry
state. It was very difficult in that time to make ends meet when you don’t have anything at all, a little bag of clothes and hardly any money in your pocket, so it was a difficult challenge. The hardship we faced was quite difficult especially whilst trying to educate my younger brother and two sisters as well. My father bought a house and found a job in the civil service and made ends meet. We tried to help as much as we could, but money was scarce and we had to economize on a lot of things. Going out and having fun was out of the question.”
The plan to return Making the decision to leave the countries in which they were born was not too difficult for some of those who made the journey to the UK during the 1960s and 1970s as ultimately they planned to gain the relevant qualifications or years of experience and then return to their parents and families. Krish intended to complete his initial nursing training and promised to return as a way of appeasing his parents: 51
NURTURING THE NATION “I think they were resigned to the fact that I was determined to do my own thing. They reluctantly accepted that. I came to do a pupil nurse course which was for two years and I said to them that I’ll be back when I have completed the course. So they were hoping that I would be back, which I wanted too. But then, after you did your pupil nurse course you wanted to do something different, something that would assist you in developing a career.” The academic Aneez Esmail, in his research on the experiences of Asian doctors in the NHS, notes that for the most part, the intention of those who left their countries of origin to work in hospitals and surgeries in the UK, was to gain skills that could be drawn on once these fully trained individuals had made their return. He notes that within India certainly, a high premium is placed on the experience to be gained from working within the NHS, particularly within private medicine. The transferable nature of these internationally acquired skills could greatly increase the marketability of returning Indian nationals. Tony Narula’s father, Yash Pall Narula, was born in 1927, and came with his family to the UK in 1958, intending to train as a surgeon. Tony’s family plan to return was a complex one, as though Yash had trained in India, he worked in Burma, as a civil surgeon. Whilst the family was living in the UK, Burma underwent a military coup, and the family were Tony Narula’s birth certificate
advised not to return. Once the coup had been established in Burma, Tony’s parents effectively became asylum seekers – Yash was classified as a ‘resident alien’ and was required to report to a police station every three months. Yash’s family members all then left Burma to live in India, and Yash decided that he would complete his training in the NHS and return to India: “So my father’s expectations were nothing other than come along, get some training, hopefully get some exams and go back. The only asset they had was the return half of their air ticket and I think it took them several years to be able to cash that in, so literally they came with a suitcase and ended up living out of a suitcase.
The only asset my parents had was the return half of their air ticket and I think it took them years to cash that in, so literally they came with a suitcase and ended up living out of a suitcase. Tony Narula
“My father worked as a trainee surgeon in England and in the early 1960s it was planned that he would go back to India and work there and I’m not sure what happened but anyway it didn’t happen. I was supposed to go to school in Darjeeling and the day I was supposed to leave England, I didn’t go and my parents stayed. I was supposed to fly to Delhi where my grandfather was supposed to meet me, I think, or an uncle and take me to boarding school. I must have been about six, seven or eight and I didn’t go.” For some, the plan to return was thwarted by their attempts to gain qualifications and the unanticipated length of time it took to successfully pass examinations or find relevant posts. Ramesh Mehta, consultant at Bedford Hospital, noted that though he planned to return to India, gaining the qualifications and posts that he set out to achieve made that plan slightly more difficult:
MAKING THE DECISION TO LEAVE
“My plan was to come here to get trained and then go back within probably two to three years. Once I came I wanted to ensure that I had the proper training and had postgraduate qualifications so as I came in, the first thing was, it was difficult to get a proper post and it took me one and a half years of locum jobs before I got my first proper training post. However, after that, to continue in the training post was very difficult and more difficult was to pass the postgraduate exam which I desperately wanted to have as a sort of confirmation that I am trained in the UK and probably more for self satisfaction.” As Ramesh suggested in his comment, gaining qualifications was necessary in order to provide confirmation, to themselves and to others such as their family members, of the time, energy and expense they had devoted to making the journey to the UK. As the academic Aneez Esmail has noted, Asian doctors often ‘ended up being tied to the UK and the NHS, because returning without fulfilling your aspirations was not an option’. Asian doctors would stay in the belief and hope that they would gain the qualifications, or work that they had set out to do. This would then enable them to return to their countries of birth, armed with the experience and status they had gained.
Ramesh eventually passed his MRCP (Membership of the Royal College of Physicians) examination − a postgraduate medical diploma which enables students to demonstrate that they have acquired a sufficient level of knowledge in their area of speciality. Passing this is necessary to be able to practise in a specialist field. By this point however, his two children had been born in Britain and were being educated in England, which also prevented his move back home. Further setbacks occurred in the shape of advice he received from the consultant he had been working with who: “… thought it was unlikely that I would progress to become a consultant so I was actually discouraged to continue into the training post. At that time, the system was, if you wanted to progress to get a consultant job, you were required to have what is called a senior registrar position. So because I was so discouraged, I thought okay anyway I only wanted to be here for a short time, so I would like to return to India and on the way I thought I would stop over in Saudi Arabia for a few years and then go back. I left in 1988 and I had a good job in Saudi Arabia where I was for four years. In between, during my annual leave I came to the UK where I was requested to do locum consultant positions. It was very interesting because suddenly there was a shortage of consultants in this country and three hospitals that I worked as locum for, all requested me to come back and join them as consultant.” The pressure of work, but also the reality of children being born, educated and raised in Britain, made the option of return less likely as time passed. For some of the female NHS employees who had come to the UK with their children to join their husbands who had arrived earlier, settling and remaining in Britain seemed the most practical thing to do. Meher Pocher, for example, who came to the UK to complete her postgraduate training at Great Ormond Street Hospital, met her husband, which altered her plans: 53
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Great Ormond Street Hospital
“I didn’t really want to live here necessarily. I thought after this year, I’d sort of travel around a bit and then go back and start looking for jobs in Bombay. Then I met up with my husband and I decided Liverpool is closer to London, than it was to Bombay! I got the job in Liverpool and we got married.” Anita Sharma, a GP in Oldham, though not regretting the journey made to the UK, did have regrets about not returning to India: “I lost my mum 6 or 7 years ago and would have liked to have gone back and serve my country.” Her sentiment echoes those who made the decision to stay, yet have, in a variety of ways, become engaged in work that enables them to feel that they have or would like to have ‘put something back’ into their home countries and communities. Ramesh Mehta is one of the founding members of an organisation called BAPIO (British Association of Physicians of Indian Origin) which has achieved many policy related successes over recent years. He notes that this voluntary work that he has become involved in, has gone some way to create opportunities in India, his country of birth: “On reflection, I feel very fortunate that I have been able to achieve a lot of my ambitions. I also feel that although I have migrated, I haven’t neglected my dues to my country of birth and I do a lot of charity and educational work which includes taking the exam to India. People like me 54
who are individually doing some charity work, there are lots of us. We estimate there are 40,000 doctors of Indian origin in this country so one quarter of the workforce really and many of them want to do some work in the country of their birth, but it is haphazard and not very well organised. So what we are hoping to do in the next few years is that this will be organised under the umbrella of BAPIO so that it’s a lot more effective and result oriented.” Kuldip Bharj, a lecturer in midwifery, came with her parents to the UK as a child from Kenya, and although they had come primarily so that she and her brother could be educated in the UK, the activities taking place in Kenya were never far from the family’s mind. Kuldip had also spent all of her life in the UK. Returning therefore for individuals like Kuldip was made all the more difficult because she felt she no longer had a home to return to: “That’s a big issue, a serious issue, because I’m Indian but I was born in Kenya. In India we’ve been visitors and when I go now, they talk to us as if we’re the foreigners and because I have a British passport I couldn’t go down and settle in India, so really England is home. I have never contemplated ever going to Africa. “There are many other people who are in similar positions because we often talk about it, once the Kenyan Asians get together. We have our own gatherings and people do say gosh we may have to leave here one day particularly my husband’s family. They are from Uganda and Ugandan Asians were turned out of Uganda so there’s still that perception that we may have to leave − well, it may happen, it may not and where would we go?
Because I’m Indian but was born in Kenya, when I go to India now they talk to us as if we’re the foreigners! So really England is home. Kuldip Bharj
MAKING THE DECISION TO LEAVE “I think it has gone down a bit but, certainly, right until the mid-1980s, a lot of people who had been turned out of Uganda had this fear because they weren’t even sending money home or buying houses and things like that. I think it took a good six, seven years. It’s been a long process and they were very scarred. They were not even wanting to furnish their houses very well because they were just very fearful of what might happen even in England.”
Initially at least my father’s intention was to raise enough money to rebuild his business in Pakistan but he began to settle and integrate into the British community. Then I and my four younger siblings who were born, educated and brought up in the UK found conversations about ‘going back to the homeland’ very alien. Rehanah Sadiq
© Altif Gulzar
Rehanah Sadiq came to the UK aged 2 and a half so remembered little about the place she was born in and did not speak about plans to return. Her father however had arrived in the UK intending to work hard, return to
Pakistan and his family and establish a business. However he found this difficult to achieve once his children were settled in Britain.
Nathya Gali in Pakistan
NURTURING THE NATION “After the Partition in 1947, my parents migrated from their home in India to what is now Pakistan. It had become very difficult for them to rebuild the business they had lost, and in 1959 my father came to Britain to work, whilst my pregnant mother stayed behind. As an educated, English speaker, my father decided that he could meet Britain’s call for labour and earn a dignified living and so began work in 1959. While he probably thought that he would make just enough money to ‘help my family along until I can restart my business and we’ll all go back’, it didn’t quite happen like that. Once he had raised enough money and established a home for us, my mother and I were called over to Britain to reunite the family where I met my father at the age of two and a half and was brought up in Sheffield. “Initially at least, my father’s intention was to raise enough money to rebuild his business in Pakistan. Education was paramount to my father and I expect the choice to settle in the UK offered the best and most affordable opportunities for his children. At the same time, he was still able to help his ageing parents and siblings by sending money to Pakistan. “My father purchased land and property in Pakistan which he rented out intending to go back ‘one day’, though this never transpired as he began to settle and integrate into the British community, and especially as I, and later my four younger siblings who were born, educated and brought up in the UK found conversations about ‘going back to the homeland’ very alien. “I would say that whilst my mother loved being with all her relatives and friends in Pakistan, she very much appreciated the ease of life to which she had become accustomed to here in the UK. She came from a very comfortable background until the time of the Partition, but in Pakistan life was a great struggle. So moving to Britain gave her some comfort and ease, though she found 56
it extremely claustrophobic to live in a small terraced property. Nevertheless, basic amenities such as running water and cooking with gas were important essentials she became accustomed to. My parents were quite happy to go abroad to visit relatives for a couple of months, but clearly also wanted to come back home to Britain. “In the end however, I believe it was us, the children, which kept them here. My four younger siblings and I were educated and brought up here, and Britain was our home. Knowing how settled we were it became increasingly difficult for my parents to toy with the idea of uprooting us and taking us back to Pakistan.” Raj Menon, a GP in Leeds who came to the UK from Singapore, planned to return home after gaining postgraduate qualifications and experience in the UK but changes regarding the qualifications that would be accepted for employment in his home country made it easier to remain in England: “I had to re-qualify in England because I wanted to return to Singapore. It was only after I passed the qualifying examination that Singapore no longer accepted qualifications acquired by Indian medical degree holders. The effect of this was far reaching for me and my wife. Our respective families are now spread over the world but we no longer have a family in Singapore.” He remained in the UK, qualifying as a General Practitioner and starting up a now busy practice. He remembers, however, the difficulty he experienced when trying to fulfil his wishes to return but has made a good and successful life for himself and his family in Leeds instead. Kalyani Katz’s decision to stay in the UK was a far more romantic affair:
MAKING THE DECISION TO LEAVE “I had no plans to stay here permanently in England and my father was very keen that I return to India to help the poor. After completing my studies I made plans to return home. I withdrew my pension contributions and I shipped all my belongings back, and then I met an Englishman, fell in love and didn’t go back. That was in 1978. And I’ve been here ever since!”
Kalyani Katz with her husband
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3 Adapting to Life in the UK I remember the day exactly − it was the 6th of April 1969 and in fact I remember the time as well, 7 o’clock in the morning! It was a cold crisp morning and the sun was shining bright and that was quite a life-changing moment. Amar Bains, Team Leader (Community Mental Health Team for Older Adults) came to the UK aged 12 and has worked for the NHS for over 25 years
Amar Bains as a new young arrival
Here we highlight some of these initial experiences within the UK for the new arrivals. Life in Britain for those who came here as young adults was rewarding, difficult for some, but always revealing. The journey itself, combined with initial first impressions of the country in which they were going to spend a proportion of their time could surpass or deflate their expectations, often both at the same time. For those coming to the country alone, these were difficult journeys to make, but the families of most had made sure at least initial arrangements were in place for accommodation or travel. Others who came with spouses and small children had other smaller practical difficulties to contend with, but for all new arrivals first impressions of the UK were never what they had anticipated. Some, like Vinod Devalia, who arrived in the UK as a teenager, were determined to prove they could succeed, despite the views of others. Others like Javed Ahmed could not believe they had finally arrived or, like Satinder Lal, simply wanted to enjoy the opportunity of regularly receiving fresh milk. For all of those arriving to start new lives in Young arrivals the UK, this served as the exciting beginning.
© Satinder Lal
Most of the nurses, midwives, GPs, consultants and auxiliary staff we consulted for this book were born abroad, either coming to the UK as young adults in search of work and/or postgraduate qualification, or accompanying their parents as young children and making the often difficult transition towards joining an English school pupil population. The years of their arrival in the UK span the period from 1952 until the 1970s.
ADAPTING TO LIFE IN THE UK
© Satinder Lal
We looked for the cheapest travel and it took altogether about 14, 15 days! We finally arrived one evening at Victoria Station. There was a gentleman who came to receive us and put us in a little one room flat in Belsize Park and that’s how our life began. Arup Banerjee
Young Indian medical students arriving in Britain
Making the journey Arup Banerjee and his wife made the journey to the UK via boat from India initially, leaving behind their 8 month-old baby to be cared for by grandparents. The journey was particularly long and quite difficult, made more so by the knowledge that they did not have their young child with them. “We looked for the cheapest travel, an Italian liner, which would leave India from a place called Hochee which is approximately 1800 miles from Calcutta in the South of India. That boat came to Genoa in Italy through Suez. And then from Genoa, we took the train to one of the ports, then crossed by ferry and landed in Folkestone or Dover and it took altogether including the train travel about 14, 15 days. So it was a long journey and not a very happy one! We were both sea sick and were sleeping in different places. We didn’t have money to have a cabin, the ticket price was £75 per head but because we were students, they gave us £5 off. We used to meet during the day time and used to eat together but we didn’t like it − we weren’t used to the western food in those days. Now looking back, I feel that they were giving very good food, now that I’m used
to it, but in those days, we couldn’t eat it. There was an Indian girl in our group, she was a bit older, and she spoke with the chef and taught him how to prepare curry and rice so they were giving us curry and rice from that day onwards! “We finally reached Genoa and got onto the train. That year, 1960 was the year of the Rome Olympics and the Games had just finished so they booked our coach into an Olympic train. So then we had no service, no link, nothing at all, we were just added on at the back of it. We had no water, no restaurant, not even a cup of tea and we travelled like this for about 17, 18 hours. Finally we reached the north coast of France. We got on the boat and we had something to eat, and then we finally arrived one evening at Victoria station. There was a gentleman who was known to a friend of ours, he came to receive us and put us in a little one room flat in Belsize Park and that’s how our life began.” Anisha Malhotra, a retired GP, had also left her children behind when she made her first journey to the UK to join her husband. He had come some time earlier to start his training. Though she found this initial trip difficult, she 59
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“Another friend who was also here came and met me at the My luggage was pretty shabby and I think my friend was a little put out by it – he was a bit grumpy airport. My luggage was pretty shabby and I think he was a little put out by it and the British Council had arranged and as we swept past somewhere I said, ‘oh, is this for me to have a taxi to where I was staying, so this friend my hall of residence?’ and he said ‘No. This is came along with me. His wife was a friend and we were Buckingham Palace!’ all in one group together in Bombay, so she had said to Meher Pocha
had also found it difficult remaining in India without her husband so knew ultimately that they would all soon be reunited: “When my husband told me that he had got an attachment and that he wanted to go and do a Diploma in Tropical Medicine I said ‘OK you go ahead’. But when he came here and he wrote his first letter saying ‘come and join me’ I could see that it would be very difficult for him to move here on his own without his family. And I was living in India with our two small babies so I decided that I had to join him. It was a challenge. But I enjoyed it, because we had to be together. I flew from Delhi to London and the journey was quite comfortable but it was a bit of a trauma in the sense that I was leaving my two small kids behind though only for a few weeks. I couldn’t have them with me because the job that my husband had was not settled at that time and he was not sure where he was going to go. With two small kids we couldn’t just travel from one place to another. So I joined him in September, and the children stayed with my mum and dad. It was very hard and very emotional but I knew that once I was here it wouldn’t be a problem for the kids to join us. That faith was there and that kept me going. I do believe there are things which happen in our lives and we have to make the best of that whatever happens.” Meher Pocha remembered little about her actual journey to the UK but recalled her arrival well: 60
him you must go and meet Meher and I’m sure he was a bit cross! He was a bit grumpy and as we sort of swept past somewhere he said this is it, so I said ‘Oh, is this my hall of residence?’, and he said ‘No, this is Buckingham Palace!’” Kailash Chand, Anisha Malhotra’s husband, found his flight to the UK daunting, despite having two brothers in the family who had trained as pilots. He, as did many arriving in the UK from various parts of Asia, had travelled alone, leaving behind his wife and two sons in India. He was, however, as with Meher, met at the airport by a complete stranger as a result of his family making arrangements with others they knew on his behalf: “I was alone and landed at Heathrow. The plane journey was also my first although two of my brothers are pilots, so this was my first real air flight. I took the PanAm flight from Delhi to Heathrow and when I landed, I was supposed to be greeted by the people we’d contacted and nobody was there. But eventually after half an hour of looking here and there, I saw a sign board with my name on and there was a woman who I thought was the contact but she wasn’t. So I introduced myself, and asked her where the person was who was supposed to pick me up. I asked ‘Are you from that family?’ and she replied ‘I am not from that family, but I am an acquaintance of your father. He had asked me to come and greet you here’.” “I’ll tell you something of Indian culture. My father was in railways, and was station superintendant in New Delhi station and this lady was visiting India.
ADAPTING TO LIFE IN THE UK
© Annu Jalais
“It was a strange experience because in those days you were not allowed to bring more than ten pounds sterling out of the country, that’s all we were allowed. So I arrived at London Heathrow via a BOAC flight from Karachi with ten pounds in my pocket and my suitcase and one or two things.
“When she went to Delhi she was robbed of her possessions and was very distraught so she went to my father’s office. She was a Bengali woman and was supposed to be travelling to Calcutta. She said ‘This has happened to me, I live in England and everything is gone’. So my father organised a ticket for her from Delhi to Calcutta and gave her 100 rupees, even though my father didn’t know that woman. So she was now in the UK, and my father must have written to her about my arrival and given her some information and she came out of gratitude for my father. She then took me to her house and looked after me. I had only three and a half or four pounds in my pocket. In those days we had a clinical attachment and my clinical attachment was at Alder Hey hospital in Liverpool and even getting from London to Liverpool, three and a half pounds wouldn’t have been sufficient. So this very kind woman organised for me to come to Liverpool.” Bernard de Sousa, who came to the UK from Karachi in Pakistan in 1967, remembered his journey well, recalling how he almost used all of the money he had brought with him, just getting out of the airport!
I had only three and a half or four pounds in my pocket and a clinical attachment at Alder Hey hospital in Liverpool. Getting from London to Liverpool, three and a half pounds wouldn’t have been sufficient. Kailash Chand
“The plan was then to take a coach from Heathrow to Victoria Station and I remember this journey was important to me because I sat on this coach and the conductress came across and said, ‘Right, tickets!’. And she said mine would be seven and six, and I thought to myself, ‘Oh I’ve only got ten pounds’. So I gave her ten pounds and she gave me change, but what she actually meant was seven shillings and six pence. So I thought this can’t be bad, you give her ten pounds and you get a lot back! But that was a lot − it was almost ten per cent of my possession gone on one trip. “Fortunately for me, I had a sister who was studying at Oxford University as a student. So I went to Oxford from London, caught the train, stayed with her for two days and borrowed fifty pounds from her to get registered because I couldn’t practise if I wasn’t registered. And you can’t get registered for ten pounds. The registration fee was about twenty pounds. I took the train up to Chichester after the weekend. And you had to work because after one month there would be no board, no lodging, nothing. Fortunately I was offered a job there after just one week’s assessment.” Bernard refers here to the British Council exchange programme which had allowed him to come to the UK and train for one month. However the excitement of that process soon waned as it was clear that once the month was over, the student would be left entirely alone to find work and accommodation. The adventure clearly had only just begun.
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Normally in Mauritius as the sun is moving from East to West, the atmosphere changes, the mood of nature changes, you can see people’s activities, you can tell what time it is by the activities of the day and the position of the sun. Here I had no concept of time. These are the sorts of things I had to adapt to. Krish Goodary
First impressions Arriving in the UK after long journeys was the beginning of an additional set of adventures. Krish Goodary, who had made the journey to England from Mauritius, found it difficult to adapt to the lack of sunshine:
“I landed at Heathrow Airport on a cold, dark, grey, misty morning and I thought to myself what am I doing here? I had mixed feelings. On the one hand I was excited − it’s an adventure for me, but then I was also very homesick, missing my parents. I was missing my family a lot. A friend of mine who was already here, he came to pick me up from the airport. So we drove to Stourbridge in the afternoon. I was excited by the illuminated street lights, especially driving past Birmingham − I thought Birmingham at night was beautiful. Then the next day when I woke up in the morning and looked out of the window, I had a very sad feeling. I was unsure whether the sadness was because I was missing my parents or the sadness was because it was ten o’clock in the morning and there was no sun! It was still dark, grey clouds, and overcast. It was opposite to this picture I had in my mind − from books and magazines − about England that it is one of those countries where everything is beautiful and luxurious. When I looked through the window, all the houses looked the same to me, the trees had no leaves on and I thought they were all dry trees! In a word I could only describe the whole atmosphere as very ‘melancholic’. 62
English village cricket
I was looking for a bit of sunshine, some natural colours, green trees and flowers, but as the day went by, I could see nothing changing here, everything was still the same. Normally in Mauritius as the sun is moving from East to West, the atmosphere changes, the mood of nature changes, you can see people’s activities, you can tell what time it is by the activities of the day and the position of the sun. Here I had no concept of time. These are the sorts of things I had to adapt to.” Ramesh Naik, who arrived in the UK from Zimbabwe, also found the concept of time difficult to become accustomed to, noting: “Because Rhodesia was a colony and therefore we looked up to England as a wonderful place and I was very interested in sport and cricket in particular, I pictured England, like this: the sun shining in the evening and you go in the villages and people are playing cricket on the greens there and everything’s green and the sun is shining and just wonderful. And then I arrived in England, came to London and then we took a train to Warwick and we passed a few villages and the sun was shining, it was green, it was in July so everything was green and they were playing cricket and I thought YES! And then things changed. I didn’t realize that clocks changed, the clocks went back so the first day I was back, it did change and I was late for everything that I was supposed to be doing, or was I early or something like that and then realized that perhaps it wasn’t the place that I thought it might be, because it got colder and colder and colder!”
ADAPTING TO LIFE IN THE UK The weather often features in the accounts of those arriving in the UK from various parts of the Commonwealth, and the Asian migrants were no exception. Following their long journey via boat to England, Arup Banerjee and his wife arrived in London with very little money:
Though the majority of the doctors featured in this book had learned English in their countries of birth and learned a great deal about the UK before arriving, adapting to regional accents and other cultural differences proved a little confusing. Kailash Chand had taken up a clinical attachment at Alder Hey hospital and found it difficult understanding the Liverpudlian accents of his patients: “Language, culture, understanding, everything was absolutely foreign and you learn very interesting things when you’re trying to get used to it. Especially coming to Liverpool as the Liverpudlian accent is very different, even now one struggles at times to understand what people
© Satinder Lal
“We had absolutely no contact, no link, had £40 in the pocket which was in the bank but we had an enormous amount of courage. My wife was obviously upset because of the baby she left behind so she used to cry quite often. She used to miss the baby and we were together of course in a very cold country and we didn’t have coats. It was September, very cold and it was raining, so one chap saw us and he said to us go and buy a coat. The name ‘Burton’ was mentioned. ‘It is a good shop Burton, go and buy a coat. It will cost you about seven or eight guineas’, he said, ‘both you and your wife get something otherwise you’ll catch pneumonia’. So we did that and we used to go to Woolworths because we found it was a cheaper shop.
We bought a little can, a little rice, and my wife used to cook on a little ring in our room and that was very nice. Finally I got this locum job in surgery and it was a good experience, but we didn’t have accommodation so the hospital gave me a single room, and either my wife used to sleep on the bed and I used to sleep on the floor or vice versa.”
Milk given to children in India by the British Government circa 1935
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One of the many surprises was that pasteurised milk in bottles was available in any quantity from the milkman. In India it was mostly obtained from the cow herd and to be certain of the quality, one had to watch the milkman milking the cow. Here the milkman offered as many pints of bottled milk as I wanted.
are conveying. I remember once I was in A&E and a lady came with a small abscess and I said the abscess has not matured yet, I’ll give you some antibiotics and you come back in four or five days. She was very agitated and started shouting ‘I want to die, I want to die’. I didn’t know what was going on. So I asked the sister in charge to come and said ‘I’m trying to do what is best for her and she is shouting and screaming’. So the sister said ‘She is not saying that she wants to die, she is saying that she wants it today’!” For Satinder Lal, who came to the UK from India in 1952, the ready availability of milk was a pleasant surprise: “One of the many surprises that stuck in my mind, was that unadulterated and pasteurised milk in bottles was available in any quantity from the milkman. In India as well as Africa this standard was rare as was the amount. It was mostly obtained from the cow herd and to be certain of the quality, one had to watch the milkman milking the cow. The milkman, visiting my landlady in Edinburgh surprised me by offering as many pints of bottled milk as I wanted. I only wanted one but the surprise was pleasant and heart warming.”
Settling in For some of the prospective doctors who came to the UK, accommodation was linked to the clinical attachment that they had been recruited into before making the journey. 64
Settling in for these individuals was not seamless but the search for initial accommodation was not an immediate worry. Meher Pocher came to the UK in 1974 via a British Council funded medical fellowship and did not need initially to search for accommodation. She had no real difficulties with settling in and due to the friendships she began to nurture at the Institute of Child Health, where she undertook her laboratory work, she was able to find out the information that she needed to settle effectively:
“There was a very nice bunch of people at the laboratory at the Institute of Child Health where I did my lab work, I just asked them where a good place is to buy meat or whatever. I’d never really done any serious cooking. I asked what joints of meat should I be getting and there was this lovely lady who used to clean the laboratory equipment called May and she used to say get best end of neck or get so-and- so and, you know, people told me what to do if it was different from what I was used to.” She found her initial months in England very pleasant in view of this support and these emerging friendships. She did notice however that not everyone was as immediately welcoming as others:
“I found people quite pleasant, it was quite interesting. I once went to the Boots close to the hall of residence and there was this lady who was very grumpy and I thought I wonder if it’s because I’m Indian and then I noticed she was grumpy and abrupt with everybody. She was just a grumpy and abrupt lady! And another interesting experience was people assume that if you’re Indian or foreign, they won’t understand what you say. I used to go to a Post Office quite close to the hall and if I was wearing trousers or a dress, no problem. “If I went in a sari, almost before I’d said what I wanted the guy would say ‘Pardon?’, so I just stopped repeating until he had heard and it was clear but it was just an automatic assumption that ‘I think that I won’t understand what
ADAPTING TO LIFE IN THE UK this person is saying’. So that was quite interesting. Not in an unpleasant way at all but I thought this guy thinks he won’t understand what I say because I’m wearing a Sari.” Dipanka Dutta, who arrived in the UK briefly in 1989 to take the PLAB test and then again in 1991 to find work, found his colleagues very welcoming. He did however experience some initial racial abuse from people in parts of West Yorkshire where his first posts were located, but found it easier to settle in other parts of the country when other jobs became available: “I wouldn’t say we found it difficult to fit in, all our colleagues and people that we worked with were all very friendly and welcoming but we did experience a little strangeness in West Yorkshire. In places like Rotherham and Dewsbury, for instance, when I first went into Rotherham and I used to travel on a bus to say the town centre, I found that nobody would sit next to me. So there might be people standing but nobody would sit next to me. And we actually faced some open racism in Dewsbury with people shouting at you on the streets, driving past and shouting Paki and so on. But when we moved to other parts of the country, we found that it was different there.”
accents or many idioms which I had never heard. I knew very little about the English culture. In India English was taught as another Indian language and no introduction to English culture was included in our English lessons. Our English text books had characters called Ram and Sita who travelled in a bullock cart instead of Mary and John who travelled in a car! So there was no introduction to English culture. It was such a shock to my system to discover how different life here was.” Rahat Sohail, a bilingual speech and language therapist, found her early months in the UK a little lonely. She found no one to talk to initially when she and her husband moved to Coventry, working on her thesis in the local library during the day while her husband was at work. Despite there being other Asian families in the area, she didn’t make friends − those around her were largely Sikh, and though she and her husband found that they could go to the cinema and watch Hindi films, which they couldn’t fully understand, she felt very lonely when her husband was not with her.
Kalyani Katz found her first months in the UK very lonely, but also found the language difficult to get accustomed to: “First and foremost, I experienced intense loneliness in England. I was brought up with three siblings in a small house. So privacy was not a concept that I was ever used to. We children slept on mattresses on the floor in one room at night. I had never been on my own in a house or stayed in a room on my own. I don’t know how I survived – sometimes I still have nightmares about my early years in England. I was so lonely. Second problem was that of language. Initially I found communicating pretty difficult. Having studied English in India, I thought that I knew English until I came here. Language spoken here was totally different! I was not used to the regional
Rahat Sohail 1972 with an award
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Learning in English schools © Getty Images
Being a child from overseas in an English school The experiences of children who had been born in various parts of Asia were not always positive, particularly within English schools. Often this was to do with the curiosity of the local children, which could often become quite negative and in some cases, violent. These latter instances followed those children who came over as teenagers or as older children – those who arrived as babies or toddlers, knew no other experience, being too young to remember life in their countries of origin. For many, however, negative or awkward experiences simply strengthened their resolve to do well educationally. Nine of the interviewees came to the UK with their families as 66
children – Albert Persaud, Vinod Devalia, Kuldip Bharj, Malkit Uppal, Rehanah Sadiq, Qaisra Khan, Amar Bains, Tony Narula and Manju Bhavnani. Some remembered their childhoods in the UK more vividly than others, but most still felt a link with the countries they were born in.
We eventually obtained a place in school, as soon as we walked in, these White kids spat at us and called us names. It was horrible. We were treated as though we couldn’t speak English at all – we were kept separate from the White kids and were taught ‘this is a fork, this is a spoon’. We were all laughing, thinking what is this?!’ Vinod Devalia
ADAPTING TO LIFE IN THE UK
“… when we arrived, I remember, we were leaving a country with everything but we only had two suitcases actually. I had two or three shirts and a couple of trousers, that’s all we had. We landed on the Saturday and on the Monday morning at 7 a.m. my father was at the front of a factory called Corah looking for a job, and he did get a job and started working as a factory worker. The Monday my father started, a week later my mother went to another factory, and started work there, so they both started working in factories straight away. We were split up because we didn’t know where to stay, my parents were staying in one house with one cousin, myself, my brother and my sister were staying in another house with another cousin and we used to get together for meal times in the evening.” While waiting for a place in school, Vinod felt strongly that he should contribute to the family income and worked as a labourer for a time at a toy warehouse, after passing an initial mental maths test so quickly that the supervisor gave him the job instantly. He worked for four months but his father wanted him to go to school and continue with his education: “So anyway, we eventually obtained a place in school, we went on a Monday, I remember it so well. As we walked into the school, Soar Valley School in Leicester − they had just opened this school about four or six months previously. As soon as I walked in, me and my sister, we were going to register, there was a landing, these kids there they were all White kids, they spat at us and they called us all kinds of names. Oh it was horrible, and we were all taken as an immigrant group so there were about two to four hundred Indian kids from Uganda and Kenya
Vinod Devalia came to the UK aged 15 in 1972 from Kenya, when his family along with many other Kenyan Asians, were told to leave the country. Initially life as a teenager in Britain was difficult, as the family had to be split up:
and various places, and we were treated as if we couldn’t speak English at all. The first week or so we were kept separate from the White kids because there were very few Indians there and we were the big Indian group, so the very first day we were taught ‘You need to learn about how to eat and this is a fork, this is a spoon’. It was like that and we were all laughing, what is this?! “Then we tried to integrate into the classes and I remember, in the second week I was beaten up because this White kid came and said, ‘Oi, I don’t like you’ and he just head butted me and punched me everywhere. I ended up with a black eye and nose bleeding everywhere. So you can see what it was like.” Tony Narula, who came over with his father who was then a trainee surgeon, had a more positive experience, undertaking his secondary education at a boarding school in Surrey, where he quickly integrated into a school with other sons of doctors. However the class background of those coming to the UK as children, was a strong influence on experience. Vinod’s parents had humble beginnings, his father was a photographer who then lost his business when Kenyan policies around Asian business ownership began to change: “My father was a photographer then and he had a tiny photographic shop and used to do portraits and family photos in the old days. We weren’t well off at all. It was 67
NURTURING THE NATION more like a very simple life, very moderate lifestyle and when we were told to leave, initially it was oh god what are we going to do? We had no money. A lot of my father’s friends and relatives were all coming to the UK and there was already a community in London which was sort of established. So for us it was almost like the Irish coming here, we were pure immigrants coming here with nothing. I know a lot of the Ugandans were extremely rich people but we weren’t and I needed to work initially. We had no money, we had nothing basically, there was no point hanging around.” Vinod therefore realized the doors that could be opened to him, were he to do well educationally. However his attempts to gain qualifications were not always welcomed and often disregarded by his careers teacher. It was therefore a huge personal achievement for him not only to pass his GCSEs and A levels, but to also get into medical school, in spite of attempts to send him elsewhere. The barriers to his career within the NHS began very early, in his first interactions with both the local education system and his school’s careers teacher: “I went to the Headmasters of different schools myself, at fifteen years old, alone and I said to them, this is not the right school for me and they said ‘Sorry it’s the education authority who decide, go and see the Director of Education’. So I went to the Director of Education one day, he said look here son, I can’t do anything, go back to your Headmaster. So there we are, didn’t have any support, any help, so I went back to the Headmaster, he said ‘Look what you can do … is just sit in the library and do what you like and if you need some help, ask the teachers’. So I said, ‘Can I enter the O levels, sciences, because sciences are universal aren’t they?’ I couldn’t do history because it’s all European history. At school in Nairobi we did African history, so I said I’ll do the sciences, English and Maths in O levels, so I just studied myself in the library and sought some help from the teachers now and 68
again. I sat my O levels. My careers master in the school said ‘Son you’ve got a one in a hundred chance of passing one O level’. “I got my exams and then I got into sixth form. The careers master said, ‘What do you want to do?’, and I said ‘I don’t know, maybe I’ll do medicine’ because in the first year I did quite well in the exams, so he said ‘Well, you’ve got a fat chance in hell in getting an offer to do medicine’.” Vinod passed his A levels and was subsequently given a place to study medicine at Glasgow University, a moment he described as the most wonderful day of his life: “I still regard it as the best day of my life! Because I wanted to get into medicine and I wanted to achieve and I had all these hurdles. There were so many hurdles all the time and it was as if I had shackles everywhere and suddenly when the result came through, that was it, I could not walk, I was flying! Believe me I was so happy, I’ve never ever been so happy, nothing that has happened in my life, ever like that day because it was such a crucial, crucial, crucial result. It was a turning point in my life because one moment I had nothing, and then, yes, there was this opportunity to make something of myself.” Manju Bhavnani, a consultant haematologist, came to the UK with her family aged 11, moving from a boarding school she had attended in Masoori in India, to a grammar school in London. Having come here with her family, the close ties with her sisters, and parents, made settling into British life relatively easy. She made many friends at school, and found the teachers extremely helpful. Like Vinod, she began, however, to experience initial difficulties when attempting to gain entry to medical school but for different reasons: “When I was at school, my Careers Mistress tried to put me off because it was very hard for girls to get in for medicine. I don’t think anyone of the younger generation
ADAPTING TO LIFE IN THE UK will understand it now, but at that time we accepted it as the norm. So in the 1960s, when I was applying, I was told ‘You’ll never get in, you’re a girl, and they take mainly boys’. The quota in Bristol was, I think, 12 girls, the rest were boys out of a class of 60. There were only eight places for us as four had entered earlier to do the First MB. I had an interview. It was quite tough, and I was absolutely delighted to get in.”
When I was at school, my Careers Mistress tried to put me off because it was very hard for girls to get in for medicine. I don’t think anyone of the younger generation will understand it now, but at that time we accepted it as the norm. Manju Bhavnani
Kuldip Bharj, a midwife and Senior Lecturer in midwifery, came to the UK from Kenya in 1966 with her father and brother when she was 13. She, as others had done, had formed an impression of the UK based on what she had learnt about it at school in Kenya, and found the reality to be a little different: “I must admit when we came here it was winter, it was dark, cobbled streets, it was just horrendous! You know, as a child you just had this vision that England is something very different, you know, wonderland, that’s what it was like, that’s the picture that you painted. And I remember I was interested in history, I took it for one of my subjects and most of the history quite interestingly was British history and you read about honesty, you read about how people went about their business and so on.” Kuldip found the initial experience of life in England difficult, as she had come without her mother. Her family also found themselves sharing a house with another family as they had no relatives living in the country. As the eldest daughter, she was given a number of cooking and cleaning responsibilities, and remembered feeling quite lonely:
“We came to live with the family who were introduced to us by relatives back in Kenya and it was a back-toback house. It looked very overcrowded because initially my father, myself and my brother came and my mother and the three other children joined within about three months. For me it was very lonely because the family we stayed with, there were just three of them and the mother and father worked − the father was on nights, mother was working during the day. So it was just horror! Firstly, I was lonely, I was without my mum, secondly, we were in a household that was back to back, we didn’t have a bathroom in the house, so you had to go into the back for a bath and the toilet was outside, it was just awful. “I can remember it just being awful and really depressing. I became engrossed in household chores because the people who we stayed with, the woman was working so I took on some cooking and then most of the time was really spent looking around Bradford, looking at schools and finding out how we’d start schooling.” Kuldip’s story echoes a familiar theme with those who had arrived in the UK during the late 1960s as many families found themselves split whilst others arrived early to find work in order to bring other family members over later once settled. For older children, such as Kuldip, taking on adult responsibilities such as looking after the home or finding work, as Vinod Devalia had done, took initial priority over schooling. However, their parents were concerned for the continued educational progress of their children. Coming to the UK therefore for the adults who made the journey between the 1950s and 1970s had economic but also educational reasons − Kuldip’s father had been a teacher in Kenya and upon retirement was faced with the choice of migrating to India or England, choosing the latter in view of the educational opportunities available for his children in the country. Unlike Vinod’s, Kuldip’s experience of schooling was far more pleasant. The education authority in Bradford upon 69
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I remember sometimes wanting to be more English and feeling that I didn’t know enough, trying to read what everyone else had read, trying to meet up two different cultures. Qaisra Khan
assessing her and her siblings, decided to send them to a grammar school on the other side of the town, which impacted greatly on the educational experience she enjoyed:
“I can’t recollect having any major cultural clashes,
clothing was not a problem, food was not a problem, I think partly because of, I guess, our upbringing, because we were in an English school in Kenya, we could speak English fluently. We had to go in an assessment centre in Bradford in those days where they assessed our ability to speak English and I think we went into a good school because we did live in an area which was highly populated with minority people, and I guess we wouldn’t have known at the time but once our assessment was carried out we were then sent to a grammar school which was completely at the different end of the city. I think we were just fortunate because I’m sure we didn’t know at the time, we just ended up there and I think we were just
fortunate. I think what made it easier is that we fitted in with the culture and I think that made it easier at school. I remember, I had a lot of English friends but if I think about it, I was able to help them with their school work like maths. I’m sure those were the things that made it easier! In fact we even did our GCSEs a year earlier than the rest of the cohort, we were more forward in terms of our education than the children here.” Qaisra Khan, a former Spiritual and Cultural Care Coordinator for Oxleas NHS Trust, came to the UK with her parents at the age of two, growing up in Manchester. She recalled specific childhood experiences which were certainly mixed and moving beyond them was important to her: “I remember once saying to my mother ‘English was so easy for me to learn’, and she said ‘Oh yeah?!’ and then she told me of a story when I was very little: my brother was being beaten up on the street, I went up to this bloke and told him to stop beating up my little brother … you know … and the only English word I used was ‘No’ and the rest was all Punjabi. “I remember sometimes wanting to be more English and feeling that I didn’t know enough, trying to read what everyone else had read, trying to meet up two different cultures. I remember, you know, going to a wedding, and doing mehndi, and you know at our primary school they used to check your hands before you went into dinner. And they checked my hands and there was mehndi on my hands and they said ‘Go and wash that’ and I went to the toilets and I still remember crying because it wouldn’t wash off and I went back. Twice. And there was me trying to meet the expectations of the teacher, whilst trying to meet the expectations of something else. Not being able to wash the mehndi off and crying. I mean there were little things like that. You think about them when you think about them or instead you just get on with life.”
ADAPTING TO LIFE IN THE UK Rehanah Sadiq, a Muslim Hospital Chaplain, was born in Pakistan and like Qaisra, came to the UK at the tender age of 2 and a half. Her experience of school reflected the area she grew up in – there were very few Asian children where she lived so she simply didn’t notice any differences between her and children of other ethnic backgrounds until they were pointed out:
The homes were quite small – I was used to the open plains in Punjab and the children in the vicinity. Here everyone kept mostly to themselves. There was a mixed response – I wouldn’t say they were outwardly hostile but they weren’t that welcoming. Amar Bains
“I often knew nothing different. I now laugh at the naivety “I didn’t know what to expect, I’m not sure whether I was or purity of young children! I remember one incident excited about the journey over; it was planned by my when I must have been around five or six years old and grandparents for my mother to join my father in England not long started school. I was playing in the school yard and that was initially supposed to be for a few years, until and, as the only Asian girl in my school, some boys they felt ready to go back home and settle back there. But decided to tease me. They called out ‘Blackie! Blackie!’ and, that never happened. I remember the day exactly - it was in response, I looked around to see who in the playground 6 April 1969 and in fact I remember the time as well, 7 might be black! o’clock in the morning! It was a cold crisp morning and the sun was shining bright and that was quite a life“It didn’t occur to me really that I was any different. changing moment. The homes were quite small, I was However, there were a few things I was aware of: I knew used to the open plains in Punjab and the children in that my parents spoke a different language and that the vicinity; here everyone kept mostly to themselves, the school dinners being served were different from and there were a lot of communities living here, which the meals we had at home. I also began to notice that in Punjab I hadn’t come across. There was the Gujarati my clothes were a bit different from everybody else’s. I community, the Muslim community and the Hindihad homemade dresses and everyone else had ‘bought’ speaking community. Here in Birmingham, there was dresses and I began to wonder why my parents didn’t buy more of a cultural mix, so the neighbourhoods were very dresses for me. As I grew up these differences continued supportive and the host community, there was a mixed to be highlighted by peers, but as I hardly had any Asian response. I wouldn’t say they were outwardly hostile, but friends around me, it took me a long time to associate this they weren’t that welcoming. There wasn’t that sense difference with being a cultural one. So you could say that of integration at that stage, that came much later. The I grew up as a somewhat confused child.” community seemed to stick to their own, to what they Amar Bains, Team Leader for a community mental health knew, what they felt comfortable with. The shopping areas team for older people in Warwick, came to the UK when were quite segregated, and some still remain that way.” she was twelve and a half with her mother in 1969. They Amar’s early experiences of school and growing up were initially settled in Birmingham in the West Midlands positive and she acknowledged that growing up in a to join her father who had come over in 1962. She community with other South Asians was supportive. remembers well her first impressions as a child of coming Having this support around her and her family made it to the UK: far easier to become accustomed to her new home and to make sense of the curious responses of others. 71
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© Shahzad Firoz
Nowadays children have freedom, the freedom to say we’re British. But then you go walking down the road and people are not going to say you’re British. They are going to say that you’re Indian. Malkit Uppal Children at a fair
Malkit Uppal came to the UK aged 11 in 1962 with her family. She could not remember much about her time in school, but did remember how she felt when she first arrived as a child in Southampton. Her life growing up was difficult, as money within the family was scarce. She was however ultimately very happy: “Well my dad came in 1953 and I was only a year old. He came as a labourer. Then all my family came. I’ve got one sister and one brother. He came back to India and we all came together here. That was 1962. The weather was so cold! No central heating, and there was only one fireplace and we couldn’t work it at night time. Everything was second hand. Not like nowadays, everything is new. I found it cold and I don’t know if I liked it. We lived with my aunties, then my father bought a five bedroom house in 1963. My dad was doing 45 hours and was earning £6 a week and that was a lot of money. Then I went to school and I attended maybe for about two years but I didn’t go to school much. In those days you left at 15, not 18 or 19. “I had a good life, a happy life. I can’t lie. We didn’t have many coats but I had a yellow one that cost me half a crown. That was a lot of money in those days but I was happy about it. I had two dresses, one to keep for best. You only had one pair of shoes and if those broke, then you would get another pair. We never had too much. In 1970 we had a three drawer chest with one cupboard where you hung things and there was room. My dad only had one best suit.” 72
Malkit however recognizes the differences between her childhood and that of her own children and does not feel that these changes were always for the better! She saw a clear generation gap between herself and younger people of Indian heritage, like her own children, born in the UK. However she can happily reminisce about her childhood and her time growing up in the UK: “Our parents worked hard. This generation they don’t, they answer you back! If I say something my children say ‘Mummy, you are too precious’. Before we would never speak and what your parents said, we would have to do it. My point of view is that I like the olden days, I was happy. Now people are more into education. In those days there was more love in your family and community and no fighting. Nowadays you see fighting but no love. In those days you didn’t have butter but you gave it to them. If someone came, you’d put a biscuit on the table and they were appreciative. My nephew and nieces came from school and had bread and butter with jam and were happy. “Not now, my children say, ‘We don’t want that. We want something good’. If a guest comes you have to make the samosa and pakora. In those days you had no worries. My brothers would stay two weeks and you were happy. The olden days nobody moaned. I know the money wasn’t good, but I was happy. Nowadays children have freedom. The freedom to say we’re British. But then you go walking down the road and people are not going to say you’re British, they are going to say that you’re Indian.”
Children enjoying food at the fair
Finding work and achieving qualifications Once the newly arrived migrants had found accommodation and begun the process of settling in, the reality of the reason for their travel to the UK would have rapidly become apparent. For those who had arrived in the UK as adults in order to continue with medical training, there was little time for settling in. Many of these migrants had made initial arrangements for work and study before they had left their homes abroad and could disembark from planes and boats and find accommodation either with relatives, or, for the lucky few, with the hospitals where their training was due to start. Immediately after this, they had to negotiate local unfamiliar systems of travel, navigating their way through areas on local buses and trains to get to their places of work. Ila Basu who came to the UK in 1977, to take up a post at St Martin’s Hospital in Bath, arrived in the UK on 6 November to start a clinical attachment the following day. She found the initial work and training fine but her first post following this four week probationary period was extremely difficult. Though she had worked as a Senior House Officer in India and therefore had experience of dealing with patients, this first NHS experience in Obstetrics and Gynaecology was very daunting.
“It was such a busy job, such a hectic duty. I used to get frightened – 24 hours you have to be on your feet, doing 25 to 30 deliveries a night and as a junior SHO in the morning you have 10 patients for induction and you have to assess them, then put the syntocinon drip on. You have to come every two hours to assess them, and then you deliver the baby and do an episiotomy stitch up. If there is a caesarean section you have to arrange the theatre and assist the caesarean section. It was continuous on your toes – you could not even sit down. I used to get scared of on call day. The weekend on call duty would start on Friday 9 a.m. and continued on Saturday and Sunday and the duty finished on Monday at 5 p.m. It was a killing duty I found. I did not want to do Obstetrics. I was frightened of this continuous work and I thought I couldn’t carry on with this and gave it up.”
© Khairil Zhafri
© Shahzad Firoz
ADAPTING TO LIFE IN THE UK
Whilst Ila did not enjoy this running start others revelled in it. Javed Ahmed is a Consultant Cardiologist and came to the UK from Pakistan in 1983 to undertake postgraduate work and study. He arrived in the UK in October and had an exam to take the following week: “I still remember that October in 1983 because it was cold. When I arrived in October, it was quite hot in Pakistan, and when I arrived at the airport and my brother was there to receive me, I just had on an ordinary shirt 73
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quite soon after arriving in the UK from Kenya, gaining In those days, there wasn’t anything like the necessary medical qualifications that he had now induction. I went, did my paperwork with the Human set his heart on, despite his financial limitations, was Resources department and after I completed it, the extremely important. consultant met me, showed me around and I literally “I did everything myself, whereas all the Scottish kids … started working the next day! Javed Ahmed
actually, and the moment I came out I felt so cold you see. But I was very, very excited because I had to take an exam in a week’s time, so I wasn’t thinking of anything else initially when I landed at Heathrow except that I wanted to go and take that exam.”
their mums and dads had done everything for them, so they were kind of saying look at this guy. And of course I did everything, I did all my washing, ironing, everything, I organised everything for myself. A lot of the other students used to live at home and of course half their dads were lawyers and solicitors and doctors and here I was, a nobody doing everything myself.
“So I went to Wales and I was so excited, I couldn’t sleep the night before. I’d always imagined I would go and work in one of the hospitals in the UK. That was really one of the best days of my life! Basically in those days, there wasn’t anything like induction. I went there and did my paperwork with the human resources department. They were very nice, and after I completed the paperwork, the consultant who was in charge he met me and showed me around, and I literally started working the next day!”
“So I must say that the Scots had a really easy time because they were living at home, their tea was ready for them, all they had to do was come to university, go home, study and at weekends have a nice time. But for me it was different, the only thing on my mind was getting that degree, so I worked all the time and I didn’t have money to go out and have a nice time because I never took much money from my parents. The Scottish kids, their parents were rich, they used to go and spend £10 a weekend for example and in those days £10 was a lot of money. I didn’t have any money. I might go out once every three or four weeks or so just for a drink and they would go out and spend £10 every weekend getting drunk, so my life was totally different to theirs. It was a tough time but it was alright. The main thing was the education and I had that opportunity.”
Javed’s clear excitement about having the opportunity to work in an environment that he’d read about while a student in Pakistan and keenness to get some immediate work experience reflected the aspirations of other migrants from overseas. For some, this illustrated their acknowledgement of how important it was to gain the qualifications or the positions that they had come to the UK to get − and success was essential. For others, like Vinod Devalia who had passed his O levels and A levels
Vinod also ensured that during his summer holidays he would get important work experience, writing off to request a research studentship with the National Institute for Medical Research in London at the end of his third year, and the following year he wrote to the Director of the Laboratory of Medical Biology in Cambridge, requesting the opportunity to conduct some work experience. As a result he began to create for himself an impressive CV.
After passing his examination, Javed went on to take up a number of short term posts as a locum around the UK. He stayed initially with his brother in Birmingham, then immediately after passing his exam took up an 11-day locum position in a hospital in Wales, moving to Wrexham, then Bournemouth:
ADAPTING TO LIFE IN THE UK it because I want to develop my career in nursing’. She said ‘But you’re not clever, you’re not intelligent, why are you doing it? Half the time you don’t understand what is being taught, what is being said’. I said ‘No, it’s not that I don’t understand, it’s the accent and your local dialect that I struggle with. Whatever is written on the board or in the books, and if you spoke clearly to me, I understand all that’.”
Vinod Devalia with proud parents at graduation
Krish Goodary who had come to the UK from Mauritius to undertake his nursing training worked extremely hard to get ahead of his class once it became apparent to him that his fellow students thought him a little stupid because his English was not as good as theirs. “It was the local accent and dialect that I struggled with. People were, I suppose, getting frustrated or they had no patience with me. They had to repeat themselves a lot because I did not always understand what they were saying. I became very isolated. That led to me avoiding groups unless it was on a one-to-one. I wouldn’t go and sit in a group and it was more prominent at lunch times in the canteen. People would just join a table and sit down for their meals but I used to find it intimidating so I didn’t go to the canteen. I used to take sandwiches and go in a quiet room to eat. But then because I wasn’t mixing, the other students in my class used to think I was anti-social, so they started to avoid me as I was avoiding them! I was avoiding them for a reason because it was difficult to communicate with them. Then people were thinking I’m not intelligent! They used to say he hasn’t got a clue what you’re talking about. And I was the only boy in the class! There was a girl named Glenys who said to me one day, ‘Krish why are you doing this course?’ I said ‘I’m doing
People judge you as you present yourself and I knew I was intelligent, I can understand, speak, read and write good English so to work through the problems I made myself more knowledgeable. I did a lot of research and reading on the subjects and was prepared for all the lectures. Krish Goodary
‘‘Those sorts of problems brought home to me, that it’s not just that I’m having problems understanding people, people thought I was not intelligent. I asked myself, ‘What am I doing here, if people see me as not clever?’. That hit me hard and I thought long and hard of how to overcome the problem. I was very patient. I was open to challenge Glenys because I thought, ‘In fact she is doing me a favour – she’s pointing out to me where my weak points are, and I used to go home at night and think about it. People judge you as you present yourself. And I knew within me, I am intelligent, I can understand, speak, read and write good English. One way for me to work through the problem was to make myself more knowledgeable. For example, we used to have a weekly planner of what’s on the timetable for the week at school. The night before, I used to do a lot of research and reading on the subjects to be taught the next day. Hence when we went into class, I was prepared for all the lectures. I understood what was being taught. When the lecturers asked questions to the class, I volunteered to answer them. So people over the months started to change their views about me.” 75
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4 Progressing within the NHS © Dr C Kotur, 1982
The NHS owes an everlasting debt of gratitude to Asian doctors who have been the backbone and have helped to build the NHS, delivering care in areas that have been hard to reach and working in ‘Cinderella’ specialities where it was difficult to attract local graduates. The NHS will always be grateful to this group of doctors for the care provided to patients in these vulnerable groups. Professor Iqbal Singh, Chair of the GMC Equality and Diversity Committee
© Satinder Lal
Good working relationships between Asian doctors and colleagues
Asian individuals within the NHS took on a broad spectrum of roles within nursing, midwifery, in hospital kitchens and over recent years as administrators, NHS managers and consultants. The majority however became doctors, GPs and dentists. Progress for these individuals depended not only on personal resolve but also on support from senior colleagues. The difficulties in progressing or finding work led some to make the decision to return home earlier than they had anticipated, or to look for postgraduate training and work in America or the Middle East. However those who have remained reflected on the opportunities it gave them to realize their dreams of working in medicine. Here we chart their progress.
Asian doctors working in Britain with what was then the latest equipment
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for consultant posts took time and effort. Those doctors who had conducted their initial training abroad came to the UK intending to sit the MRCP (Membership of the Royal College of Physicians) examination, which would enable them to demonstrate knowledge in an area of specialism. Ramesh Mehta failed his MRCP examination five times, eventually taking it in Ireland and passing there first time:
Finding work and developing a career in the NHS was not always easy. Some Asian doctors working in the NHS in its early years found continued and successful progression particularly difficult and saw themselves having to react to negative responses from patients and assumptions from prospective employers about their ability to speak English effectively. Further obstacles in the shape of constantly changing rules and policies about “I never received the proper training that the local immigration created additional problems. For female graduates would have had. None of the consultants took an interest in my career progression, and I think that is doctors and NHS workers, combining their own family the reason I couldn’t pass the examination in this country. responsibilities with the necessity of working in a job to Although everybody was very friendly, when it comes to the best of their ability created other barriers which males crunch time like when you compete with a local graduate, were less likely to face. Many of these difficulties reflected then the discrimination gently creeps in.” historical developments about the response of British society generally to new arrivals from the Commonwealth Ramesh strongly believes that overseas doctors and − as a large institution, the NHS was no different to other trainees were very much seen as ‘outsiders’, which made public sector employers during the 1960s to 1980s. Overall, progression through the NHS difficult: however, the Asian employees we spoke to were able to “I think there is a problem there, I think I would call it overcome whatever obstacles they were presented with. ‘lace curtain racism’. It’s a very subtle thing, like people So female doctors drew heavily on the assistance of child don’t give you a smile back for example or will not chat carers and sometimes extended family members; others to you, you are the one who needs to do the extra effort welcomed the support of mentors and other colleagues to get into the professional community. It’s a sort of club within their places of work. Ultimately it was the of people who have been there or who are there who just recognition of their hard work and personal success from want to have their own group or gang and they won’t peers in the form of awards, honorary posts or simply via easily accommodate outsiders. However, in my experience, the appreciation of the patients they looked after that in spite of the fact that I have progressed a lot in my career, enabled these employees to acknowledge for themselves I had to work extra hard to get where I am today and I’m the importance of their contribution. sure for a local graduate, it would have been much, much easier.” Facing and overcoming barriers Many aspiring doctors who came to the UK to complete postgraduate study ultimately desired the post of hospital consultant. It can be a lengthy process and achieving this status remains a difficult one for all prospective doctors, regardless of background, but certainly passing the examinations necessary to be able to compete effectively
I never received the proper training that the local graduates would have had and none of the consultants took an interest in my career progression. Ramesh Mehta
NURTURING THE NATION Ramesh, as with others who had successfully gained consultant status, appreciated the gains he had made but acknowledged the difficulties that others had experienced. The reference to the preferences made by recruiters within the NHS for ‘local graduates’ was a common theme, and those seeking training positions were quickly made aware of the likelihood of getting a post over who had both been born and trained within the UK. Ramesh Naik recognized that he had had very little difficulty progressing to the role of consultant and kidney specialist for an NHS Trust in Bedfordshire, working his way up from a newly arrived postgraduate student in 1972, to Registrar, Senior Registrar and Consultant. He knew, however, that the experiences of many of his colleagues were far from perfect and that colleagues who trained with him had either had to return to India, or retrain as GPs in order to overcome the ‘local graduate’ barrier:
Ramesh Naik at work
“I was treated no differently; patients might have thought that my accent was slightly different, therefore they’d ask me my name and ask me where I came from, not because they didn’t trust me but because they were just interested, curious, but I had no problems. However I know some of my colleagues, people that I know have 78
felt, in a way, discriminated against. I didn’t. My friends here are Asian doctors who came to this country and they found it difficult to progress in the hospital environment and therefore had to go into general practice. In the areas that they were able to practise, in Reading for example and in Berkshire, these are all in areas where there were either Asians or African-Caribbeans and the majority of GPs in the deprived areas of Reading are Asian doctors. But they’re now coming to retirement actually so it will be interesting to see who follows in their footsteps.”
Patients might have thought that my accent was slightly different, therefore they’d ask me my name and ask me where I came from, not because they didn’t trust me but because they were just interested. Ramesh Naik
Ramesh’s view here is an important one given that the high numbers of Asian doctors who came to work within the NHS in its early years are indeed retiring or approaching retirement. At the time of the 60th anniversary of the birth of the NHS, newspaper reports and the Department of Health itself, noted the important contribution of the pioneering early Asian doctors and the necessity of ensuring NHS Trusts had made preparations to replace them once they retired. Ramesh’s discussion of the areas that the majority of Asian GPs had found themselves working in when they arrived in the UK is interesting. Qualified British born doctors at that time shunned work in deprived inner city and rural practices and hospitals so it was in these areas that many Asian GPs and hospital doctors found work. Replacing those doctors who had shown commitment to these practices and the patients served by them may not be an easy process given that historically they were seen as undesirable locations by other, usually locally born, doctors.
PROGRESSING WITHIN THE NHS Rai Baishnab worked as a GP for 34 years in Salford, a fairly deprived area at the time. The social and economic conditions of the area had deteriorated during the time he spent working there to the extent that he would attend all local home visits in an old car left unlocked so it was clear that he had nothing worth stealing. He recognized however that many overseas doctors had found themselves working in areas such as these, and though he had not personally experienced much in the way of discrimination, knew that this factor illustrated how unequal the experiences of overseas born Asian doctors were in comparison to their British born colleagues.
In Manchester there are some socially deprived areas and the overseas doctors are there but why are the overseas doctors only in the deprived areas and the good areas are taken over by the local doctors? Rai Baishnab
“Initially it was a nice place but after about 10 or 15 years the social conditions have deteriorated a lot and there’s a lot of criminality around. But again, after a few years, that criminality is less now. Glasgow and Salford are famous for unemployment, and people drink and smoke and there are also problems resulting from the social deprivation. It made my job difficult. We had an interview with the local MP saying that the area is getting progressively worse and worse. We as GPs are dealing with the public and really the criminals are taking their activity wherever they want, breaking into a car to get something, urging children to do criminal activity. “Doctors cannot go to house visits because the cars are broken into and we cannot use good cars. If the car is good it’s a doctor’s − a Mercedes or a BMW − and they are a target. Whenever I did a housecall and took the car there I didn’t lock the car in a way to show that there is nothing in the car. You can open the door and see what you like!
In Manchester there are some socially deprived areas and the overseas doctors are there but the local graduates are in good areas, so obviously why are the overseas doctors only in the deprived areas and the good areas are taken over by the local doctors? And in the same way, I have seen so many of my colleagues in the hospital, they have just the qualifications to be consultants but they are not made consultants, they are given the post for associate specialist or medical assistant which is, I must say a post created for the overseas doctors. Because the people who are the associate specialists, they are better than qualified, but because they are overseas qualified, they are not given the consultancy posts.”
Rangena Tilkaran with fellow nurses
Seeing and understanding the differences in experience between overseas clinicians and those who were British born was done in a pragmatic way by some. Rangena Tilkaran, a retired nurse, who had come to the UK from Trinidad had many positive experiences whilst in the NHS, and had progressed from post to post fairly easily. Rather than accepting hers was a good working experience and denying the validity of others’ difficulty, Rangena recognized inequalities and spoke out when necessary: “There were times when people would say, ‘I don’t want her to look after me’ because of my race. There were times when colleagues would be talking about those from other races and I would say ‘Well what about me?’ and they would say ‘No not you!’. When people who know me say certain things I say ‘Well I am of a different race too’. 79
NURTURING THE NATION “It’s difficult – I knew I was the token person where I worked when I was made Lead Nurse. It depends where you work, what sort of Trust. My Trust was not that good – midwifery was fine – there were many midwives from abroad but general medicine was very white.” Like Rangena, Kusum Bhatt, who worked both as a hospital social worker and a primary care counsellor in Newcastle, recognised the very different ways that Asian healthcare staff experienced recruitment and progression. She strongly felt that minority ethnic staff should use their skills to support all and not just the members of their own communities as to do so would only reinforce the limited views of some of the early recruiters: “In one department where I applied, someone said to me, ‘Why don’t you go to Huddersfield or Bradford?’ She thought there were more Asian people there. And I thought that was a racist remark. Is she thinking, ‘because you come from India, you must work with people from your own kind’? Why should I? I like to work with a broader client group rather than narrowing down. And this is one thing I feel as a matter of principle. Even with counselling people were making the argument that the Asians should have an Asian counsellor and I said I don’t believe that. If you have broad experience and you’re doing your job, people need to work with you, because they can trust you. That’s the primary quality, not because of the colour of skin. Actually, I had some of the Asian clients refuse to come to me for counselling because they felt I might be talking to somebody else who was Asian about their problem!”
Some people were quite good but we got comments. All you could do was keep quiet otherwise you wouldn’t move forward, you won’t get a job. The way you spoke, the dialect you had were sometimes slightly frowned upon. Rashmikant Shah
For others who experienced racism directly, it was sometimes felt that to ignore comments was the best response to take, particularly in view of the fragile nature of career progression for Asian healthcare professionals. Rashmikant Shah, a dental surgeon working in the West Midlands illustrated this well when describing an encounter with a lecturer:
“I was doing a primary exam and there was a bit of a racist comment. They asked me a question and I could not answer it at the time and the lecturer said something like ‘These are the sort of people you get’. Some people were quite good but we got comments like that. All you could do was keep quiet otherwise you wouldn’t move forward. You won’t get a job or anything. The way you spoke, the dialect you had were sometimes slightly frowned upon.” In his research on Asian doctors, Aneez Esmail detailed the number of letters written to the British Medical Journal during the 1970s, by doctors bemoaning the standard of English spoken by Asian doctors. As Rashmikant notes: “Because I was a natively born Asian I didn’t have the problems of accent or language or intonation and because of that I think I’ve been treated fairly well. However, I’ve seen people who are similar who didn’t get treated as well purely because of accent or communication skills and that’s a recurrent theme as you go up the ladder in the NHS. I’ve been treated very well and I think you get to a point where there are certain things you achieve and you see people who are envious of what you’ve achieved and you’ve got to manage that quite carefully.” It is also clear that Rashmikant experienced great difficulty in getting his qualifications recognized in the UK when he came to England from India. He had had to literally
PROGRESSING WITHIN THE NHS start over again, re-qualifying as quickly as he could as his family had just been expelled from Uganda with very little money. The GMC refused to recognize medical degrees obtained from India after May 1975. Though it is not clear whether Rashmikant was suffering at the hands of this policy, it is possible that this was the case Dipankar Dutta felt that the restrictions on access to the UK made life initially difficult for him when he decided to return to England after taking the PLAB test. Being given leave to remain in the UK so that he could work as a doctor was his greatest barrier to progress in his view: “The Calman reforms set out more structured training for doctors in their career paths to consultancy. You have to get into a training programme and you’re awarded a certificate of completion of specialist training at the end of five years and then you apply to be a consultant. So you had to get a national training number to join the rotation and to get that, your immigration status has to be such that you are no longer subject to regulation, that you have leave to remain in the UK basically. And that enables you to get the national number and then you get the job. If I’d been from the European Union, I would have been able to do as I like and stay as long as I like or work in any speciality.” Nagendra Sarmah gave up progressing in his career in gynaecology to go into general practice in order to see more of his family. He found it incredibly difficult to find work as a GP: “In 1972 when I went for the interview the senior partner said ‘We will give you this much money’. But when I joined the practice he halved it. He promised me that he would give me £5000 and it was per year, not per month. He told me, £5000 for you and £5000 for me. And I was about 32−33 years old then. So after two years he suddenly decided to write a new contract and in the new contract he said that he will take three months off during
summertime and I have to cover. And I will get four weeks holiday. He will also keep his share in the practice and he will only do let’s say 3−4 days a week. And I did not agree. Then he kicked me out because the house practice was his. And in those days, if your senior partner kicks you out nobody helps you. Today there are these organisations like the Local Medical Community that could have helped me, but I was a foreign Indian doctor and the chairman, secretary and all these doctors didn’t help me.
Nagendra Sarmah as a young doctor
“Luckily, there was a health centre and the public director I met him and told him the situation and he saved me. So he said ‘What we can do is give you a room, you can share our community clinic. You can do mornings and then evenings but in between, you cannot use it because our clinics are going on’. But my senior partner only gave me 700 patients. With 700 patients you cannot survive – and he cut me off completely. And when a patient asked about me because I was getting popular, as I was a young doctor and they liked me, he just said ‘He has left us, I don’t know where he’s gone’.” Eventually Nagendra applied for a retiring GP’s practice and out of 52 applicants and 8 shortlisted, he was selected. He then set about building up his practice: “By the time I came and because patients are given a choice, about 100 patients left because I had joined the practice. They didn’t want to go to Asian doctors here at that time and in the 1970s there was bad publicity about South Asian doctors, from the Press, anti Asian immigrants and that sort of thing. Chorlton-cum-Hardy 81
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In those days being a single handed doctor means you are responsible for you patients 365 days a year. Even Xmas and bank holidays – you are not off, you are on call. So you can’t even go for a shower! That was hard work.
is a conservative area, it is suburban and away from Manchester, so people are usually teachers, doctors, professors and engineers, and for them, accepting an Indian doctor was perhaps a bit too much. So I came, I joined and I had to really work hard. “In the 1970s, 1980s and 1990s – even now probably – well things have changed, but in those days, being a singlehanded doctor means you are responsible for your patients 365 days a year. Even Xmas and bank holidays. You are not off, you are on call. Your patients have access to you. So you can’t even go for a shower! My wife would have to take the call. I would have to say ‘I’m going to shower can you take the call?’ And that was hard work. In those days there were very high demands of home visits. Ten home visits a day. And home visits are for what? Flu, nappy rash? I remember very clearly one call at 4 in the morning – constipation! And the complaint levels against Asian doctors are very high. British doctors do their mistake and get away with it. Although, I was lucky. During my 26 years in Chorlton I only had one complaint, and that was not a public one. But I’m saying in the fear, I would say that I was probably practising defensive medicine. In the fear to be good and keep the popularity I was working hard, constantly. So when I finished morning surgery the time would be 3–4 p.m., and then evening surgery starts. Then the last patient is at 7 p.m. and you finish at 8 p.m. And then you have the volume of prescriptions you have to sign. So I didn’t have lunch, because it is my house surgery, so I sit in the surgery room and I finish at 11 p.m. 82
So I never saw my two little girls getting up and by the time I’d finished they’d gone to bed. I couldn’t tell them bedtime stories – it is sad.” Nagendra’s comments are particularly ironic as he had originally wanted to give up pursuing consultancy posts so that he could spend more time with his family working as a GP. Despite missing out on bedtime stories with their father, Nagendra’s daughters went on to do well, one becoming an Assistant Professor in Anaesthesia at the University of Toronto and the other a teacher who has taught across the world. He expresses intense pride in their achievements. What Nagendra’s testimony also points to, however, is the very difficult position that single-handed GPs found themselves in. Research published in 2009 has found that single-handed GPs, regardless of their ethnic background, are six times as likely as those working in larger practices to receive complaints that ultimately put them in front of the GMC. A high proportion of these single-handed GP practices are run by overseas born Asian doctors. There are fewer of these sorts of surgeries nowadays − in 1948 around half of all GPs worked single-handedly and this reduced to 10 per cent by 2008. The few that remain tend to be located in more deprived areas, so Nagendra’s experience of surburban Chorlton-cum-Hardy was very different. The hard work he had to engage in so that he could win over patients, does, however, fit with the general sorts of experiences Asian GPs had in the early years of the NHS.
There’s no doubt in the 1970s and 1980s, you had to fit in to get on and despite being at public school in Cambridge, you might think I’ve got plenty of the relevant criteria on my side but it was a fact that your surname could ban you from shortlisting. Antony Narula
PROGRESSING WITHIN THE NHS
Ear Nose & Throat Hospital
Tony Narula feels that real progress has been made since the period in which he was conducting his postgraduate training and working in house jobs in various hospitals around the country. In order, however, to see how far things had improved, it was useful to reflect on the experiences he had had as a young man, acknowledging that even with his educational privilege and contacts, he still found it difficult in the early years to progress: “When I trained in the 1980s, you must remember that it was still very different to how it is now. There were still a lot of barriers to progress if you were a foreigner and just your name could stop you getting on short lists. I’ve had plenty of experience of that but it’s completely different now. It’s never been easy to make progress but I’m pleased that in my lifetime, it’s changed completely. “There’s no doubt in the 1970s and 1980s and probably before that, you had to fit in to get on and despite being at public school in Cambridge, you might think I’ve got plenty of the relevant criteria on my side but it was a fact that your surname could ban you from shortlisting in some places. “I think if you look at my speciality of ENT − Ear, Nose & Throat − surgery, about something like a quarter of all consultants in my training era were of Asian origin but almost none in a training hospital. I worked at Guy’s Hospital for a bit and there was a brilliant surgeon who was of Egyptian origin. He was exceptional in that he’d made it to that level and there was one Asian surgeon at
the National ENT Hospital who was a senior lecturer and consultant. You couldn’t find other role models like that because they just weren’t around, so there were quite significant barriers. And when looking for promotion and that kind of thing, one had occasionally thought, this is more difficult than it ought to be.” Manju Bhavnani had her first experience of discrimination on the basis of her ethnic background when applying for consultant posts: ‘Well when I was looking for jobs, it was really hard. When I went and looked round one job, I felt unwelcome, when I met the person in charge. He complimented me on my English, which as I told him, was my mother tongue, and I complimented him on his! I applied, but I knew I wouldn’t get the job. It would have been difficult working with him. Apart from this instance, however, I have always got the job I applied for.” Overcoming these barriers for many took some time. For example, Raj Menon, experienced a great deal of difficulty achieving his goal of becoming a doctor, but eventually over time, these obstacles were overcome: “I experienced discrimination based on colour and the general assumption that an overseas doctor was not good. Fighting to prove yourself at every step is difficult. As junior doctors we had to study on our own and pass examinations. No help was given and study leave was rarely granted as the hospital wanted to save money. Then I chose general practice as it was a growing speciality in 1974−75. I was lucky enough to get into a three year training programme and enjoyed the entire programme. The reason I chose general practice was because there was not much future for me in hospital medicine except in the Cinderella specialities like psychiatry or geriatrics. In 1979 general practice became a popular specialty for British graduates and I had to find a job. The lush middle class suburbs would not take an overseas graduate and it was 83
NURTURING THE NATION in deprived industrial South Leeds that I was offered a job, to take on a small practice where the senior partner was about to retire. Fortunately, the senior partner who was from Northern Ireland, took to me and helped me to settle into the practice before he retired. “I built my practice in this very deprived area of South Leeds. The population is entirely poor white working class so in my early years I received a great deal of racial abuse. Now I am part of the furniture.”
Fighting to prove yourself at every step is difficult. As junior doctors we had to study on our own and pass examinations. No help was given and study leave was rarely granted as the hospital wanted to save money.
For Muhammad Khan, a retired Muslim consultant, it was difficult to find work locally − he had a young family and no longer wanted to move around the country in order to find consultant posts. He found that his choices were limited, so overcame this particular barrier very quickly by deciding, as did other doctors of Asian descent whom he knew, to leave the UK to work in the Middle East:
“A job came up in the Birmingham region, and then I went for a job and I was the only candidate, so they said literally the job is yours. So then I had to move my family from East London but I wanted to stay in East London, so I refused. Then the Royal London hospital said we can’t have you any longer. Then two of my colleagues went on to leave for the Middle East, and they said come too, and I said what do I do with my children, and they said there’s a better education there. I said what do I do with my house? So in the end I did go. I think I was very lucky. The hospital was staffed by people from the UK, and the equipment was brilliant, and they had flying doctors and helicopters. I had nothing to compare it to.” Like Muhammad, Ramesh Mehta also went to work in the Middle East, twice in fact during his medical career. On both occasions he did so to overcome particular barriers, initially to try and save enough money to come to the UK to study, given his humble beginnings, but then once he had passed his MRCP, went to Saudi Arabia, given how difficult he had found it to find a consultancy post. Rahat Sohail, a bilingual speech and language therapist, followed her husband to the Middle East before finding her NHS post − he too had gone there to seek work and it was usual for the entire family to go. Having children educated in the Middle East was viewed particularly positively, as was the way of life there which was usually far more comfortable than life in the UK. For Arup Banerjee, however, going to work abroad in Malaysia for a time with his family was not the positive experience he had thought it would be:
Muhammad Khan and hospital colleagues in Saudi Arabia
“I was given a lectureship in medicine in Kuala Lumpur in Malaysia. They paid my fare all the way to Kuala Lumpur and I stayed there for three and a half years. We had our third child born there. We lived in a very nice house, we had three servants including a chauffeur and my wife didn’t drive so we had two cars and one
Reproduced courtesy of Wikipedia
PROGRESSING WITHIN THE NHS
Malaysia’s national monument, Tugu Negara, is the world’s largest freestanding bronze sculpture
was for her. She was working in anaesthetics and I was in medicine and we were both very busy. Anyway, we couldn’t stay there because I was a foreigner so everywhere I went I had to show my identity card, my wife was challenged many times and asked ‘How long are you going to stay in our country? You can’t speak the language, what are you doing here?’ That sort of thing. They spoke so many languages, how can I speak three or four versions of Chinese, Malay, Tamil?”
Combining work and family
Kusum Bhatt and family
Asian women working within the NHS experienced similar barriers to women working in other parts of the public and private sector. Female doctors with families found life challenging, particularly those with husbands attempting to rise through the ranks within the NHS themselves. Women working in other areas within the health service told similar stories but again these testimonies reflected their determination to overcome any potential difficulties. This occurred through drawing on the invaluable support of reliable childcare or extended families, either in the UK or in the countries they were born in. Women often made compromises, abandoning their careers or training as hospital doctors to work in general practice, or in some circumstances, giving up dreams of nursing or work in related caring professions to look after their children. Navinder Jhutti was born in the UK and worked as a care assistant in South London, with aspirations to go into nursing. A single parent, she abandoned these plans and the long hours they entailed in order to look after her children. She works as a housekeeper for Oxleas NHS Trust but used to be employed as a Healthcare Assistant: “Well my interest was working with the elderly, community care work. I used to work on a ward as a Healthcare Assistant. I have always wanted to help people. I left that job because of family commitments so I became a housekeeper. It waslonger hours and I can’t work longer hours. I’d rather work part-time and have that time with my family. Maybe one day I will go back to what I used to do. I would like to do something better but at the end of the day a job is a job for me. Maybe one day, I want to go back and do that work again. But you know because I work in that kind of environment anyway and you feel part of the team, they don’t treat you differently. “When I first started this job, I did feel a bit left out because when I used to go into the office to sign in, I would see the other Oxleas staff and I would think, well I 85
NURTURING THE NATION used to do that before. I think the staff understood how I felt and they encouraged me not to think like that which was really nice of them. The staff they really encourage you and they do say to me ‘You’re too good for this kind of work’. You know, at the end of the day, I don’t mind this kind of work. I have my reason that is why I’m doing it. But the staff always encourage me to do something else, they are always telling me there’s a job here in Oxleas so apply for it and everything, which I might do. Actually there’s one coming up for a Support Worker, so I might go for the interview and see what happens. “At the end of the day, I think as a single parent, it gets more difficult to have what you want because you’ve got your family. I think family is important and I would like to go back to the role as Care Assistant but at the end of the day I put my family first.” Malkit Uppal, a server assistant in Warwick, also raising her family alone, abandoned training as a care assistant in order to look after her children, although when she had decided to remain a cook, she was still with her husband. She found the stresses of family and work life difficult at the start of her married life and ultimately would have preferred to have spent less time working and more time with her children. “The family they wanted you to do everything, cook and clean, everything. In those days you weren’t allowed to work, only the man was allowed to work. You have to stay at home and do the house work. My sister used to work at Central Hospital and she got me a job in a kitchen as someone was leaving. I worked in the kitchen for 21 years and I’ve done cooking for 7 years. Been a deputy supervisor and I enjoyed it. I really enjoyed it. I could have done that. Lots of people asked me to be a care assistant but I didn’t want to do it. In those days I couldn’t because I had a family. I would be there until half past seven, and then the children would be in school though I had someone to look after them. 86
“Then in 1987, my husband had a car accident and I have been a widow since then. My eldest daughter and my husband died. Back then I didn’t go to work for a year, mainly because my children were in the hospital. After that I carried on and worked in the main kitchen mainly to get my confidence back.” Ila Basu, a GP in East London, found her path to general practice blocked at three stages. At first her father was reluctant to invest financially in his daughter’s wish to become a doctor, believing it not to be profession for women: “When I passed my school O levels I wanted to do medicine and science and my father said no because of co-education and he wouldn’t allow me to do science. So I had to do a hunger strike. When I was angry, I would not eat. So for seven days I did not eat, I fasted saying unless you give me permission, I will not eat. My mother was on my side but my father said ‘Why would you want to send her to the medical college, she will get married and this is a waste of money’. But my mother said ‘No we must let her study medicine’. Anyway, that was the fight with my father, and my mother was on my side for co-education. My mother was a trained school teacher but my father did not allow her to work after marriage so she was just a housewife. We were one brother and two sisters. In the family my brother was the most dear person because he was the son. So it was discrimination in the house also!”
When I passed my school O levels I wanted to do medicine and science and my father said no because of co-education. So I had to do a hunger strike. So for seven days I did not eat saying unless you give me permission, I will not eat! Ila Basu
PROGRESSING WITHIN THE NHS Ila however had great resolve, and, after qualifying, came to England and ran a single-handed practice in which the numbers of patients began to grow rapidly. She had begun her career in obstetrics and then anaesthesia but did not enjoy hospital medicine, eventually finding work she preferred in general practice. “When I was expecting my daughter I knew that the surgery would ask me to leave because of the pregnancy, and I didn’t want to tell anyone when I got pregnant, you see. But one day the receptionist asked me ‘Ila do you want coffee?’ and I said ‘No’, then they asked if I was pregnant and I had to say ‘Yes!’ So the senior partner called me and said that I used to work very hard but that I wouldn’t now be able to work as hard as I did, giving me verbal notice citing my pregnancy as the reason. So I went to the BMA and they said that I could do two things. Either I could take my partner to the industrial tribunal for unfair dismissal because as a lady you have the right to get pregnant and have children, or you can start your own practice.”
Ila Basu medical certificate
the dinner. My husband would leave home at 8 a.m. and return at 8 p.m. expecting dinner at the table. “Physically I could not cope with the pressure. I felt like a working machine. I could not even smile when the patient came through the door and I thought that I would have to give it up. I told my husband that I don’t want to work anymore.
Initially she was unable to get a bank loan in order to set up her own practice so she borrowed money from friends, found a building which she rented and renovated. However, she began to find the combination of running the practice, answering house calls and looking after a young family incredibly difficult but eventually gained the agreement from her husband to run a job-sharing practice in the same area:
“Then a government white paper said that we can job share. My husband gave up his junior partnership in Hackney and he said ‘I will do the job share with you. You do the morning surgery’. Because we did not have two consulting rooms, I would do the morning surgery at 8 o’clock, pick the baby up from nursery at 3:30 to 4 o’clock, and go home to look after her. And he used to do locum work in the morning or his study and then evening surgery. And that is how the practice list grew to 2500.”
“So I started with my 150 patients, and I would drop my baby to the baby minder at 9 a.m. and pick her up at 7 p.m. and carry on doing the work until the practice built up to 1800 patients. And then it was really too much pressure, because at that time, every time a patient called you for a visit you had to go. I had 1800 patients, all alone. So I had to take all the paperwork home, take the baby from the baby minder, give her a bath, feed her and make
Her final barrier came in the shape of the managers within the Family Health Services Authority (FHSA) serving her surgery. Her attempts to get planning permission for larger premises in order to extend her now joint practice were consistently blocked. She however engaged in a long and protracted fight with the FHSA but with the support of the BMA and the Royal College of General Practitioners, she eventually got the planning permission. The FHSA finally 87
NURTURING THE NATION admitted that they had been wrong, initially thinking that her practice would not survive. Her daughter is now at medical school and has no doubt learned much from her mother’s resilience, fighting spirit and determination. For Kusum Bhatt, as with Ila, some of the barriers to her career pathway began even before her life as a student, though for her these reflected the progressiveness of her own family compared to others: “In those times, the daughters didn’t go to college. So our family was quite exceptional in many ways and my expectations were really that I wanted to be a doctor or a lawyer. When my father died, my mother had to take care of all the marriages. She selected the marriage for me in Agra, and because she knew that I wanted to carry on in a career, she made my father-in-law promise that I would continue with my education. My husband’s family though were very, very conservative, so there was a lot of difficulty for me to continue with my education.” However when Kusum left India in 1960 to join her new husband who had settled in Sunderland, she was able to pursue her ambitions. However the process was not an easy one as while she set about trying to find a suitable course, she was simultaneously caring for her son, born a year later, who was showing signs of a congenital disability. “In the UK because I had no experience of social work, the University couldn’t take me on the social work course. So the Nottingham lecturer referred me to Newcastle University where they had one course for people not qualified but with practical experience, but said in my case they would have to design a new course! I mean the lecturers were wonderful really. “They designed the course for one year, for me to do social administration, social psychology, politics and economics, and they made a condition that I need to pass on those. 88
So I did that and at the end of the period, I realised I was pregnant with my daughter. And I thought, oh gosh, what am I going to do? I was really very upset. I finished in August/September and the baby was due in November. I didn’t tell before that, because I was not showing and I was too scared to tell them in case they felt less of me. But the lecturer was quite understanding and said why don’t you have your children and then come back? I said I might change my mind because I might become too domesticated! So I made a kind of hard pact with her, and my daughter was born. The following year, I was going to come back, but about that time my son was showing signs of disability – he had the callipers on and had some problems with his speech - so I asked for another year. When I returned, my childcare arrangement was a lot better and I was a lot happier about my domestic situation.” Anita Sharma, a GP in Oldham saw the potential for barriers to her career − she arrived in the UK pregnant with her first child but was adamant that she was able to continue with postgraduate study. She insists that her progress is in large part due to the presence of good and reliable childcare and would advise any young female aspiring doctor with intentions of having a family to do the same: ”My husband and I met in India. We knew each other for 7 years before we got married. I got pregnant when I was in year 2 of MD (post graduate degree in Obstetrics and Gynaecology). This year was rather hard and stressful. “The pressure of the final examination and coping with the pregnancy was just too much at the time. I moved in to my university accommodation but sometimes women can be your worst enemies. Working in a department with a workforce of women doctors, I gained no sympathy for being pregnant. I had to do my share of on calls whether tired or sick – it just did not matter.
PROGRESSING WITHIN THE NHS “I arrived in England in April 78 and my first child was born by caesarean section in May 78. New in England, I had no friends. During visiting time, in the maternity ward, I was the only one who had no visitor. My husband came only when he was not on call – those days the on call rota used to be one in two. Seeing the tears in my eyes the midwife would come and talk to me. “I believe it takes a strong will and hard work to achieve what we aspire to. What’s important is to have confidence in your abilities. Being organised is the key to the successful running of career and family. You need to have plan A, B and C. For me the choice was either to stay at home and be a mum who picks her children from school or making a career. You cannot rise in your profession if you spend 10 years bringing up your children and then expect to be at the top of your profession. Conference flyer featuring Ila Basu discussing ways to overcome barriers
“I am very proud of what I have achieved and I only have to thank my supportive husband, my nanny and my two very healthy children who never troubled me. My race or gender has not hindered my success and being married to a doctor has helped me a lot as we understand each other’s stresses. “But where are the women doctor’s role models? As a woman doctor it can be difficult to do justice to your family, children and profession. I suppose I have been lucky.” Manju Bhavnani saw how few women went into her field of medicine in the early days and she remembered the negative way that some male colleagues responded to
other female doctors at that time. Her participation on a training scheme for women, which enabled her to study for her MRCPath on a part-time basis, was instrumental in her doing well, and she admits that having this opportunity was particularly helpful: “Because I was a woman, I got on Anita Sharma the part-time women’s training scheme. I experienced, not racism, but some sexism. By that time I was becoming aware of feminism. If anyone said anything about a woman that they wouldn’t say about a man, I would react and I would stand up and defend my ground. There were four women on our training scheme (I was the only part-timer), and six or seven men. We stood our ground and we’ve all done well. It helps to be firm. I was very lucky that I passed my MRCPath exam first time. “This is an exam which is called an exit exam, and it confirms that you are ready to be a consultant. It’s not like the MRCP where you have the training afterwards. I was very lucky that I did pass the exam, and that made people look at me in a different way. I think that was what helped me to get my Consultant job in Wigan.” After she got the Consultant job in Wigan, she worked single-handedly for thirteen years. In that time, she set up a good Haematology and Blood Transfusion Service, and eventually became Clinical Director of Pathology. She also set up a Clinical Haematology Service for patients with haematological disease, as there was no such service in Wigan when she took up her post. Manju became the first Lead Clinician for Cancer in the Trust, eventually representing Wigan in the Regional Cancer Network. She was the first Chair of the Manchester Haematology Cancer Group in the Manchester Cancer Network, and 89
NURTURING THE NATION was appointed as a National Lead for Haematology Cancer, to advise the Department of Health on Haematology treatment. “The other haematologists in the North West Region wanted to have me as their Chair for the newly formed Haematology Group in the Cancer Network, as I was seen as impartial, and capable of getting agreement and resources for the many changes proposed in the National Plan. I was successful in this role, and perhaps as a result of this, I was really honoured to have been appointed a National Lead for Cancer. Usually these posts were taken by Professors or Consultants from teaching hospitals, and I was one of the few women from a district general hospital to hold such a post. Though it is a lot of extra
work, I feel it is essential for all doctors to embrace managerial roles, as that is a way to improve services for patients. I feel fortunate that throughout my career, I have been given the opportunity to undertake these roles, and as a result, to be involved in shaping future services for patients.”
Support and mentoring Key to success for many Asian NHS employees was the presence and assistance of specific mentors, or often simple networks of support either within their area of medicine or in the hospitals they were training in. Such support was of great comfort to them, as it gave new arrivals the confidence for example to communicate with other students on their courses, with their colleagues or their patients. It also took a variety of forms − from established and well-renowned consultants and medical directors to ward sisters and neighbours. Krish Goodary found his time in Stourbridge, whilst completing his nursing training, quite difficult. Although he had learnt English in Mauritius and had gained an English O level among five others, before coming to the UK, he was unable to fully understand the accents of local people, which over time began to affect both his confidence and his progress on his course:
Manju Bhavnani away from work
Though it is a lot of extra work, I feel it is essential for all doctors to embrace managerial roles, as that is a way to improve services for patients. I feel fortunate that throughout my career, I have been given the opportunity to undertake these roles, and as a result, to be involved in shaping future services for patients. Manju Bhavnani
“The day after I arrived, the first person I was introduced to was the nursing officer who came to meet me. She had this broad Black Country accent from Dudley and I didn’t understand a word she was saying! And she looked at me and said ‘You don’t understand my accent do you?’ So it was like this for about a month, very difficult and that was the first barrier. But then it had a ripple effect on other things. I started feeling stupid, I started feeling incompetent, it started bringing other problems because of lack of communication, so instead of integrating, I started to become a recluse because I thought I can’t communicate, what can I do?
© Karen Gupta
PROGRESSING WITHIN THE NHS
Nurses from all backgrounds supporting each other, St Stephens Hospital,1963
“I used to try and make sense of what a person was saying within the context of the conversation. I often picked two or three words from a sentence, put them in the context of what was going on before responding. There was always a five to ten seconds delay in responding! There was a girl in my class, Alison Davies, she was a very caring person, she was the same age as me, twenty, I don’t know if she felt sorry for me but she used to come and talk to me. One day she invited me to her home. She picked me up and I met her husband. It was a Friday evening. We had fish and chips. I later learnt that it was a traditional dish for Fridays. A few weeks later she introduced me to her family − her mum, dad and brother. I felt very comfortable and integrated well with the family. They could clearly see that I couldn’t understand them and Alison used to say to her mum, dad and brother, ‘When you speak to Krish, speak slowly because he can’t understand when you speak fast’. They were a very empathic family and they made me realize that there are some good people who are prepared to go that extra distance to help you.” This support helped Krish overcome his homesickness and gave him the confidence to move forward in his nursing course. However, despite this achievement, he found it difficult to progress to the next level of training as he had ultimately wanted to become a registered nurse (SRN) and found his career going in a direction not of his initial choosing:
“There were about 25, 26 of us in the class and 20 passed, but out of the 20 about 12 of us wanted to go on and do our student nurse training to get our registration. I was very disappointed that I wasn’t accepted. The others were and I was disappointed because my achievement throughout the two years was always higher than everybody else and I considered myself a good nurse despite all the difficulties. I found it difficult to understand why I couldn’t get accepted to do my registration. I was the only one who had five O levels – the others didn’t have any. “Later on I found out that the Director of Nurse Education didn’t like people from abroad moving on in their chosen career. That made me think a lot because I had never come across an attitude like this before. I thought to myself that I will not allow his attitude be a barrier to my career. But I was a victim of someone’s attitude and I didn’t know how to challenge him. These days you know your rights, you know you can challenge issues, you know the law, you know there are organisations that you can go to for advice and guidance or to take up a case on your behalf, but those days we didn’t have them or they were not as transparent. For example if somebody made a racist comment towards you, you just had to accept it or pretend you did not hear it. I think the Director of Nurse Education was in a position of power and abused his position by being divisive. Later on I found out that he wasn’t the only one, there were many like him. Gladly, now there is clearer legislation to protect people.” Krish found moral support in a person who did not hold great influence or power in a similar way to the consultants who supported other Asian doctors struggling to progress. However, the support this particular nursing auxiliary offered to Krish worked in a similar way to that of the fellow student who helped him to understand local English accents − he felt powerless against the Director who had barred his access to the nurses training course, 91
NURTURING THE NATION but the person who gave him support gave him the confidence to move on from the obstacles placed in front of him.
“You couldn’t talk to anybody. If you talked to your Mauritian colleagues, they were in the same position as you, there’s nothing they could do about it. There was one lady, Mrs Patterson; she was a West Indian woman from Jamaica. She always said to me, ‘Listen son, you fight for your rights, you stand up for yourself, don’t allow them to talk down to you’. She used to spoil you and treat you as a son. She very much embraced you and she was such a comfort to me. She said ‘Look there’s nothing we can do but you’ve got to fight for it, don’t allow them to talk to you like that’. I wasn’t confident enough to challenge people, but she was. If anybody said something that was out of line, she used to challenge them and people wouldn’t challenge her back! But whenever I was struggling, I found standing by Mrs Patterson gave me such warmth and comfort, bless her.” Krish moved on to work in an outpatient’s clinic in Dudley. He then completed his learning disabilities training. He went on to work as a ward manager and later on worked in the community, specializing in supporting people presenting with challenging behaviours, in Merseyside. However he never forgot the support of Alison Davies and Mrs Patterson. Krish’s experience was similar to another Mauritian nurse, Kay Lutchmayah, who had found herself undertaking the duties of a sister, but was not being paid for this extra work and responsibility. With the help of a supportive clinical nurse manager, she wrote to her employers and let them know what had occurred, appealing the ‘D’ grade level she was working at. On the basis of this help, she was successfully rewarded with an upgrade to ‘E’ but she found herself working again at a ‘D’ grade level, just before she was due to retire. The experience left her disappointed: 92
“It doesn’t matter how much experience or qualification you have − if your face fits you get the promotion. I could not wait to stop working, so you count your days until retirement.” Kay talked about difficulty with progressing in a similar way to other Black and minority ethnic nurses some of whom were featured in Many Rivers to Cross (Kramer, 2006). They too spoke of some of the experiences they had had when trying to move from pupil nurse (SEN) to registered nurse (SRN). For Asian doctors desperately trying to progress through the ranks, support was incredibly important in order to navigate some of the more persistent barriers relating to the perceptions that others had of them. Tony Narula had experienced some difficulty moving from the position of Registrar to Senior Registrar. However, having mentors in a hospital in Nottingham who believed he had the potential to do well, significantly helped him to move forward: “I moved to Nottingham from my middle grade post, and in those days, you had to become a middle grade Registrar. Then you had to become what’s called a Senior Registrar − that distinction has now been removed but it meant that if you didn’t make the next step up, there was no consultant career. So that was quite a difficult barrier for everybody and I did have a lot of trouble getting to that stage but my bosses in Nottingham were very, very supportive of me and basically continued to encourage me throughout and said ‘Don’t worry, we’ll back you until you get what we think you deserve’. And they did.” “One mustn’t underestimate the importance of your colleagues in all of this. I’ve had supportive colleagues when I was a trainee; supportive colleagues who helped me get my first consultant job and supportive colleagues here.”
PROGRESSING WITHIN THE NHS Kailash Chand’s opportunity to progress followed a particularly good performance in a game of cricket between clinical and non-clinical staff at Alder Hey hospital. He’d been working there for one week only, and had begun to have anxieties about supporting a wife who was herself trying to find work in the NHS and a baby back in India. “One fine Saturday morning I was bleeped and when I got to the switch, they said your consultant wants to talk to you. I come from a cultural background where you would think ‘Only one week has passed and the consultant wants to see me on a Saturday and he’s going to tell me that I’m not competent, that I can’t speak English and better go back’. So there were those real fears. The first thing he says is that we’re supposed to be playing a cricket match with this non-clinical side, but he didn’t know that I knew anything about cricket. He said ‘we have eight players but we need eleven so I want you to come and just be a part of the team’. Anyway, I bowled and got three wickets in my first bowl and we won that match. And the next thing on Monday morning, my consultant called me in the office and said ‘I have seen you, you can speak good English, you’re clinically not too bad’. They used to give you work for one month before you got clearance, so he said ‘I’m happy and satisfied and you can look for a job’.” Kailash’s consultant offered him support in speaking to relevant people to assist him with his next steps having spotted his sporting aptitude and having the time to get to know him during that game of cricket. Vinod Devalia experienced a great deal of support on his long journey to the position of consultant, but has found that support has waned since he began working as a single-handed GP in a rural location in Wales. Coping with antagonistic patients was helped by the support of senior staff: “When I was in Peterborough, a South African man came in with chest pains. He’d had a heart attack or similar and
he said ‘I don’t want to see that doctor’. I was a Registrar and my Consultant said ‘This is not South Africa, you will see whoever is here. I would easily have him as my doctor at any time so you’re going to have him, you don’t have a choice, he’s going to be looking after you’.” These responses by patients were echoed in the testimonies of others who found themselves in similar positions: “Most of the problems arise when you speak and the accent is different and people don’t understand and then they complain. I think someone complained once and my chief offered a choice: ‘Well you can see him or you can go home”. A support like that is the most welcome.’ Satinder Lal
“Generally patients were lovely, and they treated me as the rest of the nurses really, like everybody else and it was fine. There was only one patient, I think it was when I was a third year student, on the cardiothoracic ward, and he didn’t want someone who was black to look after him. So I said fine basically. The worst and the best thing happened in the end, because he needed his stitches removed and I was the only person who could do it. There was nobody else on duty who could do it, so he told the doctors that he didn’t want me doing it, so they said fine, ‘If you don’t want her, you’ll just have to stay there without having it removed until somebody comes who can do it’. He wanted the doctors to do it and they said sorry we can’t. Eventually he allowed me to do it, and I think he was quite surprised, because at the end he apologised. I think he thought I’d try and retaliate, either hurt him or something. So I did it and he was OK, and after that he went home.” Rangena Tilkaran And for others, they found that simply doing their jobs confounded any ill-informed assumptions that patients had about their abilities:
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“Professor Shields and Robert Sells were a great support There was one patient, on the cardiothoracic at Liverpool. Robert was the Transplant Director. He ward, and he didn’t want someone who was black to negotiated with the professor for me to do two days a week look after him. So I said fine. He needed his stitches in the general surgical unit in Liverpool. So everyone had removed and I was the only person who could do it. been at that stage very supportive. But I must say initially There was nobody else on duty who could. He wanted when I wanted to get into teaching hospitals, I went to a lot of interviews and never got anywhere until this break the doctors to do it and they said sorry we can’t. Eventually he allowed me to do it, and I think he was came up. So I took a sideways step into transplant and then got quite surprised, because at the end he apologised. I back into general surgery. Eventually I got appointed to think he thought I’d try and retaliate. Rangena Tilkaran
“A couple had said that they didn’t want to be cared for by Asians or Black people. I couldn’t understand. I was on nights at the time and the Sister in charge said you look after this side of the corridor and we’ll look after that side and you know, you think nothing of it and I carried on working. But the night got very busy, the Sisters who were looking after this particular patient had to go into theatre so I was amongst some others left behind to look after the delivery suite. The woman went into established labour, then called for help, I went in and carried on helping and assisting her to birth and afterwards, her partner came and gave me a big hug like they normally do. By then the Sister had come out of the theatre and in the staff room she said, ‘I’m surprised he gave you a kiss’, and that’s when I found out that they didn’t want to be cared for by Asians.” Kuldip Bharj Not only did the interventions of senior colleagues provide some respite from initial problems, which often came from patients refusing to be treated by non-white staff, it also gave these prospective doctors, nurses and non-clinical Asian workers confidence in their abilities to continue within the health service. Bernard de Sousa was advised by a Professor in Bristol to abandon surgery, given both how competitive it was and the difficulty he would have getting work compared to local graduates. 94
Bury. There used to be between 20 and 40 applicants for a Consultant job in those days but eventually I got appointed as a Consultant Surgeon here in Bury. Six months later I went down to a conference in Southampton where I came across Professor Hughes from Bristol who was there. He remembered me and was gracious enough to say ‘Before you say anything, I must apologise. I was obviously wrong’. I told him ‘I’m glad to say thank you for your advice as it made me more determined to carry on’. In spite of its shortcomings, it has been a privilege to work in the NHS for 41 years.”
Going the extra mile Working in the NHS during the 1960s and 1970s clearly posed challenges for Asian prospective employees. However many have had very successful careers, or have been able to gain access to areas within the Health Service that they had only dreamed of as children. These particular individuals completed extra hours of study, approached well-respected individuals for advice or became involved in a range of voluntary groups. It was this hard work and initiative that also helped these doctors and nurses to surpass expectation. Manju Bhavnani recalled the great support she had from key individuals during her attempts to achieve the position of consultant. One, who had taught her at a hospital in north west London, gave her the additional
© Satinder Lal
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Satinder Lal at work circa 1970
NURTURING THE NATION support she needed to pass her MRCPath examination. The other, a consultant in Manchester, enabled her to gain the practical experience necessary to pass the exam. Both individuals recognized Manju’s potential and gave her the encouragement and support she needed, and she expressed great thanks for that. However Manju herself showed great initiative in going slightly further than perhaps others may have done in order to gain experience. She noted that: “I hadn’t got a job and I’d just had a baby, so what I did − such a cheek – was that I went to the local hospital where my parents lived, and knocked on the door of the Haematologist, and said ‘I want to do haematology, I need to study for the exam, can you help me?’. And the woman Consultant looked at me and said ‘Have you got any references in this country?’ So I gave her two names, one had retired and one had gone to New Zealand. Later she rang me and said, ‘I’ve rung the man in New Zealand and the retired person has given you a good reference too, so you can start working’. She arranged for me to work as a locum SHO and she taught me. She was absolutely brilliant. She pointed out that because I was Indian, I might have difficulty in getting a Consultant post, and because she was also from abroad, she was very understanding. She said she could see my potential but that I would have to pass the first part of the MRCPath examination. She made me do essays and marked them and made me do more essays and whenever there was a chance to speak or do a piece of research, she made me do it and present it. “I was only a locum but as a result of that, I actually became more confident in haematology, and when I took the exam, I passed it. As a result, the Consultant in Manchester supported me to get a part-time training post in Haematology, in Manchester. This, together with my very supportive husband, enabled me to train and
look after my family, and though the training period was longer, I gained more experience and passed the final part of the MRCPath exam.” Like Manju, Rangena Tilkaran employed a bold approach once she had qualified as a midwife and acknowledges that this greatly assisted her in finding, and keeping, her post: “When I completed my midwifery study I wrote to the Senior Midwifery Officer at Hammersmith Hospital asking her if she had any vacancies for a staff midwife and, she asked me to go and see her. I think she was impressed by my boldness and offered me a job. She took a risk and gave me a great opportunity. I started there the day following my results and worked there in various capacities for 33 years.” Others, like Karna Dev Bardhan, felt it was both the support of mentors as well as simple luck that led to a successful career in the NHS. He had been interested in research since his medical school days in India but unlike other consultants spent much of his time in Rotherham conducting research and clinical trials rather than simply reaping the financial benefits of his position, recalling: “On starting at Rotherham I asked my bosses ‘I would love to have some lab space’. They were surprised (assuming I would wish to build up a private practice in my spare time!) but nevertheless made space available. From this our research grew. The early clinical trials brought in some research grants from industry, which in those days was considered a gift for personal use. Consultants’ salaries then were very low and we had financial problems but my wife was keen that the grants be used for research and to help others less fortunate (rather than for a ‘nice Mercedes’, which one of our hospital finance chaps jokingly suggested. It is not my style!). These early grants supported both our clinical research and our first fundamental science PhD.”
PROGRESSING WITHIN THE NHS The Bardhan Research and Education Trust (BRET) was later established, which made it possible to support locally a succession of PhDs by young scientists, talented medics interested in research and the clinical research team at Rotherham. BRET now provides support nationally. Mentorship of the young and the care of patients doctors have the privilege of looking after are central to his beliefs. He tells his trainees: “If you really want to impress me, don’t show me your brilliance: that’s a given. Tell me how much your heart ached for your patients, that you came to see them even after hours, sorted out their problems, spent time with them and treated them as though they were your own kith and kin. That is the mark of a physician.” Going that extra mile and treating patients as you would do a member of your own family, were sentiments echoed by many. In much the same way that many spoke of having to work harder than White British counterparts, these Asian NHS workers spoke of wanting to do the best job they could do, given how hard they had worked to get to their positions. Doing the best job they could do within the NHS invariably meant doing their best for their patients: “A GP in Reading phoned me one day and said ‘Look, my brother’s daughter in Bangladesh has got leukaemia and there’s no treatment for her there’. So I went to the Haematology Consultant here and I said ‘This is our story, would you be prepared to provide free treatment for that girl?’ and she said ‘Yes’. But I thought we don’t really want the NHS to bear the burden because she’s not an NHS patient so all the treatment here must be paid for. So we raised the money. We raised £30,000 within two or three weeks and she had the treatment and she was cured of the leukaemia.” Ramesh Naik
Dr Naik is thanked for his help
been involved with, not just me on my own but other people, they’ve really worked hard to make things better. For example, I used to chair a group here in Leeds looking at Black and ethnic minority communities city-wide. Some of the work we’ve done as a group of people was really about improving services so I think they’ve contributed to the NHS through their dedication and their real motivation.” Kuldip Bharj “The biggest satisfaction I get is if I receive rewards from my patients. I think, to me, if a patient is happy, that is the best thing in my life. I want my patients to think that I have really treated them well and I’ve really continued to look after them well.” Javed Ahmed
“I’ve not come across any Asian who has half heartedly done things. When I look at some of the work that I’ve 97
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5 Job Satisfaction and Achievement © A. Dutta
When I came to England I loved it because it was the first time a consultant had said, ‘What do you think?’ I remember thinking, ‘Why is he asking me?’ as I was so junior. I thought how wonderful that they have respect for my opinion. Kalyani Katz, Consultant, Elderly Psychiatry − came to the UK in 1975 and has worked for the NHS ever since
Anil Dutta with colleagues at Upton Hospital circa 1954
Voon Cheng Chan certificate
JOB SATISFACTION AND ACHIEVEMENT We’ve heard some of the incredible stories of journeys made and careers built by our interviewees who all worked within the health service for many years. Some started outside of it and came to it a little later in life. Only one, Anil Dutta, began his working life in the UK but then returned to a successful career back in India. Even with Anil however, his fond recall of his days working within the NHS illustrate the impact that it has had on all of those who have spent time within it. Here we take a look at what ultimately these individuals enjoyed about the health service and what they believe some of their greatest achievements have been.
Job satisfaction There were certain aspects of an interviewees’ role which they believed to have been their crowning moment. Often these were small but significant issues or occurrences but given that people so rarely have the opportunity to celebrate a job well done, it is important to highlight them here. Voon Cheng, a midwife in Essex found it deeply satisfying to see the babies she had delivered now returning to her as adults to have their own children. Remaining in the same place for years at a time had therefore served her well: “Being in one place has its good points and bad points. If you move around different hospitals you’ll see different things, but to me, when you stay in one place, this is your community, your town, your place and I now see babies that are born here, the babies that I delivered, are coming back to have their own babies! I think it’s fascinating, to see that in your lifetime, whereas if you’re on the move all the time, you don’t actually see that. It’s like you establish yourself as part of the community.” Rahat Sohail, a bilingual speech therapist, enjoys her work so much that she no longer sees it as work:
“Some parents, they don’t think that it is their role to sit on the floor with their children to play with them until you explain to them. And when they see the results, they appreciate it. It is really useful to explain to them if they don’t speak English. And sometimes the parents when they leave the room they say to a co-worker ‘Will you be here next time?’. You can see in their eyes that they want someone who can speak their language. “It was really good to learn every day a different thing and then because I do write as well, it was a really good opportunity for me to have some input in the service, giving advice about culturally appropriate assessments. It fitted in with my family life to have this job and for me this job is like my hobby, I just enjoy every day. Really enjoyed my job and I am still there.” Tony Narula expressed a view probably shared by all of those interviewed – that satisfaction from doing his job related very heavily to the response of patients he has been able to help: “It’s very rewarding and let’s be honest, it’s a very decent way of earning a living. And it’s very rewarding if you work hard and I’m sure that’s akin to a lot of jobs but the pleasure of having individual people being grateful to you every week is tremendously satisfying and one shouldn’t underestimate how that makes you feel about yourself. It gives you a good feeling of self worth but it’s important to try to prick the bubble from time to time.”
Achievements within the job Each of the individuals interviewed for this book made important achievements in their work, with some being more reluctant than others to admit to their own successes. The evidence for many of these achievements can be seen clearly, for example in view of their continued work and progress within the NHS in spite of the many barriers and difficulties expressed on earlier pages. 99
NURTURING THE NATION Newspaper cutting about Dr Ramesh Naik
avoidance of ties when carrying out clinical activity. The traditional doctors’ white coat will not be allowed. The new clothing guidance will ensure good hand and wrist washing’. The BMA’s central consultants’ and specialists’ committee in 2007 had already raised questions about the policy, but it had been largely adopted by individual NHS Trusts across the country. Rehanah was approached by practicing Muslim female hospital staff deeply concerned about the implications of this policy on their need to protect their dignity and remain covered according to their faith. Some were even considering giving up careers in medicine. She noted: “Without compromising infection control I believed that there could be a solution for the Muslim female staff who felt they did not want to be bare below the elbow, as it would compromise their faith and dignity. They were washing their hands in accordance with procedures to ensure good hand hygiene, but wearing garments with full length sleeves which their supervisors and managers were not accepting given this Department of Health policy.
Others were able to name particular achievements that they personally felt proud of. For example, Rangena Tilkaran mentored minority ethnic managers for the NHS Management Programme and represented the Unit she worked in as Lead Nurse on a BBC Pebble Mill television show. Since retiring however, Rangena has also been heavily involved in health promotion in other countries. For Rehanah Sadiq, lobbying the hospital in which she works as a Muslim chaplain to remove the policy of Muslim nurses having to be ‘Bare below the Elbow’ was a significant achievement. The policy, introduced by the Department of Health in 2008 as a means of infection control and announced by the then Secretary of State, Alan Johnson, required hospital staff to wear ‘short sleeves, no wrist watch, no jewellery and allied to this the 100
“I was one of the people asked to join in a round table discussion with the Department of Health and Muslim Council of Britain (MCB) about the issue, which had
Rehanah Sadiq with other chaplaincy colleagues
JOB SATISFACTION AND ACHIEVEMENT become a problem nationally. We discussed the possible options of permitting three-quarter length sleeves and disposable over-sleeves. “Eventually I piloted a 3 month trial with some of our junior doctors, using a disposable over- sleeve. After normal hand washing procedure, those women who wanted to keep their arms covered would do so with disposable over-sleeves. Like disposable gloves, they were easy to put on and take off. “I did this with the support of the Trust, the Chief Nurse and my Manager. We piloted this, found it to be very successful and I am so grateful to Allah that our Trust accepted it. The University Hospital Birmingham, where it was piloted, felt that the purchasing of the over-sleeves was not a financial issue since the number of staff that would need to use them was minimal. While the doctors were willing to pay for their over-sleeves, they were told, ‘No, we will pay for this’, which for me shows the value afforded to our staff in ensuring that they were given the respect and dignity they felt was essential to their working life.
Navinder Jhutti, who had given up work as a Care Assistant to find work that would enable her to look after her children, very much Navinder Jhutti enjoyed her job but often receiving award referred to it as being nothing particularly special. In 2010, she received an award for her work which recognized the job she did daily, sharing this recognition with the whole of the NHS Trust in which she worked. This achievement is particularly special, as it allowed her to look at the job she did entirely differently and indeed far more positively than she had done prior to receiving the award:
“Do you know what? I still don’t know why they nominated me. But I was so chuffed when they did. I was so nervous that when I was going up on the stage, I thought was going to faint or something! It was at the O2 in Greenwich and there were so many people there, I was surprised actually. There were at least about 500, 600, all of them from Oxleas Trust. I just felt shocked. I mean there was me being awarded within the NHS, and “Staff who may have felt compelled to give up their I got this award. I was just really, really, nervous going up careers are now content. However, I still receive calls from the stage and handshaking the people that gave me the other NHS Trusts where the employees want to leave award. So it was brilliant, absolutely. I might be a cleaner, work because they cannot cope with what is now being or whatever you want to call it and I thought no one enforced on them. They want to know how our Trust would have noticed a cleaner instead thinking ‘She’s just a resolved the issue so they can put it to their Trusts. On cleaner’, you think people just think that, but I was quite numerous occasions people have commented to me saying, happy actually. It encouraged me more to do well, so I was ‘I am leaving my trust and I will only apply to University quite happy.” Hospital Birmingham or other Trusts where they will For Ramesh Mehta, the personal achievements he had respect my faith, religion, culture and dignity’.” witnessed throughout his career within the NHS were combined with those he, and all of those involved in BAPIO, had achieved. Therefore on one level some of his greatest achievements lay in the work he did on an every day basis with his patients:
NURTURING THE NATION “My greatest achievement I feel is the constant feedback that I get from patients who are so grateful for my work. Almost every year, I have patient surveys regarding my work and nearly one hundred per cent of patients are so grateful and they say very good or excellent. I think that is very satisfying for me. “ However, other achievements related to the wider forms of work he did, outside of his ‘day job’: “My work for the Royal College, I feel is very satisfying… I have assisted the College, having failed the exam several times myself and knowing the issues, into changing the prototype of the examination and making it a lot more, not only sensible, but also reasonable. So one or two examiners cannot fail the candidates any more in the new system. I also feel greatly satisfied that I’m taking the College exam to India as Principal Regional Examiner for the College for South Asia, taking a good quality examination to others in the Indian context. I feel satisfied that because of my work, the NHS has recognized it and has given me awards for excellence in my work, so these are the things which really satisfy me a lot.” And he, as with many others who had participated in work outside of their everyday job, but to which they were deeply committed, had a great sense of achievement from assisting others. This voluntary work that a great many of our interviewees were involved in, on top of the extremely long hours they had worked for the NHS, is testament to their resolve and ultimately overall contribution. “Because of BAPIO’s assistance, we have ensured that several thousand Asian doctors were a lot more confident, they understood the barriers and how to get over the barriers to career progression. We also managed to assist a lot of doctors who were in difficulty at all different levels, whether junior doctors, not able to progress, or GPs being referred to the General Medical Council. A lot of them came to us and we provided them with a lot of support. 102
Ramesh Mehta at work
JOB SATISFACTION AND ACHIEVEMENT “One of our crowning moments, we believe, was in 2006, when there were thousands of doctors who came to the country because the British government a few years previous to that were going out to recruit senior doctors. But they did not advertise it properly and the impression was that there was a big demand for training posts…. A lot of doctors from the Indian subcontinent in 2005 − we estimate 10,000 − came to take the exam because before being granted licence to work in this country, they had to take this test conducted by the General Medical Council for which they had to spend nearly £500 each. Ten thousand of them came in one year and we had been talking to the Department of Health, the General Medical Council, BMA and saying, ‘We don’t have places, this is a small country, why are they coming? They don’t understand what’s happening here’. But nothing was done and suddenly in panic in early 2006, the Department of Health, along with the Home Office, decided to change the visa regulations and that was applied retrospectively. “So all these doctors who had spent thousands of pounds including fees and travel and subsistence to stay had to be packed up and we thought this was very unfair so we took the government to court. That case went up to the House of Lords where eventually we won, so I think that was one of the crowning moments and we felt very happy that the legal system worked very well.” Satinder Lal, a retired consultant physician, has many achievements that he has acquired during his 40 years of working for the National Health Service. One that he wanted to mention however was the impact he had on the management of chest diseases in the hospital: “I introduced the modern method of treatment of patients with pulmonary tuberculosis by treating them in an acute respiratory ward rather than a tuberculosis sanatorium, and also providing supervised drug treatment. I persuaded the management to close the Bury Sanatorium and
reassured them and the staff, that I would monitor the health of the staff at six monthly periods. Thankfully, the staff remained free of tuberculosis and my practice was accepted. “Diagnosis and treatment of asthma had made much progress in the late 1950s and early 1960s. I introduced the process of monitoring patients in the clinics by health visitors and by patients self monitoring by supplying them with Peak Flow Meters. Nagendra Sarmah, a retired GP in Manchester, achieved a great deal once he had been able to overcome the difficulties he experienced with finding a practice where he was treated fairly. Not only was he able to run a singlehanded practice with a list of 3300 by the time he retired in 2001, but he received an award for his services to patients based essentially on his ability to spot major health difficulties in patients. “One of my patients, 14 years old, was the youngest heart transplant patient in the UK at that time in 1984. One evening surgery, this father brings his 14 year old son and said his stomach is upset. And I said, ‘why, what is the problem with his stomach?’ And he said, ‘he’s off his food,’ so I examined his stomach and when I examined his tummy he’s got a big liver. And then I listened to his lungs and he’s got plenty of fluid in his lungs and then I listened to his heart and his heart is failing. It’s nearly 6 p.m. so I said to the father, ‘Ian, I’m going to ring tomorrow morning to get a special appointment to go to the hospital to see a cardiologist so contact me at 11’. “I’d just finished my surgery at 7.30 and the father came after surgery hours. I’d just sat down for my meal, but I told him, ‘Look I suspect that your son’s got a heart problem, but I’m not the expert, I want him to see one’. Meanwhile I had booked an appointment with the cardiologist at the Manchester Hospital for 2 p.m. so I rang the boy’s mother and I said ‘Are you coming to collect this 103
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Nagendra Sarmah early on in his career with his first car used as an ambulance in Nantwich
letter for hospital?’ and she said ‘Oh, you’re making lots of fuss. Why do we have to go to hospital?’ I said, ‘For my sake, go and have a chat!’ So he was admitted to hospital and was discharged with plenty of water tablets to drain his lungs. And the hospital said ‘We can’t do anymore’. I was off that weekend and I disappeared off to Bolton to visit a friend, and I was just sitting down for a meal when my wife rang and said can you come? The boy’s out off hospital and they are very upset. The family said the consultant invited them to his room, gave them a cup of tea. They asked me ‘What does it mean? When the hospital give you a cup of tea? That’s the end of the story, isn’t it? They gave us a cup of tea and washed their hands of us’. “So I said, ‘OK’, leave it with me, I rang the consultant and I sent the boy to Manchester Royal Hospital because they have a new cardiologist department, a children’s unit. I spoke to the consultant at 10.40 p.m., he was not very happy and I said, ‘this is the situation, can you help me?’ He said, ‘Send the boy tomorrow, don’t write a letter, just send the boy. I will look out for him and, they can do a cardiogram’. Then when I was on holiday I bought an English newspaper, The Telegraph, and it said the ‘youngest heart transplant in England – 14 year old boy’.” 104
Arup Banerjee achieved a great many things during his career in geriatrics, including being elected to President of the Geriatrics Society, receiving an OBE in 1996. However, what can be considered an achievement of note is where an individual uses a public appointment to further the progress of individuals who require someone to advocate on their behalf. He sat on the Clinical Excellence Awards committee for twelve years and has used his position to good effect: “I sat on the merit awards committee for about twelve years and the amount of lobbying you get! And then people say, ‘Oh alright he’s one of our chaps, you should try to pull some string’ but I say, ‘Sorry mate, no string pulling for me’. If the CV is good, if he’s done some good work, I shall support him but I’m not going to pull any string for somebody who’s not deserving. Sorry, no way, you can call me what you like, but I won’t do that, even for my children. I told my children when they became doctors, don’t expect daddy will pull strings because I don’t like that. You get better and then you’ll get something out of your own merits, that’s the way you should receive it, that’s the way I did it in my life, I didn’t have anybody to help me.” Shiv Pande, a retired GP from India, also had a great many achievements, setting up a thriving practice in Liverpool, working as a magistrate and getting involved in television programmes that helped to advise Asian community members, living in the North West of England, of their housing and other rights. He also, however, was instrumental in bringing the PLAB test to India as he was appalled at the pass rate of International Medical Graduates sitting the test in the UK: “Whatever I have done, I have tried to make the best use of the moment and the time which was available to me and contribute to society so that I don’t feel I have wasted my time in that respect. In 1994 when I became a member
JOB SATISFACTION AND ACHIEVEMENT of the General Medical Council, with the same spirit that I should contribute, I was able to start the PLAB test in India. Doctors were coming and the pass rates were only 30 per cent, that means that 70 per cent were failing, living in this country in harsh conditions, away from family, away from their profession, so why not do the examination in their country of origin? So I approached the chief executive and he said, ‘yes, we are quite happy to do it provided the different governments allow it’. So I approached the Indian government and was very happy that they welcomed my suggestion. So a two man delegation went to India, myself and the Chief Executive and started the PLAB test in India. And I’m happy to say after that, it has started in Pakistan, Sri Lanka, Bangladesh, Egypt, Nigeria, and many other countries.”
The benefits of working in the NHS Although not all interviewees had come to the UK specifically to work within the NHS, a large number of them considered it to be among one of the best health care systems in the world and therefore greatly appreciated being part of its workforce. Given that most of them had started their lives in other countries and some had even had the opportunity to work within other health care systems, these individuals were in a good position to reflect on the uniqueness of the NHS. There was a general feeling however that often having a free health service was very much taken for granted by those who used it as patients. Their positions as migrants to the country gave them a broader view of its advantages: “This is the best health service in the whole world. Recently I went to America for one week to see friends. I could not believe my eyes the way the American health service works. If you have no money or you are in a low income group, how can you survive your health problem? People in this country don’t realize how fortunate they are to have the National Health Service. It is a great service
and I hope it stays. For people with little money, it is great, the national health. It is much abused because it is all free, but it is still great.” – Ila Basu, GP Like Ila, Kailash Chand, had had the opportunity to travel and recognized the unique quality of the British health system. One of the reasons for coming to the UK therefore for him, aside from the wishes of his family, had been his wish to participate within the NHS as he had been instinctively drawn to its purpose: “In India, I had passionately believed and supported the NHS and saw that it was a unique service provided to everybody irrespective of ability to pay. It is needs based and I think there’s no good model anywhere else. I’ve travelled to various parts of the world and even though we always moan and groan, I still think that the NHS in my view is something to be proud of and that view I formed when I was in India. I wanted to see for myself what the system was and how the system delivers and I also believe that those dreams and ambition can be useful and relevant to the Indian democracy − to health, education. All those things were, and are important to me.” Kumar Kotegoankar, a GP in Bury has achieved a great deal since starting up his single-handed practice in 1980, becoming heavily involved in the training of new GPs and starting up the first single occupancy nursing home in the area. He feels that though he has achieved much, the part the NHS has played in his success has been significant: “The NHS has provided me a with unique opportunity to practise the science of medicine as an art and to have the satisfaction of being a doctor. We need to express a communal gratitude to the late Aneurin Bevan, for creating it and I am certain one should ask the question, what did the NHS do for you?” Dipankar Dutta and his wife had come to the UK to train initially and had actually made the journey back to India to seek work. They had found, however, the experience of 105
NURTURING THE NATION NHS system and the kind of quality and the organisation of the NHS, and we wanted to replicate that in India. We wanted to work in proper established hospitals in India and there weren’t many of them around at that time. There are now, the whole scene has changed a lot in the last ten years. But we weren’t really progressing much and weren’t really enjoying working there and we thought we might try coming back to the UK to see if we could work as consultants.” Karna Bardhan, a retired consultant gastroenterologist also recognized the benefits of working for the NHS and though he initially knew little about the health service, he quickly began to realize its strength as a system of health care given the backdrop for its development. He sees the strength of the NHS as being located specifically in its workforce, recognizing that those who were at the forefront of its initial development had come out of a very challenging historical period and had become pioneers of another historical moment: “Crucially these were people who had just survived a war and they had to make do as best as they could. And when you factor that in you realize that the reason why so much was accomplished by so few in Britain was because of the nature of these circumstances.” Anil Dutta reference letter
working as doctors in India difficult in comparison to the free health system that they had spent time training in and recognized the systems and structures of the NHS as strengths: “We stayed in India for a little over a year and we decided to come back. The reason for that was bad luck − when we got to India, the situation there wasn’t all that great from the point of view of jobs and career progression. My wife and I, both of us, we found that all we could do was private medicine and start a practice and things like that and we didn’t actually want that. We had got used to the 106
For some of the retirees, recognizing how much had changed didn’t affect their overall view of the importance of a free national health service. For Anil Dutta, who worked in the NHS during its very early years, the changes have been immense. Work during the 1950s was particularly hard and he acknowledges that work for doctors in the modern day NHS remains hard, but for different reasons: “In the 1950s medical knowledge had not advanced as it has today. Patient care was not such a hard task as it is today with rapid advances in technology. We did not have to stand by for cardiac arrest. We did not have the ICUs.
JOB SATISFACTION AND ACHIEVEMENT of Asian descent so enormous, as they bring a variety of experiences, skills and local knowledge to their work, that those trained in the UK simply do not have:
Social and historical changes – smoking in hospital
We had very few life support equipments. We did not have the difficult invasive bed side manoeuvres like central line insertions and various catheter-based procedures to carry out. We did not have endoscopes. Our long hours those days were exhausting but not so exacting. “Smoking was excessive in the 1950s. Almost every doctor and nurse smoked. Thoracic surgeons who cut off cancerous lungs smoked incessantly. I remember watching Mr Norman Barret at a lecture with a lighted cigarette between his lips. There is a great change now for the better. When we were young doctors in hospitals we used to drink too much. Frequent parties were held. “The NHS impressed me greatly. It must be a great blessing to be permanently relieved of the worries about the cost and availability of medical treatment, especially in emergencies. The state looked after its citizens from the cradle to the grave at a minimal − in those days − cost. How reassuring it must be to see everything done properly and promptly.”
The overall contribution of those of Asian descent Meher Pocha, a partly retired consultant paediatrician, felt that the knowledge she had acquired in India had proved of great help in her work. It is these sorts of skills, in her view, that make the contribution of those
“People who’ve trained in these countries, the knowledge base is much greater, I feel, because of the different education styles. An interesting example was when I was in Liverpool. This child came in and they said he had a convulsion. I took one look at this child and said, ‘he’s got tetanus’. You don’t see tetanus in this country that much so even I was a bit doubtful. I was covering somebody else and I phoned his consultant and said, ‘Would we admit a child with tetanus at the Alder Hey or would we send him to the infectious diseases hospital?’. So he said, ‘Do you mean tetany? Tetany is a lack of calcium’. I said, ‘I mean tetanus’, so he said, ‘I’ve never seen a case’ and I’m absolutely certain that if I hadn’t been there at that time, because it wasn’t my weekend really, it would have taken a lot longer to come to that diagnosis. But once you’ve seen a case, you know it. “This is why people who’ve trained in India or South East Asia, would have had a lot of clinical experience as well of a very wide variety of medical conditions, so they bring that both theoretical and practical knowledge of a very wide range of things. They’re also probably used to working absurd hours, I mean when I went to Liverpool they said it’s a very busy job − one in three days a busy job! So there’s the experience of having worked extremely hard in extremely difficult circumstances with relatively poor equipment, relatively poor access to investigations, you know, you knew the investigations but they were quite difficult to get and things like that, so that is invaluable.” Some of the greatest contributions to the NHS were made by those who worked in the areas of medicine shunned by British born doctors. Geriatrics was one such area, and in view of the reluctance of British doctors to work 107
NURTURING THE NATION within it, by 1974 60 per cent of geriatric consultants were born overseas. In the early days of the NHS, older and chronically ill patients were left in the long stay wards of large hospitals, confined to bed often without seeing a doctor for endless periods of time. Many of the interviewees either worked within geriatrics or knew others who had done so. These people, such as Satinder Lal, were instrumental in changing some of these practices: “When I took on the post of Consultant Physician in 1964, I was also to share the care of 300 geriatric beds with the other two physicians. Therefore, 100 of these became my responsibility. I had little interest in the subject. I used to go to say hello to the patients, have a cup of tea with the sisters and come home as I had no specific training in the care of these type of patients. This was so not just in Bury but also in Bolton, Wigan and elsewhere. Geriatric beds were used as a dumping ground for people they couldn’t help, mostly patients with long-term illnesses. I tried to persuade my geriatrics colleagues to go on a rota with us but failed. “Finally, we appointed a Consultant Geriatrician, and he was able to say to the physicians, ‘My beds are not a dumping ground for patients you do not want to manage, you will need to learn to manage or not to accept them in the first instance’. It was difficult for that generation but we did a lot of good work for the region and got geriatrics recognized.” Finally it is important to note that each of the interviewees and indeed all of those of Asian descent who were either international medical graduates, migrant children or children of migrants, have had their own part to play in the building of the NHS. Not only do they recognize the sacrifices made by others like them working in the NHS but acknowledge what they themselves have been instrumental in succeeding:
I think Asian people have been the backbone of the NHS and without them it would have collapsed, not only because of the numbers of them but the quality of work they provide.
I “think we have contributed enormously. Looking at doctors and dentists, they filled a big gap in the NHS. Their grandchildren have grown up to be doctors, academics and regional and national medical experts. They have contributed a lot and we have come a long way. Rashmikant Shah
I think the Asian community’s contributed a huge amount, like with the African-Caribbean community mainly with the nurses. The nurses came to this country and provided the backbone of the nursing in the NHS. I think the Asian doctors from India and Pakistan provided the backbone for NHS medical services and doctors, perhaps not in the higher level as consultants in hospitals but at the level of General Practitioners especially. Ramesh Naik
JOB SATISFACTION AND ACHIEVEMENT
Albert Persaud meeting Jesse Jackson
The health service was built on the backbone of migrants. Without the Commonwealth Britain would never have won the war. My grandfather died fighting for this country but had never been here. Likewise the commonwealth migrants did not audition to come here but we helped to build the National Health Service. We are not just the backbone of the Service, the NHS is the backbone of us. It is us who took the strain.
NURTURING THE NATION
6 The Modern Day NHS © James Stringer
Equality legislation has played a key role in promoting equality and diversity, and combating discriminatory practices. There have been many individuals who have championed the cause of diversity, sometimes at some risk to themselves. Professor Bhupinder Sandhu, Consultant Paediatrician & Gastroenterologist, Former Chair of BMA Equal Opportunities Committee
Department of Health, Richmond House
Bhupinder and family
THE MODERN DAY NHS The NHS has undergone a number of changes since those first groups of hopeful Asian doctors and nurses arrived in the UK. Given the nature of the experiences of these early arrivals, their commitment to unpopular areas of medicine and to serve patients in deprived inner city and rural communities, the NHS has engaged in various initiatives to address inequalities within its labour force. This chapter will look at some of these changes and initiatives and hear from some of the key individuals working in the areas of health, ethnicity and workforce development − individuals such as Dr Rafik Taibjee, Chair of the British Medical Association Equality and Diversity Committee; Professor Iqbal Singh, Chair of the General Medical Council Equality & Diversity Committee; Sir Keith Pearson, Chair of the Healthcare Education England; and Dean Royles, Chief Executive, NHS Employers. We will also include the views of former staff members Surinder Sharma, previously the National Director of Equality and Human Rights and Harbhajan Brar, previously Director of Human Resources, both of whom worked at the Department of Health, as well as Professor Bhupinder Sandhu, former Chair of the BMA Equal Opportunities Committee. The chapter will also reflect on the views of the young NHS, the trainee and junior doctors and those already becoming experts in their field, some of whom are the children of individuals we interviewed for this book. They are the generation of health service workers that those we interviewed carved the way for when they first arrived in the hospitals, general practices and dental surgeries of the new NHS and it is pertinent that we close this collection of stories with their contributions.
Minority ethnic groups in the NHS today The NHS is one of the largest employers in the world, employing up to 1.3 million people. Current estimates suggest that minority ethnic employees make up 30 per
NHS Employers Stand
cent of the NHS workforce, and 17 per cent of clinicians are from a minority ethnic background. Given that in 2011, 14 per cent of the population in England and Wales were black and minority ethnic, the NHS workforce, particularly at the level of clinical practice, is extremely ethnically diverse. Those currently registered to practise as doctors in the UK continue to be made up of individuals who have qualified abroad. In 2010 just 10 per cent of all doctors registered with the General Medical Council qualified in India, followed by 3.6 per cent qualifying in Pakistan. Latest figures suggest that a third of doctors in the UK qualified outside of it. If we look at the picture of those who qualified both here and abroad in 2010, almost 12 per cent of registered doctors were Indian, 3.8 per cent were Pakistani and 1.6 per cent were Chinese. Only 37 per cent of doctors registered to practise in the UK were White British, and just 64 per cent of practising doctors conducted their initial medical training in the UK. The background of those achieving the status of Consultant has also changed dramatically since the early 1960s. Between 1964 and 1991, 81.5 per cent of all consultants appointed during that period were White and had trained in the UK and 9.1 per cent were non-White and had trained abroad. Between 1992 and 2001, however, the number of consultants who were non-White and had completed their training abroad had risen to 14.1 per cent. Though the participation 111
NURTURING THE NATION rates of overseas doctors in the NHS have been high, these individuals have not been evenly spread across all specialities and the picture at the level of senior executive is uneven. However the increasing numbers of those of Asian heritage who continue to choose the NHS as their employer, combined with the range of initiatives to address improving equality for all across the service, point to positive developments for the future. There have also been changes in the types of countries that overseas born NHS workers now come from. The changes to the nursing workforce in this regard are particularly telling. In 2001/2 the nursing and midwifery workforce experienced a large surge in non-EU overseas born nurses seeking registration with 15,064 joining the register, compared to approximately 8,400 in the previous year. Out of these internationally recruited nurses, the vast majority have been of Filipino or Indian descent – in 2001 7235 nurses born in the Philippines were registered to work in the UK and 289 were recruited from India. At about this time, the UK published the NHS Code for International Recruitment, which provided guidance on the ethical recruitment of individuals from particular countries outside the EU. In order to prevent a shortage of qualified medical staff in these countries and to stem the ‘brain drain’ to the UK, this list of countries from which recruitment should not occur included South Africa and the Caribbean which certainly had an impact on the lower numbers of nurses from those countries on the Nursing and Midwifery Council register. This compares with the post-war and early 1960s picture. Large numbers of nurses born in the Caribbean worked in the NHS during the early life of the NHS providing at that time much needed labour throughout the health service. The numbers of individuals coming to the UK from India, tended at that time to reflect the links between Britain and the Indian Medical Colleges, which meant that Indian NHS recruits were more likely to be doctors than 112
Scientific research – Asian female NHS staff work across a variety of fields
nurses. Thousands of other nurses between 2002 and 2006 have come from a broader spread of countries including South Africa, Nigeria, Zimbabwe, Pakistan, Australia and New Zealand. Indeed the numbers of nurses on the NMC register who are Indian born remains the highest of all non-EU international nurses. NHS doctors have also been recruited from France and Germany, often working in the UK as locums providing care on an out-of hours basis, or carrying out NHS procedures within private health care institutions. The numbers of new recruits from overseas, certainly from outside of Europe, is however likely to dwindle over coming years. A new permanent limit on the numbers of people who were born or live outside of the EEA (European Economic Area) who want to come to the UK
THE MODERN DAY NHS to work or study was announced by the UK Government in late 2010. The different routes into the UK taken by many of those we interviewed for this book were drastically reduced in 2008. Historically there have been approximately 80 different ways of coming into the UK to work or study. This has now been reduced to just five. There are also likely to be a number of further changes to immigration rules over coming months. And whilst the numbers of nurses recruited from the Philippines may have been high during the early 2000s, these figures have dwindled due to the recruitment freezes and funding crises occurring across the public sector. Just under 250 Filipino nurses entered the nursing and midwifery register in 2008 compared to just over 7000 at the end of 2001. It has been suggested that this has resulted in many overseas trained nurses being unable to find work. It is indeed true that the NHS relies less now on recruiting from those parts of the Commonwealth than it did in the years when our interviewees made their journeys. Yet ironically there are still Trusts and specialist areas of medicine with job vacancies that remain difficult to fill.
Evidence of progress The participation of individuals of Asian descent in the NHS continues, however, to grow. Tighter immigration controls are indeed likely to affect the numbers of current International Medical Graduates who are able to make the journey to come and work within the NHS. However, the children and grandchildren of those initial trailblazers are making their own journeys into the NHS. Britishborn Asian students are currently over-represented in British medical schools − in 2003 over 30 per cent of those entering medical school were from Black and minority ethnic backgrounds and two-thirds of these students were of Asian origin. Asian students also face an equal chance to White students of getting a place at a medical, pharmacy or dental school and overall 73 per cent of Asian applicants will be successful.
Within the workforce itself, there have been encouraging improvements − in 2004, 7.5 per cent of executive directors were from Black and Minority Ethnic groups which compares with 6.3 per cent in June 2003. More significantly, 5.1 per cent of NHS Executive Directors were Asian with the largest proportion (at 22 per cent) to be found in the North East London Strategic Health Authority, followed by Birmingham at 12 per cent. Currently around 30 per cent of clinicians in the NHS are from BME backgrounds.
New developments Breaking Through In 2003 the NHS launched its Breaking Through programme, in order to promote race equality and assist with implementing the Race Relations (Amendment) Act which was brought into force in 2001. Importantly this policy aimed to encourage black and minority ethnic NHS workers into senior positions within the NHS and involves mentoring and leadership programmes. A study commissioned by the Royal College of Nursing in 2008 examined the experiences of nurses from black and minority ethnic backgrounds who had participated in the Breaking Through programme. Nurses in that particular study who had progressed to managerial or supervisory levels talked about the difficulty in having their new positions, or potential for promotion, accepted by other colleagues, suggesting that there is some work to be done around support mechanisms for high achieving nurses. However programmes such as Breaking Through provide useful opportunities for mentoring which is always important for aspiring staff.
The Equality and Diversity Council In 2009 the Department of Health set up the Equality and Diversity Council (EDC), a sub-committee of the NHS Management Board chaired by Sir David Nicholson, the 113
NURTURING THE NATION then Chief Executive of the NHS. The council was created to have a strategic overview of equality and diversity across the National Health Service. The Department is committed to reducing discrimination and inequalities for both its workforce and patients. The EDC includes representatives from across the NHS, trade unions, patient groups and the voluntary sector, all of whom are committed to issues of equality and can ensure that the aims of the Council are enforced through their own networks. Importantly the council worked closely with the Equality and Human Rights Commission and NHS Employers to develop the Equality Delivery System providing a national package of tools and guidance to support NHS organisations to meet the requirements of the public sector Equality Duty included within the 2010 Equality Act.
NHS Employers NHS Employers runs an Equality and Diversity Team which provides advice and guidance to individual Trusts and shares the good practice that differing NHS organisations are engaging in. The team represents the views of these organisations on the full range of Equality and Diversity issues. The Equality and Diversity pages on the NHS Employers website provide advice and guidance on subjects as diverse as Dress Codes and Discrimination to a Diversity Calendar, and are fully informative.
Professor Carol Baxter is Head of Equality, Diversity and Human Rights at NHS Employers. Featured in the book Many Rivers to Cross (Kramer, 2006), Professor Baxter has noted that “The NHS is about caring and those who care must be given every support and opportunity to fulfil their potential. NHS Employers works hard supporting NHS organisations
as places where all staff, whatever their differences, feel valued and have a fair and equitable quality of working life, where we accept the difference between individuals and value the benefits that diversity brings”.
NHS Confederation BME Leadership Forum NHS Employers are part of the NHS Confederation which is the independent membership body for all NHS organisations. The Confederation itself runs a BME Leadership Forum which was founded in 2003 to increase the leadership opportunities for individuals from BME backgrounds and to ensure the NHS could respond well to the needs of those from BME communities. One of the key aims of the forum is to promote race equality within the NHS both with regards to health and social care policy work and in the support for aspirant BME leaders within the health service. The forum is jointly hosted by the NHS Confederation and the Royal College of Nurses (RCN) and staff from across a number of bodies including the RCN, the NHS Confederation and NHS Employers are members of the forum’s steering group.
The General Medical Council and the British Medical Association The particular experiences of Asian doctors in the early decades of the National Health Service have certainly influenced the direction that policy on race and equality has taken within the General Medical Council, the British Medical Association and the Department of Health. Research has noted that overseas born Asian doctors are more likely to be placed in front of a GMC complaints committee. This has led to movements within the GMC to ensure that the complaints panels are more ethnically representative. The Clinical Excellence Awards which reward doctors for achievements within their profession, have often been criticized for a lack of transparency behind the decisions made and the doctors chosen. Asian
THE MODERN DAY NHS doctors are also less likely to achieve awards at the Gold level, though do so at the level of Bronze and Silver. In light of this, the GMC and the Department of Health are working to reform the way that awards are given. Iqbal Singh is Chair of the GMC Equality & Diversity Committee and is also a Consultant Physician in Medicine for the Elderly. He also sits as Medical Vice Chair of the Committee on Clinical Excellence Awards for the North West and was previously a Commissioner for the Healthcare Commission. He notes that Iqbal Singh important work has occurred within the General Medical Council with regard to promoting equality and diversity: “Initiatives on equality and diversity have made it possible and ensured that Asian doctors have been able to make a key and significant contribution to health care across all specialities and in all areas of clinical, educational and regulatory practice. Some of the key successes for the General Medical Council include the abolition of limited registration, the ability for staff and associate specialists to get onto the specialist register through Article 14 and overall an improvement in the PLAB test. The GMC’s understanding and commitment to valuing diversity is also reflected by the success of the BME Doctor’s Forum and the need to address issues of equality and diversity by joint working and the sharing of information through the Diversity Partners Forum. The GMC is committed to ensuring the diversity of Fitness to Practise panels thereby increasing stakeholder confidence. The grant of entry to the specialist register for some doctors and staff and associate specialist grades has enabled these doctors to progress in their careers and lead, develop and deliver health services as consultants in various specialities.
Figures and data from the Advisory Committee on Clinical Excellence Awards show improved outcomes and greater numbers of BME doctors being successful at the bronze and silver levels. The decision-making groups and the regional sub-committees now reflect the diversity of the medical workforce. The work of the NHS Appointments Commission in terms of health care is laudable and this is reflected in the greater number and diversity of the nonexecutive members and chairs on the NHS boards.” Dr Rafik Taibjee is Chair of the BMA Equal Opportunities Committee and is also GP Principal at Merton Medical Practice, CoChair of GLADD (Gay and Lesbian Association of Doctors and Dentists) and Programme Director of Kings College GP Training Scheme. He notes how important having a diverse workforce has Rafik Taibjee been to the NHS though recognises that more work still needs to occur in securing recruitment progression opportunities for staff of Asian descent: “It is clear that we still have significant issues in Asian staff reaching the top of their professions, and that Asian doctors have less chance of being shortlisted for a job vacancy, when compared with White British Doctors, as demonstrated by Everington and Esmail’s research. We know that Asian doctors sometimes, but by no means always, perform less well at clinical examinations. The NHS needs to support any doctor at risk of failure to help them pass their clinical exams – all doctors have the raw ingredients of caring and intelligence that should be able to be shaped into producing a good doctor.” Professor Bhupinder Sandhu, Consultant Paediatrician and Gastroenterologist at the Bristol Royal Hospital for Children and former Chair of the BMA Equal Opportunities Committee agrees, noting: 115
NURTURING THE NATION “We have made massive advances, but we still have some way to go to reach racial equality. As for equality and diversity, the NHS should aim to be a beacon of excellent practice. We all need to work hard to make sure this happens. “Individuals of Asian descent have made significant national and international contributions in their chosen specialist fields, disproportionate to our numbers in academic medicine. We have contributed to the recognition of equality and diversity issues in the NHS, and combated the worst excesses of discrimination for our colleagues and patients.”
Marking Asian contributions to the National Health Service This book has highlighted the enormous sacrifices and compromises made by those who came to the UK with hopes of training as SRNs, as surgeons or consultants, but who found their attempts to do so tempered by a set of assumptions about their abilities or their language difficulties. However Asian doctors and nurses came and remained. Those working in ‘Cinderella’ specialties such as geriatrics and psychiatry, or in general practice in deprived parts of Britain carved out careers for themselves and as a result, along with the Caribbean nurses and auxiliaries, formed the ‘backbone’ of the NHS. Acknowledging their commitment to the health service, in the face of clear difficulty, is vitally important. Surinder Sharma who was National Director of Equality and Human Rights at the Department of Health between 2004-2012, suggests that the contribution of those of Asian descent has been immense, not only with regard to the labour gaps they filled in the early decades of the NHS, but also in view of the cultural impact Asian employees have had on the places and people they have been in contact with over time: 116
“The Asian contribution professionally has been huge, but also I think socially and culturally it’s been huge as well. If you look at areas like Devon or Cornwall, or other areas of Wales which were under-served, the gaps have been plugged by doctors from South Asia or qualified South Asian doctors from the UK. The same Surinder Sharma with nursing, but also culturally it’s uplifted those areas; it’s brought a different culture, different ways, and different people into those areas, which wouldn’t have been seen. It hasn’t just been the big cities where these Asian doctors are, they’re in all sorts of areas. In terms of contribution they’ve made Britain a diverse country.” Asian doctors have also, in Surinder’s view, been at the forefront of innovation with regard not only to new technologies, but also those ‘Cinderella’ specialisms that other doctors wanted to avoid: “In new areas, like geriatrics, the Asian contribution has been enormous, because those areas weren’t specialisms in their own right originally. Huge contributions were made in new areas of medicine, new areas of care and leading edge thinking. Also look at some of the chairs of the Royal Colleges, and the contribution they’ve made, both to the BMA and the GMC, and internationally. I mean Lord Darzi, who became a minister at the end made new discoveries in terms of new ways of working with keyhole surgery and the whole use of robotics in care. So really the contribution has been enormous.” Harbhajan Brar was Director of Human Resources at the Department of Health between 2007 and 2011, and has worked for over 23 years in the field. He also sees the contribution of Asian staff, both historically and in the future, of great importance, noting that:
THE MODERN DAY NHS “People of Asian descent have contributed in every sphere of the NHS from its inception − from porters to cleaners, from nurses to matrons to midwives through to doctors and consultants. They have and will continue to be an integral part in the development of the NHS. The role of Asian staff is no different to any other member of staff, in that they are an integral part of the team that serves the best interests of patients. A diverse workforce can help to achieve a better understanding of health inequalities, as they bring with them a particular perspective/knowledge that helps to better understand a patient’s needs.” Sir Keith Pearson is Chair of Health Eduction England and was formerly Chair of the NHS Confederation. He has worked within the health care sector for over 30 years and prior to his work with the NHS, Keith worked in the private sector, as Chief Executive of BUPA, working also in Hong Kong, Thailand and Singapore. He Sir Keith Pearson believes that the full contribution of those of Asian descent to the NHS can be traced back historically to the legacy of those who came and worked in the UK even before the NHS was established: “People of Asian descent have been contributing to British medicine and health care since before the NHS was created. Frederick Ackbar Mahomed, who was only 35 years old when he died in 1884, is only now recognized for his contribution to the understanding of essential hypertension and was instrumental in developing the collective investigation record. And Dr Chuni
The Royal College of Surgeons
Lal Katial, who died in 1978, was the driving force behind the creation of Finsbury Health Centre.” Indeed, some of the more recent medical pioneers of minority ethnic descent have received much swifter recognition, including the eminent surgeons Professor Ajay Kakkar and Professor Ara Darzi, both of whom have been elevated to the House of Lords. Lord Kakkar is Professor of Surgery at University College London and Lord Darzi is Professor of Surgery at Imperial College London, and was a Government Minister in the House of Lords from 2007–2009. In agreement with the view previously highlighted by Surinder Sharma, Sir Pearson also suggests that the areas Asian staff have worked in have often been those shunned by others:
Frederick Ackbar Mahomed
“Staff of Asian descent have played a key role in supporting the health service and improving the health of patients and the public since the NHS was created in 1948. Many clinical staff of Asian descent have chosen to work in challenging specialties within the health service and 117
NURTURING THE NATION have delivered care and support for patients through their roles as nurses, paramedics, other healthcare professional roles, cleaners, porters, and other support staff to the NHS. In total 6.6 per cent of staff in the NHS are of Asian descent, including 26 per cent of medical staff, 30 per cent of doctors and 5 per cent of staff from non-medical backgrounds. “In the modern NHS, people of Asian descent are also shaping and influencing policy at the highest level, with serving Chief Executives of Asian descent and senior civil servants within the Department of Health. Staff of Asian descent have made a huge contribution to the NHS, and we must make sure that talented staff from Asian backgrounds regularly make the leap into senior roles within the health service.” Dean Royles is Chief Executive of NHS Employers having previously worked as Director of Workforce and Education at NHS North West and as Director of Human Resources and Communications at United Lincolnshire Hospitals NHS Trust. He fully believes that the lasting contribution of those of Asian decent to the NHS has been Dean Royles enormous reflecting on their historical presence as members of staff throughout the decades: “Just as the NHS has relied on Caribbean workers from the beginning, it has also relied on a constant and steady stream of professionals from the Asian sub continent. This reliance has had social, economic and cultural benefits for the NHS and the wider economy and has underpinned a rich and fruitful relationship between the UK and India and Pakistan and other Asian countries. Currently around seven per cent of the NHS workforce – over 90,000 staff – describe themselves as Asian or Asian British.” 118
Some of the greatest impact he believes has been on those receiving care within the health service: “The economic relationship between the UK and Asia has included a regular migration flow between the two regions. This means that many NHS patients come from Asia and inevitably welcome how their care is being provided by a diverse workforce. The additional benefit of this exchange is that the Asian doctors and nurses bring new ideas and different perspectives into the workplace and contribute to its continuous improvement.” This is a view shared by others who can see how important having a diverse workforce can be for those from diverse backgrounds and not simply with regards to the sense of safety or familiarity that this may engender as Rafik Taibjee, Chair of the BMA Equal Opportunities Committee, notes: “People of Asian descent can often understand first-hand the journeys, experiences, trials and tribulations that our patients face, putting them in a powerful place to empathise and serve their needs. “Whilst using translators is of course helpful, being able to talk to patients in their first language certainly improves care, as does having an understanding of cultural nuances. I remember seeing an Indian patient with respiratory problems, and the Indian nurse in my team wondering if it related to making chapattis, and it turned out this diagnosis was spot-on!” Iqbal Singh from the GMC also sees the contribution of Asian staff to the NHS as integral to its success: “The NHS owes an everlasting debt of gratitude to Asian doctors who have been the backbone and have helped to build the NHS, delivering care in areas that have been hard to reach and working in ‘Cinderella’ specialties where
THE MODERN DAY NHS it was difficult to attract local graduates. The NHS will always be grateful to this group of doctors for the care provided to patients in these vulnerable groups. “Asian doctors have made a huge and significant contribution to all aspects of delivery of health care in the UK − GMC data and anecdotal evidence show high patient satisfaction rates with Asian doctors. Their contributions to the care of older people and to people with mental illnesses are hugely significant where Asian doctors as geriatricians and psychiatrists have made an important difference to the policy, strategy and delivery of care, improving access and helping to address inequalities.”
The modern NHS Some of the interviewees spoken to for this book commented on how important it was to give something back to their communities or to go that extra mile − spending time on research or getting involved voluntarily in organisations set up to support other Asian medics. Ensuring a good future for younger NHS employees clearly forms part of these opinions and importantly these sentiments are also shared by younger up-andcoming NHS professionals. Those just embarking on medical careers or who have begun to build emerging reputations for themselves within the NHS are those for whom individuals such as Ramesh Mehta, founding president of BAPIO, or Shiv Pande, former Chairman of BIDA, have worked hard, paving the way so that younger Asian doctors would not have similar experiences. It is useful therefore to take some time to reflect on what younger doctors feel have been the benefit to them of the historical contributions of their parents, grandparents and those who came to the UK before them. We spoke to the children of two of our interviewees – Aditi Shah, daughter of Rashmikant, and Uma Basu, daughter of Ila and also consulted three other young and upcoming Asian medics – Yasmin Heerah, GP; Harpreet Sood, Foundation Doctor; and Sripurna Basu, Junior Doctor.
Uma Basu, Foundation Doctor
Yasmin Heerah, GP
Kiran Patel, 41, featured within this book and founder of the South Asian Health Foundation, urges younger doctors to be aware of the contribution of first generation Asian doctors and nurses. He suggests that younger Asian doctors should: “Give something back. Don’t just rest on your laurels, give something back because I think that makes your work rewarding. Young Asian medics mustn’t forget what your fathers and colleagues went through in order for you to be able to be where you are. I think when you start thinking along those lines you start to be on a wavelength which opens so many conversations, opportunities and experiences, it’s almost unbelievable.” Giving back is certainly an issue which resonates with younger Asian medics, but is not restricted to them. Ramesh Mehta talked openly about wanting to establish ways of enabling those of Asian descent to be able to give back to their communities back in India. Ila Basu regularly sends money for philanthropic work back to India.Her daughter, Uma Basu, recognized that this is what her parents are doing: “My parents are both GPs and they send quite a lot of money back home to India for hospitals and schools, just because they say that they feel guilty that they were never 119
NURTURING THE NATION able to serve the people of their country. They do send a lot of money back home.” Yasmin Heerah, a young GP, considers this wish to give back as intrinsic to the way overseas-born Asian health workers see their roles: “It’s probably part of the culture or the nature of Asian culture that you give back to your community and to your forefathers.” Other young doctors, like Harpeet Sood, a Foundation Doctor, are clearly impressed by this process of gift-giving, seeing it as a legacy from those who came over in the very early years, who had always wanted to return, but in failing to do so, make their contributions to their home countries in other ways: “Sometimes they go back and do some training and to teach people over there, or go back and do 50 operations in two weeks! It’s because they have the skills to do that and because they’re so well trained here and they have so much exposure to the Royal Colleges, and in India they don’t have that. “One of my mentors is a lead in surgery. He makes a lot of money and half of it he sends back to India, on medical camps, projects − he supports a medical college out there and you think, hopefully I can do that, if I’m that successful. I think it’s amazing. Aditi Shah, a young GP notes that the altruism showm by Asian medically trained individuals is not restricted to sharing their skills in their countries of birth but is also demonstrated by wrok they do closer to home. “My uncle is an Ophthalmologist and goes back to India and does eye camps. There’s a team of people from the UK who go, not just Asian people but other people who he works with and would like to get involved in projects. There are many Asian people who work in the NHS 120
but also give back to their own communities. So for example in Barnet there’s a Cardiologist who does health promotion activities at religious and cultural events. My father in law who is a retired biochemist, organises health melas (gatherings) where they bring together the entire multidisciplinary team of medics, Aditi Shah, GP nurses, biochemists, pharmacists and have an annual event where they invite the entire community to have a health check done. I think that’s the nice thing about Asian culture, that people try to help the entire community.” Although, in acknowledging the philanthropic spirit these various family members and colleagues demonstrated, it was also pointed out that some of the older Asian doctors had found themselves in positions which were quite difficult to keep. It would have been quite difficult therefore for them to give as much or as regularly as these admittedly younger medics. As Sripurna Basu, Junior Doctor and BAMA member notes: “I think a lot of the older generation had the aspiration to do charity work in India, but a lot of them didn’t feel secure in their jobs to leave their work for a year or six months and go back to India or Pakistan and work there and come back. Recently I found with the Pakistan flood, we had a registrar who is from Pakistan and he went back for a couple of months and he was able to take that time off work to do that and then come back whereas I don’t think in my parents’ generation, they would have been able to do that. Or to feel confident enough to make those kind of decisions or to be able to go abroad and then come back here and carry on with their training. So I think there’s more opportunity now and I think there’s more confidence among people who are able to do these things.”
THE MODERN DAY NHS Younger doctors are also aware that many first generation Asian medics found themselves working in historically unpopular areas of medicine such as geriatrics, or located in isolated rural or inner city hospitals or GP surgeries. They saw this as no longer an issue for young Asian doctors, suggesting that areas of medicine such as surgery, were now populated by large numbers of Asian students. However, the difference between the paths taken by early Asian doctors then and younger doctors now is that those within the modern NHS have more of a choice. Older first generation doctors found themselves pushed into particular areas of medicine or more deprived local areas. Younger doctors on the other hand feel that choosing to go into certain areas which serve large minority ethnic populations, both in relation to medicine as well as geographically, can only be a good thing.
round goodwill that enable the full and wide contribution of Asian NHS workers to be celebrated. This book, and the testimonies within it, have gone some way to ensuring that those celebrations incorporate the real, lived experiences of those who paved the way for the modern day Asian medic. It’s therefore pertinent to end with the view of one of those working within the modern NHS on the overall impact of those who came before them:
I think that the Asian community certainly kept the NHS going. They’ve formed such a huge workforce and without the workforce, it wouldn’t be as it is today. They just formed the backbone really with their dedication and hard work. Yasmin Heerah, GP
As Aditi Shah suggests: “I think that people’s culture plays a part and so there is an affinity for some people to work in specialities such as Diabetology and Cardiology as these diseases are prevalent amongst Asian people. It may also be just personal experience. If your family includes somebody with severe diabetes, or someone who has had a heart attack, you may want to give back to the NHS in that way. Certainly population based activities and health promotion, are done more and more by GPs working in communities and with ethnic minority populations. This is an important role for GPs and Asian doctors have the advantage of being able to communicate health promotion and health prevention messages to patients in their own language, an important skill within an increasingly diverse UK population.” These legacies demonstrate the overall historical Asian contribution to the NHS for the young medics following close on their heels. It is this, together with the growing number of initiatives, changed ways of working, and all-
Providing support for patients
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List of interviewees Name
Country of birth
Area worked in
Associate Specialist in Urology
Team Leader, Community Health Team for older adults
Rai Mohan Baishnab
Consultant Physician, geriatrician (retired)
Karna Dev Bardhan
Consultant Physician and Gastroenterologist (retired)
Senior lecturer in midwifery
Social worker (retired)
Voon Cheng Chan
Bernard De Sousa
Consultant Surgeon (retired)
Anil Kumar Dutta
Consultant Physician (retired)
Slough & India
LIST OF INTERVIEWEES Dipankar Dutta
Consultant Physician, Old Age Medicine
Nurse, Care coordinator (retired)
Consultant in old age psychiatry
Muhammad Yunus Khan
Spiritual and cultural care coordinator
Consultant Physician, respiratory medicine (retired)
Consultant & Lead Paediatrician
Antony Ajay Pall Narula
Director & Founder of the Centre for Applied Research & Evaluation (retired)
NURTURING THE NATION
Consultant Paediatrician (partly retired)
Muslim Women’s Chaplain
Bilingual Speech Therapist
Lead Nurse and Manager, Gynaecology (retired)
Country of birth
Birthplace of parents
Area working in
Trainee Junior Doctor
India and Uganda
List of ABBREVIATIONS BAMA
British Asian Medical Association
British Association of Physicians of Indian Origin
British International Doctors’ Association (formerly ODA)
British Medical Association
British Medical Journal
General Certificate of Secondary Education
General Medical Council
Fellow of the European Committee on Sexual Medicine
International Medical Graduate
Local Medical Committee
Multidisciplinary Joint Committee of Sexual Medicine
Primary Care Trust
Professional and Linguistic Assessment Board
State Enrolled Nurse (Pupil Nurse)
State Registered Nurse
Senior House Officer
Overseas Doctors’ Association
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REFERENCES AND SOURCES BOOKs AND ARTICLES Kate Blackman (2011) “Equality and Diversity: Exploring perceptions through the NHS staff survey”, paper presented at the UK Social Policy Association Conference, July, http://www.socialpolicy.org.uk/lincoln2011/Blackman%20P5.pdf Joanna Bornat, Leroi Henry and Parvati Raghuram (2009) “Don’t Mix Race with the Specialty: Interviewing South Asian Overseastrained Geriatricians”, Oral History, Spring: 74-84. James Buchan (2002) “International recruitment of nurses: United Kingdom case study”, Queen Mary University College, http://eresearch. qmu.ac.uk/18/1/JBreport.pdf Sukhwant Dhaliwal and Sonia McKay (2008) The Work-Life Experiences of Black Nurses in the UK: A Report for the Royal College of Nursing, RCN. Aneez Esmail (2007), “Asian doctors in the NHS: service and betrayal”, British Journal of General Practice, October: 827–834. Mel Gorman (1988) “Introduction of Western Science into Colonial India: Role of the Calcutta Medical College”, Proceedings of the American Philosophical Society, 132(3): 276–298. Randall Hansen (2000) Citizenship and Immigration in Post-war Britain: The Institutional Origins of a Multicultural Nation. Oxford: Oxford University Press Roger Jeffrey (1979) “Recognizing India’s doctors: The Institutionalization of Medical Dependency, 1918-1939”, Modern Asian Studies, 13(2): 301–326. Emma J. Jones and Stephanie J. Snow (2010) Against the Odds: Black and Minority Ethnic Clinicians and Manchester, 1948 to 2009, Manchester NHS Primary Care Trust and University of Manchester. Ann Kramer (2006) Many Rivers to Cross: The History of the Caribbean Contribution to the NHS. London: Department of Health. David J Smith, (1980). Overseas Doctors in the National Health Service. London: Policy Studies Institute. Stephanie Snow and Emma Jones (2011) “Immigration and the National Health Service: putting history to the forefront”, History and Policy, http://www.historyandpolicy.org/papers/policypaper-118.html
Donald H Taylor Jr and Aneez Esmail (1999) “Retrospective Analysis of Census Data on General Practitioners who Qualified in South Asia: Who Will Replace Them as They Retire?” British Medical Journal, 30 January. Ansar Ahmed Ullah and John Eversley (2010) Bengalis in London’s East End. London: Swadhinata Trust.
Other Materials I for India (2005) Documentary about Yash and Sheel Suri who in 1966 leave India for a temporary stay in England, with Yash working as a doctor. He buys projectors, tape recorders, and movie cameras, and sends one set to India beginning a 40-year exchange of tapes and Super 8 movies between his family in India and his household near Manchester. Director: Sandhya Suri. Overseas trained South Asian Geriatricians interviews, (British Library collection ref. C1356) 60 interviews with South Asian geriatricians carried out by Joanna Bornat, Leroi Henry and Parvati Raghuram for an Open University project. The audios and transcripts from this project are archived at the British Library for public use Eastside Community Heritage produced a video documentary and touring mini exhibition on the life and work of Dr Bala Prasad, a GP born in India who ran a surgery in Barking, together with a local pharmacy and for some time during the 1940s was the only nonwhite doctor in the area: www.hidden-histories.org.uk From Raj to the Rhondda: Asian Doctors in the NHS, a film by the BBC, 2003. The Indian Doctor, a television series by the BBC, 2011.
REFERENCES AND SOURCES
Websites Connecting Histories: www.connectinghistories.org.uk Exploring 20th Century London: www.20thcenturylondon.org.uk Migrant Health Workers in the NHS: www.migranthealthworkers.org.uk/ Moving Here: www.movinghere.org.uk NHS BME Network www.nhsbmenetwork.org.uk/ NHS Confederation BME Leadership Forum: www.nhsconfed.org/Networks/bme/Pages/BME-leadership-forum. aspx NHS Employers, Equality and Diversity: www.nhsemployers.org/EmploymentPolicyAndPractice/ EqualityAndDiversity/Pages/Home.aspx Striking Women: www.leeds.ac.uk/strikingwomen/gategourmet/chronology Swadhinata Trust: www.swadhinata.org.uk Through My Eyes: Stories of Conflict, Belonging and Identity: www.throughmyeyes.org.uk
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Acknowledgements A great deal of support and time was put in by a variety of individuals and groups in order to assist with the materials, information and interviews used for this book and we would very much like to thank all of the following: to our stakeholders, Denise Linay, Royal College of Midwives; Dr Leroi Henry, and Professor Joanna Bornat, Open University; Dr Sripurna Basu, British Asian Medical Association; Dr Emma Jones and Dr Stephanie Snow, University of Manchester; Dr Shiv Pande, MBE, British International Doctors’ Association; Manjit Bedi, Society of Chiropodists and Podiatrists; Buddhdev Pandya MBE, British Association of Physicians of Indian Origin and Professor Bhupinder Sandhu, British Medical Association. We would also like to thank the following organizations and networks: the British Medical Association, British Asian Medical Association, British Association of Physicians of Indian Origin, British Indian Doctors’ Association, British Dental Association, Royal College of Physicians, Improving Health Project, Enfield Racial Equality Council, Equality and Diversity Team at NHS North West, the Health Service Journal, BMA News, East Finchley Library, Small Heath Library, Aston Library, Manchester Library and Information Service and Coventry and Warwickshire NHS Partnership Trust.
PHOTOGRAPHS Runnymede is grateful for permission to reproduce photographs (copyright-holders mentioned where known in the caption), especially to those of our interviewees who willingly donated photographs and certificates of their own. Cover photos: courtesy of Satinder Lal, Vinod Devalia, Ramesh Naik, Muhammad Yunus Khan, Rangena Tilkaran Amarpal Bains, Daniel Berthoud, Karen Gupta and Vijay Jethwa. Photographs of interviewees: Vijay Jethwa. Special thanks are also extended to Karen and Protap Gupta and Dr C Kotur for providing us with permission to use their photographs. Thanks to Getty Images and also to NHS Employers for reproduction of photographs of Dean Royles, Carol Baxter and Sir Keith Pearson. Additional copyright information includes the following: Page 44 Intendance Street, Port Louis, Mauritius, © Simisa/ Wikimedia Commons Page 48 Kek Lok Si – Chinese Temple, Penang Island, Malaysia © Daniel Berthoud/Wikimedia Commons Page 51 Working in Dentistry © Leeds City Council, 2006 Page 54 Great Ormond Street Hospital © Nigel Cox/ Wikimedia Commons
We would also like to extend great thanks to the Department of Health, for commissioning this project and to NHS Employers for supporting the publication of this book. Our deepest thanks are also extended to Cecile Day for her tireless support for this work.
Page 62 Village Cricket, © Fred Porton/Wikimedia Commons
Thanks also to Filiz Caran, Cathy Douglas, Jessica Sims, Benedicte Eichen and Joanna Tsoni for all of their assistance with transcribing; to Vijay Jethwa for the photography; to Vastiana Belfon for sourcing pictures; to Karen Toma and Hannah Miller for work on the project, to Valentina Migliarini and Saher Ali for conducting interviews, to Sondhya Gupta for advice with layouts, to Robin Frampton for editorial work, David Fathers for the branding and design of the website, Amanda Carroll for book design, Stephen Cooper (Millipedia) for the website development, and very special thanks to Klara Schmitz for assisting with all elements of the project.
Page 110 Richmond House © James Stringer/Creative Commons
Our deepest thanks however go to all of the NHS staff who so willingly gave their time to take part in interviews for this project your stories have provided the essence of this book and we hope we have done justice to your voices.
Page 72 Heathrow Arrivals © Khairil Zhafri/Creative Commons Page 97 Article and photo appear courtesy of The Reading Post Page 112 Female Scientific Research Team © Darren Baker Page 121 Providing Support to Patients © spotmatikphoto While every effort has been made to trace and acknowledge copyright, the publisher apologizes for any accidental infringement or where copyright has proved to be untraceable. The publisher would be pleased to come to a suitable arrangement in any such case with the rightful owner.
Nurturing the Nation provides information on the migration journeys and working lives of 40 NHS staff, all of Asian descent, who came to the UK from various parts of the world. It includes the voices of nurses and midwives from Mauritius, Trinidad and Malaysia; doctors and dentists from India, Kenya, and Singapore; and psychiatrists and therapists from Pakistan. The majority of the featured individuals have retired, or are approaching retirement, but many still work within the Health Service and most, if not all, continue to play an active role in their local communities, either as health professionals or in other important ways. Their stories echo those of many others who have made similar journeys from across the world to work in the UK, in order to provide an essential service to the people who live here. The book provides an initial insight into the journeys they took, the decisions that they made and the plans to return and paints a fascinating picture of the lives of the Asian men and women who have made, and continue to make, a major contribution to the NHS.