November 11 IMG Focus Group

Participants:

• Tades Negasa, an asylee from Ethiopia, preparing for USMLE step I.
• Ghassan Azeez, a refugee from Iraq, preparing for USMLE step I.
• Ahmed Al- Anii, a refugee from Iraq, preparing for USMLE step I.
• Tatiana Chernenko, a permanent resident from Russia, preparing for USMLE step II CK. Passed step I and II CS.
• Alla Capbell, Permanent Resident from Russia. Passed USMLE step I & II currently applying for residency as well as attending observership sessions. Scheduled to start clinical observership at Center for International Health in December 2009.
• Yilma Fenta, an asylee from Ethiopia. Passed USMLE step I and II, currently applying for residency.
• Tedla Kefene, US Citizen from Ethiopia. Passed USMLE step I& II, currently applying for residency.
• Edwin Bogonko, Kenyan IMG, currently a hospitalist at St. Francis Hospital, volunteer mentor at AAFACD.

Edwin Bogonko observed that language and communication are the biggest initial barriers for doctors who arrive in the US from non-English speaking countries. But they are just the first of many barriers he identified. Assuming the language problem is surmounted, the next obstacles for the refugee doctor, he said, are:

• Finding time and money to study for the necessary tests. He couldn’t afford the Kaplan course so was forced to study on his own while he held a full time job.
• Discrimination and disinterest: He recalled an interview with the director of a surgery residency in which the doctor had obviously not read his resume. Nor did he have time for the interview. Instead he told Edwin to follow him to his next appointment. Edwin observed that the doctor towered over him, and never looked him in the eye. The doctor ultimately told Edwin, “You’re wasting your time.” Edwin said he thought, “This is not the only door. Do I want to hang around with people like this?”
• Securing a meaningful letter of recommendation to a residency program. By Edwin’s account, he benefited from luck. He served as a translator for a Botswana professor who was in the US for treatment of heart problems, and helped the local doctor navigate cultural and language issues that would otherwise have been vexing. Because of this relationship, the local doctor called a HCMC residency director on Edwin’s behalf. This led to nine months of observerships/rotations over a two-year period, and, eventually, a residency position.

Tedla Kefene said that it was especially frustrating to him to know that members of his community are being underserved by doctors who were unfamiliar with the language and customs of his countrymen, while he and others who are trained physicians are unable to help. He offered the example of an acquaintance who was told that she needed a biopsy of a mass in her neck. She was afraid to go back to the doctor, because she understood that the doctor planned to cut her neck.

Yilma said that in his opinion doctors from relatively undeveloped countries often had better diagnostic skills, because in their practice they were less able to rely on the tests that are so common in this country. But he felt that those skills were ignored in the competition for residency positions. “Here,” he said, “the focus is only on your test scores and your date of graduation.”

Ahmed explained that there is a critical difference between his situation as a refugee from Iraq and that of IMGs from, for instance, India, who are here as a matter of choice. “I left everything. I have nothing to go back to,” he said. “I don’t have that choice to go back.” But he was also willing to adjust his dreams. “If it is not possible to be a doctor, then maybe pharmacology, or biochemistry…” he said.

Tades said that he had been a political prisoner for nine years, and as a result had particular problems. When he went to Smiley’s Clinic, he said as an example, he was led to a small exam room where the nurse shut the door behind him. His reaction was fear, because his experiences as a detainee in similar small rooms had been so painful. For him, counseling, guidance and psychological preparation were the most important steps toward becoming a doctor again in the US.

For Yilma and Alla, some sort of financial assistance for support while studying was also significant.

Edwin laid out a series of steps that he thought would most help refugee doctors. First, he said, there should be assistance with language and acculturation for those who need it. Next help with testing, followed by opportunities for observerships. There should be a structure for evaluation of those participating in observerships, so observers could get help to realize their shortcomings and understand what to do to make the grade. Having been observed and evaluated, they could hope to get meaningful letters of recommendation to residency programs. Upon completion of a residency, he said he believed that doctors would return to their community to serve in payment for the help they had received.

“It is time to tell the medical community, ‘Stop, something is not right here,’” Edwin said.

“When they hear our stories, people will cry,” said Alla.