Carry on doctors?

“I’m a doctor but I don’t practise here,” explains Faduma
Hussein, a refugee doctor from Somalia. She would like to be
working as a family planning doctor, but says she was not given the
necessary guidance and advice when she arrived in England in 1994.
She regrets not taking the necessary exams. “But now it’s too
late,” she says.

Hussein has 19 years’ experience as a doctor in Somalia, where she
became a consultant gynaecologist. She now works as a lay health
adviser at the Community Health Project in Waltham Forest, London,
helping refugees and asylum seekers to register with a GP and
carrying out health promotion work. She is also an adviser in
African Well Women clinics, working with women who have experienced
genital mutilation.

Hussein believes that applying their skills should be made easier
for refugee doctors, whose knowledge should not be wasted “working
in a restaurant”.

“There are a lot of refugee doctors who come to this country not
because they want to work but because they come running. They have
the knowledge. Something has to be done for them,” she says.

Hussein is by no means the only refugee doctor whose medical skills
have gone to waste. A database set up in May 2001 by the British
Medical Association lists 865 refugee doctors who want to work for
the NHS. Nearly half are from Iraq and Afghanistan, while other
common countries of origin include Iran, Pakistan, and Sudan. The
NHS is short of thousands of doctors, so why aren’t these trained
medical staff being snapped up as soon as they are granted refugee

The answer centres on their qualifications. Many find that the
medical training they received in their home countries does not
permit them to be registered with the General Medical Council, the
registering body for doctors in the UK.

As a result, in order to practise, most have to go through a tough
requalifying process. This starts with a language exam, the
International English Language Testing System, and is followed by a
test of their medical knowledge by taking the two-part Professional
and Linguistic Assessment Board (Plab) exam.

Finding out how to requalify can be a hurdle in itself, and the
cost is vast. Many refugees survive on benefits while they study,
and finding the money to sit the exams is difficult. The language
exam costs £78 and, although the GMC has waived the fee for
the first two attempts at part one, all doctors must pay the
£430 fee to sit part two.

“I can’t understand how people manage to survive,” says Edwin
Borman, chairperson of the BMA’s international committee.

Those who can, get jobs, although these tend to be menial and
unrelated to medicine. Others are forced to rely on the support of
family and friends. But Borman insists the requalification process
for refugee doctors should not be made easier.

“We are clear on this. Refugee doctors, in exactly the same way as
other doctors coming from outside the European Economic Area,
should meet all the criteria. They are necessary quality

Many refugee doctors who have gone through the process say that,
although they hated it at the time, they understand why it was
necessary, Borman says.

Although the BMA stands by the current requalification process, it
would like easier access to “clinical attachments” – placements in
hospitals or general practice settings. These can be difficult to
set up and, amazingly, some hospitals have tried to charge for

Preparing for the exams is difficult, and several programmes have
been set up to assist refugee doctors with their studying. The
Refugees Into Jobs project runs a weekly club attended by about 15
doctors. A Kenyan doctor who requalified 20 years ago helps
attendees to prepare for the exam by answering past Plab

Mohamed Deria, senior initial assessment officer at the project,
says that refugee doctors do not question the exam process. “They
accept the tests. What they can’t accept is that after the whole
process they don’t get a job easily,” he says.

The situation has improved over the past two years, with people now
waiting about six months to start work once they have passed the
exams. Before, some had to wait as long as three years, he

Yet the issue is more than merely passing the exams and finding a
job. John Eversley, honorary senior lecturer on the Refugee Doctors
Programme at Queen Mary University of London, says refugee doctors
continue to face barriers when they have entered the labour

Those who get into a first job that is not a training post may “end
up in the backwater”, he says, in work that nobody else wants and
which offers no continual professional development.

“Even if they get into a training post, it may not be the
speciality they originally trained for or worked in. People have to
take what’s there,” he says.

Given the current shortage of doctors, it would be foolish for the
NHS to overlook this group. Financially it makes sense – it costs
just £4,000 to retrain a refugee doctor compared with the
£200,000 cost of training a medical student from scratch. And
the service delivery argument is clear too, as refugee doctors can
offer cultural and linguistic understanding that is often

Current trends on how to tackle the NHS recruitment crisis have
included bringing in health professionals from overseas. Such
initiatives may solve problems in the short term but, as the saying
goes, there’s no place like home, and most international workers
eventually want to return. For once, refugee workers have the
long-term advantage, as, after obtaining asylum, going home isn’t
an option.

Another way to requalify 

“I’ve been through hell and back,” says Elizabeth Olayokun. She
has just requalified as a doctor after discovering an alternative
to the Professional and Linguistic Assessment Board (Plab) route. 
Olayokun left Nigeria for safety reasons in 1986 and believes it is
too dangerous to return. She says her family was persecuted by the
government because her father was the leader of the Liberal party.
She recalls police arriving at her house to make arrests and says
her father was imprisoned for most of the 1970s. 

After studying medicine in Russia, Olayokun arrived in England
with her young son in 1994. To pursue her career in medicine she
set about studying for the Plab, but she had so little money she
couldn’t afford the textbooks. 

She got by on paltry savings from her job in Russia, and her
husband sent money from Nigeria when he could. Olayokun failed the
Plab exam three times. During a study session with some doctors she
heard about a course at St George’s Medical School in Tooting,
south London. Passing the United Examining Board exam at the end of
the course would allow her to practise as a doctor, without having
to go back to the Plab. 

She started the course in 2001, and has just qualified after
equalities grant-making organisation the Stone Ashdown Trust paid
for her to sit her final exam. She is now waiting to start work as
a junior house officer. Her career in medicine looks bright but for
others not so because the course – which cost her £15,000,
most of which she still owes – is being scrapped owing to a lack of

Olayokun believes the government should find the money to fund
the course. “Plab is not the right route. From my experience, Plab
does not give you what you need to work as a doctor,” she says.

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