Dr Pratik Mammode has spent much of the past year on the front lines of India’s fight against the coronavirus.

Until recently, the 26-year-old junior resident doctor had been on Covid-19 duties, donning and doffing personal protective equipment day in, day out on 12-hour shifts at a 1,500-bed facility in India’s capital city of Delhi.

He remembers being sweaty and horribly dehydrated for most of the four months he was on-call.

Tough though the experience was, he was prepared for the challenge, having interned at an 8,000-bed facility in Henan province, China, where he completed a six-year medical degree at Zhengzhou University.

But fighting Covid-19 is not the only challenge Dr Mammode’s education in China has prepared him for.

Since his contract expired in mid-August (he is waiting for it to be renewed), Dr Mammode has been informally coaching several other Indian medical students who graduated in China on how to pass one of India’s toughest licensing exams.

The Foreign Medical Graduate Examination (FMGE) – which usually takes place in June but was delayed by Covid-19 to Aug 31 this year – is a mandatory test set by the Medical Council of India that most students who graduate abroad must pass to practise in India.

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Last year, the last time the test was held, 15,500 students took the exam and just 4,242 passed. The same year, a government analysis found that from 2015 to 2018 less than 15 per cent of students passed. For those with a Chinese medical degree, the pass rate was even lower, at less than 12 per cent.

This puts Dr Mammode in a small minority of people. He cleared the exam on his first attempt in 2018, answering 174 of the 300 questions correctly. One of his peers at Zhengzhou University was less fortunate and this year took the exam for the fourth time.

Like Dr Mammode and his peer, most of those taking the exam have graduated from Chinese universities. Roughly, 7,000-8,000 students from India fly to China every year to enrol for a medical degree.

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That such a large percentage of them return to India unable to practise has become a concern in a year when India has crossed 4 million coronavirus cases and its hospitals are crying out for extra hands.

Instead, thousands of medical graduates who could help in the fight against Covid-19 sit idle at home, trapped in a system begging for reform.

Complicating the picture are military tensions at the border between India and China , which have fuelled rampant anti-China prejudices and been transferred onto students with Chinese medical educations, some of whom say they are derogatorily referred to as “China ka maal” (Product of China).

“Certainly, in a pandemic situation, the government could have used emergency powers to enlist foreign graduates,” says Professor Rama V Baru at the Centre of Social Medicine and Community Health at Delhi’s Jawaharlal Nehru University. But even if it had, there would be complications as each state government would have had to pass orders of its own.

Another complication is that the FMGE is not required for all countries. Students who completed degrees in the United States , Britain, Australia, New Zealand and Canada, do not need to take it.

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“I feel there is a systematic effort to keep out foreign medical graduates from some countries,” Baru says. “If you are anyway commercialising medical education, why make that distinction? What makes them say that some private college in Tamil Nadu is training its students better than the Wuhan medical university? I really don’t think this is a level playing field,” she says.

In a July 2020 study, Baru and Delhi-based Institute of Chinese Studies fellow Madhurima Nundy found that the discrimination was not limited to the FMGE.

“One thing we learned is that private hospitals did employ Indian doctors returning from China, but they were treated very poorly within the hierarchy. There appears to be an informal co-option of these doctors, but the public sector still hasn’t given the green light,” she says.

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Getting harder?

Many students perceive this year’s exam to have been particularly hard, so much so that dozens who sat it attempted to hold a silent protest on Sept 3 outside the Medical Council of India’s building in Delhi.

The protesters – who were disbanded by police – felt this year’s paper was “extremely unfair”. Results declared on Saturday showed that of the 17,789 students who took the exam on Aug 31 just 1697 passed.

“I couldn’t believe it! It was more advanced than a postgraduate exam,” says Md Asad, a resident of Delhi who graduated in June last year from Russia’s Kazan State Medical University, and was among those protesting. “They were asking five-liner questions and giving us a minute to answer. Since the exam, I have just been really depressed.”

Dr Mammode’s peer, who was taking the exam for the fourth time, felt it had been even harder than usual, saying the whole style of the questions had changed.

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“Many students wonder if this is revenge by the government since we appealed to the Medical Council asking it to lower the pass percentage from 50 per cent to 30 per cent so more of us could qualify and help out with Covid-19 duties ,” he says.

“They made it so difficult for us! Every single person who walked out of the exam centre along with me looked stunned.”

Across the country, groups of foreign medical graduates have begun to organise protests to petition the medical council to reduce the FMGE’s qualifying marks. Banners at a protest in the north-eastern state of Manipur last week read “FMG Lives Matter”and “Let Foreign Medical Graduates Serve”.

In Delhi, the same group that organised the protest had made a representationearly last month, pointing out that if the government reduced the qualifying marks for the December 2019 and August 2020 exams, India would immediately have an extra 30,000 doctors who could be put to work in rural areas.

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Many feel the students have fallen through the gaps as India and China go cold on collaborations launched in more optimistic times.

Nundy’s study points out that China opened its education system to students from overseas in 2003 and that the following year 150 Indian students went to study medicine in the country.

Since then demand has boomed, with the number nearing the 10,000 mark. The trend is being encouraged by fierce competition for limited places in India and the expense of private medical colleges.

Saumyajit Bhaduri was among the 2014 wave who went to study medicine in China and was hoping to graduate this June. “Many of my classmates, like me, ended up going abroad because we couldn’t make it to central universities in India and our parents didn’t have the huge amounts of money needed to send us to private universities,” he says.

Bhaduri is among the more than 20,000 Indian medical students pursuing higher education in China who are currently stranded in India due to the pandemic. He attempted the FMGE in December 2019 and re-took it last month.

“To say it was tough would be an understatement,” he says. “I used to be amused when people said ‘I want to serve my country’ but after I have stayed home through this lockdown and read articles about how Ayurvedic and Homeopathic doctors are working in ICUs in India’s hospitals, I realise we have the basic knowledge, we are trained as doctors, and yet we can’t do much. Frankly, I feel completely betrayed.”

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This article was first published in South China Morning Post.



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