Abstract
The British Association of Physicians of Indian Origin
(BAPIO) undertook a humanitarian project to come to the aid of a number of migrant
doctors who were in the UK to take the Professional & Linguistic Assessment Board’s
(PLAB) part 2 clinical examination, and had become stranded due to the lockdown during
the first surge of the COVID-19 pandemic. The BAPIO PLAB stranded doctors’ project
started as a serendipitous exercise in the third week of March 2020 with first a handful
of migrant doctors, until it reached a peak of 267 doctors from 19 countries, and
involved collaboration with multiple voluntary organisations, stakeholders, regulatory
agencies and governments.
There was no denying the complexity and intricacy of the
demands on the stranded doctors, but it was even more pleasing to witness how the
project team were more than ready to meet the challenges. Under the umbrella of BAPIO,
the project team doctors, who previously had barely known each other, took on all the
challenges - teaching, pastoral support, career advice, writing curriculum vitae,
finding food, accommodation and funds for those in need; organising professional
support, links with the General Medical Council, the High Commission of India and the
U.K. Home Office. The project was concluded on 19 September, with all the doctors either
returning home or making a decision to work in the NHS when conditions allowed them to.
It is not possible to know how many passed their PLAB
part 2 exams, but we estimated that over 50% did. The weekly virtual meetings, the
camaraderie, the scale of the project, and most importantly bringing it to a closure
without any major crisis, was only possible through sheer determination, understanding
the needs, professionalism, leadership and excellent communication. The lessons from
this project are important to illustrate the role of voluntary organisations (such as
BAPIO) and the effectiveness of having established collaborative networks with official
bodies and government agencies, for the future benefit migrant professionals.
Introduction
The British Association of Physicians of Indian Origin
(BAPIO) is a non-political, national, voluntary medical organisation that supports
members and other healthcare professionals through education, training, policy making,
and advocacy. Since its inception in 1996, BAPIO has actively promoted the principles of
diversity, equality and supported migrant doctors in their acclimatisation to the
healthcare sector in the UK. This support also extends to those who may have run into
professional or personal challenges. BAPIO in its philanthropic role contributes to
promoting access to better healthcare globally and responds to aid victims of natural
disasters across the globe. BAPIO has a history of campaigning and collaborating with
other organisations in the course of improving the UK National Health Service (NHS)
systems as well as directly and indirectly, promoting quality of care and safety for
patients. In this context, BAPIO is recognised by organisations and NHS doctors as a
body that can provide valuable assistance to doctors in difficulty, particularly those
who may have qualified abroad, or belong to under-represented minorities.
Stranded migrant doctors
BAPIO received notification on 19 March 2020 from an
Indian junior doctor that she was stranded and helpless after the General Medical
Council (GMC) announced on 17 March 2020 that it was cancelling the Professional and
Linguistic Assessments Board
1 (PLAB) part 2
examinations, with immediate effect due to an imminent lockdown imposed by the UK
government, amid concerns of safety for the candidates, examiners and staff. The
examination is a pre-requisite to foreign doctors gaining entry to the U.K. medical
register, so that they can practice or train here. Simultaneously, this stranded doctor,
who had been active on social media, had made contact with Dean of Royal College of
Psychiatrists via a tweet which was also picked up by two psychiatry trainees. The group
widened to include two other trainees in psychiatry and one Staff Grade doctor, and in
time following contact with BAPIO, two other doctors, a plastic surgeon in Manchester,
and a psychiatrist and Medical Director also in Manchester. The numbers of stranded
doctors contacting the ‘BAPIO PLAB family’, as they were later referred to, grew quite
quickly. Some urgency was placed on supporting these doctors by the Chair of the BAPIO
Institute for Health Research, , who wrote to the President and Chairman of BAPIO
informing us that there were 23 Indian doctors stranded in Manchester and urgent help
was required.
PLAB Project Team
In the overall scheme of the project there were
multiple needs for this group of doctors, and so internally it was necessary to
determine roles and responsibilities. The BAPIO PLAB project team comprised seven key
members and led by the Chair for the BAPIO Central Executive Committee. The first
objective for the project team was to have an understanding of the task, and to ensure
that there were good channels of communication. This must be prefaced with the fact that
all of the doctors who had formed the team were busy front line workers, and so this was
very much over and above their clinical and personal responsibilities. None of them had
been formally trained or assessed for any particular skills they brought into the task,
the assumption being that as they had volunteered or asked to volunteer and they had the
passion and commitment to support the stranded doctors. Interestingly perhaps, the
binding thread was the fact that all of the PLAB Project team members were themselves
international medical graduates. It is very likely that their own initial experiences on
arrival to the U.K. consolidated their commitment to the cause. Roles were not actively
assigned to the team members, except in the case of the role of ‘Salford project lead’
and Treasurer, so that there was financial governance in how funds were raised as well
as utilised.
Characteristics of the stranded doctors
The project team rapidly organised a rescue package as
it was obvious that the 23 doctors initial doctors who had been in touch were without
finances, estranged from family and friends, some were emotionally distressed and many
were without accommodation and insufficient means for obtaining food. It was also
evident that they were not the only ones in this predicament.
Fig 1. PLAB stranded doctors’ country of
origin.
Indeed, the numbers grew quite rapidly, so that within a
matter of weeks the total numbers of doctors supported was 267 who originated from 26
different countries (
Figure 1). As the pie chart demonstrates,
the majority of doctors came from the Indian subcontinent, with Indians constituting the
largest percentage of these doctors (24%), followed by Pakistanis (18%), Nepalese (12%
), Burmese (6%) and Bangladeshis (5%). From the African subcontinent, the Sudanese (9%)
and Nigerians (8%) were by far the largest group. The gender distribution was almost
evenly split with a slight preponderance of males.
There is no denying the complexity of this project.
Homeless, away from their countries and families, restrictions from Covid-19, short of
finances or access to funds, stuck in a foreign country there were many issues that
immediate and at crisis point for these stranded doctors. As well as all of that there
were a group of highly skilled doctors without jobs, and with additional frustration of
not being in their home countries to support colleagues at a time of this global
pandemic.
The impact on the mental health of these doctors was of
concern to the project team from the moment of contact, and as
Figure
2 demonstrates they were open in their admission to their experiences and
symptoms. The team were aware that these doctors would have more resilience than usual
and many were likely to be high achievers in their home countries, but nonetheless they
were away from their support networks, and the likelihood was that they would experience
significant issues of stress and anxiety
2. Fortunately,
all project team members were well equipped to support them or direct them to
appropriate channels, which in the end proved vital as none of them suffered a serious
mental health breakdown.
Fig 2. Emotional experiences of the stranded
doctors
Salford Project
BAPIO made arrangements with the University of Salford to
provide subsidised accommodation for those with the most urgent need. This was only
possible because of the established links with the Dean of the School of Health and
Society and since the University had to shut down and disperse its students following
the lockdown. The Salford lead took on the responsibility for allocating rooms,
arranging transport as well as giving them pastoral support. Food costs were met with by
BAPIO, and additionally free meals were delivered by the Shrimad Rajchandra Covid-19
S.A.F.E. initiative organised by Sonal Mehta and the local Sikh temple, whenever
possible.
In what was undoubtedly the most complex part of this
operation, it fell on the Salford Lead to provide personal care and support to all the
doctors that were in the Halls of Residence, and that sometimes included meeting their
religious needs, celebrating birthdays, organising medical care, keeping them
Covid-safe, holding their hands when they were distressed, and on many occasions,
sitting up with them late to prepare them for interviews
Figures
3 and 4. The Salford group were also an integral part of the
overall PLAB family, and therefore they benefited from the additional educational
training sessions as well as the liaison and collaboration that were undertaken with
external agencies.
Fig 3 and 4. Activities at Salford
accommodation
Collaboration is key to success (
Figure 5)
It was very clear from the outset that the project was
only viable if BAPIO could link up with several other agencies. The largest group of
junior doctors were from India (almost a quarter), so the strong links we had with the
High Commission of India (HCI) in London and Birmingham became a very useful axis for
providing them with rapid information about flights as well as Covid restrictions during
the flight as well as on arrival at the ports in India. So in this regard the virtual
sessions conducted with the Deputy High Commissioner and Consulate General in Birmingham
proved very useful as well as direct links with Mr Rohit Vadhwana, First Secretary
(Economics) of the Indian High Commission (London).
Fig 5. Essential areas of collaboration
A further crucial link was forged with the GMC, which
recognising the plight of the doctors, got involved from the most senior person in the
organisation, Charlie Massey, Chief Executive Officer, to those within the examinations
department, in particular Richard Hankins, Head of Examinations and Abi Boyson,
Assessment Change, QA and Customer Experience manager. There were a number of successes
in this collaboration, such as, obtaining refunds for the examinations that were
cancelled, free entry to the exams that were scheduled, bringing forward the date of the
first examinations to August rather than October, prioritising the exams for those
stranded in the U.K., and allowing the doctors to work as ‘Medical Support Workers’
which did not require medical registration but would have given them experience of
working in hospitals as well as being remunerated. However, there was little taking up
of this role due to hospitals being acute with Covid and because the doctors were
focused on exam preparations.
As illustrated above (
Figure 2)
this was in fact a stressful time for the doctors. Despite the 24/7 support available to
them there were signs that some needed counselling, and in the case of one individual,
psychiatric treatment. This was provided by NHS Practitioner Health
3 (PH), an organisation set up by Professor Dame Clare Gerada and one
with extensive experience in treating doctors with mental illness. This proved to be an
invaluable, confidential service that the doctors who accessed it appreciated very much
the personable treatment they received from the counsellors and doctors who were
treating them.
There was a pressing need to highlight the importance of
visas for these doctors. BAPIO undertook the responsibility of writing to the Home
Secretary with details of each of the doctors, after obtaining their consent, to ensure
that if require their visas would be extended beyond their expiry. This was done in
conjunction with other organisations such as the British Medical Association (BMA), the
Nepalese Doctors Association (NPA), the Association of Pakistani Physicians in Northern
Europe (APPNE) and the British International Doctors Association (BIDA).
Central to this operation was the need to raise funds.
Much of the funds were raised through two BAPIO campaigns. However, it became clear as
the global lockdown became extended to beyond the first three months that was
anticipated, that the funds would run dry. This information had spread to Nicky
Jayesinghe, Director of Foundation for Medical Research and Director of Corporate
Development, BMA. On her encouragement, BAPIO teamed up with a charity Doctors in
Distress
4 (DiD) with whose support were able to
successfully bid for significant funds from the BMA’s charitable arm. All the funds
raised went to accommodation and food, though there was also an emergency relief fund
for those doctors who were in financial difficulty.
Our internal collaborations within BAPIO were continuous,
and paid huge dividends. There was encouragement from officers and members of BAPIO. A
key role was played by the Medical Director of Medical Defence Shield (MDS) as each
stranded doctor was provided free indemnity from the MDS for up to a year.
Conclusion
There was consensus that the project would conclude on
19 September 2020, as per the expectation being that all the stranded doctors would have
either taken their PLAB 2 exams or had a later date to do this and hence would have
returned to their home countries.
There were no predetermined parameters for what success
would look like as that did not seem important in an emergent and evolving scenario.
From our point of view everyone was safe, they all felt financially and emotionally
supported, everyone had a roof over their heads, and no one was left hungry. From the
stranded doctors’ point of view, a major part of success would be passing their exams.
The GMC confirmed that of those who sat the exam, 79% had passed (the average pass rate
was 70.4% in the previous five years), though unsurprisingly the Salford group had a
slightly higher pass rate of around 81%. Some of the doctors had found training jobs in
the NHS, but the majority have now returned home with the intention of applying for jobs
at a later time.
BAPIO Covid-19 Award
Recognising the significant effort and contribution
the seven PLAB Project team members had made, often at the expense of their own personal
time, the BAPIO Awards Committee were unanimous in their decision that they were all
worthy of the Covid-19 award. This was symbolically collected on their behalf by the
Project Leader Raka Maitra, at a virtual awards ceremony during the BAPIO Annual
Conference on 21 November 2020, and individual awards were dispatched to each recipient.
Compliments and comments
This group of PLAB doctors were generous in their
praise for individual project team members as well as BAPIO as a whole. Multiple
messages on social media, via Twitter, WhatsApp, Facebook, were received as well as
emails, text messages and phone calls,. Some of these are replicated in the
table 1 below, and as well as these, there were videos of songs,
poetry, and all manner by which they showed the gratefulness of support they are
received at a time of distress and vulnerability.
Table 1: Comments and Compliments from the
Stranded doctors
Hi Dr Shevonne,
I got my results today and I
passed the exam. I do not know where to begin, except say that all this is
because of you. I’m here because of your hardwork and support. Me and the rest,
we couldn’t have been here if it weren’t for the core team’s, you all took us as
one of your own and helped us achieve this.❤
Words fail me Dr Shevonne, I do not
know what to say. Surely just saying thank you wouldn’t suffice .. |
| Friedrich Nietzsche one of my favourite
philosophers once said "he who has a WHY can bear any HOW”. Everyone here has a
why and the most noble "WHY" ever I think in history of mankind and it's the
betterment of your fellow man's life so I say this to all my BAPIO brethren
passed or not, you can bear any “HOW”, anything life throws at you, you will be
able to beat .... I wish you all, all the best in the world and congratulations
to everyone who passed and hang in there to everyone who hasn't ..Salam |
1st September 2020 and by grace of almighty I
passed my exam and am now in the process of getting my
registration.
I would like to specially thanks Dr Bhavana Chawda,
consultant psychiatrist and a member of BAPIO who gave me my first NHS
experience in the form a clinical attachment in psychiatry at Dorothy Pattison
Hospital. |
| Done with my exam and I am absolutely not sure
about the results. But, I am extremely glad that I have met such extremely cool,
caring and super inspiring people of this BAPIO team❤️. |
| Our last goodbye. We will miss you Dr Gaj. You have
been there through thick and thin for us. You truly are a Godfather for all of
us. We were blessed to have a guardian angel like you. We always longed for the
day you'd come and visit and eagerly text each other asking about your
whereabouts! Cant thank you enough for all that you’ve done. I believe we
started out as strangers and ended up being a family. Will definitely miss
Salford, especially Dr. Gaj. ❤️❤️❤️ |
| I am glad to inform you that I passed my
PLAB2 at my 4th attempt. Those who failed don’t be disheartened. If I can,
anybody can. Whenever JS said he took four attempts to pass PLAB, I had a rush
of adrenaline. I am really grateful to all the people around. |
