Flying far, but returning to the family nest:

Home to roots

Graduates with foreign degrees:

Aditha Dissanayake

December 20, 2008. She trudges through ankle deep snow, from the hospital to her ramshackle apartment. Having just completed 8 hours of training as part of her degree in medicine at the X University, even through the sound of the snowstorm raging around her, she keeps hearing the voice of her professor’s rapid-fire admonitions. A perfectionist in the operating theatre, he makes sure his students take their profession seriously. “This patient may just be a dummy, but you are killing her!”. He raps his students.

The apartment she shares with two others is cold and lonely. She takes her phone into her hands. “I can’t do this. I want to come home,” she sobs. The voice at the other end is comforting, yet demanding. “You can do it. Our family never gives up. We are survivors!” her father tells her. “Shh...” soothes her mother. “You can’t let us down now.”

Flash forward. December, 2010. Twenty five year old Marshi (not her real name), is back home with her degree in medicine obtained from the University of X, China. Now that the Advanced Level exam results are out, to all her younger brethren, who are worried they will not have the right Z score to enter a local university, and who are contemplating enrolling in less expensive universities in other Asian countries, she has this to say; “prepare yourself for the most vigorous days of your life.”

Marshi is only one among the thousands of students who enroll in foreign universities every year. Her story is the story of many others who are forced to leave the country in their determination to study for a degree, be it in science, engineering, law or the arts.

Speaking for most foreign graduates who live on shoestring budgets Marshi describes the harsh weather, the freezing apartment, the empty pots and pans when she returned home after a grueling day at the hospital and the nights spent on a few cream crackers to sooth her grumbling stomach. “Long hours of standing in the hospital, exams every two weeks, cooking, cleaning, washing, paying bills....I thought I was growing old prematurely!”.

Strange cultures

To add to these woes most Sri Lankan graduates living in foreign countries have to adopt themselves to strange cultures. Some universities have such rigid disciplining, coming to terms with their laws are as hard as passing the exams. “The university I attended has a history of being part of the red army and being honoured by Mao Tsetong. They still run the place with a huge book of rules and regulations! There were times when I and the other foreign students were exasperated by their strict disciplining! It felt as though we were in a military training school rather than in a university!.” Getting used to the low temperatures is another obstacle most students find hard to scale. On winter days when the temperature was a freezing -30 degrees Marshi says she would ask herself “What on earth am I doing here?” And wonder if she too would die from hypothermia as Jack Dawson does in “The Titanic.”

But survive she did, like the many others before her, and today she is home to fulfill her dream of following in her parent’s footsteps, by becoming a doctor. “As a kid I grew up watching my parents who are doctors, I have lived in hospitals, as a kid, because when they could not find a baby sitter they took me to work with them. All I ever wanted in my life was to be like them.”

One wonders if she would have been so ardent about her dream if she had known in her childhood that for her, studying for a medical degree here in Sri Lanka would never be possible. As revealed in a Communique issued by the University Grants Commission, “Admission to universities is extremely competitive and the mere fact that an applicant has satisfied the minimum requirements and the pre-requisites is no guarantee that he/she will be admitted.

In recent years the numbers ranging from 108,000 - 131,000 have obtained the minimum requirements for admission to universities, but the actual number admitted has been only about 17,000 - 21,000.” In such a milieu it is inevitable that ambitious students seek other pastures when it comes to their higher education. “After two attempts at the A-L exam, I was not going to give up my goal!” says Marshi. “I have a sister and a brother, and my parents could afford me only so much! I went to China to fulfill my dream!”

Dream

A dream that hovers on the brink of turning into a nightmare, once the foreign graduates return home. Even though throughout the five or six years they live on foreign pastures they know no other pasture could be as green as the pastures at home, once they return they begin to have doubts about the decision to serve their motherland instead of migrating to a so-called “developed” country like the USA, UK or Canada. Most graduates with medical degrees lament their colleagues at home treat them as outcasts because they have degrees from foreign universities.

“When we go abroad to get our degrees in medicine we enroll ourselves in universities which have been approved by the World Heath Organization, so we are not quacks by any chance!” says Marshi.

A graduate with a medical degree from a university in Russia, who is now working in a local hospital, who wishes to remain anonymous, echoes the same sentiments. Having returned home after seven years in Russia to find the Act 16 exams were delayed by one and half years, when she finally passed the exam after attending tuition classes paying exorbitant fees, with extreme difficulties (graduates with foreign degrees are not allowed into local hospitals to examine patients as part of fulfilling the requirements for the exam) she was posted to Batticaloa and later to Vavuniya. “We are given step-motherly treatment” she explains. “When appointments are given to graduates, those with the local medical degree are on the top of the list and those who have foreign degrees are at the bottom, so they end up having to serve in difficult areas as the North and East.”

Is there no solution to help graduates with foreign medical degrees who return home? Would a government-recognized educational program that helps them prepare for the “ERPM” exam solve the problem?

Marshi and her senior counterpart with the Russian qualifications agree. “Even after we start work as qualified doctors our colleagues treat us as if we have got the plague.” Adds the latter.

“But I survived and will continue to survive because at the end of the day I know the patients I treat are my own kindred, and that I am serving my motherland.”

So would you, if your mantra too is “I will survive.” To quote the Buddha, Cetana ham bikkhawe, kammam vadami” (motive itself is action).

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Scaling the ERPM hurdle

“According to Dr N J Nonis, Registrar, Sri Lanka Medical Council, the Examination for Registration to Practice Medicine in Sri Lanka (ERPM)/ACT 16 conducted by the Sri Lanka Medical Council (SLMC) “is applicable to all foreign graduates from recognized medical schools and universities. The list of such schools is available as a booklet and also in the Council website. The exam has a theory part - Part A and Clinical/Viva voce part - Part B. A candidate must pass Part A to go for Part B. Following a court order last year, the same Multiple Choice Question Papers used for the Final MBBS of local medical schools are used for Part A.”

“Held in March or April every year, through the ERPM exam a candidate’s ability to approach medical practice with the appropriate intellectual skills of enquiry, clinical reasoning, critical thinking and decision making is assessed.

ERPM also examines if candidates posses sufficient knowledge of the basic and clinical sciences and have the ability to create a differential diagnosis and rationalize a treatment plan for common clinical situations prevalent in Sri Lanka.”

A lawyer’s lot

A twenty-three year old Sri Lankan with a degree from UK who has returned home and wishes to start practicing here says

“Foreign LLB graduates and UK Solicitors have to do all three years at law school again, do a practical training course and serve a period of apprenticeship.

Barristers from England, Scotland and Ireland must do exams in (i) Civil procedure, Pleadings and Law of Executors and Administrators, (ii) Law of Property, (iii) Tax Law, (iv) Industrial Law and (v) Commercial Law 1.

If they have done a pupillage in the UK they do not have to do the practical training course or apprenticeship but if they haven’t done pupillage then they must do both.”