Insights From International Doctors On The Frontlines Of The Pandemic

IRA FLATOW: This is Science Friday. I am Ira Flatow. As the pandemic was ramping up in March, New York’s Governor Andrew Cuomo and California’s Gavin Newsom put out a call for medical professionals to come to their states to help with the crisis. As it turns out, many of those on the frontlines aren’t just from out of state, but out of country, international doctors.

Up to a quarter of working doctors in the US have come from abroad. What is the role of international doctors on the US medical system? And how have they been affected during the pandemic? Here to fill in that story is Max Blau. He’s a health care journalist based out of Atlanta. Thanks, Max, hi. Welcome to Science Friday.

MAX BLAU: Thanks for having me, Ira.

IRA FLATOW: How important a role do foreign-born doctors play in the US medical force?

MAX BLAU: They play a vital role, especially in areas that have shortages of doctors, which tend to be rural areas. In the state I live, Georgia, most of the state is defined as a rural area. And many of those counties are classified as medically underserved, either across all specialties or in some specialties. And in many of the places where no other doctor is willing to go, it is foreign-born doctors and foreign-trained doctors who fill in the gaps of America’s health care system.

IRA FLATOW: Tell us about the pathways that doctors use to come to the US and practice medicine.

MAX BLAU: It’s a complicated one that is often made more difficult by the red tape that exists when a doctor, who has trained in another country and worked there as a doctor, needs to come over to the US. One example of a doctor, who I have written about in the past, is Dr. Berzingi, who is a Iraqi cardiologist, who fled in the ’90s from the Saddam Hussein regime and came over to the US.

In many countries, the medical education you have there does not translate to the medical education requirements in the US. So he had to start his whole medical education over, taking classes and doing residency. Typically, when you finish medical school, you can either go back to your home country, or you can get a visa to practice in a medically underserved area. And he ultimately ended up in rural West Virginia.

Even to this day, now that he’s worked his way back to being a cardiologist, part of his practice is still driving 90 minutes every day to and from a tiny rural town called Elkins, where he’s the only cardiologist in that area. And so you have this situation where ultimately these doctors who have been extremely resilient, by way of going back through the entire medical education process, ultimately end up in places that no other doctor wants to go. And they are the only foreign doctor or person some of these communities have seen, just given the demographics of who often live in rural areas in this country.

IRA FLATOW: The Trump administration has put travel restrictions and immigration policies affecting all people coming into the country. How have those policies affected doctors?

MAX BLAU: With every new class of medical students and medical residents that come in, those international doctors rely on what’s known as a J1 Visa to work in the United States. Over the past several years, restrictions have, at times, threatened the possibility of those doctors being allowed into the US.

This year is probably the biggest threat in that regard, in the sense that process, both with the Trump administration’s continued shutdown or restrictions of immigration, of processing visas and things like that, along with the coronavirus pandemic, those two things together, come later this year, when those residents are supposed to be filling a position at a teaching hospital, that’s going to mean that as many as 4,200 slots will either go unfilled or may have some other alternative person, who may not be as qualified in those slots. So it’s definitely going to impact teaching hospitals that rely on residents, and in particular foreign-born or foreign-trained residents to fill in the gaps of health care.

IRA FLATOW: Well, Max, thanks for filling us in on that.

MAX BLAU: Thanks for having me.

IRA FLATOW: Max Blau is a health care journalist based out of Atlanta. Now I want to bring on two of these doctors to get their perspective on what it has been like to work on the front lines during the pandemic. They’re here to speak about their own personal experiences and not on behalf of their organizations. Let me welcome first Dr. Muhammad Jahanzaib Anwar. He is a postgraduate resident at the Montefiore Medical Center, Wakefield Campus, in the Bronx, in New York. Welcome to Science Friday.

MUHAMMAD ANWAR: Thank you.

IRA FLATOW: And Dr. Quinn Lougheide, just graduated from residency training in Lincoln Hospital in the South Bronx. Congratulations.

QUINN LOUGHEIDE: Whoo-hoo. Thank you. And thank you for having me.

IRA FLATOW: Oh, you’re quite welcome. Let me begin with you Dr. Lougheide. You both were working in the Bronx. And we know that’s an area that had among the highest number of cases and deaths. Give us an idea of what that has been like.

QUINN LOUGHEIDE: So I would say it’s been– it was crazy. It was a crazy experience. I don’t know if that’s like a good radio word. But it was like being in a war zone. So it was– during the peak of the pandemic, you would go to work, and I would say like every half an hour, if you’re like in the ER, or in the ICU, every half an hour, you would get a new admission of somebody that was critically ill, that you had to intubate almost immediately.

And overhead, there was just constant overheading at least every half an hour or every hour– anesthesia for intubation to 9 Bravo, anesthesia for intubation to 6B. 126 code– so a code is like cardiac arrest. 126 code to 6B. 126 code to 5B. Just every half an hour. So if you can just imagine like those sounds going off every half an hour, the sounds of vents going off, just like vents alarming, like catastrophes happening, patients rolling in who are critically ill. Like, it was like the Wild West. It was wild.

IRA FLATOW: I’m sure you must agree, Dr. Anwar.

MOHAMMED ANVAR: Yes, when we started in March, it was just the beginning of the pandemic. I would say that I was a part of the first COVID team that the hospital made. I was working in clinic, but they pulled me from the clinic to work at the COVID team. Being first in the COVID, being exposed to the COVID patients, as the first one, the first responders in the hospital, I think I agree with Lougheide that it was like rapid response. We called rapid response every 30 minutes, code CSC, patient’s crashing.

I have never seen in my life– my life, like I have been practicing for six, seven years, but the doctors over here who have been working for 30 to 40 years, and they are saying that they haven’t seen anything like that. They haven’t seen anything like that.

IRA FLATOW: Dr. Lougheide, what do you think is the biggest medical need right now in the communities you are working in during the pandemic?

QUINN LOUGHEIDE: That’s a tough question. I would say that’s very– it’s a very multifactorial– the answer is multifactorial. Right now, the pandemic has kind of abated a bit. And now we have some cases that are starting to trickle in because of decreased in social isolation. So I would say at the beginning of the pandemic, the things that we needed the most, and if we do have a spike again, what we will need again, is going to be– our traveling nurses have gone home, so it’s going to be support staff again. It’s traveling nurses, respiratory therapists, IV pumps, IV machines, supplies to put into patients, medications.

We were short all of those. And if we do get a peak again, It will happen. But I will say that in addition to those things, one of the things that’s most needed in the Bronx are actually support services for patients that leave the hospital. So one of our biggest difficulties in making sure that our patient population– so just a side note, our patient population in the South Bronx is the poorest Congressional district in the United States. And so one of the things that our patients need desperately to keep healthy, once they leave, is social services.

And so we don’t have enough social workers, enough social supports for patients once they leave the hospital. And so they tend to fall through the cracks. So they may get discharged, but say they need antibiotics, or they need something else to go home, their insurance may not cover it, or they may not have proper insurance to get the medication, or they may need at-home nursing care, and they won’t be able to get that.

And so it’s kind of like a crack in the system, where we try our best, but then once we need to get you out of the hospital, we don’t have the things that you need outside of the hospital. And I think that’s really important.

IRA FLATOW: And we’ve been hearing a lot about that, that the lack of resources in these communities, once they leave. Dr. Anwar, do you see the same thing?

MUHAMMAD ANWAR: Yes, I would like to add that in the hospital, when you’re managing these patients of COVID-19, they’re getting proper antibiotics. They’re getting proper nutrition. But when they leave the hospital, the question arise about their nutrition, their diet, how it can be healthy, how their lifestyle can be healthy, so that they can recover quickly and get back to their normal routine. And hopefully, they cannot contract in future, or do not develop the complications of COVID-19.

So the resources, their social economic status, how we can improve their healthy lifestyle, and so that they can follow up with the proper primary care. A lot of our patients doesn’t even have a primary care, because they don’t have insurance. So how they can follow with the primary care for their medicines, for their refills, for their nutrition, for their social support. So after leaving the hospital, the follow up with the primary care, that has to be very important. And with this COVID-19 pandemic still there, it’s really hard to get a proper follow up for these patient.

IRA FLATOW: Let’s talk about your individual journeys as international doctors, getting to the Bronx. Dr. Anwar, let me begin with you first. What was it like? What did it take for you to get here and train in the US?

MUHAMMAD ANWAR: It’s a very long journey. I started– when I completed my medical in Pakistan, I realized that I have to go to US to do a residency. It’s a long way to come here. We have to take three exams– [INAUDIBLE] exams– that are very expensive. And when you convert the currency, foreign exchange, it’s so different. The US dollar, as compared to Pakistan, it is very different. So it’s a lot of money that you have to invest coming here, a lot of resources.

And then when you come here, that you apply for residency, you do volunteer work to build up your resume. It takes at least three to four years of hard work to get into what we all, international medical graduates, are in here. And then it’s not just getting into residency. It’s the whole lifestyle change from your own community. You’re coming from Pakistan, you’re coming from India, you’re coming from Caribbean. It’s the whole change in culture.

And you adopt this culture from your family members. And the residency is very, very tough. It’s hours and hours of work, intense work, not just physical and mental, but also emotional work. And you’re away from your family, your friends. You just migrated to somewhere else. And you’re getting into a system that’s totally new. So it takes a lot of time, effort, to just get into the residency. And then the whole residency, your three years, is a whole lot of, what I can say is difficult times that all of the international medical graduates face.

IRA FLATOW: I’m Ira Flatow. And this is Science Friday from WNYC Studios. And Dr. Lougheide, did you have a similar experience? Or was yours different?

QUINN LOUGHEIDE: It’s so expensive, but I would say the most stressful thing is the fact that that’s your only option. So in Trinidad in order to specialize, you have to either go to the US or the UK to become a specialist. And we don’t have specialists in Trinidad. We have a shortage of specialists. So there’s no training there. You have to come here to be specialized.

For us, it’s kind of like do or die. Like, if I don’t get it, I spent all this money, I spent all of this emotional energy, and then you fail, it’s like it’s one of the worst things ever. But to do it, it’s an amazing feat. But there’s also then the additional stress of everything else that comes after. So for instance, during medical school I was deported briefly.

I did two years of my clinical rotations in the US. And then I went to Canada for one of my friend’s weddings. And we have paperwork from immigration that says that we are doing medical school in the United States. And I was coming back through immigration. And they pulled me aside. They put me in a detention room, which was like a white room. And they just left me there, sitting, for like four hours.

When it became around the time where I would miss my flight, and I went up to them, and I had my paper in my hand. You’re not allowed to use your phone or electronics in this room, so I had no contact with my family or anybody. I was just off the radar. I went up to the immigration office, and I told them, hey, I’m a med student, like why am I being kept in his room? And he just told me, said go sit back down.

And I was so scared. By then, I was like, look, I’ve missed my flight. I don’t know why I’m here. I started to cry. He told me you overstayed your stay in the US. And I said, I would never overstay my stay in the US. Like, I have 100% not done that. He said, you did. I have your information in front of me. And I said, well, I have my information here too. And I have never overstayed. And I would never do that, because I just want to get through medical school.

And he said, well, I’m not allowing you back into the US. And I said, all of my stuff is in my apartment there, so what do you want me to do. And he said, do you have enough money to book a flight back to Trinidad? Then he said, I’ll give you five days stamped in your passport to go to New York, and pack up your apartment, and leave.

MUHAMMAD ANWAR: Wow.

QUINN LOUGHEIDE: So he let me out of detention. I got another flight. I called my family. I called my school to let them know what happened. My mom flew to New York. She met me. We packed up my apartment. I went back home. We got an immigration lawyer, who looked into my eye I-94s and stuff. And he was like, he doesn’t see anything wrong. I didn’t do anything wrong.

And my mom came back to the US, and actually stopped in immigration and asked them what, if anything, was wrong. And they said, we don’t see anything on her– on my documents that say that I overstayed or anything. But it is written here that he only gave her five days. So we would recommend that she stays in Trinidad for a few months until the air clears.

So I did stay in Trinidad for a few months. I graduated med school late. But that is the kind of like mental trauma that we live with on a daily basis. Like every time I leave the US, am I going to have trouble getting back in? So those kind of things really affect you mentally, just the fact that I’m always kind of afraid. Like when they were having the ICE raids, I knew that there were some Trinidadians who got picked up in that who were legal. And so I was like worried. Like those are things that are kind of just like a mental worry all the time.

MUHAMMAD ANWAR: Wow. My story is not that, but I like to add some part of it. Because my name start as Muhammad, so I was always, always, always picked up in immigration, and I was given into a primary. Then I’d go to a secondary, then I’d go to a tertiary. And there was a time when I was in Chicago going through my immigration. And the immigration officer was very nice, he was very nice.

But he said, oh, your name is Muhammad Anwar. People do really miss my middle name, Jahanzaib. Oh, your name is Muhammad Anwar. There is a terrorist with similar name. Let me just check if you are the one.

QUINN LOUGHEIDE: Oh, my gosh.

MUHAMMAD ANWAR: I was like OK.

QUINN LOUGHEIDE: Yeah.

MUHAMMAD ANWAR: He could have just run the check and not tell me that you’re telling me that I’m a terrorist, I probably be a terrorist.

QUINN LOUGHEIDE: Yeah.

MUHAMMAD ANWAR: We are here to serve the people of United States.

QUINN LOUGHEIDE: Yeah.

MUHAMMAD ANWAR: Our benefit is that we’re learning, but we are serving the community of United States. And I think being picked up as terrorist, or being picked up as someone who’s coming as illegal, or overstaying, is something that really hurts us.

QUINN LOUGHEIDE: Yeah.

IRA FLATOW: I don’t know what to say. I’ve never heard stories quite like that. And certainly, it’s not something that we residents of the US would ever think about, you know, when we go to another country, of being hassled like that. I want to thank both of you for taking time to be with us. And wishing you all good luck wherever you go and whatever you’re going to be working on. Thank you. Thank you very much.

MUHAMMAD ANWAR: Thank you so much.

QUINN LOUGHEIDE: Thanks Ira.

QUINN LOUGHEIDE: Thank you.

IRA FLATOW: Dr. Muhammad Jahanzaib Anwar is a postgraduate resident at Montefiore Medical Center, Wakefield Campus in the Bronx. Dr. Quinn Lougheide is just graduated from residency training at Lincoln Hospital, also in the South Bronx.

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