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International Medical Graduates

Return to homecountry: Thoughts of an IMG mother

Abeera Mansur, MBBS, FACP
Lahore, Pakistan

"What has made you return?" we are asked incredulously, both in the U.S. and in Pakistan. Having stayed in the U.S. for around ten years, we had grown used to the system there and felt that this could be home too. Yet at the back of our minds was the feeling that we owed it to our parents and families and the people to come back and give it a try.

After having done my training in Internal Medicine, I did a sub-specialty fellowship in Nephrology. My husband trained in Gastroenterology. As we had always thought of returning to our country, we made sure that we saved enough for our transition period. During our visits back to Pakistan, we would always make it a point to meet physicians whom we had planned on working with in the future. In the meantime we cleared our Internal Medicine and subspecialty boards and obtained licenses just to ensure that if for any reason we had to come back to the U.S., we would have that option.

During our stay in the U.S. we had three children, a four year old boy, a girl who is two going on twenty, and an aggressive one year old. Our resolve to go back to Pakistan grew stronger after we had the children. We wanted to give them an environment where they felt that they were loved. With doting grandparents, aunts and cousins, they have no dearth of people who can take care of them. People who will babysit at the drop of a hat not because they are paid for it but because they love to. I may have to start a quota system in order to ensure that all my relatives get enough of my children.

Adjustment for them has been no problem. It has not been so easy for myself and my husband. In all honesty, there is no shortage of jobs, but these jobs don't even pay for your children's school tuition. Almost everyone in Pakistan has some form of private practice. Both my husband and I have taken up positions at two Trust Hospitals in addition to starting our own private practice. Trained in the U.S., you take for granted all the facilities that are available. One is surprised everyday by yet another something that isn't how it should be. You learn to become a nurse, a technician, a social worker and a pharmacist in addition to being a physician. Behind this apparent chaos is the obvious lack of resources that are needed in the development and maintenance of an infrastructure. In addition, one is faced with this poverty at the individual patient level, when people have to sell even their clothes in order to provide medical care to their loved ones.

Pakistan is a country of one hundred and forty million people. Most of them go to a physician only when they absolutely have to. Most of them have no access to a physician. The patients that we come across are perhaps the more fortunate ones as they live in a big city. The ones living in far off villages may not even make it to a local hospital, or if they do that hospital may not be equipped to deal with their problem.

It is a challenge in every way but I think we are making some headway even though it may be at a snail's pace.

In a city of seven million with only ten nephrologists, I have started campaigns for screening for renal diseases and patient education. We have started giving lectures to the general practitioners in order to better treat diabetes so that diabetic nephropathy could be delayed and also for the screening, prevention and treatment of hepatitis. In addition we are in the process of establishing a foundation for the relief of poor patients. The hearts of the Pakistanis are big, and we have been given many donations.

At present our time is spent on both academic and clinical activities. My husband and I are both faculty members of a new medical college. Both of us are dedicated to academic development in this country, which includes the teaching of medical students as well as residents. My husband has taken a very active role in the development of a curriculum for the medical school. In addition, he is on the advisory board of the Residency committee of one of the hospitals. In the future we aim to develop an environment which is conducive for research. We have many dreams and hope that some of them will be realized.

Brief bio:

Abeera Mansur is a graduate of the Punjab University, Pakistan. She did her residency in Internal Medicine at the State University of New York- Brooklyn and a fellowship in Nephrology from New York University. Following this she did another year of Immunology fellowship.

She is an Assistant Professor at Famita Memorial Hospital, Lahore, Pakistan. In addition she is a visiting consultant at Shalimar Hospital.

This article was prepared for the ACP IMG Web site in 2000.

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