Dr. Imran Yousaf- doctor to doctors

Obituaries are one of the most popular sections of the British Medical Journal. One presumes that this is because they are one of the few places in a journal, the raison d’etre of which is furthering the advancement of scientific medicine, where one can find a doctor with a face, a life of flesh and blood, and occasionally, courage.

P.W.J. Bartrip, in his Mirror of Medicine- the History of the BMJ (BMJ, London and Clarendon Press, Oxford, 1990) describes the journal as the social face of the medical profession, focussing on its long history of engaging with reform and politics. Much of this is true, because that is precisely what sets the fairness and social sensitivity of the British pioneers- the Lancet and the BMJ, apart from the often contrived political correctness of the American journals.

And that is why it is surprising that an obituary to Dr. Yousaf has not been forthcoming in the journal. And there’s only so much one can wait.

Dr. Yousaf came to wider attention at the height of the Highly Skilled Migrant and International Medical Graduate (IMG) crisis in 2006. He was the face of a legal challenge launched by the British Association of Physicians of Indian Origin (BAPIO) against the Blair government’s decision to abolish the (Work) Permit free Training visas for overseas doctors in post-graduate training. Under the new rules, IMGs had to seek a work permit under a labour market test that legally prioritized U.K/ E.U graduates over them. Those already in the system were offered an attractive option- entry into the points based Highly Skilled Migrant Programme (HSMP), a fast-tracked route to citizenship, provided they made the cut at 60 points. This would allow the doctors already in the system to complete their training within the National Health Service (NHS) on equal terms.

But what of Post-PLAB unemployed doctors like Dr. Yousaf, who had come to the U.K earlier, at a time when the Department of Health (DoH), and the General Medical Council (GMC), aided by the British Council, were facilitating the assessment/recruitment of overseas doctors in their countries of origin at a frenetic pace? This recruitment had been conducted under the publicized framework of an Equal Opportunities Recruitment Policy. Despite investing much time and money (under a staggering exchange rate) in the U.K, many of these doctors were still unemployed i.e. they had not yet been able to enter post-graduate training.

They would have to return, said the DoH and the Home Office. And many of their overseas colleagues eligible for the HSMP scheme, by now secure in the belief that their bases were covered, concurred, albeit reluctantly. Never mind that the PPUDs faced personal and financial ruin.

However, BAPIO had other ideas; and were publicly (though always not privately) supported by many of the Medical Royal Colleges representing traditional ‘shortage specialties’. Demonstrations, television interviews and negotiations ensued, culminating in the legal challenge before the High Court. But they needed an applicant for the challenge, a doctor who was willing to stick his neck out and more, someone who was willing to deal with the potentially catastrophic fallout confrontation with the established order could bring onto his professional prospects.

And in Imran Yousaf they found their man. And as Dr. Ramesh Mehta, President of BAPIO said, “Being unemployed and still looking for work, going up against the Government was a very brave thing to do."

I didn’t know Imran personally, and that obviously limits this obituary. He must have arrived in the U.K in the winter of 2004-5, shortly after saying farewell to his family in their village outside Lahore. He must have been overjoyed when he passed the clinical Part 2 of the PLAB Test. Post-graduate training and a career in his chosen specialty, beckoned. He must have applied for posts all over the country. He might have been short listed for some posts and attended interviews. And somewhere along the way, he acquired a label; he became a Post-PLAB Unemployed Doctor (PPUD). And though this may have brought with it a peculiar indignity, it might also have brought with it a certain resilient strength, the camaraderie of a professional underclass.

As time passed, money would have grown short. He’d have borrowed, first from family (The Independent mentions that he’d used up his family’s entire savings), then friends, then acquaintances, then anybody. However, this did nothing to deter his determination, and he managed to pass Part 1 of the Membership of the Royal College of Physicians (MRCP), a difficult exam even under ordinary circumstances.

And then the Government pulled two jokers out of the visa pack. Despite the NHS website clearly guaranteeing Equal Opportunities employment to HSMP holders (30 % of consultants in the NHS are overseas doctors), the DoH postponed, and then declined clarifying the obvious; that this applied to HSMP holders applying for post-graduate training within it. Next, the HSMP scheme was revised in November 2006, with retrospective effect. That is, migrants who had been welcomed into the U.K under the HSMP scheme were informed that when their visas came up for renewal, they would have to meet a new, higher cut-off of 75 points. In addition, most of the original points categories viz. past experience, partner’s qualifications, exceptional academic achievement etc. would be deleted wholesale. Entire families transplanted to the U.K faced imminent evacuation; professional, financial and personal ruin.

Almost overnight, The Imran-BAPIO appeal at the High Court held pressing relevance for the previously disinclined HSMP doctors and the wider circle of professionals under the HSMP scheme. And this included professional migrants from places as far afield as New Zealand and Russia, and Nigeria and Brazil. This pleasant, fresh faced 28 year old now held international relevance, and in an ironic twist, had also become an unwitting symbol of subcontinental diasporic unity.

It was December 2006. Imran was now, according to peer reports, almost 13,000 £ in debt, relatively little in the U.K, but a fortune in Pakistan. Unable to pay the rent for his Burnley flat share, he was reduced to sleeping out the winter on the floor of a pizza shop. Increasingly depressed and indebted, friends became worried about him. A fellow doctor invited him to stay with him in Bedford. He could sleep in a local GP’s surgery.

On the night of 19th January, he found himself alone in the surgery. He was penniless and cold, possibly hungry. The verdict on his joint appeal with BAPIO had been postponed to February. He’d recently applied for yet another extension to his visitor’s visa. He’d received a reply from the Home Office earlier that day. His application had been rejected. Was this the price of him living the Hippocratic oath in letter and spirit , and sticking his neck out so remarkably far for his colleagues?

He was found hanging the next day. Although he left no note, beside him was the letter from the Home Office saying there would be no further extensions on his visa.

Ladies and gentlemen, take a bow. Before Imran Yousaf, doctor of courage.