An opportunity to be grateful for? Exploring discourses about international medical graduates from India and Pakistan to the UK between 1960 and 1980.

INTRODUCTION: Following India and Pakistan gaining independence from British colonial rule, many doctors from these countries migrated to the UK and supported its fledgling National Health Service (NHS). Although this contribution is now widely celebrated, these doctors often faced hardship and hostility at the time and continue to face discrimination and racism in UK medical education. This study sought to examine discursive framings about Indian and Pakistani International Medical Graduates (IPIMGs) in the early period of their migration to the UK, between 1960 and 1980. METHODS: We assembled a textual archive of publications relating to IPIMGs in the UK during this time period in The BMJ. We employed critical discourse analysis to examine knowledge and power relations in these texts, drawing on postcolonialism through the contrapuntal approach developed by Edward Said. RESULTS: The dominant discourse in this archive was one of opportunity. This included the opportunity for training, which was not available to IPIMGs in an equitable way, the missed opportunity to frame IPIMGs as saviours of the NHS rather than 'cheap labour', and the opportunity these doctors were framed to be held by being in the 'superior' British system, for which they should be grateful. Notably, there was also an opportunity to oppose, as IPIMGs challenged notions of incompetence directed at them. CONCLUSION: As IPIMGs in the UK continue to face discrimination, we shed light on how their cultural positioning has been historically founded and engrained in the imagination of the British medical profession by examining discursive trends to uncover historical tensions and contradictions.

Fighting Prejudice and Absorbing Refugees From Nazism: The National Committee for the Resettlement of Foreign Physicians, 1939-1945.

In the 1930s and 1940s, the medical profession reacted with hostility and erected formidable barriers to refugee physicians from Nazi-dominated Europe who sought to practice medicine in the United States. Yet, refugee physicians ultimately succeeded, with 77% of them working as doctors by 1945 and 98.6% by 1947. Although physician skills are readily transferable, and the United States had a genuine need for doctors after World War II drew 55 000 physicians into the military, refugee physicians' success can be attributed to the courageous physician leaders who lobbied on their behalf and the creation of the National Committee for the Resettlement of Foreign Physicians-an organization that helped immigrant physicians pass licensing examinations, identify locations for employment, and overcome barriers to integration into American society.

Unfathomable Journey: The Context of Dr. Otto Walter's Departure from Australia.

Fifty years ago, erstwhile eminent Jewish physician Dr Otto Walter abandoned life in Australia to return to Austria, leaving his crestfallen young grandson, Garry, to wonder why he had gone. In this paper, the author explores the possible reasons for his grandfather's departure, weaving in aspects of Otto's extraordinary life, including the flight from Vienna after Kristallnacht (the German Reich's coordinated night of attacks on Jewish property), and the struggles to stay one step ahead of the Nazis in Europe. Otto was to settle in the British Mandate for Palestine (later Israel), before coming to Australia in 1949 on the Cyrenia­serving as ship's doctor for Jewish refugees. In Australia, the consummate medical skills that had proven life-saving for Otto's family, were not formally recognised, marking the end of a distinguished career.

The transformation of psychoanalysis in America: emigré analysts and the New York Psychoanalytic Society and institute, 1935-1961.

Part I reviews the role of the Emergency Committee on Relief and Immigration of the American Psychoanalytic Association, chaired by Lawrence Kubie and Bettina Warburg, members of the New York Psychoanalytic Society, in facilitating the immigration to the United States of scores of European analysts and candidates between 1938 and 1943. The challenges facing the committee are outlined in reports written by Kubie and Warburg. In particular, the intractable problem of how to integrate European lay analysts into the American Psychoanalytic Association was an ever present problem. Part II describes the impact emigré analysts had on the intellectual life of the New York Psychoanalytic Society and Institute, and considers how the psychoanalytic work of the emigrés was influenced by their move to America. The reminiscences of two emigré analysts, Peter Neubauer and Kurt R. Eissler, on their experience of coming to the United States close the paper.

Reflections on a heart surgery career with insights for Western-trained medical specialists in developing countries.

Herein, I describe my experience (spanning 40 years) in helping to develop the specialty of cardiovascular surgery in Syria. Especially in the early years, the challenges were daunting. We initially performed thoracic, vascular, and closed-heart operations while dealing with inadequate facilities, bureaucratic delays, and poorly qualified personnel. After our independent surgical center was established in early 1976, we performed 1 open-heart and 1 closed-heart procedure per day. Open-heart procedures evolved from the few and simple to the multiple and complex, and we solved difficulties as they arose. Today, our cardiac surgical center occupies an entire 6-floor building. We have 12 cardiac surgeons, 10 surgical residents, a formal 6-year surgical residency program, a pediatric cardiac unit, an annual caseload of 1,600, and plans to double our productivity in 2 years. The tribulations of establishing sophisticated surgical programs in a developing country are offset by the variety of clinicopathologic conditions that are encountered, and even more so by the psychological rewards of overcoming adversity and serving a population in need. This account may prove to be insightful for Western-trained physicians who seek to develop specialized medical care in emerging societies.

"Worse than being married": the exodus of British doctors from the National Health Service to Canada, c. 1955-75.

Despite a sizeable literature on the evolution of health insurance in Britain and Canada, there is virtually no research on the transnational migration of physicians between these countries in the immediate postwar period. This article hopes to address this neglected subject. Three inter-related topics will be examined. First, the paper will summarize the debate over physician emigration from the National Health Service (NHS) in postwar Britain. It will demonstrate how British social scientists and politicians began to come to grips with a major demographic exodus of British-trained doctors in the late 1950s and early 1960s. Second, it will analyze the changing health human resource situation in 1960s Canada, which focused, for practical and cultural reasons, on General Medical Council of Britain licensed practitioners. Third, through oral interviews of British-trained physicians who settled in Canada during the 1960s, it will examine the professional and personal reasons why physicians left Britain for Canada. It reveals that, among a myriad of personal issues that motivated a physician to leave the NHS, the inflexibility and hierarchical nature of British medicine loomed very large. The paper will conclude by reflecting on the contemporary significance of this fascinating historical phenomenon.

[Historical development of modern anatomical education in Japan].

The medical schools in the beginning of Meiji era were diverse both in the founders and in the way of education, frequently employing foreign teachers of various nationalities. In 1871, German teachers were appointed to organized medical education at the medical school of the university of Tokyo. The anatomical education in the school was conducted by German teachers, i.e. Miller (1871-1873), Dönitz (1873-1877), Gierke (1877-1880) and Disse (1880-1885), followed by Koganei who returned from the study in Germany. In 1882 (Meiji 15th), the general rule for medical school was enforced so that the medical schools were practically obliged to employ numbers of graduates of the university of Tokyo. In 1887 (Meiji 20th), the educational system was reformed so that many of the medical schools were closed, and the medical schools were integrated into one university, five national senior high schools and three prefectural ones in addition to four private ones. After that most of anatomical teachers were either graduates of the university of Tokyo or those who studied in the anatomical department of the university. Before 1877 (Meiji 10th), the anatomical books were mainly translated from English books, and foreign teachers of various nationality were employed in many medical schools in Japan. After 1877 (Meiji 10th), the anatomical books based on the lectures by German teachers at the university of Tokyo were published. The anatomical books after 1887 (Meiji 20th) were written based on German books, and the German anatomical terms were utilized. After 1905 (Meiji 38th), the original Japanese anatomical books appeared, employing international anatomical terms. At the first meeting of Japanese Association of Anatomists in 1893 (Meiji 26th), the Japanese anatomical teachers met together and most of them were graduates of the university of Tokyo or fellows of its anatomical department.

The 'Brain Drain' of physicians: historical antecedents to an ethical debate, c. 1960-79.

Many western industrialized countries are currently suffering from a crisis in health human resources, one that involves a debate over the recruitment and licensing of foreign-trained doctors and nurses. The intense public policy interest in foreign-trained medical personnel, however, is not new. During the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed to be national doctor and nursing 'shortages' in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will examine the historical antecedents to this ethical debate. It will trace the early articulation of the idea of a 'brain drain', one that emerged from the loss of NHS doctors to other western jurisdictions in the 1950s and 1960s. Only over time did the discussion turn to the 'manpower' losses of 'third world countries', but the inability to track physician migration, amongst other variables, muted any concerted ethical debate. By contrast, the last decade's literature has witnessed a dramatically different ethical framework, informed by globalization, the rise of South Africa as a source donor country, and the ongoing catastrophe of the AIDS epidemic. Unlike the literature of the early 1970s, recent scholarship has focussed on a new framework of global ethics.

International medical graduates: lessons from the past and hopes for the future.

The high levels of unemployment among international medical graduates (IMGs) in the UK and the skewed career structure of the NHS may stem from the 1930 withdrawal of General Medical Council recognition for Indian degrees forcing Indian colleges to align more closely with Western medical practices. From 2001 emigration to the UK surged just when UK medical schools were increasing their output. The result was severe unemployment among IMGs. The visa restrictions put in place to correct this make it difficult for IMGs to come to the UK even for short periods of experience. However, the Medical Training Initiative visa category offers an alternative and allows them the opportunity to gain up to two years' UK experience. The NHS has been in debt to IMGs and the countries that trained them since its inception. We must look for new ways to maintain international links and for the NHS to play a positive role in the global health economy.