Vivek Gumaste's Blog: Musings

V.Q.E: The Tale of an Indian Physician in the United Kingdom
of the 1980’s. Vivek Gumaste. Notion Press.com, Chennai 2018.
210pp, ` 299, ISBN: 978–1–64467–978–4.
This intriguingly titled, slim volume is a
slice from the life of Dr Vivek Gumaste,
currently working as a gastroenterologist
in the USA. It offers a glimpse into his
journey from being a newly minted doctor
in India to his final-chosen destination
overseas.
This is an unusual book in that its title
is an enigmatic acronym, which most
doctors of the current generation may not
be familiar with. In the 1980s, Indian
physicians aspiring to work in the USA
needed to pass the Visa Qualifying Examination (VQE), which
has now been replaced by the United States Medical Licensing
Examination (USMLE). To further compound matters, the Indian
government did not allow the examination to be held in India. The
only convenient centres for Indian doctors were Karachi, Manila
and London. Travel being expensive and the result of the
examination uncertain, Dr Gumaste decided to enter the UK
medical system by doing the Professional and Linguistics
Assessment Board (PLAB) examination, with his sights firmly set
on eventually making it to the USA.
This set the stage for the next 2 years and 6 months of which
this book is a recollection.
It is an unvarnished account of all that Dr Gumaste experienced
during his time in the UK. What strikes the reader instantly is the
remarkable honesty with which he has described this period in his
life. There are no euphemisms and no attempt to whitewash any
of the incidents that took place.
One needs to keep in mind that the author was only 26 years old
when he came to England and, by his own admission, abhorred all
things British. As going back to India without achieving his
ambition was not an option and working long term in the UK was
not acceptable, he was left with no choice but to take up a series
of temporary locum jobs all over Britain.
His first test came when he had to pass the PLAB which, in
addition to testing his medical knowledge, included a linguistic
component involving a comprehension of various British accents.
Fortunately, 3 weeks later, he was informed that he had passed!
This set the stage for his career in the UK as a locum physician,
working at temporary jobs sometimes as short as a weekend,
moving from place to place in search of work with the added
uncertainty that no work often meant nowhere to stay. We are also
introduced to Dr Gumaste’s perplexing dislike for geriatrics and
for rheumatology which he considered ‘unglamorous’ and nonchallenging.
Along the way, he met an entire ensemble cast of characters
including a 90-year-old lady in her hospital bed screaming ‘Blackie,
Blackie! I don’t want to be treated by Blackies,’ There was a Sri
Lankan doctor who changed his name from Dr Marianyagam to Dr
Marion to fit in with his British colleagues; Dr Tiruchirapalli
Krishnamachari who resisted being renamed Dr Chris by his
consultant and Dr Dutta, the Bengali consultant, married to a
British lady, who wore a bow tie and left no stone unturned to act
and sound British. His Indian origins asserted themselves at
mealtimes when he generously shared his stock of green chillies
with fellow diners.
There were many struggles in store for the author in England—
the weather which was always cold, the food which he found too
bland, the cubicle-like accommodation for young doctors, the
long working hours and the barely suppressed racism including a
terrifying encounter with skinheads on the London underground.
Commenting on the English system of healthcare, Dr Gumaste
highlights both the chaotic and haphazard career progression and
the invisible glass ceiling which kept many overseas doctors in
relatively junior positions.
The book also offers a glimpse into the major political events
of the time including the Falklands war, Margaret Thatcher’s
opposition to immigrants and Enoch Powell’s infamous speech
exhorting the need for ‘voluntary re-emigration’.
What shines through in this narrative is the author’s frankness
and honesty in providing an unvarnished account of his time in the
UK and his struggle to come to terms with his situation in every
way. It offers a rare glimpse into the lives of Indian doctors when
they moved overseas to greener pastures 40 years back.
It was Dr Gumaste’s sheer grit and single-mindedness of
purpose to achieve his goal of getting to the USA that saw him
through some difficult times. His story would serve as an inspiration
even today to young physicians to dream and to follow their
dreams.
Who should read this book? It would be primarily of interest
to Indian doctors, especially those aspiring to go abroad. It would
also attract older physicians who could reminisce about their time
in the UK. Physicians in Britain would do well to look back at how
the system of work and education in the National Health Service
has evolved over time. For the sake of the lay reader, Dr Gumaste
has given explanations of medical terms and procedures although
this would be superfluous for the medical reader.
With 210 pages, the book is a handy and easy-to-carry memoir.
The typeface is clear, and the material is chronologically arranged.
This book awaits a sequel chronicling Dr Gumaste’s initial
experiences in the USA after he made it there. Maybe ‘Life after
VQE.’?
VIVEK ARYA
Department of Rheumatology
Ladywell Building
North Devon District Hosptial
Barnstaple
EX31 4JB
UK

Book Extract
Title: V.Q.E: The Tale of an Indian Physician in the United Kingdom of the 1980’s
Paperback: 224 pages
Printed: IngramSpark
ISBN: 978-1-64467-978-4 (sc)
ISBN:978-1-64467-854-1 (ebook)
Price: $7.99; $2.99 (kindle)
Author: Vivek Gumaste

He was tall, easily over 6 feet, distinguished looking and some would say even handsome for his age. Clad in a gray suit under a physician’s white coat he was busy demonstrating the cruel effects of rheumatoid arthritis on the proximal interphalangeal joint (the joint closest to the base of your finger) when I stumbled in to join the rounds, already a few minutes late and still dazed from the weekend call.
He broke off his sentence in mid-stream, turned to me with a benevolent smile and asked politely, “Where are you from, sir?”
“Epping,” I blurted out without realizing the incongruity of such a response coming as it were from a brown-skinned Indian or Asian house officer.
He froze paused for a moment, the irritation clearly showing on his face, and then persisted., “I mean originally,” he persisted.
“From India.” I said.
It was the 1980s, the world was still relatively insular and I suppose the English consultant could be excused for his pattern of questioning which was obviously prompted by the color of my skin. However 30 years later despite a vastly changed global environment, diehard British attitudes like this appear not to have changed. Even if you have been born and brought up in Britain and know no other land other than Britain and no other language other than English, you are still subject to uncomfortable questioning because of your color, as this excerpt from an article titled, “Tired of being asked where I am from” by Ariane Sherine which appeared in The Guardian in March 2010 (nearly 30 years after my experiences in the UK) indicates:
“So here’s a ready-made answer for the overly curious. Last weekend, I had The Conversation for the 3,897th time — and this time, it took place in central London just two roads away from the hospital where I was born. As usual, it went like this:
Stranger: Where are you from? (Translation: You look a bit brown. Why are you brown?)
Me: London.
Stranger: No, where are you really from? (Translation: You are clearly telling me untruths. Brown people do not come from London.)
Me: London.
Stranger (exasperated): No, where are your parents from? (Translation: Now you’re just being obtuse.)
Me: Africa and America.
Stranger (confused): Erm...so where are your family from, like, back in the day? (Translation: People who come from Africa and America do not look like you.)
Me: Iran, India, Africa, America and England.
Stranger (relieved): India and Iran! Do you ever go back?
At this point, I have to explain that it’s hard to go back to somewhere you have never been. I’ve lived in London since I was a zygote, have a London accent and don’t speak any languages except English — yet just because I’m cashew-coloured, I’m often questioned about my heritage. “
Despite this awkward introduction, my subsequent interaction with Dr Howard-Williams, that was the consultant’s name, was without incident. Dr Howard-Williams was a kindly gentleman who spoke in a soft polite tone that exuded genuine empathy. He had a special interest in rheumatology or joint diseases. Accordingly, his ward consisted of mostly patients with joint diseases. The burden of arthritis in the UK is enormous and imposes a hefty strain on society. Arthritis is in fact the most common cause among people receiving Disability Living Allowance (DLA) in the UK. No wonder rheumatology, unlike in India was an important subject and a distinct specialty.
My exposure to joint diseases during my training in India was limited. Arthritis in India was not a common medical student topic as in the UK and the chronic nature of the diseases made it an item of less priority; infectious diseases and other life-threatening disorders took precedence. Rheumatology was a little bit of a novelty for me and I found the rounds fairly interesting. I would be less than honest if I used any other term stronger than that to describe my feelings for this field. Rheumatology by nature was pedestrian, not glamorous like cardiology or cardiac surgery and even less exciting than specialties that concentrated on the digestive system or lung problems.
Nevertheless, Dr Howard-Williams was a good teacher and I learnt a lot from him in those two weeks that I spent on his unit. Specifically, I learnt how to differentiate between rheumatoid arthritis and osteoarthritis, the two main commonly encountered joint problems.
Dr Williams was the epitome of English punctuality. He started rounds exactly at 9 a.m. and was very particular that every member of his team be there on time. The team itself consisted of three other physicians apart from me. There was Tom Waitman, the senior registrar who appeared perpetually tired and had good reason to be. He was nearly 40 years old, with thinking hair, and was yet to land a consultant position. All his energy was consumed in looking for one. He was the friendliest of the lot and one who came across as truly good at heart.
Nice is not a word that I would use to describe the other two: civil, but definitely not nice. Next in the hierarchy was John Smith, the registrar, a red-haired Englishman with a goatee who was extremely uptight on rounds but who did loosen up once Dr Williams had left the scene. He had been to India once and made it a point to comment on the inefficiency and corruptness of the Indian bureaucracy whenever he got a chance. The last member of the team was Mindy Turcot the SHO who constantly peered at me through large thick glasses, was physically on the heavy side and did not stand out as being particularly knowledgeable with regard to medicine.
Rounds usually lasted for about three hours but on some days could go on for four to five hours with a break for lunch between two sessions. Rounds were not confined to medical topics and frequently the conversation veered to include local issues and international politics. Without such distractions, rounds can become unbearable especially towards the fag end.
Dr Williams, like many English consultants, was a frequent visitor in a professional capacity to many of Britain’s former colonies. Libya’s Muammar Al-Gaddafi was at the height of his eccentricity in the 80s and Dr Williams had just returned from a trip to Libya. He spent a good half hour one day recalling his recent visit there, regaling us with details of camel jaunts into the desert and telling us of how he had made his displeasure explicitly known to his local contacts with regard to Gaddafi’s wayward ways, in particular his repressive policies.
Post-rounds banter was also interesting, sometimes even more interesting than the rounds themselves. Juicy tidbits surfaced that could not be voiced on rounds. It was a free-for-all. No topic or individual was off limits. A gossip piece doing the rounds was that Dr Williams had just married someone 20 years his junior and was desperately trying to keep in shape to match her age. Whether this was true or not I never really was able to confirm. Sexual peccadilloes of junior doctors and nurses were another staple item with specific events often being described in great detail and with relish.

Extract from book My India : Musings of a Patriot (kindle edition Re 49 Amazon. in)

It is ironical that this left liberal secular lobby which effectively suppressed the nationalist voice by shutting it out of the English language media for over 50 years should raise a hue and cry about freedom of speech. This writer who has been writing for over 30 years has personal experience in this regard.
Editorial prerogative has been used as an excuse to deny nationalist advocates a space. Recently Rajiv Malhotra, a scholarly nationalist champion- not a rabid hate monger, was denied a right to respond when concocted and exaggerated charges of plagiarism against him were freely circulated in Indian English language publications.
Malini Parthasarty, editor the Hindu wrote this in reply to Rajiv Malhotra’s request: “The newspaper’s right to exercise its own judgment on the need to give space to a self-proclaimed impugned party, must be protected especially in a climate where frenzy is building up on social media virtually dictating an agenda of political and cultural priorities to the media, demanding compliance. We must be careful not to feed into this frenzy or to legitimise it in any way,”
In her book, this dictum however is only applicable to the ‘other side.’ (pp 240)