Reflections of a UK-based Indian doctor on promoting Indo–UK health collaboration
[To cite: Madhok R. Reflections of a UK-based Indian doctor on promoting Indo–UK health collaboration. Natl Med J India 2023;36:192. DOI: 10.25259/NMJI_485_2022]
You can take a person out of India, but you cannot take India out of the person; hence, many doctors who move abroad to work explore ways of giving back. For what it is worth, I wish to share the story of what I did and learnt.
Like many in my generation, I could not wait to leave India (sic) and did so as soon as I graduated from Maulana Azad Medical College, Delhi in 1980. The two most popular destinations were the UK and the USA, with the first often being the stepping stone for the latter, usually due to difficulties in getting the visa for the USA. Many people did not like the challenges facing overseas doctors in the National Health Service (NHS) in the UK. To a large extent, this trend has continued, and India continues to supply the medical workforce globally. After the initial struggles in the NHS and as soon as I was able to, I started thinking about ways to use my position for the betterment of both health systems. As I finish my active professional life after over 40 years in the UK, what can I share that may be of some help to those considering similar journeys?
To pack four decades here is challenging and so you may want to see a report where I have described my work to promote Indo–UK collaboration for health systems capacity building (www.ramareflections.com/pdfs/Lage-Raho-MunnaBhai.pdf). In essence, I used all my positions—whether jobrelated or additional such as when I was Chairman of the British Association of Physicians of Indian Origin or on the General Medical Council—to try and form links on education, research or clinical services. I followed health developments in India closely and made frequent visits there (before the Zoom days when physical travel was needed) to explore ways to add value by engaging with various organizations in India, ranging from the government to the private and voluntary sectors.
So, what are some important lessons that I learnt? One, be clear about what you want to focus on—whether on a single issue in depth or more widely; I chose the latter, working on a range of issues, which meant that it was hard to make inroads. Two, suspend all judgements about India—it is a country of contrasts, where the best and the worst co-exist, impressing and appalling in equal measure. Three, as all societies, India has its unique ways of working—how things are done is still a mystery to me, and as the saying goes when in Rome do as the Romans do, one has to respect the local traditions and methods. Four, despite or rather for these reasons, be clear about your ‘red-lines’, i.e. the things that you would not do. For example, from a western professional perspective, many practices in India can be a challenge for outsiders including commercialism and corruption in various guises and one needs to be mindful of these. Five, do not fixate on outcomes at the beginning, make a start and let things evolve over time—one cannot go with a rigid time-tabled action plan; hence, be flexible. Six, do not try and control things from a distance; instead, rely on local people and their expertise (some of my medical heroes are from India), helping them as you can but letting them do the ‘doing’ and trusting them. Seven, embark on such work only if you truly believe in it. It would not be easy but it will be rewarding. I feel that I got more out of the alliances I formed than I was able to give back.
Although pleased that I made some difference in small ways, I wish I had done more; the disturbing reports from India during the acute phase of the Covid-19 pandemic made me sad.1
We need to recognize that health is now truly global—it is more a case of intra- rather than inter-country differences in how health problems are addressed. Hence, we need to learn and work in an international context. India in this sense provides a wonderful opportunity as it is both—the problem with its poor health indices and the solution with its untapped potential. In my youth the advice was ‘Go West’ but now a days I would urge younger doctors to ‘Go East’—you won’t regret time spent in India!
NOTE: My thanks to all those people who helped me over the years.
About the author
Rajan Madhok is a public health doctor and lives in North Wales, UK. For his background and details of current work see www.ramareflections.com/