Random reflections of a first generation immigrant doctor
My first impression of Britain was not a very pleasant one – the immigration officer who dealt with me in Heathrow , tried his best to make my entry difficult by finding some loophole in my story as to why I was coming to Britain – for postgraduate medical training - and when he had to concede that I was entitled to be admitted, he stamped my passport with reluctance muttering ‘now get the hell out of here‘ as he did. Not quite the welcome I had hoped for, admittedly. The weather on the day was equally unwelcoming, dark and gloomy, with a steady drizzle, but it was more or less what I had expected, so I was not disappointed. After all, no one comes to Britain for the weather. My intention had been to stay for about two or three years, get my post graduate qualifications and return to Sri Lanka to practice my newly enhanced clinical skills. Fate had other plans for me and my family, and I have now lived in Britain for 42 years, bar two when I did go back to Sri Lanka briefly, before returning to Britain to resume my career here. Life for me has been mostly pleasant, despite some enforced changes in career plans and the occasional encounter with racism. Although Britain has seen some major changes in this time, the basic fundamentals of decency and respect for law and order still prevail and it remains one of the best places in the world to live in.
I have chosen a few subjects to comment on – the choice may seem somewhat random, or quirky even – but they may strike a chord with many of my friends. The choice is inevitably influenced by the fact that the audience consists of retired or semi-retired doctors of Sri Lankan origin like me.
Which Lingo ?
If, like me , you have been watching the new game on ITV, Lingo , you may have noticed the number of first generation BAME who participate in it and perform very well. Their fluency in English is remarkable , despite the fact for most of them, it was their second language. As Sri Lankans, we would probably fare well in this game, as the standard of English in our schools was indisputably high, and most of us sailed through easily in the English test component of the PLAB test. I have worked in over 25 hospitals in England and Wales in my NHS career, spanning over 40 years, and have often been complimented on how good my English was. (Such compliments were often accompanied by the comment’ hope you don’t mind my saying so, but …’, as it is considered rude to make such personal comments). One comment that amused me was when a nursing colleague said to me ‘ I wish my Spanish was as good as your English’. Perhaps she was unaware of the fact that English was widely used in Sri Lanka, thanks to our colonial history, where as her knowledge of Spanish was what she had learnt from her holidays in the Costa del Sol.
Another aspect of the use of language that has always struck me, is that most of my Sri Lankan friends would always speak in English to each other, when there was an English colleague present in the group. I had always been proud of this, until I had an unpleasant experience on a train journey from London Waterloo to Southampton where I was living at the time. There was a group of us, all Sri Lankan doctors, discussing the proceedings of the conference we had just attended, and the conversation was entirely in English, partly because there were both Tamils and Sinhalese in the group. There were a couple of skinhead types, standing a few feet away, who had overheard our conversations. One of them said to the other ‘these buggers are talking to each other in English’, something that seemed to surprise him. His friend, who did not seem too impressed by this, remarked’ Because they have been living here for damn too long‘. I had overheard his comment, and could not help glancing at him, but he glared menacingly at me, challenging me to react, which of course I did not. So, you can’t win them all!
How racist is Britain today ?
Much has been written in the past few months on the subject of racism in the USA, and many column inches have been expended on racism closer home. The trigger for this amount of attention was the gruesome killing of George Floyd in Minneapolis, which resulted in a revival of the Black Lives Matter movement. Massive protest marches were held in major cities the world over. In Bristol, the statue of Edward Colston, a notorious slave trader, was toppled from its pedestal by an angry mob and dragged into Bristol harbour where it lay for weeks before being removed by the council. Even the statue of Winston Churchill in parliament square was daubed with graffiti. While it a historical truth that racism was an integral feature of Colonial Britain, as it was considered essential to keep their subjects in their place, is modern Britain just as racist ? I would like to consider this question from different perspectives.
Like many others of a similar background as mine, I have encountered casual racism in different forms. Most job interviews I have attended in Britain over the years, invariably resulted in the appointment of a white candidate ostensibly because ‘ his/her training was of a higher quality and his/her credentials were more suited to the post’. Asian and black doctors at the time were appointed as consultants in less popular specialties like geriatrics, psychiatry and venereology which local candidates generally spurned. However, matters have improved hugely for second generation BAME doctors, as they have all been trained locally to the same standards. Thus, they are now appointed to mainstream specialties, like general medicine, general surgery, cardiology, neurology and the like.
I have encountered overt racism on only a couple of occasions when someone shouted the P.. word at me on a London street. Twice in 40 years is no big deal and I have never been the victim of a physical attack. Perhaps I was lucky not to be in the wrong place at the wrong time. Overall, I think the situation vis a vis race relations is much better now. Extreme right organisations like the National Front and the British National Party who were in the ascendant in the seventies, have been pushed to the extreme fringe now and their membership is fast shrinking. Admittedly, there was a spike in the incidence of racist incidents soon after the Brexit referendum in June 2016, but this subsided quickly when the perpetrators realised that the vote would have no impact on the numbers of ethnic minority population, who were here to stay and had no intention of leaving the UK ! The British public has become accustomed to seeing brown or black faces in their neighbourhood, and in many instances their doctor, corner shop owner, lawyer, dentist or the petrol station staff is very often from a BAME background. Equality laws, which prohibit discrimination on the basis of race, religion, disability, which are now enshrined in the statute books or sexuality, have helped to reduce overt discrimination in most settings. I am not, for a moment , claiming that racism does not exist in Britain any more, as the attitude of not trusting ‘Johnny Foreigner’ will not totally disappear for a very long time. However, the basic belief that most of the native population have in justice and fair play, is why I firmly believe that Britain is a great place to live in, as I said at the beginning.
My son / daughter, the doctor …
In post-independence SriLanka, the three top professions that the young people were encouraged to aspire to, were medicine, engineering and accountancy. Anything else, like law and civil service was considered next best. The top three professions were considered safe options, with guaranteed decent incomes, job security and good pensions. (I will gloss over the marketability in the dowry stakes !) Medicine, which was considered a noble profession in which there was the added satisfaction of being able to help people directly, probably still tops the table. Incidentally, does anyone know of any other country in the world where engineers have assigned themselves the prefix Er – why should doctors have a monopoly on prefixes - another first for the mother country. Naturally, competition to enter these three professions was fierce, with all aspirants shepherded between tuition classes to ensure they obtained high grades in Advance Level that were an essential requirement for university entry. Even today, the situation as far as Sri Lanka is concerned, has not changed much, except that with a thriving mercantile sector after the economic liberalisation initiated by JRJ, openings there are also much sought after now.
It is probably not surprising that the offspring of immigrant doctors often chose to follow their parents into medical careers, a trend seen the world over in all careers and professions. I have lost count of the number of occasions when well-meaning friends have asked me why I had not guided my two daughters into medical careers, almost as if I had somehow failed them in that respect. The fact that they both have successful careers, one in law and the other in the civil service, much to my satisfaction somehow seems to baffle these friends. I am also aware of some instances where some children who had been nudged into medical careers, in which they were not very happy, and on occasion have even changed careers into law, finance or the arts etc. The arts were not a career choice many Sri Lankan parents encouraged their children into, but I am delighted to see that this is changing and many second generation Sri Lankans, like Romesh Ranganathan, Nihal Arthanayake, Shyama Perera, George Alagiah, and James Coomaraswamy, to name but a few, have made a mark on TV and other media.
Interestingly, even amongst the Caucasians, a medical career is held in high regard, but a degree in PPE at Oxford or Cambridge, followed by a glittering career in politics or the world of finance – notably actuarial careers or hedge fund management- is also highly sought after. A recent BMJ carries the results of a You Gov survey of 22,000 people in 16 countries, which found that a career in science was the top career choice followed closely by medicine . Probably a result of the publicity given to Dr. Chris Whitty, Prof. Jonathan van Tam, Dr. Patrick Vallance, amongst others !
I will end by reiterating that this is only a snapshot of life in Britain by a first generation Sri Lankan doctor in his dotage. Undoubtedly, there are many other aspects of life that I could have commented on, but space does not permit me to do so. Maybe another time.