1. Living and working 'in someone else's home': overseas-trained South Asian geriatricians reflections on their experiences in the UK health system Joanna Bornat, Leroi Henry, Parvati Raghuram 37th Annual Conference of the British Society of Gerontology, University of West of England, 4-6 September 2008

2. ‘In the initial days they filled the jobs when nobody else would take it. And they tried to copy the best leaders. And implement changes in their own patch like the best leaders had done. So there were geriatricians in hospitals where facilities were so poor I probably wouldn’t work in those even today. And so that’s one of the things that they went to the areas where local doctors didn’t go. And they filled those jobs where local doctors weren’t interested. It wasn’t that the local doctors didn’t get those jobs. They weren’t interested in those jobs’ (LO22).

3. Experiencing ‘home’: becoming a geriatrician encountering cultural differences with respect to age dealing with discrimination and racism

4. Ethnic origins of overseas trained Consultant Geriatricians 2004

5. Interviewees by country of origin

6. Interviewees by Deanery

7. Interviewees by age

8. Methods 60 oral history interviews with retired and serving geriatricians 30 Completed 23 Transcribed

9. Selection of informants Primarily recruited through British Geriatrics Society: Invitation letters Newsletter Personal contacts Searches of hospital and other websites Snowballing

10. Becoming a geriatrician Migration as an established pattern of medical training Professional life course constrained by post-colonial career development and by choice and opportunity Geriatrics not a first choice Strategies for upward progression Role of patronage and sponsorship Similarities with pioneer careers Architects of change

11. Because my consultant, who was exactly like me, I know him now, he was a trained cardiologist and then there were openings in geriatrics so he quickly moved into that area and he said ‘Look if you want to go through the fast track up then this is a less crowded road. You could do geriatrics and you could do cardiology and you could, it would be a good way up rather than waiting in the queue’. L0023

12. In that post I spent most of the time in the ward looking after the patients. Being totally committed to the patients and teaching. And making myself known by presenting cases to the various groups of meetings. I even published a paper I think – no I wasn’t published at that time, no. Whatever I could do locally to people to know me I made every effort. When most of the people might go home by five o clock I never went home until I see my last patient. I stayed back to see that (inaudible). And so one day one of the consultants turned up at about six thirty, seven in the evening and he saw me still doing the round and said ‘What are you doing there?’ ‘I’m finishing my patients. Still there are two more left’. He said ‘You are too dedicated’, he said, and the next year recommended me for a senior registrarship post to the professor. L0025

13. But when I came and I had said at the interview that my idea of practising geriatric medicine would be to provide a holistic sort of comprehensive service to the elderly. That means the acute; you know, plus rehabilitation, out patient, follow up, day hospital, everything. But including acute. So within ten months of me joining the department from an old fashioned department went straight to acute service from 1 st of December 1982, sorry, 1 st of October 1982. So it went total acute. And we started accepting all medical emergencies in the elderly

14. Cultural difference: age and ageing Assumptions as to veneration and filial piety Questioning universality Acknowledging contribution of context

15. The Asian or South Asian people it is tradition that they have to look up to their elderly parents, something like that. The reason is that in the local population the young people usually go where job is there leaving their elderly people in Walsall or the place of origin. Even with greatest aim or hope they cannot do the job because they are away. They cannot stay with their parents. But in Asian people elderly people usually stay with their children. Initially it is a bit strange that local people are avoiding their parents but gradually I got accustomed to the idea that this is the custom in this country… I thought that the people were very self centred initially. Then I gradually understood that it is socio- economic reason that they cannot. Even with the good wishes, or good aim, they cannot do the job.(L030)

16. Explaining discrimination and racism Experiencing discrimination as a geriatrician Experiencing everyday racism Excluding practices

17. Again I was supposed to look after the acute, rehabilitation, continuing care and five hospitals, running around seeing all these patients. During the hospital the prejudice against geriatric hospital is well entrenched here. Geriatricians are not considered as real consultants, or doctors even. You try to go and sit in the consultants’ dining room, you get ignored, (laughs)? …I am talking in 1986. You get completely ignored. You don’t know how to … partly I think it’s a complex reasons for that, one you are new. The other consultants they knew each other, they have been working here for a long time. Second you are an Asian, ok. And you haven’t got a lot of common subjects to talk to at that time. You knew very little of people. Even though you are a consultant sitting in the room. You don’t know the politics of the hospital (laughs) So there was many issues were there. (L025)

18. …the Catch 22 thing, I applied for a job, I was interviewed, in Midlands, West Midlands, in the interview room and thing and then the feedback I had was I could see my (loud noises from microphone) Mine was fifteen twenty minutes. I could see. Anyway, the feedback I had was ‘Well we thought you haven’t got enough geriatric experience. You need at least one year more or something, two years’. So I said ‘Fine’. I think it was a couple of weeks later or a few weeks later I was interviewed in the same room for a senior registrar job. I think there were four. I didn’t get the job. This time I was interviewed more like consultant interview. I was really grilled and I thought I had done very well. And then the feedback I had was it was the same person who said to me, ‘Oh I tell you what we said about you, we thought you were too good, you were too experienced. You ought to be consultant’. It was the same person…I was speechless… I thought it was pure racist…there was no other reason.

19. Conclusions A marginalised specialty provides a pathway for career progression Migrant doctors’ contribution to the development of the specialty Evidence of recruitment practices in NHS Cultural adjustments and compromises Multiple discriminations Role of racism and localism in determining opportunities