In Search of A Promised Land, the Burmese Medical Nomads

Comments: I am also a little bit disappointed with this word Nomads which means (according to Wiki)_
Nomadic people “those who let pasture herds”), are communities of people who move from one place to another, rather than settling permanently in one location. Most of the Myanmar doctors are not constantly moving from one place to another. We all have just migrated as expatriates abroad. Most of us are settled in one place.

An expatriate (in abbreviated form, expat) is a person temporarily or permanently residing in a country and culture other than that of the person’s upbringing or legal residence. In common usage, the term is often used in the context of pro…fessionals sent abroad by their companies, as opposed to locally hired staff (who can also be foreigners). The differentiation found in common usage usually comes down to socio-economic factors. There is no set definition and usage does vary depending on context and individual preferences and prejudices.

  1. So, skilled professionals working in another country are described as expatriates,
  2. whereas a manual labourer who has moved to another country to earn more money might be labelled an ‘immigrant’. ttp://en.wikipedia.org/wiki/Expatriates

But if you kindly allow me to correct the article; most of the Burmese doctors allowed to practice (after getting PR or Citizenships) are actually opening their own clinics or franchised or partnerships in the city centres of the main capital of Malaysia, Kuala Lumpur or other State Capitals but not in rural areas.

Source_ In Search of A Promised Land, the Burmese Medical Nomads taken and shared from  Than Naing Oo‘s Face Book.

Lately a few had raised interest and discussed about the immigration of Burmese medical professionals in our medical schools’ on line forum.  Coincidently, I wrote an article about this two years ago that was  published in the ” Annals of AMIM 2009″. Here is the article: In Search of A Promised Land – the Burmese Medical Nomads by Jivaka 

It was during one winter night last year that the thought really struck me. I was looking at the yearbook database of our class (1987, IM-1) which was prepared for our twentieth reunion. Based on the addresses listed, approximately eighty of my classmates (a whopping twenty five percents of the graduating class) were abroad in no less than thirteen different countries; a phenomenon not unique to our class. Why? Have we become the “medical nomads” or the “medical gypsies” of the early 21st century?  How about researching this exodus in a constructive manner which could then potentially shed some useful light if not solutions?

Historical Background

It used to be that our MBBS degree was widely recognized. But not any more. Partly because the world has changed and partly because of the short-sightedness of the former Burmese Socialist Program Party (BSPP) regimen that had made changes in our education system out of paranoia, megalomania and misplaced nationalism from 1964 onwards. For instance, Burmese Medical Graduates (BMGs) up to 1975 were able to register directly with the UK General Medical Council (GMC). Later graduates needed to pass the Professional and Linguistic Assessment Board (PLAB) exam before they were allowed to register with GMC. To be fair, that change also applied to many other medical schools in the rest of the world (e.g. India). But certain medical schools such as those in Hong Kong and Singapore are still recognized by the GMC up to the present day. For the USA, up to the early 60s, all you needed was to pass the Visa Qualifying Exam (VQE – which was the predecessor of FMGEMS and the present day USMLE) that could be taken at the US embassy in Burma.

But very few BMGs left the country till mid 60s despite such easy opportunities. Why would they? The working conditions at home were good, the hospitals were well- equipped, the training was reasonably at par with the rest of the world and the populace adored the medical profession as saviors of lives. On the other hand, following the army’s coup in 1962 which was followed by creation of the BSPP, many started to leave the country. But in the late 60s, the government clamped down on foreign departures.  Therefore from the 1970s to 1988 not many were able to leave the country.  Those who left the country were denounced as traitors. They were never allowed to visit Burma once they had left. Therefore only a few who had a very strong family support abroad or those who had the staunchest anti-BSPP sentiment left the country then. And all along the way during the next 26 years, the health care system and the hospitals continued to crumple in tandem with the rest of the country.

By the time we became housemen, only 60-70 out of the 550 doctors graduating per year ( from the three medical schools in the country) could get into the civil service government doctor jobs which provide an opportunity for further professional and post graduate (PG) training. And that whole selection process was rigged with bribery and nepotism. The rest were unemployed in a sense and just had to practice in small outpatient GP clinics utilizing cheaply imported medicines from the neighboring countries. At best they were practicing in the capacity of extended health care providers such as physician assistants. The morale was low and many altogether quit practicing medicine.

Then along came the 1988 uprisings and its accompanying sociopolitical changes. For a brief period rules were relaxed. Pseudo market economy was introduced. Foreign travel became easier. Expatriates were allowed to return for visits. With the advent of the technology, satellite news, computers and the internet, the populace had become more aware of what was happening in the outside world. All of those had led to the most recent wave of BMGs leaving the country. It became suddenly too easy to join the government civil service and unlike before, people were bribing to get out of government service than to get into it. Private hospitals popped up. But there are many downsides too. Many experienced senior physicians and faculty members left the country leaving a void so hard to fill in certain fields.

Finally, in the last six or seven years, the policy had turned around 180 degrees and doctors were not allowed to leave at all. At the same time, new medical schools were founded (University of Medicine, Magway and the Defense Services Institute of Medicine) though they have not been listed in the WHO directory. The intakes in each school were increased dramatically and the curriculum was shortened to a state unheard of anywhere in the world, leading to many more unhappy and unemployed doctors whose training was of questionable quality trapped in the country.

Findings

 1. Those that had pursued Biomedical Scientist Pathways

For BMGs, this is a lesser known route. What most did not realize is that , during our seven years of medical training, we learnt equal or adequate credits to earn a Bachelor degree in biomedical sciences based on our zoology, chemistry, biochemistry, physiology etc courses that we took. Therefore, with such credit hours and with a good score in Test of English as a Foreign Language (TOEFL) or International English Testing System ( IELTS), we can apply for admission to master level courses in those subjects at many English -speaking universities or even directly into a PhD program in some countries. During these courses, one may apply for graduate assistant posts to ease the financial burden. After the MS degree, one may find a job in the biomedical industry or may opt to study for PhD. This is followed by a 1-2 year of post-doc work before one decides to seek employment either in an academic setting or in private biomedical sectors. In academia, tenure posts are highly sought after. Most scientists take pride in eventually having one’s own lab where he leads a team of other graduate (i.e. MS or PhD) students while he teaches, publishes and tries to receive grants to fund his lab and personnel. It is a very alien idea from how we were trained and you really must have a passion to do this stuff for the rest of your life.

 2. Those that had pursued Public Health Pathway 

By the same token, a BMG can apply for enrollment in a Master level course in Public Health or Epidemiology at an overseas University. But finding an employment afterward is quite difficult especially if you plan to settle in the so called first world countries instead of planning to work in the third world countries (so called the fields), NGOs or UN agencies. It is a little easier if you have prior public health work experience and it is also dependent upon your communication and language skills. The employers are not expecting you to be a physician but rather to be an educator, team leader, policy maker who can teach present, debate and communicate. Basically one must be able to talk the talk and talk well.

But nowadays what most fresh BMGs do is using MPH courses as stepping stones to get an entry student visa and to buff up their CVs with thesis and publication. During the course, most simultaneously study for clinical qualification exams such as USMLE and then after graduation most try to transfer back to clinician training pathways. Or likewise in the scientist pathway, you have the option of continuing as a PhD student. United Nations Volunteer (UNV) jobs were more popular in the 80s and 90s. The job also involves providing some primary health care and is sort of a combined public health and clinician role in remote third world countries.

3. Those who had pursued Clinician Pathway and settled in different countries

AUSTRALIA

It used to be that entering the land of the kangaroos as a physician was extremely difficult unless you had a family related immigrant visa. Medical registration was tightly regulated too. But things had become easier since around 2000 as there had been a shortage of physicians in the rural areas. The body that sets the standards for registration is Australian Medical Council (AMC) http://www.amc.org.au/  which also holds the screening exams for the overseas trained doctors (OTDs). There are two types of medical registration, full (unconditional) and conditional. You can eventually receive a full registration after working for a certain period under supervision (a minimum twelve moths in a teaching hospital) with a conditional registration and passing the necessary exams at the end of the training period. 

To get a conditional registration, you need to pass the English proficiency test (Occupational English Test – OET), a written MCQ exam and the clinical exam.  If you have passed the exams and have found an employer, Department of immigration and citizenship (http://www.immi.gov.au/index.htm ) issues temporary visas (up to 4 years) for those with a conditional registration. Once you have a full registration, employers can also sponsor you for a permanent visa should they desire. Presently, most of the newly arrived enter Australia with visit visas and try to clear the AMC exams. Most of the newcomer BMGs are working in the rural countryside. Those who had arrived decades ago are mostly concentrated around urban metropolitan areas such as Sydney and Melbourne.  The beauty of Australia lies in the fact that while enjoying all the efficiencies of a western society, proximity to Asia makes it a lot easier to visit Burma whenever you feel homesick. Burmese Medical Association Australia (BMAA) http://www.geocities.com/bma_aust/   is based in Sydney. Following is a web link to an article in the journal “Australian Doctor” which provides a lot of useful information,  http://www.australiandoctor.com.au/news/e7/0c04d2e7.asp .

 JAMAICA

In theory, the Medical Council of Jamaica recognizes our MBBS degree to enter House Office (HO) training posts there and it actually was possible to do so till a few years ago. But the recent immigration rule changes in England have indirectly affected this. Jamaican Medical School is still being recognized by the GMC. As a result, most newly graduated Jamaican doctors used to go to UK leaving HO jobs in Jamaica to be filled by the overseas graduates. But UK changed their rules in early 2006 abolishing the permit free training visa category for the overseas physicians. Thus it required any non European Union (EU) citizens apply for work permits and suddenly the hospitals stopped hiring non-EU graduates. Therefore nowadays Jamaican graduates are filling their own HO positions making more difficult for overseas graduates to get those. 

Medical Officer (MO) positions (MO 1-4) follow the HO jobs. For an overseas graduate to advance to a MO job, then you will have to pass the Jamaican qualification exam. This requirement will be waived if you have already passed the British PLAB exam or the USMLE exam. After you have done a year or so of MO level jobs, you may either leave the training and set out to practice as a GP or you may try to get into their post graduate training scheme (a few more MO years) to become a specialist. Presently there are about 50-60 Burmese doctors working in Jamaica with quite a few being Jamaican system trained specialists. Recently, a Burmese Buddhist monastery with a resident abbot was established in the capital Kingston. For an excellent overview of working conditions and the useful contact addresses, please refer to http://careerfocus.bmj.com/cgi/content/full/324/7351/S188, an article from BMJ 2002; 324:S188

 SINGAPORE 

The Singapore Medical Council (SMC) (http://www.smc.gov.sg/html/SMC_Home.html ) governs the medical registration in the Lion City. Its rules over the years had been variable depending on the physician demand of the country. For the BMGs, the three relevant types of registration are Full, Conditional and Temporary. Full registration is self explanatory.  Burmese MBBS degree holders can apply for a Temporary registration provided you have identified an employer and you have passed the English exam. But it is site and period specific meaning that you can work only in that particular job for a specified period. BMGs with postgraduate degrees (such as MSc, FRCS, MRCP etc) and a prior job experience can apply for conditional registration but you still have to work under the supervision of a physician with a full registration. For a BMG to achieve full registration, he must have completed a specified period of service under conditional registration and must be supported by a good assessment report on the performance.

Previously, it was very hard for BMGs to find any clinical position in Singapore. But about ten years ago, Singapore opened many out-patient polyclinics and to staff those many overseas doctors were given temporary registration even without requiring to pass the English exam. But it is a one way registration needing periodic renewals. Thus the assessment letter from your supervisor is crucial in the extension of registration. Likewise about five years ago, the acute care hospitals had a shortage of junior doctors to provide service and such that so called clinical associate positions and temporary registration were given out relatively easily. But they are not training posts and don’t offer you a chance to progress. Even for ones with postgraduate degree holding conditional registrations, getting a full registration depends on the assessment report by the supervisor and supposedly a lot of subjectivity surrounds that process. Another dirty little secret is, for a given similar junior doctor position, the salary is less for non Singaporeans. And that is legal. Also recently, the Singapore Medical School had increased the number of its student intake and expecting more doctors of their own in the next few years.  Therefore the future of the BMGs at this point is a little uncertain especially for those with temporary registrations.

REPUBLIC OF SOUTH AFRICA (RSA)

It was a popular destination for BMGs in the early 90s since there was a severe shortage of physicians there. It was about that time when the apartheid fell and Nelson Mandela led black government came into power. Many expected civil unrest and fled the country which included doctors.  Therefore till around 1994, BMGs were able to apply for MO positions without any prerequisite screening exam and were able to get them quite easily especially in rural areas. Many were able to get into the training schemes later and had become South African (SA) trained specialists. But nowadays things had tightened up. You not only require to pass the SA Dental and Medical Professions Board Exam but also require a letter from the government’s Foreign Work Force Management Program (FWMP) on one’s employability and the need in RSA. In short, RSA is no longer putting out the welcome mat to the foreign doctors and no more BMGs were entering the country in the last couple of years. Most of those who arrived there in the early 90s had now left for Australia in the last five years.

 JAPAN

Japan is not an easy or a friendly country to receive clinical training. Far difficult is to get a license or practice clinical medicine afterwards even if you were fortunate enough to have received clinical training there. Japan has no shortage of clinicians and its licensing rules are one of the most discriminatory against foreign trained physicians. But where Japan shines is the relative ease of getting scholarships and financial support in its PhD programs. For Japanese doctors, even for clinicians, a post graduate training means getting a PhD degree. For the overseas doctors, most of the PhD courses are biomedical sciences though some could be pseudo-clinical. But even then, most of the times, the trainee spends time in clinical research, animal labs, didactics and very occasional observership in the hospital wards. A foreign doctor is not allowed to actively manage a patient in Japan, even as a trainee. You apply directly to the professors to be accepted as a PhD student but you still have to sit for and pass a universal PhD entrance exam where Japanese language proficiency is part of the assessment. Once accepted, most PhD students get one or the other forms of scholarships because of the mighty Yen and the affluence of the country as a whole. On the other hand, most overseas trained doctors leave Japan once they have completed their PhDs as there is no further job prospect except some rare instances in the fields of Pathology and Radiology since these don’t require direct patient contact.

 TAIWAN

It is probably the only medical market in the world where doctors trained in the Indian subcontinent have not been able to crack into.  BMGs that arrived at Taiwan before 1990 were able to sit for the Taiwanese license exam right away in a similar manner to the Taiwanese graduates. It is very similar to a USMLE exam though the questions are in Chinese. Once you have cleared this licensing exam, you can enter the residency and fellowship training which is again quite similar to the USA model. But for the foreign trained doctors who arrived at Taiwan later than 1990 have to pass a “PreTest” before they are allowed to sit for the actual License exam.  In the past, BMGs who hadn’t passed the PreTest were able to work unofficially as assistants to the fully licensed doctors in small private clinics. This is not possible anymore now. At the completion of the training, a doctor can apply for government sector jobs or work at private hospitals and clinics. Government doctor jobs are highly sought after since they are viewed prestigious and the benefits are excellent. National Health Insurance (NHI) was introduced in Taiwan around 1994 making health insurance available to every citizen. Hospitals and doctors are reimbursed by the NHI for the services they had rendered.

UNITED KINGDOM

The present atmosphere in the UK for BMGs is hostile at best especially for the newly arrived. It is with such a heavy heart that the author makes this kind of remark as he himself started his life abroad in this very England and had many fond memories there. For the longest time one could remember, UK was a natural choice for BMGs who wished to get further training and possibly migration. Our schools were modeled after them. Our professors were trained there.

The author himself left Burma in 1989 for UK. For the PLAB examinees, the British embassy in Yangon easily issued PLAB visas which could be extended up to two years while trying to clear the exam though you couldn’t legally hold any job during that period. Once one had cleared the PLAB (which was an extremely difficult task with a pass rate of 15-20 percent around the time the author took it), you receive a limited registration (license) from the GMC and can start applying for trainee house officer (HO) or senior house officer (SHO) posts. Also your PLAB visa is converted to a “permit free training status” which is good for 4 years with possible extension on a case by case consideration. During those four years, you work (and be trained) as a SHO or a registrar and try to finish the post grad exams like MRCP, FRCS etc. UK training was used to be more of one to one hands-on apprentice manner than a didactic well structured US style residency training. You learnt more from experience but also had more freedom to work unsupervised as frivolous malpractice law suits were uncommon.

All hospitals in UK were owned by the government (NHS), had HO and SHO training posts and all doctors were on salary. Hospitals provided living quarters. As there was no difference in salary between a brain surgeon and a shrink, people chose the specialties based on one’s interest and altruism than any monetary motive. But the problem was that fellowship level subspecialty training posts (senior registrars-SR) were so few and far in between since all the SRs were guaranteed consultancy afterwards. Therefore most overseas graduates leave the country after 3-5 years with a postgraduate degree (e.g. MRCP) under their belt though they can’t be considered as fully trained sub-specialists yet.

In the mid 90s, based on the Calman report, UK decided to increase their consultant workforce. More SR positions were created and many overseas graduates suddenly were able to get into the training scheme, becoming consultants later. By leaving for USA after the MRCP in 1993, the author himself like many during that time missed out this gold rush. On the other hand it was just the calm before the storm. All the other changes that followed were deleterious to the overseas graduates ever since. Firstly, with the creation of European Union (EU) many EU doctors arrived at UK as they do not need to sit for PLAB nor required British visas. Secondly, UK government decided to increase the number of its medical school entrants. Thirdly, England started to change and tried to copy the American style of medical training for better or worse. “Modernizing Medical Careers” scheme was introduced in the late 90s. HO and SHO posts were replaced with a two year foundation house officer posts after which you choose between the 5-6 years specialty registrar (StR) posts that lead to a consultancy or the three years GP registrar posts which lead to a Principal GP post. The selection process for the StR posts was named “Medical Training Application Services (MTAS)” which was again modeled after the National Resident Matching Program (NRMP) from USA. But the final nail in the coffin arrived in March of 2006 when Home Office made changes in visa and immigration rules. It abolished the “permit free training” category.  It means that for a non-EU doctor, even after one has passed the PLAB exam, unless the hospital applies a work permit for him, he can not be employed. All the IMGs including the BMGs were really hit hurt by those changes. Therefore with all the above turmoil presently, unless there is a drastic reversal of course, no BMGs should go to UK in author’s opinion. For an excellent review, please refer to the editorial in the BMJ 22 September 2007 issue, http://www.bmj.com/cgi/content/extract/335/7620/593 .

Since UK is such a small country, there really isn’t any area where practicing Burmese doctors are truly concentrated. All are spread out. Most established ones are either GPs or consultants or staff grades. In the last 1-2 years, very few new BMGs are arriving or surviving there.

 MALAYSIA

One peculiar finding in Malaysia is the presence of a large concentration of former Burmese medical school faculty members. Most had become faculty in the Malaysian Medical Schools. But for those who want to practice clinical medicine, Malaysian Medical Council recognizes our MBBS degree and in theory you are eligible to apply for a full registration. But finding a job is of another totally different matter. Those with a subspecialty training fare better. Others are working at smaller hospitals and clinics in mostly rural areas.

 UNITED STATES OF AMERICA:

Apart the very few exceptions, USA requires every FMG to pass USMLE and starts from the residency training year-1 regardless of your prior experience if one wants to be a clinician. There is an excellent slide show on the web pages of BMA-NA  http://www.bma-na.net/  and AMIMA http://www.amima.net/  offering advice to BMGs on how to successfully land a residency spot. If you don’t have an immigrant visa (i.e. a green card), the hospital (the residency program) can sponsor you for a J-1 or an H-1 visa depending on how desperately they need you.  Obviously stronger programs (i.e. university programs) are less willing to do so unless you have extra ordinary qualifications or scores. Research, including bench type is highly encouraged during the training. Most of the BMGs end up doing Medicine and related specialties as surgical specialties are harder to get into. Some continue 2-4 years of fellowship training in a chosen specialty after the three years internal medicine residency to become specialists.  Getting into a fellowship is similarly if not more competitive than getting into a residency. In general, surgical specialties and procedure rich medical sub-specialties offer better financial rewards. In any case, work hours in America are generally longer than the European counterparts.

One who has completed the residency training in any particular clinical medicine field is called an attending physician. They need no supervision in their daily practices. The attending physician may not be as prestigious looking as a UK consultant physician but has the similar autonomy. They call in consults to specialist attendings when they need help. Again, unlike Britain, many US hospitals have no house officers and the attending physicians and the nurses run the show. Most of the hospitals that have residency training are concentrated in the bigger and older cities such as New York City, Chicago and Philadelphia etc 

In US, majority of the health care facilities including the doctors’ offices are owned privately which bill the patient’s insurance company for the services they rendered. One beauty of the US system is, as long as you have fulfilled the licensing and training requirements, you don’t need an employer, at least in theory. You may set up your own practice at a street corner should you desire. In general, people with entrepreneurship tend to do better in the USA. On the other hand, because of such lack of central planning, physician distribution in the country is quite unequal and regulated mostly by the market forces. After residency, if one agrees to go and work in a designated physician shortage areas for 3-5 years, the rules allow employers to sponsor you for a green card. Many IMGs including this author obtained a green card by that route.

The largest concentrations of practicing and trainee Burmese physicians are located in New York City, Los Angeles, San Francisco Bay area, Chicago and Baltimore Washington DC areas though smaller numbers are spread out all over the country. BMA-NA, AMIMA, MAMES and BAMA are the Burmese physician associations in the USA although AMIMA is more global.

 Conclusion

I hope I succeeded in sketching a somewhat portrait of the Burmese medical diasporas in the various adopted lands. In most countries, circumstances determining the ease of immigration and job availability are often changing constantly, making it impossible to decide which one is the Promised Land at any given time. Unfortunately, the cliché phrase, “Timing is everything” is still quite so true. Everywhere the politicians and the native leaders of the organized medicine will chant the equal opportunity mantra time and again. Don’t be fooled by this sweet talking. A safe rule of thumb is, every country will look out for their own graduates over the IMGs at any time. But in all fairness, the author believes that USA despite its many shortfalls had the most consistent and transparent track record of accommodating the newcomers year after years. And of course a healthy dose of perseverance and hardworking is useful at anywhere. Be prepared for a harsh life during the first few years abroad. Keep a plan B in case things fall apart because of the factors beyond your control at the country of your first choice. Of course some of those advices don’t apply to ones who have already secured family related immigrant visas. 

Again, the author reiterates that the opinions in this article are of his own and personal and not intended to be used in a reference manner in any official or legal argument. Likewise, despite every effort to assure the accuracy, the reader should always consult the respective organizations and the immigration departments for the most up to date information. I also regret that I wasn’t informed enough to comment on certain countries such as Hong Kong, Brunei and Canada though a sizable Burmese medical Diaspora exist there.  Finally I had hoped that this article would be of some use to the newcomers or the would-be newcomers in finding the greenest pasture anywhere by understanding the trends that had shaped the events in the past and learning from the mistakes of people who had walked similar paths before them.

 

 

 

Please read my experience of being discriminated by many countries_

Xenophobia, Racial and Religious Discriminations blocking the private doctors’ Postings for the training everywhere

I had just copied few paragraphs below, to taste from the above posting.

Dr Thet Thet Soe had asked me, “I’d like to know whether there are any postings for clinical. I’ve passed MRCP Part 1 and want to get on-job-training there. Pl advice me how shall i proceed?”

Dear Dr Thet Thet Soe,

                                 In Malaysia and Singapore, as the members of the ASEAN, which is acting as a club for governments and neglect the citizens, Myanmar Government endorsed doctors only could get official postings to get on-job-training. Other Myanmar citizens need to attend the MSc in Medicine or relevant subjects to get the required, MRCP approved training in Malaysia. Singapore conveniently just ignores the ordinary Myanmar Doctors.

Similar practices are sadly practicing in most of the countries around the world, including the so called ‘democratic’ and ‘free’ UK.

Those governments had given various excuses to deny me the required training after I passed the MRCOG Part 1, held in Singapore. Although I had 10 yrs of experience, the MRCOG board recognized it as 2 slots of six months each only.  

(According to my Professors and Rectors, may be, they value the Demonstrator posts in Medical University.) MRCOG told me to get another year of training in OG proper. But I could not even get that proper training in Malaysia, Singapore and Myanmar.

Nowadays, as UK is under EU, they are freely allowing EU member doctors from poor former East Europe. All the other doctors must get the Immigration approval. In my POV (Point of View) his is also a form of an unfair DISCRIMINATION against other doctors coming from the whole world. This is not MARITOCRACY nor DEMOCRACY but EU CRAZY only.

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7 Responses to “In Search of A Promised Land, the Burmese Medical Nomads”

  1. PhingPhing Says:

    Wonderful ! This is a great story and good for my experience.Thank you for your sharing.

  2. Aye Myat Mon Says:

    Thank you so much, sir!! I have read this article during my student life but i didn’t think much.. Now, i am almost done with my house-surgeon period. As far as i decided, i will leave Burma.. Currently, i plan to go and work in Jamaica and from there i would like to join to America with USMLE. Could you kindly suggest me? I am really in need of information and help.. Thank you

  3. Phyo Paing Says:

    Very good article. It’s very helpful and motivational for exploring the history of Burma Medical society.

  4. medical forums Says:

    medical forums…

    […]In Search of A Promised Land, the Burmese Medical Nomads « Dr Ko Ko Gyi’s Blog[…]…

  5. mego gerges Says:

    thanks for helpful details, i have completed usmle with 99 scores and mrcp part 1 and 2 writing exam, i got job offer from governmental hospital in Singapore, my question is : is it enough to have MRCP part 1 and 2 writing exam ( without PACES yet ) for registration in medical council in Singapore ??? i appreciate reply to my question ,,,,,,thank you

  6. Rebuttal to the Racist Bama Buddhist attacking my fellow Muslim doctor cum Human Rights Activist | Dr. Abdul Rahman Zafrudin @ Ko Ko Gyi Says:

    […] In Search of A Promised Land, the Burmese Medical Nomads […]

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