Education and Employment of Nepali Doctors and Nurses

- Dr Chandra Laksamba

This article is about the employment and social mobility of Nepali doctors, nurses, and their children in the UK. It mainly explores past and present trends and highlights possible future directions. Hence, the article is more descriptive than analytical

The presence of Nepali doctors in the UK can be traced back to the early 1950s. Nepali doctors came to the UK mainly to pursue higher medical degrees such as: Fellow of Royal College of Surgeons (FRCS), Member of the Royal College of Physicians (MRCP), Member of the Royal College of Pathologists (MRCPath), Member of the Royal College of Obstetricians and Gynaecologists (MRCOG), Fellow of Royal College of Anaesthetists (FRCAS), Member of Royal College of Psychiatrists (MRCPsych), Member of the Royal College of General Practitioners (MRCGP), and so on. MRCP, FRCS, FRCAS, MRCOG, MRCPsych, MRCPath, MRCGP are UK postgraduate diplomas which require sitting an examination. By contrast, Fellowships, for instance FRCP, FRCOG, FRCGP, FRCPsych, and FRCPath, are honorary diplomas which are generally awarded after working several years in the respective field of medicine without having to sit for any exam.

Drs Mrigendra Raj Pandey (first Nepali MRCP), Surya Bahadur Basnyat (first Nepali FRCS) and Kanti Giri (first Nepali MRCOG), S.K. Pahari, Dambar Bahadur Karki, Ishwar Lal Acharya, C. P.Maskey, Siphala Pradhan, Sabitri Gurung and Dibya Shree Malla, Raghubir Vaidya, Mahendra Prasad, Dwarika Prasad Manandhar, Laxman Paudyal and Laxmi Narayan Prasad came to the UK for higher medical degrees under UK government scholarship programmes in the 1950s and 60s. Dr Hemang Dixit, who did his MBBS degree in London in 1950s, is the first Nepali MBBS doctor qualified in the UK. Since the 1960s, Nepali doctors have started to settle and practise in the UK on and after completion of their higher degrees. In the process of medical practice, Nepali doctors were able to reach the specialist positions such as: Dr Shambhu Adhikari is the first Nepali consultant physician, Dr Badriman Shrestha is the first Nepali consultant surgeon, Dr Prem Bikram Hamal is the first consultant pathologist, Dr Rekha Shrestha is the first consultant obstetricians and gynaecologist, the late Dr Ramji Gautam was the first consultant anaesthetist, Dr Kesharlal Shrestha is the first psychiatric consultant, and Dr Anil Tuladhar is the first consultant paediatrician. Dr Pinaki Prasad Acharya (father of the late Shailaja Acharya, former Deputy Prime Minister of Nepal and leader of Nepali Congress) was the first Nepali doctor to have worked as a General Medical Practitioner (GP) in the UK.

According to Dr Raghav Dhital OBE, Dr Phauda Raj Thebe and the present Joint Secretary NDAUK, Dr Beena Subba, there are today about 300 doctors from junior level to consultants (approximately 30 are consultants) who are carrying out medical practice across the UK. The Centre for Nepal Studies UK (CNSUK)’s large-scale survey of 2008 estimated 200 Nepali doctors in medical practice in the UK. Most of them came to the UK since the early 1960s and stayed back on and after their studies. In addition,CNSUK estimates, 100 Nepali doctors, qualified in and around 2009-2014 from various different countries (including the UK), joined the UK’s National Health Service (NHS) and roughly 50 junior doctors are currently in the process of joining the NHS. The majority of junior doctors are spouses, sons, and daughters of serving and ex-Gurkha soldiers. Approximately ten children of Nepalis in the UK are currently studying medicine in UK universities including Oxford and Cambridge. About 50 children of Nepalis living in the UK are pursuing MBBS and equivalent medical degrees from Nepal, Bangladesh, China, India, and other European countries.

In 1985 Nepali doctors practising in the UK established their own association, called the Nepalese Doctors’ Association UK (NDAUK). According to Dr Arun Jha, Chairman NDA UK, the organisation is open to all Nepali doctors, has  as its main aims and objectives: to promote comradeship among the Nepali doctors in the UK; to provide a forum for regular meetings; to publish a newsletter/souvenir; to exchange ideas, news and views; to contribute to the development of the health service in Nepal within the NDAUK’s capacity; to sponsor charities in Nepal and the UK; to establish a link with similar associations in Nepal and elsewhere; to facilitate exchange of medical students and doctors between Nepal and the UK. In addition, NDAUK has been conducting once a year since early 2000s a programme called ‘Support for New Doctors and Trainees in the UK’, focused on imparting skills and knowledge, which is very helpful for newly arrived junior doctors in their adaptation and employment process. This programme is also an example to all Nepali professional organisations in the UK in order to help in generating knowledge and skills for newcomers.

Many sons and daughters of Nepali doctors in the UK have followed their parents into the medical profession. For example, Ranjita Dhital (pharmacist), Drs Robin Sherchan, Rishav Dhital, Jitendra Thebe, Numa Thebe, Alicia Shrestha, Anne Shrestha, Donna Shrestha, Shivani Shrestha, Sabrina Shrestha, Kishore Lekhak, Animesh Jha, Akhilesh Jha, Anish Dhital, Kamala Dhital, Prativa Dhital, Dhiraj Tripathi, Siri Gautam, Bobby Hamal, Anup Pradhan, Pravin Joshi, Mona Karki, Lekhak Jnr, Olga Prajapati, Sarbendra Pradhanang, Mr Bijaya Rajlawat, Anu Shrestha, Nitesh Sharma, Sanjeeb Nepali (dentist), Kapil Rijal (dentist), Sandesh Acharya, Nanu Acharya Hamal, Ava Acharya, Ghosh Jnr, Sophie Dhungana Bhandari, Meghan Dhital,   Nandan Gautam, Anil Ghosh, Akash Karki, Prasima Shrivastava, Sangeeta Shrestha Sharma, and Sharmila Shrestha. In the case of Nepali nurses, about half a dozen Nepali female nurses joined ‘The Queen Alexandra's Royal Army Nursing Corps’ as a Nursing Officer in the late 1950s. Apart from the armed forces, the first Nepali male nurse to work in the UK was Mr Rajendra Chhetri. He arrived at St Peter’s Hospital, Chertsey, Surrey, on a freezing January day in 1969. After some trials and tribulations he finally made it to State Registered Nurse. He spent most of his nursing career with the challenges of the Mental Health Nursing and retired in 2013. Another Nepali nurse, Mrs Tuka Chhetri, came to the UK in the 1980s. She has worked continuously in the nursing profession since her arrival. In addition, she has also done health-related charity work, such as the establishment of child birthing centres in different parts of Nepal. A significant migration of Nepali nurses only started in the early 2000s after the implementation of the UK Government’s Highly Skilled Migrant Programme (HSMP). According to the President of Nepalese Nurses Association UK (NNA UK) Mr Basu Lamichhane, NNA UK has been representing all the Nepali Nurses living in the UK, however, obtaining the true figure of how many nurses are living and practising in the UK has been a daunting task as they are scattered across the country and many of them show little interest to be involved in organisations such as NNA UK.

With the introduction of a policy requirement of International English Language Testing System (IELTS) Level 7 for nurses who wish to practise in the UK, a large number of Nepali nurses are finding difficulty in achieving the Level 7. Before, they only had to score IELTS Level 6 followed by completion of an adaptation course which automatically used to qualify them to be registered with the Nursing and Midwifery Council (NMC). Mr Lamichhane said, approximately only 60 per cent of Nepali nurses are in their profession. Taking this into account, NNA UK is planning to provide training and guidance to Nepali nurses for their adaptation and IELTS courses. The association also gives advice and guidance to members in registering with the NMC and the Royal College of Nursing (RCN) and other professional bodies. NNA UK has been supporting the members who are in need and sought help by providing confidential advice and suggestions on employment-related issues such as unfair dismissal, employment rights, and opportunities. NNA UK is also planning to conduct a nursing profession-related conference in the near future on a regular basis to enhance knowledge and skills suitable for the rapidly changing globalised world after successfully organising a conference of such nature at the beginning of this year. Being himself a male nurse, Mr Lamichhane has been encouraging many Nepalis males to consider nursing as a profession. In the UK and many developed countries, the ratio of male nurses stands up to 40 per cent. This is a profession with plenty of options and career opportunities. In recent years, significant numbers of second-generation Nepalis, mainly ex-Gurkhas’ sons and daughters, are becoming qualified in the nursing profession from UK universities. They have joined the NHS, as they do not have to do IELTS, familiarisation courses, and prerequisite exams. CNSUK also estimates that there are more than 10 male nurses qualified from the UK universities who are currently working in the NHS. There are very small numbers of male nurses qualified from Nepal who are in practice in the UK.

In conclusion, Nepali doctors in the UK are economically, professionally, and educationally better off than other recently migrated Nepalis. In the case of Nepali nurses, they are still in a transitional stage, in the process of integration and establishment. A small number of young doctors and a large number of nurses are finding difficulties in passing the prerequisite exams. Doctors and nurses qualified outside the UK have to pass tough professional entry exams, including an English-language proficiency test, in order to practise in the UK. In addition, this article also clearly indicates that the success rate in the medical profession of second-generation Nepalis in the UK is highly promising.

I would like to thank: Dr Raghav Dhital OBE, Dr Phauda Raj Thebe, Dr Arun Jha, Dr Beena Subba, Mr Basu Lamichhane, and Professor David Gellner for their valuable comments and suggestions.

(Dr Chandra Laksmba is a Senior Researcher of CNSUK)