Fresh off the boat

Twenty-two years ago, when I first landed in the UK, I arrived as a qualified anaesthetist. I didn’t think of myself as a ‘female doctor’. I did not classify myself as one from the ‘ethnic minorities’. Both of those things were incidental to the fact that there was a job to be done and I could do it well, even if it was in a completely different setting, four and a half thousand miles away from home, at Antrim Area Hospital, Antrim, Northern Ireland. I was nervous but being from an army family, I was accustomed to moving every couple of years from one state of India to another (states as different as Punjab and Bengal), making it my own, learning from a different way of life and moving on to the next. I was sure of my ability to adapt.

My belongings comprised of a family photograph in a silver frame, a suitcase, mostly filled with books and two hundred pounds in cash. From the window of the plane I could see forty shades of green, in a mesmerising patchwork across the fields and hills of Ireland. The sky was the deepest, most startling blue. My heart was up in my throat with the excitement of living and working in a country where everyone was educated (why wouldn’t they be if education was free?)  and well-mannered (why wouldn’t they be if everyone was well looked after by the Government?)

One of the secretaries from the Antrim Area Hospital, Mary, very kindly came to receive me at the airport. The drive from Aldergrove Airport to the hospital was like gliding through a picture postcard. After Delhi, I could fully appreciate the wide golden-green expanses gleaming in the sunshine with not one human being in sight. When I complemented Mary on how gorgeous her country was, she was perplexed, “Really?”

Saagar was 5 years old then. He had stayed back with his dad. My plan was to find my feet and have him join me as soon as possible. I wanted to get my post-graduate exams within one or two years and go back to work in India. In the next few months, as I settled into my job, I acquired a cheap second hand Renault 19, found a family home and an appropriate child-minder. In the tea room of the hospital, the nurses would tell me about their families and ask me about mine. When I told them that I had a 5 years old child back home, they would say, “How could you leave him there?” I didn’t know what to say to that.

I still don’t.

Day 741

“If you believe you’re a citizen of the world,” said our dear Prime Minister on the 5th October at the Conservative party’s conference, “you’re a citizen of nowhere. You don’t understand what the very word ‘citizenship’ means.”

That statement is a huge disappointment. I don’t agree.

What does the word citizenship mean?

It is variously defined as the position or status of an individual viewed as a member of a society and their behaviour in terms of duties, obligations and rights of a citizen and a person recognised under the custom or law as being a legal member of a sovereign state.

 For me, citizenship is a sense of belonging. While I hold a British passport, I don’t feel that the first 3 decades of my life that I spent in India count for nothing. I may not officially be a ‘citizen’ of India but I have an affinity and love for that land which far outweighs any official document. When I visited Uganda a few years ago, I felt like I belonged there. I felt a strong connection with the people and the earth. It felt like home.

 People who see themselves as citizens of the world feel part of a rich boundless tapestry rather than an isolated, discreet nation or group. They know, deep down, that a smaller vision of citizenship creates “us” and “them”.

 Perhaps world citizenship is a stance against people like the PM who manipulate the “us” and “them” to demonise the enemy of the day and thereby justify heinous acts of brutality. The unfounded suspicion of the “other” justifies total lack of respect. The difference in appearance is made out to be sufficient ground for fear and disgust.

The world is smaller than ever before. We all belong to one large family. Borders are man-made. All we need is love and respect. We all suffer hunger and pain in the same way. Our loss and anger is the same. Our blood is red, irrespective of the country we belong to. Enough blood has already been shed in the name of pettiness of one kind or another. Let us not buy into this small mindedness. Let us be proud citizens of the world.

Day 736

In the NHS, staff morale is at an all time low.

Non-UK staff have been insulted by the Secretary of State and Prime Minister and made to feel that their work is not appreciated and their presence neither wanted nor likely to be tolerated in the not too distant future. Considering that at least one-third of the NHS staff has its origins outside of the UK, this does not bode well for the future.

Our medical students are threatened with financial handcuffs to tie them to the NHS for four years as if they hadn’t already paid tuition fees and won’t be going on to pay punitive taxes for the rest of their careers. Junior doctors are being subjected to an unnecessary new contract which is unsafe and unfair, that they voted against and that discriminates against women, less than full time workers and those who wish to improve themselves as doctors by undertaking research or further training.

The salaries have been falling since 2003. Meanwhile, hovering in the background, there have been two years of national negotiations about a potential new and toxic consultant contract. The press continues to make doctors look lazy and loaded. Fewer school kids are applying for places in medical schools than ever before. More junior doctors are looking for jobs abroad than ever before.

The UK environment for doctors is not attractive.


Day 728

A landscape of musical notes emanated from four musical instruments inspired by movement of people across the globe in search of a land of gold. When I closed my eyes, I could feel the magical textures at my fingertips and sense the turbulent river flowing and a lone vessel struggling to carry a tonne of isolation and desperation across to a place of hope. Vibrant colours could be heard and pathos felt in the core of my heart and every pore on my skin. The conversations and unison between those colours filled the space with absolute empathy for those forced to leave their homes, a cry against injustice of the refugee crisis. Crossing the Rubicon….dissolving boundaries…reunion…last chance…a boat to nowhere…

Land of Gold – an ode to those displaced.

Find the kind heart,
Rest your feet and soul.
May your kind heart
Find the land of gold.
Pay attention, say your name
Listen closely and keep warm.
Gentle hands, you are brave,
Look at me and carry on.
All is good, I love you.
You can hear me, you can call.
Sing your song with ease and pride.
I’ll be there, not far behind.
Tell them I walked
Tell them I walked your way
Tell them I walked
Tell them I walked your way

– By Anoushka Shankar


Day 336

After my son first went to university, I would find any old excuse to stay out till late after work, coming back home just in time for bed. I did this for a month before saying to myself, “You can’t keep running away from yourself.” After a few big cries, I found new ways of moving forward. I discovered Ikebana, long evening walks and Come Dine with Me.

Today I did the same thing. My partner is out of town tonight. So, I browsed through books at Foyles, walked along the South bank of the Thames, watched a contemporary dance recital and had dinner by myself at a nice restaurant. I read these beautiful lines about moving that deeply resonated with me – “Migration meant far more than a journey across unknown seas to strange lands. At times the desire to preserve a link with what had been left behind failed because of sheer distance. Tenacity was needed to keep alive some sense of permanence, some sense of the known. Often that devotion to remembered tradition was jolted by shifts and changes in the old home country. The passing of time and generations in the new lands brought its own inner journeys. It created its own powerful alchemy out of things half remembered or wholly rejected. Loss and gain were the materials out of which new ways of belonging both to the present and the past were crafted.”


But ultimately, for me, home is not  just a place. It’s a person.

Day 318

Some people live their entire lives within a circle of 1 kilometre radius – born at the local hospital, went to the local primary and then secondary school, met their spouse at the local pub, worked at a local office or business and buried in the local cemetery. I met a lot of people like that in Northern Ireland and their level of contentment never ceased to amaze me.

At present, many countries are in a state of utter chaos. Multitudes of people are leaving their homes and countries to be somewhere better and safer even if it costs them their lives. Some venture out with their children. They step into the unknown with hardly any belongings or certainty. I wonder how desperate one has to be to do that!

One of the social factors well known to predispose individuals to psychosis is migration. There are 3 main reasons for it:

  • Family break-up
  • Adjust to living in large urban areas
  • Social inequalities in the new country

A Dutch study has shown that the risk of psychotic disorders is higher for non-Western immigrants to the Netherlands than for Dutch citizens. The risk of psychotic disorders in the Hague was highest among those who migrated between ages 0 and 4, but in those who migrated after age 29 the risk was no higher than that for Dutch citizens. Ethnic minority-related environmental exposures such as social disadvantage, exclusion and adversity after migration may explain the higher risk of psychotic disorder among younger migrants.

More than 2000 people have already died this year while attempting to cross the Mediterranean. Many more are missing or in camps. The refugee numbers in the Middle East run into millions of which thousands are children. Not only is the present state of affairs lamentable, it does not bode well for their mental well-being.

Day 260

Fishermen in the Mediterranean have been catching human corpses on a regular basis lately. Every morning on the news I hear about migrants desperate to leave their own homes and countries to find better lives elsewhere, often risking everything they have including their lives. They claim to be doing so in order to escape torture, extreme poverty, rape and other forms of violence.

At present we, the human race, can boast of the largest human migrations ever in the history of human kind – 60 million people. The population of UK is 64 million.  3500 people died last year crossing the Med while 13,500 were rescued. This year more than 1600 people have already lost their lives in this way.

I am a migrant. I came to the UK to work and be better at my job. I had contract in hand. I was to go to a place called Antrim. I had never heard of it before. I had no family or friends there. It was a beautiful place but I was all alone for 9 months. I arranged a rented house, a car and a child minder before my son came to join me. It was a difficult time. Communication technology was not great at that time. Phone calls were prohibitively expensive. No mobile phones, Skype or WhatsApp existed. Just the good old postal service and very brief phone calls. It was a desperately isolating experience despite the fact that I was warm, safe, fed and watered.

When I hear the stories of migrants making unbelievable journeys across the seas with nearly no money, nowhere to go, horrific experiences from their past and complete uncertainty of the future, I can’t imagine how frazzled their state of mind must be.

How come millions of people are not able to live in their own homes and countries?  What becomes of them?

How did we come to this?