The current COVID-19 pandemic highlights physician and healthcare workforce shortages due to surges in patient care needs. Migrant-physicians are finding innovative ways to apply medical knowledge and skills as a doctor because of barriers and delays they encounter in achieving professional recognition. The following is an interview with Dr. Mohannad Altabban, an internal medicine physician who lives in the Netherlands after leaving Syria in 2013. The interview has been revised for clarity and readability.
Tiffany: Mohannad, thank you for this opportunity to talk with you about your experiences. Can you describe your background as a physician and why you moved to the Netherlands?
Mohannad: I finished my specialty training in Internal Medicine in 2011 in my home country of Syria. I practiced medicine in Syria, Jordan, and Yemen between 2007 to 2015. Because of the way the specialty track is structured in Syria, most of our time during Internal Medicine training is spent in the emergency room, intensive care and coronary care units. After finishing training, I worked in governmental public hospital, private hospital, and non-governmental organization hospital settings until 2013. In the beginning of 2013, I received threats and I was forced to leave Syria, so I moved to Jordan where I stayed for six months. While in Jordan, I worked as an internist-intensivist in a war trauma unit for Syrian refugees. However, the unit was forced to close because the government refused to grant licenses for continuing legal medical practice to us, meaning that only Jordanian-licensed physicians were permitted to continue working in the unit. At the end of 2013, I moved to Yemen and worked there for almost two years as an intensivist and manager of an intensive care unit. Syrian physicians were recognized and licensed by the Yemeni government with no need for a long bureaucratic process or examinations. However, in 2015, the Gulf-Alliance in the Arabian Peninsula started bombing the country and most Syrian physicians were forced to leave, again. I left Yemen to Saudi Arabia, where, again, we Syrian physicians faced the same recognition and licensing bureaucratic problems. I then moved to the Netherlands to do a Master of Global Health and start rebuilding myself and my future, along with the future of my family of four.
Tiffany: This is an incredible and dangerous journey you have been forced to take from your home country to the Netherlands. How do your experiences and knowledge on global health influence how you view the global response to the COVID-19 pandemic?
Mohannad: Global Health taught me a lot. On March 11, 2020, I advised the local elementary school to allow their children to go home and engage in tele-education. I was concerned for their health and safety first before the WHO announced COVID-19 as a global pandemic. This concern was because the vast majority of the school students belong to vulnerable populations. The next day, the World Health Organization announced COVID-19 as a global pandemic. The Dutch government responded later in implementing regulations for social distancing without a total “lockdown”, which in my opinion, was too late. Globalization has changed how quickly infectious diseases travel across the world, and we, as a society, have not yet learned our lessons from Ebola, H1N1, and other previous outbreaks.
In my view, this pandemic highlights serious flaws in our preparedness: (1) contemporary health systems can still be fatally underprepared or designed to respond to such circumstances; (2) the national as well as international healthcare workforce should be engaged in new contexts, especially during a pandemic when all hands are needed; and (3) clear mismatches in prioritization of population health and the global economy have surfaced. Furthermore, when you drive a car, you do not arrive at a crossroad and then break, you must slow down while approaching the crossroad to anticipate dangers. Similarly, anticipating dangers and proactively enacting healthcare policies are essential global health promotion mechanisms, but the governments globally still cannot do that. While digital and technological advancements allow more connectedness than ever, we clearly remain vulnerable as human beings.
Tiffany: With your background also as an internist, how are you currently applying your medical expertise to help patients and colleagues in this challenging time?
Mohannad: I see three main ways to help during this pandemic even though I am not practicing clinical medicine in the Netherlands. Social media offers quick access and communication between physicians like me who want to help others, using medical knowledge and skills, but cannot legally work as a physician where I live now.
First, reassurance. Posts on social media help provide knowledge on how to deal with sickness, hygiene, updates and news, and spread awareness that while COVID-19 is a major public health threat, it can be tackled with simple preventive measures. I also use social media to post limericks, jokes, funny videos, and pictures that bring a smile on the face of a scared population, but also teach something at the same time. Second, I’m a member of a Facebook group, the Syrian Coalition of Medical Consults. We remotely help people living in Syria or in refugee camps in one of the neighboring countries of Syria with their medical conditions, diagnosis and treatment. This can be done using regular posts, anonymous posts, or directly via private messages. Finally, there is a Dawini group (Dawidi in English means treat me) for Syrian healthcare workers. The group includes physicians and other clinicians who share experiences, knowledge, cases, articles, etc. Members use this platform to stay connected, and to help each other by sharing medical information and advice on solving or managing a complex case.
We cannot provide medical advice in the Netherlands. In the Netherlands alone, in 2014 there were 12 Syrian physician-refugees, which has continued to grow yearly to 62 as of 2017.1 I expect there are many more now, and also in other countries. We can help with social and scientific action, but not with clinical practice because foreign doctors (literally translated from Dutch buitenlandse artsen) are not allowed to provide direct patient care due to extensive professional regulations—a common barrier in many western countries. Such strict regulation alienates and excludes valuable, experienced physicians and healthcare workers, who have specialized skills and genuinely want to help. It’s also a matter of making a living as a refugee as well. However, the professional recognition pathway costs an enormous amount of time and money.2
Recently, the Royal Dutch Medical Association advised that the medical labour market may hire non-registered physicians if they have work experience in the last ten years and in an emergency situation, like the current pandemic.3 However, I suspect that the medical labour market will not make use of this new regulation. The problem has always been that the medical labour market would prefer registered and licensed practitioners, most often for liability and insurance issues but perhaps for other reasons.
Tiffany: Thanks, Mohannad, for sharing your perspectives. I agree with you on several points. Social media has made information sharing in the global medical community easier than ever and is needed when the evidence base is actively developing to guide direct patient care treatment and evidence-based public health policies. One pandemic-related Facebook group I joined recently is Behavioral Health and Suicide / Violence Prevention in COVID-19, as there is also increasing concern about the mental health consequences of the pandemic for healthcare workers and the general public. Additionally, I agree there is a tremendous amount of untapped talent in migrant clinicians, just as you have done, and that finding ways to expedite the applications of such talent in a competency-based manner is one possibility to help address local clinical care needs.
Mohannad: Thank you for this opportunity. My thanks are also to my teachers, superiors, professors, and seniors and people from whom I learned so much. I thank them for everything they have taught me. They opened my eyes to so much, beyond my ability to explain. I hope they all stay sane, healthy, and socially active, even if physically remote, during these difficult times. We are together in this, let this be a lesson to all humans who still have the mindset of us versus them. We need to stand together to overcome the current public health crisis and the ones yet to come.
Tiffany: As pandemic-related measures continue around the globe, physicians, their patients, and healthcare leaders need to continue innovating and advocating for more accessible and equitable care. As we’ve discussed today, a key part of this is considering physician-migrants’ skills and the diversity that they bring to the workforce when professional recognition procedures strive for their inclusion. As a global medical community, we are, indeed, #BetterTogether.