Thread by @ikeanya

Yesterday in a suite at @Taj51BG I experienced a maelstrom of emotions. Joy at being reunited with people I had fought shoulder to shoulder with, in the greatest battle I have ever been involved in. Underneath the joy was fresh anger provoked by relieving the events of 2006….

…. recalling the totally unnecessary human costs of that battle, rage at the cynical inhumane way in which powerful people had tried to commit a blatant injustice because they felt the victims were voiceless & powerless & that no one in the UK cared very much about them anyway…

Thankfully we proved them wrong on one count, but jury remains out on the 2nd as memories of how virtually all the British institutions that ought to have challenged this @DHSCgovuk conceived & implemented injustice failed. From @BBCNews & other media to @TheBMA & even the CRE…

& there was deep sadness that although a life was lost & in spite of the anti racist statements from these institutions in the wake of the #blacklivesmatter movement, no organisation/person was held accountable, & none including @bmj_latest had acknowledged the role they played

As we recorded scenes for a documentary recounting the events of 2006, next to people who I had shared intense moments with, but not seen for 15 years, I remembered & was bolstered by what I’d tweeted after watching @DavidOlusoga’s excellent programme on immigrants in the NHS

https://twitter.com/ikeanya/status/1415783379203670026

That battle is now memorialised in English case law in a series of judgments from the UK Crown Court, the Appeals Court right up to the @UKHouseofLords or @UKSupremeCourt as it is now. BAPIO Action Ltd & anor. vs Sec of State Health & Anor publications.parliament.uk/pa/ld200708/ld…

So who was BAPIO Action Ltd & who was Anor? Why had they ended up in a series of court cases against the Sec of State for Health and the Home Secretary? Hear the description of Lord Bingham of Cornhill who wrote & read the lead judgment at the final @UKHouseofLords case:

“claimant is a company established by @BAPIOUK to represent the interests of doctors from the subcontinent…One such was the 2nd claimant, Dr Imran Yousaf, an IMG from Pakistan, who was adversely affected by the changes & who, perhaps as a result, took his own life in Jan 2007”

How did I, not being from the subcontinent come in? First, because although I wasn’t personally affected by the changes, I was so upset by the blatant way the grave injustice had been initiated & implemented by @DHSCgovuk, an abuse of power that I wanted to join to fight it….

2nd reason goes back to 2005 UK general elections the first I had witnessed since arriving to study @LSHTM in Sept 2001 The @UKLabour led by Blair was squaring off against the Michael Howard-led @Conservatives…

The @Conservatives billboards with their “nudge nudge wink wink” slogan: Are you thinking what I’m thinking preceded by sentences like “I mean, how hard is it to keep a hospital clean?" & "It's not racist to impose limits on immigration" were everywhere independent.co.uk/news/uk/politi…

I was reasonably settled as a year 2 registrar in Bristol & had just been to Nigeria for a few weeks leave, taking advantage of the February cheap tickets, but I returned to what seemed a different country, which I could only ascribe to the election campaign & rhetoric…

It began at immigration @HeathrowAirport when for the first time I was grilled in a way I had never been. By then I had a 5 year contract with @NHS & a visa for that time so was used to cursory questioning on returning. But this time the immigration officer having noted my job

Asked how I intended to get to Bristol from Heathrow. I said I’d catch @HeathrowExpress to Paddington where I’d change for a train to Bristol? “And what stations does that train stop at, on its way to Bristol?” I looked again at him, sure he was joking but no he was dead serious

Fortunately, in those early years, I fled back to London almost every weekend & so the stops were inscribed in my memory. “Reading, Didcot Parkway, Swindon…” I paused. He was still looking at me so I continued “Chippenham, Bath Spa…” & then he lazily gestured I could stop…

Shaken, I picked up my luggage & went into a WH Smith to see newspapers with headlines about immigrant benefits scroungers & lying asylum seekers. Perhaps I was still sensitive after the immigration encounter but it all seemed much more hostile & anti-immigrant….

Final straw was a few evenings later, walking back from Whiteladies Road to flat in Kingsdown. In front of the Bristol Royal Infirmary, absentmindedly, I nearly collided with a pedestrian coming the other way. As I profusely apologised, he snarled “F**k off back to the jungle”

It was first time in my nearly 4 years then of living in Britain that I’d experienced such an overt act of racism. And I was really shaken. I struggled to sleep that night, tossing & turning like the princess in The Princess & the Pea. I hadn’t expected to be so upset but I was

And I continued to link the apparently new “hostile environment” to the elections & the ubiquitous Are You Thinking What I’m Thinking billboards. My colleagues said as much the next day, indicating there was usually a ramping up of anti-immigrant sentiment at elections but …

“It usually settles down once the elections were over”. I didn’t care if it was cyclical, it just felt pretty unpleasant. So I wrote 2 letters, 1 describing what I’d observed to @MetroUKNews& the 2nd to all immigrant doctors & nurses I knew suggesting we start wearing badges…

With, “Proud to be an Immigrant” to work, to remind people of the contributions we made every day. It seemed to strike a chord & unexpectedly, responses poured in, asking how we could take it forward. Also an interview request came from @BBCBristol which I naively agreed to…

(In my defence I barely had any media training). A black limo pitched up just before lunch & next I was in studio for a live late morning call in with the secretary of the @TheBMA in a London studio saying how he thought my idea was terrible news.bbc.co.uk/1/hi/england/b…

I thought it was just a chat with @vicderbyshire about proposal & why I’d made it. I wasn’t expecting a challenge, not least from @TheBMA which I was a fully paid up member of. And I hadn’t told anyone at work thinking it was personal & I’d kept out my job or employer details…

That afternoon I was summoned to an incandescent top boss who had had to spend hours fending off enquiries from media & NHS bosses. I remember the opening line was “It would have been simple courtesy to let me know…” I was handed the trust media policy & got a slap on the wrist

But I made valuable contacts through that episode, like from @BAPIOUK, @Sajay70 @ZorbaTheDoc @SatheeshMatthew & the boss @RameshMehta15. Fine comrades. @donflynnmrn then of @JCWI_UK & later @migrants_rights was another who became valuable collaborator & @DrUmeshPrabhu & more

We kept in touch on various issues affecting immigrant doctors in the NHS & so when in April 2006, the @DHSCgovuk issued the ill-thought guidance on employment to @NHS trusts, either oblivious of its impact on the lives & fortunes of so many who had given up so much to come….

To the UK under the Highly Skilled Migrant Programme. I’ll use Lord Bingham summary to explain aa he gets to the heart of the issue in his @UKHouseofLords judgment. In 2003, the UK Highly Skilled Migrant Programme was opened to doctors from non EEA countries. UK needed them…

“Applicants who met the necessary skills criteria for admission under HSMP had to show that they intended to make their main home in the United Kingdom & that they could maintain themselves & their dependants without recourse to public funds…”

“If the conditions were met the applicant might be granted leave to enter for 12 months…renewable for up to a further 3 years & then further renewable if the conditions continued to be satisfied. After 5 years,the entrant would be eligible for indefinite leave to remain”

As expected, drs came in droves. All with the ambition of taking any medical job & then applying for a specialist training post, most of which lasted more than 5 years, more or less guaranteeing them indefinite leave to remain in the UK & make their lives here as HSMP expected…

In 2005, just 2 years after opening floodgates, @DHSCgovuk suddenly realised there might not be enough training posts for all the newcomers plus graduates from UK med schools. Why it suddenly happened remains a mystery but medical workforce planning has never been a strength here

With perennial boom & bust periods both in medicine as a whole but also in various specialties. It swings from panicked “we won’t have enough drs or GPs or pathologists, open the floodgates & then a short while later “we have too many drs or GPs or pathologists, shut the gates”

You would think that if you were responsible for such a mess, you would put on your big boy/big girl/big non-binary pants, own it & clean it up, no? But why bother when there was a convenient group you could dump the mess on? A group without cohesion, voiceless & most damningly..

“Economic migrants” who’d selfishly abandoned creaking health systems in their home countries to greedily make money in the UK. Never mind that as my sis Dr @ChibunduOnuzo says (& I always quote): Migrants want what you want, why is that so frightening? theguardian.com/commentisfree/…

So they/we were perfect targets. Unloved on right because? Well because immigrants & a source of disquiet for liberal left who preferred the clear cut refugee & asylum seeker recipients of their benevolence to these wishy washy go where the money flows economic migrants

So @DHSCgovuk first blocked off other avenue (I’d benefited from this) to specialist training for international medical graduates which gave you 5 year visa once accepted on a specialist training programme. Was restricted to non-UK citizens who’d trained in UK med schools…

Not satisfied, they went to @ukhomeoffice asking them to change the HSMP rules so only graduates of UK medical school could now get HSMP. For reasons best known to them & unlikely to be out of an abundance of love for IMGs (international med grads), @ukhomeoffice declined…

Still not satisfied & worried IMGs with many years of experience would outperform UK fresh graduates in competitive recruitment exercises for specialist training, @DHSCgovuk, either unmindful of or dismissive of the impact of their actions on drs they’d begged to come in 2003/4

Moved to further restrict access. The bad faith & malintent is clear from Lord Bingham’s judgment. The way permit free training, (the version I’d used) was changed “with minimal prior publicity, in order to prevent prospective applicants for PFT anticipating the restriction”

Also in the way, the final killer blow, the guidance “issued” by @DHSCgovuk in April 2006 which declared that @NHS employers could only treat IMGs as UK/EEA in recruitment if they had enough leave to remain to cover the duration of the post being recruited to. Now remember….

Shortest training programme was minimum of 5 years. HSMP drs, those who were enticed to come over in the fat years of 2003/4 were given 12 month visas first & if they met all the conditions they got another 3 year visa. Then if they achieved that, they’d get 1 yr then indefinite

So by changing these rules, at a stroke, all HSMP drs (who were mostly black & brown btw) were ineligible for training posts. Worse, without access to training posts, there was chance they’d be unable to continue to meet the earnings requirements for extending their HSMP visas….

So their lives & their families lives could be destroyed, caught in limbo. Meanwhile @NHS patients would arguably miss out on their expertise & experience. At first we thought it was an error & then we thought it must be something prospective, only applying to those coming later

But no @DHSCgovuk insisted, it took immediate effect, meaning they were moving the goalposts in the middle of the match; reneging on the terms underpinning the HSMP programme, which had led many to uproot their lives, careers & families to move to Britain. We were sure they did..

Not understand the impact of the changes but when after we explained, all we got was a shrug from Lord Warner, junior minister @DHSCgovuk it was clear that this was a cynical sacrifice of the lives & careers of so many Asian & African doctors to cover @DHSCgovuk poor planning..,

I’ve always hated injustice, particularly of this kind, where the powerful oppressed the powerless & says “what can you do? Yes I know what I’m doing is unjust but tough, nothing you can do about it” My blood boiled & I was certain everyone else would be horrified, but no…

@TheBMA failing to recognise/acknowledge conflict of interest between UK trained members & IMG members came out for majority, advising no grounds for judicial or other review & sad though it was, it was what it was. That was when I became active in BMA learning processes…

We appealed to the then Commission for Racial Equality & again got a wishy washy response. We went to all the media outlets, no interest. Many senior colleagues toed the line of “it’s very sad but we must look after our own first”, the famed English sense of fair play vanishing..

We decided to organise a demonstration that would attract the media & public attention. That was duly held in Trafalgar Square/Whitehall with minimal media coverage beyond one that mockingly called it something like “the best behaved, best dressed protest ever in central London”

What the mocking journalist had inadvertently grasped was this- we were not revolutionaries or activists. We just wanted the opportunity to compete for & secure jobs. I remember the police rudely, brusquely dispersing us at the end of the rally

With the demonstration bringing neither the media or public awareness that we had hoped for, we were desperate, I wss by now an honorary associate member of @BAPIOUK & remember the long meetings in east London & elsewhere strategising. We now had one last hope -English justice

Time for bed. TBC but I’ll pause with a snippet- a few senior Nigerian colleagues reached out to “give advice” -I was to be careful in associating with “those Indians” who would lead me into trouble & leave me high & dry. Each time I asked who else was fighting this, silence…

Thanks for all the RTs, likes & compliments. Got a few moments so I’ll add a few bits here. We were at point where demonstration hadn’t led to media or public support. One of the few accounts of the demo was in the Workers Revolutionary Party newspaper wrp.org.uk/features/race-…

The piece quite rightly prominently featured Dr Peter Trewby, one time associate international dean of @RCPhysicians who was one of few white English doctors who publicly & vocally condemned the unfairness of the moves by @DHSCgovuk. Back to the story. Time was running out…

IMGs were reporting harrowing tales of how having suffered all kinds of privation to get through their PLAB (foreign dr qualifying) exams, confident once they passed, getting a job would be easy & they could start repaying their debts suddenly found their applications discarded

They were being told they were ineligible for jobs & were stranded. We tried to write to/ meet MPs & members of @UKHouseofLords without much progress. We knew little about UK political & legal structures & processes but knew this was patently unfair but everyone was ignoring it

The only option left was to take @DHSCgovuk ugly decision & action to the English judicial system famed for its fairness & hope for justice there. But how did you even initiate this? How did you even engage a lawyer? Did we need a solicitor or a barrister? If so which kind?

And there was the question of financing the judicial review, likely to run into hundreds of thousands of pounds? And in 2006, certainly among IMGs crowdfunding was not really a thing. But beauty of the group was the members’ diverse strengths & insights. Someone knew a lawyer…

…another was tech savvy & knew how to set up a system for collecting money. We had seen response from IMG community at the demonstration. The media & public may have ignored it but it had electrified the IMG community. Younger ones because they or friends directly hit….

Older international medical graduates still bitter at previous examples of similar callous unjust decisions such as after the Calman reforms in the 90s which had disrupted and in some cases destroyed their careers and visions for the future. This felt like deja vu to many…

Excellent account of terrible injustice wrought during Calman reforms in Kjartan Sveinsson’s groundbreaking 2015 @LSEnews PhD thesis
“Swimming against the tide: trajectories & experiences of migration amongst Nigerian doctors in England” available online etheses.lse.ac.uk/3279/

So we started to make enquiries re lawyers & secured one. Now with idea of costs, we were able to launch appeal for funds to pursue the judicial review. Some, even IMGs were skeptics. Was it any use? Wouldn’t it be better if the affected just cut their losses & went elsewhere…

For many of us that wasn’t an option because it would mean that the @DHSCgovuk politicians & civil servants behind the changes would get away easily with their unjust inhumane decision & would be encouraged to keep behaving badly. We had to do something even if like the tortoise

In the Igbo proverb we were only able to leave markings in the dust to show that there had at least been a struggle, that IMGs hadn’t just walked meekly like lambs to the slaughter. The money flowed in, fuelled by our rage at the blatant dismissive injustice & spirits were high

Till we met another roadblock. Had been advised that company be set up to pursue case to avoid making @BAPIOUK & its trustees liable if the case was lost. Given signals from @DHSCgovuk they obviously found us an irritant & we knew were we to lose, they would turn the screws hard

So the company was set up as advised but then lawyers said they needed another plaintiff, someone who was directly affected by the changes @BAPIOUK Ltd could not bring the case by itself. How were we to find someone newly immigrated, with no job, willing to take on @DHSCgovuk….

How could we ask anyone to make that sacrifice, knowing what usually happened to whistleblowers & anyone who raised their head above the parapet in the UK medical system? We were despondent, perhaps we had lost to @DHSCgovuk after all. We however agreed to put the call out with..

…caveats about the risks. News soon came that a young Pakistani doctor Imran Yousaf who came from a rural subsistence farming family & who had passed his PLAB a while back but because of the new rules had found himself ruled out for every job he had applied. Everything for him..

Hung on the outcome of this case. I wrote about Imran when he died & the piece was published in @TheBMA news with the title “He just wanted to work” & rather than reproduce it in new tweets I’ll attach screenshots here but before then I must mention the first hearing in the case

It was at the Royal Courts of Justice & we had turned up en masse in a variety of suits. We entered court, after security screening emerging blinking into its imposing grandeur and into the courtroom. We sat on the hard wooden benches ranged in rows, across the room,

On the other side a handful of men & women, all white, as far as I could see, presumably civil servants from @DHSCgovuk with their barrister with whom they chattered familiarly unlike us. When the judge appeared robed & I think wigged, the case began. It seemed to be conducted…

In a banter and code that it seemed we were the only ones oblivious to but jokes & witty asides were exchanged between the judge, counsel on both sides which the @DHSCgovuk seemed to find amusing too but which went right over our heads. I remember our puzzled looks as we tried…

To ask each other if the other understood what was going on. At a point, the solicitor turned & whispered “Dr Yousaf” & it was then I realised the somber young man sitting beside me breathing heavily & gulping from time to time was Imran Yousaf. He had moved his gangly legs aside

To let me in to sit beside him. It was the first & only time I saw him. My last memory of him, still vivid is of him walking with @BAPIOUK exec & our lawyers for lunch while I rushed with @Sajay70 to print evidence of the closing date for applying to training programmes.

The judge had requested that evidence before ruling on our counsels applications or an injunction that would prevent IMGs from being discriminated against in the current recruitment round. If this was not done, any judgment in our favour would be pointless as harm done

Injunction was granted & months later a judgment which was not in our favour. I remember my horror at seeing this in a text from @ZorbaTheDoc & even worse the words that followed. Imran had been found in a room at the GP practice that had given him shelter, his life gone….

My sadness was amplified by the lack of coverage around this in most of the UK media. This at a time when tabloid front pages & highbrow columnists alike were exercised by Jade Goody using a racially charged epithet on the actress Shilpa Shetty in the Big Brother House….

You can read my piece on Imran in tge screenshots accompanying this tweet & tge one that follows

https://twitter.com/ikeanya/status/1196854037381079040

To summarise, we appealed & won on appeal & @DHSCgovuk then appealed to the @UKHouseofLords where we again won (I think that’s the right sequence of events), in any case, the final judgment was in our favour although for various reasons. Perhaps more important than the judgment

Was that a small group had managed to establish that international medical graduates could never be wholly taken for granted again in the UK. The days of making us scapegoats & victims of every policy or political failure, confident that we were voiceless & powerless were gone…

@loveenatandon asked us each on Saturday how we had felt when we finally won. Had we been elated? Shouting and jumping for joy. None of us remembered that. Surely she continued we must have been excited. And we probably should have been but it felt so momentous & heavy…

And tinged with the knowledge of the costs of the victory, memories of Imran still fresh. As @BAPIOUK prepares to celebrate its 25th anniversary next month, it would be a great gesture if @DHSCgovuk @bmj_latest @TheBMA & all who stood by while this happened acknowledged failings

And perhaps memorialise Imran Yousaf. @BAPIOUK already has a prize endowed in his name, but perhaps a portrait in @TheBMA House to join the serried ranks there? Or something somewhere that acknowledges his role as we all burnish our anti racist creds post #BlackLivesMatter