New Delhi: When she was just 17 years old, Anamika Halder left her family behind in Jamshedpur and travelled abroad for the first time to live alone in a country where she didn’t know anyone and couldn’t speak a word of the language. There was no other choice.
The daughter of a small transport business owner and a nurse, Halder had always dreamed of becoming a doctor. She had studied hard and even qualified in the medical entrance exam, but her grades had fallen just short of earning her a seat in an Indian college.
She was heartbroken, until hope again appeared — in the form of an agent who said he could arrange a seat at a medical college in China for just around Rs 10 lakh. Not just that, he promised he could guide her through each step of her journey, from housing to food.
This was in 2013. Today, Halder wears a white coat at work, serving part-time at two government hospitals in Bokaro — but the story doesn’t end like that for everyone.
Less than one in five Indian medical students with overseas degrees pass the Foreign Medical Graduates Examination (FMGE), the licensure requirement for graduates from certain countries to practise medicine in India, government data obtained by ThePrint shows.
The number of applicants is still booming, though — and a giant network of unregulated agents is a big part of the reason why.
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The brokers of medical education
Elaborate networks of agents, spread across India’s villages and cities, have emerged to meet the giant gap between the demand for medical education and the availability of seats.
Last year, for instance, about 8.7 lakh students passed the National Eligibility cum Entrance Test (NEET), qualifying them to study medicine. However, there are only about 86,000 medical college seats (government and private combined) in India, which means that only about 10 per cent of qualified candidates are able to to study in the country.
New private medical colleges are springing up in India, but their fees are often prohibitively high. The typical cost of an MBBS degree in countries like China, Ukraine, and Georgia ranges from Rs 15 lakh-50 lakh, but private colleges in India charge anywhere between Rs 30 lakh and Rs 1.5 crore.
An agent’s job is to apprise and then herd students to these rather more affordable foreign shores.
“You don’t need any degree, qualification, office, registration, or licence to be an agent,” says Manish Jaiswal, a Kolkata-based educational consultant. “You just need convincing skills.”
And, agents are everywhere that students might be. Outside medical coaching institutions and NEET examination centres, agents can often be seen passing out business cards and pamphlets to medical aspirants and their anxious parents: “MBBS for Rs 15 lakh”, “MBBS without donations”.
Local newspapers, too, are filled with advertisements for recruitment fairs at upmarket hotels, and YouTube is awash in professionally produced videos on life in foreign medical institutions.
Large agents, operating from major cities, have networks of sub-contractors who recruit students from tier-2 and tier-3 cities, even villages. Typically, contractors at the top of this pyramid have deals with medical education centres abroad, guaranteeing them certain numbers of students in return for exclusivity. The agent makes a one-time fee of between Rs 50,000 and Rs 2,50,000 per student, depending on the services they provide and the fees paid.
Although the plight of Indian medical students trapped in Ukraine has brought the issue national attention, there are tens of thousands more studying across eastern Europe and Central Asia, China, even Bangladesh and Nepal.
The dark side of agent power
Little effort is needed to understand why agents are so important to the system. “Even if you go to these countries on your own, how do you manage the sheer logistics of it?” asks Saurabh Sachchar, a practising doctor in Dehradun who went to Russia in 2013.
“Agents say, ‘I know the language, I know everybody. I will make sure your child is fed and he has a room. I will help him in buying winter clothing. I will be there to take care of him.’ And parents want all this, so they pay,” he says.
When Indian students found themselves trapped in Ukrainian university basements, many said they found local agents more helpful than their far-away government.
“I was lucky that my local contacts in Ukraine helped in arranging transport and logistics for my students to reach the borders,” says Maidul Seikh, Director at Edurizon, a private consultancy firm based in Delhi. Seikh managed to bring around 500 students back to India.
The agent system, though, has a dark side, too. In many foreign universities, the management hands over the responsibility of foreign students to hostel wardens, mess supervisors, and student administrators from India — all put in place by the same agents who bring the university revenue.
“College managements happily appoint the agents as vice-deans of foreign students and all students are placed under them,” Sachchar says. “Everything happens through that person. The moment you speak out against them, they can chuck you out.”
Several students ThePrint spoke to said that agents often charged them double the tuition fee for the first year, and accepted money in cash without giving them receipts.
One Kashmiri student who wanted to study in Ukraine tried applying to a university in Kharkiv directly but was told by the management that she would need to go via the appointed agent.
“The university I went to is run by two Indian men from Punjab and they have their network of agents in all states. They regularly charge students double tuition and hostel fee. The Indian agents are running the public universities there,” she says.
At the end of the road, though, there isn’t always a pot of gold waiting.
Side-effects of a medical degree: Status, social mobility, dowry
“Every single person here is either a doctor or is studying to be one,” Mohammad Azharuddin Mulla says wryly, surveying the warren of one-room apartments that rise up from the lanes of New Delhi’s Gautam Nagar.
In 2016, Mulla had arrived in Gautam Nagar after completing a medical degree from the Philippines. Like everyone else, Mulla slaved at his desk for 18 hours a day or more, living on fried snacks and sugary tea served in paper cups.
Today, he practises medicine in Muddebihal, a village in Karnataka, where he runs an independent practice. There’s been no real return on the investment he made, though. He charges only Rs 50 from his patients, most of whom are poor, knowing they will turn to quacks if he asks for more.
There are no figures for what becomes of foreign-educated doctors who do not pass the FMGE. However, there is anecdotal evidence that many do find work: some run family-owned nursing homes or hospitals in India, some find opportunities abroad, and others make a living as agents — the demand for foreign medical education is only growing, after all.
This willingness of parents to pay for a medical degree abroad, some experts believe, is spurred not just by hopes of large pay packets in the future but by a desire for social position and respect.
“We have become an extremely aspirational society,” says Rama Baru, professor at the Centre of Social Medicine and Community Health in Jawaharlal Nehru University. “People want to see social mobility in their lives. They may not be educated parents, but they want to say that their daughter or son is a doctor.”
“For men the dowry grows significantly if he is a doctor and for women it means that they can actually break the class barrier because of their education,” Baru adds. “They may still pay a dowry, but they can marry into a family with a higher economic status.”
Agents succeed not just by offering the opportunity to make a good living, but exploiting the aspirations, insecurities, and hopes of students and their families.
Back in her hometown, Anamika Halder is a role model in her family and community. Through the same agent, now, her sister is studying medicine in a college in Bangladesh. Halder’s cousin, inspired by her, is also preparing to join the same profession.
“We have found a new respect with which people see us. They look at my dad and say that he made his daughter a doctor and the other one is on her way to becoming one,” she says.
(Edited by Asavari Singh)
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Source: The Print
