In a country where anti-immigrant sentiment gave rise to the Brexit movement, Britain’s health care system depends heavily on foreign doctors, who are now on the front lines fighting the epidemic. Dr. Adil el-Tayar, a transplant surgeon from Sudan, died from the coronavirus while practicing medicine in Britain. The eight men moved to Britain from different corners of its former empire, all of them doctors or doctors-to-be, becoming foot soldiers in the effort to build a free universal health service after World War II. Now their names have become stacked atop a grim list: the first, and so far only, doctors publicly reported to have died after catching the coronavirus in Britain’s aching National Health Service. For a country ripped apart in recent years by Brexit and the anti-immigrant movement that birthed it, the deaths of the eight doctors — from Egypt, India, Nigeria, Pakistan, Sri Lanka and Sudan — attest to the extraordinary dependence of Britain’s treasured health service on workers from abroad. It is a story tinged with racism, as white, British doctors have largely dominated the prestigious disciplines while foreign doctors have typically found work in places and practices that are apparently putting them on the dangerous front lines of the coronavirus pandemic. “When people were standing on the street clapping for N.H.S. workers, I thought, ‘A year and a half ago, they were talking about Brexit and how these immigrants have come into our country and want to take our jobs,’” said Dr. Hisham el-Khidir, whose cousin Dr. Adil el-Tayar, a transplant surgeon, died on March 25 from the coronavirus in western London. In Britain, almost a third of doctors in National Health Service hospitals are immigrants. “Now today, it’s the same immigrants that are trying to work with the locals,” said Dr. el-Khidir, a surgeon in Norwich, “and they are dying on the front lines.” By Tuesday, 7,097 people had died in British hospitals from the coronavirus, the government said on Wednesday, a leap of 938 from the day before, the largest daily rise in the death toll. And the victims have included not just the eight doctors but a number of nurses who worked alongside them, at least one from overseas. Health workers are stretched thin as hospitals across the country are filled with patients, including Prime Minister Boris Johnson, who this week was moved into intensive care with the coronavirus. Britain is not the only country reckoning with its debt to foreign doctors amid the terror and chaos of the pandemic. In the United States, where immigrants make up more than a quarter of all doctors but often face long waits for green cards, New York and New Jersey have already cleared the way for graduates of overseas medical schools to suit up in the coronavirus response. But Britain, where nearly a third of doctors in National Health Service hospitals are immigrants, has especially strong links to the medical school systems of its former colonies, making it a natural landing place. That was true for Dr. el-Tayar, 64, the oldest son of a government clerk and a housewife from Atbara, Sudan, a railway city on the Nile. He had 11 siblings, and one left a special impression: Osman, a brother, who became ill as a child and died without suitable medical treatment. Though Dr. el-Tayar rarely spoke of his brother’s death, he gave the same name to his oldest son. “In my mind, I think that’s what led him to medicine,” Dr. el-Khidir said. “He didn’t want anyone else in his family to feel that.” Dr. Adil El-Tayar After graduating from the University of Khartoum, Dr. el-Tayar decided to help address a tide of kidney disease sweeping across sub-Saharan Africa. So he moved to Britain in the early 1990s to train as a specialist transplant surgeon. He returned to Sudan around 2010 and helped set up a transplant program there. But the deteriorating political situation in Sudan and the recent birth of a son persuaded Dr. el-Tayar to settle back in Britain, where he went to work once again for the health service. Having lost his status as a senior doctor when he left for Sudan, he had taken up work filling in at a surgical assessment unit in Herefordshire, northwest of London, examining patients coming through the emergency room. It was there that his family believes Dr. el-Tayar, working with only rudimentary protective gear, contracted the virus. Sequestered in the western London home where he loved sitting next to his 12-year-old son, he became so short of breath recently that he could not string together a sentence. While on a ventilator, his heart failed him. Had the health service started screening hospital patients for the virus sooner or supplied doctors with better protective gear, Dr. el-Tayar might have lived, said his cousin, Dr. el-Khidir. “In our morbidity analyses, we go through each and every case and ask, ‘Was it preventable? Was it avoidable?’” he said. “I’m trying to answer this question with my cousin now. Even with all the difficulties, I’ve got to say the answer has to be yes.” Analysts warn that doctor shortages across countries ravaged by the coronavirus will worsen as the virus spreads. While ventilators may be the scarcest resource for now, a shortage of doctors and nurses trained to operate them could leave hospitals struggling to make use even of what they have. By recruiting foreign doctors, Britain saves the roughly $270,000 in taxpayer money that it costs to train doctors locally, a boon to a system that does not spend enough on medical education to staff its own hospitals. That effectively leaves Britain depending on the largess of countries with weaker health care systems to train its own work force. Liverpool Town Hall, in northwestern England, illuminated with blue lights in March in honor of the National Health Service. Even so, the doctors are hampered by thousands of dollars in annual visa fees and, on top of that, a $500 surcharge for using the very health service they work for. Excluded from the most prestigious disciplines, immigrant doctors have come to dominate so-called Cinderella specialties, like family and elderly medicine, turning them into pillars of Britain’s health system. And unlike choosier Britain-born doctors, they have historically gone to work in what one lawmaker in 1961 called “the rottenest, worst hospitals in the country,” the very ones that most needed a doctor. Those same places are now squarely in the path of the virus. “Migrant doctors are architects of the N.H.S. — they’re what built it and held it together and worked in the most unpopular, most difficult areas, where white British doctors don’t want to go and work,” said Dr. Aneez Esmail, a professor of general practice at the University of Manchester. “It’s a hidden story.” When Dr. el-Tayar moved to Britain in the 1990s, he was following a pipeline laid by the family of another doctor who has now died after contracting the coronavirus: Dr. Amged el-Hawrani, 55. An ear, nose and throat specialist, Dr. el-Hawrani was about 11 when his father, a radiologist, brought the family in 1975 from Khartoum to Taunton, a town in southwestern England, and then Bristol, a bigger city nearby. Dr. Amged el-HawraniCredit...University Hospitals of Derby and Burton NHS Foundation Trust Many Sudanese doctors at the time were burnishing their skills in Britain before returning home or moving to Persian Gulf countries for higher wages. But Dr. el-Hawrani’s family turned their home into a staging post for Sudanese doctors interested in longer-term stays, hosting their families during exams or house hunts. “The more the merrier,” said Amal el-Hawrani, a younger brother of Dr. el-Hawrani. “My mum always liked that.” Being British-Sudanese in the 1980s was not easy. Race riots flared in cities across the country. Mosques were scarce. Dr. el-Hawrani went to school almost exclusively with white British classmates. The young doctor quietly stood up for his family: When someone once tried to kill a 100-year-old fern in their garden by cutting out a ring of bark, Dr. el-Hawrani snapped off branches and nailed them across the gap so that nutrients could get across. Still, discrimination bothered him. When it came time to follow his father into medicine, Dr. el-Hawrani told his brother that he “wanted to be an orthopedic surgeon but felt that maybe because of certain prejudices he didn’t get it.” His resolve only grew stronger after an older brother, Ashraf, a fellow doctor, died at 29 of causes related to asthma. Dr. el-Hawrani discovered his brother’s body. Before Dr. el-Hawrani’s death, on March 28, he had finally come around to the idea that his only son, Ashraf, named in his brother’s memory, would study English instead of the family trade. Ashraf said in a statement that his father “was dedicated towards his family.” “Now he has to make his decisions about which university to go to on his own,” Amal el-Hawrani said of Ashraf. “He was expecting to have his father’s help.” The coronavirus has taken a devastating toll on migrant doctors across Britain, leaving at least six others dead: Dr. Habib Zaidi, 76, a longtime general practitioner from Pakistan; Dr. Alfa Sa’adu, 68, a geriatric doctor from Nigeria; Dr. Jitendra Rathod, 62, a heart surgeon from India; Dr. Anton Sebastianpillai, in his 70s, a geriatric doctor from Sri Lanka; Dr. Mohamed Sami Shousha, 79, a breast tissue specialist from Egypt; and Dr. Syed Haider, in his 80s, a general practitioner from Pakistan. Barry Hudson, a longtime patient of Dr. Zaidi in southeastern England, recalled their exam table conversations about England’s cricket team. “He was a big figure in the community,” Mr. Hudson said. “He had a proper doctor’s manner. He didn’t rush anybody.” Dr. Habib ZaidiCredit...NHS Southend CCG For families that love to gather, grieving at a distance has been wrenching. Dr. el-Tayar was buried beside his father and grandfather in Sudan, as he had wanted. But because only cargo planes were flying there, his wife and children could not accompany the coffin. At Dr. el-Hawrani’s burial, an imam said a prayer before a small, spread-out crowd, and the doctor’s four living brothers and son lowered his coffin into the ground. Then they dispersed. His brother, Amal el-Hawrani, permitted himself a single intimacy: a hug with his mother, because “I couldn’t turn that away,” he said. Then she returned to her home in Bristol, along with a son who had visited Dr. el-Hawrani in the hospital. Fearful of passing on the virus, he had to forbid her from his room to keep her from bringing in food. Source
