From catamaran to CantabrigiaBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7075.234a (Published 18 January 1997) Cite this as: BMJ 1997;314:234
“Dear Dr Badrinath
I am delighted to inform you that you have been awarded a scholarship to read for the MPhil degree in epidemiology in Cambridge.”
It was the first week of August and I had just returned from the outreach clinic to the Indian coastal town of Manipal, where I was assistant professor. As I read the letter tears rolled: this was the culmination of my long battle to study epidemiology abroad. I was granted leave without pay for a year.
I soon realised that this budding epidemiologist would never blossom without a doctorate–so I worked hard and completed my MPhil with high grades. My next task was to secure funding for a PhD. With the help and guidance of my supervisor, Professor Nick Day, a proposal for a case control study on acute leukaemia in East Anglia was drawn up and submitted to the local health authority. Our aim was to determine the aetiology of adult leukaemia by interviewing patients with the permission of the consultants and study age and sex matched controls with the general practitioners' approval. I became the self appointed data clerk, secretary, interviewer, project officer, and epidemiologist.
When I began interviewing the patients in the control arm I was confronted with a problem. As a rural Indian general practitioner I could charge only five rupees (about 10p) for each patient and travelled by scooter bought with a bank loan or in a catamaran to reach water-logged areas. In England I could not drive and had to depend on British Rail and buses. People gave me directions such as “Go straight on at the roundabout on the A428.” When I confessed that I did not have a car I could sense the change at the other end. So I became the owner of an imaginary car and noticed that people started to treat me better. Inevitably a problem arose when someone would ask me, “Where are you parked, doctor?” So besides my discreet research on public transport I also had to find a place nearby where a sensible person would park: “Oh, I just parked at the council car park.” But some doctors would see me off at the door and to complete my act I had to take out my bike keys (I always biked to the station) and walk towards a decent car praying that it wasn't the doctor's car.
I realised that travel consumed most of my time. To reach a house on the Norfolk coast I had to board my bike, three trains, two buses, and of course … walk. These expeditions sometimes took five hours. Realising that I had travelled by public transport from Cambridge I was considered inhuman by the aristocrats and superhuman by the working class. Just to quote a Suffolk general practitioner: “Either you are too dedicated to your research or you must be absolutely mad.” When I was waiting for a bus with an inch of snow under my feet on a dark January afternoon with the North Sea wind blowing hard I realised that the latter description suited me rather well. The general practitioners were helpful and understanding–some even had sandwiches ready when our meeting was at lunch time.
By this time there were some developments on the domestic front. We succeeded in convincing the British High Commission that I had the necessary means to support my family, and so my wife and two children joined me. An unfurnished flat without heating was all we could afford. British generosity, however, came to our rescue and staff in my department lent us all we needed from cutlery to a dining table. Car boot sales and charity shops were also very handy.
After seeing my ordeal on public transport my wife decided that she had to somehow sponsor my driving tuition. She enrolled at the local supermarket to work at the weekends while I went through the literature on leukaemia and looked after the children. I joined a driving school and eventually was declared fit to drive on British roads. Owning a car, however, remained a distant dream.
During my case interviews I found that despite being devastated by the diagnosis all the patients accepted it and were comforted by friends and relatives. The patients had a close rapport with the haematology team and all of them praised the staff. Control interviews were different. For example, “I am from India and have come to Britain for training.” Mrs S: “Did you come by train from Cambridge? Oh dear, you should be glad that in this country you needn't travel on the train but in the train.”
At last we managed to save enough and I became the proud owner of a car. After travelling 20 000 miles by public transport life changed overnight. People faxed maps, and I could complete a week's work in half a day.
When I sit back and look at my computer screen I am overwhelmed with mixed emotions. My heart feels heavy for the many patients with leukaemia who spoke to me for hours, always asking in the end “Why me?” and who are not with us anymore. Yet I am consoled by the fact that they faced their illness with courage and dignity, and mankind gave them the best it could offer.
I have come a long way from a tiny Indian town to the pinnacle of academia in Europe. Nevertheless, having been turned down three times by the Public Service Commission for the post of a medical officer and forced to give up my title of assistant professor–my former employers refused me further leave–I find myself unemployed at the age of 36, with an empty bank account and a wife and two children to care for. Thanks to the British Empire, two thirds of the globe speak English and this will be my territory to search for a living. In the near future I will return to the catamaran to get to my patients, but this time I can charge 10 rupees (20p) for a consultation.