BRAND NEW DOCTORS: The Commencement of Tianjin Medical University on July 1, 2019, in Tianjin, China

Sowmiya Ashok finds that Indians who can afford to pay Rs 30-50 lakhs but cannot get seats in Indian medical colleges are turning to Chinese colleges, which often do not require any minimum percentage. However, to be certified in India they then have to pass the Foreign Medical Graduate Exam (FMGE) — a mandatory screening test conducted by the Medical Council of India (MCI)

Every time she flew back from home in Anand, Gujarat, 24-year-old Rashi Patel would carry in her checked-in luggage men who had a lot to say and weighed on an average 3 kg. This is how Deepak Marwah, AK Setiya, Gobind Rai Garg, BD Chaurasia and K Sembulingam came to live in northeastern China, on her bookshelf at the Tianjin Medical University’s (TMU) student dormitory.
Last winter, Patel scored 186 marks out of 300 in the Foreign Medical Graduate Exam (FMGE), a mandatory screening test conducted by the Medical Council of India (MCI) for students who obtain medical degrees from colleges outside India but are keen to practise medicine back home. The exam can be taken twice a year — June and December — starting from the student’s internship year. To clear the “extremely tough” FMGE, Patel “thoroughly read Indian notes” day and night. “I mostly read Deepak Marwah sir’s notes. They are very good,” she says.
On July 1, 2019, Patel, along with 123 Indian students, graduated with an MBBS degree from TMU in a ceremony held at the university’s indoor basketball court. She topped her batch, her smiling face captured in a poster affixed to a pole adjacent to the parking lot on the campus: “youxiù bìyè sheng (excellent graduate student)”, it read.
China, which has been offering undergraduate medical courses in English since around 2004, has over the years emerged as a destination for foreign students, mostly from the subcontinent. Since then, through a combination of hearsay and an informal network of private agents, thousands of aspiring doctors in India have opted for a Chinese medical degree.
For these Indians, whose dreams of donning the scrub are often stymied by fierce competition back home and the limited number of medical seats — 84,127 seats are on offer in a mere 573 colleges, government and private, in 2019-2020, according to the government’s recent response in Parliament — China is an attractive option, the country an emerging player in a market that has traditionally been dominated by Russia and other east European countries.
Patel is at the end of her China journey. So is her classmate Mrinalini KVSS, who is preoccupied with sending home four years of purchases made on Taobao, a Chinese online shopping website. “Mostly clothes,” she says, laughing.
Originally bound for Nanjing Medical University in the eastern Jiangsu province, Mrinalini enrolled in TMU “by mistake” in 2013. “My agent messed up,” she says. According to students The Sunday Express spoke to, the ‘agent’, a crucial conduit for this journey to China, can be anyone — a high school teacher, a friendly neighbourhood uncle, an NGO in rural Tamil Nadu, or seniors who graduated from medical schools in China but couldn’t clear the FMGE. In one case, it was the student’s uncle. This student even got a discount, but only on the commission he paid his agent-uncle.
Sunidhi Jhamb from Ludhiana in Punjab, who also graduated from TMU and came to China in November 2013, says that soon after her Class 12 results were out, her father received several phone calls from agents about medical courses in Ukraine, Russia and China. “Maybe the agents got the phone number from the forms that I filled up for medical entrance tests in India,” she says.
Sitting in her room at the Foreign Students’ Hostel in Cangzhou, a city in China’s eastern Hebei province, Jhamb says, “I didn’t have a choice back then. I was only getting a seat in dentistry at Rajpura (in Punjab’s Patiala district), which I didn’t want. My father knew someone whose relative was studying for an MBBS degree here. So we felt we could trust China.”
Jhamb is among 57 international students — Indians and Sri Lankans — in her batch who have completed their internship at Cangzhou Central Hospital next door. She has now launched into full-time preparation for the FMGE.

NO CRITERIA

On the face of it, a degree from China is an alluring option, says a former student who does not wish to be identified. “There are no criteria by which you get admitted to a course. If you have the money, you get admission,” he says, adding that this is reflected in the quality of students who end up in China.
Around 7,000-8,000 Indian students travel to China every year for an MBBS degree. Though some universities specify their requirements — the need to have passed high school with a certain minimum percentage — in many other instances, students say, there are no entry barriers.
Says Madhurima Nundy, Associate Fellow of the Delhi-based Institute of Chinese Studies, “China is a good option for those not qualifying the public medical college exams (in India). Studying in China is far cheaper than studying in private medical colleges in India. Besides, some of these (Chinese) universities are rated high by international standards when compared to Russian universities.”
Patel says her parents spent roughly 30-40 lakh for her six years in China. A 1st year student’s fee structure, shared by an agent, adds up to around 22.5 lakh a year, which includes tuition fee, hostel, food, health insurance, residential permit, physical examination, textbooks and “experiment material”. That makes Chinese colleges a good alternative to private medical colleges in India with their sky-high capitation fees. “My niece paid85 lakh in capitation fees for a seat in a private college in Pune,” says 57-year-old Mumbai-resident Pawan Sharma, who chose to send his son Harshit to Tianjin.
Jose Akash, a 4th year student from Trichy in Tamil Nadu who studies in Beijing’s Capital Medical University (CMU), says, “My mother decided that I should be a doctor. In my generation, there are no doctors in the family. So I had to be one.”
Akash’s family had to shell out `2.5 lakh as commission, apart from paying for the agent to travel alongside him on the flight to China — the agent even visited her relative on the pretext of dropping him off. Akash says he couldn’t manage a seat in a medical college in Trichy in Tamil Nadu despite his family’s connections in the DMK. “The AIADMK is in power in the state,” he sighs.
Four years ago, all that Akash knew about China was what many Tamil children growing up in the late ’90s and early 2000s knew: insight from Bruce Lee films dubbed in Tamil that played late in the night on Vijay TV. “I had no desire to come here. I had seen things about China which I thought I wouldn’t like. But after I came here, I loved it. Have you checked out the Burger King in Beijing?” he asks.
ENGLISH ONLY?

For 2019, CMU is fourth on an approved list of medical universities prepared by China’s Ministry of Education (MoE) that can accept international students. The list, which is released every year ahead of the admission season after a “thorough scrutiny of the English-medium standards including examining the infrastructure, amenities and proficiency of the faculty” of the universities offering medical education, is also uploaded on the MCI’s website as a useful guide for aspiring medical students.
For this academic year, the list contains 45 medical universities across China, with 3,370 seats on offer. Many of the universities are concentrated in eastern provinces such as Jiangsu, Shandong and Zhejiang.
Official sources The Sunday Express spoke to said the overwhelming majority of foreign students in the 45 universities are Indian, many of them from South India. Besides, there are students from Bangladesh, Pakistan, Sri Lanka and some African countries, a source said.
Earlier this year, on April 29, the Embassy of India in Beijing said in a press release: “Prospective students are advised to note carefully that only these 45 Chinese Universities (mentioned in the list) are authorised to admit international students for an MBBS degree in English. They may also note the warning in the notification that teaching of MBBS courses under a bilingual (English/Chinese) model is strictly forbidden.”

Nundy says this is a “good move” since there were many bilingual universities (about 214) of lower quality that were also listed till about 2017. “There is much variation in the curriculum and pedagogy across these universities when it comes to medical education for international students and there needs to be some kind of quality check,” she says.
Though the language clause — which “strictly forbids” these medical schools from teaching bilingual MBBS courses to international students — is what draws international students, once they enrol, students realise early on that there is no escaping Mandarin while in China. The language training programme is an in-built component in the MBBS course and it runs for a minimum of three years. Also integrated into the syllabus are courses on traditional Chinese medicine and medical terms in Mandarin.
The language barrier is often cited as the main reason for Indian medical graduates not wanting to stay back in China. “In my final year of internship, half the time I was listening to patients and then turning to the doctors to know what they were saying,” says Mrinalini, adding, “How can you help patients when you can’t communicate with them? It becomes very frustrating.”
To practise in hospitals in China, students say they must clear at least Level 5 of the Hanyu Shuiping Kaoshi or the Chinese proficiency test, which requires one to know 2,500 commonly used words and grammar patterns.
However, the former student says that while there are policies in place to mandatorily teach international students in English, the quality of teaching leaves a lot to be desired. “There are teachers who cannot speak English at all. They ask Chinese students who can speak English to read out loud and record PowerPoint presentations, which are then played in classrooms,” he says, adding, “Over the years, this has led to universities requiring students to learn more Mandarin.”
During role-plays in Chinese class during his first year, Manoj Sharma, a native of Cuddalore, Tamil Nadu, also from Patel’s batch, was always the bingren (patient). “It is easy to memorise Chinese words for cough or fever and let the person who is acting as the doctor memorise the bigger words,” he laughs. “But learning the language is necessary. It helped me make friends.”
During his internship, Sharma often walked over to the park across the hospital where Chinese senior citizens practised martial arts. “Cangzhou is historically known for wushu or Chinese martial arts. The old men would teach me martial arts and introduce me to their friends as their Indian student,” he says.

SAMOSAS AND CHAI

The signs of an ecosystem developing around the growing Indian student population are apparent in the local market at Tianjin, where Haldiram’s Murukku packets and Amul ghee sit on shelves above rows of noodles. At the Hassan Restaurant, named after the Chinese owner who carries around his pet parrot perched on his shoulder, samosas are for 3¥, dal rice for 12¥, and chicken biryani for 22¥. (One ¥ or yuan roughly converts to `10.)
“Indians starved for comfort food often turn to Pakistani and Bangladeshi restaurants,” says a former student from Kerala, who studied at Zhengzhou University in east-central China’s Henan Province. “At the end of the day, we want dal and rice. How much noodles can one eat?”
When he joined Zhengzhou University, many told him it was a “beautiful place for dating” because of “its magical garden”. Yet, when he got to the campus, he felt he had made a mistake. “To begin with, the town outside felt a decade older than the richer parts of China. The university had great facilities but lacked good teachers. But since 2015, things have been changing. The quality of faculty has improved a lot.”
Like many of his seniors, he depended heavily on Bangladeshi professor Dr Najeeb’s “World’s Most Popular Medical Lectures” on YouTube. Most students admit campus life in China isn’t too different from what it would have been in India but comes with a Chinese background score. Members of the Indian community often stay and cook together, celebrate birthdays together, feature each other in short films on Valentine’s Day and play cricket together. This year, CMU’s cricket team led by 4th year student Ramesh Kamalesh beat Tianjin Strikers by 25 runs in the annual summer cup.
But there are some things about Chinese campuses that stand out for students. For one, the co-ed dormitories, unheard of back in Trichy where Akash went to school, which slapped fines on boys for speaking to girls on campus. “No one seems to care about such things here,” says Kamalesh. The privilege is reserved, however, for international students. A few kilometres away, the Chinese medical students live in gendered dorms. The other distinct feature of Chinese campuses is the complete ban on protests.
In the weeks leading up to the graduation of a batch of medical students, testimonies began circulating on the Chinese messaging app WeChat, where students reflected on their time in China. On June 22, Indian student Bimcle Riji from Jiamusi University in Heilongjiang province — one of the universities not on the MoE’s approved list for the year — wrote a lengthy note in English about his experience and the people he met during his stay in China.
About his teacher Chen Gueng, he wrote: “Speaking in front of the entire batch is almost a difficult task for me but I am very thankful to my teacher for (giving me the) opportunity… to organise my thoughts, create effective presentations and voice my opinions in an effective way.”

FMGE

Despite these happy stories, most students admit the “real problem” arises when they return to India with their degrees. Official figures with the MCI show that in 2018, only about 15% of students who took the FMGE cleared the exam.
“The FMGE is based on the Indian curriculum. With standards so vastly different, no wonder many foreign graduate students fail. There is no exit exam for students graduating from private medical colleges in India, when there are concerns about the accountability and quality of many of these colleges as well,” says Nundy.
In a 2016 paper, she analysed data from 2012-14 to show that medical colleges in China and Russia had the highest number of Indian students and the lowest pass percentage of 18.9 in the FMGE. The pass percentage has been declining since, she says.
Though Rashi Patel has managed to pass the gruelling exam, practising in India is just a “backup” option for her. “I think she should go to the US. We don’t like working in India,” says Rashi’s surgeon father Bharat Patel outside the graduation hall at Tianjin Medical University. “In India, work is getting less and there is more maar peet (violence directed at doctors).”
Rashi hopes to head to the US but her classmate, 23-year-old Vegaas Singh, is staying back in China. He too graduated this July, in the presence of his 91-year-old grandfather Col (retd) J P Singh Sahi, who flew from Delhi to see him receive his degree and pose for a photograph with TMU’s Dean. Yet, for Vegaas, the medical degree is only a part of who he is. A bodybuilder and a basketball player, Vegaas put TMU on the basketball map for six straight years, winning every tournament.
Today, he endorses, among other things, shoes made by Li-Ning, a top sports brand in China. He often receives shoes, caps, jerseys, sweatpants and protein shakes in the mail requesting for the products to be promoted on Douyin, the Chinese version of TikTok. He says the anatomy lessons in college helped him work on his muscles in the gym. “For some reason, I can’t find my eighth ab. It’s just 7,” he joked recently in Chinese on his WeChat moments.
Vegaas says bodybuilding was never on his agenda. As a “tall, thin guy from India wearing something on his head (Vegaas is Sikh and wears a turban)”, he became a spectacle in China when he landed at 18. People stared, took pictures and “made fun” of him. Frustrated, Vegaas hit the gym.
Last year, his muscular body and his obedient cat Marvel went viral on Douyin, triggering his steady rise to become a Chinese influencer or a KOL, a key opinion leader. Fourteen months later, he has 1,34,000 followers.
“I feel I have made a base for myself here. A lot of people know me and appreciate what I am doing,” he says, adding, “I don’t want to let go of medicine completely. So I am considering rehab medicine. But I want to be a semi-professional bodybuilder, which is expensive to fund. I would need sponsors and fans. So it makes sense for me to stay here.”

Courtesy: Indian Express