When I was growing up in India as a teenager in 1980s Mumbai (Bombay as it was called then), a ghazal (a form of rhyming love poetry) sung by the noted singer Pankaj Udhas had become famous and was on everyone’s lips. I would hear the song, ‘चिट्ठीआईहै’ (‘Chitthi aayee hai’, translation: a letter has arrived) from the Hindi movie ‘नाम’ (‘Naam’, meaning name) on popular radio channels, on the weekly television programme based on Hindi film songs, at functions and ceremonies. I could not relate to the sentiments expressed in the song at the time- which spoke of the sense of yearning and grief expressed by a father when his son goes abroad to work and leaves a family behind broken by loss and separation.

I could connect however to the emotion expressed in Pankaj Udhas’s soulful voice and the chord it struck in the parents of some of my older friends who had migrated overseas to study or work. At a time when arguably the exodus from India was at its zenith, the quiet weeping and the messy guilt it brought, along with shiny hope, found utterance in songs like the one above. As Shakespeare wrote in Macbeth,

“Give sorrow words; the grief that does not speak knits up the o-er wrought heart and bids it break.”

Many years later, over 25 years in fact after I migrated to the UK, as I sit writing this blog, trying to make sense of the devastation caused by Covid19 and taking refuge in well remembered songs from my youth, the sentiments expressed in the ghazal hit me with full force. Stories whirl slowly like a kaleidoscope in front of my eyes. I remember the sadness in the voices of my indigenous colleagues and friends as they talk of being unable to visit their elderly parents; lonely and afraid in hospitals and care homes, due to pandemic restrictions which are understandable but sometimes unbearable.

I recall the resigned acceptance of fear and loneliness in a newly arrived doctor’s voice, talking of being very ill with Covid-19 at the beginning of the pandemic and not having any food in the house. Alone in the UK with her family in Africa, she eventually remembered a taxi driver from her part of the world who had ferried her to and from work before the pandemic and was able to ask him to deliver food and leave it on her door step for two weeks while she was self-isolating.

Then there was the international medical student who had to remain; anxious and isolated at the flat he was sharing with three other UK students, all of whom were able to return to their families before the first lockdown. Even after the lockdown restrictions were lifted he was terrified of leaving the flat for fear of breaking a rule inadvertently, being stopped by the police and his student visa being rescinded.

A friend of ours recently journeyed to his home country to see his terminally ill father after several attempts to travel through the latest phase of lockdown, with flights being cancelled and then restricted. His father, caught between wanting to see his son and fear for his son’s risk of Covid19 and the stress of quarantine, tried to dissuade him. Our friend travelled, only to hear that his father died while he was quarantining in a hotel after landing. I cannot imagine being bereaved and grieving in that place of soulless isolation.

I remember the sorrow, the part yearning and part acceptance in my father’s voice in India when I told him, following his hospitalisation and fortunate recovery, that I would not be able to travel to see him in February as I had hoped, due to Covid19 raging again in the UK. That there was another lockdown, with international travel once again restricted. That the time required for quarantine meant that I would not be able to actually spend time with my family and neither would I be able to take a period of extended leave from work. I could not let down my employers, my patients and colleagues by taking that much time off or God forbid, falling ill during travel. I can visualise my father straining to hear me, rocking in his chair as he looked out of his sitting room window in Mumbai, where he lives alone since my mother passed away almost 12 years ago. The nervous frisson that passes through me at the memory is similar I am sure, to what millions are feeling right now across the world.

“No one ever told me that grief felt so like fear.”
― C.S. Lewis, A Grief Observed

For those of us who are international medical graduates (IMGs) mostly from the LAMIC (low and middle income countries) diaspora, there is also often a self or externally imposed ‘good immigrant’ narrative. To paraphrase the writer Nikesh Shukla a “constant anxiety we feel as people of colour (read immigrants) to justify our space, to show that we have earned our place at the table, continues to hound us”.

But things can be different. Dr Nitin Shrotri, a Consultant Urologist in the NHS in the UK, wrote a personal piece for the BMA (British Medical Association) where he described his own positive experience and made a case for parents of international NHS workers to be given Indefinite Leave to Remain in the UK. As Dr Shrotri says, “this will go a long way, and make our doctors feel valued and cared for”.

Alongside many individual doctors calling for changes in immigration rules to help retain and send a message of support to NHS workers, a powerful blog in the British Medical Journal (BMJ)  by leading members of BAPIO (British Association of Physicians of Indian Origin), APPNE (Association of Pakistani Physicians of Northern Europe) and the BMA also asks the Government to review the unnecessarily stringent rules for the Adult Dependant Relative visa, and highlights the plight that many doctors of international origin are faced with the in the wake of Covid-19. A survey carried out by these organisations with several hundred responses revealed a significant proportion of the doctors experiencing stress, feeling unsupported by their employers for flexible leave and feeling it affected their professionalism and work adversely (nearly 60%).

Pankaj Udhas’ song continues:

देश पराया छोड़ के आजा (Desh paraaya chod ke aaja, translation: leave the alien country and return)

पंछी पिंजरा तोड़ के आजा (Panchi pinjra tod ke aaja, translation: Oh bird, break free of your cage and return)

In a peri- pandemic world, it does not feel too fanciful to talk of having to choose between Scylla and Charybdis.* Where do the boundaries lie for me and others between love and duty to my work as a doctor, to the NHS which is overburdened right now and to the love for my family, in my motherland? The choices we make around migration are largely ours but which can never be undone fully. We can never un-know what it is to be caught in a dualism that gives and takes in equal measure.

“The tears I feel today

I’ll wait to shed tomorrow. (Anne McCaffrey, Dragonsinger)

In the survey referred to above, almost 85% of doctors had considered relocating to their country of origin or another country where they would feel more supported. We need to collect this data regularly in the UK when doctors, including international doctors leave the NHS to work abroad. Grief unshared and unexpressed; when people are oceans apart, trying to bridge a yawning gulf of indifference, inequalities and illness, can swell up to consume us. There is a powerful humane, moral, social and financial case to be made for healthcare workers serving the NHS and care sectors in the UK to be able to have their parents and adult dependants with them.

Amidst this sombre landscape, love wafts through like a breath of fresh air. As has been expressed many times and in the simple but strong words here:

“So it’s true, when all is said and done, grief is the price we pay for love.”
― E.A. Bucchianeri, Brushstrokes of a Gadfly

We cannot bring back our loved ones and we may be far apart from them, but we can cherish and nurture the wellspring of love from which grief gushes forth yet can be channelled too to build a new future. For as Mahatma Gandhi said:

*Being between Scylla and Charybdis is an idiom deriving from Greek mythology, which has been associated with the proverbial advice “to choose the lesser of two evils”.

Musingly yours

Ananta Dave