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Diary of a U.S. IMG

The New Physician October 2001
After a series of rejections from U.S. medical schools, a high-school valedictorian turned to Grenada for a medical education and discovered that an offshore school was just the ticket to helping him achieve
his dreams of becoming a physician.



Going to medical school in the Caribbean is not for everyone, but I consider it one of the most enriching learning experiences of my life. I don’t claim to be a prototypical U.S. international medical graduate (IMG), but I feel my experience is pretty representative. I was a high-school valedictorian, University of California, Berkeley, biology graduate, overachiever rejected by several U.S. medical schools in what I’ve rationalized to be a highly competitive application year. After overcoming the initial disappointment of not getting into a U.S. medical program, I quickly realized there were other options and found a St. George’s University School of Medicine (SGU) application on my desk. I applied and was accepted.


Naively, I only researched SGU one week prior to my departure to the Caribbean. Yes, I was so hungry to get into medical school that I blind-
ly applied to an institution I knew little about—except that it would grant me an M.D. From my better-late-than-never research, I learned that SGU’s students spend one-and-a-half years in Grenada studying the basic sciences (anatomy, histology, biochemistry, neurology, physiology, etc.), then another five months on the island of St. Vincent to complete courses in pathophysiology, pharmacy and clinical skills. Students also conduct rotations at St. Vincent’s hospital. Both islands are located on the southern tip of the Caribbean Islands. Grenada is about 90 miles north of Venezuela—just out of reach of the hurricane belt. SGU students then leave the Caribbean to spend their clinical years on rotations at health-care institutions in the United States or England.


I had many ideas of what school would be like in the Caribbean. Imagining it to be similar to spending two years at Club Med, I pictured sun, sand and beaches with an occasional medical school exam every semester. A couple of years in paradise and then I’d be back in the United States to do my clinical clerkships—piece of cake (or so I thought). So one thing led to another, and there I was, jetting away to a tropical island.


With the time-zone difference and thousands of miles, the trip took longer than a day and a half (Los Angeles to Miami, Miami to San Juan, San Juan to Grenada). I had no friends or family to accompany me, only two enormous bags containing my life’s belongings for the next few years. I doubted my decision the entire time. Would I be able to get the residency I want after I graduate? Did I have what it takes to make it in medical school? Was it too late to turn back?


It was evening when I finally stepped off the airplane. I was groggy, but, hey, I was about to enter paradise, right? There are two dormitory campuses at St. George’s—Grand Anse and True Blue. Most first-term students are placed in the dorms on the beautiful Grand Anse Beach, so that was to be my new home. The resident assistant directed me to my room on the first floor of what used to be an old hotel. The moment I opened the door, reality hit. I had to share a room the size of my tiny kitchen back home with two other guys. My bed was a beat-down, old mattress resting on the floor. A single light bulb hung on the wall, welcoming me to my Club Med.


I wasn’t the only medical student with tropical dreams. Most of my classmates had misconceptions about what medical school would be like in Grenada. And once those dreams shattered, many of us thought about quitting; some did. Those who did missed their friends and family too much or perhaps just wished they could have a decent hamburger once in a while.


And those who remained often had mixed opinions about their experiences. Yes, the beach was gorgeous, and the water was so clear you could see the plants, fish and sand 10 feet underwater. But that’s all you saw—ocean to the east, west, north and south—and panic would set in. I suppose you could call it Island Fever, an afebrile disease of big-city dwellers living on a small island. To relax, many students flew back to the states after a stressful week of exams. Others merely jumped on a small airplane and visited nearby islands like Barbados or, my favorite, Margarita.


The local cuisine, I do admit, was quite delicious—a mixture of Caribbean and Indian flavors (if you ever visit Grenada, try the Kalooloo soup!). However, variety was somewhat lacking. The only two American food chains were Pizza Hut and KFC. And, depending on the day and time, sometimes KFC would be out of chicken. SGU’s main campus did have a cafeteria, though, and if you lived in Grand Anse, a few Grenadian women affectionately called “The Ladies” catered delicious meals. I once arranged a meal plan with one of The Ladies named Rosie, because no matter how hard she worked or how busy she was, she always had time for a smile. On special days, Rosie would make these delicious brownies, and she always threw in an extra portion for me with a quiet laugh and a playful smile. For students who chose to cook for themselves, the local grocery stores provided a modest selection of U.S. brand names. However, imported goods usually carried a hefty cost.


Few people could afford renting a car in Grenada, so most of us traveled by the local transit system—“the Reggae bus.” These were small minivans decorated in island colors and plastered with stickers with such names as “Cool Riding” or “De Fast One.” All were equipped with mega-subwoofer speaker systems blasting Reggae music. Every driver could probably find a job with NASCAR, as each one was able to negotiate the most death-defying curves and two-way road systems with ease, nearly giving every American passenger an MI with each near-miss. The van’s doorman collected one EC (Eastern Caribbean Dollar) for each bus ride, responding to a firm knock on the wall or ceiling by the passenger wishing to stop. There are no amusement parks in Grenada, but if you want the thrill of a roller coaster, one EC will get you the next best thing.


I think most people could tolerate the minor inconveniences of living on a small island, but I had the most difficulty dealing with the distance from friends and family. Medical school is tough enough, but place it in a remote location where there’s a local monopoly on long-distance phone calls (meaning: almost $3 per minute) and you sort of lose your support network. Tolerance, flexibility and perseverance were keys to my survival. You make do with what you have, you adapt, and soon you find that life in the Caribbean is not so bad. You make friends quickly on the island because, unlike the “Survivor” TV show, you don’t get to kick off the ones you don’t like. And soon you settle into the slow pace and the relaxed island culture.


The dearth of distractions made studying more attractive, so many of my SGU classmates, including myself, did well on the United States Medical Licensing Examination (USMLE) Step I exams. There were numerous review groups, peer-tutoring sessions and extra office hours before the tests. The administration promoted academic excellence and invested heavily in improving the scholastic environment.


For example, the medical campus underwent numerous changes while I was there—new dormitory buildings, a state-of-the-art library on a cliff overlooking the beautiful True Blue Bay, and a pathology and marine biology building fully equipped with an aqua bay were all added during my years on the island. The campus was truly self-sufficient with its own bank, recycled water supply, grocery store, cafeteria and fully stocked weight room. We were only missing an Olympic-sized pool. The latest rumor among the locals was that we were building our own city—indeed we were.


Despite these luxuries, we still lived in a developing country, and sporadic power outages and water shortages were inevitable. Strangely, these would always occur right before final exams, as if the administration were purposely trying to make it more difficult for us. One power outage occurred in the middle of my anatomy lab practical. Station 19: “The red flag points to a wrist bone frequently fractured in elderly females.” I was in the middle of trying to remember a silly mnemonic device when the room went dark.


“OK, do not move from your station and keep your eyes directly on your station,” our professor ordered. After five minutes, the lights and air conditioner still did not resume, and the smell from the cadavers was beginning to make my eyes water. “No worries,” as the locals say on the island—a motto to be cherished in moments like this. Another five minutes passed, still no power. So we opened all the window shades to let the light in and continued the exam. My next station was a plain film of the abdomen, easily read by sunlight.


The best parts of my offshore experience were the numerous adventures I had that I would never have been able to enjoy if I had attended a U.S. medical school. One particularly memorable event occurred near the end of my first semester. A friend of mine was up late studying one night. She came into my room and awakened me from my slumber, her face beaming with a huge smile. “Quick, get up and follow me,” she whispered. So I did.


“Where are we going?” I asked. My eyes were tired, and only the moon lit our path.


She just put a finger to her lips and begged, “Quiet, you’ll scare it.” We stepped onto the beach, only a few steps from our dormitory. Then I saw it. The creature was enormous, and as we approached it, a monstrous hiss bellowed from its mouth. We had been told giant sea turtles rarely find their way onto Grand Anse Beach. This one was ready to lay some eggs. We got close enough to take pictures, but not too close to test its jaw strength. It was truly an amazing event.


Another memorable adventure occurred right before I was to leave Grenada to continue my studies in the United States. One of the school-bus drivers took me on a tour of the island. I rode shotgun in his little Jeep, and in the back seat were two English women who worked at the orphanage where I volunteered. We journeyed around the island all day. First, we saw a rum factory that used to be a sugar mill. Next, we drove to the north end of the island to view an abandoned airport; remnants of an old airplane from the U.S. invasion littered the runway. Then we ventured to the highest point of the island—to an extinct volcano that is now a lake. The locals said that a man was once sucked to the bottom while swimming, so I didn’t care to test the waters. Finally, we settled at a hot spring in the middle of the rainforest. Parking the Jeep on the edge of the road, we hiked into the jungle.


It was a serene, late afternoon day, and it seemed as if Mother Nature were trying to quietly welcome us. Our trail was a little muddy from a morning rain shower, and we followed its gentle incline as the wind swept softly through the trees. I heard the lone voice of a Rasta man singing prayers to God in the distance, and the smell of his pipe greeted me before he did. The hot spring was yellow from sulfur, and the heat from the waters created a mist enveloping the entire area. We stepped into the spring slowly, trying not to disturb the sand below. I sat in the center of the pool, bathed by its warmth, and I thought, “I’m in the middle of a tropical jungle.” It was one of the most ethereal and cleansing moments of my life. The next day I left for the United States and said goodbye to Grenada. I had completed my preclinical training.


SGU’s main office in Bay Shore, New York, arranges students’ rotations with various affiliate hospitals in the United States or in England. I spent my clinical years in California and New York. My first core clerkship was in internal medicine; I had requested the Alameda County Medical Center in Oakland, California, because I was familiar with the area and still had many friends from college nearby. Although I had already completed and passed the USMLE Step I, I still worried if my foreign medical education would be up to par with U.S. standards.


The clerkship was rigorous and demanding. This was my time to learn the practice of medicine, and I eagerly absorbed it all. U.S. medical students also rotated in the hospital, and I came to realize that it doesn’t matter where you come from—there are “no color lines” with overbearing residents and attendings. Like most third-year medical students, I made a few rookie mistakes. I got locked in the wrong stairwell, lost my team when I went to drop off films at radiology, fumbled presentations at morning reports, and was yelled at by nurses and physicians for being in the wrong place at the wrong time. But I never felt that my knowledge base was inadequate, nor did I feel out of place. I eventually learned to be more at ease in the role of a clinician, and the early mistakes only inspired me to improve myself. It was a trial by fire, requiring me to adapt to adversity and function effectively in unfamiliar territory—lessons I knew well from my experiences in the Caribbean.


My next rotations were in New York, where I completed my other major core clerkships—psychiatry, Ob-Gyn, surgery and pediatrics. Wherever I went, I heard SGU students described as being resourceful, hard-working and flexible. Perhaps we had something to prove or merely appreciated being back in the U.S. system. I met other IMGs and U.S. allopathic and osteopathic medical students. It was an interesting time, and I formed valuable friendships with memories to last a lifetime.


It all seems to have gone by so fast. Now, as I take a deep, cleansing breath, I can proudly say I’m embarking on a new adventure—residency. When I first started medical school, I really had no idea of what I was getting into. In retrospect, I believe that I could not have had a better life experience than to pursue an international medical education. I feel that I am well prepared for the next stage of my career. I’ve spent the last decade of my life chasing after this dream to become a physician, and now that it’s over, I’m almost at a loss for words. I feel a powerful sense of serenity and pride.


I matched at the Los Angeles County/University of Southern California internal medicine residency program. It was my second choice, and I’m ecstatic with the outcome. This whole process has been quite ironic; my heart broke with every rejection letter from U.S. medical schools, but when I was applying for residency, I was turning down interview invitations at some of the very same medical schools that rejected me earlier. I’ll save the political commentary for another time, but I will say this: No matter what dream you have, don’t let adversity stop you. I’ve experienced many disappointments and have made many sacrifices, but I would not have changed a single day.
Warren Banta is an internal medicine resident at the Los Angeles County/University of Southern California Medical Center. Comments about this article can be directed to tnp@amsa.org.