“We could share difficulties,” Adhikari said. “He (Torres) was here before me, so he told me how to go forward, what books to read.”
For months, the Bhutanese and Cuban doctors studied together at a library.
“More than one time, Khem called us and said, ‘I cannot go on with this.’ ” Torres said. “You could almost feel the fracture in his voice. … I said, ‘You can. You will feel this, this, this. But it’s OK. You can do this!’ “
Step by step
Meanwhile, Nguyagwa was walking them and other aspiring doctors through plans he had assembled under the advice of medical professionals and a few other immigrant doctors who had earned the right to practice in the state.
“Initially, I would tell them, ‘These are the steps … and walk them through the steps one by one,” he said.
Once the steps were understood, it was time to develop an individual plan of action. Nguyagwa would sit down and help each individual weigh the various options, then write a plan.
For Adhikari, the Bhutanese doctor, one option was to pay a professional agency such as Kaplan Medical to prep him for the exams.
He already had studied medicine for years in India. So, strapped for cash like most refugees, he chose to study independently.
Nguyagwa would strictly police his progress.
“My work was to keep calling him from time to time asking, ‘Are you on track with the plan you have in place? When are you sitting for the exams?’ ” Nguyagwa. “That kind of push helps someone to remember.”
The association also provided connections with professional mentors and modest financial support to cover the cost of books and materials.
Like many refugees, Adhikari, 42, had come to the United States with little but a compelling personal story, an impressive professional résumé and a hefty share of hope.
During the 1990s, long-simmering ethnic tension in his homeland, Bhutan, exploded into violence, driving more than 100,000 people into refugee camps set up in Nepal by the U.N. High Commission for Refugees.
Adhikari, who had been in India for medical school, could not return to Bhutan. Instead, he treated his fellow Bhutanese in the camps for nearly 18 years with some time off to pursue post-residency training in India.
After years of international negotiations, the Bhutanese refugees entered one of the largest resettlement programs in world history. The United States agreed to accept up to 60,000 of them beginning in 2008.
By that time, Adhikari was working in Nepal as a physician for the agency charged with resettling the refugees, the International Organization for Migration. Should he go himself?
“I was in a fix,” he said. “I would come to the United States at the risk of losing my profession.”
Staying behind, though, would leave him and his family without a country. There was no chance of returning to Bhutan. But in Nepal, they were temporary, foreign guests.
“I am married, and I have two kids,” Adhikari said. “I was making them stateless.”
Life in the refugee camp was a struggle. Why not struggle in America?, he thought.
“I will go there, and I will do what I can,” he decided.
Arrived in winter
A physician friend was working in Minnesota, so that would be their destination. The family arrived in the Twin Cities in November 2009.
“It was snowing,” Adhikari recalled. “That caused some depression, of course, because we had always thought snow would be in the mountains only.”
His clear goal was to study for licensure exams and take them as quickly as possible. How to do that was not at all clear.
“In the beginning, it was really tough,” Adhikari said. “You never know what course to go, what books to read.”
By that time, though, word of Nguyagwa and the association had spread through immigrant and refugee circles.
“I was lucky enough to catch hold of Stephen,” Adhikari said. “Other people knew about him, so I came here.”
This year Adhikari, Torres and Acosta cleared their first major hurdle: They passed all three of the state board exams.
Now, though, they face an even more daunting challenge: winning the fierce competition to get into a residency program.
“We have finished all of our tests, and we were thinking that would be the hard part of the process,” Acosta said. “But we found out that we have another hard part, trying to get into residency.”
Of some 250 medical professionals who have participated in the association’s program, only about 20 doctors have stepped up to residency programs so far, Nguyagwa said. About 20 nurses have gone all of the way to nursing jobs, he said. A few dentists, pharmacists and professionals in other medical specialties also have gone through the program and landed jobs.
Torres and Adhikari got a lucky break. They won two of the four slots this year in the Preparation for Residency Program Nicholson directs at the U of M. For seven months they will get intensive training on the health-care system, including hands-on work helping other doctors in clinics and hospitals much like the training given to advanced medical school students.
“We try to give them enough clinical training so they can be competitive in the residency match,” Nicholson said.
All three Somali doctors who went through the program last year won residency slots. So prospects are bright for this year’s class.
More tentative are the future prospects for other foreign-trained doctors. The state had funded the $150,000 program, but lawmakers cut the funding during 2011 budget negotiations. U of M President Eric Kaler came up with the money to keep the program running, but the loss of state funding makes it more vulnerable.
Nicholson argues that the program is a bargain for Minnesota. The cost of putting a future doctor through medical school and related training runs at least $300,000, he said.
For $150,000, four foreign-trained doctors — who have managed to pass the medical board exams, often with help from the Association — can be prepared in just a few months to compete for residency slots.
Funding remains a struggle for the association too. Holder continues to cobble together grants and appropriations from foundations and other sources such as the U.S. Department of Labor and the U.S. Office of Refugee Resettlement.
Meanwhile, Holder and Nguyagwa have moved on to new challenges while also keeping a finger in the association’s work.
Holder is the executive director of Women’s Initiative for Self Empowerment, a nonprofit aiming to help immigrant women and girls succeed economically.
Nguyagwa recently finished studying under a Bush Fellowship at the U of M’s Humphrey School, and now he is starting a six-month fellowship in bilingual communication at Georgetown University in Washington, D.C.