Abroad

CAMPTON, Ky. To stay in the United States and become eligible for a green card, Dr. Nadeem Shaikh had a choice to make in 1997: practice medicine for three years in an inner-city neighborhood or in the hollows of Wolfe County in Eastern Kentucky under a program that allows Kentucky and other states to recommend waivers for international doctors who choose to work in medically underserved areas of America rather than return to their home countries.

When his contract ended, Shaikh made another decision to stay in Campton with his Pakistani wife and four children and maybe retire there.

He is one of only three doctors for the remote county's 6,936 people.

"I felt I could do a lot of good here," said Shaikh, who estimates he sees more than 50 patients a day at his clinic.

Shaikh, 38, who left Karachi, Pakistan in 1993 to finish his medical training at the University of Chicago, is among at least 134 foreign-born doctors who did residencies at American medical schools and now work in areas of Kentucky that sufferfrom a doctor shortage, according to the Cabinet for Health Services.

The placement of the international doctors depends on approval of the U.S. State Department, immigration authorities and other federal officials, Hensley said. That vetting process became more rigorous with background checks after the terrorist attacks of Sept.11, 2001.

For Shaikh, who will become eligible for American citizenship next year, there was no evidence of post-9/11 hostility toward U.S. immigrants.

"I had people from the county actually guarding my office," Shaikh said. "They stood watch and made sure no one bothered me."

For patients, Shaikh's presence is appreciated and needed.

"If it weren't for Dr. Shaikh, there wouldn't be any place for people to go," said Jo Dalton, a patient. "There just aren't enough doctors around here."

Unlike some other international doctors who have been in the United States a shorter time, Shaikh's English has become Americanized, Dalton said.

"The only complaint I hear about some foreign doctors is that they're hard to understand, but that's not a problem with Dr. Shaikh," Dalton said.

Nationwide, about one in every five active physicians is an international medical graduate, the UK study said. In many Eastern Kentucky counties, the percentage of foreign-trained doctors is much higher.

"The international doctors have been terribly important in Eastern Kentucky," said Wayne Myers, a former director of the UK Center for Rural Health. "Without them, health care would have flat out collapsed."

During 2002 in 21 Eastern Kentucky counties, 30 percent of the doctors were foreign-born, according to the UK study. Of Wolfe County's three doctors, two are from Pakistan

The county's sole American-born doctor is 78-year old Paul Maddox, a jack-of-all trades physician who birthed many of the patients who now sit in Shaikh's waiting area. Three more foreign-trained doctors are scheduled to open a clinic in Campton later this year.

Maddox, who has practiced medicine in Wolfe County since 1953, the past several years on a part-time basis at a nursing home, said the international medical graduates have saved his county from a medical crisis.

"I think they're doing a tremendous job," said Maddox, whose records show 1.5million patient visits and the delivery of more than 6,000 babies during his 50-year career. "We're lucky to have them."

Billie Burton, another of Shaikh's patients, said the community will never be able to truly replace Maddox, but in Shaikh the residents have found a doctor whom they trust.

"If Dr. Shaikh wasn't here, I'd be letting a lot of things go, healthwise," Burton said. "We need doctors who will stay here, not ones you get used to and then they leave."

Shaikh said he spends nearly all his time treating acute ailments but eventually hopes to be able to practice a more preventive type of medicine by expanding his clinic in areas with high rates of diabetes, heart disease and obesity.

"That's my goal," Shaikh said. "To promote better health."