Search Results for: science

Free Science, One Paper at a Time

Longreads Pick

On Father’s Day three years ago, biologist Jonathan Eisen decided he’d like to republish all his father’s papers. His father, Howard Eisen, a biologist and a researcher at the National Institutes of Health, had published 40-some-odd papers by the time that he died by suicide at age 45. That had been in Febuary 1987, while Jonathan, a sophomore at college, was on the verge of discovering his own love of biology. At the time, virtually all scientific papers were just on paper.

Source: Wired
Published: May 11, 2011
Length: 4 minutes (1,033 words)

The Best Longreads of 2010: Science, Medicine & Technology

The Best Longreads of 2010: Science, Medicine & Technology

Weird Science

Longreads Pick

Testimony from forensic experts can be the most persuasive evidence presented at trial, but often juries don’t realize that the analysis of hair, fire, and even fingerprints may not be so scientific.

Source: Texas Monthly
Published: May 1, 2010
Length: 34 minutes (8,530 words)

The Science of Success

Longreads Pick

Most of us have genes that make us as hardy as dandelions: able to take root and survive almost anywhere. A few of us, however, are more like the orchid: fragile and fickle.

Source: The Atlantic
Published: Dec 1, 2009
Length: 9 minutes (2,271 words)

How Kevin Bacon sparked a new branch of science

Longreads Pick

The theory that everyone in the world is six friendships away from everyone else is regarded by many as a myth. So what happens when the theory is put to the test?

Source: BBC
Published: May 5, 2009
Length: 7 minutes (1,898 words)

The Top 5 Longreads of the Week

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Here are five stories that moved us this week, and the reasons why.

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1. Has Witch City Lost Its Way?

Kathryn Miles | Boston Magazine | October 22, 2021 | 3,758 words

Modern-day witchcraft is big business, and Salem, Massachusetts, is its epicenter. Witch-themed boutiques along Essex Street sell everything a 21st-century witch needs, from tarot card decks and spell kits to $300 custom wands. Stores like these cater not only to self-identifying witches and warlocks, but also Halloween tourists making their pilgrimage to the city each October and people claiming ancestral ties to Colonial settlers (or those accused as heretics in the 1692 trials). Kathryn Miles captures a festive, bustling local scene, but are shop owners simply commodifying a spiritual practice? And is there a better way for Salem to address and educate people about its ugly past? Miles’ own ancestral history is marked with a dark moment in 1660 — one that has left generations of her family to make sense of their legacy. She examines present-day Salem from this perspective, and asks: “Is a witch-based tourism economy the best way to honor the legacy of executed individuals who weren’t even witches in the first place?” With Halloween just days away, this Boston magazine story is a fitting read, and offers a glimpse into Salem’s lively community — as well as the past that it grapples with. —CLR

2. Aftermath

Briohny Doyle | The Griffith Review | October 24, 2021 | 3,500 words

“Aftermath” begins and ends with scenes set on water — an oyster farm on a lake, a rental house on a bay. These fluid bookends are apt for an essay that ruminates on the illusion of before and after that we all lean on to cope with uncertainty. Whether we’re responding to COVID-19, climate change, or personal grief — all of which come to bear in Briohny Doyle’s gorgeous essay — humans tend to yearn for the way things were or the way they might be, for an idealized past or dreamed-of future, for “fixed points” and “the simplicity of distance.” Doyle challenges readers, and herself, to instead bear witness to accrual and to care for ourselves in the context of the ongoing. “Fragile life,” Doyle writes. “All we have to work with. At least as precious as it is unimportant.” We must protect ourselves, she continues, from becoming “food for bad ideas.” I couldn’t help but think of a line in King Lear: “Ripeness is all.” When you’re reminded of Shakespeare, you know you’re reading something special. —SD

3. Shadow City, Invisible City: Walking Through an Ever-Changing Kabul

Taran Khan | LitHub | October 21, 2021 | 2,667 words

Taran Khan writes of friends and acquaintances betrayed by the donor agencies and NGOs who ghosted longtime Afghan employees pleading for help to flee Taliban rule after the U.S. pulled out of Afghanistan in August. Many Afghans now fear the Taliban’s retribution for collaborating with the agencies who left them behind, texts and email pleas unanswered. “My fellow Americans, the war in Afghanistan is now over,” declared President Biden on television. Those the U.S. government and NGOs abandoned in their hasty retreat now face new and more insidious dangers. Khan writes: “My grandmother, who had grown up in northern India in a home marked by rigid gender segregation, told me how she used to listen to the poets who frequented the male quarters of her house through cracks in the wall. In the days after the Taliban’s takeover, I listened to Kabul through cracks in the silence that descended on the city. In the voices of friends I could reach on the phone, and behind their fear and their laughter, their assurances and their hesitating requests, I heard the streets and the soundtrack of the city’s everyday life, away from the transient media glare.” —KS

4. Under The Influence

Stephen J. Lyons | The Sun Magazine | October 1, 2021 | 1,672 words

A certain swath of people can relate to being a child left in a vehicle while dad drinks beer in the dim, smoky interior of a local pub. (This didn’t happen to me, though my best friend said she taught herself dozens of yo-yo tricks during those long afternoons.) At The Sun Magazine, Stephen J. Lyons recounts waiting for his beloved blue-collar, stogie-smoking grandpa to emerge from the bar. Lyons witnesses his usually quiet grandpa change after a few pub stops. As the truck speeds over ridges and around curves in rural Iowa, grudges and grievances bubble to the surface, sucked out the window of the rusty pick-up truck as his grandpa spits and mutters about wrongs and injustices. The love and loyalty Lyons feels for his grandpa reminded me of my own childhood, times when my dad was not ok to drive but did so anyway after late nights at relatives’ places across town, times when adult hubris (I’m fine!) and the need to blow off steam from another week at a dirty, unsatisfying job outweighed better judgement. This piece reminds me that we all fail one another from time to time, knowingly and unknowingly. And that perhaps because of that failure, we need love and grace all the more. —KS

5. Sci-Fi Icon Neal Stephenson Finally Takes on Global Warming

Adam Rogers | Wired | October 26, 2021 | 4,348 words

Neal Stephenson isn’t the sort of writer you profile. He’s the sort of writer you think about profiling, sure, but he’s not going to invite you into his life or discuss the vagaries of craft or unburden himself of his deep-seated fears. What he’s going to do, instead, is write. That’s what he’s done since 1984 — big ol’ books that tend to huddle together under the “science fiction” umbrella but are as urgent as they are speculative. His latest, Terminal Shock, might be the most urgent yet, attempting to envision what would happen if people actually tried a theoretical process called solar geoengineering to cool off the planet. So if you’re going to profile Neal Stephenson, you’re going to need to figure out his whys and his hows, not his whos and his whats. Good thing, then, that the person doing the profiling happens to be one of the few journalists around as well-versed in genre fiction as they are in climate change. Rogers, an accomplished science journalist, aims his entire arsenal at making this a piece about the science of imagination — about how not to give up on the (admittedly bleak) future, how to turn real science into real hope, and what it means for someone as lauded and prolific as Stephenson to continue pushing us to team up and just figure this damn thing out already. —PR

Neal Stephenson Finally Takes on Global Warming

Longreads Pick

“His superscience this time isn’t a metaverse or a space colony. It’s engineering to address an imminent threat. After a few years of unrelenting wildfires, hurricanes, disease outbreaks, and other natural disasters linked directly or indirectly to climate change, the idea that the world’s preeminent technologists might take up the cause where policymakers seem to have failed is almost hopeful.”

Source: Wired
Published: Oct 26, 2021
Length: 17 minutes (4,348 words)

The Top 5 Longreads of the Week

Ronald McDonald Balloon in Macy's Thanksgiving Day Parade, New York City, New York (Photo by: Joe Sohm/Visions of America/Universal Images Group via Getty Images)

Here are five stories that moved us this week, and the reasons why.

Sign up to receive this list free every Friday in your inbox.

1. A Peer-Reviewed Portrait of Suffering

Daniel Engber | The Atlantic | October 6, 2021 | 7,200 words

The best science stories are human stories, ones that show the impact of lab experiments, clinical investigations, and complicated data on people’s lives. Daniel Engber’s poignant profile of the Sulzer family falls squarely in this camp. When three-year-old Liviana suffered a traumatic brain injury in the Sulzers’ backyard, her mother and father — a bioengineer who specializes in regenerative medicine and a professor of rehabilitative robotics, respectively — were forced to bring their work home. They mustered their expertise to help Livie, but quickly met the limits of the technology they’d spent their careers developing and championing. How, then, could they heal her, and themselves? The answers are surprising. I was moved by Engber’s portrayal of scientific minds challenged to reconsider the lens through which they analyze the world; of a family navigating protracted trauma; and of the love, patience, and curiosity that keep the Sulzers’ hope alive. —SD

2. The Great Beyond

Sara Reinis | Real Life | October 7, 2021 | 2,299 words

I’ve been contemplating how social media has changed the way we grieve for a while now, ever since my best friend died 10 years ago. I’d experienced mourning in a new, distributed way: collectively and on screen, as his friends across the U.S. and his relatives from Nairobi I’d never met all gathered on his Facebook profile over weeks, months, years. Some people left quick comments, as if they passed by a cemetery to leave flowers; others lingered, typing as if they were communicating with him in real time. How was social media changing the way we experience loss? For Sara Reinis, it’s also been a decade since a loved one — her brother — passed away. In her recent essay for Real Life, she stirs up many questions for me again, plus new ones. What does it mean when we interact with the Facebook and Instagram profiles of deceased loved ones and celebrities as pilgrimage sites — digital shrines and tombstones we (re)visit, deliberately or not, across an algorithm-powered internet? And what about someone like me, who has since deleted Facebook and Instagram? Am I missing out on novel, ever-evolving ways to mourn? (Should I be intermingling with the avatars of the dead?) After all, as Reinis writes, “the dead will outnumber the living” on Facebook by 2100. She asks thoughtful questions, and I’m now thinking about the idea she poses that the Western approach to grief — a mostly private and “ceremoniously finite” event like a funeral — may evolve into something very public, social, and continuous. And the biggest question she asks looms over me: Can we even trust tech giants with our digital remains? —CLR

3. My Father, The Hitman

James Dolan | D Magazine | October 11, 2021 | 5,021 words

Sometimes all it takes is a single sentence to draw you fully and completely into a story and James Dolan does just that with the opening to “My Father, the Hitman.” “My dad had gotten out of prison, and, for the first time in years, we were sitting down to dinner. It turned out to be the last time I ever saw him alive.” This fantastic portrait is filthy with detail, the kind that makes you want to slow down and savor every word. —KS

4. Tongue Stuck

Irina Dumitrescu | The Rumpus | October 12, 2021 | 2,662 words

Irina Dumitrescu considers the beauty of her Romanian heritage and her decision to teach the language to her son Maxi, so that he can more deeply understand and appreciate his extended family. “I wanted him to know his grandparents in Romanian. I wanted him to know how funny and smart they are, to sense that spirit that is so often lost in a second language.” This is more than just a beautiful essay on identity. Dumitrescu looks critically at her Romanian skills but her words become poetry to me as a reader — despite not knowing the language — when she uses them with such deep intimacy: “I spoke to him in the way that felt most natural, and that meant the language I’d heard when I was small. This was the language in which I was cuddled and pampered, caressed, and sometimes scolded. I suddenly understood how wonderful Romanian is for talking to children. How many darling diminutives I had ready for each part of his body. He had tiny fingers, degețele; a wee belly, burtic; a sweet little nose, năsuc; and dear little feet, picioruțe. Romanian has a treasure of endings to make each noun Lilliputian: -uțuri, -eluri, -ioruri. English seemed then a bulky, hulking way to speak, and for the first time I could not believe that there were people who used the same heavy word for the coarse fist of a grown man and the delicate hand of a newborn.” —KS

5. The Death of Ronald McDonald

Amelia Tait | Vice | October 4, 2021 | 1,600 words

Within the first 15 minutes of a family road trip, I would start the chant: “Can we stop at McDonald’s?” Every British motorway service station seemed to have one, and they were always adorned with Ronald McDonald — Ronald climbing frames, Ronald slides, or just plain old Ronald statues. So it was with great interest that I read Amelia Tait’s fun piece about the demise of this iconic clown in British advertising. (He clings on in the United States with a few in-person appearances according to his U.S.-based Instagram account.) Despite a last-ditch effort, with “a new look, swapping his jumpsuit for a red blazer and a bowtie” he quietly slipped out of the U.K. in 2014 and, as Tait finds out, everyone seems to be rather cagey as to why, cryptically claiming they “are not allowed to talk” as if Ronald is part of the underground clown mafia. Despite these obstacles, Tait jumps wholeheartedly into this mystery and discovers that Ronald’s decline is due to a combination of the ethics of advertising fast food to children, and the realization that a clown with a red wig is just plain creepy. I really enjoyed Tait’s enthusiasm and humor as she explores why Ronald McDonald, along with his sidekick the Hamburglar, are out of a job. —CW

Nine Longreads Stories Recognized Across This Year’s ‘Best American’ and ‘Year’s Best’ Series

Cover art by HMH Books and Triumph Books

Our team is thrilled to announce four anthology inclusions and five notable mentions across the 2021 Best American and Year’s Best series. Congratulations to the following Longreads contributors — and to all the writers featured in these editions — for their exceptional, memorable work.

The Best American Essays 2021

Notable mentions:

On Solitude (and Isolation and Loneliness [and Brackets])” by Sarah Fay

Sarah Fay reflects on four years spent in solitude (and isolation [and loneliness]), viewing it through the lens of punctuation. An adapted version of Sarah’s essay will be included in her forthcoming memoir, Pathological: The True Story of Six Misdiagnoses.

How to Learn Everything: The MasterClass Diaries” by Irina Dumitrescu

Irina Dumitrescu, an essayist and professor of medieval English literature, binged for six months on online courses led by celebrities like RuPaul, Anna Wintour, and Gordon Ramsay. Her piece on MasterClass is a delightful take on discovery, the power of celebrity, and learning new things.

Through a Glass, Tearfully” by Maureen Stanton

This heartfelt and illuminating essay by Maureen Stanton recounts her history of crying in inappropriate moments while also considering tears from gender-based and political perspectives. Read it and weep.

(Who Gets to) Just Up and Move” by Nicole Walker

In a poignant personal piece on climate change and the erasure of the Ute and Shoshone Tribes from Utah’s Salt Lake Valley, Nicole Walker beautifully contemplates the nature of migration. Read more…

Doctors Without Patients: The Eritrean Physicians Stuck in American Licensing Limbo

Illustration by Carolyn Wells

Shoshana Akabas | Longreads | October 2021 | 16 minutes (4,762 words)

*Haben Araya was working in the local hospital when a farmer came in, bleeding from his gums. He was suffering from a snakebite — a case she’d seen many times.

*At the request of the doctors involved, some names have been changed.

Before Araya sought asylum in the United States, before she helplessly watched the COVID-19 pandemic tear across the country, and before she learned about what doctors must go through to relicense in America, she worked as one of a handful of physicians on staff at a local hospital in her home country of Eritrea. She was a general practitioner, responsible for everything from pediatric preventative medicine to minor surgeries and gynecology. She served as the regional appointed physician for malaria case management and the hospital’s Director for Tuberculosis Control. If a patient needed to be transferred to another hospital, she had to write the referral. Call the ambulance. Make sure the ambulance has enough gas. Find someone to fill up the tank.

Snakebite cases were heartbreaking for Araya because she knew the medication was prohibitively expensive: 840 Eritrean Nakfa for a single vial (about 56 USD). Sometimes four or five vials were required, costing more than many farmers would earn in a year.

The hospital insisted on taking some sort of collateral until the bill was paid, but Araya knew the farmers were good for the money. She also knew that they would likely sell their goats or sheep — whatever animals they relied on for their livelihoods — to pay for the treatment. And then, she knew, they and their children would return in a few months’ time with severe cases of malnutrition and a host of consequent health issues.

A nearby military clinic, where there was no on-site physician, had a stock of antivenom. In exchange for a free supply for her patients, Araya told the administrator of the unit that she would provide medical consultation and training. It was not a perfect solution, Araya admits, but her job was to do anything she could for her patients. “We have to do our best with what we know,” she says. “Every day we had to be more than a doctor.”

***

Doctors trained in resource-limited environments possess a unique skill set. They’re adaptable, creative, and work well under pressure. Yet, upon arriving in the U.S., internationally trained physicians like Araya must go through a licensing process so arduous it can take nearly ten years to complete. There are currently an estimated 165,000 internationally trained medical professionals living in the United States and underutilizing their skills. Many, like Araya, are sitting on crisis management experience the United States never thought they would need — until the pandemic hit.


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Eritrea has a single medical school: the Orotta College of Medicine and Health Sciences, offering a six-year medical program. With only 30 to 40 spots in each graduating class, the nationwide competition was fierce. “When I applied to medical school, my dad always tried to impress on me that I need to have Plan B and Plan C,” says Lily Yemane, an expat Eritrean physician like Araya.  But she couldn’t think of any other job she wanted to do.

In the United States, the pandemic forced many doctors who had never experienced shortages to make life-or-death choices about who would be given oxygen, but for Araya and Yemane, that kind of challenge was part of their regular work as physicians. “You have an idea of how a certain patient can be helped, but you don’t have the resources,” explains Yemane. “Two or three patients need a medication, and you have to decide who to give it to.” With only one or two ambulances per hospital, she often fought to convince the administration to deploy their ambulance for her patients.

Resource scarcity wasn’t the only issue. Living under the oppressive regime in Eritrea bled into every aspect of their personal and professional lives. “We don’t choose where we work, we don’t negotiate our salaries,” says Araya. “The government, basically they put our names in a fishbowl.”

Since President Isais Afwerki came to power following the country’s independence in 1993, freedom has been stifled. Afwerki’s extrajudicial executions, imprisonment of journalists and religious minorities, indefinite forced labor sentences, and other human rights violations have been documented by the United Nations Human Rights Council. Reporters Without Borders, on its World Press Freedom Index this year, ranked Eritrea last, below North Korea. There have been no presidential elections held in the country’s 28-year history. “ … You don’t get any say, you don’t vote. We’ve never voted in our entire life,” says Yemane.

When political prisoners were brought to the hospital for care — often for tuberculosis or scabies, the result of years in captivity — doctors were forced to defer to a system they vehemently opposed. Some prisoners were journalists; others had been caught at the border, trying to flee the country. “You almost never ask why,” says Yemane. “You don’t want to know.”

Each time a prisoner was brought for treatment, Yemane had to convince the guards to admit the patient to the hospital for necessary care, raising suspicions that she was on the prisoner’s side. Except once: Yemane supervised the care of a prisoner with kidney failure. When she went to check on him in the recovery facility, she was surprised to find the patient with his family, and the guards nowhere to be found. “He was free,” she says, “but they only let him go because they thought he was dying.”

There was no single moment that pushed Yemane or Araya to leave and follow their family and friends who had already fled to the US. Instead, the burden of oppression and persecution simply grew until they felt they had no choice. “My rights as a human being were being violated,” says Araya. “I did not have the freedom — that basic, basic freedom … we all deserve as human beings.”

 ***

Yemane did not arrive in the United States naive to American culture or to the challenge ahead. She’d read plenty of English literature and loved watching Oscar-nominated movies, from My Fair Lady to La La Land. But still, the culture shock was real. While waiting the nine months for her work permit to be approved, she lived with a family member and took an anatomy course at the local public college, working towards a physician assistant’s degree in case she couldn’t relicense. Eager to resume medical practice, she also began volunteering at a free clinic, which helped her to feel more at home as she gradually met more like-minded people.

Reporters Without Borders, on its World Press Freedom Index this year, ranked Eritrea last, below North Korea. There have been no presidential elections held in the country’s 28-year history.

When Araya reached the United States the following year, more than a dozen Eritrean doctors like Yemane — who’d fled in the months before her — warned her of the difficult road ahead. She’d have to have her credentials verified before she could sit for the three intensive U.S. medical licensing exams (USMLE) and apply for a residency program to repeat her training — the last step before finally being able to practice on her own.

For most refugees arriving with few resources, the financial cost — of translating educational records into English, covering the exam fees (nearly $1,000 each), and working a clinical internship (often unpaid) to help get a residency — is prohibitive. And the Eritrean doctors were struggling to get past the very first step in the process. For their primary source verification, authorized representatives from the Eritrean medical school would need to confirm that their documents, including their diploma and transcript, were authentic.

They’d contacted the Educational Commission for Foreign Medical Graduates (ECFMG), a non-governmental, non-profit agency, responsible for primary source verification. Of roughly 3,500 operational institutions in the World Directory of Medical Schools, ECFMG accepts credentials from approximately three-quarters — including the medical school in Eritrea. But when Araya and Yemane’s colleagues applied for verification, the Eritrean administrators wouldn’t respond to ECFMG’s inquiries.

The medical school and placement system in Eritrea, like many countries, is controlled by the government, which has the power to withhold the records of anyone they don’t want to assist. “In the eyes of the government,” says Yemane, “we are traitors — which is not true. We served our country when we were there. I worked with very little pay, like everybody else in the country, for four years, outside of my hometown. And we did serve the people. We did our best. But the government was not understanding of that. So when we left, we were considered traitors.”

Kara Oleyn, Vice President for Programs and Services at ECFMG, was assigned to their case. ECFMG sees 20,000 applications each year, and Oleyn was no stranger to verification challenges. When ISIS infiltrated Iraq and medical school officials fled to the south, Oleyn’s team worked with the Iraqi Ministry of Health to track them down, so they could provide verification for their former students. In Crimea, where both the Russian and Ukrainian governments claimed the medical university, they had to determine who was actually authorized to verify credentials. “We do need to assure the public that the individuals who are going to be laying hands on them have the appropriate credentials,” says Oleyn, “and primary source verification is a big part of that.”

But Araya’s and Yemane’s cases — and the cases of their Eritrean colleagues — stumped Oleyn. “There was absolutely no information coming out of Eritrea,” she says.

Araya and her peers were devastated. “The fact that the government I left was able to affect me here — it was just heartbreaking,” says Araya. “America, they gave me protection to stay here, but the [Eritrean] government was able to retaliate and hold me hostage, even when I’m here.”

In rare cases where verification couldn’t be obtained — often for political asylees — the ECFMG used an alternate process: having three U.S.-licensed physicians who attended the same international school swear on their medical license that they have personal knowledge that the individual graduated from medical school. Unfortunately, the Eritrean medical school, founded less than 20 years ago, had no prior graduates working in the United States to provide testimony.

Oleyn’s three-person team relentlessly contacted any sources they thought might be able to share information. “We were trying to triangulate exams that we knew they took in Sudan with Sudanese officials, and we couldn’t get anywhere,” she says. Even the US Department of State couldn’t offer any contacts in Eritrea besides those already refusing to cooperate. Instead, the State Department confirmed what she recalled the Eritrean applicants had already told her: “They’re not going to reply to you, because they don’t want their physicians … their young, bright, educated people to leave their country.”

Yemane and Araya’s feeling of helplessness intensified as the pandemic rolled through their new homeland, and they watched as the news quickly became saturated with reports of hospitals running out of beds and doctors to care for COVID patients. When Eritrea went into lockdown, they feared for their friends and family left behind. Yemane would close her eyes and remember the limited number of beds in the hospital’s ICU, imagining them all filled. The staff was already underpaid and overworked before the pandemic.

“In a perfect world, when this happens, what do you do? You just go home and you help, and then you come back,” says Yemane. “We could not go back home, even to help, even to contribute.” And in America, she couldn’t help either. “… Imagine sitting with the capacity to do something but not being able to do anything … What was the whole point of your training if you cannot do something, even in a pandemic?”

Many internationally trained doctors have valuable experience working in the thick of SARS and Ebola epidemics, conflict zones, and other limited-resource conditions — not unlike the conditions faced by hospitals across the United States, as doctors scrambled for personal protective equipment. “When you have a shortage in supplies all the time, you get creative,” Yemane explains. “When we didn’t have ventilators, we could make CPAPs out of things that you can access at the hospital. So we have that kind of mindset.”

Jina Krause-Vilmar, the president and CEO of Upwardly Global, a nonprofit organization that provides career services to immigrants and refugees (including several interviewed for this story), says that, despite knowing the risks of COVID-19, their clients were anxious to help and “in tears about the idea that they were standing on the sidelines at a time when their communities were suffering.”

Unable to assist medical efforts directly, Yemane volunteered for a mutual aid society to help with cooking and delivering food to a local homeless encampment, but she wished she could do more. At the height of the pandemic, “that’s when it was most painful,” she says. “You see the hospitals running low on supplies, on skill[ed workers], and you’re sitting at home doing nothing when you could have been out there helping people.”

Yemane would close her eyes and remember the limited number of beds in the hospital’s ICU, imagining them all filled.

In a few select states, desperation finally bred change, and internationally trained physicians were given the opportunity to contribute. New York (home to roughly 13,000 foreign-trained medical professionals not able to make full use of their skills) joined New Jersey, Massachusetts, Nevada, and Colorado in adapting licensing guidelines to allow foreign-trained physicians to help with COVID efforts at various levels — but with limited success.

For some, the application was too difficult. Upwardly Global heard that in one state Russian applicants were deterred because the drop-down menu on the online application accidentally omitted “Russia” as an option for country of origin. Some, like Yemane, applied to the NJ licensing program but never heard back.

“These were emergency policies that were designed and implemented at a time of unprecedented need and at a time when states were trying to mount a response to a public health crisis like no other,” says Jacki Esposito, director of U.S. Policy and Advocacy for World Education Services Global Talent Bridge, a non-profit dedicated to helping international students, immigrants, and refugees achieve their educational and career goals. “So just by virtue of the fact that they were designed and implemented very quickly, there wasn’t the time and the space to consult all of the various stakeholders that would be consulted in a permanent reform process.”

For example, according to Esposito, some states require applicants to have active, valid licenses in another country, but many people — refugees especially — let their licenses lapse to avoid yearly fees and continuing education requirements. Esposito says the application could have required that a foreign license was in good standing when it was last active to accomplish the same goal — of weeding out those applicants with disciplinary actions on their record. “It really was a mix of getting the eligibility requirements right so that they maintain health and safety standards, but at the same time are accessible for applicants,” says Esposito. “Eligibility requirements must be workable for these policies to be effective.”

Without the time to be more intentional about the design of the application process, inform employers about the policy, or conduct outreach to applicants, the opportunity went underutilized. By the end of 2020, the New Jersey Board of Medical Examiners, which operated the most robust program for applicants without residency experience, had received approximately 1,100 applications for temporary medical licenses, but, according to a spokesperson at the New Jersey Division of Consumer Affairs, they issued emergency licenses to only 35 individuals. And according to Gothamist, not all who received emergency licenses were able to secure positions. Many applicants who were eligible for similar programs across the country didn’t know where to look for jobs, and hospitals weren’t sure they were allowed to accept internationally trained applicants — or just thought it was easier to not employ them.

“When push came to shove, the hospitals would rather repurpose a plastic surgeon,” says Tamar Frolichstein-Appel, a senior employment services associate at Upwardly Global, who believes better outcomes could be achieved if healthcare employers, legislators, and NGOs work in partnership. Without buy-in from employers who are willing to hire from this talent pool, a license doesn’t make much of a difference. “It’s a missed opportunity that we have not, as a country, leveraged the immense talent that immigrant and refugee doctors and other healthcare workers offer,” says Esposito.

Amid the crisis, a door was cracked open for a select few. But, by and large, doctors like Araya and Yemane watched the pandemic unfold, stuck outside of a system they desperately wanted to be part of. “We got so antsy to do something,” Yemane says. “It’s a privilege to be able to help in that time, and we didn’t have that.”

***

As more time passed without any news of progress from ECFMG, the persistent uncertainty began to take a toll on the Eritrean doctors stuck in limbo. “A few of us went back to medical school again. But to go to medical school twice in one lifetime — it’s a lot to ask,” says Yemane.

After fleeing Eritrea, another doctor, Abraham Solomon, chose this option to avoid being at the mercy of a stalled bureaucratic process. But he couldn’t simply repeat medical school; he had to go back even further and complete up to 90 credits of undergraduate pre-med requirements before even taking the Medical College Admission Test (MCAT). As he sat through freshman seminars for the second time in his life, he had a strong sense that this situation wasn’t fair, but he had to make peace with it. “What [I] had to do was more important than getting lost in the emotions,” says Solomon, who worked in customer service to pay for school. “At that point, you understand this is something you can’t control.”

Mohamed Khalif, who left Somalia as a refugee when he was two years old, moved around the world with his family before graduating medical school in China. While studying for the USMLE in Washington State, he worked as a security guard and then took night shifts at a pie factory so he could volunteer at a medical clinic. Khalif has valuable skills and is fluent in five languages, including Urdu and  Mandarin, but even after he passed the USMLE he failed to match with a residency program. The screening for residency programs filters out candidates without “hands-on” clinical experience in the United States: few applicants can afford unpaid internships, and few institutions are willing to take them on over U.S. medical students. The applications cost Khalif more than $6,000 each year, in addition to flights and hotels for interviews. After four years, he decided he had to go in another direction.

As the founder of the nonprofit Washington Academy for International Medical Graduates (WAIMG), he now advocates for those who face the same challenges and offers professional development opportunities through his organization. Through this work, he met folks with similar stories, like a Japanese neurosurgeon who married an American and moved to the U.S., but, even after passing the USMLE, was still working at Starbucks because she couldn’t match into a residency program. Khalif’s organization hired her for a job that would count as “hands-on” clinical experience to improve her prospects.

“Once she found this job,” says Khalif, “she actually cried. And I felt that. Because that’s what I’ve been through — those kinds of odd jobs — and I cried with her.” These stories keep him hopeful, even though he’s not able to practice: the fact that he’s making it possible for so many others.

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The matching process is a major concern for Araya, Yemane, and their peers — not having their official transcripts or diplomas will likely pose problems during the difficult process of applying to residencies — once they even reach that stage. This year, only 55 percent of immigrant international medical graduates who applied for residency were matched to first-year positions, compared to 93 percent of U.S. graduates.

And every year Araya and Yemane have spent fighting for the right to even sit the exams has cost them: The more time that passes after a candidate’s graduation year, the harder it can be to secure a residency match.

“When you only consider somebody’s graduating year as a criteria and not know the story behind that, it hurts a lot of people. It hurts a lot of people who are really passionate,” says Araya. “To come here to fight for all these years to go back into your profession — that tells a lot about the persistence and the passion that person has for medicine.”

Amid the crisis, a door was cracked open for a select few. But, by and large, doctors like Araya and Yemane watched the pandemic unfold, stuck outside of a system they desperately wanted to be part of.

Khalif began to look for a solution that wouldn’t require physicians to repeat their entire residency. “Legislators did not know about this match process and this residency process,” says Khalif. “They thought people could apply for residency through Indeed Job Search or something.”

Members from Khalif’s non-profit met with legislators and eventually started gaining traction. “COVID really changed people’s minds,” says Khalif, and in May 2021, Washington Governor Jay Inslee signed into law SHB 1129, which allows limited licenses to be granted to internationally trained doctors in Washington who have completed their USMLE, without requiring residency to be repeated in the U.S. “Once you pass all your exams now, you don’t have to settle for an odd job, or leave the profession like I did,” says Khalif. “You can qualify for a license and work under the supervision of a physician, and you can take care of patients.”

The bill was overwhelmingly supported on both sides. Republican representative Mary Dye says that her small county of Garfield, with only a handful of doctors, has benefited from internationally trained physicians from Bangladesh and South Korea, who can work without the equipment, facilities, and large medical teams that most U.S. doctors rely on. “In rural America, we need people that have different experiences,” Dye explained. “We’re grateful to have … people that are capable of serving in these remote locations, under challenging conditions, with lots of limitations, and still provide wonderful medical care for our community.”

From the rural healthcare crisis to expanding medical access for at-risk populations, advocates believe internationally trained physicians could be part of the solution if given the opportunity. “I think they have a huge role to play in terms of health equity access, because of that cultural language fluency,” says Krause-Vilmar.

“We need to re-envision what the process is for licensure for doctors in the United States,” says Esposito, “so that we are not leaving out people who have 20 years of experience in a field where we know that we need more doctors.”

Without any change in legislation in California, the current residency hurdles are still daunting for Araya and Yemane, who hope that, when the time comes, institutions will consider their circumstances and give them a chance to prove themselves. “We are all a loss for our country,” Araya says. “I hope we’re not a loss here.”

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One night, more than a year into the investigation process, Oleyn was working late in her Philadelphia office when she received a call from one of the Eritrean applicants. She detailed everything her team had tried — most recently, reaching out to the medical school in Cuba that had a partnership with the Eritrean medical school. But it was another dead end.

“Anything you can think of,” she asked on the phone that night. Anything at all.

In an attempt to leave no stone unturned, the applicants submitted lists of people they’d come into contact with during medical school — in the hope of providing a useful connection. As Oleyn’s team searched for leads through the lists of names, they found that one was a dean at a U.S. medical school. It turned out that a small number of U.S. physicians — faculty members of American medical schools like George Washington University — helped establish the school in Eritrea. The connection provided a glimmer of hope after months of coming up empty-handed.

A caseworker from Oleyn’s team contacted the dean; he didn’t remember the specific students but put them in touch with other American faculty members who had taught or helped design the post-graduate training curriculum in Eritrea. Oleyn’s team asked those physicians to verify the information about the applicants: the courses they took, which textbooks were used, and their graduation dates. They responded enthusiastically about the qualifications of each applicant and eagerly asked how they could help.

The alternate form of verification — with all the supporting evidence they had amassed — was presented to the ECFMG’s board of trustees, which finally granted approval in summer 2020. Araya and Yemane could move forward to the exam stage. When Yemane heard the news, she felt like she’d finally gotten her life back. “There was a time when I was too scared to be hopeful about that because I didn’t want to be disappointed,” she says.

Solomon had just finished a year of intro courses — Biology, Chemistry, and Physics — when the decision was released. He no longer had to repeat the rest of the prerequisite courses and medical school, and he was thankful to finally have some control over the next steps. “This is a challenge I can overcome,” he says. “An exam is just an exam. You study. You prepare.”

“It’s a good thing that we’re doing this exam,” Yemane says. “It’s a good way to revisit the basic sciences and to familiarize ourselves with what’s most important and most common in this country.”

The Eritrean physicians continue to stay in touch through their Whatsapp group, meeting occasionally, sharing job opportunities, and cheering each other on. Araya says she won’t stop rooting for their success. “Passing the exam, getting matched [with a residency program] has become more than even being a doctor: Just proving that the government back home, the school — whoever could not give us our certificates, credentials — that actually, there is justice in the world, and they could not dictate our professional pathways.”

This year, only 55 percent of immigrant international medical graduates who applied for residency were matched to first-year positions, compared to 93 percent of U.S. graduates.

In a thank you note Oleyn received an Eritrean physician wrote: “This shall also afford every graduate the privilege to revisit his/her oath to humanity, to summon his/her medical expertise, and to engage hereafter in the honored service of the people of the United States of America.”

It remains the most gratifying case Oleyn has seen in her 22 years at ECFMG.

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On a warm Thursday in June 2021, Yemane traveled to San Jose to take her first exam. She hadn’t slept well the night before. Kept awake by nerves, she’d scrolled through Reddit, where other nervous exam-takers shared their anxieties. But in the morning, she pretended she’d had the best sleep of her life. “I think that worked,” she laughs. “I think I fooled my brain.”

The test center was familiar because she’d paid $75 to take a practice exam there earlier that week, but it was nerve-wracking all the same. “There was a lot of pressure on me, because I’m one of the first people taking the exam from my country,” she says. “And we begged for three years for this opportunity.”

She reminded herself that she was prepared. She’d done over 7,000 practice questions. She thought about a text her friend sent, telling her that the test outcome would not change her identity. She imagined her father and mother telling her, “You were created for this.”

When she finished the eight-hour exam, a sense of relief washed over her. This was the hardest test for her; the next one focuses on clinical skills, and she hopes to sit for it in spring 2022. After that, she will take the third and final test. The next challenge — applying for residencies — will be the final step in the long and expensive licensing process.

For now, though, she’s taking one step at a time. As she anxiously awaits the results, she knows that even if she doesn’t get the score she’s hoping for, she was brave just to take the exam after everything she’s been through. “That’s what I’m doing right now,” she says. “I’m celebrating the bravery.”

Shoshana Akabas is a writer and teacher based in New York. She primarily writes fiction and reports on refugee policy and issues of forced migration. 

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Editor: Carolyn Wells 
Fact checker: Nora Belblidia