In memory of Dr Syed Waqqar Ali Shah

Dr Naveed Abbas
Surgical Registrar,
Midland Regional
Hospital, Portlaoise

Family is a wonderful thing. In Pakistani culture it refers to not just your parents and siblings, but also to nearly any close relatives that you have been happily or begrudgingly in touch with or know of. That concept may seem odd to most of the Western world where personal autonomy is paramount. But while it can bring unwanted intrusion into personal lives, it also gives this incredible sense of collective happiness and sorrow. Joy is multiplied and grief divided. In Ireland, our community is our family.

I knew Dr Syed Waqqar Ali Shah. Indirectly. His death, nonetheless, felt like a death in the family. I had met him a few times at our religious gatherings, when the sense of duty and family drives us closer together than at any other time throughout the year. In the fleetest of conversations, it was immediately evident that he was a lovely, caring, and genial man. But like hundreds of other Pakistani doctors, he was worn out and tired.

For 20 years, Dr Waqqar served the HSE in different capacities. His last stint was in the Mater Hospital, Dublin, where he was providing locum support as an emergency medicine registrar. It was there that he was taken ill. It was there that he breathed his last.

In the last week [at time of writing], all major newspapers and media outlets gave extensive coverage in regard to Ruth Morrissey, the courageous cancer survivor who passed away having lit a beacon of hope for thousands of women in Ireland. But while photojournalists actively requested a family photo of Ruth Morrissey, the one that matched her husband’s description of her, not a single media outlet asked for a different picture of Dr Waqqar – other than the picture somebody took off his GoFundMe page. Day in and day out, the same picture was used on TV and in all the newspapers. I am sure the family would have other pictures of someone so well loved. This gentleman had saved many lives in 20 years of service to Ireland. Yet, in death, he was dealt with like a second-class citizen.

This automatic and unconscious bias is merely a reflection of the deep rooted, and in medical terms, “sub-clinical” racism prevalent in Ireland. The HSE itself is so open about it, that it is a wonder that it has survived so long without being sued. In a recent newspaper article, Dr Rita Doyle, the President of the Irish Medical Council, minced few words in describing immigrant doctors as the backbone of the HSE. She stressed that the legal barrier which prevents training these doctors be removed. She is utterly right. Unbelievably, there are actual laws against immigrant doctors being trained in Ireland.

The UK and Ireland are perhaps the only two countries in the world with a two-tiered training system. One tier is made up of medics who are not only trained, pampered, and looked after as the next “big things”, but are paid a lot more to do the exact same work as the other tier. The other tier is the actual workforce. They do all the heavy lifting and service hospitals all across Ireland – the provincial hospitals which the first tier disregard. They would rather go off to sunny Australia or New Zealand than to come and service these orphaned hospitals. You can guess who carries the workload there. Immigrant doctors.

There is no effort from either the RCSI, RCPI or any other body to train or develop these immigrant professionals. They are instead relied upon to automatically adapt and train themselves and fill these second tier jobs. And in these jobs, they flit from one orphaned hospital to another, an endless loop, a vicious cycle. Dr Waqqar was in the same system for 20 years. It’s legitimate to ask why he never progressed to a consultant position. Isn’t 20 years enough time to train someone to that level?

The truth is Ireland is working on an inherently racist system. A less-than-casual look at the training posts and numbers as well as the demography of the consultant cohort will be enough to delineate a clear pattern of bias against immigrant doctors. No means of career progression exists and few doctors will take the road of an open challenge to the HSE-RCSI-RCPI cohort. Most jump ship to the UK or the US where, in a short time, they become consultants and lead departments.

When Dr Waqqar passed away, everyone in the HSE was quick to tweet and give a statement. Paul Reid the HSE CEO praised his diligent work and selfless care for patients. There was a story of his generosity towards a homeless patient. Stephen Donnelly has promised to compensate the families of the frontline workers that have lost the battle to Covid-19. And yes, like the NHS, we also clapped for our carers.

On Friday 31 July, it was Eid. Another occasion for all the Muslims of Ireland. It was strange though; Zoom prayers are not the norm. Covid-19 was supposed to rob us of this important event. But something strange happened. Something beautiful. In a stadium as synonymous with the Irish as anything else, there were echoes of the call for prayer. Two hundred Muslim prayer-goers knelt and prayed on the hallowed turf of Croke Park and for a fleeting moment, we all saw the possibility of what could be achieved if the desire and drive to do something positive was strong enough.

It is time we stopped using our hands for meaningless sounds and started doing something. We need to start training as many doctors as we can and that should not be based on the fairness of their skin or their country of origin, but on their skill and hard work. The laws prohibiting such practice should be abolished immediately. We require public activism and support to bring these about.

I am sure Dr Syed Waqqar Ali Shah would have wanted the same.