Kyrgyzstan: Indian Medical Students Caught in Diploma Mill?

In a light vinyl jacket, Adi slides awkwardly on the ice in front of his Bishkek dormitory. It’s the first time he’s ever seen snow: “It’s like God’s grace falling down.”

The 20-year-old from Uttar Pradesh, India’s most populous province, arrived in Kyrgyzstan this fall to start work on a five-year medical degree at the International University of Kyrgyzstan (MUK). At home, medical school became a distant dream after he did poorly on entrance exams. But his parents’ demands were not open to dispute: “Since I was a child, I heard I would become a doctor. My father is a doctor. I will be a doctor.”

MUK’s International Medical School has over 1,000 students, mostly from India and Pakistan. The courses are taught in English and many students live in designated dormitories in downtown Bishkek. Best of all, admission does not require top grades or impressive exam results, only a few thousand dollars a year—less than many Indian universities. But the quality of the training raises major concerns. After the Soviet Union fell apart, Kyrgyzstan’s education and healthcare standards plummeted. A report released in February by the International Crisis Group (ICG) points to a “human resource catastrophe” in healthcare, with “many older professionals regard[ing] most of those trained in the past 15 years as unqualified.”

The students don’t seem to mind. One said he likes the easy routine and not having to study: “The teachers don’t know much English. So if you speak English well, you automatically pass.” Cramped dormitory rooms accommodate six students each. Many of the rooms don’t have space for desks.

The influx of Indian students to Kyrgyzstan and other formerly Soviet republics is not a particularly new trend. Educational exchange programs began bringing Indians to the then-Soviet Union during the Cold War. But after Communism collapsed, so did subsidies, and many schools could not afford to operate, explains MUK’s Vice Rector for International Affairs Arsen Aidaraliev. State schools began charging tuition. Foreign students were in a better position to pay than locals. With the abundance of would-be Indian medical students, Aidaraliev, who studied medical-school management at the University of South Florida, saw an opportunity.

The first class, in 2003, had 20 students. Today, the school enrolls over 1,000—twice as many as the capacity advertised on its website. Many learn about the program through advertisements in Indian newspapers. Prospective students apply through “agents” – some of whom were once medical students in the former Soviet Union. These agents take care of logistics, place the students, secure visas, charter flights, lodging and even arrange for three Indian meals a day, explained one agent, Phani Bhushan, who works closely with Aidaraliev. He takes a one-time fee of $1,000 for placement and provides room and board for $2,000. Tuition is approximately $2,000 per year at MUK’s international medical program.

Criticism of Kyrgyzstan’s current system of medical education has poured in from different quarters. According to the ICG report, “A family practitioner in the central Kyrgyz city of Naryn complained that many young doctors cannot diagnose properly, so ‘we advise patients to pay twice and seek a second opinion.’” Another physician told ICG that, as “tacit recognition” of the poor quality of training, “Russian clinics accept only those Kyrgyz […] doctors who graduated before 1991, the year of the Soviet collapse.”

One American health specialist called the idea of bringing foreign students to study medicine in Kyrgyzstan “horrifying.” And according to the UN, a July 2006 survey of medical students at nine institutions in Kyrgyzstan rated their level of knowledge between 2 and 2.6 on a five-point scale.

Concerns about quality don’t faze many Indian students, said an Indian diplomat in Bishkek, because his country’s upwardly mobile population sees medicine as a prestigious profession. “India’s economy is growing and many parents can now afford to send their children to medical school. This year there were about 30 percent more students coming to Kyrgyzstan than last year,” said the diplomat, speaking on condition of anonymity because he was not cleared to speak publically on the issue.

“The social status of doctors in India is very high,” he added. “There are millions of applications for hundreds of seats [in medical schools]. This drives people here [to Kyrgyzstan]. Anyone who scores less than a 98 percent on his entrance exams won’t get in” in India.

Academic rigor and hands-on training do not appear to be hallmarks of the MUK program. Instead, students say they focus on preparing for a qualifying exam administered by the Medical Council of India (MCI). The school brings Indian coaches to Bishkek for special test-prep seminars. Students say the program focuses mostly on theory, rather than practice, even when it comes to basics such as anatomy.

“We see the post-mortem autopsy carried out by local doctors, but we don’t get to touch. The teachers translate for us,” said fourth-year student Jenif, 21, from Andhra Pradesh. (Like Adi, Jenif insisted her last name not be printed, fearing retribution from school officials.) “They give us more theory but less practice. That helps us do well on exams at home. In India it is the opposite: Less theory and more practice.”

It’s unclear how many students pass the MCI certification. Bhushan, the agent, said 70 percent pass; Aidaraliev, the administrator, said 60 percent; and the Indian diplomat said 16 percent, calling that a massive improvement over recent years when only 1 percent passed: “The schools here are happy to take more students. They only want money. They have maybe 60 spots, but they take 250 students,” he said.

Asked if he would send his child to one of these doctors, the diplomat recoiled: “I would never. I’d ask to see their diploma. But in India no one knows.”