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MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

India has exported thousands of doctors to America and elsewhere. For decades, doctors trained in India have given in into the temptation to practice abroad where the money is better and the technology is more sophisticated.

But Indian medicine is changing and the physician brain drain to beginning to reverse.

NPR's Richard Knox went to Bangalore for this story, the last in our series on international medicine.

Dr. PRABHAKAR REDDY (Emergency Room Doctor, Bangalore): (Speaking in foreign language)

RICHARD KNOX: Dr. Prabhakar Reddy is an emergency room doctor in Bangalore, an Indian boomtown known for its call centers and software factories. He used to have a good life in Louisiana, a nice income and Cajun food.

Dr. REDDY: I loved my crawfish there.

(Soundbite of laughter)

Dr. REDDY: So at Louisiana, people grow crawfish in their backyards, sort of a crawfish port.

KNOX: Ask Reddy why he left a handsome salary and all that crawfish to practice medicine in India, and he tells you about a case he treated here not long ago -a suicidal 17-year-old.

Dr. REDDY: He walked into this emergency room with his father and said I failed in my exams so I didn't want to live anymore. So I took my father's blood pressure medication - Norvasc.

KNOX: The boy showed Reddy a fistful of empty pill packs and Reddy immediately sent him to the ICU.

Dr. Rajanna Sreedhara, a colleague who also practiced in America, picked up the phone and called back to the states for help.

Dr. RAJANNA SREEDHARA (Kidney Specialist): I actually called the poison-control number. It went to poison-control in Chicago.

Dr. REDDY: 1-800-212-POISON.

Dr. R. SREEDHARA: Poison, yeah.

KNOX: The Chicago experts gave some advice, but there was no way to reverse the overdose. It was already too late.

Dr. R. SREEDHARA: He was just crashing. His blood pressure was dropping. He had multisystem failure. His breathing was not good. So he had to be put on a ventilator.

KNOX: Did you think you were going to lose him at this point?

Dr. R. SREEDHARA: Absolutely. I mean, patients in that type of situation, I would say, 99 out of 100 times, we would lose such a patient.

KNOX: A team of specialists rushed to rescue the boy. All of them, it turns out, had practiced in America - a lung doctor and a cardiologist who came back from New York City, along with Reddy and Sreedhara, a kidney specialist who spent years in America.

Dr. R. SREEDHARA: I have some (unintelligible).

KNOX: It's just like the returning team, isn't it.

Dr. R. SREEDHARA: Yeah.

(Soundbite of laughter)

Dr. R. SREEDHARA: All the people who had their training in the United States were enrolled here.

KNOX: The group brought a spare-no-expense attitude to the case.

Dr. R. SREEDHARA: Because he was only 17, we were not ready to give up. We knew that if we could hold him for a couple of more hours or days that we probably could keep him alive.

KNOX: The team desperately tried everything they could think of as the boy teetered near death.

Mustering a team like that - with decades of experience in the States - was unheard of in India until recently. That kind of care is accessible now to only a minority of Indians - those who have plenty of cash, or the few who have health insurance.

But that's a growing number. Soon India's middle class will be as large as the entire U.S. population. For-profit hospitals are springing up all over India to serve these patients. And they're offering signing bonuses and stock options to attract Indian doctors from America. That's got many Indian doctors in America thinking about going home.

Dr. MANAS KAUSHIK (Harvard School of Public Health) : Hey, how are you doing?

KNOX: Dr. Manas Kaushik grabs a cup of coffee on the Harvard Medical Area campus in Boston, 8,000 miles from Bangalore.

Dr. KAUSHIK: And this is decaf, do you want decaf?

KNOX: Oh no, regular coffee.

Kaushik is Indian himself. He is now at the Harvard School of Public Health where he's done research on the brain drain of doctors out of India.

KNOX: Do you take milk or sugar?

Dr. KAUSHIK: Oh yeah.

He tracked hundreds of graduates from the All India Institute of Medical Sciences, India's equivalent of Harvard Medical School. Kaushik looked at alumni dating back to the 1950s.

Dr. KAUSHIK: Over this period, we roughly had 450 physicians who graduated from the All India Institute of Medical Sciences. And almost 50 percent of them emigrated to the U.S.

KNOX: Fifty percent?

Dr. KAUSHIK: That's right.

KNOX: Five-O?

Dr. KAUSHIK: That's right, five-zero.

KNOX: In 50 years, Kaushik says, only one of those doctor-emigrants went back to India and he returned to America a year later. No other country has exported as many physicians as India. More than 40,000 practice in the United States, so that's one of every 20 U.S. doctors who comes from India.

But Kaushik says the tide is beginning to turn. There are no numbers, but there's lots of anecdotal evidence that Indian doctors are buzzing about the new opportunities to practice American-style medicine in India.

Dr. KAUSHIK: I'm a recent immigrant myself, and I have talked to a lot of my friends who have made tough decisions, moving to the U.S., and some of them are thinking of going back.

KNOX: Kaushik plans to return to India to help build a more equitable health system.

Dr. KAUSHIK: I see India changing all the time. It's just a very exciting time to be an Indian.

(Soundbite of people talking)

KNOX: Back in Bangalore, Rajanna Sreedhara, the kidney specialist and his wife Malathi, are in the vanguard of the trend. They're in their 40s, with two young girls. The Sreedharas gave up successful practices in Tampa to come home to Bangalore. Malathi Sreedhara is a pediatrician, she's cooking dinner in her well-equipped kitchen.

(Soundbite of frying)

Dr. MALATHI SREEDHARA (Pediatrician): So what I'm making now is called poori, that's common Indian breakfast. I was making this one for dinner now because I don't have too much time for all this in the morning.

(Soundbite of frying)

KNOX: The Sreedharas work hard - six days a week, sometimes even on Sunday. But they live well, by any standard. They recently built a three-story house in a nice neighborhood. It had 12-foot ceilings and teak woodwork.

Dr. R. SREEDHARA: We have four bedrooms, and a study, living room and dining. This is a moderate-sized house, I would say.

(Soundbite of laughter)

Dr. R. SREEDHARA: It's not very big, you know.

Unidentified Man: Is this bigger than your house in Florida?

Dr. M. SREEDHARA: Oh yeah.

Dr. R. SREEDHARA: Yeah.

Dr. M. SREEDHARA: Yeah, yeah.

(Soundbite of laughter)

KNOX: But, the Sreedharas say, they earn much less than they did in Tampa.

Dr. R. SREEDHARA: I would say, currently, I'm probably making one-tenth of what I was making in the U.S.

KNOX: One-tenth?

Dr. R. SREEDHARA: Yes, one-tenth. And that's what I had planned, you know. We live very modestly.

Dr. M. SREEDHARA: Conservatively.

KNOX: The equivalent of $30,000 goes a long way in Bangalore. Besides a big new house, it buys servants, private schools and nice vacations. But the biggest lure is simply, it's home.

(Soundbite of elevator)

KNOX: Rajanna Sreedhara says he might not have come back if Indian medicine hadn't changed so much, at least in the for-profit hospitals like this one where he works. It's as well-equipped as almost any in America.

A case in point is that 17-year-old boy who tried to kill himself after failing his exams. To save his life, Sreedhara and his fellow returnees came up with a radical solution that might only have occurred to doctors who'd practiced in America. They hooked him up to a heart-lung machine.

Dr. R. SREEDHARA: Within minutes after starting it, his urine output was good, you know, his blood pressure got better. So we were able to get him through this very dangerous phase. And by, I think, about 28 hours, we took him off the machine. I mean, I think, you know, without that, he wouldn't be alive.

KNOX: The dramatic rescue shows how much Indian medicine has changed since Sreedhara went to America.

Dr. R. SREEDHARA: Suddenly when I left India in '87, you know, I had never even seen a ventilator or a cardiopulmonary bypass machine. So, I mean, suddenly, whatever procedure that can be done anywhere in the world can be done in India. But the thing is, only in some places, not everywhere.

KNOX: And that troubles him. As a kidney specialist, Sreedhara sees many patients who need life-saving dialysis. But fewer than 5 percent of Indians with kidney failure can afford it. So we have to say no, knowing they're going to die.

That's the price of returning, he says. It's good to be home, and it's exciting to play a role in the new India. But Sreedhara knows it will be a long time before the vast majority of Indians are able to get the American-style medicine that he and his colleagues practice.

Richard Knox, NPR News.

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