‘I’m at the bottom of the barrel because I didn't go to a school in Ireland’

When Nithya Rajendran moved to Co Sligo in 2017, people often asked if she was Filipino. Locals in Sligo town often expressed surprise when she explained she had come from India to work in a private hospital.

"People from Pakistan and Sudan have recruitment companies that get them into the HSE but coming here was more of a struggle for me. I organised everything and got a two-year work permit for a private hospital; they only did elective surgeries, and it was very small. If I broke that contract the HSE wouldn't take me on so I kept going with it."

Rajendran did not specifically plan to move to Ireland but had taken both the Irish and British licensing exams. "The Irish one came through first and that's how I ended up here. I honestly thought it was the same as the UK at the time.

“Sligo was a very small place but it actually didn’t feel too different to India because people had the same values and way of thinking. It wasn’t very diverse but it wasn’t racist at all. People took me under their wing. I never felt like a stranger in Sligo.”

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Born and brought up in the southern Indian state of Tamil Nadu, Rajendran was the first member of her family to study medicine. She moved to the city of Bangalore for medical school before securing a job in a local hospital.

“There’s no proper working laws back home so we worked for at least six days a week with two 24-hour shifts per week. That SHO [senior house officer] job was killing me.”

After six months in the job, Rajendran moved to Glasgow for a year to study for a research degree in medical genetics. "It was while I was in Scotland that I realised I wanted to be back doing clinical work. So I went back to Chennai where I worked for another 2½ years years in emergency medicine."

When Ranjendran arrived in Sligo in 2017 she had no idea her Indian internship made her ineligible for specialist training programmes in Ireland. And she quickly discovered that building a medical career in Ireland would be far more complicated than she initially anticipated.

After two years in the west of Ireland, she secured Stamp 4 immigration permission and moved to Beaumont Hospital's A&E department. "It was very different to what I thought emergency departments would be like in foreign countries. The nurses were short-staffed, the waiting times were ridiculous, it was chaos. But working there made me much more confident as a clinician."

Things got really bad in February, there were too many people with the variants and we saw a high mortality rate

After nine months in Beaumont, Rajendran moved into a registrar position at Tallaght hospital. For this new job she had to commute by bus and Luas an hour and a half each way. “They thought I’d run away but I finished the entire six months, and that’s when Covid hit.”

Rajendran was redeployed to Tallaght hospital's emergency department when the pandemic was declared. "At that point nobody knew anything about the disease, we were hearing stories that everyone was dying in China. Then I started doing on-call as well and realised there wasn't enough PPE."

Rajendran’s mother happened to be visiting from India with her one-year-old nephew when Ireland went into lockdown. “They ended up here with me for nearly a year; they just left in January. I was so afraid I was going to infect my 60-year-old mother or nephew with Covid. My mum would disinfect me every time I came home. But I was very cautious and we never showed any symptoms.”

Last July, Rajendran moved to St James’s Hospital and in November she started working full time on the hospital’s Covid-19 ward. While work before Christmas was tiring, the real challenge came with the third wave, she says.

"A few people left for jobs in Australia in January and they didn't have enough SHOs to fill the posts. Things got really bad in February, there were too many people with the variants and we saw a high mortality rate. That's very demotivating as a doctor. You keep wondering is there something else we could have done. The only saving grace this time was we could let families in when a person was near the end of life.

“Honestly I think that’s when people get burnt out. But you have to keep going and be stoic about it. There’s no one to replace us. There’s people that need taking care of. I try to be strong.”

When we speak, Rajendran is about to take a week’s annual leave. It’s her first break since before Christmas. “I think it’s the first time I’m looking forward to time off. I’m a workaholic, I usually don’t bother with leave.”

A legislative change which passed in November 2020 means all non-EU doctors can apply for specialist training programmes, including those with internships not previously recognised by the Irish Medical Council.

However, as Rajendran discovered, non-EU doctors are ranked bottom of the programme list because of a preference system which allocates first places to Irish citizens, followed by EU nationals, applicants with immediate European family and those who are married to an Irish or EU citizen. Doctors educated outside the EU, who hold Stamp 4 immigration permission but do not fall under family or marriage categories, are only considered if training places are unfilled after the first round.

I love this country but I know professionally I can't progress here. I think in the long term I'll have to leave

Rajendran says her senior colleagues have always been hugely supportive but admits feeling disillusioned watching her Irish and European colleagues progress ahead of her.

“It’s the system that’s the problem here, not the doctors. The consultants are always looking out for me. But the system makes you feel worthless. Discrimination is the norm here when you’re an immigrant. I’m at the bottom of the barrel because I didn’t go to a school in Ireland.

"I'm very proud that I came to this country on my own. I shouldn't need to marry an Irish person to get on to a training course, that seems ridiculous to me. I'm not willing to do that for my career. I understand the logic is to keep Irish people here but so many are still going to Australia and Canada. I'm 32 and I can see consultants who are the same age as me.

“I love this country but I know professionally I can’t progress here. I think in the long term I’ll have to leave.”