In January 2020, 20-year-old medical student Rizwana P Rasheed returned to Thrissur in Kerala on board an evacuation flight from Wuhan in China, where the spread of Covid-19 had sparked alarm. Rasheed, who was nearing the end of her second year studying medicine in Wuhan University, believed her trip to India would be short. On January 30, she tested positive for Covid-19, becoming the first person in India to be diagnosed with the virus.

More than two years later and after suffering a second bout of Covid-19, Rasheed is still in India and in the fifth and final year of the MBBS degree. She has been following every update from her university and the Chinese government in the hope that foreign students will be allowed to return to the country.

China follows a strict “zero-Covid” policy to control the spread of the virus and has banned foreign students from entering the country since the outbreak of the pandemic. Like Rasheed, more than 20,000 Indian students are studying through online classes conducted by Chinese universities.

Since February, Indian students have been campaigning and demanding that they be allowed to return to Chinese universities. They have repeatedly urged the Indian government to take up the matter with China.

China remains the only country to have banned the entry of foreign students, except those from South Korea. On March 14, Chinese Foreign Ministry spokesperson Zhao Lijian said the country would consider allowing the return of a few foreign students with “actual needs”.

On March 25, External Affairs Minister S Jaishankar met his Chinese counterpart Wang Yi and discussed the matter with him but there has been no progress since then. With China in midst of another lockdown as cases peak for the first time since 2020, there has been no indication that foreign nationals will be allowed to return.

Back home, Indian medical students are struggling to obtain much-required practical experience and apply for medical internships as a result of conflicting guidelines.

Internship struggle

Rasheed, who had always wanted to become a doctor, has spent nearly three years of the five-year course attending online classes. Her father, Rasheed K, who runs a grocery store in Thrissur, said he had struggled to arrange money for her education in China – Rs 8 lakh. “It is difficult for her to study like this,” he said.

Since the past three months, Rasheed has also been attending coaching classes in Thiruvananthapuram to prepare for the Foreign Medical Graduates Examination to pursue an internship in India, her father said. Had she been in China, the internship would have been arranged through Wuhan University.

According to the regulations of the National Medical Commission, students who have earned medical degrees abroad and wish to do an internship in India must pass the Foreign Medical Graduates Examination to get a licence to practice.

On February 8, however, the National Medical Commission warned medical aspirants that it does not recognise online medical courses, a system that China has adopted for overseas students. Indian students of China’s Ningbo University then approached the Delhi High Court to demand that the National Medical Commission provide them with practical training. In March, students began another online campaign asking the government to facilitate their return to China or arrange for practical experience in India.

According to the Ministry of External Affairs, on March 4, the National Medical Commission issued a circular stating that it will allow internship for students who could not complete it in foreign institutes. Students, however, said on ground the process of registration with state medical councils remains difficult.

Rachita Kurmi, a medical student spearheading the online campaign, said that the National Medical Commission does not recognise foreign medical degrees unless students attend a stipulated number of physical classes and complete an internship at their university. “All our money, efforts and resources could go in vain,” she said.

Medical students protest in Kerala to demand registration. Photo: By special arrangement

Licence applications rejected

Students, such as Mohammed Imran, 25, are caught in between such guidelines as well as the changing norms of state governments. Imran had taken admission in the Zhejiang University in Hangzhou city in 2015 and graduated in 2020, months after the pandemic broke out. “I had to attend my last semester through online classes from home during the pandemic. We had no option,” said Imran.

Students usually stay back to continue a year-long internship in China. But Imran could not return to China due to the lockdown in India. In 2021, Imran passed the Foreign Medical Graduates Examination and applied for a licence in his home state of Tamil Nadu, but the state medical council rejected it as a part of his learning had been held online.

Several students like Imran then filed a writ petition in the Madras High Court to get a registration certificate in Tamil Nadu. On July 29, the Madras High Court ruled in favour of students and directed the state council to issue provisional registration certificates to students who had graduated from foreign universities.

Imran got a provisional registration in November following which he applied at the Government Medical college in Nagapattinam for an internship and paid Rs 2 lakh. But in March, the state government withheld the provisional registration. “The college dean called me and asked me to stop coming. He said the state government had notified them because of an ongoing case in the Supreme Court,” Imran said.

The National Medical Commission has filed an appeal in the Supreme Court opposing the Madras High Court order. The Commission has maintained that students who did not complete clinical practice are not entitled to provisional registration.

The NMC has opposed a Madras High Court ruling to provide medical students provisional registration.

So far, Kerala and Tamil Nadu have refused to grant medical registration to MBBS graduates from Chinese universities who have been unable to attend in-person classes. Imran said some other states and Union Territories like Chandigarh, Harayana, Bihar have granted medical registration to such students.

Like many others, Rasheed is worried that the lack of clinical and practical exposure in medicine might hamper her prospects of getting a licence from the state government. “We don’t know whether she will get a licence in Kerala for internship,” her father said.

Imran said, “It is all very confusing. Different states are following NMC’s directions differently. I have already lost a year of my internship.” Medical students who graduated from Chinese universities in 2021 are also facing a similar problem. Imran, along with a few other students, is now fighting the case in the apex court.

Local hospitals an option

Several students are now approaching Indian hospitals for clinical experience in the hope that the National Medical Commission will recognise it if they cannot return to China. A 23-year-old fifth-year student from Anhui University in China’s Hefei city contacted a relative who runs a small hospital in Rajasthan to get clinical experience.

The student, who requested anonymity, said, “Very few like me have been able to find a hospital or clinic where they can get practical exposure.” Most students had to get their theoretical knowledge from online classes these past two years, he said. The student, who will appear for the Foreign Medical Graduates Examination in December, said he was hoping that the lack of practical classes in China would be compensated by an internship in India.

Similarly, Alka Krishnan, a third-year medical student of Yangzhou University, visits a local hospital close to her home in Kannur in Kerala to observe surgical procedures. “I have to pay them some amount to allow me to shadow a senior doctor and observe procedures. Sometimes, they allow me to see patients in the outpatient department,” Krishnan said.

Krishnan has spent the last two years at her home struggling to follow online classes. “I am trying my best to understand, but it is very difficult to study medicine through online classes,” she said.

In 2020, she had decided to approach a hospital on her own for practical knowledge. She said was hoping that the National Medical Commission will recognise such experience. “I am juggling between classes and hospital. But there is nothing we can do except hope for the Indian government to take a lenient stand,” she said.

“As per NMC guidelines, we need practical exposure from our college. They don’t allow practical exposure from other hospitals,” said Krishnan, adding that students do not know if their clinical experience will be recognised.

So far, some state medical councils have refused to recognise even this experience. On March 19, over 150 students protested outside the Kerala Secretariat seeking the recognition of their foreign degrees and provision of medical registration. Krishnan was one of them. “It is not our fault that China has refused entry of foreign students,” she said.

Krishnan said students have submitted letters to parliamentarians and legislators and sought help from the government, but it was “offering no support”.

Rasheed, meanwhile, plans to appear for the Foreign Medical Graduates Examination in June. Her father said the family is hoping that the Supreme Court ruling will be in the students’ favour. “I understand very little of what is happening. But I do see my daughter troubled by all this,” he said.