All Photos Courtesy of Tsegereda Wubea
In June of 1983, my mother, Tsegereda Wubea graduated from veterinary school in Ethiopia, one of six women in a class of 93 at Debre Zeit University. As she accepted her diploma she felt a sense of relief that all her hard work had brought her to this moment.
Fifteen years later, in May of 1998, my mother again received her diploma. This time it was a nursing degree from San Jose State University in Northern California. She'd done all that hard work--again. I was just three years old but I remember it clearly, standing with my twin brother Eyouab Tadesse unable to wait for her to cross the stage so we could give her the special bouquet of flowers we had for her. Instead I scurried toward her. I wrapped my arms tightly around her hips and buried my face in the folds of her black graduation gown.
At the time I didn't know that this was my mother's second college graduation, and it wasn't until many years later that I understood the horrors of the Ethiopian Civil War that led my parents to flee to the U.S. In 1985, at the age of 23, my mom trekked through the Sahara desert for two weeks on foot, seeking a better life. She and my father, Tadesse Kassathen in the early days of their courtship, came to America traumatized by the destruction in their home country, hoping they'd be able to pick up their lives and careers where they'd left off.
Their relationship endured, but they soon realized that all the effort they'd put in to their education and training in Ethiopia didn't count for much in the U.S. On that front they would have to start over. Reflecting on her experiences, my mom told me: "I was naive to know how it worked here."
Over the next six years, confronted with an aging population, the U.S. will need to hire 2.3 million new health care workers, from home health aides to lab technicians to nurses and doctors, according to a study by global health care staffing consultancy Mercer.Immigrants educated outside the U.S. who could help fill that void face a variety of hurdles that are now just beginning to be addressed.
Indeed my mom's arduous path to re-joining the professional workforce in America two decades ago is reflective of an experience common to many immigrants even today, especially those working in health care, where the standards of U.S. education and training are regarded as the highest in the world.
Immigrants with medical degrees who wish to practice in the U.S. typically must go back to school to meet the expectations of employers and qualify for positions comparable to what they held in their home countries. According to a report on occupational licensing barriers by the Little Hoover Commission, governing bodies are ill-equipped to weigh the previous education of immigrants with the requirements in the U.S. "The licensing board may not be able to translate the applicant's foreign education and experience to the board's requirements," the commission found.
A 2009-2013 study from the New American Economy and Migration Policy Institute found that two million college-educated immigrants in the U.S. were either underemployed or unemployed in "low-skilled or semiskilled jobs that fail to draw on their education and expertise." An estimated 15 percent of immigrants who hold undergraduate degrees in medical health sciences and services were either underemployed or unemployed.
Skilled immigrants discouraged by the obstacles may switch professions. Or they may opt to support their children's educational and professional pursuits instead of trying to re-create their own. To provide for their families, many end up giving up and settling for low-skilled jobs such as driving a cab, contributing to a phenomenon known as "brain waste."
"The countries from which they left lose a valuable human resource, and the country that supposedly gains that resource is not using that resource.
"When college-educated immigrants are not able to start their careers in the United States after their arrival, we see it as a major policy problem," said Jeanne Batalova, senior policy analyst at the Migration Policy Institute. "The countries from which they left lose a valuable human resource, and the country that supposedly gains that resource is not using that resource. So in the end, it's a loss on both accounts."
When my parents arrived in the United States over thirty years ago, there weren't too many programs and organizations that aided immigrants in transitioning into healthcare. Now, in light of a massive nationwide labor shortage in the profession, that's beginning to change. The Association of Schools of Public Health has projected a shortage of 250,000 public health workers by next year. And the Bureau of Labor Statistics has projected that the registered nurse workforce will have more than a million job openings by 2024--and not nearly enough trained professionals to fill them.
An effort is underway on the legislative front to begin to try to tackle the problem. California Congresswoman Lucille Roybal-Allard has proposed a bill to award grants to organizations providing career support for internationally educated health professionals. The PATH (Professional's Access to Health Workforce Integration) Act would appropriate $4.5 million over three years and would award three-year grants to up to five eligible organizations.
"We're hoping to address the need for health professionals [where] there's similar disparities in access to care in more urban areas that are lower income [and] for communities of color," said Alejandra Leynez, a public health policy fellow for Roybal-Allard. "Essentially the bill would be creating a new grant program that goes to different organizations that are trying to help immigrants go through the credential process and English language skills specifically for the [U.S.] health workforce."
As the issue of immigrant policies contributes to the polarization of the country, the politics of that debate is further threatening the role immigrants play in the healthcare shortage, Leynez said. "Immigrants come here for various reasons, but usually for a better life," she said. "You want to pursue something in hopefully a society that's giving you opportunities."
The need for immigrant health professionals in rural and underserved areas is critical, Leynez said. One in every 10 medical professionals works in rural areas, while one fifth of the population lives in rural communities. In order for internationally educated healthcare professionals to be awarded a PATH grant, they must be affiliated with a clinical/public health services organization, a nonprofit, or academic institution. The Secretary of Health and Human Services may award grants through mentioned entities to foreign educated health professionals.
"Anyone who is helped through these grants would be required up to no more than a year to work in one of these underserved areas," Leynez said.
At the state level, the Minnesota Department of Health allocates a million dollars a year through its International Medical Graduate Assistance Program to help address challenges foreign physicians experience when re-entering their professions. In California, UCLA's International Medical Graduate Program trains foreign medical graduates who are bilingual and bicultural to work in underserved communities.
Upwardly Global, a San Francisco non-profit, works to eliminate employment barriers for skilled immigrants and refugees. With offices in Chicago, New York, and D.C., Upwardly Global works with local community organizations on outreach and providing services to immigrants. The organization helps members with online job training, resume/cover letter writing and holds career fairs across the nation to help immigrants figure out the best path for them to pursue professionally.
According to Upwardly Global by giving proper career support to unemployed or underemployed skilled immigrants, research indicates income can typically increase by 215 to 900 percent.
Emmanuel Imah, Upwardly Global's alumni engagement manager, was a product of the program himself. Originally from Nigeria, he worked in the IT sector before moving to the U.S. in 2007. He heard about Upwardly Global through a local public radio program. "Getting a job and being successful at a job are two different things," he said. "Looking for a job is is a full time job itself."
Looking for prospective jobs within an immigrant's area of expertise can be equally difficult. By creating a six-week online training program for jobseekers, immigrants can access resources more readily and do so at their own pace. In-house coaches, available online, will then help them focus on the specific industry they're looking to work in. According to Imah, in San Francisco alone, over 40% of immigrants are qualified for STEM work, including healthcare.
"They [highly skilled immigrants] are always amazed at the fact that they are getting this service free and no one is asking them to pay," he said. "Volunteers [are] very open, happy, [and] receptive to support them in their job search."
When my mother was unable to get a job with her foreign degree, she set about arranging to re-attend college. After learning that college is not free in America (as it was in Ethiopia) she made the difficult decision not to go back and re-do veterinary school--it was far too expensive.
Instead, the counselor at her community college advised that if she wanted an affordable degree in the medical profession she should to transfer into the nursing program at San Jose State, where she could complete her studies and become a registered nurse within four years.
"I said to him, why are you asking me to go to nursing," my mom recalled. In Ethiopia, nursing was considered a lower profession--more caretaker than medical professional.
However, her counselor persuaded her that nursing would be a secure profession if she planned to raise a family. Soon she came around to the idea and after completing her nursing prerequisites in 1993, she was accepted for the SJSU nursing program for fall of 1994. The year she started nursing school she also married my father. Then my brother and I came along, and in 1998 so did her second college degree. Within those four years she became a registered nurse, with no student debt.
"We don't have a mom, dad or uncle. We can't ask could we borrow money to pay our tuition or pay our rent," my mom said. "We don't have anybody. We have to do everything and so we have to work. It just gives you motivation because you don't have any backup."
My father also transferred to SJSU in 1994 with my mother, majoring in biology and clinical sciences. This was his first college degree: in Ethiopia he was conscripted to work for the government. While in college and with infants at home, he also worked full-time as a lab technician.
One of the hardest things about attending a public university, he said, is the shortage of courses offered each semester. If you couldn't get into a class one semester, you'd have to wait the following year to enroll. "It's challenging and time consuming," he said. "Of course, I would have been done in two years if it weren't [for] that and having full time work."
Despite the challenges, my dad was committed to receiving a good education. "It was very difficult to attend school while working full time," he said. "But what we were looking for was achieving our goals."
My parents' medical professions are reflective of a large presence of African immigrants in the healthcare sector. About 30 percent of African immigrants work in healthcare in the U.S., compared to 13 percent of the total U.S. population. According to a Migration Policy Institute study, African immigrants possess higher levels of educational attainment than the rest of the immigrant population, as well as those who are U.S.-born.
40 percent of African immigrants have a bachelor's degree, with one in three within the STEM field. But in the U.S., for the African refugee population in particular, it can be even more difficult to transfer their expertise because employers in America rely heavily on their knowledge of the colleges applicants attended.
"Reputation is a major factor in hiring," Batalova said. "It's how comfortable, how familiar employers are with what credentials people present."
Immigration status makes a difference as well. "Immigrants from Africa, at the moment, come through three main channels: some are highly skilled and come with either work visas or student visas and they usually don't have a problem," Batalova said. "But the other two are diversity visa and refugees, and the refugees, they often don't have the documents to show even though they have [credentials] or practice [back home]."
Networking becomes that much harder for immigrants who have no connections. Assistance in navigating the American workforce starts with helpful counselors, financial support, and resource guidance, sources of support not all immigrants have awareness of or access to. "Knowledge [of resources] is absolutely critical," Batalvoa said, "and often missing when immigrants start on their own."
Yemisarech Kifle, a retired pulmonologist, said she was naive when she first came to America in 1982. Originally arriving in D.C., she moved to Iowa with her family because her husband at the time had a friend living there. Kifle was a licensed medical doctor in Ethiopia--she had completed three years of pre-med and three years of residency at Addis Ababa University, the country's most highly regarded institution for higher learning. When she came to America she passed the medical board exam but had to re-apply for a residency program because the quality of educational training standards back home couldn't be properly assessed.
She continued to apply to residency programs and kept getting rejected. "It was definitely disheartening," she said. "That's the point I just said I don't think I'll ever go back to practicing medicine. I almost kind of gave up."
Kifle wound up working as a lab research assistant for six years until she got accepted into a residency program for pediatrics at Kings County Hospital at Brooklyn in 1988. Even though it was a decent job, it wasn't like the work she was doing in Ethiopia, intense and demanding work in the rural countryside.
"If you're on your own and you don't know the country, you don't know the system...so imagine, what can you do?"
"We'd see a lot of patients because that is the main hospital in that region, people come from really rural areas, all the way from the mountains they travel days to come and see you," she said. "At a day clinic we'd see about 30-40 patients a day, with only two to four doctors."
The transition from her work as a physician in Ethiopia to research assistant in the U.S. was tough.
"If you're on your own, and you don't know the country, you don't know the system," she said. "So imagine, what can you do?"
Kifle said had she known the opportunities the East Coast had to offer, she would never have moved to Iowa."If someone from the D.C. area would have told me, 'stay in D.C. and Howard University will take you as a resident,' I would not have gone to Iowa and been stuck there," she said. "Once I went there I didn't have enough money, I have two kids… so I don't know how to move back, because how can you move back to a big city without anything?"
After completing her residency, she got a fellowship in 1992 to specialize in pediatric pulmonology at the University of Florida College of Medicine at Gainesville, eventually becoming the Associate Medical Director of the Pediatric Sleep Center at Seattle Children's Hospital and Clinical Associate Professor in the Department of Pediatrics at the University of Washington School of Medicine.
Her journey was tough and frustrating but, she said it was a process she had to endure. "I don't like to say everything is a waste of time because you learn something." she said. "You have to say everything happens for a reason just to make yourself feel better."
For my mom, Tsegereda --as well as for my dad, Tadesse --everything did happen for a reason, and in the long-run their journey worked out well. Once my mother finished her nursing program, she started working as a registered nurse at Stanford's Bone and Marrow Transplant Unit, a job she's held for over 20 years. "I love it," she told me. "I have the chance to be at the bedside with my patients."
My father went on to get his masters in biomedical laboratory science at San Francisco State and his MBA at St. Mary's College and is now the senior clinical laboratory scientist for Genomic Health, a biotech company.
Now both are close to retirement, but they have no plans to slow down. My mother wants to take her expertise from her time at Stanford and volunteer around the world with the Oncology Nursing Society, especially in underdeveloped countries. "To teach people how to take care of patients with chemotherapy," she told me. "How to handle side effects, and how to protect themselves while giving chemo is important."
My dad dreams of returning to Ethiopia and opening a clinical laboratory to provide high-quality, affordable lab tests to those who can't afford them. He also wants to teach part-time, "agitating people to become aware of protecting their environment and adapting family planning in their lives," he told me.
For my part, I wish my parents' journey had been easier, and I hope the path to success won't be quite as rough for current and future immigrants who come to America trained and ready to provide medical care. But my mom says she's satisfied. "When I reflect back on all the things that we went through," she said, "it's worth it."
Being educated during the Ethiopian Civil War
Fleeing to Sudan and coming to America
The Price and Sacrifice for an Education
College, Marriage, and Twins
Click on the image to read me and my brother's perspective on our parents educational journey
