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Hostile treatment

Dr Shashi Awai
HOME ALONE: Dr Awai could no longer work so spent many anxious days at home

Fifteen years in the UK, committed to the NHS and valued by her hospital, Shashi Awai seems just the kind of immigrant the home secretary recently celebrated. Sadly, his own department has treated her very differently. Tim Tonkin reports

Home secretary Sajid Javid could not have been clearer about the benefits of immigration at last month’s Conservative Party conference.

It had allowed the UK to ‘adopt many of the best bits of other countries’, said Mr Javid, himself the son of immigrants. ‘We want to welcome people to this country.’

So, it was presumably a different Home Office to the one Mr Javid leads that wrote a letter to an ENT doctor, Shashi Awai, which seems in turn callous and patronising.

Dr Awai, a trust-grade doctor from Nepal who has lived in the UK for 15 years, was applying for leave to remain. She loves the NHS and loves this country.



It was a love which the Home Office did not reciprocate. In rejecting her application, a letter from the Home Office told Dr Awai ‘you can maintain contact with your friends in the UK from overseas via the use of modern communications and it is open to them to visit you in Nepal’.

Her education, skills and experience, so valued by her hospital in Surrey, would help her find ‘suitable employment’ in her country of origin – never mind that she has been away from Nepal so long that she can no longer even read or write the language.

‘I am not after money, I just want to use my skills to help people with the greatest need’

It made clear that she should make immediate plans to leave the UK warning she could be detained, forceably removed or imprisoned for up to six months for failing to comply.

‘This decision stopped me from being what I am,’ she says.

Even though her case has now been resolved following support from the BMA, Dr Awai describes the experience as a 'nightmare'.

For Dr Awai, the practice of medicine is instead indivisible from working in a values-based system which offers universal healthcare.


Altruistic values

She wanted to be a doctor from an early age, influenced by the death of her sister while they were children. The daughter of farmers-turned-teachers, she grew up valuing the importance of education.

At the age of 18, owing to the limited options at that time for studying medicine in her home country, Dr Awai travelled to Russia where she spent the best part of a decade studying medicine, eventually gaining a master’s degree before completing four years’ training in ENT.


Dr Shashi Awai 01

Having originally wanted to practise medicine in her home country, she returned briefly to Nepal in 1999, and for six months attempted to provide the care she had sought for years to give. The reality soon left her disillusioned.

‘The healthcare [in Nepal] is not universal and the resources are not always there. If your patient needs to go to theatre you might find that there’s no ambulance to take them there or no anaesthetic when they arrive. Many patients cannot even afford treatment in the first place.

‘My friends from medical school who went back to Nepal to work are all very well off.

'If I had remained there I would have gone into private practice, become a consultant and become very rich.


Out to help

‘For me, however, I am not after money [by being a doctor], I just want to use my skills to help people with the greatest need.’

In 2003, Dr Awai arrived in the UK and was quickly enchanted by its way of life and its commitment to universal healthcare.

‘I applied for a volunteer job because I know how overburdened the NHS is. But that's not allowed if you do not have a visa’

‘I was really taken by the diversity of this country; the language, the food and the different cultures, and the tolerant attitudes within society.’

With limited English, Dr Awai spent the next six years residing on a Tier 4 student visa, completing the various assessments and examinations required for her to be able to practise in the UK.

After completing her PLAB (professional and linguistics assessment board) examination in 2012, she secured a locum ENT role at East Surrey Hospital in Redhill in 2013, with the position becoming permanent in June the following year.


Family problems

During her time living and working in the UK, Dr Awai met and married a British citizen, and in November 2013, she was granted leave to remain in the UK until May 2016 on the basis that she was the spouse of a person ‘present and settled in the UK’.

It was in March 2015, following the breakdown of her marriage and after more than a decade in the country, that she applied to the Home Office for indefinite leave to remain.

Dr Shashi Awai 01

Two months later, the Home Office contacted Dr Awai to notify her that her application had been rejected, a decision she successfully appealed at the first tier of the immigration tribunal in 2016.

In the same year she met now-fiancé Ian, a telecoms analyst, and for a short while, it appeared that her immigration ordeal was over.

Relief proved short-lived, however, with the Home Office moving to appeal the ruling and managing to overturn the decision at the tribunal’s second tier the following year.


Plunged into debt

Despite lodging another application for indefinite leave, this time on the grounds of human rights, the expiration of her previous leave to remain has meant that Dr Awai has not been able to work since April 2017.

Her lack of income coupled with her ongoing legal fees have resulted in her falling into around £20,000 worth of debt.

‘Sometimes it's still hard to believe this nightmare has disappeared’

While the appeals were ongoing her hospital wrote letters of support to both the Home Office and Dr Awai’s MP, telling the latter that she was an ‘extremely valuable member of the ENT team’ and warning of how challenging it was to find ‘doctors with a similar level of experience and ability’.

She says she felt like she was in limbo, with every phone call bringing the possibility of a decision. Her career, her hopes to start a family, were all put on hold.



She says: ‘I was lucky enough that I have a fiancé who, along with friends and family, has supported me financially – how else would I have survived for nearly 20 months not working?

‘The most painful thing, however, is the fact that I, as a fully qualified doctor, have had to stop working.

Shashi Awai in postgraduate training

‘I applied for a volunteer job [at the hospital] – because I know how overburdened the NHS is.

'I thought that even though I cannot work as a doctor maybe I can take blood tests or help a junior doctor with their notes – but discovered that volunteering is also not allowed if you do not have a visa.’


Go to the press

Dr Awai finally decided to go public with her situation, giving an interview to BBC Surrey on 19 September.

The BMA took up Dr Awai’s case and wrote to the Home Office, with BMA council chair Chaand Nagpaul describing the treatment she has received as ‘outrageous’.

‘I was speechless and had to go outside for some fresh air’

Dr Nagpaul said in the letter that Dr Awai’s situation demonstrated how the inflexibility of the UK’s immigration system was hindering the NHS from recruiting the staff that it needed.

After more than a year of uncertainty and unemployment, the pressure from the BMA and the media paid off.

Last month, Dr Awai received notification from the Home Office confirming that, after reconsidering her case, it had decided to grant her leave to remain in the UK until 2021.


Surprise reprieve

‘I did not believe it at first,’ says Dr Awai. ‘I was speechless and had to go outside for some fresh air. It took 30 minutes or so for the news to sink in, sometimes it’s still hard to believe that this nightmare has disappeared.’

Once she has her passport returned with a renewed visa, she hopes to resume work this month.

Dr Awai also believes she will now have an opportunity to apply for permanent residence. Next year, she plans to marry.

‘I do not want to look backwards now, I just want to thank everyone who supported me during this difficult time.’

Follow the BMA's guidance on immigration

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