“As a doctor, you can help a few patients per day. As a researcher, the whole world can benefit from your findings”

“As a doctor, you can help a few patients per day. As a researcher, the whole world can benefit from your findings”

Syrian neurosurgeon couldn’t to continue his career in the Netherlands, now he is a researcher

19-02-2024 · Background

“If only they had given me the opportunity to practise my profession here – supervised me to see what I could do, and then decided if I met the requirements. But that didn’t happen. I think it’s a waste of money and talent.” Mohamed Kassem was a neurosurgeon when he fled Syria in 2012, but he found himself unable to continue his career in the Netherlands. He now works as a postdoctoral researcher at CARIM.

After a decade in our country, research and teaching have become Mohamed Kassem’s new passions, he cheerfully declares in Dutch. Last December, at the age of 45, he earned his PhD from Maastricht University for his research on predictors of stroke risk. He has been a postdoctoral researcher at CARIM, the UM research institute for cardiovascular diseases, for almost a year now.

 

Firefighters

“Ask a child in the Middle East what they want to be when they grow up, and they’ll say, ‘a doctor’ or ‘an engineer’. Here in the Netherlands, children want to be firefighters or police officers. These jobs have a bad reputation in Syria. In Syria, you’d never wave at the police the way I’ve taught my five-year-old son to do here in Maastricht.” Kassem realised his childhood dream of becoming a doctor. He was a neurosurgeon when he took to the streets in 2011. “It was the beginning of the Arab Spring. Young people were demonstrating, demanding democracy, freedom, a multi-party system, separation of religion and state. We wanted Assad to go. Fifty or sixty years ago, before the Assads came to power, Syria was a liberal country with women in parliament.”

The peaceful demonstrations were eventually crushed by the regime – everyone remembers the images. “The army fired on the demonstrators, and cities like Aleppo and Homs were heavily bombed.” The conflict ultimately escalated into a civil war, leading to a humanitarian crisis. Hundreds of thousands of people were killed and millions displaced.

During that time, Kassem was called up for military service. “I didn’t want to go into the military and be forced to kill my own people. I fled for political reasons, but also because refusing conscription is punishable by death.” He ended up in Turkey, where he joined the Red Cross as a medical coordinator. When the Syrian regime learnt of this, they retaliated by arresting his brother and his best friend as leverage. Kassem’s brother was released after a year and payment of a large ransom. His best friend didn’t survive, succumbing to injuries from torture.

Fleeing by boat

“My work in Turkey was putting my family and friends in danger. I quit my job and decided to head to Europe. It would be a dangerous journey, but I had little choice. It was either die or start a new life.” He boarded a boat with his wife, who was a pharmacist in Syria. She fled the country one evening after learning from a friend that the police were planning to arrest her that night. “She’d been labelled an activist. In all the chaos, she had to leave almost everything behind, including the degree she’d earned in Ukraine.”

It was his wife who wanted to go to the Netherlands once they had reached the European mainland. “I wanted to go to Germany, where I would have more opportunities as a neurosurgeon. But she had researched the Netherlands, reading about human rights and gender equality.”

In 2014, they moved from one asylum seekers’ centre to another – eight in total – until they were granted residence permits in 2015 and could start the civic integration process. “I studied hard to learn the language and start working as quickly as possible.”

By then, he had come to realise that continuing his career as a neurosurgeon would be next to impossible. He hadn’t practised in years, and the Dutch requirements are strict. To practise in the Netherlands, certain healthcare professionals, including doctors and pharmacists, must be registered in the BIG register. To be eligible for registration, foreign specialists must have a good command of the Dutch language and recognised qualifications. Kassem would have had to register as a physician and redo his six years of neurosurgery training, despite having covered the same content in Syria. “My eighteen years of study in Syria – six years of high school, six years of medical school, six years of specialty training – easily cost the public about half a million euros. If only they had given me the opportunity to practise my profession here – supervised me to see what I could do, and then decided if I met the requirements. But that didn’t happen. I think it’s a waste of money and talent, particularly in a country facing a shortage of healthcare workers.”

A good move

But he didn’t dwell on the setback for long. He enrolled in the research master’s in Biomedical Sciences at UM, which turned out to be a good move. After obtaining his degree in 2019, he went straight into the PhD programme he completed last December. “I love doing research. As a doctor, you can help a few patients per day. As a researcher, the whole world can benefit from your findings.”

Kassem hopes that the results of his PhD dissertation, entitled “Intraplaque Hemorrhage on carotid MRI in stroke patients: on the Road Towards Clinical Application”, will find their way into medical practice. He studied the composition of plaques, the substances that build up in the carotid artery and lead to narrowing (atherosclerosis). When a plaque ruptures, a blood clot may form and travel to the brain, causing a stroke or TIA. Why are some plaques associated with a higher risk than others? Kassem patiently explains, “Imagine you have two apples of the same size and colour. You need to eat one now and the other later. But how do we know which apple will go bad first and needs to be eaten first? You can’t tell from the outside. Using advanced MRI techniques, we’ll look for specific features indicating that the apple may go bad. The same goes for carotid artery plaques. You look for minuscule features that may cause bleeding in the plaque and therefore a blood clot and, ultimately, a stroke or TIA. Patients with rupture-prone plaques may benefit from carotid surgery, while others may not.”

Future

Looking ahead to the future, he says, “I want to contribute to the country that provided safety for me and my family and gave me the opportunity to go back to university. I want to do medical research that will benefit people in the Netherlands. And I hope that my son and daughter are proud of us, and happy with the life my wife and I are building here.”

The Netherlands only automatically recognises qualifications issued in Europe

Why is it so difficult for refugees like Mohamed Kassem to continue practising medicine here? “In the Netherlands, we want to make sure that practising doctors are qualified”, explains Professor Frank Smeenk. “That’s why we only recognise specialist qualifications from the European Union, Norway, Iceland, Liechtenstein and Switzerland. A pulmonologist from Greece can practise here, but they need to pass a language test, and they must have completed the minimum years of training required by the EU. If the Greek programme is three years while the EU requirement is four years, their degree won’t be recognised automatically.”

Smeenk, a professor of Quality Improvement of Residency Training at Maastricht University, used to work as a pulmonologist at the Catharina Hospital in Eindhoven. He has been a board member and the vice-chair of the Medical Specialties Board of the Royal Dutch Medical Association (KNMG) for eight years. “We don’t know what neurosurgery training looks like in Syria”, he continues. “Do neurosurgeons in training need to perform the same number of surgeries? How difficult are those surgeries? We don’t have that information. You can’t learn medicine from books alone. That’s why we don’t automatically recognise qualifications from outside the European Economic Area (EEA). However, non-EEA nationals can still apply for registration in the Dutch specialist register. The Medical Specialist Registration Committee (RGS) will assess if their training and experience meet the requirements. The Registration Committee may decide that additional training is needed.”

Even for Europeans, the process isn’t always straightforward. “Some time ago, Leiden University wanted to appoint a German doctor as professor and head of the Department of Pulmonary Diseases. He had trained in internal medicine and later specialised in pulmonary diseases. Pulmonology was not a separate specialty in Germany at the time, so he was registered as an internist rather than a pulmonologist. This meant that we couldn’t register him as a pulmonologist, which meant that he couldn’t take the job, even though he was perfectly competent. He was told to work under the supervision of a peer in Amsterdam for six months. If he completed this assessment period successfully – and we had no doubt about that – we could recognise his qualifications. Sometimes a solution can be found, but everyone must ultimately meet the training requirements.”

He points out another common issue faced by refugees, including Kassem. Before a foreign doctor can be registered as a medical specialist in the Netherlands, they must first be registered in the BIG register, just like all Dutch doctors. “If I haven’t practised as a pulmonologist for five years, I lose my doctor’s registration and my BIG registration. This applies to all doctors in the Netherlands. Medicine is always evolving; half of our knowledge will be outdated in ten years. Everything is aimed at making sure that practising doctors are competent. If a refugee hasn’t practiced medicine in two years but possesses the necessary qualifications, it’s up to the Registration Committee to decide if additional training is needed.”

Author: Riki Janssen

Photo: archive CARIM

Categories: news_top, People
Tags: refugee,mohamed kassem,syria,research,carim,instagram

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