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Post 9/11 Fallout: International Students, Patients Still Facing Scrutiny

A Rutgers University researcher working on a project that could help find the cure for cancer is unable to leave her native China and return to the United States to resume her work. A Kuwaiti cancer patient seeking treatment at a prestigious U.S. teaching hospital faces difficulties in receiving a visa and instead goes to Europe for the laser operation. More than 700 international students miss their programs' start dates due to visa delays or denials. These are just a few examples of foreigners who have faced increasing scrutiny when trying to enter the United States to study, work, or seek medical treatment.

After the attacks of Sept. 11, 2001, tightened anti-terrorism background checks have substantially delayed, and in some cases barred, foreigners' entrance into this country. Nationals of the Persian Gulf and other predominantly Muslim countries, in particular, have faced more hurdles than before 9/11.

According to Carol Sayles, director of international health services at Children's Hospital Boston, teaching hospitals were among the first institutions to notice the effect of stringent visa policies. "We felt the impact [of these policies] immediately, as soon as we realized many of our Middle Eastern patients weren't able to get visas," says Sayles. Children's, the primary pediatric teaching hospital of Harvard Medical School, is the largest pediatric medical center in the United States.

Cases where a mother and child received visas, but the father was denied one, were common, according to Sayles. "I don't care where you are from," she says. "You are not going to come over here with your child seriously ill, to have some catastrophic and long-term type of medical care done, without your husband."

After 9/11, the U.S. government directed four agencies to be in charge of immigration matters - the State Department, the FBI, the former Immigration and Naturalization Service (now the Bureau of Citizenship and Immigration Services, BCIS), and the U.S. Customs Service - causing a substantial increase in the backlog and red tape involved in the issuing of visas. Both Customs and BCIS have been placed within the new Department of Homeland Security, created Jan. 24, 2003.

"The biggest problem we have today is that there are still four agencies involved," says Sayles. "If there is even a misspelling, and a red flag goes forward to an official in any post around the world, that visa application goes to Washington, which means it goes simultaneously to the FBI, Customs, and Immigration," she says. "There's zero time frame for the processing of an application in case one of these agencies ends up holding it up for some reason. The application just goes into the 'Black Hole of Calcutta.'"

Longer waits Children's Hospital

Children's Hospital Boston's 2002 fiscal year began just two weeks after 9/11, on Oct. 1, 2001. That fiscal year saw a 22 percent drop in international patients, 67 percent of whom were Middle Eastern. Because of longer waiting periods for visas, many patients have decided to go to Europe for treatment.

The fact that most patients who seek treatment outside of their native countries usually do so because of serious health problems often makes waiting out of the question. For those facing delays in U.S. visa grants, the next best option is to go to Europe.

"We are not talking about HMO patients here. These are people who have the means to go anywhere in the world," says Sayles. "As a result, Germany has tried to organize and become very competitive with us. I've been told that they have set up a system there where they can give visas within a day."

Despite such numbers, Mark Gelhouse, director of international relations at the UCLA Medical Center, hesitates before pinpointing patient volume fluctuations to new visa policies. "We have had some ups and downs in patient volume [at our medical center], but my personal view is that those fluctuations have little to do with visa restrictions. They are a symptom of changes in diplomatic relations and of persons' feelings about coming to the U.S.," says Gelhouse.

Post-9/11 visa policies did not significantly affect UCLA's patient volume, he says. "We looked at our patient volume nine months before 9/11 and nine months after for our Arab patient [population] and found that there was not a big change. We are seeing a bigger change in patient volume now with the war in Iraq," he notes.

These restrictions are not the only reason for concern, however. The real problem, according to Gelhouse, is the fact that people from Arab countries are less inclined to come to the U.S., be it for pleasure, business, or medical reasons. "We all feel we have something to worry about, because we want our Arab Gulf patients to feel welcome to come here. Right now, they don't feel welcome," he adds.

Student exchanges affected

Despite what some might interpret as a more hostile environment, many still wish to pursue educational opportunities in the United States. According to the Educational Commission for Foreign Medical Graduates, the number of international medical students applying for residency in the United States has not decreased since 9/11.

But there are cases in which medical students wishing to study at American medical schools are denied visas despite acceptance into an institution. Antonio Gotto Jr., M.D., D.Phil., dean of Cornell University Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences, says his institution has been dealing with such cases with students from Middle Eastern countries since 9/11, something he qualifies as cause for concern.

Cornell has an active international program, Dr. Gotto says, and he hopes the new climate won't affect its operations significantly. Last summer Cornell officials halted one of the medical school's international exchange programs, under which American medical students were to spend time in India, because of State Department warnings about that country.

Not surprisingly, the new climate has also affected students from abroad wishing to participate in Cornell programs here in the United States. "We have many international students who come to take an elective or work at the medical college [here in New York]," Dr. Gotto says. "The difficulty in [internationals] getting visas has been a major problem."

Cornell is the only U.S. medical school that has a satellite campus in the Middle East, in the Persian Gulf country of Qatar. The faculty and staff at the Qatar campus are mostly Americans. During the recent war in Iraq, Cornell officials were concerned about a possible ripple effect in that area of the Middle East, according to Dr. Gotto.

"We had a daily conference call for the first two weeks of the war with the dean and the chief administrator in Qatar," he says. "Everything was perfectly quiet over there; they were not aware of any anti-American sentiments. The students there were afraid that we might suspend or close the program for a period of time, and they were in tears, pleading to our faculty to stay over."

Faculty and staff in the Qatar campus were given the option to leave, but all of them chose to stay there, according to Dr. Gotto. "We also made arrangements in case of an emergency, so that we would have access to planes to fly them out of the country, but none of this had to be activated."

He says the current climate could discourage top international students from applying to U.S. Medical schools. "I fear that it will affect student exchange, and that it also may affect exchange at the professional level, such as influencing post-doctorates who want to work in the U.S.," Dr. Gotto says.

Scattered disruptions elsewhere

Although Cornell has not had problems with its international post-graduates, institutions such as the Mayo Clinic, Rutgers University, the University of Utah, and the National Institutes of Health (NIH) have had their projects disrupted because researchers who went back to their native countries for short visits ended up not being granted visas to return to the United States.

But not everyone sees cause for alarm. Philip Chen Jr., Ph.D., senior adviser to the deputy director for intramural research at NIH, says that although some researchers from foreign countries now face longer waiting periods when getting visas, the new regulations have not disrupted NIH programs significantly. "Most people who deserve to get in [the country] get in," says Dr. Chen. "It just takes them a little longer. In such cases, we try to help them by contacting the consulates and embassies overseas."

There also has been continuing discussion by the INS, State, and other involved government agencies to develop ways to screen applications properly and to avoid unnecessary delays, Dr. Chen adds.

UCLA's Gelhouse also thinks that the unfavorable international climate will not significantly affect U.S. institutions, mostly because of their prestige and quality of care. "What will always happen is that patients who can afford American medicine will continue to come here because we still have a reputation for providing the best medical care in the world," Gelhouse says. "There will always be medical patients who will want to come here and pay for it."

Similarly, despite the recent war, Children's Boston's Sayles doesn't foresee a decrease in patient volume compared to the same time last year. But she admits the environment has not been the same since 9/11. "I don't expect my numbers to decrease, but I'm not expecting to be where I was in 2000," she says.

By Suria Santana

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