Two years ago, only recently arrived from Colombia, Herlly Camacho parked cars for a valet service and served cocktails at a Miami Beach disco. Those jobs were an odd fit, considering her training. She's a surgeon. Hers is a common story. An estimated 5,000 foreign-trained doctors enter the United States legally each year. Nearly a fifth of that number, including Camacho, receive asylum or federal refugee protection after fleeing their homelands.
Most lack the time, money and help they need to earn licenses and prove themselves as American doctors. Often they abandon years of training and settle for jobs that require little or no education.
It's a loss to the United States, which faces a looming doctor shortage.
But now, in a quiet corner of Miami-Dade College, Camacho and dozens of fellow refugee doctors are studying to get their old lives back. The college is one of a handful in the nation with programs to help refugee doctors and other professionals reclaim their former careers.
One classmate, a physician from Cuba, began his life in America cleaning bathrooms at Hertz car rental. Another hauled boxes in a warehouse.
They are all studying for the same exams U.S. medical students must pass to become practicing physicians. For them, and perhaps their new nation as well, the Miami-Dade program is a lifeline.
• • •
In 2005, Dr. Herlly Camacho was a 32-year-old surgeon in charge of the emergency room at a university hospital in Medellin, Colombia.
The hospital had been warned of a large and potentially violent campus protest. By 10 a.m., soldiers had arrived and protesters were throwing Molotov cocktails.
Suddenly, masked guerrillas rushed into the emergency room carrying comrades who had been gravely wounded in an explosion.
Camacho — who received her medical education and training in Colombia — did her best to treat the injured, gingerly removing masks that in some cases had fused with skin in the heat of the blast.
In the weeks that followed, Camacho got caught in a vicious dispute between the government and the rebels. The government pressured her to testify about which rebels she had seen. The rebels threatened to kill her if she did, demolishing her car and leaving threatening notes in her office.
Then someone slipped poison under her apartment door, killing her dog.
At that moment, she realized her country was no longer her home.
"My life was happy in Colombia," Camacho says. "But when they killed my pet, that was so close, because they must have been inside my building. Alone with me."
She boarded a plane for Miami and didn't look back.
• • •
Around 89,000 immigrants came to America and qualified for protection under federal refugee laws in 2006, the year Camacho arrived. Most were granted legal status only after proving a "well-founded fear of persecution" in their homelands.
They joined a labor pool of 6.1 million immigrants who arrived in recent years with at least a college degree, thanks to globalization and rising education levels, according to the Washington-based Migration Policy Institute.
But language and licensing barriers have forced nearly a quarter of them to turn to unskilled work like dishwashing. Even in the midst of high unemployment, their skills are needed in some high-demand fields like medicine, where the doctor shortage in underserved areas is surging past 16,000 according to the American Medical Association.
For years in Florida and nationally, the federal government's refugee resettlement program has not factored in people's education and training when helping them adjust to life in the United States. In basic English classes, the doctor is seated next to the illiterate farmer.
Resettlement agencies like Lutheran Services Florida often make a special effort to help professionals apply for jobs in their fields. But they do so under fierce time pressure. Federal guidelines emphasize finding refugees a job — any job — and keeping them off welfare rolls.
"We've got eight months, maximum, to make sure people have a job and are able to support themselves," said Hiram Ruiz, director of refugee programs with the Florida Department of Children and Families. He would love to help doctors become doctors again, he says, but the government's program addresses only immediate needs.
Take Jose Lizarralde, a cardiologist from Colombia. He fled to St. Petersburg in 2002 after rebels targeted his medical team in Cali, killing one doctor and demanding large cash sums from the others.
"I worked roofing, carpeted floors, construction," he said, recalling his new life in Florida. "I do everything to survive."
Lizarralde wanted to work as a doctor in America. But his family needed to eat, and there were no programs in the area to help him prepare for the licensing exams. So he enrolled in classes to become a nurse's assistant, though he has since become a medical technician.
Even his nursing instructor says the government should do more to help foreign-trained doctors reach their potential.
"They're missing the target completely," said Paul Laurence, a registered nurse who teaches refugees in the Pinellas County adult education program. "I feel so bad about these guys. About 50 percent are working as certified nurse (assistants). Basically wiping butts."
• • •
Within weeks of arriving in Miami in early 2006, Herlly Camacho found jobs working at a disco called Bed and parking cars for a valet service.
"I watched TV in English the whole time, I listened to the radio in English," she said. "My big trouble is to talk, because I feel so insecure."
Then she began studying English at REVEST, a program at Miami-Dade College.
Since the late 1990s, the program has helped thousands of refugees learn English and gain job skills, with help from a $13.2 million federal grant administered by the state. It offers classes in nursing, accounting, computers and other trades, with the goal of helping new arrivals quickly become self-sufficient.
But Miami-Dade officials weren't happy training doctors to be nurses. They wanted to do more.
"When people come (to America) and they have nothing, they're automatically placed in a little box that says they're uneducated," said Toa Castellanos, who now coordinates foreign doctor certification at the college. "(But) usually these people come to us with a lot of education, a lot of experience."
A development in America's long-running feud with the Cuban government provided the final push.
In 2006, the federal Department of Homeland Security eased the entry requirements for Cuban medical professionals. Soon, dozens of doctors were showing up in Miami and other parts of Florida, penniless and hoping to practice medicine in America.
College officials wanted to create a focused, highly academic program that would help doctors quickly hone their English skills and prepare for the daunting, three-part U.S. Medical Licensing Examination.
All they needed was money — and they got it.
Private donors contributed $300,000 toward the new Foreign Physicians Alternative Certification program. Blue Cross/Blue Shield of Florida pledged to match that amount, and give a similar amount to neighboring Broward College. Classes began last summer.
• • •
Even with such help, the bar is set high for foreign-trained doctors who want to practice in America.
After passing their licensing exams, refugee doctors must also get their medical degree verified and secure a medical residency.
But America can only benefit from expanding its pool of potential doctors, said Dr. James Huhta, a pediatric cardiologist at All Children's Hospital in St. Petersburg. He has worked with many foreign-trained doctors.
"The board exams are good at weeding out doctors that are deficient," he added.
Other programs nationally are trying similar approaches.
In California, the Welcome Back Initiative at City College of San Francisco and San Francisco State University has helped thousands of foreign-trained doctors, nurses and other medical professionals find appropriate work.
It has set up sister programs at community colleges in Boston, Washington state and Rhode Island. All provide intensive English classes designed for medical personnel, and the San Diego program has offered a class to prepare doctors for their medical board exams.
"It may not be the best option for a person to say, 'Well, yes, I was a physician, I was the chief of surgery, and now I'm going to be a phlebotomist," said Dr. Jose Ramon Fernandez-Pena, director of the Welcome Back initiative. "It beats driving a taxi, but it may not be what (he) wants to do for the rest of his life."
• • •
Even for experienced doctors like Camacho, the medical board course at Miami-Dade College is intense.
She and her classmates are expected in class 31 hours every week, on top of whatever jobs they're holding down to pay bills. Each subject in the board exam — from immunology and microbiology to endocrine physiology — is taught by a certified physician who specializes in that area.
At one evening review session, Dr. George Lotocki of the University of Miami School of Medicine runs through the syllabus at a blistering pace. When he asks a question, he demands answers, not fumbling.
"If your blood pressure is increased, do you produce more renin or not?" he asks, when the class pauses on a diagnosis.
"No," a dozen doctors answer.
Right, he nods.
At first, many are unwilling to tell their stories to a reporter. They come from places where it's never good to read about yourself in the newspaper.
The Cuban men soon step forward, though some do so only on condition that their last names not be printed. Their families have not yet been allowed to leave the country, and they are afraid a negative comment might prolong their separation.
Dr. Eduardo Juarez was imprisoned in Cuba for several months after trying to escape. Dr. Julio had to sell ice cream and vegetables to sustain his family on a doctor's wage.
Dr. Luis Barata, who began his American life cleaning those bathrooms at Hertz, eventually found work as a pharmacist technician and medical assistant. He improved his English at REVEST, and jumped at the opportunity to study for his medical board exams.
He doesn't mind the long hours in class or the dizzying review pace. After all he's been through, it's a small price to pay.
"The course is the best thing that's happened to us," Barata says. "It's an honor for us. So we have to make a sacrifice."
Tom Marshall can be reached at firstname.lastname@example.org or (352) 848-1431.