IN the pinching cold desolation of a November night, an ambulance pulls up to the double door of a brown building in the fields of rural Pennsylvania.

The medics spill out with a gurney and their cargo: a 17-year-old boy, his skull cracked and bleeding. A woman trails behind, her hand clasped on her mouth.

This is medicine in rural America, one emergency room in several hundred miles of farmland, a solitary chance for those who manage to arrive alive. The doctor inside the building is one of the few who serves in this remote community which has for long been unable to attract physicians to its agrarian desolation.

This changed a decade ago, when after a series of physicians had come and gone, Dr Khan arrived. Born and raised in Karachi, he brought with him a young wife and soon had a growing family. That night, like so many others, Dr Khan saved a teenager’s life.

Millions of Americans walking into emergency rooms and clinics will be treated by a Pakistani doctor. For a long time before Pakistan became known for manufacturing terror, it was known for making doctors. Taking up medicine as a profession was advised from the head of many a Pakistani dinner table; it was a sword of accomplishment to be brandished by the self-made Pakistani, a testament that hard work could slay the labels of caste and class.

Doctors, like engineers, were produced and then sent off to the Gulf, Saudi Arabia, the United States — any place where they were needed. A path was carved, affording a struggling middle class armed with brains and an infinite capacity for studiousness a means to make it big.

The prescription came with ample proof of cure; long departed uncles returning as cardiothoracic surgeons, studious neighbours growing up to become paediatricians, every one of them laden with Rolexes and pictures of faraway mansions.

In the quagmire of Pakistani uncertainty, where prime ministers and generals took turns at plunder, those seeking safety could become doctors. And even from afar, Pakistani doctors held the country up, contributing millions in remittances. Pakistan’s migrant doctors supported families at home, built schools and funded hospitals, never forgetting the Pakistan that had made them, if not their fortunes.

But now this long-standing recipe for accomplishment, a cornerstone of middle-class Pakistani aspirations, has also fallen prey to the scourge of terror.

The US as well as European and some Middle Eastern nations have implemented onerous visa requirements making it all but impossible for even the most brilliant medical student to pursue training abroad. In 2002, months after 9/11, only a few Pakistani medical students got into US residency training programmes as the United States looked to affix blame.

This initial lull was rationalised as a temporary pause. With the resumption of normalcy — the fading of catastrophic memory — most Pakistani-American doctors believed there would be a return to sense. Pakistani doctors, and their parents and wives, hoped against hope that the US and the world could distinguish between healers and terrorists and not force one to pay for the sins of the other.

That day never came. Ten years after 9/11, suspicions against Pakistanis, doctors and others were transformed into labels mechanically slapped on one and all. That distant first time, when a Pakistani medical resident failed to show up for duty because of delays in visa processing, allowances were made. The seventh, eighth and ninth time it happened, programme directors at US hospitals kicked themselves for having hired a Pakistani.

The slow strangulation had begun: jobless at home and unable to leave for abroad, Pakistani doctors waited aimlessly in the warehouse, their stellar test scores impotent against the caustic stereotypes attached to their origin.

Those who managed to get to interviews could still not bank on success. According to Dr Saima Zafar, president-elect of the Association of Physicians of Pakistani descent in North America (APPNA), this past year 22 physicians from Pakistan who had managed to get through the rigorous process of residency interviews and were matched with residency programmes lost their spots after being refused visas.

Those already in residency programmes also found their positions precarious. One resident at a prestigious programme who had returned to get married found himself being taken off his return flight to America. His visa was revoked without explanation. His programme at Pennsylvania State University’s Hershey campus announced soon after that it would no longer be recruiting Pakistani medical graduates.

Many other residency programmes are likely to follow suit, if not explicitly then by simply hiring from the vast pool of foreign medical graduates from India or China or any place other than Pakistan.

It is easy to spout smug nationalistic prescriptions that urge graduating doctors to stay and work at home, aid the millions in Pakistan desperate for medical care. Yet data provided by the Ministry of Overseas Pakistanis shows that the local market cannot employ all the labour produced.

In the particular case of Pakistani doctors in the United States, the losses are incurred not only in terms of unemployed doctors, but a cessation in remittances, in the multimillion dollar aid projects run by organisations such as APPNA, and worse still, the end of the Pakistani doctor as a citizen ambassador of a country that has produced millions more healers than terrorists. On Nov 19, Pakistani American doctors all over the United States will conduct free health screenings for any American in need of them, treating, vaccinating and diagnosing without cost. They will make another hopeful effort to show that Pakistanis, so unquestioningly maligned, have long been attuned to the pain of others.

The writer is an attorney teaching political philosophy and constitutional law. rafia.zakaria@gmail.com